Male Death Registration: Year: 1971 number: 6653
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006653
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 Hagen, Herman Richard
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Irish
7. Single, Married
married
8. BIRTHPLACE Prince Edward Island
9. DATE OF BIRTH 1 6, 1899
10. AGE in Years72 Months9 Days19 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Storekeeper, Hawker Siddeley
13. Date last worked 14. Total years
15. If married name of spouse Ruby Hagen
16. NAME of Father John Hagen
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Margaret Askin
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs Herman Hagen
address 25 Balfour St., New Glasgow
Relationship to deceased Wife
21. Place of burial Abercrombie, Pictou Co.
Date of burial October 27th, 1971
22. Undertaker R. H. Porter Funeral Homes Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 25, 1971
CAUSE OF DEATH
(a) Carcinoma metastasis
(b) Carcinoma L jaw
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=498726
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