USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 15
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was as follows:
Disease ? Chief cause, Anfange et developance totheart
Contributing cause,
tz
Duration
Chief Cause Did not Legeri Return until D ce 7 h Contributing cause, Co Brandun 3/ 4 Pouce - M. D.
* If an Institution, state how long an Inmate and previous residence.
0021
2
/2 Days. Occupation,
Ward, ulturof
le (State year, month and day.)
Name and Age ?
Mitters now 22, 190$
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Rathavens. 2 Halen,
Place of l
65
Court Road
Death *
5
Residence
u
«
Age
72-
.years.
3
months.
11
.days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR> DIVORCED.
MAIDEN NAME +
Ruthuford
HUSBAND'S NAME +
Navide
BIRTHPLACE # Киш Вночичек
NAME OF
FATHER
David Ruchuford.
BIRTHPLACE
OF FATHER+
Ecoliana.
MAIDEN NAME
OF MOTHER
Pública Thatare.
1
BIRTHPLACE
OF MOTHER $
Leackand.
OCCUPATION
INFORMANT §
Laughter un Triestina
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
N . c St 1902
ADDRESS
UNDERTAKER Char R Buisson With
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190X .... to nor. 29 thec: 2 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 :
.(DURATION).
4
DAY8
Contributory :
a
(DURATION)
DAY8
(Signed)
M.D.
190 ...... (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 detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
.Registered No. Date of { if ec 2
Death
S
0
100 Lathering L. Mation Decv-1908
|4.207.37.I.M. |
Permit No.
RETURN OF DEATH. BOSTON, MASS. Windho/ 11/a
Date of Death,
Name in full,. Ella, UJ. Drinkwater Widow of Thor. O. Drinkwater (If married or divorced woman give maiden name, also name of husband.)
...
Sex, Color White
(White, Black, Mixed, Chinese, Condition, ..
Indian, etc.)
(Single, Married, Widowed or Divorced.) Age, 53 Years, " Months, / Days. Occupation,
Residence, * 36 Temple are
Ward. 221 us.
Place of Death, 36 Temple as
(State year, month and day.)
Place of Birth,.
Date of Birth, Jan 6. 1855.
Name and Birthplace \ Same. G. Sohuszon Carsontill nice
of Father, Maiden Name and Sarah, 8. Encore no. Kennebunk THE
Birthplace of Mother,
Place of Interment, Biddeford 2225
Celas. R. Peux.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
whichit wor
Boston, Dec 6 9 190.0.
Name and Age ? Ella, 13. Sunkuvalu
Age, 5-3 years.
I hereby certify that I attended deceased from Mar. 29 190 8, to Dea. S
190 8, that I last saw Les alive on the. ef Ch day of 190S
that She died on the 0 day of 190 , about 4,15/o'clock. /10
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of .... her death was as follows :
Chief cause, ...
( Contributing cause,
- cocco. ......
Chief Cause, 15 22000 ....
Duration
Contributing cause, n
M. D.
· If an Institution, state how long au Inmate and previous residence.
21
,
Braut
Disease
of Deceased,
Della B. Drinkwater Dec 5-1908
[4-'07-37.LM.]
Permit No.
RETURN OF DEATH. Hunthe BOSTON, MASS.
Date of Death, Dec. 10, 1908. 190
Name in full, Margaret S. Sparklin
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color White Condition, Single
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Indian, etc.) Divorced.)
Age, 30 Years, 5 Months, 5 Days. Occupation, Book-Keeper.
Residence, *.... 8I Somerset Ave; Winthrop, Mass:
Ward,
Place of Death, Metcalf Hospital, Winthrop, Mass:
Place of Birth, Cordova, Md:
Date of Birth, July 5, 1378.
Name and Birthplace ? Eugene
Talbot Co; Md:
of Father,
Maiden Name and Mary Hardesty,
Talbot Co; Md:
Birthplace of Mother,
Place of Interment, Winthrop, Mass:
65 Browse to lon.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winitrung Boston
190 8.
Name and Age ?
of Deceased, Margaret & Sparkling Age, 30 years.
00 years.
I hereby certify that I attended deceased from JEc 9 1908 , to. Dcero
190 8, that I last saw her
alive on the. 100
day of 1908.
that she died on the 100% day of 1908, about /2.55 clock her .t.M.,or P.M., and that, to the best of my knowledge and belief, the cause of. death was as follows :
Chief cause,
Strangulated Uterine Fibroid
Embolism (Pulmonary) 36 hours
* If an Institution, state how long an Inmate and previous residence.
