USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 1
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COMMONWEALTH OF , MASSACHUSETTS
RETURN OF A DEATH
Winthrop Mark
(CITY OR /TOWN.)
FULL NAME
Place of l
Winthrop
Death *
S
Residence
18 Herman
St
Age
51
.. years.
/
months.
19
days
STATISTICAL DETAILS
SEX JEmals
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widow
MAIDEN NAME t Joslyn Scott Lasker
HUSBAND'S NAME +
Forest F. MOOIE
BIRTHPLACE#
Robinston ME.
NAME OF FATHER Charles a Laskey
BIRTHPLACE OF FATHER# St. Johns n. B.
MAIDEN NAME OF MOTHER Lucy E. Bean
BIRTHPLACE
OF MOTHER #
maine
OCCUPATION HouseinfE
INFORMANT §
Violet Moore
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
garden Cometerglan. 5
7
190.
UNDERTAKER I. Or.L praque
ADDRESS
V20 Mendiant
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during las Jan 39 7 illness, from Dec 12 1906 .. to
190 .. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows Primary :
(DURATION).
8horas
.. DAY
Contributory :
(Signed).
Bittet call
M.D.
Jan 3 1907 (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
3 weeks
months.
. years
....
days
Where was disease contracted,
if not at place of death ?
* City or town, street and number, if any. If death occurs away from USUAL RESI DENCE, give facts called for under "Special Information." If in a Hospital of Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statisticai detalls. Iļ Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Roslyn Scott Income
.Registered No.
Date of | xar3
Death
.190
(DURATION)
DAYS
no 1- Gostyw Jest Troce. Law 3, 1907
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Emanuel Collyer
(CITY OR TOWN.)
469
FULL NAME
Place of l
Death *
5
133 @nest ano
Date of ¿
Death
.. 190
3
.months.
.days
STATISTICAL DETAILS
SEX Male
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Lyme Regis
Dorset Shirt England
NAME OF FATHER John Collyer
BIRTHPLACE
OF FATHER$
Lyme Regis
Quick Shr Impland
MAIDEN NAME.
OF MOTHER
BIRTHPLACE
OF MOTHER$
OCCUPATION
Recuerde Den Caplan
INFORMANT §
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
190.
UNDERTAKER
ADDRESS
AD Dennis. Lynn Plus
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 2 190 % to fan 4
.. 190 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
loanquetion of dienas
Contributory :
D
2mene ch(DURATION)
DAY8
(Signed)
M.D.
Sam 6 190% (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months ...................... days
Where was disease contracted,
If not at place of, death ?.
Filed .190
Clerk
* City or town, street and number, If any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details, Il Name of cemetery.
J
.years.
Residence
Age.
69
Registered No ...
4
(DURATION)
3
DAYS
Emanuel Collyer Jan 4. 1907
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
[ 12-16-1903-1,000 ] J 223
SOM
FOUNDED 1842.
. ESTA STABLISHED
A CITY 1672 STRENGTH
COMMONWEALTH OF MASSACHUSETTS
CITY OF SOMERVILLE
RETURN OF A DEATH
FULL NAME Phoebe ... Ann ... Munday
Registered No
.3.4
Date of
Death .... a.n ...... 1.3 .. ...... 190 7 ...
Age
.7.6. years
4 ... months ... 14 days
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
If a married or divorced woman, or widow
Tiney
HUSBAND'S
FULL NAME
William Henry Munday
BIRTHPLACE
Give state or country; also city, tolon, or county, of known
Shapleigh, Me.
NAME OF
FATHER
John Eaton Tiney
Gine state or country : atso city, town, or county, if known
BIRTHPLACE
OF FATHER
Shapleigh, Me.
MAIDEN NAME
OF MOTHER
Eliza Jane Abbott
Give state or country ; also city, town, or county, if known
BIRTHPLACE
OF MOTHER
Shapleigh, Me.
OCCUPATION
None
INFORMANT'S
Person giving statistical details
NAME
Mr. W. F. Munday
ADDRESS
Winthrop, Mass
(No.) ( Street )
( Town or ('ity)
PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Topsfield
(Cemetery)
Jan. 16, 1907
( Town or City, and State )
UNDERTAKER'S NAME
John Bryants' Sons
ADDRESS
353 Medford
Som.
( No.) (Street )
( Town or City)
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jan. 13, 1907 to Jan. 13, 1907, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : ( If a soldier or sailor who served in the war of the rebellion both the primary and contributory causes of death must be given.)
