Female Death Registration: Year: 1971 number: 5525
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005525
1. PLACE OF DEATH County of Kings If in City or Town Berwick
If death occured in a hospital or institution Spicer's Rest Home
3. PRINT NAME OF DECEASED Champion, Susan Charlotte
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Bedeque, Prince Edward Island
9. DATE OF BIRTH 9 30, 1873
10. AGE in Years97 Months11 Days6 | hrs or mins
11. Trade or profession Housewife
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse James Champion
16. NAME of Father Fredwick Holland
17. BIRTHPLACE PEI
18. NAME of Mother Sarah Holland
19. BIRTHPLACE PEI
20. Signature of Informant Fredwick Champion
address Berwick
Relationship to deceased Son
21. Place of burial O'Lary, PEI
Date of burial Sept 9, 1971
22. Undertaker H.C. Lindsay Funeral Homes Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 5, 1971
CAUSE OF DEATH
(a) Acute Myocardial Infarction
(b)
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/
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