Male Death Registration: Year: 1971 number: 5540
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005540
1. PLACE OF DEATH County of Pictou If in City or Town New Glasgow
If death occured in a hospital or institution MacDonald (on street)
3. PRINT NAME OF DECEASED Hazelager, Gysbertus
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Dutch
7. Single, Married
single
8. BIRTHPLACE Holland
9. DATE OF BIRTH 2 25, 1969
10. AGE in Years2 Months6 Days9 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Aris Hazelager
17. BIRTHPLACE Holland
18. NAME of Mother Trudy Hazelager
19. BIRTHPLACE Holland
20. Signature of Informant Aris Hazelager
address 484 MacDonald Street, New Glasgow
Relationship to deceased Father
21. Place of burial Churchville, NS
Date of burial September 7, 1971
22. Undertaker R.H. Porter Funeral Homes Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 3, 1971
CAUSE OF DEATH
(a) Peritoneal and Pleural hemorrhage
(b) Ruptured Liver and Spleen
(c)
other Accident: child struck by vehicle while crossing street
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/
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