Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Georgina Black death at Pugwash, Cumberland County on August 15, 1971
Female Death Registration: Year: 1971 number: 5139
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005139
1. PLACE OF DEATH County of Cumberland If in City or Town Pugwash
If death occured in a hospital or institution North Cumberland Memorial
3. PRINT NAME OF DECEASED Black, Georgina
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Port Elgin New Brunswick
9. DATE OF BIRTH 10 24, 1894
10. AGE in Years76 Months9 Days22 | hrs or mins
11. Trade or profession Housewife
12. Kind of industry
13. Date last worked June 1969 14. Total years 54
15. If married name of spouse
16. NAME of Father Jacob E Pollard
17. BIRTHPLACE New Brunswick
18. NAME of Mother Amy Ann Polley
19. BIRTHPLACE New Brunswick
20. Signature of Informant Mrs Leona Patterson
address Pugwash NS
Relationship to deceased Daughter
21. Place of burial North Port NS
Date of burial August 17 1971
22. Undertaker W I Mundle, Pugwash, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 15, 1971
CAUSE OF DEATH
(a) Arteriosclerotic heart disease
(b)
(c)
other
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