USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 22
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Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) Bitmet calf M.D.
of Physician, 5
* If an Institution, state how long an Inmate and previous residence.
John W. Graves, July, 10, 1906.
.
Town of
COMMONWEALTH OF MASSACHUSETTS WinthropY CITY OF SOMERVILLE
RETURN OF A DEATH
de Null
Place of } Death
Place of Residence
months
26
days
.Age
.. years
(No.)
(Town or City and State)
STATISTICAL DETAILS
SEX Female
COLOR
White
SINGLE, MARRIED,
WIDOWED. OR
DIVORCED Widow
MAIDEN NAME If a married or divorced woman, or widow
HUSBAND'S FULL NAME George & MCNeill
BIRTHPLACE
Give state or country ; also city, lown, or county, if known
NAME OF FATHER
Leonard Ireither
Gire state or country : also city, town, or county, if known
BIRTHPLACE OF FATHER Portsmouth N.H.
MA DEN NAME OF MOTHER abby Grover Gire state of Country : also city, lown, or county, if known
BIRTHPLACE OF MOTHER Portsmouth N.L.1.
OCCUPATION
Person giving stat ist idnt details
INFORMANT 'S NAME
ADDRESS
(No.)
( Town or City)
PLACE OF BURIAL OR REMOVAL Forest Hills
190 2
Cemetery
/
( Town or City, and Rate )
UNDERTAKER S NAME Francis MI Vision
ADDRESS Some will Live2
(street)
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 € to July11 1906. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : (If a soldier or sailor who served in the war ot the rebellion both the primary and contributory causes of death must be given. )
Primary :
Mapfretis
Two years . . ( DURATION ) . DAYS
Contributory :
.. ( DURATION ) DAYS
(Signed)
Edward 7, Page
M. D.
( Address )
(No.)
131 Cest Hoe Noitheo ( Street) ( Town or C'it ?])
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Previous Residence How long at
Place of Death ?
Years,
Months, Days
Where was disease contracted,
if not at place of death ?
Received
190
Agent of Board of Health, appointed to issue burial permits
Filed
190
City Clerk
ALL NAMES TO BE IN FULL
EDOM SOMERVIL ILLE
NATI
FREED
FOUNDED IBYŁ
MUNICIPAL
ESTABLISHED A
FULL NAME Adeline 1.
( Street )
70. Guest Are
(Name of Hospital or Institution if (m)
(No.)
119. Highland Road Somewicle
(Street)
Somerville.
Registered No.
Date of
Death
th July 11
1906
64
A CITY 1872 TIONAL STRENGTH
DATE OF BURIAL
I. (Mc Neill .
Adeline
July 11 , 1906.
Uddine de My: Meill July , 1, 190%,
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON.
FULL NAME
Caroline .. Morris
Registered No. 6012
Place of Death ) Boston
Mass Gen Hospital
and Residence S
Date of Death
July 11
1906.
Age
31
.years
months days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
Maiden Name.
Neil
Husband's Name
Fleming
Birthplace Wilmington N
Name of Father ...
-Neil
Birthplace of Father Unknown
Maiden Name
of Mother
Birthplace of Mother
=
Occupation Domestic
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1906, to 1906, 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 :
IST
RAR'S
ATRIBUS. SIT DEC
Primary (Duration) 15
Typhoid Fever 5 weeks
FFICE
1822
BO.STO
. MASS.
Contributory : (
Oedema of Lungs
(Duration)
6 hrs
(Signed)
Royal Hatch
.M.D.
July 12
1906.
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
or removal.
Mt Hope Boston Mass
Usual Residence
131 Crescent Av Winthrop
Filed.
July 13
1906.
Undertaker
W Banks
A true copy.
Attest :
EnMGlenen
Registrar.
PA
CIT
CONDITAD.
TIS REGIMINE DONATAN ABD.
Place of Burial
BIK
July 11, 1906
[4.'04.37.I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS. Uno
Name in full, Emiley
Date of Death,. Jayco
Emilly Magrath End (.Taylor (If married or divorced woman give maiden name, also name of husband.)
Sex, Simula Color,
Water Condition, Married und
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divoreed.)
Age, 42 Years, 1 Months, 3 Days. Occupation, homenaje
Residence, 8 Bellevue
Place of Death, 8
Place of Birth,. New York City
Date of Birth,. 2
Henry Magrack London Cay
amic neil London de
con New York City
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, fen 1906.
Name and Age }
of Deceased, Emily, Magrack Taylor
Age, 47 years.
