USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 18
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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 cemotery.
(DURATION). ...... DAY 8
Death S
24 Jamie L' Lord march 1 -09
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH FULL NAME Cresciam I austin
(CITY OR TOWN.)
Place of l
95, Chiley avenue
Death *
S
Residence
avantno. 16 mass
Age
85
.. years.
months.
309 days
STATISTICAL DETAILS
SEX
male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widower
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE İ
Freutham mare
NAME OF
FATHER
Charles austin
BIRTHPLACE
OF FATHER $
Wrentham
MAIDEN NAME
OF MOTHER
Mlarguet Fragua
BIRTHPLACE OF MOTHER $ Mastraveland
OCCUPATION
Retired
INFORMANT §
nejchen
F. E. Gilune
ne
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from
med. 1 1909 to Jak. 6 .190.2 ... , 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 : attroma
. (OURATION)
.....
.. DAY8
Contributory :
Inctral' Requergelateria
(-KOURATION)
DAYS*
(Signed)
M.D.
Meh. 8
.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, givo 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.
§ Namo and address of person giving statistical detalls. Il Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Wrentham Massillon 9'
190 9
UNDERTAKER
ADDRESS
Summer Floyd Hinstrop
Registered No.
Date of ¿
march 6"
Death 1
25 Hillisen s. austin march 6- 09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Catherine & Cowen
Registered No.
Place of l
Death *
S
117 Buchanan It
Date of l
Mar. 6th
1909
Residence
117 Buchanan It
Age
16
years.
6
.months ....
2.4
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME
BIRTHPLACE # Dorchester
NAME OF
FATHER
Mathias
BIRTHPLACE
OF FATHER+
Boston Mass.
MAIDEN NAME
OF MOTHER
Catherine Delory
BIRTHPLACE OF MOTHER $ antigowish M.J.
OCCUPATION
INFORMANT §
none
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 1909. to Jan 11 Habich 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 :
Primary :
Tuberculosis of lunge
several monthsRATION)
DAY
Contributory :
Sam
(DURATION) DAY
(Signed)
Bram Holling2
M.D
Man 10 1909 (Address) 267 WashingtonQue M
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, streot and number, If any. If death occurs away from USUAL RESI DENCE, give facts called for under "Special Information." If In a Hospital o Institution, give Its NAME instead of street and number.
1 In case of marrled or divorced woman, or widow.
# State or country j also city, town or county, If known.
§ Name and address of person giving statistical details, || Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
que atherine Cowen
PLACE OF BURIAL OR REMOVAL II
Int Benedict
DATE OF BURIAL Mas !! 190.9
ADDRESS
UNDERTAKER Thong. Lane
120 Havrettem3,
Death
U
..... . . .....
26 katherine to Cowar. march 6 - '09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
abby a. Clement
.Registered No.
Place of l
Achtung Mars
Death *
5
Residence
24 Underlige Street
Age 5
Age ...
51
.years.
.. months.
STATISTICAL DETAILS
gax itemale
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME +
Clement
BIRTHPLACE#
Burlington Mass
NAME OF
FATHER
man's Na Langher
BIRTHPLACE
OF FATHER+
Unknown
MAIDEN NAME
OF MOTHER
Sally &, Bell
BIRTHPLACE
OF MOTHER #
OCCUPATION
Supr Telefetune
INFORMANT §
James Mc Loughlin
(inother)
PLACE OF BURIAL OR REMOVAL !! Cremation
DATE OF BURIAL
X
190
UNDERTAKER
DaumenFloyd
ADDRESS
Minthisp
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last
illness, from.
.........
190
.to
190 ..... , that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Malignant Turan
of cette
mesul >
(DURATION).
DAYS
Contributory :
.(DURATION) DAYS
(Signed)
M.D.
In-4. 10 1909, (Address)
SPECIAL INFORMATION only for Hospitals, lastitutions, Translents, or Recent Residents.
,
How long at Place of Death ? years.
.....
months days ,
Where was diseass 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, glvo facts called for under " Special Information." If In a Hospital or . Institution, give Its NAME Instead of street and numbor. t In case of marrled or divorced woman, or widow. # Stato or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
1
9
(CITY OR TOWN.)
Date of ¿
March 9"
Death
5
9
190
.days
27 Libby a. Clement march 9-09
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
William John Orcutt
Registered No.
Date of l
Mar 12Th
1909
Residence
Age
63
.years.
.. months.
