Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
John Simon Belliveau death at Amherst, Cumberland County on August 2, 1971
Male Death Registration: Year: 1971 number: 4939
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004939
1. PLACE OF DEATH County of Cumberland If in City or Town Amherst
If death occured in a hospital or institution 54 Copp Ave.
3. PRINT NAME OF DECEASED Belliveau, John Simon
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Amherst
9. DATE OF BIRTH 4 30, 1888
10. AGE in Years83 Months3 Days3 | hrs or mins
11. Trade or profession Barber
12. Kind of industry Barbering
13. Date last worked 1961 14. Total years 53
15. If married name of spouse Helena M. Belliveau
16. NAME of Father Simon J Belliveau
17. BIRTHPLACE Memramcook, N.B.
18. NAME of Mother Elizabeth LeBlanc
19. BIRTHPLACE College Bridge, N.B.
20. Signature of Informant Victor Belliveau
address 54 Copp Ave., Amherst
Relationship to deceased Son
21. Place of burial Amherst
Date of burial August 4, 1971
22. Undertaker Campbell's Funeral Home, Amherst
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 2, 1971
CAUSE OF DEATH
(a) Myocardial Infarction
(b)
(c)
other
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