Male Death Registration: Year: 1971 number: 5586
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005586
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution Sydney City Hospital
3. PRINT NAME OF DECEASED Evely, Dwayne
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Glace Bay
9. DATE OF BIRTH 8 22, 1971
10. AGE in Years Months Days3 | 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 Kenneth Evely
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Evelyn Campbell
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Ken Evely
address 60 Fourth St., Glace Bay
Relationship to deceased Father
21. Place of burial Greenwood Cem., Glace Bay
Date of burial August 26, 1971
22. Undertaker Currys Funeral Home, Glace Bay
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 25, 1971
CAUSE OF DEATH
(a) Pulmonary Atelectasis
(b) Right upper lobe pneumonia
(c)
other Prematurity and asphyxia neonatorum
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/
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