USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 5
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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 FORTIIWITHI GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
1
1
Wintech Boston, Ing. 24 1881
This Certifies, that Harry Hampstead
died on the 23 day of August 1881, agal - 3
years,
. Level2 months, days
CAUSE OF ) Primary, Electora Pufa ture Duration
DEATII.
Secondary,
Duration
Edw& T.williamy M.D. Physician.
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),*
aug 27-1881 augustus Reed
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age,
60 Years,
Months,
Days.
6. Disease or First or Primary
Cause of, Secondary (if any)
Death, By whom certified
7. Residenec, .
8. Place of Death,
Boston Mrazo Ocean Spray Winthrop dass Sentten 0
9. Occupation, man
10. Place of Birth,
South Danvers Jeans
11. Name of Father,
12. Name of Mother, ·
.
13. Birthplace of Father,
14. Birthplace of Mother,
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
Briggs & Reed
Elisabeth
abc
Bridgewater Mars
Danach
Danvers
Mais
DATED at on 187
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
male mamúl
Ley. 2% 1851
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 THIE INTERMENT.
P 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 FORTHWITHI 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.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased,
Date and Place of Death, .
Disease, or Cause of Death, Secondary, .
First or Primary,
augustus. Reed male Ocean Spray Winthrop Mais aug 27/8h Hemorrhoids with Ubran Duration of Uland 10 days Septicemia -
Duration of probably one week?
I certify that the above is a true Return, to the best of my recollection and belief.
5, 8. 4. Campbell . 1. 10, G. Dortor
Vame, Professional Title, and Residence,
Dated at
Girl Boiler Que. 27,
188/ .
[Be very particular to fill all Blanks.]
* Reckoned to the time of death.
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthirith mirmish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decrase, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. }
The attending Physician is requested to make out his Certificate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTH.
Commonwealth of Plassachusetts. No. 15
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),
August 29 "1881. Babe
3. Sex, and whether single. Married, or Widowed.
male
White.
4. Color, t
Years,
Months,
Dayy.
6. Disease or [ First or Primary
Cause of { Secondary (if any)
Death,
By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
Fremont St Winthrop Charlee G. Emelia
12. Name of Mother, Sarah CA, Guetis
13. Birthplace of Father, .
14. Birthplace of Mother, .
St. John O. B. 4
15. Place of Interment, Common los for grave Jour Cemetery - Summer Floyd
DATED at.
Signature of Undertaker prova makin ! the Return,, Winthrop
Auquel 29 1× 81.
,
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
5. Age, .
trement Sr. Hanchop
Fremont St Winthrop
St. John Nr. 13
" 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 FORTIIWITHI GIVE NOTICE thereof -or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
wiles
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Male
Date and Place of Death, - died at
29 -21: 11 of 187%,
Disease or Cause of Death, - of
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate, Aug 129 187
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performning the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Fill out in ink. When married, erase "single" and "widow"; when widowed, erase "single" and "married."
RETURN OF DEATH TO THE CITY REGISTRAR. CITY HALL, BOSTON.
Date of Death, ..
Ocean Spray, Minthoof Vel 1 1"181
Name,
Han
4. Flanagan, Color,+
"If ite)
Age
28
.years
month 5. 10 days
Place of Death Truily
Fruvex Ht Winthrop.
WARD
Street and No.
Residence, nth. Sex, Single, Married
Occupation,
Hornesteel
Wife of
Birthplace, * 60at
.Widow of.
Name of Father,
7. 7
Name of Mother,
Elizabeth
Fawcett)
Birthplace of Father, *
& Deland.
Birthplace of Mother,
*
Cause of ) Primary,
Duration,
Death ondary, thisis Pirbuonalis
Duration, one year
Place of Interment,
Il anthrop
Date of Interment or Removal, 20 ti
1881.
Undertaker or Informant,
>*Insert Town and State.
tState whether white or black.
Boston, can
188
This Certifies, that.
died on the 17? day of.
ASS), aged. years,
1 months,
days.
CAUSE OF ) Primary, Duration DEATH.
S Secondary, Consur fe tien Pulu. Duration que je
Suis Ing all ' D Physician.
