USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 16
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1
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Murdoch
Registered No.
Place of Death
Metcalf Hospital Winthrop
Date of Death
Sept 5 1905
Age ...
./ ... years .
-
months
12
.days
STATISTICAL DETAILS
SEX
x)
COLOR
SINGLE, MARRIED,
-WIDOWED, OR
-DIVORCED
MAIDEN NAME Ť
Hathaway
HUSBAND'S NAME +
James
BIRTHPLACE #
East Boston Mass
NAME OF
FATHER
John Hathaway
BIRTHPLACE OF FATHERG Duxbury Mass
MAIDEN NAME
OF MOTHER
Margery Droves
BIRTHPLACE
OF MOTHER #
Hiscassel, Che.
OCCUPATION
INFORMANT § F. E. Brown
PLACE OF BURIAL OR REMOVAL II Wordlawn Cemetery Sepo 8 1905
DATE OF BURIAL
UNDERTAKER
Edwin & Brown
ADDRESS
E Boston
. -
Chief cause, .....
l Disease
Contributing cause, Old age
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
* If an Institution, state how long an Inmate and previous residence,
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last 1900 To illness, from. aug 29ª Sept 5 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 :
Pneumonia
3
(DURATION).
.DAYS
Contributory :
Dilatation of Stomach
(operation)
(DURATION).
6 yrs
DAYS
318mil calf
M.D.
(Signed)
Sept 5
5.
190 ...... (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
'Jsual Residence
Johnam any
How long at
Place of Death ?.
8
Days
Where was disease contracted,
East Boston
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. li Name of cemetery.
Place of Death,* y
M.D.
FULL NAME
ada
حـ
[4.'04.37.J.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
Defet 10 "1905
Name in full, France Ellen Johnson
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female
Color, White
Condition, Hidemed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 68 Years, C .Months, Days. Occupation,.
Residence, Gardner
Denthu mas
Maine Ward,
Place of Death,
37 Nachuigli are
Place of Birth, Sardin Irre
Date of Birth,
Name and Birthplace ? of Father,
William Day-
Gardner
Maiden Name and Magare Valham - Brordenham me
Birthplace of Mother, 5
Place of Interment, Lardner Maine
Summer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Boston Deletember 10 190. 5.
Name and Age ?
of Deceased, Frances 6, Johnson
Age, 68 years.
Date and Place of Death,* Sept 10" 1905- 37 Nach Chewar
Chief cause, ... Lance
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, S
A. VB. DOMMEN M.D.
* If an Institution, state how long an Inmate and previous residence.
(State year, month and day.)
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,
Rosella happen
Fria Color, Staates
Date of Death,
19003; Age,.
A
.. Years,
4 Months, 14 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
.Occupation,
*Residence, also state fully.
§ If out of town, {
15 Bracon At' Struttura mars
Place of Birth,
*Place of Death,
15 Dracon It Hrithrop mass
Name and Birthplace of Father,. HEury ?
Lestland
Maiden Name and Birthplace of Mother, Fatturina E. Kennedy, E Boolow
Place of Interment, (Give name of Cemetery),
Holy Cross, Brakdau
Dated at
1903
Signature and place of business , of Undertaker.
Frauf J. Maloney
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Primary,
aceitaSpinal Meningitis
Age, / Y. 4 M /4D. spf11 1905. Duration, 4 days Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
H& Partir
M. D.
Certifying l'hysician.
Winthrop, Mais.
Date of Certificate, Aupt. 12. 1903 .
· Give also street and number, if any. t Givo &x of Infant not named. If still-born, 80 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.
Rosella Lappen
died at 15 Bracon IL.
Disease or Cause of Death, # Secondary,
No.
RETURN OF THE DEATH
OF
at
..... ++-
Date,
190.
Filed,
.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 persou in charge of au 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 forthi thic required facts.
SECTION 11. In case the deccased was a soldier who served in the war of thic rebellion, give both the primary aud the secondary or immediate cansc of death as nearly as he can state the same. Penalty for refusal or neglect, teu dollars.
SECTION 12. Any person having charge of the funcrcal 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 healthi 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, nntil 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 Hcaltli, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for
[4.'04.37-I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, .. Sept. 13, 1905
Name in full, John Joseph Mi Leod,
nagy John for
(If a married or divorced, woman give maiden name, also name of husband.)
Sex, males Color, White
Condition, Single (Single, Married, Widowed or Divorced.)
(White, Black, Mixed, Chinese, Indian, etc.) Clerk
Age, 28 Years, - ... Months, 25 Days.
