Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Lewis Donaldson Green death at Antigonish, Antigonish County on September 17, 1971
Male Death Registration: Year: 1971 number: 5727
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005727
1. PLACE OF DEATH County of Antigonish If in City or Town Antigonish
If death occured in a hospital or institution St. Martha's Hospital
3. PRINT NAME OF DECEASED Green, Lewis Donaldson
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE White Head, Guysborough County
9. DATE OF BIRTH 3 22, 1896
10. AGE in Years75 Months5 Days26 | hrs or mins
11. Trade or profession Retired - Pensioner
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Marjorie Willia Green
16. NAME of Father William Green
17. BIRTHPLACE White Head, Guysborough Co., NS
18. NAME of Mother Naioma Hefferman
19. BIRTHPLACE White Head, Guysborough Co., NS
20. Signature of Informant William D. Green
address 7 Blackthorne Avenue, Hamilton, Ontario
Relationship to deceased Son
21. Place of burial Goshen, Guysborough Co., NS
Date of burial 20 September 1971
22. Undertaker George Parker Giffen, Goldboro, Guysborough Co., NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 17, 1971
CAUSE OF DEATH
(a) Methyl Salicylate Poisoning
(b)
(c)
other
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