Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Fred Kiczurczak death at Glace Bay, Cape Breton County on May 2, 1971
Male Death Registration: Year: 1971 number: 4514
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004514
1. PLACE OF DEATH County of Cape Breton If in City or Town Glace Bay
If death occured in a hospital or institution Glace Bay General Hospital
3. PRINT NAME OF DECEASED Kiczurczak, Fred
4. Sex
Male
5. Citizenship
Polish
6. Racial Origin
Polish
7. Single, Married
single
8. BIRTHPLACE Poland
9. DATE OF BIRTH 2 13, 1897
10. AGE in Years74 Months2 Days19 | hrs or mins
11. Trade or profession Pensioner
12. Kind of industry Coal Mining
13. Date last worked 1965 14. Total years 46
15. If married name of spouse
16. NAME of Father
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Joseph Yokuboski
address 72 Douglas Ave., Glace Bay, NS
Relationship to deceased Friend
21. Place of burial Holy Cross Cemetery, Glace Bay, NS
Date of burial May 4, 1971
22. Undertaker Curry's Funeral Home
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH May 2, 1971
CAUSE OF DEATH
(a) Atherosclerotic Heart Disease
(b)
(c)
other Pulmonary Fibrosis
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