USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 16
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30
Residence, *. 112 Buchanan It Ward,
Place of Death, ....
Bouchie M.S.
Win Chron
(State year, month and day.)
Place of Birth, Harbour, Bondk NJDate of Birth,
Name and Birthplace ? Percy+ Richard
Hermouth Masa
of Father,
Maiden Name and Birthplace of Mother,
Elizabeth Bouvier Guyshora elf.
Place of Interment, Int Benedict
Those I Lane
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age?
Boston,. Jan. 11 1909
mos of Deceased, John E. Richard Age, 2 years.
I hereby certify that I attended deceased from ow Jaw 11 1909 , to
190 , that I last saw him alive on the Lederenthe day of
January 1909,
that.
.died on the ...
eleventh
day of.
January
1909, about /0 . 45 o'clock
A.M., OF PH., and that, to the best of my knowledge and belief, the cause of.
Chief cause,
Disease 3 Contributing cause,. Imanitini
Chief Cause,
Duration Contributing cause,. 2 mos Byam Hollings. M. D.
his death was as follows :
· If an Institution, state how long an Inmate and previous residence.
-
John & Richards. aw11-1909.
[4-'07-37-LM.]
Permit No.
RETURN OF DEATH.
Cintenofo
BOSTON, MAŞS.
Name in full,
Date of Death,.
ohn radkmonth
January 13" 1909.
(If married or divorced woman give maiden name, also name of husband.)
Sex, Moale Color, Arhite -
(White, Black, Mixed, Chinese, Indian, etc.) Condition, Wanied
(Single, Married, Widowed or
Divorced.)
Retired
Age, 88 Years, 2 Months,
Days. Occupation,
Hard,
Residence,*
Place of Death, 25 mg Quintero Street
Mary "1820
(State year, month and day.)
Place of Birth,
Durchany Mass Date of Birth,
Name and Birthplace ! Johan Wadzeout = Lavthuy Dass
Lydia Perry - Plymouth Mark
of Father, Maiden Name and Birthplace of Mother, Place of Interment, Maryland Cemetery = Duphuy 2hass Dannel floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Minttirolo Boston,.
January
1909.
Name and Age ?
of Deceased, John Hadsmith Age,. 88 years.
I hereby certify that I attended deceased from.
18.78 190 , to (an 13
1909, that I last saw
alive on the. 13" day of. January 190 9,
that. .M died on the. 13 day of 1909, about 12 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. was as follows:
death
Disease ‹ S chief cause,.
old age
. .... ...
Duration
Contributing cause, Chief Cause, ..... Contributing cause, ( 3 ) Install M. D.
* If an Institution, state how long an Inmate and previous residence.
221
John tradsworth Jan 1 3-1909
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of l
46. Bartlett Roach
Death *
Residence
Age
66
. years ..
10
.. months. 5 .days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE #
Portugals Jul
Florence
NAME OF
FATHER
BIRTHPLACE OF FATHER$
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
1
OCCUPATION
Returer
INFORMANT §
Wife
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last iliness, from Der. 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 :
14
" .... (OURATION). .... OAYS
Contributory :
15Mg
(DURATION) . DAT8
(Signed)
Charles Grado,
.M.D.
thing 15 ,00.
.190 7 (Address)
SPECIAL INFORMATION only for Hospitais, 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.
1 in case of married or divorced woman, or widow.
1 Slate or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
AVANTI
ALL NAMES TO BE IN FULL
..
....
Inn 9911
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
1/17
1909.
ADDRESS
UNDERTAKER
ER Beno
Manuely Sus
Registered No.
Date of
Death
14 1909
manuel JLewis Jan 14 -109
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winthrop 1
(CITY OR TOWN.Y
FULL NAME
Mary Upton
Haskell
Place of l
133 Washing on QUE Winthrop
Death *
Residence
4
Age
78
.years.
