Male Death Registration: Year: 1971 number: 5264
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005264
1. PLACE OF DEATH County of Halifax If in City or Town Sheet Harbour
If death occured in a hospital or institution Eastern Shore Memorial Hospital
3. PRINT NAME OF DECEASED Butler, John Michael
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Irish
7. Single, Married
widowed
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 1 10, 1889
10. AGE in Years82 Months7 Days20 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Scott Paper Co
13. Date last worked 1960 14. Total years 48
15. If married name of spouse Nettie (Deceased)
16. NAME of Father Michael Butler
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Sadie Stephens
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs Margaret Field
address Sheet Harbour
Relationship to deceased Daughter
21. Place of burial Sheet Harbour
Date of burial Sept 2, 1971
22. Undertaker Duncan Crowell, PO Box 14, Sheet Harbour
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 30, 1971
CAUSE OF DEATH
(a) Broncho Pneumonia
(b) Congestive Cardiac Failure
(c)
other Obstructive Jaundice
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=497338
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