USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 1
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RETURN OF A DEATH.
Bereby Certify, as I am informed, that on the
Thirteenth day of
A. D
A. D. 185%
aged
years, 1 months, 10 days, in
Street. Said person was a
was born in ? " échellen' and was the Ganghler of
died, at No. and, by occupation, a Georges tunbella Clifford
The disease, or cause of death, was
interred, or to be interred, in
DATED, at CHinthree the 21
Informant.
day of January A. D. 1853
1
RETURN OF A DEATH.
' Derely Certify, as I am informed, that on the day of
A. D. 185,5
Jedanach I icy! died,
aged ycars, 23 months, 8 days, in
at No.
€ Hain Street. Said person was a un00 hur ican and, by occupation, a
was born in I Chelsea and was the the Gang hte of Filips L'x fully fit
The discase, or cause of death, was
interred, or to be interred, in
dring Kinitiali
1 1
Compare/ A. D. 1854 Informant.
J
RETURN OF A DEATH.
Dereby Certify, as I am informed, that on the day of
A. D. 1853 Henry herkesberry died,
at No. aged 76 years, 2 months, days, in Frenthird Street. Said person was a hurricane and, by occupation, a Farmer- was born in vithuelsen and was the Husbandof Savannah Devotesbury
The disease, or eause of death, was Tavalylich Fil
interred, or to be interred, in Winthrop
DATED, at
Minthoch
the Sveluft day of John Player
Informant.
Jan A. D. 1834
RETURN OF A DEATH.
Hereby Certify, as I am informed, that on the
Third day of . August. A. D. 1853
Mary & Bryant Winther at No.
dicd,
aged 2 years, 5 months, days, in
Shirley Street. Said person was a was born in Gast Burton and was the
· Fines Lean and, by occupation, a
Daughter of Jannes & chary Bryant
The disease, or cause of death, was
Unafery on the Brain
interred, or to be interred, in
gelen Floyd, Informant.
DATED, at .
Win throp the welult day of
Fan. A. D. 1854
RETURN OF A DEATH.
's Hereby Certify, as I am informed, that on the
day of
1// A. D. 1854
died,
aged
,3
years, 1 months, days, in
1 at No.
Street. Said person was
trish and, by occupation, a
was born in : 1. Chelsea and was the
Daughter of Janus salary termick
The disease, or cause of death, was
Thucul Distemper Sauthe Boston.
interred, or to be interred, in
DATED, at Hinthick the
27 7
day of
Echoe Pleyde Inform A. D. 1854
Collary
RETURN OF A DEATH.
Hereby Certify,
as I am informed, that on the
Sevin tear, l' day of A. D. 1854 4 years,
April
died,
aged
months, days, in
Hin 'hilfe at No.
I in their / Street. Said person was a was born in the sea and was the Jon
and, by occupation, a of fucus De Laisa Belcher-
Hear.l.
The disease, or cause of death, was
interred, or to be interred, in
of the finitherole
DATED, at His, that's the 1
day of Vite A. D. 1854 Informant.
RETURN OF A DEATH.
' Wereby Certify, as I am informed, that on the day of 1/114/11/ A. D. 1854 Duvill died,
at No. aged ycars, 2 months, days, in
Beach A
Street. Said person was Merece, and, by occupation, a
was born in 1/4/216 and was the Husband of Hanach Ment. Pantylick.
The disease, or cause of death, was
interred, or to be interred, in Hin hinche
Informant.
DATED, at
Hinthank the
27.
day of
Dec
A. D. 18 54
RETURN OF A DEATH.
calisth.
Wereby Certify, as I am informed, that on the day of
August A. D. 185 7
died,
aged
ycars, months, 2 days, in at No.
Shirley. Street. Said person was a was born in c / 1. hira and was the
and, by occupation, a Langhetinos Lavid, fully 11/11 11
1/11/11/1
The disease, or cause of death, was
interred, or to be interred, in Winthropo
DATED, at Hin Ihre/ the
Informant.
day of L.c. A. D. 185
1
RETURN OF A DEATH.
