USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 15
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Mary J. Savoir- mass
(Chanelani)
Place of Interment, Hry House Cemetery (Malden)
Summerfloyd
Öndertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Boston July 38' 190 .... 5.
of Deceased, agnes E. Paroch
Date and July 24 - 7 Oakland Sheel
Place of Death,* Peritonitis Chief cause, Disease * Pleurisy
.Age,. years. 3 34-12
......... ...
Contributing cause, Chief cause, 2 days
Duration Contributing cause, 3 days
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, 31Met calf M.D.
* If an Institution, state how long an Inmate and previous residence.
2
Name and Age )
[4.'04.37.LM.]
Permit No.
2, 53
RETURN OF DEATH. BOSTON, MASS.
Date of Death, July 27-05
Name in full, Norman Alvin Pink
(If a married or divorced woman give maiden name, also name of husband.)
Sex, mall
Color, Alite
(White, Black, Mixed, Chinese, Condition, Single
Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, Years, Months, 17. Days. Occupation,.
Residence, 56. Crest An Winthrop Mass Ward,
Place of Death, 56 Crest An Winthrop Mas"
(State year, month and day.)
Place of Birth,. It flasabeth Hospital Date of Birth, July 10-05
John y Pink Russian
Dara Mildrett Pickupky Boston
Place of Interment,
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Beth Grael West Roxbury S. Wittenburg
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, July 27 th
1905.
Name and Age? of Deceased, Harman Alain Pink .Age, ...... years. 17 Days
Date and July 27-05, 56 Crest An. Winthrop Mass
Place of Death,*
Chief cause,
Inanition.
Disease Contributing cause,
Chief cause, .. 17 days
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence } 200 George S. C. Bada of Physician,
* If an Institution, state how long an Inmate and previous residence.
483 Beacon M.D.
21
[4.'04.37-LM.]
Permit No.
RETURN OF DEATH. Drinthupo With BOSTON, MASS.
Date of Death,
august 1" 1905
Name in full, Cileen Y Opennessey
(If a married or divorced woman give maiden name, also name of husband.)
Condition, Sex, Afemale
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Age, Years, 8 Months, 6 Days.
Indian, etc.) Occupation,
Residence, New york City NY
Ward,
Place of Birth, @New york City Date of Birth,
(State year, month and day.) Aby 26"1904
David O, OHennessey Juinpool (Eng
Name and Birthplace of Father, Maiden Name and alfie9. Goddard -Granly Com
Birthplace of Mother,
Place of Interment,
It interop Cemetery Hintludy mass
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age of Deceased,
1905.
Date and Place of Death,* S august 1" 1905 -106 Shirley Street
Chief cause, ... Intestinal Hemorrhage
Disease - Contributing cause, Chief cause,
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, A. B. Norman M.D.
* If an Institution, state how long an Inmate and previous residence.
8 minutho
Age, ..
years 6 ds
Place of Death,
Color White
6
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Edna Moores
Registered No.
Place of Death *
37 Fremont Street Winthrop ... Mass
Date of Death
August 2, 1905
Age
0
years
7
months
27
.days
STATISTICAL DETAILS
SEX
female
COLOR
black
SINGLE, MARRIED, WIDOWED, OBingle DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
Newburyport, Mass.
NAME OF FATHER
BIRTHPLACE
OF FATHER+
MAIDEN NAME
OF MOTHER
Sarah J.Moores
BIRTHPLACE
OF MOTHER #
Lubec , Me.
OCCUPATION
INFORMANT §
State Board of Charity
.
PLACE OF BURIAL OR REMOVAL !!
Knollwood Cem, Sharon
DATE OF BURIAL
Aug. 3
5
190.
UNDERTAKER J. S. WATERMAN & SONS
ADDRESS
Boston
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
190 ..... 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 : Indigestion - malassimilation
(DURATION)
?
DAYS
Contributory :
Bottle fed.
(DURATION).
?
DAYS
(Signed)
S.m. Crawford
M.D.
190
...... (Address).
144 Dudley St. Rosdiese
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ?
.Days
Where was disease contracted, If not at place of death ?
Filed
aug 4
1905
Dummer Floyd
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. Il Name of cemetery.
