Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Simon Gallant death at Glace Bay, Cape County on September 23, 1971
Male Death Registration: Year: 1971 number: 5614
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005614
1. PLACE OF DEATH County of Cape If in City or Town Glace Bay
If death occured in a hospital or institution St. Joseph’s Hospital
3. PRINT NAME OF DECEASED Gallant, Simon
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
widowed
8. BIRTHPLACE Gardiner Mines
9. DATE OF BIRTH 8 13, 1895
10. AGE in Years76 Months1 Days10 | hrs or mins
11. Trade or profession Retired Miner
12. Kind of industry Dominion Coal Co.
13. Date last worked 14. Total years
15. If married name of spouse Alice Cooke (Deceased)
16. NAME of Father Simon Gallant
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Agnes Bennett
19. BIRTHPLACE Gardiner Mines, N.S
20. Signature of Informant Mrs. Agnes MacNeil
address 20 Scarboro Dr. Antigonish, NS
Relationship to deceased Daughter
21. Place of burial St. Joseph’s Cemetery, Glace Bay NS
Date of burial Sept. 26, 1971
22. Undertaker V.J. McGillivray Funeral Homes Limited. 16 Reserve St. Glace Bay
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 23, 1971
CAUSE OF DEATH
(a) Broncho Pneumonia
(b) Chronic Bronchitis
(c) Emphysema
other
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