Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Carl Vaughan Pemberton death at Windsor, Hants County on October 5, 1971
Male Death Registration: Year: 1971 number: 5919
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005919
1. PLACE OF DEATH County of Hants If in City or Town Windsor
If death occured in a hospital or institution Payzant Memorial Hospital
3. PRINT NAME OF DECEASED Pemberton, Carl Vaughan
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Three Miles Plains Nova Scotia
9. DATE OF BIRTH 8 8, 1902
10. AGE in Years69 Months1 Days27 | 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 Amy McDow
16. NAME of Father Harry Pemberton
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Hatti Vaughn
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs John Ross
address Curry's Corner Hants Co NS
Relationship to deceased daughter
21. Place of burial Maplewood Cemetery Windsor NS
Date of burial 07 Oct 1971
22. Undertaker Lindsey Funeral Home Ltd
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 5, 1971
CAUSE OF DEATH
(a) Cerebral Hemorrhage
(b) Arteriosclerosis
(c)
other
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