USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 12
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STATISTICAL DETAILS
SEX
COLOR
while
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
Southwell
HUSBAND'S NAME + Henry a. Root
BIRTHPLACE # Taunton Mass
NAME OF
FATHER
Thomas I. Southwell
BIRTHPLACE
OF FATHER+
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
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 !!
Mass Trimatory.
DATE OF BURIAL
June 29
190.
8
UNDERTAKER
es Waterman Kons.
ADDRESS
Boston
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Sam 25 190 8 tola 27 1908 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 : Combine Humanitar
2
(DURATION) DAYS
Contributory :
Brighter Disease
(DURATION). DAYS
(Signed)
M.D.
De 2/ 1908 (Address)
OCCUPATION
INFORMANT §
to Goov Uminsor
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Registered No.
53 Caroline In Rock- June 27. 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of l
Lincoln DV
Death * S
Residence
Age
months ... .... .days
STATISTICAL DETAILS
SEX
male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t HUSBAND'S NAME +
BIRTHPLACE #
NAME OF
FATHER
Willian. C. Sampson
BIRTHPLACE OF FATHER$
MAIDEN NAME 1 OF MOTHER Bissie. S. Woodile
BIRTHPLACE
OF MOTHER #
ashland Mas
OCCUPATION
2
INFORMANT § Ma. Sampson
PHYSICIAN'S CERTIFICATE
¡ HEREBY CERTIFY that I attended deceased during last illness, from .. 1908 to Jacky 3- 1908, 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 enfant (male)
(DURATION). . OAYS
Contributory :
(OURATION) .DAY8
(Signed) 2.7 Partir M.D.
July 7 19Q ..... (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 Information." if in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, if known.
§ Name and address of person giving statistical details, Il Name of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
UNDERTAKER
ADDRESS wucht
.Registered No.
Date of l Jody 3"! 1900
Death S
5 гр Sampson July 3- 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Nocturno (CITY OR TOWN.)
FULL NAME
Margaret Smidt
Place of l
Death *
5
Residence
Age
ysars.
.months
One day
STATISTICAL DETAILS
SEX
Female
COLOR
Mute
SINGLE, MARRIED, WIDOWED, OR DIVORCED V
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
NAME OF FATHER albert. G. Smith
BIRTHPLACE OF FATHER# Brooklyn n. Y.
MAIDEN NAME OF MOTHER Many Mills
BIRTHPLACE OF MOTHER + Cincinnati Ohio
OCCUPATION
INFORMANT § altert. J. Sweet
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
190. 8
UNDERTAKER
1
ADDRESS
werdhet
PHYSICIAN'S CERTIFICATE
. 190 8 to I HEREBY CERTIFY that I attended deceased during last illness, from, July 4 Same 1908, that to the bestof my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Lack of vitality
of
2 hours
(DURATION)
. DAY8
Contributory :
.(DURATION) DAY8
(Signed)
M.D.
6 190 ... (Address) homshop 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
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL INANYWANIA W SI SIHI -'VNI HIM INO 7714
.. Registered No.
46 Jagamore are
Date of { Lody
190 c
Death
Margaret Smith July 4 - 190 8
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, Tuosetia It Wentworth
July 5. 1908
(If married or divorced woman give maiden name, also name of husband.)
Sex, OFemale Color, Orbite Condition, Nidomed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, Years,
78 Years, 8 Months, ~Days. Occupation,
Residence,*
Sostar mass
Ward,
Place of Death, Thisthing mass
Place of Birth, Boston mass Date of Birth,
(State year, month and day.)
Name and Birthplace John In, Nerves-Franklin mars
of Father, Maiden Name and Susan a, Shedd- Sastan mais
Birthplace of Mother,
Place of Interment, Ledar Give Cemetery
Summer Glad Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Minttuof0 Boston, July 6 190 8 .
of Deceased, Lucretia W Wentworth Age, 78 years.
