Male Death Registration: Year: 1971 number: 4374
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004374
1. PLACE OF DEATH County of Antigonish If in City or Town Antigonish
3. PRINT NAME OF DECEASED Moffatt, Wayne Alexander
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Westphal, Halifax County Nova Scotia
9. DATE OF BIRTH 12 3, 1949
10. AGE in Years21 Months6 Days29 | hrs or mins
11. Trade or profession Welder
12. Kind of industry
13. Date last worked June 30th 14. Total years 1 yr
15. If married name of spouse Bernadette Le Foreti
16. NAME of Father William Lake
17. BIRTHPLACE NS
18. NAME of Mother Margaret Fowler
19. BIRTHPLACE NS
20. Signature of Informant William Lake
address Fox River, NS
Relationship to deceased Father
21. Place of burial Fox River, Cumb. Co. NS
Date of burial July 5, 1971
22. Undertaker S.W. Smith and Sons Ltd., Parrsboro, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 2, 1971
CAUSE OF DEATH
(a) Laceration of Brain
(b) Fracture of Skull
(c)
other Accident: Car left gravel road
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=496449
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