USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 24
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Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON.
FULL NAME
Martha ... R ... Edmund son
Registered No 10150
Place of Death }
Boston
Mass Charitable .
Eye & Ear Infirmary
and Residence S
Date of Death
Nov # 22 nd
.1906.
Age
54
.. years ...
months days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
F
W
Maiden Name
Mudie
Husband's Name
Charles
....
Birthplace
England
Name of
Father
Robert H
Birthplace
of Father
England
Maiden Name
of Mother
Martha R Mudie
Birthplace of Mother
- - PEI
Occupation
Housewife
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
.1906,
from 1906, to 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 :
RAR'S
Primary. (Duration)
Aseptic ... Thrombosis .of .... right
CZYTTATISR
o.C.avernous Sinus 31 days CONDITAA.
BOSTON. MA Punture of rt. Internal Cavotis artery
Contributory : (
(Duration)
Cerebral Ischemio ... 29 .... days ......
M.D.
(Signed)
.H.G.Langworthy.
Nov 23 ............... 1906. ....
.....
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial
Or removal winthrop Cem Mass
Usual Residence.227 .... Shirley ..... St ... Winthrop
Undertaker
Sumner .... Floyd
Filed
NOV .... 26
1906
A true copy.
Attest :
Eumylenen
Registrar.
EGIS
R
UT PATRIHUS, SIT DE
CITY.
.......
Ihr 22,1906
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mildred Clark
Registered No ....
Place of
323 Cottage IR Road Winthrop Mass
Death *
Residence
23 Galtage OR Rd Winthrop hase Age.
30
.years
9
months
13
.days
STATISTICAL DETAILS
SEX
Fromale
COLOR
White
SINGLE, MARRIED,
WIDOWED OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Dorchester Mars
NAME OF
FATHER
Henry & Clank
BIRTHPLACE
OF FATHER#
Roxfung N. H.
MAIDEN NAME
OF MOTHER
Sarah Emma Vileston
BIRTHPLACE
OF MOTHER #
Boston Jars
OCCUPATION
None
INFORMANT §
Henry 6, Clark
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from. 2014 1906 to Un 22 190.6, 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 : acute malignant Endocarditis
(DURATION)
8
DAYS
Contributory :
(DURATION) .. DAYS
(Signed)
M.D.
1906 (Address).
739 Boylston Pr
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, 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 "Speclal Information." If in a Hospital or Institutlon, 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. Jl Name of cemetery.
PLACE OF BURIAL OR REMOVAL I
Gorest Abille
DATE OF BURIAL
Nor 24 1906.
UNDERTAKER
A. L, Eastman
ADDRESS
251 Grement St
Boston Mare
Date of ¿
nov. 22
190
Death
1
Sarah a Hatch hor 22, 1906
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, nav, 29, 06
Name in full, Charlotte Cyr. nel-
Wood C Letarol
vidar de Eduard
(If married or divorced woman give malden name, also name of husband.)
Sex, Color,
(White, Black, Mixed, Chinese, Indian, etc.) Condition,
(Single, Married, Widowed or Divorced.)
Age, 89 Years ... Months,
Days. Occupation,
Residence, *. 3) Read It,
Ward
Place of Death, !! 11 11
(State year, month and day.)
Place of Birth, It John CanadDate of Birth,
Laurence Gerard
Wood Canada
Name and Birthplace of Father, Maiden Name and Birthplace of Mother,
Elizabeth Gerard
2.1
Place of Interment, Holy Cross Malden Thor. I Lane fr Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, 200 29 1906
of Deceased, Charlottes Cyr
Age, 89 years.
I hereby certify that I attended deceased from nov 29 1906, to 2000 29
1906, that I last saw
alive on the. 29- day of 200 .190 6
that she died on the 29. day of 2000 1906, about Elevagelock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death was as follows :
Chief cause, .......
Cerebral apoplexy
Disease ? Contributing cause, ..
Chief Cause,
about 4 hours
Duration
Contributing cause,.
