Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
William Henry Cossaboom death at Annapolis Royal, Annapolis County on March 26, 1971
Male Death Registration: Year: 1971 number: 2703
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 002703
1. PLACE OF DEATH County of Annapolis If in City or Town Annapolis Royal
If death occured in a hospital or institution Stewarts Nursing Home
3. PRINT NAME OF DECEASED Cossaboom, William Henry
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Gullivers Cove, Shel. County
9. DATE OF BIRTH 9 16, 1876
10. AGE in Years94 Months6 Days10 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Fisherman
13. Date last worked 14. Total years
15. If married name of spouse Edith Cossaboom
16. NAME of Father James Cossaboom
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Mariah Hankinson
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Edith Cossaboom
address 148 Queen St., Digby
Relationship to deceased Wife
21. Place of burial Port Maitland, Yar. Co.
Date of burial March 19, 1971
22. Undertaker Sweeny Funeral Home, Yar. N.S.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH March 26, 1971
CAUSE OF DEATH
(a) Acute ventricle fibrillation
(b) Congestive failure
(c)
other
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