I hereby certify that I attended deceased from 1904, to July 5
1908, that I last saw Ler .alive on the. fifth day of 1 that the died on the .. fifty- day of tuxi 1908, about 3 o'clock
190 8,
P.M., and that, to the best of my knowledge and belief, the cause of es death was as follows :
Chief cause,
Disease
Contributing cause, Sea cal shoot. velysis
Duration
Chief Cause, Contributing cause,
* If an institution, state how long an inmate and previous residence.
21
Name and Age ?
Lucretia H. Heutworth July 5, 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.
FULL NAME
abril C. Fra
Place of )
Death *
5
metcalf Hospital
Residence
93 Pleasant St
Age 54
.years.
months.
.days
STATISTICAL DETAILS
SEX
Male
COLOR
muito
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Lingue
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER gimas Thewrongy
BIRTHPLACE OF FATHER+
.
MAIDEN NAME
OF MOTHER
Michelauble Means
BIRTHPLACE
OF MOTHER#
Jury ma
OCCUPATION
INFORMANT §
Galfert. H. Welche-
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 : S Primary : ing da
skull
Contribut
lya
(Signed)
(DURATION) . DAY8 George Burgers Mapractico. 190 ...... (Address) ..
had Exam.
Voltelo,
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 II
Wundert Cancelar
DATE OF BURIAL
July 17
190.
8
ADDRESS
UNDERTAKER 6 RBenrum
* 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 o1 Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. I[ Name of cemetery.
ALL NAMES TO BE IN FULL
Registered No.
Date of l
Death
July 1>
190
57 abil C. Trewargy July 17-1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
annic. C. Cook
.Registered No.
Date
Death
Residence
Age
.years.
...... months.
days
STATISTICAL DETAILS
SEX temala
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manneni
MAIDEN NAME +
HUSBAND'S NAME + Sheldon. W. Cook
BIRTHPLACE#
Center me
NAME OF FATHER Malcolm Mac Donald
BIRTHPLACE OF FATHER# Glasgow
Touchant
MAIDEN NAME OF MOTHER Mary Jane warren;
BIRTHPLACE OF MOTHER # moose River me
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL July 200
UNDERTAKER CR. Bema.
ADDRESS wanthet ;
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from. July 8th 1908 to July 18. 1908 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 : typhoid
Contributory :
(OURATION)
10
0AY8
(Signed)
4 2hg. Porter
M.D.
july 20 190.2 .... (Address) Hg. PraH.
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death ? years. ....... ........ .. months.
....... .... . days
Where was disease outrored, If not at place of o
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 dotails. Il Name of cemetery.
ALL NAMES TO BE IN FULL
1184
Place of )
Death *
S
150 frashunston are
190
(DURATION) . DAY8
58 Quenie b. look. July 18, 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
.
(CITY OR TOWN.)
118%
Place of l
97 Washingter are
Death *
Residence
Age
.. years
months. 9 .days
STATISTICAL DETAILS
SEX Female
COLOR
white
SINGLE, MARRIED, . WIDOWED, OR DIVORCED
widow
MAIDEN NAME +
HUSBAND'S NAME +
Edward Cole
BIRTHPLACE # Quincy mais
NAME OF FATHER min Packant
BIRTHPLACE OF FATHER#
MAIDEN NAME
OF MOTHER
Claussa Pote
BIRTHPLACE OF MOTHER #
OCCUPATION
-2
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Seely y 190 & ... July 18 190 that to the best of/my knowledge and betlef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
(DURATION)
8
DAYS
Contributory : Rhumatisme.
(DURATION). 13 DAYS
(Signed)
2.8. Porão
M.D.
Ve en 20 190 8 (Address)
Hentrop
SPECIAL INFORMATION only for Hospitals, Institutlons, 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 !! My Walleton Quy
DATE OF BURIAL
4
July 20 190 8
UNDERTAKER G.R. Benmisión
ADDRESS Welt
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
FULL NAME
adeline. E. Cole
.Registered No.
Date of l
July 18
.190 S
Death
S
. .
59 adeline &. bole July 18 , 1908
[4.'07.37-LM.]
