Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Samuel Roberts death at Halifax, Halifax County on October 7, 1971
Male Death Registration: Year: 1971 number: 5973
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005973
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Victoria General Hospital
3. PRINT NAME OF DECEASED Roberts, Samuel
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Newfoundland
9. DATE OF BIRTH , 1902
10. AGE in Years69 Months Days | hrs or mins
11. Trade or profession Fisherman
12. Kind of industry
13. Date last worked 1970 14. Total years 50 years
15. If married name of spouse Lillian Mudge
16. NAME of Father John C. Roberts
17. BIRTHPLACE Newfoundland
18. NAME of Mother Mary E. Kenny
19. BIRTHPLACE Newfoundland
20. Signature of Informant Fillatre Funeral Home
address Cornerbrook, Newfoundland
Relationship to deceased
21. Place of burial Sally's Cove, Newfoundland
Date of burial 11 October 1971
22. Undertaker Halifax Funeral Home Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 7, 1971
CAUSE OF DEATH
(a) Quadriplegia
(b) Pneumonia
(c)
other Gastrointestinal Bleed
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Note: accident - fell down stairs and fractured C5-6 vertebrae