Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Mary Dombeck death at North Sydney, Cape Breton County on October 26, 1971
Female Death Registration: Year: 1971 number: 6879
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006879
1. PLACE OF DEATH County of Cape Breton If in City or Town North Sydney
If death occured in a hospital or institution St. Elizabeth Hospital
3. PRINT NAME OF DECEASED Dombeck, Mary
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Czechoslovakian
7. Single, Married
widowed
8. BIRTHPLACE Prague, Czechoslovakia
9. DATE OF BIRTH 7 31, 1880
10. AGE in Years91 Months2 Days26 | hrs or mins
11. Trade or profession Retired
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Helen Reashore
address Bras d'Or, Cape Breton Co., NS
Relationship to deceased Daughter
21. Place of burial St. Joseph's, Sydney Mines, Cape Breton Co., NS
Date of burial 29 October 1971
22. Undertaker George R. Francis, Sydney Mines, Cape Breton Co., NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 26, 1971
CAUSE OF DEATH
(a) Pulmonary Infarction
(b) Thrombosis of Left Femoral Vein
(c) Arteriosclerotic Heart Disease
other Pre-renal Azotemia
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