Disease ? Contributing cause, Chief Cause, Duration Contributing cause, a few minutes tobuy mitchell M. D.
(State year, mouth and day.)
ـيب
JIU.
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Charles. R. Gardner
Registered No ..
Place of ?
Death * S
Residence
Age
. years.
3
6
.months. .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED OP DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE#
NAME OF FATHER
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER Sarahs be. com
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT §
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 :
(DURATION). .... . DAY8
Contributory :
(DURATION). .. DAY8
(Signed).
M.D.
190 ..... (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 cccurs 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 j also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
AL' NAN 3 T. JE
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
190.
UNDERTAKER
ADDRESS
Date of lee13.
Death
.190
71
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
James Edward Manning Bigelow
Registered No.
Place of Death *
Metcalf Hospital Writtenby Mars
Date of Death.
Sec 14. 1968
Age
42
. years
4
.. months
3.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE #
E. Baston mass
NAME OF
FATHER
James Edward Manump
Bigelow
BIRTHPLACE OF FATHER$ Waterville me
MAIDEN NAME
OF MOTHER
Sarah E. york
BIRTHPLACE
OF MOTHER +
Durham d. H.
OCCUPATION Treasurer
INFORMANT §
Isabel Bigelow
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
10
190 8 .. to
14
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 :
appendiatro
5
Contributory :
Perforation A apprendre
(DURATION).
.DAYS
(DURATION). DAYS
(Signed)
Ben H mutcall
M.D.
De 15 1908 (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
Former or
59 Sunt any
Usual Residence
How long at
Place of Death ?
4
Days
Where was disease contracted,
If not at place of death ?..
at home
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 marrled or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemetery.
ALL NAMES TO BE IN FULL ......
PLACE OF BURIAL OR REMOVAL !! & Kenwood Everett
DATE OF BURIAL Sec 16
8
190.
UNDERTAKER
ADDRESS
103
Javier lavaw Mowing Dee14-1908
Bigelow
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winthrop (CITY OR TOWN
FULL NAME
Fred W. Poole
Registered No.
Place of )
Death *
S
114 Hermon St
Date of
Death Dec. 16 (1) 190 8
Residence
S
Age.
52
.years
months.
.days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t HUSBAND'S NAME +
BIRTHPLACE #
Hallowe mass
NAME OF
FATHER
Francis H, Poole
BIRTHPLACE
OF FATHER
Davis me
MAIDEN NAME
OF MOTHER
mary a Broad
BIRTHPLACE
OF MOTHER
OCCUPATION
RR GateTender
INFORMANT § Droite
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that ndod deceased during last illness, from ... .................. .... 190 ..... to
.... .......... 19 ....... , 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 : Pistol Short wound ofthe head, Sundal AYS Contributory :
(DURATION). ... DAYS
(Signed)
George Burgers Paragath
M.D.
190 ...... (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 detalis. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !!
Dedham mas,
DATE OF BURIAL
21020
190
8
UNDERTAKER
SiFloyd
ADDRESS
113
104
2
Dec 16-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Without
(CITY OR TOWN.)
FULL NAME
Emma.
C. Rich
Registered No. 470
Place of l
wondhook 1986
Death * S
Residence
) y Orlando are
Age
70
years.
months. 24 .days
STATISTICAL DETAILS
SEX
Jemals
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE #
So arringtonme
NAME OF
FATHER
Richard Hohan
BIRTHPLACE
OF FATHER #
To Quenylonthe
MAIDEN NAME OF MOTHER mary Wentworth
BIRTHPLACE OF MOTHER $/?
OCCUPATION
INFORMANT § Dampblir
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. De 18
190 ..... to the 24 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 :
(OURATION).
. DAYS
Contributory :
(Signed)
31 mutcall
M.D.
Slee 27 100g (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
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
12/28
190 ......
UNDERTAKER C. R. Benman
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information," If in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country: also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemotery.
ALL NAMES TO BE IN FULL
Date of l Dec 24 190
Death
1
(DURATION). . DAY8
106 виша С. Кив Des 24-1908
COMMONWEALTH OF MASSACHUSETTS
M.
C
RETURN OF A DEATH
(CITY OR TOWN.) 468
FULL NAME
Edwin Cooper I lobes
Registered No ..
Place of )
Date of ¿
Que 25
Death
S
190
Death *
5
Residence
tranchent mais
Age
47
>
years
.months. X .days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manuel
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Noodling n.J.
NAME OF
FATHER
Eduori Hotas
BIRTHPLACE OF FATHER # Woodbury n.J.
