Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Clifford Austin Burgess death at Centre Burlington, Hants County on November 14, 1971
Male Death Registration: Year: 1971 number: 6643
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006643
1. PLACE OF DEATH County of Hants If in City or Town Centre Burlington
3. PRINT NAME OF DECEASED Burgess, Clifford Austin
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 9 28, 1894
10. AGE in Years77 Months1 Days17 | hrs or mins
11. Trade or profession Farmer
12. Kind of industry Veg & Hay
13. Date last worked 1966 14. Total years 55
15. If married name of spouse Ruby Mae Burgess
16. NAME of Father Benjamin Burgess
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Rachel Robina Card
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Clifford Burgess
address Burlington, N. S.
Relationship to deceased wife
21. Place of burial Centre Burlington, N. S.
Date of burial Nov 16th 1971
22. Undertaker J. Wilson Allen Summerville, N. S.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH November 14, 1971
CAUSE OF DEATH
(a) Carcinoma lung
(b)
(c)
other
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