Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Grace Hazel Wagner death at Port Medway, Queens County on February 23, 1971
Female Death Registration: Year: 1971 number: 2061
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 002061
1. PLACE OF DEATH County of Queens If in City or Town Port Medway
If death occured in a hospital or institution at home
3. PRINT NAME OF DECEASED Wagner, Grace Hazel
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE East Port Midway
9. DATE OF BIRTH 12 24, 1893
10. AGE in Years77 Months1 Days30 | hrs or mins
11. Trade or profession retired
12. Kind of industry housewife
13. Date last worked 1966 14. Total years
15. If married name of spouse Charles Wagner (Dec'd)
16. NAME of Father Frank P McCoombs
17. BIRTHPLACE Nova Scotia
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Owen Wagner
address Port Midway
Relationship to deceased son
21. Place of burial Port Midway, NS
Date of burial March 1, 1971
22. Undertaker Chandlers Funeral Service Ltd, Liverpool, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH February 23, 1971
CAUSE OF DEATH
(a) Myocardial Infarction
(b) generalized arteriosclerosis
(c)
other diabetes
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