Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Brian Douglas William Roberts death at Milton, Queens County on June 4, 1971
Male Death Registration: Year: 1971 number: 3808
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003808
1. PLACE OF DEATH County of Queens If in City or Town Milton
If death occured in a hospital or institution Milford St, Milton, (at home)
3. PRINT NAME OF DECEASED Roberts, Brian Douglas William
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Liverpool
9. DATE OF BIRTH 1 21, 1971
10. AGE in Years Months4 Days14 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Douglas G Roberts
17. BIRTHPLACE Liverpool, NS
18. NAME of Mother Doris Melinda Grant
19. BIRTHPLACE Liverpool, NS
20. Signature of Informant Douglas G Roberts
address Milford St, Milton
Relationship to deceased father
21. Place of burial Milton, NS
Date of burial June 6 1971
22. Undertaker Chandler's Funeral Service Ltd, Liverpool NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 4, 1971
CAUSE OF DEATH
(a) Deceased when Dr. F.G. Bell arrived at the home
(b) none known
(c)
other
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