Boston, .. 1881
This Certifies, That Frank to , He'sne
died on the 12" day of CE fr
1881, agd.
1 years,
months,
days.
CAUSE OF ) Primary,
1
Duration ~ Weeks
DEATH.
Secondary ....................
Duration
R.J. Multin
Physician.
٢
Gel ,7 10
-Fill out in ink.
When married, erase "single" and "widow"; when widowed, erase "single" and "married."
RETURN OF DEATH TO THE CITY REGISTRAR, CITY HALL, BOSTON.
Date of Death,
Cet-20,
188/
Name,
Sarale Mc Vanish
Color, t
Age 56
... years
month
days
Place of Death
mars
WARD
Street and No.
Residence, Andrah man Sex,
Single,
Married
Wife of.
vauch
Danala Nº cauch
Occupation, ....
Birthplace,
Cafe Borelli V.S. Widow of.
Name of Father,.
Neue m=bacharin
Name of Mother,
Musquée
Birthplace of Father,
*
Cafe
Brettin
Birthplace of Mother,*
........
Cause of ) Primary, Duration,
Death
Secondary,
Duration,
Place of Interment,
Date of Interment or Removal. Oct- 22
Undertaker or Informant,
** Insert Town and State,
tState whether white or black.
-
Oy 20th 1881 Boston,
This Certifies, That Sanale Me Varich
died on the 20
day of Oct- 1881, and ...
7
ycats,
months,
days.
CAUSE OF ) Primary,.
1 .
Duration
11 inuntit
Duration
DEATH.
Secondary,
Physician.
Y
3
٢٠ Oct
No. 4
karin vi zMassachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
(0)1 29 "1881. matilda Vorechey
3. Sex. and whether single, Married, or Widowed,
J'enale (Hvidlow.)
White
4. Color, t
5. Age,
55 Years, 9 Days.
6. Disease or [ First or Primary
Cause of { Secondary (if any)
Death, [ By whom certified 60 Gael Ostin Mass. Sargent St. Tvwithrose.
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Jadon England
11. Name of Father, James Harding. 12. Name of Mother, mary Harding . 50 Landof England 13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
London England Winthrop Soun Cemetery,
Signature of. Undertaker NE other person making the Return,
Dunner et land
DATED at ..
..
Harstroje, on Colabor 29 181.
* If a Married Woman or Widow.
+ If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
Months, 23
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 TIIE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Towu 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 for Returns of Deaths may be obtained from the Town Clerk.
CHÁS. G. BROOKS, M. D. I SARATOGA PLACE, EAST BOSTON.
Musicians Certificate to accompany Return of death to16 by S' Floyd
Fulda Berthey died a Mi. Ip, on Sacerty the 24th day of Uccover, 1
1 Carcin of eta enlas
Cl. Brukes, Mr. 8
Commonwealth of Massachusetts.
No ..
17
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
.. 1881,
2. Name,
(Maiden Name),*
3. Sex. and whether single. Married, or Widowed,
Female (Infant
White
4. Color, t
5. Age, .
~Years,
. ...
Mouths,
Days.
6. Disease or [ First or Primary
Stillborn
Cause of- Secondary (if any)
Death, [ By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, .
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Offinthise ohavled FT Hilsen. angie At. Wilson Marie Massachusetts Winthrop Jour Cemetery 1
Signature of Undertaker or other person making the Return, Winthrop.
Summer Floyd
881.
DATED at.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
1
Hinchops
Ex: 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 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 for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
ame of Deceased,*
Date and Place of Death,
- died at
Cathy
1881,
Disease or Cause of Death, -
of
Still born Duration of Sickness.
I certify that the above is true, to the best of my knowledge and belief.
Tame and Residence of Certifying Physician
A. S. Souce Windhoof
Date of Certificate, ..
tificate, Not 3
1881.
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the deccase of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
No. 15
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred
1. Date of Death,
2. Name,
(Maiden Name),*
Do gato 1881. Try & Stendereon. Kinderenn.
3. Sex, and whether single. Married, or Widowed.
ofemall
(Hidered)
4. Color, t .
5. Age, .
Citite 88. Years, 10 Months, 16 Days.
