USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 8
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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 cause 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 fee 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 anafdeath The Board of Health or agent, unon receipt of such statement and certificate, shall forth-
FORM C.
Commonwealth of Ilassachusetts.
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, august 25' 190 C ased Bernard a, Jackman
Full Name of Deceased
Maiden Name,.
If a married or divorced woman or a widow give also Name of Husband,
Sex,
Color,
Single, Married, Widowed or Divorced,
Age,
Years, 9 Months, Days. Occupation,
* Residence { If out of town, } ( also state fully. }
Winthrop mass
Place of Death,
14. Would avenue
Place of Birth, Winthrop mass
Name and Birthplace of Father, Drilliam a. Jackman (Glancester) Mas
Maiden Name and Birthplace of Mother, Blanche. Roberts (Besten mars)
Place of Burial (Give name of Cemetery), ...
Winthrop Cemetery
Signature and
Sundner Ofloyd
on
Dated at
august 27
.. 190 4
place of business
of Undertaker.
18 Herman Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Bernard a. Jackman Age,
8. 9 MND.
Place and Date of Death,
died at
Winthrop august
2.5''
190 %
tastro Enteritis
Duration,
4days
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. }
wirthoof man
M. D.
Date of Certificate,
190 4
· Give also street and number, if any. | Give sex of Infant not named. If still-born, so state.
{ If a Soldier or Bailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
That RGarden.
Agent of Board of Health.
Primary,
Disease or Cause ) of Death, ţ Immediate,
No.
RETURN OF THE DEATH
OF
Bernard a. Jackman.
at
14 North avenue
Date, august 25- 190 4
Filed, august 29 190 4
[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, canse notice thereof to be given to the board of health or to the town clerk.
SECTION ". 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 elerk 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 anthorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as " stillborn ". Penalty for neglect fifty dollars.
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 sneh return shall receive from the city or town a fee 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, nutil 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-
[11-'02.37.L.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, ..... Ju.9. 27.1904
Name in full,
Francis PM Clure !
(If a married or divorced woman give maiden name, also name of husband.)
Se.v. Male
Color, White
Condition, Single (Single, Married, Widowed or Divorced.)
Age, 38 Years, 8 Months, Days. Occupation, ...
Residence, 12 Coral Que Unithuh Ward,
Place of Death, 12 Coral Une
Place of Birth, Middlebury It)
(State year, month and day.)
Date of Birth, 1866
Name and Birthplace Celulard
New york
Seeland
Helyhood Cerv Brookline
ML Burke
75 Chambers Undertaker. Boston-
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Aug 27
190 4
Name and Age ) of Deceased, 1 Francis PH Clure Age. Age, 38 years.
Date and Place of Death,* ) Flug 27 12 Coral are winthrop
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,
M.D.
* If an institution, state how long an Inmate and previous residence.
guledie and belief.
21
(White, Black, Mixed, Chinese, Indian, etc.) At Home
of Father, Maiden Name and Birthplace of Mother, ) Place of Interment,
Chief cause, ..
Francis P.N: Que
Filed aug 28" 1904
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,
Touch manning
Sex
male Color,
Date of Death, ..
1904; Age,~ Years, 7 Months, 29
Days.
Maiden Name,
or divorced.
Husband's Name,
Occupation,
Wholesale Tobacoret
Single, Married, Widowed or Divorced,.
Columbia Cottage. Mermaid 800
*Residence, {If out of town, )
¿ also state fully. 3
Boston , Roxbury Disk
Place of Birth,
*Place of Death, Winthrop mais
Denland
Name and Birthplace of Father, Katharina Dr. O'Donnell, Boston
Maiden Name and Birthplace of Mother, Jolyhood, Brookline.
Place of Interment, (Give name of Cemetery),
Dated at Winthrop mass
Frank S. Maloney
on
Signature and place of business of Undertaker.
123 Maverick LIVE 5,
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Bsiph Manning
Age, ~ Y. J M 29 D. Az 9 384 190 4.
- Primary,
Pneumonia
Duration, .
20 day
Disease or Cause of Death, # Secondary,
Enteritis
Duration,
10 de
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying I'hysician.
S 2
315 miliardy
M. D.
Date of Certificate, 190
. Give and number, if any. | Give sex of Infant not named. If still born, so state. { If a Sonlifeof Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Chas R Gardner
Agent of Board of Health.
Place and Date of Death,
died at ..
Hintturok Tonnes.
No ...