Wereby Certifi, as I am informed, that on the
bien my rightday of
1.
A. D. 1804
"agur. it ihnwill
died, Windlife at No.
iged
years, 3 months, days, in
Hinterof Street. Said person was a
was born in Win throk and was the
and, by occupation, a of steffenx Insan Burrill
The disease, or cause of death, was
interred, or to be interred, in Hintherele
Informant.
DATED, at Whiletheonly the
day of
A. D. 185 /
RETURN OF A DEATH.
y Dereby Certify, as I am informed, that on the
day of
A. D. 18.,-
died,
aged
1
years,
. .
months,
days, in
1
2
at No.
Street. Said person was a . /», and, by occupation, a
1
was born in
1
. and was the of
1.11
1.
The discase, or cause of death, was
interred, or to be interred, in
1
1
Informant.
DATED, at
/ the 1
1112
day of
A. D. 186 /
---
1
RETURN OF A DEATH.
Hereby Certify, as I am informed, that on the
day of A. D. 18 6%.
dicd,
aged years, / months, days, in
at No. 12
Street. Said person was a . H,eren zer , and, by occupation, a
was born in
and was the of
1
11
The discase, or cause of death, was
interred, or to be interred, in
1
/
Informant.
,
-
DATED, at
the
day of
A. D. 18 6/
,
RETURN OF A DEATH.
certify,
as I am informed, that on the
A. D. 18 ,/
day of died,
ged 32 years, months, days, in
Street. Said person was a
as born in Sim and was the x Brunswick
The disease, or cause of death, was terred, or to be interred, in
,
fotine . "layit
Informant.
DATED, at rifiniturethe 3
day of cheb ~ A. D. 18 / 2_
at No. and, by occupation, a
of
RETURN OF A DEATH.
Hereby Certify, as I am informed, that on the
A. D. 18 /
Dorian . L days, in
day of ,ed 24 years, months,
died,
Street. Said person was a
as born in in Century and was the
of
at No. and, by occupation, a Sedeusu
Georg0
Consumption 1
The disease, or cause of death, was
terred, or to be interred, in
DATED, at
Whenthere's the
February 11,2 facture inland day of A. D. 18 / 2
Informant.
Piecein the 7
RETURN OF A DEATH.
> Bereby Certify, as I am informed, that on the
day of frezy A. D. 185/
journaloft. died,
ed (32 years, months, days, in
at No.
Street. Said person was a
and, by occupation, a
is born in " luxberry and was the /x of
1
The disease, or cause of death, was
1
terred, or to be interred, in e
DATED, at Hilton, the
0
day of
A. D. 180 V Informant.
cef. 1
Grilled décidé -
RETURN OF A DEATH.
Hereby Certify,
as I am informed, that on the
day of
A. D. 18 >/ Mary ¿
ged 11 years, /ó months,
days, in
at No.
Street. Said person was a 1 as born in
and was the Laughter of
cun l'éthique dec 1
2
1
A
Informant.
DATED, at
the
3
day of
‘A. D. 18 5 %
died,
and, by occupation, a
The disease, or cause of death, was
terred, or to be interred, in
RETURN OF A DEATH.
Hereby Certify, as I am informed, that on the €
day of A. D. 18 61 . tudo
Chaque died,
at No.
,ed years,
19 months, 10 days, in
Street. Said person was a
and, by occupation, a
is born in
and was the Se ugliter of
war1× L'aria in in nllage
The disease, or cause of death, was
-12 :- ) 1
2
terred, or to be interred, in
Informant.
DATED, at
2
day of
A. D. 18 % 2
-
RETURN OF A DEATH.
Hereby Certify, as I am informed, that on the only weght day of A. D. 18 2 died,
turiu cenégan
years, months, days, in iso e Minbets at No. ed
Street. Said person was a
and, by occupation, a
s born in
and was the one
.