ALL NAMES TO BE IN FULL
NOKT
A 1338
SEA
1846
RETURN OF A DEATH Dunreach a. Dishman
(CITY OR TOWN.)
FULL NAME
Registered No.
Date of l
Aug. 4
1905
.. 190
Death
S
2
.. months.
21
.days
STATISTICAL DETAILS
SEX
male
COLOR
while
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME Ť
BIRTHPLACEİ
Winthrop.
NAME OF
FATHER
Charles x. Dishman
BIRTHPLACE
OF FATHER#
Each Bostan
MAIDEN NAME
OF MOTHER
Mary Trask.
BIRTHPLACE
OF MOTHER #
East Brookfield
OCCUPATION
INFORMANT § mother,
-
PLACE OF BURIAL OR REMOVAL H
Arlington - Plegar
DATE OF BURIAL
August 90 5.
ADDRESS
UNDERTAKER
a.V. Sanborn
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from augz
190 ... to aug 5 190.3.7, 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 :
meningitis
(DURATION)
3
DAY8
Contributory :
ileo-colitão
one week.
.(DURATION)
. DAYS
(Signed)
E. m. Jordan.
M.D.
190 ...... (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Placa of Death ?
years.
. ...
. months. . days
Where was disease contracted, If not at place of death ?
Filed
aug 4.
1903
5- Summer Floyd
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 detalls. || Name of cemetery.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
REVERE.
REVERE 1871
Place of l
Highland Ave Minitherole
Death *
5
Residence
Age
.. years.
[4-'04.37.LM.]
Permit No ..
RETURN OF DEATH. Mille BOSTON, MASS.
Date of Death,. auquel 4"1905
Name in full, .... un. Joseph VI
Gray
(If a married or divorced woman give maiden name, also name of husband.)
Sex, male Color
(White, Black, Mixed, Chinese, Condition, Hidoren
(Single, Married, Widowed or
Divorced.)
Age, My Years, 4 Months, 8 Days. Occupation,
Indian, etc.) Word norte.
Residence,. Muitopo mars Ward,
Place of Death,.
y Crystal Core arene
(State year, month and day.)
Place of Birth, Sheffield M James Gray = Sheffield 912
Date of Birth, Mch 27 "1826
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Judith Thomas - Unknow
Place of Interment,
Summer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, auquel 4= " /
190.0.
Name and Age
of Deceased, Angeh S. Gray
Age, 79 years. 4-8
Date and arigual 4" 1905 27 Cristal Come auree
Place of Death,* Chief cause,. Hemiplegia ......
Disease
Contributing cause, Admicity
Chief cause, Two days
Duration Contributing cause, ....
I certify that the above is true to the best of my knowledge and belief.
Name und Residence ) of Physician, If. Porter M.D.
· If an Institution, state how long an Inmate and previous residence.
2 1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
.Registered No.
Date of l
Death 1
1905
8 months 1 .months. days Residence
Age
x
.. years.
STATISTICAL DETAILS
SEX
temal volante
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
<
MAIDEN NAME Ť HUSBAND'S NAME +
BIRTHPLACE #
NAME OF
FATHER
Bergmann F. Dowell
BIRTHPLACE OF FATHER+
MAIDEN NAME
OF MOTHER
Gratuite. S. Mullen
BIRTHPLACE
OF MOTHER +
Portland me
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
190. 5
ADDRESS
PHYSICIAN'S CERTIFICATE
¡ HEREBY CERTIFY that I attended deceased during last illness, from .....
190 ..... to .190.5 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 : Cholera Infantín
.(DURATION).
1,1
DAYS
Contributory :
(DURATION) DAY8
(Signed).
M.D.
Guay 8 1905 (Address)
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years
months. days
Where was disease contracted, if not at place of death ? .
aug /
Filed ana 7" 190 5 Summer Florida Tam ·perk
* 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.
ALL NAMES TO BE IN FULL
Dorothy. Dowell
FULL NAME
Place of l
Death *
5
UNDERTAKER C. RBennon
[4.'04.37. LM.]
Permit No.
RETURN, OF DEATH. Multiop mars BOSTON
Date of Death, Cluq. 8. 1905. William Crofford allen
Name in full,
(If a married or divorced woman give maiden name, also name of husband.)