RETURN OF THE DEATH
OF Isech Manning Damage, avenue
Attamal 30'1904
Date, aluguer 30-19 da . Filed! August 31 19904
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
BOSTONIA CORDITAD. 1110.
CITY OF BOSTON. COMMONWEALTH OF MASSACHUSETTS,
CITY O RETURN OF A DEATH-1904. BOSTO
FULL NAME Frederick.W ...... Walsh
.... Registered No. 7406
Place of Death Į and Residence S
Boston, Baptist .... Hosp ...... Parker .... Hill ..
Date of Death
Sep .... 4,
1904.
Age
46
. years .. montna days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M W
M
Maiden Name
Husband's Name
Birthplace Rochester., N. Y ..
Name of
Father Frederick ... W ........ Walsh
Birthplace
of Father England
Maiden Name
of Mother
Emma ... Wignall
Birthplace
of Mother England
Occupation Publisher
Informant
Place of Burial or removal Winthrop Cem, Winthrop
Undertaker Sumner .... Floyd
Winthrop
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness
from 1904 to
1904 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 : {
Urinary ... extravasation
(Duration)
fromruptured urethia
1 wk
Contributory : {
(Duration)
Septicaemia ....
1 WE
(Signed)
.....
Q ...... E ...... Johnson
M.D
Sep 6
1904
......... ....... SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence
Winthrop., Bartlett ... Rd
Filed
Sep., .... 8.,
1904.
A true copy.
Attest:
ErMSlenen
Registrar.
Dejetender 8" 1904
AR TRIBUS, SIT DEUS
S
RAT
NO
CITY
BIS
OFFICE
BOSTONIA CONDITA AD.
.A.1822
1830.
B REGIMINE DONATA SS .
TO
N.
MA
R
Sejetember 4 " 1904
FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Date of Death,
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) epsember 4 " .190 4
Full Name of Deceased, Leage O. Perkins
Maiden Name,
= = married or divorced woman or a widow give also Name of Husband,
Sex, m Color,
Single, Married, Widowed or Divorced,
Age, Years, Months, 3 Days. Occupation,
* Residence ( If out of town, } Winthrop mass
also state fully. }
Fear
Place of Death, alamit Sheet
Place of Birth,
Name and Birthplace of Father,
"Senge " Perkins (Rhode Island)
Maiden Name and Birthplace of Mother, Jennie Sacolas-Unpur
Place of Burial (Give name of Cemetery) It anthropo Ceneley
Dated at Márchios
Signature and
Summer Offord
September
190 4
place of business of Undertaker.
218 Hemma RI
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
George 0 Pertis Age, Y. M. 3 D.
Place and Date of Death,
died at Winterop
I Setembre + 1904.
Disease or Cause of Death, ¿ Immediate,
Primary,
Malformation Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief. 4
Signature and Residence S of Certifying Physician.
M. D.
Date of Certificate, Suplentes 190 ₺.
· Give also street and number, if any. | Givo sex of Infant not named. If still-born, so state.
: If a Soldier or Sailor In tho War of the Rebellion, give both I'rimary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Charles R Garde
Agent of Board of Health.
on
No.
RETURN OF THE DEATH
OF
Pear 41 Calmont IL at
Date,.
190
4.
Filed, Defet 5"
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 cause 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 fee 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 fthe cause of death, The Board of Health or agent, upon receipt of such statement and certificate, shall forth- wasan's certificate of the
FORM C.
Commonwealth of Itlassachusetts.
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,
6
190
4
Full Name of Deceased, Stieltom (Manafo)
Maiden Name,
If a married or divorced woman or a widow give also
Name of Husband,
Sex, Color,
Single, Married, Widowed or Divorced,
Age, Years, Months, Days. Occupation,
* Residence { If out of town, } { also state fully. ) .
Shirley Sheet Winthrop Mass
Place of Death,
Place of Birth, Winthrop Mass
Name and Birthplace of Father, antaño manato =
Cataly -
Maiden Name and Birthplace of Mother, margaritle Chiffa-laty
Place of Burial (Give name of Cemetery),
Monthof Cemetery Winthrop
Dated at. Orienttrop
Summer Floyd
on Seper y 1 190 4-
Signature and place of business of Undertaker. 18Otermin@heet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Stillborn
Age, ~Y .~ M. - D.
Place and Date of Death, died & Winthrop.
Depot.
6
1904.
Disease or Cause - Primary,
Still horn. Duration,
of Death, # Immediate, 1
11 1.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
M. D.
of Certifying Physician.
Quiles Di
Date of Certificate,
Sept. 7.