= .. days ;
STATISTICAL DETAILS
SEX
Mace
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME t
HUSBAND'S NAME Ť
BIRTHPLACE $
Phill - Pa
NAME OF
FATHER
William John Orcutt
BIRTHPLACE OF FATHER$
MAIDEN NAME OF MOTHER
BIRTHPLACE
OF MOTHER $
OCCUPATION - Geluk
INFORMANT § Home Keeken
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during lastt illness, from 190 ..... .to .190.
.... ..... ,, that to the best of my knowledge and belief death occurred on the e date stated above, and that the CAUSE OF DEATH was as follows : :
Primary :
Cancer Mamach
.(OURATION)
.... DAY80
Contributory : ...
... (DURATION). .DAY88
(Signed).
M.DJ.
La 14 90G (Address).
SPECIAL INFORMATION only for Hospitais, Institutions, Transientss, or Recent Residents.
How long at Place of Death ? . years
.. months .. days
Where was disease contracted,
If not at place of death ?
Filed
190
Clerkk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Mar 15
190 .. 7.
UNDERTAKER
tel
ADDRESS
· City or town, stroet and number, If any. If death occurs away from USUAL RESI -- DENCE, give facts called for under "Special Information." If In a Hospital otr Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
¿ Stato or country; also city, town or county, if known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
Death *
S
Place of Į
146 Cliff are Worthof
Death 1
28 Willraine John Cent march, 2-1909
COMMONWEALTH OF MASSACHUSETTS
Worthrok
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Para. Louise Savory Martin
Registered No.
Place of
80 Throckets as. Wirtho Mass
Death *
1
Death
190
9
months
13
.days
STATISTICAL. DETAILS
SEX
female
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Swiscel
MAIDEN NAME t Cora. Louise martín
HUSBAND'S NAME t
BIRTHPLACE # Georgetown mars
NAME OF
FATHER
Windows Habe Savony
BIRTHPLACE OF FATHER$ Georgetown Mars
MAIDEN NAME OF MOTHER Louise Evelyn Raymond Such 17 1909 (Addres)
BIRTHPLACE
OF MOTHER
New. Shawarma
OCCUPATION
INFORMANT §
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
Mar 17AM
1909
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
1 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 : Cardiac Dropay
3 mois
(DURATION). DAYS
Contributory :
.(DURATION). . DAY 8
(Signed)
H.J. Porter
M.D.
Ministrohi
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 ?
· 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, glve Its NAME Instead of street and number.
t In case of marrled or divorced woman, or widow.
È Stato or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemotery.
Z
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Residence
. .
Age
53
.years.
Date of av 158
29
Cara Louise Harry martin march 15, 1909
FILL OUT WITH INK. THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Cambridge
FULL NAME
128 Trement
Death
Cambridge
§ Date of
lunch. 16
1909
Place of
Residence
No.
Street
City or Town
STATISTICAL DETAILS
Sex
Cotor
w
Single, Married,
Widowed or
Divorced
Olaiden Name
If a married or divorced woman or widow
Warm
Husband's Futt Name
Daniel
Birthplace
City or Town and State or Country
Denmark De
Futt Name of Father
Hace Waren
Birthplace of Father
City or Towu and State or Country
Maine
Maiden Name of Mother Hotely Juinby
Birthplace of Mother City or Town and State or Country Brentwood
Occupation at time
Informant's Name (Person giving statistical details)
No.
Street
City or Town
Elisabeth Fisker 75 Main Winthrop
Place of Buriat or Removat
Cemetery
Liwill
Undertaket's Name
Address
PHYSICIAN'S CERTIFICATE
I HEREBYCERTIFY that I attended deceased during tast Mich. 16 Tto
ittness, from
190 190 ; that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as fottows : ( If a soldier or sailor who served in the war of the rebellion both the primary and contributory causes of death, must be given)
Primary : Old age
(Duration)
Contributory :
acute dianhora
( Duration)
1 day
(Signed).
M. D.
(Address)
1129 Cambridge St Tamb.
* How long at
Place of Death ?
Years
.....
Monttis.
.......
Days
Usual Residence SPECIAL. INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Received at ofi Cian. 19 109
City Cterk .
Registered No 4/07
* Place of
Deattı
Name of Hospital or Institution, if any
No.
75
main
Street.
Winthrop
Age.
78
Years
11
Monttis
10
Days
Harriet StollingEN.
City nf
( 1/11 lith
Handelt Hellinger March 16 - 09
COMMONWEALTH OF MASSACHUSETTS
CHELSEA
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Rankin
Pileg to
Registered No.
14-5
Place of l
Chelocal mass Soldiera Home
Date of 2
Death
5
mar
1.6
.190
9
1
Residence
Winthrop,
naco
Age
75
.years.