Permit No.
Winthrop RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death,
Lucia . Marca
July 18" 1908.
Julia In Sharpe
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, White Condition, manied
(White, Black, Mixed, Chinese, Indian, etc.) Monsenige
(Single, Married, Widowed or Divorced.)
Age, 36 Years, ~ Months, ~Days. Occupation,
Residence,*
Stanthropo Mass
Ward,
Place of Death, 199Winthrop Street
Place of Birth, South Boston
(State year, month and day.) Date of Birth, Name and Birthplace Thomas Sharpe- Gangland of Father, Maiden Name and Birthplace of Mother,
Place of Interment, Calvary Limeto Bummer Gloyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, July 19 1908. Name and Age Julia In. mare croftf Age, 36 years.
of Deceased,
I hereby certify that I attended deceased from fik. 22 . 1908, to July 17.
190, that I last saw fram alive on the. 17 day of ... .. 190},
that the died on the. 18
day of. 190 8, about 9 o'clock
A.M., or P.M., and that, to the best of my knowledge and Belief, the cause of fuer death was as follows :
Disease - 5 Chief cause,
Contributing cause, on a . ala Qualema
1
Duration
- Chief Cause,
....
Contributing cause, 1/ 21). Vinter M. D.
· If an Institution, state how long an Inmate and previous residence.
Ovellie Sharper Theland
Julia No. Heurecraft July 18, 1908
1219
[4-'07.37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full, Clar a
Date of Death, Statu
July 20th 1908.
1
(If married or divorced woman give maiden name, also name of husband.)
Sex, Mals Color White
Condition, Variced
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 62 Years, 8 Months,
Days. Occupation, /merchant
Ward, Rox
Place of Death, Solin Poland Date of Birth, Oct /1845
(State year, month and day.)
Place of Birth,
Isaac Alotto Solin Roland
Name and Birthplace ?. of Father,
Maiden Name and Birthplace of Mother,
matilda Phillips
Place of Interment, East Boston Ohalini Spolam %
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
1908.
Name and Age ?
of Deceased,
I hereby certify that I attended deceased from July 17 1908, to July 20
1908, that I last saw him n alive on the. 19 th day of. July 190 8, that he. died on the 20th
day of July 1908, about 12,05o'clock
A.M., OF FAME., and that, to the best of my knowledge and belief, the cause of Lis ... death was as follows :
Disease ‹ Chief cause, myocardetis
Contributing cause, appen decités operation July 19.
Duration
Chief Cause, ..
Contributing cause, In Saramml.
M. D.
· If an Institution, state how long an Inmate and previous residence.
822 Broadway Chelsea
Winthe Boston, July 20 Age, .. 62 years.
Residence, *.
64 Waverly St
mass
arrow Stater July 20, 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Mary & Whilbrick
Registered No.
Place of Death *
37 trideur- ave Winthrop Mess
Date of Death
July 20 1908
Age
54
years
9
months
14
.days
STATISTICAL DETAILS PHYSICIAN'S CERTIFICATE
SEX Female
COLOR
Huile
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME +
Inany & Carry
HUSBAND'S NAME + James a Philbock
BIRTHPLACE # Inverness Canada
NAME OF FATHER
Robert Canning
BIRTHPLACE OF FATHER+
Inverness Canada
MAIDEN NAME
OF MOTHER
Maria Bruch
BIRTHPLACE OF MOTHER $
Ireland
OCCUPATION Housewife
INFORMANT § Langen & Phillrich
PLACE OF BURIAL OR REMOVAL II
ForEnt Hicks Centrul, 25
1908
UNDERTAKER 9
ADDRESS 1
I HEREBY CERTIFY that I attended deceased during last illness, from .. June 22 190 8 to July 26 1908, 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 : Sarcoma ofthegle.
Contributory :
.(DURATION) ......... DAYS
(Signed)
Johnson
M.D.
July 2) 1908 (Address)
Quase
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Former_or
Usual Residence
Place of Death ?
Days
Where was disease contracted, If not at place of death ?