Date and
15.06
Place of Death,* Chief cause,. Typhoid - Fever.
Disease
Contributing cause,
rhage.
Chief cause, 8
Duration
Contributing cause, .2 4 hrs.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, S MX Partir ... M.D.
* If an institution, state how long an inmate and previous residence.
July 12 1906
(State year, month and day.)
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Place of Interment,
Amely Taylor July , 12 , 140l .
[4.'04-37.LM.]
Permit No.
RETURN OF DEATH. Winthrop BOSTON, MASS.
Date of Death, July 13, 1906
Name in full, Helew Lilfew
Helen Silken Sherlock
(If a married or divorced woman give maiden name, also name of husband.)
Condition, Sex, Female Color, White
(White, Black, Mixed, Chinese, Indian, etc.)
Widowed (Single, Married, Widowed or Divorced.)
Age, 77 Years, J Months, 21 Days. Occupation,
Residence ......... Winthrop Mass
Ward,
Place of Death, Somerset Que
Place of Birth, Shelburne NS.
(State year, month and day.)
Date of Birth, Law 2 3, 1830
Name and Birthplace ? of Father,
Sherlock
England
Maiden Name and Halen Gelben
Halifax US
Birthplace of Mother, Place of Interment, Winthrop Cemetery Summer Houdt
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Booton, July 14 .. 1906. 21 do
Name and Age ? of Deceased, Helen keepon topbretone 1 Age, 17 years. 5 ms
Date and Place of Death,* S July 13" 1906 Samuel Creve Hintof Mass abdominal concer
Chief cause,
Disease Contributing cause, ....
abdominal come
Chief cause, .........
about 2 yrs
Duration
Contributing cause, .... .
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician,
about 2 zus M.D.
* If an Institution, state how long an Inmate and previous residence.
2 1
Gelen Gelfan Johnson. July. 13, 1906.
COMMONWEALTH OF MASSACHUSETTS
RETURN, OF A DEATH
..
(CITY OR TOWN.)
FULL NAME
Catherine A Burriel
Place of
Death *
5
24 Bowdown Sh
Date of July17
Death
1
.190
Residence
Age
80
.years. .
... months
mths 21 days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,7 WIDOWED, OR DIVORCED.
MAIDEN NAME + catherine & chase
HUSBAND'S NAME +
charles Burrill
BIRTHPLACE #
Marmeth ME.
NAME OF FATHER Thomas cheuse
BIRTHPLACE
OF FATHER#
Formeth M.E.
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER $
OCCUPATION
1 faure Warto
INFORMANT § Fillnew O Burrill
LACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
Winthrop
190.
UNDERTAKER
ADDRESS
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 :
old age
. (DURATION) .. DAYS
Contributory :
Paraplegia
1 ys
(DURATION)
. DAYS
(Signed)
M.D.
home /1906. (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years
.....
. months. days
Where was disease contracted, if not at place of death ?
Filed
.190
Clerk
* City or town, street and number, If any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Special informatinn." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of marrled or divorced woman, or widow.
# State or country | also city, town or county, tf known,
§ Name and address of person giving statistical details. Îl Name of cometery.
....
Registered No ...
56
Catherine C. Burrill July 17, 1906.
1
$
Catherine & Burrell,
July , 17, 1906.
Dr Metcalf
4.'04.37 . LM.]
» Permit Nó.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, Auquel 2" 19.06 Harrison gester Roberta
(If a married or divorced woman give maiden name, also name of husband.)
Sex, male " Color,
Ophile Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 1 Years, 11 Months, 22 Days. Occupation,
Residence, Printhoop Mass Ward,
Place of Death, 18 Shirley Street
Place of Birth,
Winthrop Mass Date of Birth,
(State year, month and day.) (lug 11" 1904
Hugh V. Robert Dr. Congland
Name and Birthplace ) of Father, Maiden Name and Minnie Theresa - Bolo
Birthplace of Mother, Dr intero Cemetery Winthrope mass Place of Interment,
Ouluner floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop august 3
Boston,
190 6
Name and Age Camion gester Potente Age,/ years. 11-22
of Deceased,
Date and august 211906-187 Shines & hel
Place of Death,* Chief cause, .. Diflithería
Disease -
Contributing cause, ....
Chief cause, 24 hours
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) Edward 7. Sage M.D.
of Physician,
* If an institution, state how long an inmate and previous residence.
021
Harrison Lestor Rogere, august 2 1906
--
[3.'06-37-LM.]
