Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Amy Clair Haslam death at Liverpool, Queens County on July 1, 1971
Female Death Registration: Year: 1971 number: 4307
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004307
1. PLACE OF DEATH County of Queens If in City or Town Liverpool
If death occured in a hospital or institution Queens General Hospital, Liverpool, NS
3. PRINT NAME OF DECEASED Haslam, Amy Clair
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Milton
9. DATE OF BIRTH 4 9, 1917
10. AGE in Years54 Months2 Days22 | hrs or mins
11. Trade or profession Retired Housewife
12. Kind of industry
13. Date last worked May 15/71 14. Total years
15. If married name of spouse Gerald C. Haslam
16. NAME of Father Freeman Tupper
17. BIRTHPLACE Milton, NS
18. NAME of Mother Verta Freeman
19. BIRTHPLACE Milton, NS
20. Signature of Informant G. C. Haslam
address 6 Grenville Court, Brockville, Ontario
Relationship to deceased Husband
21. Place of burial Milton, NS
Date of burial July 3, 1971
22. Undertaker Chandler's Funeral Services Ltd., Liverpool, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 1, 1971
CAUSE OF DEATH
(a) Mesenteric Thrombosis
(b) Arteriosclerosis
(c)
other Cerebrovascular Accident
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