| 1. PLACE OF DEATH |
Name of city, village, town, district municipality or place Victoria, B.C.
Street The Veterans' Hospital |
| 2. LENGTH OF STAY |
(a) In Municipality where death occurred 1 week
(b) In Province 23 yrs (c) In Canada (if immigrant) 60 yrs |
| 3. PRINT FULL NAME OF DECEASED | McFadyen Lawrence |
| 4. PERMANENT RESIDENCE OF DECEASED |
Name of city, village, town, district municipality or place Victoria, B.C.
Street or road Blackwood Ave. House No 2710 |
| 5. Sex | Male |
| 6. Citizenship | Canadian |
| 7. Racial Origin | White |
| 8. Single, Married, Widowed or Divorced | Widowed |
| 9. BIRTHPLACE | Dumbarton, Scotland |
| 10. DATE OF BIRTH | June 21 1881 |
| 11. Age | 88 Years |
| 12. Trade, profession or kind of work as logger, fisherman, office clerk etc. | Employee - T.Eaton, Co. (Edmonton, Alta.) |
| Kind of industry or business, as logging, fishing, bank, etc | |
| 13. Date deceased last worked at this occupation | 1947 |
| 14. Total yrs. spent in this occupation | 23 years |
| 15. If married or divorced give name of husband or maiden name of wife of deceased | Letitia Alabaster |
| 16. Father's Name | McFadyen James |
| 17. Maiden Name of Mother | N.K. Janet |
| 18. Birthplace | Father - Scotland Mother - Scotland |
| 19. I certify the foregoing to be true and correct to the best of my knowledge and belief |
Given under my hand at Victoria, B.C., this 30th day of November 1969
Signature of informant ??? Relationship to deceased Grandson? Address of informant 23 ??????? |
| 20. Burial, Cremation or Removal |
Cremation Date December 2 1969
Place of Burial or Cremation Saanich, V.I. Name of Cemetery Royal Oak Crematorium |
| 21. Undertaker Name | McCall Bros. Address Victoria B.C. |
| 22. DATE OF DEATH | November 25 1969 |
| 24. I HEREBY CERTIFY |
that I attended deceased from 17 November 1969
to 25 November 1969
and last saw him alive on Nov. 25 1969 |
| Cause of Death | ??? ??? |
| 24. If a woman, did the death occur either during pregnancy or within 90 days following pregnancy? | |
| 25. Was there a recent surgical operation? | no |
| 26. If a violent death, .... | |
| 27. |
Signed by ??? Designation ??? M.D. or Coroner
Address ?? Date ?? |
| 28. Print name of Doctor or Coroner, whose signature appears above | Ralph C. Smith, M.D. |
Source: Royal BC Museum