Primary
Lobular .. pneumonia.
( DURATION )
5
DAYS
Contributory :
Cardiac failure
( DURATION )
7
DAYS
(Signed)
Um. F. Patterson
M. D.
( Address) 401 Main St., Charlestown
(No.)
(Street)
( Town or City)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Previous Residence
How long at
Place of Death ?
Years,
Months,
Days
Where was disease contracted,
if not at place of death ?
Received Jan. 15, .190 7 .... Wm. P. Mitchell Agent of Board of Health, appointed to issue burial permits
Filed Jan. 17, 1907 Frederic ". Com"
City Clerk
Place of l
Death
60 Fellsway West, Somerville, Mass.
Winthrop .....
... Mass
Place of
Residence
(No.)
(Street)
( Town or City and State)
MAIDEN NAME
2 Thrive On Sunday (190,٥ / سم
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.) 469
FULL NAME
Registered No.
Place of )
27 Cottage Park Road
Date of l
Death *
S
.
Residence
Age
.years.
4
.months. 10 .days
STATISTICAL DETAILS
SEX
Male
COLOR
-
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF
FATHER
Joseph voze
BIRTHPLACE OF FATHER $ Barton mars
MAIDEN NAME OF MOTHER talebine 13 Hyde
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § Juster
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 .. to 14th
Jan. 190 .... , that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Brights Disease
(DURATION) .......... DAY8
1
Contributory :
(DURATION). .... DAY8
(Signed)
A. B. Norman
M.D.
.190 ..... (Address) Murthy, Mas
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? .years ..
months. ................... days
Where was disease contracted, if not at place of death ?
......
Filed
190 ...
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Sans 16th
190Z ..
UNDERTAKER 2.8 Dann
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Charles. E. Voss-
Death
1
kan 14
.190
no 3 Charles E. Vose. Jauret, 1907
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1907.
CITY OF BOSTON.
FULL NAME ... Jennette C Maringhi
........ Registered No ...... 496
Place of Death } Boston
and Residence S
Mass Gen Hospital
Date of Death
Jan ... 15.
1907.
Age
. years .. 3 months ... 5 days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID , DIV.
F
W
S
Maiden Name
Husband's Name
Birthplace
Winthrop Mass
Name of
Father.
Tony
Birthplace
of Father
Italy
Maiden Name
of Mother
Margaret Ceffalo
Birthplace of Mother.
Italy
.....
(SignedNHClark
M.D.
Jan 15 1907
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial C Cem Old Cambridge Mass or removal
Usual Residen295.Shirley ... St.Winthrop
Undertaker Sumner .... Floyd
Filed. Jan -17 1907.
A true copy.
Attest :
Registrar.
MARGIN RESERVED FOR BINDING.
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1907, to. that to the best of my knowledge and belief death occurred on the . 1907, date stated above, and that the CAUSE OF DEATH was as follows :
AR'S
Marasmus 3 mos
....
CITY.
DEFICE
CIVITATIS
BOSTONIA CONDITA AL
1822
18 30.
BOST
TISREGIMINH.
DONATA A.
. MA'S S.
Contributory : (Duration) Improper Food 3 mos
Occupation
--...
Informant
PATRIBUS, SIT DET Primaby (Dura Bon) IS
3 - Jamette 6 manghi Jan 15, 1907
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Carlton Reed Hartes
Registered No ...
Place of l
52 /Barthexx Roach
Date of l
Death *
5
Death 5
8
months.
.days
STATISTICAL DETAILS
SEX
Mince
COLOR
Vitute
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Wellesley Mars
NAME OF FATHER Herbert- Hiller Hanks
BIRTHPLACE OF FATHER# Burninghan- Conn
MAIDEN NAME
OF MOTHER
Mary Gerbide Standish
BIRTHPLACE OF MOTHER # Colchester Com
OCCUPATION
Eclecticcan
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
1/22
190 .. 0
UNDERTAKER
2.D. Dennis
ADDRESS Lenne mas.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ... Many 13 1907 to Jun 19 1907 that to the best of my knowledge and belief death occurred on' the date stated above, and that the CAUSE OF DEATH was as follows : Primary :
(DURATION)
Buyers
... DAY8
Contributory :
Diabetes
3 weeks
.(DURATION)
.DAYe
(Signed)
31 Ruel call
Han 22
.. 190% ... (Address)
wmthof. human
M.D.
