Male Death Registration: Year: 1971 number: 6140
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006140
1. PLACE OF DEATH County of Pictou If in City or Town New Glasgow
If death occured in a hospital or institution Glen Haven Manor
3. PRINT NAME OF DECEASED Clyburn, Franklyn Horace
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 2 2, 1885
10. AGE in Years86 Months7 Days29 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Labourer
13. Date last worked 1950 14. Total years
15. If married name of spouse Elsie Clyburn
16. NAME of Father John Henry Clyburn
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Annie Johnson
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Keith Langille
address Pleasant St. New Glasgow
Relationship to deceased Son-in-Law
21. Place of burial Lorne St. Cemetery New Glasgow
Date of burial October 3, 1971
22. Undertaker H.W. Angus, New Glasgow
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 1, 1971
CAUSE OF DEATH
(a) Myocardial Infarction
(b)
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=498213
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