7
months. 25 .days
STATISTICAL DETAILS
SEX
Finale
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME Ť
Mary Upton Black
HUSBAND'S NAME Charles Haskell
BIRTHPLACE #
Ellsworth Maine
NAME OF
FATHER
John Black
BIRTHPLACE
OF FATHER$
Ellsworth Marine
MAIDEN NAME
OF MOTHER
Do not know
BIRTHPLACE
OF MOTHER$
Do not from
OCCUPATION
INFORMANT §
Gdw. a. Pues
133 Washington avr Wanttrop
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Jan 5 1909 to Jan 15 .1909, that to the best of my knowledge and beHef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary :
(DURATION).
10
OAYS
Contributory :
Old age
(Signed)
Tery G Kowy
M.D.
Jan 16 90
1900 (Address)
28 Sacatanto
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 ; aiso city, town or county, if known.
§ Name and address of person giving statistical details. I[ Name of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !!
Fairview Genety Hyde Park
DATE OF BURIAL
UNDERTAKER
Mass
190.
ADDRESS
.Registered No.
Date of ¿
Jan. 15, 1909
Death
1
(DURATION). DAYS
.8
Inary Upton Haskell Jane 15, 1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
Death *
105 Bartlett Road
Residence
Winchoto mars
Age
47
.years.
months. .days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Marred
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Wabash. And
NAME OF
FATHER
albert Clough
BIRTHPLACE
OF FATHER#
Noulfloro n.H
MAIDEN NAME
OF MOTHER
Underon
BIRTHPLACE
OF MOTHER #
OCCUPATION
Broken
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
1/18
190.
UNDERTAKER
CR Benmoi
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last illness, from ... Jan 1 6 1909- to fa 16 190 ..... , that to the best of my knowledge and beiref death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
apoplexy
12km
(DURATION). DAYS
Contributory :
(Signed).
Bilheteall
(DURATION). .... . DAYS
M.D.
m18
...... 190.2 ... (Address)
Wantof 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 detalls. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Thomas. a. Clough
Registered No ...
Date of l
Jan 16
190 2
Death ) ..
long
9 Thomas Clough Sau 1 6, 1909
[1.'09-37-XXXM.]
Permit No. .......
RETURN OF DEATH. BOSTON, MASS.
Date of Death, .... Jan ..... 16, .... 1909.
.19
.
Name in full, Abraham M. Dunbar.
(If married or divorced woman give maiden name, also name of husband.)
Sex, Male Color, ..... White
Condition, .. Widower
(White, Black, Mixed, Chinese, (Single, Married, Widowcd or
Indian, etc.)
Divorced.)
Age, .73 Years, II Months, ... 16 Days. Occupation, Retired.
Residence, *. 95 Hermon Street, Winthrop. Ward,
Place of Death,.
95 Hermon Street, Winthrop.
Place of Birth,
Boston, Mass:
Date of Birth, ..
Jan ...... 3I, ..... 1835
Name and Birthplace ! of Father,
Joshua B. Dunbar. --- .Unknown.
.........
Maiden Name and Eliza Goldthwaite, --- Unknown.
Birthplace of Mother,
Place of Interment,
Winthrop, Mass:
* If an institution, state how long an inmate and previous residence. E. Q. Brown. Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age ?
Boston,
Jam 16
1909.
of Deceased, abraham Mr. Dunbar Age, 73 years. /12 may 1908, to Jany
I hereby certify that I attended deceased from.
1909 , that I last saw
alive on the 150 day of. Samy190%
that died on the. 16 day of. Jony 1909, about 6.30 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:
Chief cause, Cancer of Stomach
Disease Contributing cause, .....
Chief Cause,. about one year
Duration
Contributing cause,.
M. D.
...
MT" PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
21
(State year, month and day.)
LIST OF INDEFINITE TERMS WHICH SHOULD BE AVOIDED IN GIVING CAUSES OF DEATH.
Acute gastritis. State cause. Was it due to some irritant poison ?
Ascites.
Name disease causing ascites. See "Dropsy."
Asphyxla. How? Was it accidental? If so, state fully the nature of the accident. If by gases or poisonous vapors, give particulars. Was it a case of "overlying" (child) ? What disease caused this condition?
Asthenia.
A
practically worthless statement. See "Debility."
What was the cause?
Atrophy. What caused the atrophy? Was it tuberculous wasting (phthisis) ? Was it syphilis? What organ or part atrophied ?
Blood polsoning.