MAIDEN NAME OF MOTHER Machen Cooper
BIRTHPLACE OF MOTHER #
OCCUPATION Saulesman
INFORMANT §
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from nov, 2 1908 to Dec 25 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 : Hodgkinsdisease
about threemonths
Contributory :
Exhaustion
(DURATION). ..... ........ DAY8
(Signed)
Edu. Mito
M.D.
Dec 25 190 %(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. 1 State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
12/28
190.
UNDERTAKER
ADDRESS
107 Dec 25 Edwin Carper Stripes 1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.) 469
Place of
Death *
Residence
30 Levis Cover
Age.
60
years.
10
.months.
26
days
STATISTICAL DETAILS
SEX
Mule
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Manuel
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE#
NAME OF
FATHER
George W. Turksby
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Johannala Warte
BIRTHPLACE
OF MOTHER
Malden mais
OCCUPATION
INFORMANT § Woke
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Dec. 10 908 to Dec. 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 :
Cerebral Hemorrhage
16
(DURATION).
DAYS
Contributory :
Pulmonary
(DURATION)
2
. DAY8
(Signed)
M.D.
Dec.
20 1900 (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
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
Wwwthat Really-12/201
190.
UNDERTAKER
CR Bemun
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country, also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME
Horace. W. Dukesbury
Registered No.
Date of ¿
Dec 26
190 ₽
Death
108 Dec 26 Herace of Turkishany .
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Minethat
(CITY OR' TOWN.)
FULL NAME
Hmmm. I. Thompson
Place of )
Death *
5
Death
Residence
Age
68
.. years.
x
months ..
.days
STATISTICAL DETAILS
SEX
-Male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manuel
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE # Wandson mass
NAME OF
FATHER
Egna. Thompson
BIRTHPLACE OF FATHER# Wareson Mass
MAIDEN NAME OF MOTHER angelini Barbon
BIRTHPLACE
OF MOTHER#
Wurdeon Mars
OCCUPATION Kelive C
INFORMANT §
PLACE OF BURIAL OR REMOVAL II Dallas-mar
DATE OF BURIAL
12/20
190 ...!
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Oct 31 at 1908 ... to Dec. 26 th 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 : General hustrudia
(DURATION) 5
.DAYS
Contributory :
Carcinoma el intestino
1
(DURATION) laut
.. DAY8
AY8
(Signed)
Buona Hollier
M.D.
Dec. 26
1908 (Address) 267 Washington ave
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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Registered No.
5-3 Sum
Date of ¿ lec 26 19085
×
109 Dec 26 Drury E. Thompson
[4.'07-37-LM.]
Permit No. 42-
RETURN OF DEATH.
Hinttrop =
BOSTON, MASS.
Dec 29" 190 8
Name in full,
Sex, male Color, White Condition,
(White, Black, Mixed, Chinese, (Single, Marrled, Widowed or Divorced.)
Indian, etc.)
Age, ~Years, 8 Months, 16 Days. Occupation,
Residence,* Starthiof Wars
Ward,
Place of Death, 410 Shirley Sheet
Place of Birth, Anthrop Maes Date of Birth,
(State year, month and day.)
Name and Birthplace ? of Father,
John FlanaganIreland
Maiden Name and Birthplace of Mother, Place of Interment,
Elizabeth Fawcett= Ireland
Summer lefloid) Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, December 39" 1908.
of Deceased, John C. Flanagan Age, 8 years.
mix 16 da
Name and Age ?
I hereby certify that I attended deceased from. Dec. 20th, 208, Dec. 29 ch
190 , that I last saw N alive on the. 29. day of 1908,
that died on the 24 day of Dec. 190 , about 10 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, Dna.
Chief Cause, 13 days.
Duration
Contributing cause, .. IL Porte M. D.
* If an Institution, state how long an lomate and previous residence.
21
Date of Death John Elliot flanagan
(If married or divorced woman give maiden name, also name of husband.)
Flere Elliot Flanagan Dec 29-1908
[4.'07-37-LM.]
Permit No. 1-9/1909
RETURN OF DEATH.
BOSTON, MAS$.
Kannauj !"
190
9.
Name in full,
Date of Death,
Frank Godward Jemand
(If married or divorced woman give malden name, also name of husband.)
Sex, Male Color, thile Condition,
(White, Black, Mixed, Chinese, Indian, etc.) (Single, Married, Widowed or Divorced.)
Age, Years, Months, l ... Days. Occupation,.
