Town of Winthrop : Record of Deaths 1900-1903, Part 11

Author: Winthrop (Mass.)
Publication date: 1900
Publisher:
Number of Pages: 564


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 11


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36


Somos 5 Penalty for violation not exceeding fifty dollars.


F


FORM C.


Commonwealth of Massachusetts.


No.


RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK.( ALL NAMES TO BE IN FULL.)


Name,


Nancy a. Wilson


Sex,


Color,


Date of Death,


May 30


.190 %; Age, 66 Years, (


2


Months,


Days.


Maiden Name, { I


widowed }


Nancy a, anderson


Husband's Name,


Patrick Wilson


Single, Married, Widowed or Divorced, .. Occupation,


*Residence, also state fully.


§ If out of town, {


Winthrop, Mass


Place of Birth, Oreland


*Place of Death,


11, Cottage avenue Collage Stile


Name and Birthplace of Father,


Ir Elliane anderson (Unknown


Maiden Name and Birthplace of Mother,


Place of Interment, (Give name of Cemetery),


Oakwood Cemetery (Troy ny.


Dated at


Winthrop


Summer Floyd


on


May 31


190 /


Signature and


place of business


of Undertaker.


Minutos Mass


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t Nancy a. Wilson Age, 66 Y.M. D.


Place and Date of Death,


died at.


Disease or Cause of Death, # Secondary,


Primary,


May 30. 190/ .


General Tuberculosis Duration, Uncertain


Duration,


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence


of


S


Certifying Physician.


M. D. .


Winthrop Mass


Date of Certificate,


May 31st


190/.


* Give also street and number, if any. t Give sex of Infant not named. If still- born, so state.


{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health. may 31


T


or divorced.


No. 27


RETURN OF THE DEATH


OF


Nancy a. Wilson Or Stillede


11 Cottage avenue at


Date, May 30 .. 190/ -.


Filed, may 31 190 ____.


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.


SECTION S. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.


SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


Dasalte for vinlation not exceeding fifty dollars.


-


FORM C.


Commonwealth of Classachusetts.


No.


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


Name,


Hannah Belcher


Sex,


Color,


Date of Death,


June 25'


190 / ; Age,.


88 Years,


5


Months, 20 Days.


Maiden Name, { If married, widowed )


or divorced.


Hannah Floyd


Husband's Name,.


David Belcher


Single, Married, Widowed or Divorced, Occupation,


*Residence, ¿ also state fully. §


{ If out of town, {


Winthrop Mass


Place of Birth,


Winthrop Mass


*Place of Death,


99 Winthrop Street


Name and Birthplace of Father,


David Floyd


Maiden Name and Birthplace of Mother, Hannah Tewksbury


Place of Interment, (Give name of Cemetery),


Winthrop Cemetery


Dated at.


Winthrop


Signature and


Summer Efloyd


on


June 25''


190 /


place of business


of Undertaker.


Winthrop Dass


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Hannah Belcher Age, 88 Y. 5 M. 2OD.


Place and Date of Death,


died at


Thinking Mass


June 25 190/.


Disease or Cause - Primary,


of Death, ţ Secondary,


Cerebral apoplevy


Duration, immediate-


Duration,


F


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence § of Certifying Physician.


M. D.


Date of Certificate, June 26 190/ .


* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.


# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health. ne 25


1


No. 28


RETURN OF THE DEATH


OF


Hannah Welcher 99 Winthrop Street at


Date, une 25" 1901


Filed, June 26 190 __ .......


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. -


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.


SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.


SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


Penalty for violation not exceeding fifty dollars.


-


FORM C.


Commonwealth of Massachusetts.


No.


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK, ALL NAMES TO BE IN FULL.)


Name,


bare Metal Chrman


Sex,


.Color,


Date of Death,


June 24


190 /; Age, / Yeary, 4 Months,


19 Days.


Maiden Name, { If married, widowed )


or divorced.


سم


Husband's Name,


Single, Married, Widowed or Divorced, Occupation,


*Residence, { If out of town, )


? also state fully.


Winthrop


mask


Place of Birth,


Winthrop Masa


*Place of Death,


Orlando are off Bartlett Road


Name and Birthplace of Father,


Charles 6. Chiman . Patterson Pa


Maiden Name and Birthplace of Mother, Ethel Steel Meteals -


Place of Interment, (Give name of Cemetery), Winthrop Cemetery


Dated at


Winthrop


Summer Floyd


on


June 28'


.. 190 /


Signature, and place of business of Undertaker. Winthrop mase


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Carl Instead dervon Age, / Y. 4 M. /D.