Do you mean septicemia, syphilis, or any other definite Was it disease? If septicemia, what was the cause? puerperal?
Chronic pneumonia.
Congestion of lungs.
Was it acute bronchitis, broncho-pneumonia, or lobar- pneumonia? If so, state definitely. Was it passive or hypostatic congestion? If so, name disease causing the condition.
Convulsions.
What caused the convulsions? Were they epileptic, puerperal, or caused by diarrhea or enteritis (infants) ? Name the disease in which the convulsions occurred. "Convulsions" are mere symptoms and should not be given as equivalent to a proper statement of cause of death.
Debility.
What caused the debility? Name the acute or chronic disease. Debility might follow typhoid fever, diph- theria, tuberculosis, Bright's disease, and a host of other causes. The return is worthless and should never be made.
Dentition.
What was the disease causing death of the teething child ? "Dentition" is not a proper cause of death, and, like "infantile" and "old age," does little except to mark the approximate age of decedents.
Dropsy.
Was there organic disease of the stomach or other organs? If so, name the disease causing death.
Eclampsia.
Edema of lungs.
Give cause. See "Congestion of lungs."
Gastric fever.
A worthless return. Was it acute gastritis (q. v.) or some definite form of fever, as typhoid, malarial, etc .?
General paralysis.
If extended paralysis resulted from cerebral hemorrhage, the cause should be given and the expression "general paralysis" should be avoided. "General paralysis" should be written only for "general paralysis of the insane," or paretic dementia, and the statement of the fact of insanity should always be included.
Heart failure.
What disease caused the "heart failure"? The heart always "fails" before death from any cause. Ве раг- ticularly careful that deaths from diphtheria, tubercu- losis, etc., are not so reported. If organic heart disease is meant it should be so stated.
Hemorrhage of lungs.
Hypostatic congestion.
Imperfect nutrition.
Inanition.
This is a particularly pernicious term and is responsible for a multitude of worthless certificates. It sounds as if it meant something definite, but, in the majority of cases, it does not. What disease caused the inanition ? Was it syphilis, tuberculosis, cholera infantum? If inability to take food, state cause.
Infantile asthenia. See "Asthenia." The term "infantile" adds no precision to an indefinite statement.
Infantile atrophy.
Malassimilation.
What disease caused the malassimilation?
Malnutrition.
What disease caused the malnutrition ?
Marasmus.
What disease caused the "marasmus" ? Was it due to tuberculosis, syphilis, or cholera infantum? State fully, as this return in itself is practically worthless for compilation.
Meningitis. Was it epidemic cerebro-spinal meningitis? If so, write exactly in this form Did it follow scarlet fever, pneu monia, or some acute infection? If so, name the pri- mary disease. Was it traumatic? If so, state the nature of the violence which caused the meningitis Was it tuberculous meningitis?
Nephritis. Was it'acute or chronic? If acute, occurring in the cours of some disease, name the disease causing death.
Old age.
This is not a satisfactory return. The influence of age is shown by the statement of age in years, months, and days. To this the statement of "old age" as a cause of death adds nothing of value. Name the disease to which the old person succumbed.
Peritonitis. . What was the cause of the peritonitis? "Idiopathic peri tonitis" should be rarely returned.@ Was.it puerpera or traumatic? In the latter case, state mode of injury
Pernicious anemia.
If any definite cause can be assigned for the anemiaN
should be reported. Anemia due to tuberculosis, syph
ilis, etc., should be returned under the primary disease
Pneumonia. Specify definitely whether broncho-pneumonia or loba pneumonia. If sequel to influenza, state that fact.
1
Pyemia. What caused the pyemia? Was it puerperal or trau matic? If traumatic, state nature of accident causin injury.
Senile asthenia. See "Old age" and "Asthenia." Give disease causin
death.
State disease causin
Senile atrophy. See "Old age" and "Atrophy." death.
Senile decay.
See "Old age." State disease causing death.
Senile decline.
See "Old age." Name the disease, if any, that caused th
decline.
See "Old age" and "Marasmus."
Senile marasmus.
Name disease causin
death.
Shock.
What caused the shock? If from injury, state nature accident. If from surgical operation, state disease injury requiring the operation.
