Female Death Registration: Year: 1971 number: 1571
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001571
1. PLACE OF DEATH County of Cape Breton If in City or Town New Waterford
If death occured in a hospital or institution New Waterford Hospital
3. PRINT NAME OF DECEASED Deruelle, Jennie
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
widowed
8. BIRTHPLACE France
9. DATE OF BIRTH 12 19, 1892
10. AGE in Years78 Months1 Days7 | 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 Paul Deruelle
16. NAME of Father
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Mrs Jean Eldridge
address 40 Queen St Scotchtown, NS
Relationship to deceased Daughter
21. Place of burial Union Grove Cemetery, Scotchtown, NS
Date of burial January 29th 1971
22. Undertaker V.J. McGillivray Funeral Homes Limited, New Waterford, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 26, 1971
CAUSE OF DEATH
(a) Gangrene, both lower extremities
(b) Thrombosis, both femoral arteries
(c)
other Myocardial Infarction
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=493649
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