Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Robert H Clarke death at Halifax, Halifax County on July 21, 1971
Male Death Registration: Year: 1971 number: 4707
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004707
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Camp Hill Hospital
3. PRINT NAME OF DECEASED Clarke, Robert H
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
African
7. Single, Married
widowed
8. BIRTHPLACE Tracadie, Guys. County
9. DATE OF BIRTH 6 5, 1890
10. AGE in Years81 Months1 Days16 | hrs or mins
11. Trade or profession Labourer
12. Kind of industry Dockyard
13. Date last worked 1955 14. Total years 3 yrs
15. If married name of spouse
16. NAME of Father
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Mrs. Cyril Skinner
address Rear Monastery, Antigonish Co., NS
Relationship to deceased Niece
21. Place of burial Upper Big Tracadie Baptist Cemetery, NS
Date of burial 25 July 1971
22. Undertaker Curry Bros. Funeral Directors Ltd., Antigonish, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 21, 1971
CAUSE OF DEATH
(a) Renal Failure
(b)
(c)
other Arteriosclerotic Heart Disease
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Note: African Nova Scotian