Place and Date of Death,


died at


June 27. 190 /.


Disease or Cause


of Death, ;


Secondary,


Primary,


Infantile Commolina Duration, 5 hours


Duration,


I certify that the above is true to the best of my knowledge and belief.


signature and Residence S


of


M. D.


Certifying Physician.


Das am


Date , of Certificate, June 29 .190 .


* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.


# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.


Countersign and transmit to the clerk of the city or town. :


Agent of Board of Health.


27


No. 29


RETURN OF THE DEATH


OF Carl Metcalf Chrman Orlando avenue at


Date, June 2m


190 ___


Filed, June 28 1901


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death oecurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death oceurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after sueli death.


SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.


SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forthi the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to . the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


Penalty for violation not exceeding fifty dollars.


FORM C.


Commonwealth of Classachusetts.


No.


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


Name,


Ofrederick Munday


Sex,


200


Color,


W.


Date of Death,


June 30


190 / ; Age, 2 Years,


Months,


~Days.


Maiden Name,


{ If married, widowed {


or divorced.


Husband's Name,


Single, Married, Widowed or Divorced,


Occupation,


Plumber


*Residence, { If out of town, )


¿ also state fully.


Shirley Steel Winthrop


Place of Birth,


England


*Place of Death,


Minitrop mass


Name and Birthplace of Father,


Unknown


Maiden Name and Birthplace of Mother,


Winitrop Cemetery


Place of Interment, (Give name of Cemetery),


Dated


Winthrop


Bummer Floyd


on


June 30


190 /


Signature and place of business of Undertaker.


18 2 termin 21 Hanshop


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Etpodence Munday


Age, 2% r. C. D.


Place and Date of Death,


dicd at


Minttrop (June 30"


190 /.


Disease or Cause of Death, # Secondary,


Primary,


Duration,


Duration,


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence


of


Wed. Sommer


Date of Certificate,


* Give also street and number, if any. t Give sex of infant not named. If still-born, so state. # If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health.


3J


M. D.


Certifying Physician.


20


190 /.


/


Unknown


No. 30


RETURN OF THE DEATH


OF


Frederick Munday Bilialay Chemate at


Date,


une 30" 1901


Filed, July 1


190_1.


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.


SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.


SECTION 10. A physician who has attended a person during his last illness shall forthiwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.


SECTION 11. In case the deceased was a soldier who served in thic war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to thic clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS of 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of this cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


Dasely for violation not exceeding fifty dollars.


FORM C.


Commonwealth of Classachusetts.


No.


RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.


(FILE OUT WITH INK. ALL NAMES TO BE IN FULL.)


Name,


Martha Shipper


From


Sex,


Color, ..


Date of Death,


190 ) ; Age, 3 0 Years,


6


.. Months,


2 Days.


Maiden Name, (If married, widowed }


or divorced. Martha Shipper Jupeper


Husband's Name,


Ofrederic Brown


Fingle, Married, Widowed or Divorced, ... .Occupation, Otniente


*Residence, { If out of town, )


Hintenopp mask


? also state fully. }


Place of Birth, Beton Mass


*Place of Death,


Derrace avenue Winthrop


Name and Birthplace of Father,


Maiden Name and Birthplace of Mother, Have Roscoe


Place of Interment, (Give name of Cemetery), Winthrop Cemetery


Dated at


Winthrop


on July 2' .190/


Signature and place of business of Undertaker.


Summer Efloyd Winthrop Mass


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Martha Phileles BrownAge: 58 5. 6 N. 2D.


Place and Date of Death,


died at. Terrace avenue Winthrop July / 1901.


- Primary,


Sivasis Scriasis


Duration,


Duration,


3 hours.


I certify that the above is true to the best of my knowledge and belief.


Horace) Soule


M. D.


Signature and Residence S of Certifying Physician. 2 Date of Certificate,


(Winthrop mass


190.


* Give also street and number, if any. | Give sex of infant not named. If still-born, so state.


{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health.



Disease or Cause of Death, ¿ Secondary,


No. 31


RETURN OF THE DEATH


OF


Brown


Martha Phifejes L'enrace avenue at


Date, July 1


1901


Filed, July 2 190_ 1. [EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of auy of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.


SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7 five dollars.


