Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Elizabeth Sampson death at Sydney, Cape Breton County on July 3, 1971
Female Death Registration: Year: 1971 number: 4393
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004393
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution Sydney City Hospital
3. PRINT NAME OF DECEASED Sampson, Elizabeth
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Irish
7. Single, Married
widowed
8. BIRTHPLACE Cape Breton
9. DATE OF BIRTH 11 19, 1885
10. AGE in Years85 Months7 Days14 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Henri Kelly
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Mona Boudreau
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Walter Sampson
address 34 Connaught St., Sydney
Relationship to deceased Son
21. Place of burial Calvary Cemetery, Sydney
Date of burial July 6, 1971
22. Undertaker T.W. Curry Limited, Sydney
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 3, 1971
CAUSE OF DEATH
(a) Coronary Thrombosis
(b)
(c)
other
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