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death ? . years.
.... ........
months. days
Where was disease contracted, if not at place of death ?
Filed
190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known,
§ Name and address of person giving statistical details. || Name of cemetery.
19
.190
Residence
Age
25
.. years.
Z
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Carton Reed Heauto Jan 19, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Senge &, Galler
(If married or divorced woman give malden name, also name of husband.)
Sex, Male Color, White-
Condition,
(Single, Married, Widowed or Divorced.)
Age, Years,~ Months,
Mass
Ward, ....
Residence,*
Place of Death, Meteals Obspital Winthrop Sheet State yea month and day.) January 16" 1907
Place of Birth, Winthrop Mass Date of Birth,
Name and Birthplace Serge S, Colley = Falmouth Manie of Father, Maiden Name and Inuse S. Cole Nova Scotia Birthplace of Mother, Winthrop Cemetery (Jimyong Deposit Pee Tout) Place of Interment,
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
190 ........
Name and Age
of Deceased, George H Coller
Age, Malwears.
I hereby certify that I attended deceased from.
Jan 16 190 7, 00 Jahr 2_3
190 that I last saw
alive on the .. $ 3 day of Jan 190 , 0) that M
that died on the 23 day of my 190 ), about .o'clock
3 am
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows : Premature with
Disease
Contributing cause,.
Chief Cause, ..
Duration
Contributing cause,
M. D.
* If an Institution, state how long an Inmate and previous residence.
521
10 )
Chief cause,
Date of Death th January 2
(White, Black, Mixed, Chinese, Indian, ctc.) 7 Days. Occupation,
George Is lolly . Jan 23, 1907
NORTH :
CH
ELSKA
RIVERS 18TL
COMMONWEALTH OF MASSACHUSETTS
Wanthrow (CITY OR TOWN.)
.Registered No.
Place of Wo 213 Lincoln Winthrop mars
Date of
Jan 24th.
190 7
... years.
Residence
Winthrop mars
Age
65
1
.months.
23
days
STATISTICAL DETAILS
SEX
male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Cart- Berlin mars.
NAME OF
FATHER
Henry Simmons
BIRTHPLACE OF FATHER+ Scituate mars.
MAIDEN NAME
OF MOTHER
aunknown
BIRTHPLACE
OF MOTHER +
Unkno
OCCUPATION Carpenter
INFORMANT §
Lucy In Simmon
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from 1906 to cum 24/ 197, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Valvulas heart Assez
( DURATION ).
... DAYS
Contributory :
k remoto ataxia
(DURATION).
54
(Signed)
M/D.
25 190 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? . years. ..... ......... months.
...... .... day
Where was disease contracted,
If not at place of death ?
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL !
Woodlawn Lemeler Jan 29th
1907
UNDERTAKER Fli Spraque
ADDRESS
Barter
120 meridian 90
DATE OF BURIAL"
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, glvo its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
William B Simmon
RETURN OF A DEATH
FULL NAME
Death
...
Death
William B . Luiuns Jan 24, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
Hinthof
BOSTON, MASS.
Name in full,
Edward
Levens
(If marrled or divorced woman glve maiden name, also name of husband.)
Sex, Male Color While
Condition, Married
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.) Indian, etc.)
Age, 69 Years, 4 Months, 15 Days. Occupation,
Residence, *.
D'interrojo
mars
Ward,
Place of Death, 241 Shirley Street
Place of Birth,
Royalton UP
(State sear, month and day.)
Date of Birth, Dele/ 12 1836
Edward , nevine = Poslom Mass
Name and Birthplace ? of Father, Maiden Name and Queia Did = Reading mass
Birthplace of Mother,
Place of Interment,
Skinthrob Cemetery inthe man
Dumper floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Printhof Boston, july 29 1907
Name and Age !
of Deceased, peruana Age, 69 years.
I hereby certify that I attended deceased from Duely 1906, to. Jany 27
1909, that I last saw trine alive on the. 27 day of Sony 190%,
that died on the 27 day of ... Stany 1907, about /1.30o'clock
A.M.,or P.M., and that, to the best of my knowledge and belief, the cause of his death was as follows : Clinic iHeart Disease Chief cause,
Disease Contributing cause, Grippe
Duration
Chief Cause, Serve
Contributing cause, Two weeks
JEsahusan M. D.
* If an institution, state how long an inmate and previous residence.