The disease, or cause of death, was
terred, or to be interred, in
Informant.
DATED, at the 1
day of Sie A. D.
RETURN OF A DEATH.
Hereby Certify,
as I am informed, that on the
Eleventhe day of
March A. D. 1862
Mary Human died,
›d 77 years, 6 months, days, in
Street. Said person was a
s born in Boston and was the Wifi of
at No. and, by occupation, a Elph Myman
The disease, or cause of death, was tronononfiction
erred, or to be interred, in Mintturup Cemetery
Informant.
DATED, at Winthro the
to the day of
Jan A. D. 1869
RETURN OF A DEATH.
Bereby Certify,
as I am informed, that on the
May A. D. 1862 Joshua I Tewksbury died,
Eleventhe day of ged years, 11 months, days, in
at No. and, by occupation, a
Street.
Said person was a
as born in
Winterif and was the
Joue
of
Charlesy Janey Perkesbury
The disease, or cause of death, was Scarlet Sever
terred, or to be interred, in Minthade Cemetery
Informant.
day es Fan A. D. 18 0 g
DATED, at
Whenthings the 10 forme
RETURN OF A DEATH.
Bereby Certify,
as I am informed, that on the
Eighteenth
day of
May A. D. 186 2.
Arvilla Magee died,
ed 4
years, 11 months, 9 days, in
at No.
Street. Said person was a
and, by occupation, a
is born in
and was the Laughton of Edward & Caroline Magee
The disease, or cause of death, was Scarlet Frev
terred, or to be interred, in
Wintherche Cornetery
DATED, at
Winterde the
Informant.
day of fan A. D. 180 g
RETURN OF A DEATH.
Hereby Certify,
as I am informed, that on the
·
Twenty third
day of
May
A. D. 188 2
John Williams Tewksbury
died,
jed 7 .years,
months,
121
days, in
Street.
Said person was a
as born in
at No.
and, by occupation, &
of Charles & Nancy Tewksbury
and was the
Jon
The discase, or cause of death, was Scarlet Fever-
terred, or to be interred, in Matterof Cemetery
Informant.
of fam 1863
the 12
DATED, at
Nenthere
RETURN OF A DEATH.
Hereby Certify,
as I am informed, that on the
day of
2
6 A. D. 1862
"William "V" Share died,
d 32
years, 10 months, days, in
Street. Said person was a Is born in eth Chelsea and was the
at No. and, by occupation, a
den. of Ebenezer than
The disease, or cause of death, was
terred, or to be interred, in Winthrop Cemetery
Informant.
DATED, at
"Ministerofs
the
15.
day of
fan.
A. D. 18 523
RETURN OF A DEATH.
Dereby Certify, as I am informed, that on the wentythird day of
August
A. D. 180 2
Clara Henderson died,
ed 230 years, months, days, in
Street. Said person was a born in 3 : Summer er and was the
at No. and, by occupation, a
s born in
Nike of 66 Handerson
The disease, or cause of death, was erred, or to be interred, in
Санлитр Тин WinHoop Cemetery
Informant.
DATED, at
the 10 day of fun A. D. 18
RETURN OF A DEATH.
Dereby Certify, as I am informed, that on the
October A. D. 180 ℃
Nachhal Bolcher- died,
at No.
Street. Said person was a
and, by occupation, a
3 born in
I was the Daughter of Youth & Hachal Belcher
Jagratur Parials's
The disease, or cause of death, was
erred, or to be interred, in
It intherole Cemetery
Elon Cloud
Informant.
DATED, at Wentlivrede 1
the 10
¿day of
un A. D. 18623
Twentyfrist day of a 77 years, months, days, in
RETURN OF A DEATH.
Bereby Certify,
as I am informed, that on the
january A. D. 1859
t Fifteenthe day of ·tun & Stecksburg died,
52 years, 2 months, days, in
Street. Said person was a
s born in Butin
and was the
of
X
The disease, or cause of death, was
erred, or to be interred, in Mount , tuber Cemetery
Informant.
