Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Simon Wieringa death at Sandy Point, Shelburne County on April 7, 1971
Male Death Registration: Year: 1971 number: 3092
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003092
1. PLACE OF DEATH County of Shelburne If in City or Town Sandy Point
If death occured in a hospital or institution Roseway Hospital
3. PRINT NAME OF DECEASED Wieringa, Simon
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Dutch
7. Single, Married
married
8. BIRTHPLACE Ulrum, Holland
9. DATE OF BIRTH 4 15, 1902
10. AGE in Years68 Months11 Days23 | hrs or mins
11. Trade or profession Tinsmith
12. Kind of industry
13. Date last worked 1971 14. Total years 12 yrs
15. If married name of spouse Agusta
16. NAME of Father Gurt Wieringa
17. BIRTHPLACE Holland
18. NAME of Mother Holje Walters
19. BIRTHPLACE Grongingen, Holland
20. Signature of Informant Mrs. Earle Acker
address Shelburne, NS
Relationship to deceased Daughter
21. Place of burial Pine Grove Cemetery, Shelburne, NS
Date of burial April 10, 1971
22. Undertaker Huskilson's Funeral Homes, Shelburne, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH April 7, 1971
CAUSE OF DEATH
(a) Ruptured abdominal Aorta
(b) (illegible)
(c) Atherosclerosis
other
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