Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Ancil Smith death at Bridgewater, Lunenburg County on June 21, 1971
Male Death Registration: Year: 1971 number: 4065
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004065
1. PLACE OF DEATH County of Lunenburg If in City or Town Bridgewater
If death occured in a hospital or institution Dawson Memorial Hospital
3. PRINT NAME OF DECEASED Smith, Ancil
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
7. Single, Married
separated
8. BIRTHPLACE Hemford, Lunenburg County
9. DATE OF BIRTH 6 22, 1908
10. AGE in Years62 Months11 Days30 | hrs or mins
11. Trade or profession Labourer
12. Kind of industry Construction Worker Acadian Construction Co
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Dawson Memorial Hospital Records
address Bridgewater, NS
Relationship to deceased
21. Place of burial Hemford, Lun. Co. NS
Date of burial June 23, 1971
22. Undertaker Stan N. Wamback, Bridgewater, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 21, 1971
CAUSE OF DEATH
(a) Carcinoma of Stomach
(b) Metastases to Liver
(c) Jaundice
other
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