Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Adrian Dwayne Gouthro death at Glace Bay, Cape Breton County on January 24, 1971
Male Death Registration: Year: 1971 number: 1345
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001345
1. PLACE OF DEATH County of Cape Breton If in City or Town Glace Bay
If death occured in a hospital or institution St. Joseph's Hospital
3. PRINT NAME OF DECEASED Gouthro, Adrian Dwayne
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
single
8. BIRTHPLACE Glace Bay
9. DATE OF BIRTH 1 13, 1971
10. AGE in Years Months Days11 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father John Gordon Gouthro
17. BIRTHPLACE Glace Bay
18. NAME of Mother Rosalie Viola Brewer
19. BIRTHPLACE Glace Bay
20. Signature of Informant John Gordon Gouthro
address 403 Main St., Glace Bay
Relationship to deceased Father
21. Place of burial Calvary, Glace Bay
Date of burial January 25, 1971
22. Undertaker V.J. McGillivray Funeral Homes Limited, 16 Reserve St., Glace Bay
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 24, 1971
CAUSE OF DEATH
(a) Septicaemia
(b) Bilateral pneumonia
(c)
other
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