Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Gerald Sampson death at Halifax, Halifax County on November 19, 1971
Male Death Registration: Year: 1971 number: 6675
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006675
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Camp Hill Hospital
3. PRINT NAME OF DECEASED Sampson, Gerald
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Rockdale, Cape Breton
9. DATE OF BIRTH 5 22, 1911
10. AGE in Years60 Months5 Days22 | hrs or mins
11. Trade or profession Ramp Operator
12. Kind of industry Canadian Liquid Gas
13. Date last worked 1971-09-15 14. Total years 26 years
15. If married name of spouse Mary Ellen Sampson
16. NAME of Father Charles Sampson
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Sophia Peters
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Gerald Sampson (FMC)
address 3689 Albert Street, Halifax
Relationship to deceased wife
21. Place of burial Gate of Heaven Cemetery, Lower Sackville
Date of burial 1971-11-22
22. Undertaker Halifax Funeral Home
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH November 19, 1971
CAUSE OF DEATH
(a) Carenoma of the Stomach
(b)
(c)
other
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