Permit No. ..... .....
RETURN OF DEATH ..
MASS.
Date of Death, Aro 4"1906 martha & m Donald
(If married or diyorced woman give maiden name, also name of husband.)
Sex, Color,
(White, Black, Mixed, Chinese, Condition, L'école
Indian, etc.)
(Single, Married, Widowed or Diyorced.)
Age, 1 .. Years, 2 Months, ~ Days. Occupation,.
Residence, *.
Ward,
Place of Death,
(State year, month and day.)
Place of Birth,
Date of Birth,
Bridget Dermody Garland
Place of Interment,
Name and Birthplace ! of Father, Maiden Name and Birthplace of Mother, Holy Cross mulden
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, aug 45 190 6
of Deceased, Martha & Mc Donald
Age,. 1.2 years.
I hereby certify that I attended deceased from aug 1ch 1906, to aug 4h
1906, that I last saw
alive on the. 3 ª 5
day of aug 190 Q
day of. aug 190 b, about. 4.150 o'clock that died on the 4 h-
A.M., or +.M., and that, to the best of my knowledge and belief, the cause of
[ Chief cause, ........
Meningitis
Disease Contributing cause,
Chief Cause, 4 days
Duration Contributing cause, H. I Soule
· If an Institution, state how long an Inmate and previous residence.
M. D.
Name and Age?
-2 mo
her. death was as follows :
Name in full,
Marcha G. m. Donald august 4, 1966 Do.58.
1
[4.'04-37-J.M.]
Permit No.
RETURN OF DEATH. Hinthe BOSTON, MASS.
Date of Death,. august 5" 19.06 Chandler Winthrope Creighton
Name in full,
(If a married or divorced woman give maiden name, also name of husband.)
Sex, .... male Color, White
Condition,
Age, 4 Years, 7 Months, 23 Days.
(White, Black, Mixed, Chinese, Indian, etc.) Occupation,.
Residence, Winthrop Mass
Ward,
Place of Death, 27 atlantic Steel
Place of Birth, Drinthiofs
(State year, month and day.)
Date of Birth, Dee 12-1906 Name and Birthplace \ William Or, Creighton= Charleston of Father,
Maiden Name and Minnie , Whittington- Janmouth no.
Birthplace of Mother,
Place of Interment, Stintinoje Cemetery - Ventthe mass Dummer Houd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop ang 6th Boston,
1906.
Name and Age of Deceased, Lehandler Wbereichton Age, 7 years.
august 5Th 1906. 27 attantin St. Date and
Place of Death,* Chief cause, .... Typhoid Fever.
Disease -
Contributing cause, Septic abscess of Leg.
Chief cause, One week
Duration- Contributing cause, . Two weeks.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician, augustus.
* If an Institution, state how long an Inmate and previous re Mence.
Tallinar M.D. Princeton St.
? I
(Single, Married, Widowed or Divorced.)
-
august 5, 1906 20.59.
[11.'02.37-LM.]
Permit No. ....
RETURN OF DEATH. BOSTON, MASS.
Date of Death. ung 9 Th 1906
Name in full, full, Helen Genueve Kiggen
(If a married or divorced woman give maiden name, also name of husband.)
Female
Sex, Color,
(White, Black, Mixed, Chinese, Indian, etc.) Condition, Angle (Single, Married, Widowed or Divorced.)
Age, Years, Months, .. 7 Days. Occupation,
Ward,
Residence, Place of Death, Blue Acce Collage Neptune are I und koop mass (State year, month and day.) Place of Birth, Ity de Park mass. Date of Birth, June 30 1905 of Father, 1
Name and Birthplace ) Jose/2h m Kiggen Hyde Park mars
Maiden Name and Francis mary Medcalf Ireland
Birthplace of Mother, ) Place of Interment,. Calvary Cem. Boston mais.
F.O. Graham Agas Part, Maso Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, acq 7 Th - 190 6
Name and Age Helen Geneve Higgin of Deceased ,
years.
Date and Hyde Park miles on June 30- 1905 Place of Death,* ) Chief cause,. Acute indigestion
Disease Contributing cause, Chief cause, Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Nume and Residence ) of Physician, Albert B Domman M.D.
· If an Institution, state how long an inminte and previous residence.
auquel 7the 1906 No . lo
4
[4.'04.37-J.M.]
Permit No.
RETURN OF DEATH. Winthrop BOSTON, MASS.
