Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Corey Samuel Black death at Amherst, Cumberland County on March 7, 1971
Male Death Registration: Year: 1971 number: 2407
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 002407
1. PLACE OF DEATH County of Cumberland If in City or Town Amherst
If death occured in a hospital or institution Highland View Hospital
3. PRINT NAME OF DECEASED Black, Corey Samuel
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Salem, Cumb. Co
9. DATE OF BIRTH 9 10, 1888
10. AGE in Years72 Months5 Days25 | hrs or mins
11. Trade or profession Farmer
12. Kind of industry
13. Date last worked 1968 14. Total years Life
15. If married name of spouse
16. NAME of Father Blair Black
17. BIRTHPLACE New Brunswick
18. NAME of Mother Annie Black
19. BIRTHPLACE Cumb. Co, NS
20. Signature of Informant Clair Austin Black
address 10 Chignecto Street, Amherst, NS
Relationship to deceased Brother
21. Place of burial Amherst Cemetery Co.
Date of burial March 10, 1971
22. Undertaker Furlong's Funeral Home Limited, Amherst, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH March 7, 1971
CAUSE OF DEATH
(a) Hypostatic Pneumonia
(b) Myocardial Insufficiency
(c)
other
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