SECTION 10. A physician who has attended a person during his last illness shall person, upon request, furnish for registration a eertificate setting forth the required faets. SECTION 11. In case the deceased was a soldier who served in the war of the reb the secondary or immediate cause of death as nearly as he can state the same. Penalty f SECTION 12. Any person having charge of the funereal rites preliminary to the iuter the physician's certificate made in accordance with section 10, and return it, together with the board of health or to the clerk of the city or town in which the death ocenrred.


thwith after the death of said


give both the primary and or neglect, ten dollars. a human body shall obtain


acts required by section 1, to


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, uutil a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


tv for violation not exceeding fifty dollars.


[7.'00.37.XX M.]


Permit No.


RETURN OF DEATH. BOSTON.


1901


Year, 1827


Date of death


Month July 21


Birth


Month,


Day


Name in full, Maiden name,.


Male.


Sex Conjugal condition


Single .- Married. Widowed.


Color


Female.


Divorced. Widow of.


Wife of. -


Place of death?


Street, 1.


61 Locust QL


Winthrop


Place of birth,


-


Wieland


Occupation, ..


Laborar Unknown Maiden Name of Mother,


Unknown


Dieland


Birthplace of Father, Ireland Birthplace of Mother, Place of interment, Holy Cross Malden Bernard D. Mc Mackie 61 Bunlar Série @Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston, .. July 2


190 ...


Name and age of deceased, Johan Whole


Age, 74 years.


Date and place of death,* (Thrutrop mass July 2 1901


Disease Chief cause,


Contributing causc.


Chief cause, ... 36 horas


Duration Contributing cause, ..


I certify that the above is true, to the best of my knowledge and belief.


Name and residence ? of physician,


M.D.


* If in an institution, state how long an inmate and previous residence.


Chiutrop mass -


The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A.M. till | P.M., except during the months of June, July, August and September, when the office will be closed on Saturdays at 12 M. ; Sundays, 10 A.M. till 12 M . Holidays, from 10 A.M. till 12 M. ; other days, from 9 A.M. till 5 P.M.


Unknown


Age & Months, L Years, 74


Day, John Whalen


Residence,


( Days, Boston White. Black (Negro or mixed). Indian Chinese. Japanese ....


Number,


Name of Father,


Senility


Year,


Died July 2"1901 61 Loque Street Filed July 3, 1901


FORM C.


Commonwealth of Massachusetts.


No.


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


Name,


John Whitman Detrambula, Sex, ale Color,


White


Date of Death,


July 5 th


.190/ ; Age, 6 hours


Years,


Months,


Days.


NN


Husband's Name


Single, Married, Widowed or Divorced, Occupation,


*Residence, { If out of town, ) ¿ also state fully. § -1 Ocean ave. Winthings, Jeack, Winthrop Place of Birth,


*Place of Death,


, Ocean Ove Winthrop


each Monthof


Name and Birthplace of Father Hortonvy Sehambulan Jamaica, lai Man


Maiden Name and Birthplace of Mother, Thatall Golching, St. John N.B.


Place of Interment, (Give name of Cemetery), ..


trest Fille Comoley


Dated at


Minituop


Summer Floyd


on


1 190 /


Signature and place of business of Undertaker.


Stinttrop Evase


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Place and Date of Death,


died at


Christine Grith


Duration,


Duration,


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence S of


Certifying Physician.


28 Latin H-EV3


Date of Certificate, 6 190/.


* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.


{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of , Health.


Chanfulani


Age, O Y. O. M. D. July5 190/


Disease or Cause of Death, } Secondary,


Primary,


M. D.


Maiden Name.{If married, widowed ) or divorced.


No. 33


RETURN OF THE DEATH


OF John Whitman mkilain Minttuop Mass at


(Ocean Chemie)


Date, July 5'. 190 .... 1


Filed, July 6


190 __ / ... .


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death oceurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such deatlı.


SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.


SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


1-11 --


FORM C.


Commonwealth of Massachusetts.


No.


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


Name,


Eliza artella Mattheus


... Sex,


Color,


Date of Death,


July 17'


.190/ ; Age, 33 Years, 1 Monthy, 24 Days.


Maiden Name, If married, widowed {


or divorced. Eliza a. Hudson


Husband's Name,


Ojemy Mattheus


Single, Married, Widowed or Divorced, Occupation,


*Residence, also state fully.


§ If out of town, {


interrato mass


Place of Birth, P & Deland


*Place of Death, 135 Shirley Sheet


Name and Birthplace of Father, ... William B, Ohudson


Maiden Name and Birthplace of Mother, Barbara Nickelson


Place of Interment, (Give name of Cemetery),


Winthrop Cemetery


Dated at


Winthrop


Summer Floyd


on


July 18"




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