Male Death Registration: Year: 1971 number: 5568
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005568
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Camp Hill Hospital
3. PRINT NAME OF DECEASED Coolen, Salem Kelly
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 10 12, 1895
10. AGE in Years75 Months11 Days8 | hrs or mins
11. Trade or profession Retired
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Eva Longard (Seperated)
16. NAME of Father Salem Coolen
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Bessie Boutilier
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Sadie Coolen
address Canso
Relationship to deceased Common-Law Wife
21. Place of burial Fox Point, Halifax Co., NS
Date of burial Sept. 23, 1971
22. Undertaker J. Albert Walker
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 20, 1971
CAUSE OF DEATH
(a) Endocarditis
(b) Uremia
(c) Pericarditis
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/
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