M. D.
* If an Institution, state how long an Inmate and previous residence.
21
Name and Age !
Charrete leys hor3-9,1906
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,. Ifc. 2, 1,
Name in full, Frederick De Coste
(If married or divoroșu woman give maiden name, also name of husband.)
Sex, Inale
Color White
Condition, Single
Age, 38 Years, X Months, X
Days. Occupation,
Residence, *. 18 Madison ave. Mintha
Ward,
Place of Birth, .. antagonist A. S. Date of Birth,.
Name and Birthplace ? Muchael De Costo
Unknown
n
Place of Interment,
JAV glileon Medham. Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
...
Age, 38 years.
I hereby certify that I attended deceased from Decz 1906, to.
1900, that I last saw le
.alive on the. 2 day of Die 1906,
that .. died on the. 3 day of Die 1906 , about. ..... o'clock Luis death 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,
Uraenica
Contributing cause, Brights Descare Chief Cause, ... 10 hours
Duration Contributing cause,
. DEJohnson M. D.
· If an institution, state how long an inmate and previous residence.
(White, Black, Mixed, Chinese, Indian, etc.) Labour
(Single, Married, Widowed or Divorced.)
Place of Death, 18 Madison ave
(State year, month and day.)
Harleybroke.
of Father, Maiden Name and 1 Birthplace of Mother, Brookdale Cemetery
Dedham mark
190 6
Name and Age? of Deceased,
Frederick de leste no 85 Alecenter 3. 1906
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
December 4 -1906
Name in full,. anna Elizabeth Perkins anna Elizabeth Underhill (If married or divorced woman give malden name, also name of husband.)
Sex, female Color
Arhite
Condition, married
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 71 Years, / Months,. 28 Days. Occupation, Otowempe
Residence,*
mass Ward,
Place of Death, 5 Perkins Steel
Place of Birth,
Balan Was Date of Birth,
Oct 6 "1833
Name and Birthplace ! of Father,
Samuel & Underhice=Carecter 2, Or,
Maiden Name and Mary a. Dinsmore= auburnQt, Birthplace of Mother,
Place of Interment, Drietrop, Cemetery Sindhuck mass Summer Floyd Undertaker. ...
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Agc of Deceased,
Winthrop Boston, December 4 1906
anna Elizabeth Perkins Age, 71 years.
I hercby certify that I attended deceased from Nov. 29 1906, to. Dec 4
1906, that I last saw her .alive on the. 4th day of DEc 1906,
that The died on the 4tx
day of REC 1906, about /2.44 o'clock
AH, or P.M., and that, to the best of my knowledge and belief, the cause of. her death was as follows:
Chief cause,
Cerebral hemorrhage.
Disease Contributing cause, Niphetis
Chief Cause, Creval hermanhesse
Duration Contributing cause, No/Preti
and 7. Sage M. D.
* If an Institution, state how long an lomate and previous residence.
(State year, month and day.)
Nellie Louise Loving December 6, 1906.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON.
FULL NAME
Robert Walker
Registered No ..
10545
Place of Death ¿
Boston
Carney Hospital
and Residence S
Date of Death
Dec 6
1906.
33
Age
. years.
months days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
SEX
COLOR
SINGLE; MARRIED, WID., DIV.
M Blk
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 :
Maiden Name
S
RAR'S
FRIBUS, SIT DEL t&Primary. (Duration OFFICE
Pneumonia 5 days
Birthplace
Witchita Kansas
Name of Father
Ralph
BO.STO
Birthplace of Father
Maiden Name of Mother
Birthplace of Mother
Occupation Jobber
Informant
........
Place of Burial
Woodlawn Everett Mass
or removal
Undertaker W A Frink
Contributory Asthmatic Bronchitis (Duration)
9 days
(Signed)
A
O Trottier
M.D.
De.c ..... 7 .. 1906
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Rear
Usual Residence
180 Shirley StWinthropMas
Filed
Dec 8
1906
A true copy.
