Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Hazel Mae Sample death at Amherst, Cumberland County on July 24, 1971
Female Death Registration: Year: 1971 number: 4785
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004785
1. PLACE OF DEATH County of Cumberland If in City or Town Amherst
If death occured in a hospital or institution DOA, Highland View Hospital
3. PRINT NAME OF DECEASED Sample, Hazel Mae
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Scottish
7. Single, Married
divorced
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 4 25, 1939
10. AGE in Years32 Months2 Days29 | 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 James Robert Sinnis
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Elizabeth Agnes Nicholson
19. BIRTHPLACE Nova Scotia
20. Signature of Informant James W Sinnis
address RR #2, Hopewell, NS
Relationship to deceased Brother
21. Place of burial Fox Brook Cemetery, Fox Brook, Pictou Co., NS
Date of burial July 17, 1971
22. Undertaker Eagles Funeral Home, Westville, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 24, 1971
CAUSE OF DEATH
(a) Head Injury
(b) Motor Vehicle Accident
(c)
other Accident: Driver of car left highway
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