Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Vergenie Samson death at Louisdale, Richmond County on May 8, 1971
Female Death Registration: Year: 1971 number: 3453
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003453
1. PLACE OF DEATH County of Richmond If in City or Town Louisdale
If death occured in a hospital or institution Rich. Co.
3. PRINT NAME OF DECEASED Samson, Vergenie
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
widowed
8. BIRTHPLACE Louisdale, Rich. County
9. DATE OF BIRTH 9 25, 1888
10. AGE in Years82 Months7 Days13 | hrs or mins
11. Trade or profession pentioner
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Xavier Marchand
17. BIRTHPLACE Louisdale, Rich. Co.
18. NAME of Mother Marieetta Samson
19. BIRTHPLACE Louisdale, Rich. Co.
20. Signature of Informant F. Leonard Samson
address Louisdale, Rich. Co.
Relationship to deceased Son
21. Place of burial Louisdale, Rich. Co.
Date of burial May 10, 1971
22. Undertaker C.A. Boucher, Arichat
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH May 8, 1971
CAUSE OF DEATH
(a) Pneumonia
(b)
(c)
other
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