Attest :
ErMSlenen
Registrar.
Husband's Name
CIVITATIS
·BOSTONIA" CONDITA A. .182
TISREGIMINE DONATA A 1830.
MA'SS.
6
27
December6, 170%
[3.'06-146.\'M.]
(FOR POST-MORTEM EXAMINATIONS ONLY.)^ Permit No.
RETURN OF DEATH.
Winthrop BOSTON, MASS.
Date of Death, L'eember 11"1916 Ofranklin &, mies
Name in full,
(If married or divorced woman give maiden name, also name of husband.) 7
Sex, Male Color 21 hile Condition, Single
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced
Indian, etc.) 2 Kriter
Age, 65 Years, Months, ( Days. Occupation, .
Residence,
Ward
Place of Death, 6. Irwin Steel
Place of Birth, Charleston, B, C, Date of Birth,
(State year, month and day.)
Name and Birthplace ) of Father, Maiden Name and ) Birthplace of Mother, )
Place of Interment, Aimetrop bemcelery. Durchrer Floyd Undertaker.
MEDICAL EXAMINER'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Acc, !!! " 1906.
I hereby certify that I viewed the body of Name, Frankfried. Marco
. Age, GJ & years, irho died on the
day of 190 €
and to the best of my knowledge and belief, the cause of Less death was as follows : Autopsy
Disease, Chief cause, Poisoning - Ofisine or gas.
Contributing cause, tecibert
Francis Des VERRES .M. D. un unable to fielly Decide 5. 21
Franklin). hover adecember 1, 1906.
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, ..
alca 12 1906
Name in full, Charles Louis Barlow Ii
(If married or divorced woman give maiden name, also name of husband.)
Sex, Male .Color White
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowcd or Divorced.)
Age, x Years,. . .Months, 24 Days. Occupation,
Residence,* 35 Lemoins SL
Place of Death,
Place of Birth, Winther Mass Date of Birth,. Fib 1406
(State year, month and day.)
Name and Birthplace ? of Father,
Celando .L. Barton Ca Minuletorna Ch
Maiden Name and Lucy, 1? Green morris Me
Birthplace of Mother,
Place of Interment,
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, the 12' 1906
Name and Age ? Charles Luiro Burbono da 1 1906 , to Wee 12'06
I hereby certify that I attended deceased from
day of. Dec 190 1, 1906, that I last saw M alive on the. 12'
that
died on the
day of ...
1906, about 2.30 am
.o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows ;
Chief cause,
Disease
Contributing cause,
Chief Cause, 3 days
Duration Contributing cause, .. 31 Mit cast M. D.
* If an Institution, state how long an Inmate and previous residence.
21
Age, 10 mos years.
of Deceased,
Le
12
Condition,
ears, 9 ]
Charles Louis Barlow Jr. December, 2, 19 da
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winthe ah (CITY OR TOWN.)
FULL NAME
Manau
Registered No. 248
Date of Dec. 13th 1906
Death
Residence
Coral any ..
Age
......
....
years .......... months. .days
Billow Collage
STATISTICAL DETAILS
PHYSICIAN'S CERTIFICATE
| 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 :
Contributory :
(DURATION) -DAYS
(Signed)
M.D.
ALE 13
1906 (Address) 416 Woodbury
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 I
Old Cambridge
DATE OF BURIAL
....... 190
UNDERTAKER
ADDRESS
Thanked Maloney 146 Winthrop 08
SINGLE, MARKED WIDOWED, OR DIVORCED
SEX
Male White
COLOR
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE# Winthrop Mass.
NAME OF
FATHER
Coal M. Money
BIRTHPLACE
OF FATHER
England
MAIDEN NAME OF MOTHER "Elizabeth® VonB robustein
BIRTHPLACE
OF MOTHER #
Baltimore Md
OCCUPATION
INFORMANT §
Place of l
Winthrop Mass.
Death *
S
* 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.
(DURATION). DAYS
20 96
Лес. 13,1906.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME ..