Filed
.190.
Clerk
DATE OF BURIAL
* Clty or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts callod for under "Special information." If in a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
62 mary E. Phillies July 26-1908
14.'07-37. LM.|
Permit No.
RETURN OF DEATH.
Winthrop
BOSTON, MASS.
Date of Death, Senge et, Payne
30' 8
Name in full,
(If married or divorced woman give maiden name, also name of husband.)
Sex, male .Color Orhile- Condition, Married
(Single, Married, Widowed or
Divoreed.)
Age,. 57 Years, 9 Months, 9 Days. Occupation,
(White, Black, Mixed, Chinese, Indian, etc.) Retired
Residence, * Winthrop mask Ward,
Place of Death, 15 Christen Park
Place of Birth, Chelsea Mars
(State, vear, month and day.)
Date of Birth, Och 21"1859 Name and Birthplace \ Sylvanus Payne,- Grenster Mars of Father,
artie S. Horton = Eartham Mass
Maiden Name and Birthplace of Mother, Place of Interment, Danthiol, Commeter Anetuop mas Ouminerfloyd 1 Undertaker. PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH. 1908.
Name and Age
of Deceased, George 7. Payne
Age, 58 years.
I hereby certify that I attended deceased from.
1906 , that I last saw 1
alive on the. 201
day of 190 ,
be 18 that died on the 301 day of
1900 , about .. 115 .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, aproperty
Disease
Contributing cause, Immediate
Chief Cause,
Duration
Contributing cause,
315 metcalf
M. D.
· If an institution, state how long an inmate and previous residence.
Boston, July 3/2
July 30] 1908 , to Any 30-
Herege F. C aque July 20, 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Eliza. G.Barbour
.Registered No.
....
Place of )
Death *
S
5/ CThouston Pack
Residence
Wencheof Mars
Age
76
10
months. 5 .days
STATISTICAL DETAILS
SEX tenall
COLOR
SINGLE, MARRIED, -
WIDOWED, OR DIVORCED
MAIDEN NAME +
Eliza
Ranson
HUSBAND'S NAME t
BIRTHPLACE #
LE Roy 21.
NAME OF FATHER Rubin Ranson G
BIRTHPLACE OF FATHER$ Salisbury. n. J.
MAIDEN NAME
OF MOTHER
Elizabeth Ebil
BIRTHPLACE OF MOTHER $ Palestine n. y
OCCUPATION
INFORMANT S
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last illness, from ... July 17 190.4 ... to. July 31. 1908 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 :
Cardiac auchna
la despenentão
(DURATION) .. ADAY8
Contributory :
I Define
(DURATION). .... .. DAYS
(Signed)
any 2 1908 (Address)
(SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Place of Death ? . years. ..... ....
months. . days
Whero was disease contracted, If not at place of death ?
Filed
.190
Clerk
* City or town, streot and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special 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. || Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
6. ICH :
DATE OF BURIAL
Tu/2
190.
8
UNDERTAKER
ADDRESS
20-
Date of l
Death 5
July 31
190
.. years.
64 Reliza ABartow July 31, 1908
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Sarah. Jackson
.Registered No.
Date of ¿
Death
190
32_
months.
days
STATISTICAL DETAILS
SEX Female
COLOR Colored
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manuel
MAIDEN NAME +
Sarah
Johnson
HUSBAND'S NAME +
Hugh Jackson
BIRTHPLACE İ
Scharlottville va
NAME OF FATHER Robert Johnson
BIRTHPLACE OF FATHER$
MAIDEN NAME OF MOTHER annie Battles
BIRTHPLACE OF MOTHER # S charlottville
va
OCCUPATION Lainalien
INFORMANT § Hunharl
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from July 21 1908 to July 31 1908. 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 : acção es digestion
(DURATION) .. .. 0AY8
Contributory : Mitral Insufficiency Indiferente (OURATION) .DAYS
(Signed) Oghg. Parte M.D.
