Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Clark Stedman Crouse death at Coldbrook, Kings County on December 10, 1971
Male Death Registration: Year: 1971 number: 7230
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 007230
1. PLACE OF DEATH County of Kings If in City or Town Coldbrook
3. PRINT NAME OF DECEASED Crouse, Clark Stedman
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Gaspereau, Kings County
9. DATE OF BIRTH 1 29, 1935
10. AGE in Years36 Months10 Days11 | hrs or mins
11. Trade or profession Labourer
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Pauline Leopald
16. NAME of Father Spurgeon Crouse
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Ruth Stevens
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Pauline Crouse
address White Rock, Kings Co., NS
Relationship to deceased Wife
21. Place of burial Willowbank Cemetery, Kings Co., NS
Date of burial 13 December 1971
22. Undertaker H. C. Lindsay Funeral Home, Kentville, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH December 10, 1971
CAUSE OF DEATH
(a) Fracture of Neck due to motor vehicle accident
(b)
(c)
other
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