Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Wallace R Burgess death at Halifax, Halifax County on June 20, 1971
Male Death Registration: Year: 1971 number: 4216
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004216
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Camp Hill Hospital
3. PRINT NAME OF DECEASED Burgess, Wallace R
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Manitoba
9. DATE OF BIRTH 3 13, 1892
10. AGE in Years79 Months3 Days7 | hrs or mins
11. Trade or profession Forestry Engineer
12. Kind of industry
13. Date last worked 1967 14. Total years 50
15. If married name of spouse Hilda Burgess
16. NAME of Father William Wallace Burgess
17. BIRTHPLACE Quebec
18. NAME of Mother Martha Greves
19. BIRTHPLACE Quebec
20. Signature of Informant Wallace W. Burgess
address 14916-102 St., Edmonton, Alta.
Relationship to deceased Son
21. Place of burial Clyde River Cemetery, Clyde River, Shelb. Co.
Date of burial June 23, 1971
22. Undertaker H.M. Huskilson Funeral Home
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 20, 1971
CAUSE OF DEATH
(a) Acute Renal Failure
(b)
(c) Advanced Atherosclerosis
other
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