Nova Scotia Archives

Nova Scotia Births, Marriages, and Deaths

Wayne Alexander Moffatt death at Antigonish, Antigonish County on July 2, 1971

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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