Surgical operation. Surgical shock.
3
Always state the disease or injury requiring operation Unless the operation was improper or unskilfully per formed, it should not be given as the primary cause death.
Teething. Name the disease affecting the teething child. See "Den tition."
Toxemia.
Was this acute or chronic poisoning due to some externa agent? Was it auto-intoxication, due to poisons ger erated in the body by disease? If so, state the nam of the disease.
Tuberculosis. State organ affected. Do not fail to state as pulmonar tuberculosis if lungs were affected.
Tumor. Was it a cancer ? Whether a cancer or tumor, do not fa to specify organ or part of body affected.
Typhold condition.
Avoid this term as it is likely to be mistaken for typhoi
fever.
Typhoid pneumonia.
Was the primary disease typhoid fever or pneumonia ?
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? A mix ture of these diseases rarely occurs, the great majorit of cases of so-called "typho-malarial fever " being noth ing more nor less than typhoid fever.
Dyspepsia.
Name the disease in which the "dropsy" occurred.
Give cause of convulsions. Were they puerperal?
Was this not due to pulmonary tuberculosis? If so, the primary cause should be reported without fail.
Name the disease causing the passive or hypostatic con- gestion.
State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.
Was this not pulmonary tuberculosis?
See "Atrophy."
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
nathan&
nickerson
Place of l
Death *
80 Read St.
Residence
80 Read 20
Age
37
... years ..
months ..
.. days
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 : asphyxiation by Suspension Suicidal - . (DURATION). DAY8
Contributory :
(DURATION) .......... DAY8
ed) Senza Burgers magnet
.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 cemetory.
1180
Winthrop (CITY OR TOWY.)
Registered No.
Date of l
Death
1
Jan
16.
1909
STATISTICAL DETAILS
SEX
COLOR
male White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME $
.
BIRTHPLACE#
Harwich Mass
NAME OF FATHER Nathan E. Niekeren
BIRTHPLACE
OF FATHER$
Harwich mare
MAIDEN NAME
OF MOTHER
Rebecca Gorham.
BIRTHPLACE
OF MOTHER
Otarwich mais
OCCUPATION
Salesman
INFORMANT §
Jis nie Reizen
( Site )
PLACE OF BURIAL OR REMOVAL !!
Hamich Mare
DATE OR BURIAL
Jan 19.
. 190 ..
UNDERTAKER
Summer Fryd
ADDRESS
1180=
nett & horbesson 11 nathan tenickerson Jan 16, 190 9
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Samuel et, Brass
.Registered No .. 12
Place of
1
16 Schouten Pink
Death *
S
Residence
filtro1. mars
Age
68
.years.
7
months 2 1
.days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE;
Oleringfield Vermind
NAME OF
FATHER
Mais Rogus
BIRTHPLACE OF FATHER$ Hartland Vermont
MAIDEN NAME
OF MOTHER
Larinda Bemús
BIRTHPLACE
OF MOTHER#
Un Rizoma
OCCUPATION blue battle Bineau
INFORMANT § Daughter
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jany 23 1909 to Jouy 25 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 :
Chronic Interstitial naple
ritis and chronic valuela
Heart Disease , several years
(DURATIONO
.. DAY8
Contributory :
Broncho primera
.(OURATION).
3
DAYS
(Signed)
Johnson
M.D.
Jury 26 1909 (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
Cleri
* City or town, street and number, If any. If death occurs away from USUAL RESI DENCE, give facts called for under "Spoclal Information." If In a Hospital o Institution, giva Its NAME Instead of street and numbor.
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 BURIAL OR REMOVAL#
UNDERTAKER
n
6 Summer land
DATE OF BURIAL 2.28 190 9
ADDRESS
0
Date of ¿
Slan 25 190
9
Death
12 Samuel n. Rogers Saw 25.19/09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
William Henry Heway
Registered No.
13
Place of
#26 Reddy L'élect
Death *
S
Date of ¿
1 Jun 20
190
Death
Residence
Age
54
.. years
3
months. 12 days
STATISTICAL DETAILS
SEX Male
COLOR
Mute
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widow
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE#
NAME OF
FATHER
Williani S. Hemay
BIRTHPLACE
OF FATHER$
Freland
MAIDEN NAME
OF MOTHER
Kacherane J'lavere
BIRTHPLACE
OF MOTHER $
OCCUPATION
INFORMANT $
Liste
miss frances.