DATED, at Winthrop the 19
day of Funcan A. D. 18 33
at No. and, by occupation, &
RETURN OF A DEATH.
Bereby Certify,
as I am informed, that on the
Jeconel day of February A. D. 1859
Charles
died,
a 35 years, months, days, in at No.
Street. Said person was a
and, by occupation, a
born in
Besten
and was the
of
The disease, or cause of death, was
erred, or to be interred, in
Monthich
Gerneterif.
Informant.
DATED, at
Winthrop
the
day of February A. D. 1863
DEATHS
YEARS MISSING
1855-6-7-8-9 1864-5-6-7-8-9- 1870-1-2-3-4-5-6 1877-2-9 1882-(1)
NOT COMPLETE
To the Clerk of the Town in which the Death occurred.
1. Name,
Chicl
(Maiden Name,)*
2. Date of Death, . .
March 22, 1868
3. Place of Death,
·
4. Residence,
5. Sex, and whether Single, Married, or Widowed,
6. Age,
Years, ____
Months,
Days,
7. Color,t ·
30 Minutos
8. Occupation,
9. Disease or ( Firat or Primary, .
Cause of
Secondary, (if any,)
Death,
By whom certified,
10. Place of Birth, .
11. Place of Interment, .
Mount Nubien
1
12. Name of Father, ·
13. Birthplace of Father, .
14. Name of Mother,
15. Birthplace of Mother,
Signature of Undertaker or other person making the Return,
-
Dated at.
, on 25 Juni
1864
* If a Married Woman or a Widow.
+W.) White. (A ) African. (M ) Mixed White and African If of other Races, specify what ..
[Be very particular to fill all Blanks.]
.
.
ellevar Á
Sarah Finegan
1
1
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTIIWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for negleet, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
To the Clerk of the Town in which the Death occurred.
1. Name,
.
Enniee Perlesburg
(Maiden Name,)*
Morgan
2. Date of Death, .
·
3. Place of Death, . ·
4. Residence,
5. Sex, and whether Single, Married, or Widowed,
6. Age,
78 Years,
Months,
Days.
7. Color,t ·
8. Occupation,
9. Disease or
First or Primary,
Cause of Secondary, (if any,)
Death, . ( By whom certified,
10. Place of Birth, .
11. Place of Interment, .
Winthrop Cemetery
12. Name of Father,
.
13. Birthplace of Father, ·
14. Name of Mother, ·
15. Birthplace of Mother,
Signature of Undertaker or other person making the Return,
Dated at.
Winthercf
-, on
25 Juin
186₺
* If a Married Woman or a Widow. ?(W ) White (A ) African (M ) Mixed White and African If of other Rares, specify what.
[Be very particular to fill all Blanks. ]
.
.
August 9 180g Winthropu - -
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
> In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Cierk. Penalty for neglect, twenty dollars. ·
Blank forms of Returns may be obtained from the Town Clerk.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Name,
.
Caroline A Belcher Findings
2. Date of Death, .
3. Place of Death,
4. Residence,
5. Sex, and whether Single, Married, or Widowed,
Married
3) Years, 2 Months, 24 Days.
6. Age,
7. Color,t
8. Occupation,
9. Disease or First or Primary, .
Cause of Secondary, (if any,)
Death, . l By whom certified,
10. Place of Birth,
11. Place of Interment, .
12. Name of Father,
13. Birthplace of Father,
14. Name of Mother, ·
15. Birthplace of Mother,
Winsthinch Cemetery Funes "The Sinking) Eliot Maine Lavina Finkun 91 York Mains
Signature of Undertaker or other person making the Return,
filan Floyd
Dated at _.
, on 25 Jan
1864
* If a Married Woman or a Widow. +(W ) White (A ) African (M ) Mixed White and African. If of other Races, specify what.