Sex, male
Color, Flute
Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, Years, ~ Months, 26 Days.
Occupation, Retired
Residence, 111 Court Road
Ward Werd Winthrop
Place of Death, 111 Court Road
Place of Birth,. Every mills, me, Date of Birth,
(State year, month and day.)
July 131828,
Samuel allen
abigail Pray
Name and Birthplace ? of Father, Maiden Name and Place of Interment, ? Birthplace of Mother, Pine Grove Cemetery, Lynn Mas During Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Boston, Cluq. 8 1905
Name and Age ? of Deceased, Hilliam Croford aller Age. 77.
.years.
Date and aug, 8, 1905 #111 Court Road
Place of Death,* Senility
Chief cause,. ......
Disease -
Contributing cause, arteriosclerosis
Chief cause, ... ....
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, 5 ... M.D.
· If an Institution, state how long an inmate and previous residence.
21
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Lester Franklin Dowell
Registered No.
Place of Death
*
Date of Death
Age
X years
.. years
months
3
days
STATISTICAL DETAILS
SEX
Mule
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Benjeman . F. Dowell
BIRTHPLACE OF FATHER# Cambridge mas
MAIDEN NAME OF MOTHER Gerlinde. J. Muller
BIRTHPLACE OF MOTHER # Porland 1/2/2
OCCUPATION
INFORMANT § montre & pacher
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 .. 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 : Cholera Infantino
(DURATION). DAYS
Contributory :
(OURATION) 21 . DAYS
(Signed)
86 2 Somle
30
M.D.
ana 9 190
05
.(Address).
Willwork
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at Place of Death ? .Days
Where was disease contracted, if not at place of death ?
Filed awa 10
.190 .. 5.
D'immer etloud
Clerk
PLACE OF BURIAL OR REMOVAL !!
Winthrop Genety
DATE OF BURIAL
auf 11
190 ..
UNDERTAKER
ADDRESS
5
* 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 detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
[4.'04.37. L.M.]
Permit No.
RETURN OF DEATH. Huettrop BOSTON, MASS.
Date of Death,
aug. 91905.
Name in full,
Sex, In
(If a married or divorced roman give maiden name, also name of husband.)
Color
Condition,
(Single, Married, Widowed or
Divorced.)
Age, 46 % Years, Months, .. 26 Days.
Occupatign,.
Residence, 182 Hinttrop St.
Ward,
Place of Death, 182 Hrutturap &r.
Place of Birth, Cambridge
(state year, month and day.)
Date of Birth, Sept. 14,1859
Name and Birthplace ) of Father,
albert arkersoy-Roxbury
Maiden Name and augusta Lincoly - Cohasset
Birthplace of Mother, Huittrop Cemetery
Place of Interment,
Dumny Floyd
Undertaker
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Hruturp
Boston, aug. 10
190 5.
Name and Age !
of Deceased, albert L. askerson .Age, ... 46 years.
Date and Place of Death,* aug91905, 182 Winthrop St
Disease Contributing cause, .....
Chief cause, 4 days
Duration Contributing cause, .....
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, . EJohnson M.D.
· If an Institution, state how long an Inmate and previous residence.
21
(White, Black, Mixed, Chinese, Indian, etc.) Cordage Infor
albert Lincoln anderson
Chief cause, .. Cerebro Spinal Meningitis
--
--
[4.'04-37. L.M.]
Permit No.
RETURN OF DEATH. Unutticos BOSTON, MASS.
Date of Death,
august 9. 19.05.
Name in full, Cordellia S.P. Bugler
Gilbert D. Bugler f a married or divorced woman give maiden name, also name of husband.)
Sex, Female Color ZUhits (White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Condition, Married
Indian, etc.)
Age,. 75 Years, 8 Months, 24 Days. Occupation,.
Residence, 14 Pinckney Street-Boston Ward, 11 Place of Death, I Underhill SX, Winthrop Mass. August 9.19.05
Place of Birth, Vernon. Vermont
Date of Birth, November 15 1839
Name and Birthplace ) forel Pratt
Place of Interment,
of Father, Maiden Name and Birthplace of Mother, It Hake Cemetery
During Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Huettrop
Boston, ..
ang 10.