Residence, Medard. Mass,
Budy Came as hoce
eachment Nonthiol, Mass as Fort Heart Place of Death, (State year, month and day.) Medford Mass Date of Birth, Aug. 19,1877.
Place of Birth,
Name and Birthplace ? of Father,
Daniel S. M& Lead. Boston mass Maiden Name and Mary Mc Kenna. l. cland,
Birthplace of Mother, ) Place of Interment,. St. Maria Limiting malden Mass. Edwa Gasse Meditar Mass Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age )
of Deceased, John 1. Medard.
Age, 28 years.
Place of Death,*
Chief cause, .......
Drowning
Disease
Contributing cause,.
Accident
Chief cause,
Duration Contributing cause, .......
I certify that the above is true to the best of my knowledge and belief.
Name und Residence )
Francis @Harris
-
med. Loamin M.D. of Physician, S
* If an Institution, state how long an Inmate and previous residence.
Winthrop Self 18th
1905.
Date and Sept, 135
In water of
Beachnach
Occupation, Ward,
[4.'04.37-J.M.]
Permit No.
RETURN OF DEATH. Winthrop BOSTON, MASS.
Date of Death,
Sellember 17" 1905
Name in full,
Emma Gertrude aiken.
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female.
Color, Orhite
Condition, married (Single, Married, Widowed or Divorced.)
(White, Black, Mixed, Chinese, Indian, etc.)
Age, 5 Years, 8 Months, 8 Days. Occupation,
Residence,. Of interop
Mass Ward,
Place of Death, yy Hinterof Steel
Place of Birth, Charleston Mass Date of Birth,
(State year, month and day.) Jang "1848
Name and Birthplace \ Samuel G. Underhice=Chester DU. O. of Father,
Maiden Name and Mary a, Dinsmore-auburn NOV. Birthplace of Mother,
Place of Interment, Winthrop Cemetery- Winthrop mass Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Drinthao10 Boston, September /M 1905
Name and Age ? of Deceased, Emma Gertrude auRen Age, 57 years. 8mos -8ds
Date and September 17 " 1905, 14 Minthope Street Place of Death,* Chief cause, ... . Endocarditis
Disease
Contributing cause, .. Phlebitis
Chief cause,
Duration -
Contributing cause, not known
I certify that the above is true to the best of my knowledge and belief. 1
Name and Residence ) n. a. morrison of Physician, S
* If an institution, state how long an Inmate and previous residence.
80 Princeton At. M.D.
1
21
East Artin
-
5
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary newcomb Palfray
Registered No.
Place of }
Death *
5 ..
40 Sargent If Winthrop Than
Residence
22
Age
62
b
months
27
days
STATISTICAL DETAILS
SEX
t'enale
COLOR
rtute
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
1
manuel
MAIDEN NAME +
Mary. 12. Palfray
HUSBAND'S NAME +
Bengeman C. Palfrey
BIRTHPLACE #
Trucco muss Cape cod
NAME OF
FATHER
alkaman Pain
BIRTHPLACE
OF FATHER$
Troco Mais
1. २
MAIDEN NAME
OF MOTHER
Rebecca Rich
BIRTHPLACE
OF MOTHER $
Truro Mars
OCCUPATION
House wife
INFORMANT §
and
Lister
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from Sept 26' 1903 ... to Sept 26' 190 .. 0.5, 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 : Cancer / Breast
.(DURATI
. DAYS
Contributory :
(DURATION)
.. DAYS
(Signed).
Bis Metcalf
M.D.
Sept
1 2 8
1905 (Address)
worthof mass
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 !!
DATE OF BURIAL
9/28
190.5~
UNDERTAKER
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 detalis. li Name of cemetery.
ALL NAMES TO BE IN FULL
Date of l
SEX.1.26#
190~
Death
1
.. years.
14 mos
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,
Catharina A. Flanagan
Sex?
true Color.
White
Date of Death,
190; Age, 83 .Years, 2 Months, 1 7 Days.
Maiden Name, { If married, widowed )
or divorced. p
Catharina A Recuar
-
Husband's Name, FrhuIlquaqaw
Single, Married, Widowed or Divorced, Hidoru .Occupation,
*Residence, also state fully.
{ If out of town, {
25 Highland. Avv
Place of Birth, atova Scotia
*Place of Death, 25 Marcaud Av Histtrop, Dass
Name and Birthplace of Father, Thoseas Gunnar Akland
Falia Falch. 11 Maiden Name and Birthplace of Mother, ... If AugratinEs tam As, Boston
Place of Interment, (Glve name of Cemetery)
Dated at.