Date of Death,
august 15 1906
Name in full, Sarah Gilman Mattheus
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, While-
Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.)
78 Years, ~Months, 2Days. Occupation, Age, ..
Residence,
naes Ward,
Place of Death, 167 Winthrop Street
(State year, month and day.)
Place of Birth, Freedom W Cf Date of Birth,
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Place of Interment,
Jonathan Dieman
annie Rendere Lee -2 04.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Dimostof? august
/0 1900.
Name and Age Sarah &. Mattheus
Age, 78 years. 29 de
of Deceased, Date and august 15. 1906-16 Hinttrump Succes
Place of Death,* - Chief cause, ... . Daranarna Utini
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, 5 M.D.
* If an institution, state how long an Inmate and previous residence.
auquel 15, 1906 200.
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, Aug 19 1906
Name in full, Mary Pauline MS Carthy Mary Pauline Donovan (If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, White
Condition, ma price (White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.) Indian, etc.) Home Age, 36 Years, Months, 28 Days. Occupation,
Residence,*
4) Main Ar
Ward,
Place of Death, 41 Main
Place of Birth, Cash Boston
(State year, month and day.) Date of Birth, greve 22-1810
Name and Birthplace Timothy Donovan! Ireland of Father, Maiden Name and Birthplace of Mother,
Annie M. O. Donnie- Scotland
Place of Interment, Atoly leross Walden
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston ..... 49.2.1 1906.
Name and Age )
of Deceased, 5 Ihans
e
acting In bartin Age, 3 years.
I hereby certify that I attended deceased from. any 4' 190k, to Chung: 19.00
1906, that I last saw
alive on the. 19 day of 190 G
that
died on the
.day of
Infust
19% , about 9 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death was as follows :
Disease ‹ Chief cause,
Contributing cause,
Chief Cause, The year
Duration
Contributing cause, (1)met calf M. D.
* If an Institution, state how long an inmate and previous residence.
521
t
1 01 2
( august 1 9, 190% 20.62
[4.'04.37. J _. M.]
Permit No.
RETURN OF DEATH. Mintha BOSTON, MASS.
Date of Death,
auquel 21"1906
Name in full,
James Q. abbott Il.
(If a married or divorced woman give maiden name, also name of husband.)
Sex, ....
male
Color,
Othrice
Condition,
Widower
(Single, Married, Widowed or
Divorced.)
Age, 45 Years, 6 Months, ~ Days. Occupation,
(White, Black, Mixed, Chinese, Indian, etc.) Shipping Clerk
Residence, Winthrop Mass
Ward,
Place of Death, y Belcher Street
Place of Birth, Laurence Mass Date of Birth,
(State year, month and day.)
Name and Birthplace ) of Father,
James L. abbott- andover mamie
Maiden Name and
Mary E, Pearl-Ionele mass
Birthplace of Mother,
Place of Interment,
Stunttrop Cemetery- Winthrop mar
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Minstera po august 2 2ª 1906.
Name and Age
of Deceased, James, G. abbott In
Age, 45 years. 6 mos
Date and auquel 21 "1906 -7. Belcher estrel, Place of Death,* S Chief cause, .. Lenkauma Disease-
Contributing cause, General Imboly Khambasis
Chief cause, 5 yrs
Duration Contributing cause, one week
I certify that the above is true to the best of my knowledge and belief. Name and Residence , of Physician, Birmet calf M.D.
* If an Institution, state how long an inmate and previous residence.
James I Wovous fr Cinquet 21, 1906 no. 63
١
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON.
FULL NAME
Mary
E.
Smith
Registered No.
7380
Place of Death ¿ Boston
Boothby Hospt. --- Winthrop , Locust St.
and Residence S
Date of Death
Aug . 22
1906.
Age
41
years.
months days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
F
W
M
1906, 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: from 1906, to
Maiden Name
Brown
S
PATRIBUS, SIT DE
Primary
Shock 24 hrs.
.... (Duratiany
OFFICE:
C
Name of
Father.
John Brown
BO.STO
N. MA.S.S.
of Father England
Contributory : 2
Operation for Fibroid
(Duration)
Uterus
2 days
Birthplace
England
of Mother
(Signed)
J .W.Lane
M.D.
Occupation
None
Aug . 24
1906
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
or removal.
Forest Hills
Usual Residence.
"Winthrop"
Undertaker
M . Barry
Filed
Aug . 25
1906
A true copy.
Attest :
ENMSlenen
Registrar.
RAR'S
Husband's Name
Edison J.Smith
CITY.
