Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Ellen Agnes Clark death at Halifax, Halifax County on June 15, 1971
Female Death Registration: Year: 1971 number: 3846
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003846
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Victoria General Hospital
3. PRINT NAME OF DECEASED Clark, Ellen Agnes
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Burmingham, England
9. DATE OF BIRTH 9 21, 1888
10. AGE in Years82 Months8 Days24 | hrs or mins
11. Trade or profession Retired
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Richardson
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Joseph Clark
address 34 Carleton St. Dartmouth
Relationship to deceased Son
21. Place of burial Fairview Cemetery, Halifax
Date of burial June 18, 1971
22. Undertaker Mattatall Funeral Service Ltd, Dartmouth
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 15, 1971
CAUSE OF DEATH
(a) Respiratory Arrest
(b) Carcinoma of colon with metastases
(c) (illegible) metastases
other
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