Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
John Jagosz death at Cole Harbour, Halifax County on April 11, 1971
Male Death Registration: Year: 1971 number: 2779
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 002779
1. PLACE OF DEATH County of Halifax If in City or Town Cole Harbour
If death occured in a hospital or institution Hfx. Co. Hospital
3. PRINT NAME OF DECEASED Jagosz, John
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Polish
7. Single, Married
single
8. BIRTHPLACE Poland.
9. DATE OF BIRTH ,
10. AGE in Years71 Months Days | hrs or mins
11. Trade or profession Nil
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse (Single)
16. NAME of Father
17. BIRTHPLACE (Poland)
18. NAME of Mother Unknown.
19. BIRTHPLACE Poland.
20. Signature of Informant Hfx Co. Hospital N.S
address Cole Harbour N.S.
Relationship to deceased None.
21. Place of burial MountHermon Cemetery, Dartmouth, NS
Date of burial April 14, 1971
22. Undertaker A L Mattatall Funerasl Service Ltd, Dartmouth, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH April 11, 1971
CAUSE OF DEATH
(a) Bronchopneumonia
(b) Pulmonary Heart Disease
(c)
other
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