Female Death Registration: Year: 1971 number: 5472
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005472
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
3. PRINT NAME OF DECEASED Polley, Agnes
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Scottish
7. Single, Married
widowed
8. BIRTHPLACE Scotland
9. DATE OF BIRTH 8 29, 1895
10. AGE in Years75 Months11 Days23 | hrs or mins
11. Trade or profession At Home
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Alexander Smith
17. BIRTHPLACE Scotland
18. NAME of Mother Jessie Stirton
19. BIRTHPLACE Scotland
20. Signature of Informant Mrs. Albert Davis
address 57 Richmond St., Sydney, NS
Relationship to deceased Daughter
21. Place of burial Hardwood Hill Cemetery, Sydney, NS
Date of burial Aug 25, 1971
22. Undertaker R. H. Fillmore Funeral Home Ltd., Sydney, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 21, 1971
CAUSE OF DEATH
(a) Coronary Thrombosis
(b)
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/
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