Place of
Death *
S
Residence
Age
2
.. years.
5
.months.
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
NAME OF
FATHER A
Molidaore.
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Mary E Kanell
BIRTHPLACE
OF MOTHER#
Deolor
OCCUPATION
INFORMANT §
ML
PLACE OF BURIAL OR REMOVAL li
DATE OF BURIAL
MC19"
1
6 190. 0
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during las 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 :
(DURATION). 2 DAYS
Contributory :
Convulsing
.. (DURATION)
2
. DAY
(Signed)
31 melcall
M. D
Slu 18
190. 2 ... (Address).
SPECIAL INFORMATION only for Hospitalsy Institutions, Transients or Recent Residents.
How long at
Place of Death 7
... years.
.... ....
months. ................... day
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. A 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.
.Registered No.
Date of Į
Death
.190
no 90 Harriet Fulham alec. 17, 1906.
[3.'06 37-LMI.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
Dee 21/19.06
Name in full, ausor Chester
(If married or divorced woman give maiden name, also name of husband.)
Sex, quale .Color, Ikhite'
Condition, married
Age, 80 Years, .
Months,
Days. Occupation,
4 Residence, *. Of culture mass
Ward ....
Place of Death, 145 Crest avenue
Place of Birth, Fitz william NA Date of Birth ...
(State year, month and day.)
Martin Studen - Fitz william IL H
Name and Birthplace of Father, Maiden Name and Birthplace of Mother,
Mary Chamlerin- Finowilliam not
Place of Interment, Edgewilliam MI 24
floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston Dec. 21st 1906 ..
Name und Agc! of Deceased, Martin Structur Age, 80 years.
I hereby certify that I attended deceased from Dee. 7 1906, to De, 25th
190 , that I last saw Lim alive on the. to th day of. 190.6,
that
died on the ....
212h
day of
Due.
1906, about.
3 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. his death was as follows :
Disease ‹ Chief cause,
Contributing cause, Mitral Insufficiency
Chief Cause,
Duration Contributing cause, Indiferente
M. D.
* If an Institution, state how long an Inmate and previous residence.
21
(Single, Married, Widowed or Divorced.)
(White, Black, Mixed, Chinese, Indian, etc.) Salesman
anson Streeter Dec 20, 1906.
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full, Serge Es. Jerking
Date of Death,
N'December 2 3"1906
(If married or divorced woman give maiden name, also name of husband.)
Sex, male. Color While Condition, Manier
(White, Black, Mixed, Chinese,
(Single, Married, Widowed or
Divorced.)
Age, 7 Years, 2 Months,
Days. Occupation,
mass
Ward,
Place of Death, 55, attantie Steel
Place of Birth, South Berwick Me Date of Birth,.
(State year, month and day.)
May 14" 1829
Name and Birthplace Ofilder It, Per Rinie = Unknome of Father,
Maiden Name and Charity Ticker = Unknown
Birthplace of Mother,
Place of Interment,
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Boston, Dec 26 1906
Name and Agc ?
of Deceased, Seo. G! Perkins
Age, 77 years.
I hereby certify that I attended deceased from .... time 1906, to Dec- 23
190 6, that I last saw the
hum alive on the. 17 day of. Dec 190€,
that died on the 23 day of Dec 190 , about 11 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. Luis death was as follows :
Chief cause,
Vener & Dreck Cervical Cercinonca)
Disease ? Contributing cause,
Chief Cause,. Que ye a
Duration Contributing cause,
M. D.
* If an institution, state how long an lamate and previous residence.
5321
Indian, etc.) Brick Mason
Residence,*
Dec 2 3, 1906.
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
Hinthope BOSTON, MASS.
Date of Death,
December 25" 19 06
Name in full, Offerman
10. Burrice
(If married or divorced woman give maiden name, aiso name of husband.)
