Male Death Registration: Year: 1971 number: 2615
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 002615
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution Sydney City Hospital
3. PRINT NAME OF DECEASED Johnson, Samuel
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Sydney
9. DATE OF BIRTH 2 11, 1907
10. AGE in Years64 Months1 Days15 | hrs or mins
11. Trade or profession Industrial Relations
12. Kind of industry DEVCO
13. Date last worked 1971 14. Total years 15 yrs
15. If married name of spouse Margaret Jane White
16. NAME of Father Angus Johnson
17. BIRTHPLACE Leitches Creek, Cape Breton
18. NAME of Mother Mary Johnson
19. BIRTHPLACE Leitches Creek, Cape Breton
20. Signature of Informant Mrs Samuel Johnson
address New Victoria, Cape Breton, NS
Relationship to deceased wife
21. Place of burial St Alphonse Cemetery, Victoria Mines, NS
Date of burial March 28, 1971
22. Undertaker V J McGillivray Funeral Homes Limited, New Waterford, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH March 26, 1971
CAUSE OF DEATH
(a) Bronchopneumonia
(b) Chronic Bronchitis
(c) Emphysema
other Pulmonary Tuberulosis Inactive
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=494692
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