190%
· Give also street and number, if any. | Give sex of Infant not named. If still-born, so state.
¡ If a Soldier or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
Dillon Enfant
(manago) 125 Shirley Sweet at
Date,
Desetember 6" 1904
Filed, Destemida y 190.
4
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose honse a death occurs and the oldest next of kin of a deceased person in the oity or town in which the death occurs, shall, within five days thereafter, canse 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 S. 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. If of a child born dead, both the birth and death shall be reported as " stillborn ". l'enalty for neglect fifty dollars.
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 cause 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 fee 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 hnman body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shull be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a toute of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
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.)
Date of Death, September 10" 1904.
Full Name of Deceased, Edward Lewis Le Ware
Maiden Name,
If a married or divorced
woman or a widow give also
Name of Husband,
Sex,
Color, .. Or
Single, Married, Widowed or Divorced,
Age, Years, 2 Months, 6 Days. Occupation,
* Residence { If out of town, } [ also state fully. }
Winthrop mass
Place of Death,
63
Pauline Steel - Hintenap Mass
Place of Birth,
Name and Birthplace of Father, Gred O. Le Ware-Richville VF
Maiden Name and Birthplace of Mother, Victoria Dian-It, Boylston mass
Place of Burial (Give name of Cemetery)
OHoly Cross Cemetery-malden
....
Dated at
on
Dejotember 18
190 4
Signature and
place of business
of Undertaker.
18 Oderman Bleel
Winthrop mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Godward J. Le Hace
Age, 8.2 M. 6 D.
Place and Date of Death,
Primary,
Malmitación
Duration,
.190 4.
Duration,
I certify that the above is true to the best of my knowledge and belief.
M. D.
Signature and Residenee
of
Certifying Physician.
Wünscheräng Murs
Date of Certificate,
(cf) 10
1904.
· Give also street and number, if any. t Give sex of infant not named. If stijl-born, so state.
! If a Soldier or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Charles R Garcia
Agent of Board of Health.
Summer Ofloyd
Disease or Cause
of Death, ±
Immediate,
died at
63 Pauline Dr. September 10
No.
RETURN OF THE DEATH
OF
Edward Penis Je Stare at 63 Pauline Sweet
..........
Date, Dejetente TO
190 4
Filed, September 10 190
[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, canse 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 anthorized 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 cause 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 fee 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, nntil 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 s certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- .3.11 ..
plusicia.
BOSTONIA CONDITAD. 1130.
INE DOMA
CITY OF BOSTON. COMMONWEALTH OF MASSACHUSETTS.
CITY Of
RETURN OF A DEATH-1904. BOSTO
FULL NAME Arthur M. Lacy
Registered No .... 7.5.10
Place of Death ¿ and Residence S
Boston,
Children's ... Hosp.
Date of Death
Sep ... Il,.
.....
1904.
Age
. years
4
months 4 days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
W
S
Maiden Name
Husband's Name
Birthplace. Boston
Name of
Father James Lacy
Birthplace
of Father. Brookline
Maiden Name
of Mother
Catherine Gilbride
Birthplace of Mother. Boston
Occupation -- ......
Informant.
Place of Burial
or removal Brookline, Holyhood ... Cem
Undertaker James J. O'Day ....... Brookline
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness
from 1904 to 1904 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)
S
Atrophy -- 4 mo.s
Contributory : { (Duration)
(Signed).
R. S. Rowland
M.D
Sep.11, 1904
.....
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence Winthrop. ......
Filed
Sep. 12 ..
1904.
A true copy.
Attest :
Registrar.
R AR PATRIBUS, SIT DEUS N
CITY
JOB
FFICE
BOSTONIA
1822
CONDITA AD.
18 30.
B SREGIMINE
DONATA A
SS.
T
O
N. MA
[4.'04-37-I.M.]
RETURN OF DEATH. BOSTON, MASS.
Winthrop
Date of Death, Juht 16 th 19.04
Name in full,
Jennie L. Parker
(If a married en dimemed woman give maiden name, chemotd.
Sex,
Jennie Z. Brown female Color white
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divoreed.)
Age, 5-8 Years, Months, Days. Occupation, none
Residence, Con. Grove & Temple ave Vanthe Ward,
Place of Death, Winthrop
(State year, month and day.)
Date of Birth, March 9
Name and Birthplace ) of Father, Maiden Name and Birthplace of Mother,
Place of Interment, Trust Hills
. L. Eastman Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Sept. 16th
1904
Name and Age )
of Deceased, Jennie L. Parker
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