.. months ..
20
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
m
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
Jaquelloro maine
NAME OF FATHER Leri K Rankin
BIRTHPLACE OF FATHER$
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER +
Sidney, maine
OCCUPATION Gracez
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 1
illness, from tel 18. 1909 to mar 16, 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 : Heart disease Chronic Primary :
intestinal -nephritis. Cristitia
(DURATION). DAYS
Contributory :
Cemarchage from
stomach
(DURATION). .. DAYS
(Signed)
Robert ( Blood
M.D.
rnav. It, 1909) (Address)
Soldiers' Marx,
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
-
.years.
.....
- ... months. 2.7 days
Where was disease contracted, if not at place of death ?
Filed priav. 19, 1909
Charles Htleaf
23,
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, er 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 II
J'aisurl'e
DATE OF BURIAL rural 19 1901
/
UNDERTAKER
ADDRESS
.
Death *
Jeleg 2. Rankings march 16 - 09
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH David 1. 2, Donald
FULL NAME
Place of Death
20 Harvard H: Huithrop, mais
Date of Death
mar 16 ª 1909.
Age
38
- years.
.months
days
STATISTICAL DETAILS
SEX Male
COLOR
SINUCISE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE +
Cape Breton A. S.
The . Mi Donald
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER hary stillwantto
BIRTHPLACE OF MOTHER $ Chpou Burton A. S.
OCCUPATION Teamotro
INFORMANT § White, Imant & SDuld
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190.5 ... 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 : meningitis
.(DURATION)
1
DAYS
Contributory :
(DURATION) DAYS
(Signed).
M.D.
mehil 1909 (Address)
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! Holy Cross, Malden
UNDERTAKER Franck V. mal oney
DATE OF BURIAL
Mav18- 1909
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, glve 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.
ADDRESSO , 350 Mariflush LA. Name of cemetery.
.Registered No. ..........
-.
30 David & m Dowald march 16-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWM)
FULL NAME
Menge Nr. SerPme
Registered No.
Date of l
Death
March 18 190g
Residence
55 atlantic Street
Age
.years.
2
months.
10
.days
STATISTICAL DETAILS
SEX
male
COLOR Othite 1
SINGLE, MARRIED WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
East Boston Mass
NAME OF
FATHER
George &s. Perkins
BIRTHPLACE
OF FATHER$
Berwick maine
MAIDEN NAME
OF MOTHER
Madalina J. merrill
BIRTHPLACE
OF MOTHER #
South Scituate Mars
OCCUPATION
Porcimative Engineer
INFORMANT §
mother
Madeline D. maria
PLACE OF BURIAL OR REMOVAL I
Hunnitrop Cometur
DATE OF BURIAL
190
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. mar 15 1909 ... to
Juan 18 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 : Cerebral apapiery
(DURATION)
3
DAY8
Contributory :
several years
(DURATION)
. DAYS
(Signed)
M.D.
Juan 19 1909
.(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, givo facts called for under "Special 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. È Stato 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 }
cintutor. Mars
Death *
S
31 Jeorge m. Perkeine march 18-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Strand a Magle
Place of
Death *
Residence
263 Main Street
Age
61
.. years.
2
.months. 21 .days
STATISTICAL DETAILS
SEX
COLOR
Male White-
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
now
BIRTHPLACE#
Mouth Chelsea (Revere)
NAME OF
FATHER
Edward Magre
BIRTHPLACE
OF FATHER$
Boston mars
MAIDEN NAME
OF MOTHER
Locandine Jeuteslu
BIRTHPLACE
OF MOTHER $
Chelsea Mass
OCCUPATION
Effervesman
INFORMANT S
June Emma magee
(gripe)
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from Dec 14 .. 1908 to march 19 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 :
Central Hammerhager
1
(OURATION).
. 0AY8
Contributory :
3
(OURATION)
.....
.. OAYS
(Signed)
Ennyand
Ja Lesha
M.D.
Dnem 20 1905 (Address)
2- Celulose fr
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 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 dotalls. Il Name of cemetery.
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
. .. ... . 190.
UNDERTAKER DannzurFloyd
ADDRESS
.Registered No.
Date of March 19" 1909
Death S
вашача а. тада march 19-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Wesley Sarl Welcher
.Registered No ...
Place of )
Death *
5
5% Boucom. PL
Date of ¿
Mar 20
Death S
.190
Residence
Age
years. 5 months 1th. .days
STATISTICAL DETAILS
SEX
21%.
COLOR
w -
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE #
NAME OF FATHER Herbert 2.
