Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Perley Glenburn Barclay death at Lantz, Hants County on April 30, 1971
Male Death Registration: Year: 1971 number: 3198
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003198
1. PLACE OF DEATH County of Hants If in City or Town Lantz
If death occured in a hospital or institution on highway
3. PRINT NAME OF DECEASED Barclay, Perley Glenburn
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Scottish
7. Single, Married
single
8. BIRTHPLACE Halifax
9. DATE OF BIRTH 11 10, 1951
10. AGE in Years19 Months5 Days20 | hrs or mins
11. Trade or profession at school
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Perley Barclay
17. BIRTHPLACE NS
18. NAME of Mother Mary Nickerson
19. BIRTHPLACE NS
20. Signature of Informant Perley Barclay
address Enfield NS
Relationship to deceased father
21. Place of burial Jordan Falls, Shel. Co, NS
Date of burial May 3 1971
22. Undertaker Ettinger Funeral Service
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH April 30, 1971
CAUSE OF DEATH
(a) Fractured skull, brain damage, fracture of cervical spine
(b)
(c) multiple fractures head, neck, ribs and internal injuries
other Accident: Passenger thrown from car & struck pole
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