Nova Scotia Archives

Nova Scotia Births, Marriages, and Deaths

Michelle Ann Samson death at Louisdale, Richmond County on August 2, 1971

Female Death Registration: Year: 1971 number: 4968

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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH

02 - 004968

1. PLACE OF DEATH   County of Richmond If in City or Town Louisdale

3. PRINT NAME OF DECEASED Samson, Michelle Ann

4. Sex

Female

5. Citizenship

Canadian

6. Racial Origin

French

7. Single, Married

single

8. BIRTHPLACE Louisdale, Rich. County

9. DATE OF BIRTH 6  23, 1962

10. AGE in  Years9  Months1  Days12 | 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 Dannie Samson

17. BIRTHPLACE Louisdale, Rich Co., NS

18. NAME of Mother Jean Marchand

19. BIRTHPLACE Louisdale, Rich. Co., NS

20. Signature of Informant Dannie Samson

      address Louisdale, Rich. Co., NS

      Relationship to deceased Father

21. Place of burial Louisdale

      Date of burial Aug 4, 1971

22. Undertaker C.A. Boucher Funeral Home

MEDICAL CERTIFICATE OF DEATH

23. DATE OF DEATH August 2, 1971

CAUSE OF DEATH

(a) Drowning

(b)

(c)

other Accident: while swimming

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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=497043

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