Male Death Registration: Year: 1971 number: 4200
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004200
1. PLACE OF DEATH County of Shelburne If in City or Town Newellton
If death occured in a hospital or institution Highway 330, NS- on route to hospital
3. PRINT NAME OF DECEASED Nickerson, Winburn Oscar
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 4 9, 1887
10. AGE in Years84 Months2 Days17 | hrs or mins
11. Trade or profession Fisherman
12. Kind of industry
13. Date last worked 1946 14. Total years 50
15. If married name of spouse
16. NAME of Father Berton Nickerson
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Margret Cunningham
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Edward Nickerson
address Clarks Harbour, NS
Relationship to deceased Son
21. Place of burial West Head, NS
Date of burial June 30, 1971
22. Undertaker Kenney Funeral Service, Barrington, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 26, 1971
CAUSE OF DEATH
(a) Congestive Cardiac Failure
(b) Cor Pulmonale
(c) Emphysema
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=496275
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