Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Charles Sampson death at Sydney, Cape Breton County on October 28, 1971
Male Death Registration: Year: 1971 number: 6726
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006726
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution Sydney City Hospital
3. PRINT NAME OF DECEASED Sampson, Charles
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE River Bourgeois
9. DATE OF BIRTH 12 30, 1919
10. AGE in Years51 Months9 Days28 | hrs or mins
11. Trade or profession Labourer
12. Kind of industry
13. Date last worked July 30, 1971 14. Total years 23 years
15. If married name of spouse Elizabeth Sampson
16. NAME of Father Charles James Sampson
17. BIRTHPLACE River Bourgeois
18. NAME of Mother Mary Elizabeth Burke
19. BIRTHPLACE River Bourgeois
20. Signature of Informant Mrs. Susan Stone
address River Bourgeois
Relationship to deceased Sister
21. Place of burial Catholic Cemetery River Bourgeois
Date of burial October 31, 1971
22. Undertaker T.W. Curry Ltd. Sydney
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 28, 1971
CAUSE OF DEATH
(a) Carcinoma gastric
(b)
(c)
other
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