Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Melbourne Donnelly death at Middleton, Annapolis County on September 13, 1971
Male Death Registration: Year: 1971 number: 5576
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005576
1. PLACE OF DEATH County of Annapolis If in City or Town Middleton
If death occured in a hospital or institution Soldiers Memorial Hospital
3. PRINT NAME OF DECEASED Donnelly, Melbourne
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Port George, Annapolis County
9. DATE OF BIRTH 4 6, 1884
10. AGE in Years87 Months5 Days7 | hrs or mins
11. Trade or profession Farmer
12. Kind of industry
13. Date last worked 1968 14. Total years 70 years
15. If married name of spouse Muriel Donnelly
16. NAME of Father Samuel Donnelly
17. BIRTHPLACE Nova Scotia
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Graham Donnelly
address Port George, Annapolis Co., NS
Relationship to deceased Son
21. Place of burial Port George, Annapolis Co., NS
Date of burial 16 September 1971
22. Undertaker Frederick G. Roop Funeral Service, Middleton, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 13, 1971
CAUSE OF DEATH
(a) Congestive Heart Failure
(b)
(c)
other Cerebral Atherosclerosis with Chronic Brain Syndrome
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