Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Simon W. Richard death at Guysborough, Guysborough County on June 16, 1971
Male Death Registration: Year: 1971 number: 4036
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004036
1. PLACE OF DEATH County of Guysborough If in City or Town Guysborough
If death occured in a hospital or institution Guysborough Memorial Hospital
3. PRINT NAME OF DECEASED Richard, Simon W.
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
widowed
8. BIRTHPLACE Charlo's Cove
9. DATE OF BIRTH 12 31, 1884
10. AGE in Years86 Months5 Days16 | 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 William Richard
17. BIRTHPLACE Charlos Cove
18. NAME of Mother Angele Boudreau
19. BIRTHPLACE Charlos Cove
20. Signature of Informant Ethel Richard
address Charlos Cove, NS
Relationship to deceased Daughter in law
21. Place of burial Charlos Cove, NS
Date of burial June 19, 1971
22. Undertaker Nathan Rhynold, Philips Harbour, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 16, 1971
CAUSE OF DEATH
(a) Cerebral Thrombosis
(b)
(c)
other Peptic Ulcer
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