Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Clinton Jason Clark death at Upper Graville, Annapolis County on February 5, 1971
Male Death Registration: Year: 1971 number: 2119
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 002119
1. PLACE OF DEATH County of Annapolis If in City or Town Upper Graville
If death occured in a hospital or institution his home
3. PRINT NAME OF DECEASED Clark, Clinton Jason
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Bridgetown
9. DATE OF BIRTH 10 21, 1915
10. AGE in Years55 Months3 Days31 | hrs or mins
11. Trade or profession Assistant Post Master
12. Kind of industry
13. Date last worked 1971 14. Total years
15. If married name of spouse Mrs. Barbara Clark
16. NAME of Father John Clark
17. BIRTHPLACE NS
18. NAME of Mother Beatrice Taylor
19. BIRTHPLACE NS
20. Signature of Informant Mrs. Barbara Clark
address Upper Granville, Anna Co, NS
Relationship to deceased wife
21. Place of burial Bridgetown, NS
Date of burial February 8, 1971
22. Undertaker Bridgetown Funeral Home
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH February 5, 1971
CAUSE OF DEATH
(a) Acute massive myocardial infarction
(b) Cardiac Arrest
(c)
other
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