Residence,*
Ward,
Place of Death, 439, Scritturafo Streel
Place of Birth, Winthrop mass
(State year, month and day.)
Date of Birth, De031/1908
frank Leonard = Johnson City-venn
Name and Birthplace \ of Father, Maiden Name and Wand E. Genge= Stinttrop Mass
Birthplace of Mother, 5
Place of Interment, Stinthat Cemetery
ummer@lord
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Anthropo Boston Januar
1909
1 day of Deceased, Frank E Le ernand Age, years.
I hereby certify that I attended deceased from. Dec 31 190%, to Jan 125
1909 , that I last saw 1. alive on the 1 ex-
day of Jan 1909,
that
died on the.
day of
Jan
1904, about
7 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 : Premature infant-
Disease ‹ - Chief cause,
...... Contributing cause,.
Chief Cause, ....
Duration Contributing cause, Narace 80ml
M. D.
· If an Institution, state how long an Inmate and previous residence.
21
Name and Age ?
he
14-
parks durand derwand
Jan 1-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Welchw/
(CITY OR DOWN.)
FULL NAME
Wendell. Francis
Bucc
Registered No ..
Date of l
Death *
S
Residence
Worthing ton
Age
.years.
5-
.months. 14 .days
STATISTICAL DETAILS
SEX
m.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
.S.
MAIDEN NAME t HUSBAND'S NAME +
BIRTHPLACE #
aston Dass
NAME OF
FATHER
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
Blanch Lillian Wakefield
BIRTHPLACE
OF MOTHER #
OCCUPATION
School Boy
INFORMANT § Jacher
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from 1 1909 to form. 6, 1909 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: Convulsions Primary : Urgencia
. (DURATION).
1
DAYS
Contributory :
Search Fever
(DURATION).
4
DAY'S
(Signed)
M.D.
Jan.
8
190 9(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
PLACE OF BURIAL OR REMOVAL II
MT Hohe Bouton-
DATE OF BURIAL
190
UNDERTAKER
CRIBeruna
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Place of
25 Tarteshay 54
Death
C
190
7
2 Strudele Francis Ball Jaw 6 - 1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
D Foster Farrar
Registered No.
56 87
Piace of Death *
33 Herman Lt
Date of Death
January 8 ix
Age
66
. years.
months
.days
STATISTICAL DETAILS
SEX
male
COLOR
While
SINGLE, MARRIED, WIDOWED; OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
-
BIRTHPLACE +
Boston Mass
NAME OF
FATHER
Daniel
BIRTHPLACE
OF FATHER +
Boston
MAIDEN NAME
OF MOTHER
Unknown Fisher
BIRTHPLACE
OF MOTHER $
Boston Mass
OCCUPATION
Relived
INFORMANT §
Laurence A. Sullivan
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from. Jan 2 1909 to Jau get 1909 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 Bronchitis
(DURATION) ...
DAYS
Contributory :
Valvalor Isent deseine
(DURATION) for queso
(Signed)
M.D.
San 9
1909 (Address)
55 Way way ans
tuto
With
man
SPECIAL INFORMATION only for Hospitais, 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 II
DATE OF BURIAL
Jan 10
190 .. 9.
UNDERTAKER
J.7. Sullivan
ADDRESS 358 Monter St Bughton Mars
* 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.
13 D. Foster Farrar Sau 8-1909
-
3.
201-3
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Capdelupo
.
Registered No.
Place of )
26 Center Ik Weichert Mais
Death *
5
Residence
26 Centi St
Sultan
Age
.. years
months.
days
STATISTICAL DETAILS
SEX
COLOR
While
SINGLE, MARRIED
WIDOWED, OR
DIVORCED
babe
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
Vietato mais
NAME OF
FATHER
Michal Capodilupo
BIRTHPLACE
OF FATHER+
Haty
MAIDEN NAME
OF MOTHER
Lovingini Kisces
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § Michal Copoacheter
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that 1 attended deceased during last illness, from 190.1 ... 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 : Salvam
(DURATION). .DAYS
Contributory :
Stillborn
(DURATION) . DAYS
(Signed)
M.D.
1909 (Address)
Winthrop
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 "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 detalls. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
190
UNDERTAKER
ADDRESS
Death
5.
Date of l
Jan 115
1909
4 Capaclupo Jan 11-1909
#319 months SL 930
[4.'07.37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, Jank 1909.
Name in full,
John @ Richard
(If married or divorced woman give maiden name, also name of husband.)
Sex,
Color
Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowcd or Indian, etc.) Divorced.)
Age, Years, 9 Months, 9 Days. Occupation,
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