1905
Name and Age ?.
of Deceased,
Cordellig &P. Bugle, Age, 75
years.
Date and aug 9, 1905- 9 Iunderline $1
Place of Death,* S Chief cause, ..... Hemiplegia Disease Contributing cause, Somety
Chief cause, Tuna years.
Duration Contributing cause,.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, 5
HS. Partir M.D.
* If an institution, state how long an Inmate and previous residence.
2 1
(State year, month and day.)
.
[4.'04-37. LM.]
Permit No.
RETURN OF DEATH. Hauttrop BOSTON, MASS. -
aug. 9.19.s.
Name in full,
Morrison- Hugh Macaulay
(If a married or divorces woman give maiden name, also name of husband.)
Sex, Female Color
Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Indian, etc.)
Age,. 92 Years, 7 Months, /5 Days. Occupation,.
Residence, 144 Shirley SV
Ward, Nultrop
Place of Death, 144 Shirley St.
Place of Birth, P.E. Island
Date of Birth,
tate year, month and day.) DEC 25 1813.
Name and Birthplace ) of Father,
augus: moniso
- Scotland
Maiden Name and ? Flora Steele
Scotland
Birthplace of Mother,
Place of Interment, Calvary Cemetery
Summer Floyd
UndertakerO
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop aug. 10,
Boston,
Margaret Macaulay Age, 92 years.
1905.
Name and Age ? of Deceased,
Date and aug 9, 1905-144 Shirley St. Hice
Place of Death,* Chief cause,
Disease
Contributing cause,.
Chief cause,
Duration Contributing cause,. Old age
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, E 7. Sage M.D.
* If an Institution, state how long an Inmate and previous residence.
21
Date of Death, Margaret Macaulay
[4.'04.37. LM.]
Permit No.
RETURN OF DEATH. Huhu BOSTON, MASS.
Date of Death,
auquel 10"1905
Name in full, .. John S, Jenkhu
(If a married or divorced woman give maiden name, also name of husband.)
Sex,
Male
Color
White
Condition,
married
(White, Black, Mixed, Chinese,
(Single, Married, Widowed or Divoreed.)
Age, 70 Years, !! .Months, 23 Days. Occupation,
Residence,
quais
Ward,
Place of Death,
125 Pleasant Steel
Place of Birth,
Chelsea Mars
(State year, month and day.)
Date of Birth,
aug 18"1834
Name and Birthplace ? of Father,
Phillipe Tenkes hun
Chelsea Suass
Maiden Name and
randy
Sturges Chelsea Spass
Birthplace of Mother,
Place of Interment,
anthrop Cemetery
Summer Ofloud
Undertaker. 18 Hemmin Strel
PHYSIC 'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age ? tofu 0, es entahuy
Deceased,
Date and ve of Death,*
August 10"19050-125 Pleasant Slice
Chief cause,.
....
Carcinoma"? intestines
Diseuse
Contributing cause,
Chief cause, about Eight weeks
Duration
Contributing cause, ...
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, 1
· If an Institution, state how long an Inmate and previous residence.
28 Lacologen M.D.
2
auquel 11" 1905.
Age, 70 years.
Indian, etc.) Farmer
L
٢
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, ..
Alargare Juke
Sex,
Color,
Date of Death,
Aug. 10'
190 J; Age,
Jet Years,?
Months,.
Days.
Maiden Name,
{ If married, widowed )
or divorced.
HOEET.
Husband's Name, _....
Single, Married, Widowed or Divorced, Occupation,
*Residence, { If out of town, )
¿ also state fully.
12 Mitantie for manetuape
P.6.2.
Place of Birth,
*Place of Death,
12
Entanto So. Durituale
Name and Birthplace of Father,
William
Maiden Name and Birthplace of Mother finitiva want - Scotland
Place of Interment, (Give name of Cemetery),
East Boutin Gem
&& Brown.
Dated at
Rug. 11' 1905
Signature and place of business of Undertaker.
Last Doston
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
M.
. ....
.. D.
Margaret Surle Age 4?Y.
Place and Date of Death,
died at 12 atlantic St
Cucq 10 1905.