Sex, male Color,
Condition, manied
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Days. Occupation, deameler Age, 36 Years, ~ Months,
Residence,* ..
mass
Ward,
Place of Death, 24, Bowdoin Steel
Place of Birth, Winthrop Mass
(State year, month and day.)
Date of Birth,
Name and Birthplace ) Charles Burrice- Hinttudo Mars
of Father,
Maiden Name and Katherine b. Chase-Sunny me.
Birthplace of Mother,
Place of Interment,
Winthrop Cemetery-Hinttury- Mass
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston December 26" 190 6.
Name and Agc \ Gilman Q, Burrice, Age, 3 6 years.
I hereby certify that I attended deceased from. à mil 1906, to Rec 25°
190 , that I last saw
alive on the 25 day of 1907
that died on the 25- day of Dea 1906, about .. o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of no death was as follows :
Disease 3 s chief cause,
Contributing cause, Tuberculosis A Bunch 1
Duration
Contributing cause, 2 mos
............
M. D.
* If an institution, state how long an Inmate and previous residence.
421
of Deceased,
Chief Cause, 2 yrs
Gilmany O. Buril Dec. 20, 1906.
[3.'06 37-L.M.]
Permit No.
Winthrop
BOSTON, MASS.
Date of Death,
Deambu 26 "1986
Name in full, Sarah Breweder
(If married or divorced woman give maiden name, also name of husband.)
Sex, temale Color,
While
Condition,
Widened
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 82 Years, 6 .Months, Days. Occupation,
Residence,*
Vinterof Mass
Ward,
Place of Death, 85 Pauline Street
(State year, month and day.)
Place of Birth,
Portsmouth n A Date of Birth,
Name and Birthplace James martin Portsmouth » Of
of Father, Maiden Name and mercy Page Northampton, n. H Birthplace of Mother,
Place of Interment, D'empnay Dejesit in Pee Jams
ermel to be al vatlan (temetés
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Hinthis Boston, Dec 27 1906.
Name and Age !
of Deceased, Sarah Brewster Age, 82
years.
I hereby certify that I attended deceased from Dies 22 1906, to Dee 26
1900, that I last saw the
alive on the Dec 25 day of. 1906,
that died on the. 26 2 day of 190 G about 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, old age
Contributing cause, Bronchitis
Duration
Chief Cause, .. Contributing cause, 4 days
5315 metall M. D.
* If an institution, state how long an inmate and previous residence.
RETURN OF DEATH.
Sarah Brewster alecs. 26.1906.
-
[3.'06 37-LM.]
Permit No.
Winthrop
RETURN OF DEATH.
BOSTON, MASS.
Date of Death, .. December 27-1916
Name in full, .. Collie amanda Steward
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color,
(White, Black, Mixed, Chinese, Indian, etc.) Condition, married
Age, 6.4 Years, a 2 Months, 5 Days. Occupation,
Residence,* Winthrop Mass
Ward,
Place of Death, 53 Centre Street
Oc/ 22"1842 (State year, mouth and day.)
Place of Birth, Gloucester Mass Date of Birth,
Name and Birthplace 1
Jacob browse - Unknown.
of Father, abbie Bange
Plymouth Mass
Place of Interment, Dintinop Cometeria Summer Lloyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Boston, December 28" 1906.
Is de Name and Age Allie amanda Steward Age, 64 years. 2= 5
of Deceased,
I hereby certify that I attended deceased from Leec. 29 1906, to ale. 274
1906, that I last saw 1230 pm, alive on the .... day of .. 122. 190 G
that. She died on the. 3) tm day of drevent: 190 , about 13 o'clock
A.M., or P.N., and that, to the best of my knowledge and belicf, the cause of her death was as follows :
Chief cause,
tant Failure
Disease
Contributing cause, .. masa. Har montag
Duration
Chief Cause, ... . Contributing cause,
1
2 M. D.
* If an Institution, state how long an inmate and previous residence.
21
(Single, Married, Widowed or Divorced.)
Maiden Name and Birthplace of Mother,
abbie amanda Sterrand. December 27, 1906
.
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