[Be very particular to fill all Blanks .;
·
Consumptie Kitten
(Maiden Name,)
defatoember 98, 1868 Winthrop
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased residcd,) having first been obtained, the person having charge of suclı Interinent must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Name,
Lydia Lang ·
(Maiden Name,)*
Walker
2. Date of Death, .
3. Place of Death, ·
October 21 , 180g Winthrop.
4. Residence, ·
5. Sex, and whether Single, Married, or Widowed,
Married
1
49 Years, 2 Months,
Days.
6. Age,
7. Color,t ·
8. Occupation, .
9. Disease or L First or Primary, .
Cause of 1 Secondary, (If any,)
Consumption
Death,
1
By whom certified,
10. Place of Birth, .
11. Place of Interment, .
12. Name of Father, ·
.
14. Name of Mother, ·
15. Birthplace of Mother,
Signature of Undertaker or other person making the Return,
7
felice Thayd
Dated at
Winstore/2
->
25 Jan
802/
* If a Married Woman or a Widow. +(W.) White (A ) African (M ) Mixed White and African. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Winthrop Cemetery
13. Birthplace of Father,
.
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town' in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
J. F. Farwell & Co., City Printers, 32 Congress Street, Boston.
Boston, tanken
Hirano
18621 wo Olumen
This Certifies that
died on the UILday of Jany 1814 aged 76 years,
months,~ days.
CAUSE OF) First, (in order of time.)
Duration, *
DEATH.
Second,
Cousin tivir
Duration!
PM. Crane
Physician.
* Reckoned to the time of death.
Physicians' Certificates can be obtained on application at the City Registrar's Office, No. 6 City Hall Avenue.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Name, · (Maiden Name,)*
Frederick & Raby
2. Date of Death, .
Sou 26. 1864
3. Place of Death,
Winthrofr. Winthrop
4. Residence, ·
5. Sex, and whether Single, Married, or Widowed,
Male Single
6 Years, 6 Months, 26 Days.
6. Age,
7. Color,t
8. Occupation,
9. Disease or
First or Primary,
Cause of Secondary, (if any,)
Scarlet Hever
Death, · By whom certified,
10. Place of Birth,
11. Place of Interment, .
12. Name of Father, ·
·
Henry Roby
1119
14. Name of Mother, ·
.
Mary Holy
New Jersey
Signature of Undertaker or other person making the Return,
falun Hayd
Undertaker
Dated at
, on Jan. 30
1867
* If a Married Woman or a Widow.
!(W.) White. (A ) African. (M ) Mixed White and African If of other Races, specify what.
[Be very particular to fill all Blanks.]
Dr H. S. Joule.
Wiriltiraju
13. Birthplace of Father,
15. Birthplace of Mother,
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Name,
E
Thomas Floyd
(Maiden Name,)*
2. Date of Death, .
Dec 10h 186%
3. Place of Death,
Minttirato
1. Residence,
5. Sex, and whether Single, Married, or Widowed,
Mamed
64 Years, 3 Months,
Days.
6. Age,
7. Color,t ·
·
harmer
9. Disease or ( First or Primary, .
Cause of Secondary, (if any,)
Typhoid Fever
Death,
.
By whom certified,
Dr S. Ingalls Chelsea
10. Place of Birth,
11. Place of Interment, .
12. Name of Father,
13. Birthplace of Father, C
14. Name of Mother, ·
.
Hannah Floyd Chelica
Signature of Undertaker or other person making the Return,
IOundertaker-
Dated at
Winthrop,
, on Jan 30
186>
* If a Married Woman or a Widow. +(W ) White (A ) African (M ) Mixed White and African. If of other Races, specify what.
[Be very particular to fill all Blanks .;
Withiran
David Floyd Chelsea
15. Birthplace of Mother,
8. Occupation,
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Name, · (Maiden Name,)*
Ann Burrill
Belcher
2. Date of Death, .
3. Place of Death,
4. Residence,
- fanicary 24, 18by dintherav Winthrop Widowed
6. Age, ·
79 Years,.
11 Months, 26 Days.
7. Color,t
·
8. Occupation,
9. Disease or
First or Primary, .
