Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Leroy Lewis Clayton death at Annapolis Royal, Annapolis County on September 16, 1971
Male Death Registration: Year: 1971 number: 5459
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005459
1. PLACE OF DEATH County of Annapolis If in City or Town Annapolis Royal
If death occured in a hospital or institution Annapolis General Hospital
3. PRINT NAME OF DECEASED Clayton, Leroy Lewis
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Scottish
7. Single, Married
married
8. BIRTHPLACE Young Cove
9. DATE OF BIRTH 3 13, 1901
10. AGE in Years70 Months6 Days3 | hrs or mins
11. Trade or profession Retired/Pensionier
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Mrs. Allison A. Clayton
16. NAME of Father John Clayton
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Ellen Guest
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Charles Clayton
address Hillsburn, Anna. Co., NS
Relationship to deceased Son
21. Place of burial Hillsburn, NS
Date of burial September 18, 1971
22. Undertaker Chisholm's Funeral Home, Granville Ferry, Annapolis Co., NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 16, 1971
CAUSE OF DEATH
(a) Respiratory Failure
(b) Pneumonia
(c) Emphysema
other Congestive Heart Failure
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