Birthplace
England
CTYTT
BOSTONIA" CONDITAA.
ATIS REGIMINE DONATA A 1130.
Birthplace
Maiden Name
Unknown
of Mother
Informant
Place of Burial
I HEREBY CERTIFY that I attended deceased during last illness,
aug 22, 1906.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Elizabeth &e Grave
Registered No.
Place of Death *
Chester Cottage
Dolphin Que
Date of Death.
aug 29
1906
Age
44
. years
10
months
8
days
STATISTICAL DETAILS
SEX
Jimale
COLOR
While.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME +
Demayer
Selden
HUSBAND'S NAME +
BIRTHPLACE + Bastón
NAME OF
FATHER
Raymond Dejmayer
BIRTHPLACE
OF FATHER+
Germany
MAIDEN NAME
OF MOTHER
Ever Schwell
BIRTHPLACE
OF MOTHER
Germany
OCCUPATION House Wife
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL II
Forest Hills
DATE OF BURIAL Away 31 190150
UNDERTAKER
ADDRESS/
2324 Nask St
& SItalermandsans Bacher
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from 1906 to Jun 29 6
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 : Lancer al Utima
1
3. 42. (DURATION). .DAYS
Contributory :
Lus- attack Diarrhea
(Signed)
Dr. Ada Dv. Bearse
.(DURATION)
. DAY8
.M.D.
Muy 29 1906
.(Address)
12 Horner St, 20
Dorchester
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. |[ Name of cemetery.
ALL NAMES TO BE IN FULL
Elizabeth G. Grove. august 26, 1906 20. 64
AC
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.)
Date of Death, aluguel 28. 190 6
Full Name of Deceased, Cagandria a, Olaynes
Maiden Name, Aktionmama a Richardson
If a married or divorced woman or a widow give also Name of Husband, Holu Heury Hay nes
Sex, Color, .. Single, Married, Widowed or Divorced,
Age, 45 Years, Months, Days. Occupation,
* Residence { If out of town, } { also state fully. ) .
5 Sea View av Authrop
Place of Death, Theleal Hospital Winthrop. Mars
Place of Birth, Bloomington, SUL
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery) Winthrop Onefety Winthrop Mare
Summer Floyd
Dated at .. aluguer 28 to 190 6
Signature and place of business of Undertaker.
18. Herman Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Carsandría a Haynes Age, 45%. M. D.
Place and Date of Death, died at Winthrop auquel 20 1906
Disease or Cause of Death, #
Primary,
Chronic altrimentis
Duration, . 4ch.
Immediate,
Duration,
sweets
I certify that the above is truc to the best of my knowledge and belief.
Signature and Residence S Certifying Physlclan.
M. D.
Date of Certificate, 24" 190 %.
· Give also street and number, if any. f Glve sex of Infant not named. If still-born, 80 state.
{ If a Soldier or Sailor In the War of the Rebelllon, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
on
No.
RETURN OF THE DEATH
Cassandra a Hay-ne. Cinq 28, 1901 20.60
OF
at .....
Date, _.
190
........... .
Filed, ....
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
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 shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate canse of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fec of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city, or town or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. DOSTON MASS
Name in full, Jannett
Date of Death, BEkt 9 1906 , Hansell Jannett Grant" Ivm H. Hansell (If married or divorced woman give maiden name, also name of husband.)
Sex,
imate Color,
White
Condition, Marie
(White, Black, Mixed, Chinese, Indian, etc.) Houseurge
Residence, *.
9 Wheelock It Winthro hard, Mas
Place of Death,
62
(State year, mouth and day.) Hauta Courety Nova Scotia Date of Birth, Jan 15-1844,
Place of Birth,
Donald Grant= Hanty County A.S.
Name and Birthplace ? of Father, Maiden Name and Birthplace of Mother, Minthurt Osme
Maria ..
Wright
Place of Interment,
Chan. R. Crimson
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Sept-9 190 6
of Deceased, Jannett Hansell Age, 62 years.
I hereby certify that I attended deceased from June 18 1906, to Sift9h
1900 that I last saw
alive on the day of Sept 190 4
5.30 day of Sept 1900, about o'clock that died on the 95
J.M., or P.M., and that, to the best of my knowledge and belief, the cause of .. death was as follows :
Disease ? s chief cause,
Contributing cause, 4.
Chief Cause, 2 years
Duration
Contributing cause,
M. D.
* If an institution, state how long an inmate and previous residence.
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