Circa 2 1908 (Address)
Hemetrof
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
DATE OF BURIAL
190.0
UNDERTAKER
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Spocial Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
ALL NAMES TO BE IN FULL
Place of )
32 Pestenis Sho
Death * S
Residence
Age
years.
65 Sarah Jackrow July 31, 19,08
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1908.
CITY OF BOSTON
FULL NAME
Mary A Hosie
Registered No. 7054
Place of Death ¿
Boston
Long Island . Hospt
and Residence
Date of Death
Aug 4
1908.
Age
56
years
months.
.......... .days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
Maiden Name Wentworth
Howard Th Hosia
Husband's Name.
Quincy
Birthplace
Name of Father Jeremiah "entwor
Birthplace of Father Unknown muss
Maiden Name Abigail Jones
of Mother .
Unknown mass
Occupation
Informant
Place of Burial or removal
Quincy""'s Wollaston"
7 C Callivan
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1908, to 1908, 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
CITY:
UT PATRIBUS. SIT DE Primaoy (Dura Giòn
Nephritis
DEFICE
CIVITATIS
Z BOUTONIA CONDITAA.
ATISREGIMIN DONATA A.
0
MASS.
Contributory : / Cystitis (Duration) S
(Signed)
G W Holmes
M.D.
Aug 4 1908
SPECIAL INFORMATION from Hospitals, Institutions, Trensients, or Recent Residents.
Usual Residence
Winthrop' Billon Avel
Filed
ALE 7
1908
Undertaker
A true copy.
Attest :
EMMElenen
Registrar.
Birthplace of Mother
many a. Hosie. Cmq 4-1908.
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of
Metall 1 forptal
Death *
S
Residence
Age
X
.....
.. years.
.months.
.days
STATISTICAL DETAILS
SEX
Female
COLOR
what
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
nine
HUSBAND'S NAME +
none
BIRTHPLACE #
winshop. Hoplat
NAME OF
FATHER
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER $
ReBB.
OCCUPATION
INFORMANT §
Churchill
Nurse
PLACE OF BURIAL OR REMOVALI
DATE OF BURIAL
Rug /6
.. 190 CD
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 : Premative
. (DURATION)
1 dans
Contributory :
.(DURATION) .. DAYS
(Signed)
M.D.
190.
.(Address)
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 "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, if known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Registered No.
Date of
Death
1
190
66
Лении 2
aug 10,1908
No.
50
E
PERMIT. FOR TRANSIT. Via Reid Newfoundland Company.
Form 142
In the town of .. .
Le Iskus.
.. District of ..
august 15
. . 190 g
Permission is hereby given to remove the remains of ...
aged.
63
. who died at.
on the.
13
day of Iluz (City, or 'Township an District.) .190 8 The cause of death being ... "Hemiplegia
cerebral haunon , have which is but an wifechino .disease,and a Transit Permit being asked for burial at.
Name of Undertaker :
Signed by
1
NAdjof Medical Attendant :
(Official Title.)
a Milf
(P. (). Address.)
mese
. in the Province or State of.
Chancery
destination.
Form
BACK.
Colony of .
Date
I Hereby Certify, That the body of.
named in this transit p 1
has been prepared by me for transportation by being.
Province of.
(Signed)
Undertak
County of
On this.
day of.
A.I)
before me, a.
(Notary Public, Justice of the Peace), in anu yo Colony of Newfoundland aforesaid, personally appeared.
to me known, and made oath and said that all of the statements contained in the foregoing are true.
Sworn and subscribed to before me this.
day of. A.D
[SEAL]
Undertaker's Affidavit-Infectious or Contagious Disease.
Permit No.
11229
RETURN OF DEATH. BOSTON, MASS.
Date of Death, August 13 190
Name in full,
00 6tiza Chancer
(If married or divorced woman give maiden name, also name of husband.)
Condition, Sex, finale Color,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, 63 Years,. Months,
Days. Occupation,
Residence,*
Place of Death, f+ John hfd
(State year, month and day.)
Place of Birth,
Date of Birth,
..........
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
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