Date of Death, Jan 2/-1907
Edwards Hereux, Jour. 2%. 1907
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full, of
(If married or divorced woman give maiden name, also name of husband.)
Sex, Color
Condition,
(White, Black, Mixed, Chinese, Indian, etc.) (Single, Married, Widowed or Divorced.) 88,
Age, Years, Months, C
- Days. Occupation,
Residence,*
355 Winthrop Il.
Ward,
Place of Death, Harithrok mass.
Place of Birth,
Date of Birth,
Finland
emrah O'Brien
Place of Interment,
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Holy Cross, Dalle
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,.
Jun. 28 '
190).
Name and Agel
of Deceased, Man Tenergrant-
Age,. 88 years.
I hereby certify that I attended deceased from 190 , to
190 , that I last saw .... .............. alive on the ..... day of
190
that ... died on the .... day of 190 , about o'clock
her. death was as follows:
Disease ? Chief cause,
Contributing cause, ....
Chief Cause, ... 2 days o
Duration
Contributing cause, .......
3/ Mutuals
M. D.
· If an institution, state how long an inmate and previous residence.
Jau 28"1907,
Date of Death Mary Sandradast'
e Nicholas
Hidow
(State year, mouth and day.)
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of.
Pneumonia.
Mary Gendergast Jan 28, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
Virtual
BOSTON, MASS.
Name in full, Do Edwin H. Daniele
Date of Death,S January 30 "1907 any
(If married or divorced woman glve maiden name, also name of husband.)
Sex, male Color Ithite
Condition, Married
(Single, Married, Widowed or
Divorced.)
Age, 69 Years, / Months, 9 Days. Occupation,
(White, Black, Mixed, Chinese, Indian, etc.) Dentist
Residence,*
@Winthrop Wass
Ward,
Place of Death,
Syren Street
Point Shirley
Place of Birth, Cheater Come
Date of Birth, Dec21" 1837
Name and Birthplace Ofenry . Daniels
of Father, Maiden Name and Belinda alnord
Birthplace of Mother, Place of Interment, Temporary Deposit Recent Dummer Gfloyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Hintenofo
January 31" 190%.
of Deceased, Dr. Godwin Q. Daniele Age, 69 years. 1710 90
I hereby certify that I attended deceased from. Jan. 29th 1907, to.
190, that I last saw Enis alive on the 29the day of Jam. 190),
day of Jan. 190 7, about. 6 .o'clock that he died on the 30Th
A.M., o P.M., and that, to the best of my knowledge and belief, the cause of.
dcath was as follows :
Chief cause, La Grippe, Bronchitis 4 Disease " Contributing cause, Age and general weakness.
Chief Cause, .
Duration Contributing cause, A. 13 Dorman M. D.
* If an Institution, state how long an Inmate and previous residence.
521
Name and Age ?
Hate year, month and day.)
No T Dr. Edin do. Daniela Jan 20.1901
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Zum a. Russell
Registered No.
Date of l
Death S
190
Death *
Residence
#
Age
31
.years.
.months.
2 4
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
OHlamia
MAIDEN NAME +
Lucy. a. aileens
HUSBAND'S NAME t
Freck. In Russell
BIRTHPLACE #
Shingdise e mars
NAME OF
FATHER
Thomas. Benton Chickens
BIRTHPLACE
OF FATHER #
Barnard Hermanla
MAIDEN NAME
OF MOTHER
Finances. A. Series.
BIRTHPLACE
OF MOTHER #
Brookfield nem,
OCCUPATION
INFORMANT §
Filed
mar 6
.190
Clerk
PLACE OF BURIAL OR REMOVAL II
Sunderland mato
DATE OF BURIAL
2/6
190
UNDERTAKER
1
ADDRESS
Ferma Me11
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 29 Feel. 3 1907, 190 ..... to that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary :
(DURATION). . . DAY8
Contributory :
Themmonic
(DURATION)
5
DAY8
(Signed)
BI Metal
M.D.
190
.. (Address).
mitcall Hospital
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
. years ...
months.
2.
days
Where was disease contracted,
If not at place of death ?
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls.
Il Name of cemetery.
Place of l melillo Hobetal
10 Lucy a . Quesell Feb 3, 1907
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Henty J Vinal
.Registered No.
14
Place of l
Death *
New England Sanitarium Stoneham, Mass
Date of l
Death Feb. 4,1907. 190
Residence
Winthrop Mass.
Age
57
.. years.
