Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Ann Elizabeth Sampson death at New Glasgow, Pictou County on November 2, 1971
Female Death Registration: Year: 1971 number: 6502
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006502
1. PLACE OF DEATH County of Pictou If in City or Town New Glasgow
If death occured in a hospital or institution Aberdeen Hospital
3. PRINT NAME OF DECEASED Sampson, Ann Elizabeth
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE England
9. DATE OF BIRTH 12 9, 1890
10. AGE in Years80 Months10 Days24 | hrs or mins
11. Trade or profession Housewife
12. Kind of industry
13. Date last worked 1961 14. Total years
15. If married name of spouse John Sampson
16. NAME of Father William Henry Cottell
17. BIRTHPLACE England
18. NAME of Mother Susan Wilson
19. BIRTHPLACE England
20. Signature of Informant William Cooke
address RR1 New Glasgow
Relationship to deceased Son
21. Place of burial Christ The King Cemetery, Trenton
Date of burial November 5, 1971
22. Undertaker Ross Funeral Home
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH November 2, 1971
CAUSE OF DEATH
(a) Pulmonary emhypena
(b)
(c)
other
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