Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Evangeline Mary Mombourquette death at Mill Lake Road, Lunenburg County on August 13, 1971
Female Death Registration: Year: 1971 number: 5057
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005057
1. PLACE OF DEATH County of Lunenburg If in City or Town Mill Lake Road
3. PRINT NAME OF DECEASED Mombourquette, Evangeline Mary
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
widowed
8. BIRTHPLACE Arichat
9. DATE OF BIRTH 5 31, 1888
10. AGE in Years83 Months2 Days13 | hrs or mins
11. Trade or profession Housewife
12. Kind of industry
13. Date last worked 1963 14. Total years 50 yrs
15. If married name of spouse Late Simon Mombourquette
16. NAME of Father Lawrence Terrio
17. BIRTHPLACE L'Ardoise, Cape Breton
18. NAME of Mother Marguerite Marchand
19. BIRTHPLACE Cape Breton, NS
20. Signature of Informant William E. Ryan
address 6447 Roslyn Rd. Hfx.
Relationship to deceased Son-in-law
21. Place of burial Gate of Heaven Cemetery, Lr Sackville
Date of burial August 16, 1971
22. Undertaker Cruikshank's Funeral Home Limited, Halifax
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 13, 1971
CAUSE OF DEATH
(a) Myocardial Infarction
(b) Diabetes Mellitus
(c)
other
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