Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Louisa Forman Roberts death at Yarmouth, Yarmouth County on January 31, 1971
Female Death Registration: Year: 1971 number: 1520
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001520
1. PLACE OF DEATH County of Yarmouth If in City or Town Yarmouth
If death occured in a hospital or institution Yarmouth Hospital
3. PRINT NAME OF DECEASED Roberts, Louisa Forman
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Richfield, Digby County
9. DATE OF BIRTH 3 19, 1885
10. AGE in Years85 Months10 Days12 | hrs or mins
11. Trade or profession At home
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Forman Gavel
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Annie Hatfield
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Warren E. Roberts
address Yarmouth
Relationship to deceased Son
21. Place of burial Kemptville, Yarmouth County
Date of burial February 2, 1971
22. Undertaker Sweeny Funeral Home, Yarmouth
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 31, 1971
CAUSE OF DEATH
(a) Cerebral Thrombosis
(b) Arteriosclerosis
(c)
other Renal Infarction
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