Cause of Secondary, (if any,)
Death,
·
By whom certified,
10. Place of Birth,
.
11. Place of Interment, .
12. Name of Father, ·
13. Birthplace of Father,
14. Name of Mother,
·
,
15. Birthplace of Mother,
Signature of Undertaker or other person making the Return,
John Meye
(Undertaker
Dated at_
Wintherin
_, on.
Jan 30
1868
* If a Married Woman or a Widow. t(W.) White (A ) African (M ) Mixed White and African. If of other Races, specify what.
[Be very particular to fill all Blanks. ]
Chelsea
Winthrop
Nathaniel Belcher
Dr El Ungalla
5. Sex, and whether Single, Married, or Widowed,
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
-
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Name, · C
Flora Me Weston eslors
(Maiden Name,)
2. Date of Death, .
3. Place of Death,
fazu 27 1867 Winthrop.
1. Residence,
5. Sex, and whether Single, Married, or Widowed,
Female Single
6. Ago,
7. Color,t
8. Occupation,
EScurlut Fi
Cause of Secondary, (if any,)
Deatlı, .1 By whom certified,
10. Place of Birth, .
.
11. Place of Interment, . Winthrola Washburne "Western 12. Name of Father, . 13. Birthplace of Father, Marshfield Hannah Werten 14. Name of Mother, · · 15. Birthplace of Mother, (Vew Journey
Signature of Undertaker or other person making the Return,
fahre Alud (undertaker). 1868
Dated at
TWinttarefa, on Jan 20
* If a Married Woman or a Widow. +(W ) White (A ) African. (M ) Mixed White and African. If of other Races, specify what.
[Be very particular to fill all Blanks .;
Years, __. 10 Months, Days. MV
9. Disease or First or Primary,
Bref Ingalls
The Undertaker, or other informant, is requested to report the facts-together with the Physician's . Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
" In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Name, · (Maiden Name,)*
·Sancy B Belcher Belcher
2. Date of Death, .
3. Place of Death,
July 21. 1867 Winthrop Winthrop
4. Residence,
5. Sex, and whether Single, Married, or Widowed,
Female Single
6. Age,
17 Years, 18 Months,
Days.
7. Color,t ·
8. Oceupation,
Platic Rheumatisin
Cause of Secondary, (if any,)
Deatlı,
. ¿ By whom certified,
10. Place of Birth, ·
Chelsea
Winthrop
Thomas ( Belcher
13. Birthplace of Father, Chelsea
14. Name of Mother, ·
.
15. Birthplace of Mother,
Signature of Undertaker or other person making the Return,
fehn Floyd
Aundertaker 1
Dated at
Winthrop, on Jan 20
18 68
" If a Married Woman or a Widow. +(W ) White (A ) African (M ) Mixed White and African If of other Races, specify what.
[Be very particular to ûll all Blanks.]
1
9. Discase or First or Primary,
Or If I Joule
11. Place of Interment, .
12. Name of Father, ·
Hannah B Belcher Chelsea
The Undertaker, or other informant, is requested to report the faets-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Name, · (Maiden Name,)*
·Chary A Martin
Martin
2. Date of Death, .
3. Place of Death, ·
4. Residence,
5. Sex, and whether Single, Married, or Widowed,
Female Single
6. Age,
7. Color,t ·
8. Occupation,
9. Disease or First or Primary, .
Dysentery
Cause of Secondary, (If any,)
Art of loule.
Death,
.
L
By whom certified,
10. Place of Birth,
11. Place of Interment, . ·
East Boston
Jorgestor
12. Name of Father, .
.
Nicholus Martin. Varlared
15. Birthplace of Father, ·
14. Name of Mother,
.
Mary Martin
15. Birthplace of Mother,
Poland
Signature of Undertaker or other person making the Return,
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