Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Mary Agnes Bellefontaine death at Halifax, Halifax County on June 13, 1971
Female Death Registration: Year: 1971 number: 3836
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003836
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Halifax Infirmary
3. PRINT NAME OF DECEASED Bellefontaine, Mary Agnes
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 2 29, 1898
10. AGE in Years73 Months3 Days15 | hrs or mins
11. Trade or profession Housewife
12. Kind of industry Housekeeping
13. Date last worked Dec 1970 14. Total years 42
15. If married name of spouse Joseph B. Bellefontaine
16. NAME of Father William Bellefontaine
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Dorothy Bellefontaine
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Joseph B. Bellefontaine
address West Chezzetcook, NS
Relationship to deceased Husband
21. Place of burial West Chezzetcook
Date of burial June 16, 1971
22. Undertaker Rowlings Funeral Service, Musquodoboit Harbour, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 13, 1971
CAUSE OF DEATH
(a) Extrusive Pulmonary Fibrosis
(b) with Pulmonale respiratory failure
(c)
other Arteriosclerotic Heart Disease
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