Aspx' 2800
1905,
Signature and place of business of Undertaker.
146 )sultrop AR;
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Catharin A. of Lauragan Age, 83 Y, 2 M.1 7D.
Place and Date of Death,
died at ..
25 Highland Az
Sept 274 1905.
Disease or Cause of Death, # Secondary,
{ Primary,
Pneumonia
Duration,
2 days
angina Pectoris
Duration,
8 piano
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifylng Physician. Sept. 29th 1905.
42 Quincy ave
· 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.
....
Frank . Muloray
on
Date of Certificate,
Thomas Pigott
M. D.
No.
RETURN OF THE DEATH
OF
at
Date,
190. .
Filed,
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 kiudred, 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 negleet 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, furuish 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 funcreal rites preliminary to the interment of a human body shall obtaiu the physician's certificate made in accordanec 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 towu 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.
[4.'04.37.J.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
Depetember 28 1905
Name in full, Katherine C. munson
(If a married or divorced, woman give maiden name, also name of husband.)
Sex,. Female Color, White
Condition, Hedon
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 65 Years, Months, Days.
Occupation, Dressmaker
Residence, Printhop mass
Ward,
Place of Death, Sturgis Street
Place of Birth, Gennesee Valleyny Date of Birth,
(State year, month and day.)
Name and Birthplace of Father, Maiden Name and Birthplace of Mother,
Worknow.
Place of Interment, Winthrop Cemetery Winthrope mass Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, 801525 190 ... 6 ...
Name and Age )
of Deceased, Mrs. K. C. Minson
Age, 60 + years.
Date and Saft 28 No 20. Sturgis &t Waithoof Place of Death,* Chief cause,. Pulmonary Tuberculosis Disease and weak heart Contributing cause, Previous how healthst for digestion
Chief cause, Pulmonary Tuberculosis 6 months Duration Contributing cause, Weak heart toligeation 10 years
I certify that the above is true to the best of my knowledge and belief.
Name and Residence )
of Physician, S Edward I. Eage M.D.
* If an Institution, state how long an Inmate and previous residence.
[4.'04.37.I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death October 1" 1905
Name in full,.
Serge Edinin Stilling
(If a married or divorced woman give maiden name, also name of husband.)
Sex, male Color, arhite Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 2 Years,C Months, 2 Days. Occupation,
Residence, Printho mass
Ward,
Place of Death, 8. Deal Street
Place of Birth,
Winthrop Mass Date of Birth,
(State year, month and day.) Jeje128"190
Finland
Name and Birthplace of Father, Maiden Name and Otellie Scheppip Daland
Birthplace of Mother,
Place of Interment, Holy Cross, Malden mass
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH. Hinterof Colorer 1st
190.85.
Name and Age of Deceased, Lenge Edwin fishing 10
years. de
Date and October 1 1905-8 Real Steel Place of Death,* S L Chief cause, .... . Infantile Spinal Paralysis.
Disease
Contributing cause,
Chief cause, Sylt- Days
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) I.E Johnson. M.D.
of Physician, S
* If an institution, state how long an Inmate and previous residence.
I
[4.'04.37. I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,. (@tobee 3"1905 Elizabeth Mary Murphy
Name in full,
(If a married or divorced woman give maiden name, also name of husband.) 2 Female Color White
Condition, Sex,
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Indian, etc.) Divorced.) -
Age, ... Years, 2 Months, 12 Days.
Occupation,
Ward, Residence, Winthrop Mars
Place of Death, 91 Shirley Sheet
(State year, month and day.)
Place of Birth, Of inttrop mass Date of Birth July 2 0" 1905
Name and Birthplace ? Saluer Thomlar-
Ireland
of Father, Maiden Name and annie Muychy Winthrop Birthplace of Mother,
Place of Interment, Minttual Cemetery
Suturer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
isthoop October 3"
190,5.
Name and Age ?
of Deceased, Elizabeth many Murphy Age~years .. 2mos
Date and October 3,1903, 91 Shirley Sheet 12 Days
Place of Death,* Chief cause, Malnutrition
Disease - Contributing cause,
Chicf cause, 2 Inas.
Duration Contributing cause, ..
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, I.l. Carter M.D.
* If an institution, state how long an Inmate and previous residence.
[4.'04.37.J.M.]
Permit No.
RETURN OF DEATH. South BOSTON, MASS.
Date of Death,.
Colober y"1905
Name in full, Serena E. Siles
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female Color White
Condition,
Vidamed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 59 Years, ~Months, 2 Days. Occupation,
Residence, It interrato Mass
Ward,
Place of Death, 9 Beach Road
(State year, month and day.)