Iting
PLACE OF BURIAL OR REMOVAL I Orleans Man
DATE OF BURIAL
1/30
190.
UNDERTAKER
CRBinmon.
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 200. 15 1909 to Jen- 28 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 :
bari
of areall
(DURATION). DAYS
Contributory :
(DURATION). .DAYS
(Signed)
M.D.
. ~ / 190 9 (Address)
Marchioh.
SPECIAL INFORMATION only for Hospitais, 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 numbor.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Namo and address of person giving statistical detalls. Il Name of cemetery.
ALL NAMES TO BE IN FULL
13
Face 28- 1909
COMMONWEALTH OF MASSACHUSETTS
Belmont
(CITY OR TOWN.)
FULL NAME
Place of
1
McLean Hospital, Waverley
Death
Residence
Mack,
Age.
47
.. years.
7
months.
3
.days
STATISTICAL DETAILS
SEX
Male
COLOR
while
SINGLE, MARRIED, WIDO VED, OR DIVORCED
Manner
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE $
Cambridge
NAME OF FATHER Firmas S. Clarkson
BIRTHPLACE
OF FATHER$
Scotland
MAIDEN NAME OF MOTHER
Helen 211. Zadalt
BIRTHPLACE OF MOTHER $
Cambridge
OCCUPATION Tobacco Dealer
INFORMANT §
arthur blackson
PLACE OF BURIAL OR REMOVAL H Cambridge Con
DATE OF BURIAL
Feb. 7 1909
NDERTAKER mens Litchfield
ADDRESS
Cambridge
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 2 . 1909 to 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 : Lobar Pneu na
6
(DURATION).
OAYO
Contributory :
General Paralisi 5heures (DURATION). .. DAYO
(Signed)
& Stanley abbot
.M.D. Heb 4 1909 CA
Ms Lean
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death ? . years. .................. months. 2 days
Where was disease contracted, If not at place of death ?
Filed
Feb. 5,1909 Chan Houlaban
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for undor "Spocial Information." If In a Hospital on Institution, give Its NAME Instead of street and number. 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
RETURN, OF A DEATH Johny Clarkson
Registered No ..
16
Date of l
Death S
190
4
...
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
LorenZina Casodiluna
Place of l
Death *
1
Winthrop-Mass
Residence
26 Central St.
Age
28
.. years.
5
.months. 26 .days
STATISTICAL DETAILS
SEX Female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
verce wife of Michele Capo dilugo
BIRTHPLACE # Staly - Taurasi
NAME OF FATHER Raffaele Vesce
BIRTHPLACE OF FATHER# Italy - Taurasi
MAIDEN NAME
OF MOTHER
Javeria Fierro
BIRTHPLACE OF MOTHER+ Italy - Taurasi
OCCUPATION
At Home
INFORMANT S
Angelo Jannini
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. 1) a- 24. 190.9 ... to fet 7 1905 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)
16
DAY
Contributory ?
.(DURATION). .DAY
(Signed)
M.D.
190 ...... (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death ? .years.
16
months.
days
Where was disease contracted,
per forma
If not at place of death ?
Filed
190
Clerk
PLACE OF BURIAL OR REMOVALI
DATE OF BURIAL
2 Poly Gross.walder ter. 8 -1909
...
UNDERTAKER
11. Cangiano
ADDRESS
* 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, glve Its NAME Instead of street and number.
t In caso of marrled or divorced woman, or widow. # State or country| also clly, 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 l Тев. в. 190 9
Death
14
Lorenzuia Capacilupo Feb-6-1909.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Franceo. D. Khimaly
Registered No.
Place of
Death *
5
17 Hulchacón LI-
Residence
Age
.years ..
months. days
STATISTICAL DETAILS
SEX
COLOR
vituti
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
NAME OF
FATHER
Francis. D. Kennedy
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
anna. I. Welch
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 190.7 ... 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 :
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.