Disease or Cause
-
Primary,
of Death, ±
/ Secondary,
Duration,
3 coupe.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence § of
SWilland Cop,
.M. D.
Certifylng Physician.
22 Onivector St., Q" Bouton.
Date of Certificate,
aug. 11,
1900.
· Give also street and number, if any. t Give set 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.
6han R Bauch Agent of Board of Health.
on
Dysentery.
No.
RETURN OF THE DEATH
OF
at
Date,
Filed,
190. 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 oecurred.
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 sneh 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 faets.
SECTION 11. In ease 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 aceordanec with section 10, and return it, together with the facts required by section 1, to the board of health or to the elerk of the city or town in which the death oceurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a eity 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 certifieate arc 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 ation
[4.'04-37.J.M.]
Permit No.
RETURN OF DEATH. Winthrop BOSTON, MASS.
Date of Death,
august 24"1905
Name in full, addie Me Jevis
aluguer
(If a married or divorced woman give maiden name, also name of husband.)
Sex,. Ofemale .. Color, White Condition, Single
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age,. 65 Years, Months, ~Days.
Occupation,
Residence, Winthrop Mass
Ward,
Place of Death, 100 1, 100 Shirley Street
Place of Birth, Chatham Gass Date of Birth,
(State year, month and day.)
Name and Birthplace Genial Ferris - Hingham Wass of Father, Maiden Name and Polly young
Birthplace of Mother,
Place of Interment, Chatham mass
Summer Floyd
Undertaken! 18 HermanClal
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Qvisthry. august 25" 1905.
Name und Age ? of Deceased, addie m ferie
Age, 65 years.
Date and august 24
Place of Death,*
Chief cause,. Cardine failure ...
Disease
Contributing cause, Intéritis
Chief cause, one year Duration - Contributing cause, 3 days
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, 631 Melcall M.D.
* If an Institution, state how long an Inmate and previous residence.
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
. . ..
Hiza
Eliza Han.
.Registered No.
# 9 Hathone Chvr Winthrop Take
Place of Death *
Date of Death
August, 30th
Age.
81
. years
/
months 5 .days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + Foster.
HUSBAND'S NAME + HEury V. RowEll.
BIRTHPLACE # Boston Mare.
NAME OF
He John Foster.
BIRTHPLACE
OF FATHER#
Hot. Known
MAIDEN NAME
OF MOTHER
Juan L. Presley,
BIRTHPLACE OF MOTHER +, Ist Known.
OCCUPATION
INFORMANT S Mie.
Coffier.
(Daughter) 171 Harvard aus Culation
PHYSICIAN'S CERTIFICATE
Aug 24K 1900 to Ang 30 1905 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 : Information age
(DURATION)
.. DAY'S
Contributory :
(DURATION) /6 .DAYS
(Signed)
MillardAPaul
M.D.
Aug 30 1905 (Address) 157 Hauser Si
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ?
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. I[ Name of cemetery.
PLACE OF BURIAL OR REMOVAL I
mit Hope.
DATE OF BURIAL
190 .***
UNDERTAKER
ADDRESS John Bryant 2 15 auxtru.SA
I HEREBY CERTIFY that I attended deceased during last illness, from
ALL NAMES TO BE IN FULL
[4.'04.37-J.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, Sept. 3, 1905
Name in full, Mary ann Tegan
M.a. Doherty. Widow. John
(If/a married or divorced woman give maiden name, also name of husband.) .
Sex, Color, 2.
Condition, Widow
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 72 Years, Months, Days. Occupation, ....
Residence, 2 Michigan avs.
Ward,
Place of Death, Butter It. Hunthof
Place of Birth,
Date of Birth,
(State year, month and day.) apr 24
Henry Doherty.
Ireland.
Name and Birthplace of Father, Maiden Name and 1 taba wood
Ireland
Birthplace of Mother Place of Interment,
Calvary Cemetery Bo station
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Dept. 3 1905.
Name and Age of Deceased, Mary ann Regen Age, 72 years.
Date and Sept. 2 a 1 705 butter the Manchrop
Place of Death,* Chief cause, Apoplexes 1 Disease Contributing eause,
Chief cause, Insta
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, 5
1 M.D.
* If an Institution, state how long an inmate and previous residence.
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