Place of Birth, Marktno Mask Date of Birth,
Lamaman Of, Russell Marlboro
Name and Birthplace of Father, Maiden Name and Serena Rice - marlboro
Birthplace of Mother, Place of Interment, Brigham Cemetery= Marlboro Mass
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Detalu Boston, 190.5.
Name and Age )
of Deceased, Serena 6. Giles
Age, 59 years. 2 D2,
Date and October y" 1905-9 Beach Road Huntrop
Place of Death,*
Chief cause, Ammonia
Disease Contributing cause, General Debility
Chief cause, dix days
2
Duration 3 Contributing cause, en definite
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.
2 I
[4.'04-37.J.M.]
Permit No.
RETURN OF DEATH. Mintluo BOSTON, MASS.
Date of Death,
Q of 10 " 1905
Name in full, Theodate S. Gerald
Sex, Female
Color,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
62 Years, Months, ~Days.
Occupation,
Age,
Residence, Winthrop
mass
Ward,
Place of Death, 23 Hutchinson Street
(State year, month and day.)
Place of Birth, alexandrian Of, Date of Birth,
Name and Birthplace ) Unknown
of Father, Maiden Name and Birthplace of Mother,
Unk Conom
Place of Interment, Edson Cemetery Loude Wars DummerFloyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthurston, October 10 ' 1905.
Name and Age Theodate S. Gerald Age, 82 years. of Deceased, Date and October 10 "1905, - 23 Hutchinson@let
Place of Death,*
Chief cause, Cerebral Hemorrhage
Disease- Contributing cause, ..
Chief cause, One week
Duration Contributing cause, ........
I certify that the above is true-to the best of my knowledge and belief.
Name and Residence ) of Physician, S
315 metcalf
........ M.D.
* If an institution, state how long an inmate and previous residence.
(If a married or divorced woman give maiden name, also name of husband.)
Condition,
Vidomed
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Streeter
Registered No.
Place of Death *
metall Itosfulat
Date of Death
010 1905
Age.
. . years
3/ .. months
.days
STATISTICAL DETAILS
SEX Formule
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
x
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
2
NAME OF
FATHER
BIRTHPLACE OF FATHER*
MAIDEN NAME OF MOTHER Cami Lamont
BIRTHPLACE OF MOTHER $ Douglas town M.B.
OCCUPATION
INFORMANT § flachen
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from oct 10 . 1905 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 :
Still born
(DURATION). .OAYS
Contributory :
(Signed)
31 mel call
... (OURATION) DAYS
M.D.
190 5 (Address).
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
PLACE OF BURIAL OR REMOVAL !!
UNDERTAKER CIR. Bemusar
DATE OF BURIAL Cecl 16 ,5
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.
-
COMMONWEALTH OF MASSACHUSETTS
10. Winthrop (CITY OR TOWNĄ
RETURN OF A DEATH
FULL NAME
Hasel C. Lunch
Registered No.
Date of l
ilct. 1000
190 5
.months. 17 .days
STATISTICAL DETAILS
SEX
Female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE :
Baston
NAME OF
FATHER
TE hasles & Lynch.
BIRTHPLACE
OF FATHER#
Baston
MAIDEN NAME
OF MOTHER
Florence Boeduran
BIRTHPLACE
OF MOTHER #
Boston
OCCUPATION
Fathers
Celeste.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from. July 15.1905 to Oct10, 1905, that to the best of myknowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary :
Contributory : Castro nistes tival invitati (BUTION) 2 months Strancismag m.D.
(Signed)
Oct 16 1905 (Address) 112manish
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 ?
INFORMANT § Filed Charles to Lynch 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.
In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person glving statistical detalls.
ADDRESS I tunesways Name of cemetery.
CA
PLACE OF BURIAL OR REMOVAL !!
voly tesoro Malden
UNDERTAKER James zullen
DATE OF BURIAL
...... 1900
Place of l Short Beach Sonttrop
Death *
5
Residence
Short Beach Hunting Age
X
.. years.
Death \
Dr. maguer 5 -4 Main LY
[4.'04.37.I.M.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS. Winthrop
Date of Death,
October 19 " 1905
Name in full, George Ourner Young
ing
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Nale Color, White Condition,. Single
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 39 Years, Months,C
Days. Occupation,. 1
Residence, Winthrop mass
Ward,
Place of Death, 167 or 169 Winthrope Steel
Place of Birth, Beston Mass Date of Birth,
(State year, month and day.)
Name and Birthplace ) John yama, Boston
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