Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Cyril John Samson death at South River Bourgeois, Richmond County on November 28, 1971
Male Death Registration: Year: 1971 number: 7326
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 007326
1. PLACE OF DEATH County of Richmond If in City or Town South River Bourgeois
3. PRINT NAME OF DECEASED Samson, Cyril John
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
single
8. BIRTHPLACE South River Bourgeois
9. DATE OF BIRTH 7 15, 1904
10. AGE in Years67 Months4 Days14 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Seaman
13. Date last worked December 1, 1962 14. Total years 35 years
15. If married name of spouse
16. NAME of Father Elie Samson
17. BIRTHPLACE South River Bourgeois
18. NAME of Mother Adelaide Fougere
19. BIRTHPLACE Cannes
20. Signature of Informant Thomas M. Samson
address South River Bourgeois
Relationship to deceased Brother
21. Place of burial River Bourgeois Roman Catholic Cemetery
Date of burial December 2, 1971
22. Undertaker Alex A. Morrison St. Peters
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH November 28, 1971
CAUSE OF DEATH
(a) found dead on floor of his cabin
(b)
(c)
other
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