6. Disease or First of Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, Margaret Mr. Queen Woollund
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker the person making
summerfa.
the Return,
DATED at
1
1 10
Ent trop, on Other 10it 1881
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (1.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
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 au 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 for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Mary Re Henderson
Date and Place of Death, - died at. Winthrop NA 9ª
1881,
Disease or Cause of Death, - of Old age Dur Duration of Sickness
..
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician.
Ale I. Seule Winthrop
Date of Certificate,
Ecate, Non g
1881.
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performning the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Commonwealth of Massachusetts. No. 19
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, 0 November 14 "1881.
2. Name,
Lucinda H. Walker.
(Maiden Name),
3. Sex, and whether single. Married, or Widowed.
Firmale (married)
White
4. Color, t
5. Age,
62 Years, 4
Months, 14
Days.
6. Disease or First or Primary
Cause of { Secondary (if any)
Death,
[ By whom certified
7. Residence,
8. Place of Death,
Centre St. Marchiopo
Centre St.
Winthrop
9. Occupation, .
10. Place of Birth, . Deerfield et. It.
11. Name of Father, David Robinson
12. Name of Mother, . Lucinda Robinson
13. Birthplace of Father, .
Dierfield et. H.
14. Birthplace of Mother, . Ofking OF.It.
15. Place of Interment, Newburyport Mare
Signature of Undertaker or other person makin! the Return,,
Summer 'floyd
DATED at.
, on
Other 15.
18 81.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
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 FORTIIWITHI GIVE NOTICE thereof - or report these facts-to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Ass Lucinda He Walker
Date and Place of Death, - died at. Winthrop Non 14ª
1881 , Disease or Cause of Death, - of . Cancer of Breast Duration of Sickness unfencruel
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician He, I. Joule M.D
Date of Certificate, Non 15
188%
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Fill out in ink.
When married, erase "single" and "widow"; when widowed, erase "single" and "married."
RETURN OF DEATH TO THE CITY REGISTRAR. CITY HALL, BOSTON.
Date of Death, Nov. 22 18 81
Name,
William Woon
Color, +
Age 73. years C month days
Place of Death
Pleasant Sh. Wonthoy
WARD
Street and No
Residence,
...
Winthrop
Sex, m Singles.
Married
Occupation,
TymMiman With
Birthplace,*
Name of Father,
War
1
Name of Mother, Hannan
Birthplace of Father,
Vancore
Birthplace of Mother,
Cause of ) Primary,
Duration,
Death
Secondary,
Duration,
Place of Interment,
Basta
Date of Interment or Removal,
Undertaker or Informant,
*Insert Town and State
tState whether white or black.
Word
Boston, Nov 22º 1881
This Certifies, that William Wood
died on the 220
day of Nov 1881, aged 73 years,
6 months,
days.
CAUSE OF ) Primary, the T Mely Duration 1
1
DEATII. Secondary, Tar Lac Duration
3 ..
Physician.
No. 20,
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
6 Ec 30 mm 1881 Maria H. jose
2. Name,
(Maiden Name),
3. Sex, and whether single. Married, or Widowed.
Dj'enale (Chimanied)
ichile
4. Color, t
5. Age,
21 Years, X
Months,
Days.
6. Disease or First or Primary
Cause of Secondary (if any)
Death,
By whom certified
7. Residence, vintrop. (Menthol SF)
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Selfact. Maine,
11. Name of Father, Prilliam H. Morse
12. Name of Mother, June 18. Moree Yintrille Maine
13. Birthplace of Father, .
14. Birthplace of Mother, . barline: "une!
15. Place of Interment, demparary delesit in Joun
Receiving 1 0mb
Signature of Undertaker or other person makin!
the Return, .
Summer 's lond
DATED at.
0
, On ...
December 31 18
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
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 FORTHIWITHI GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Maria A . 11, 22€
Date and Place of Death, - died at Wintherof Thec 30
1881
Disease or Cause of Death, - of Consumption Duration of Sickness Ved
I certify that the above is true, to the best of my knowledge and belief.
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