Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Henry Samson death at Sydney, Cape Breton County on July 7, 1971
Male Death Registration: Year: 1971 number: 4637
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004637
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution DOA Sydney City Hospital
3. PRINT NAME OF DECEASED Samson, Henry
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Little Anse, Rich. County
9. DATE OF BIRTH 3 13, 1901
10. AGE in Years70 Months3 Days24 | hrs or mins
11. Trade or profession Pensioner
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Florence Louise Samson
16. NAME of Father Daniel C Samson
17. BIRTHPLACE Petit De Grat, Rich. Co.
18. NAME of Mother Marie Boudreau
19. BIRTHPLACE Petit De Grat, Rich. Co.
20. Signature of Informant Florence Louise Samson
address Little Anse, Rich. Co.
Relationship to deceased Wife
21. Place of burial Petit De Grat, NS
Date of burial July 9, 1971
22. Undertaker C A Boucher Funeral Home, Arichat, CB
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 7, 1971
CAUSE OF DEATH
(a) Vertebrobasilar cerebrovascular accident
(b) Acute pulmonary edema
(c)
other Arteriosclerotic Heart Disease
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