-
.months - .days
STATISTICAL DETAILS
SEX
Male
COLOR ...
mhite
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE +
Quincy, Mass.
NAME OF
FATHER
Howard Vinal
BIRTHPLACE
OF FATHER $
Scituate, Lass.
MAIDEN NAME
OF MOTHER
Claris Wentworth
BIRTHPLACE OF MOTHER $ Unknown
OCCUPATION Shoe Manufacturer.
INFORMANT § A.TI. Vinal
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jan.26 190.7.
to Feb. 4, 190790 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Cancer of Dowel
Tuo .... years. (OURATION). DAYS
Contributory :
( DURATION) .. DAY
(Signed). M.D.Nicola M. D.
Feb. 4 1907 (Address) Melrose, Maga.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? . years. ....... ....
months days
Where was disease contracted, If not at place of death ?...
Filed Feb. 1 190
George MGreen neu Form Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital on Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. " Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II Waterman & Con
Sector, 1300.
UNDERTAKER Mr. & Mrs. P.T. Cairoli_
DATE OF BURIAL
removal
... Feb .. ... ... 190.7 ..
: 1
ADDRESS Velrone, l'a.
Stonenam
Feb. et, 1904
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of Death,
Ichmany 16"140/
Name in full, Hra ma Pherson
(If marrled or divorced woman give maiden name, also name of husband.)
Sex, itemale Color,
(White, Black, Mixed, Chinese, While
Condition,
(Single, Married, Widowed or
Divorced.)
Age, 73 Years, Months, ~Days. Occupation,
Residence, *. () Finthup mais
Ward,
Place of Death, 21. Thornton Street
Place of Birth, PER Land
(State year, month and day.)
Date of Birth,
archibald Mo. Pharm-
Scotland
Name and Birthplace ? of Father, Maiden Name and Manyque good Scotland
Birthplace of Mother, 5
Place of Interment,
Cambridge Gemeten Cartagena
Seminer Floyd
1
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Achthay, Boston, Filmany 16' 190 7.
Name and Age ?
of Deceased, Flora Int Pher Age, 73 years.
I hereby certify that I attended deceased from. Frazy .190), to tam 24'07
190 , that I last saw.
alive on the 24
day of 190),
that ( me died on the. 16' day of 190 ), about ... am- o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows :
Chief cause,
Cancer 1 literas
Disease Contributing cause,
Chief Cause, ..
Duration
Contributing cause, Bimil call M. D.
· If an institution, state how long an Inmate and previous residence.
Jamany
Indian, etc.)
no !! Flora Me Pherson Feb 16, 1907
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Partiamil
5. Johan.
(If married or divorced woman give maiden name, also name of husband.)
Sex,
Color,
Condition,
Age, 3 Years, 7 Months,
(White, Black, Mixed, Chinese, Indian, etc.) 8 Days. Occupation,
(Single, Married, Widowed or Divorced.)
Residence,* Jo. Iarmich Mark. Ward,
Place of Death, Y60 Bowdown So. Huntera Mars.
(State year, month and day.) Place of Birth Dr. Jannicke Man Date of Birth, July 14 1/20.
Name and Birthplace \ Joueple
Sallie Truffe
~Mana.
of Father, Maiden Name and Birthplace of Mother, 5 Place of Interment, ......... No. daniele mais. & E Broun.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age?
Boston, Feb- 22" 1907.
of Deceased, nathaniel 7 Markam Age, 83 years.
I hereby certify that I attended deceased from tab- 18 190) , to 76 22"
190 ), that I last saw alive on the 2- 22 day of 2 190%. that died on the 2 2nd day of 190 ) about / 2 o'clock
N.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death was as follows:
Disease S Chief cause,
Pneumonia
Contributing cause, old age
Duration
Chief Cause, ...... 4 days
Contributing cause, 85 gers 31 Mel call M. D.
· If an institution, state how long an inmate and previous residence.
Date of Death,.
Hab. 22' 1909
neighbor
Feb 24, 190 r
[ 12-16-1903-1,000] J 223
COMMONWEALTH OF MASSACHUSETTS
CITY OF SOMERVILLE
RETURN OF A DEATH
FULL NAME Mary ........ Bucknam
Registered No.
154
Place of }
Death
67 Beech Street, Somerville, Mass.
Date of
Death
Feb ...... 25 ...... 190 .7
Place of
Residence
Winthrop ..... Ma.s.s.
(Town or City and State)
STATISTICAL DETAILS
SEX
Female
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