BIRTHPLACE OF FATHER$ Marchant
MAIDEN NAME
OF MOTHER
Lerince, W. White
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT S
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
3/28
190 ..
9
UNDERTAKER
ADDRESS , Имев
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from mich 13 190:9 .. 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 :
Primaria / Brancho)
.(DURATION).
7
.DAYe
Contributory :
.(DURATION)
. DAY8
(Signed)
M.D.
med 21 1909 (Address).
3
SPECIAL INFORMATION only for Hospitais, Institutlons, 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 "Speclai 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
2
1
33 7 Wesley Carl Belcher. march 20, '09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Whichrol
(CITY OR TOWN.)
FULL NAME
Pachistreba. Ellis Darlow
.Registered No ....
..
Place of l
35 Lincoln Street Wanting
Death *
S
Residence
Manage 75 11 .. years
months.
3
days ys
=
STATISTICAL DETAILS
SEX
female
COLOR
White
SINGLE, MARRIED, WIDOWED, OR 1 DIVORCED widow
MAIDEN NAME +
/touranl
HUSBAND'S NAME
Lewis. M. Barlow
BIRTHPLACE #
Jandurch Mars
NAME OF
FATHER
Chas Howard
BIRTHPLACE
OF FATHER+
Easton Molaro
MAIDEN NAME
OF MOTHER
mary Lough
BIRTHPLACE
OF MOTHER #
Sandwich Mass
OCCUPATION
INFORMANT §
for
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last ist illness, from mch 14 190.9 .. to that to the best of my knowledge and belief death occurred on the he date stated above, and that the CAUSE OF DEATH was as follows : 's : Primary : Pneumoni
(DURATION).
.. DAYS Y8
Contributory :
(DURATION)
.. DAY9 Y8
(Signed)
(3) Metal
M.D. ).
mehr0 1904 (Address)
SPECIAL INFORMATION only for Hospitais, institutions, Transients, ts, or Recent Residents.
How long at Place of Death ? . years. ....... . months. ..... .days ys
Where was disease contracted,
if not at place of death ?
Filed
190
Clerk rk
* City or town, street and number, if any. if death occurs away from USUAL RESI- SI- DENCE, give facts called for under "Special Information." If in a Hospital or 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 statisticai detalis. Il Name of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !!
meridian Com
DATE OF BURIAL
8/24
9
190.
UNDERTAKER
ADDRESS
Date of l
3/21
Death
S
.. 190
99
3 cl Mathsbeing Elles Barlow march 21 2019
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Elizabeth a. m: Carthy
Registered No ...
Place of
16 nevada 3%.
Death *
S
Residence
16 neva dal SI
Age
48
.years.
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
Elizabeth
HUSBAND'S NAME
Eugene mª Carthy
BIRTHPLACE#
Hyde Park, mass.
NAME OF FATHER
John murray
BIRTHPLACE OF FATHER₮ Ireland.
MAIDEN NAME
OF MOTHER
Elizabeth mur
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION none
INFORMANT §
Eugene m: Carthy
PLACE OF BURIAL OR REMOVAL !!
Calvary
DATE OF BURIAL
mar 24
1909
UNDERTAKER Those: J. Lane
ADDRESS 120 Havre Si East Bastón
PHYSICIAN'S CERTIFICATE
Sam. I HEREBY CERTIFY that I attended deceased during last illness, from,. 15. 1909 to march 22 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 : Carciname of small intecture
1 1/2 lejos
(DURATION).
-DAYS
Contributory :
(DURATION)
. DAYS
(Signed)
I.q. Parter
M.D.
Ich. 22 1909 (Address).
Hinter of Mars
3
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 details. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
-
Date of l
mar. 22
.190
9
Death
S
35 Eelyjebeth a more Carthy march 22-09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Hattie Daralas
Place of Orintendto mars
Death *
Residence
Stitial Mass
Age
84
.years ..
2
.months
.days
STATISTICAL DETAILS
SEX Hemale
COLOR
White
SINGLE, MARRIED, WIDOWED, OB DIVORCED
MAIDEN NAME +
Or attie
HUSBAND'S NAME +
Edward Douglas
BIRTHPLACE#
S. Seland
NAME OF
FATHER
Janknow
BIRTHPLACE
OF FATHER#
England
MAIDEN NAME
OF MOTHER
Mary Deacon Cook
BIRTHPLACE
OF MOTHER +
9 6, deland
OCCUPATION
INFORMANT §
Daughter
Mis Joshua Remiby
PLACE OF BURIAL OR REMOVAL II
Scrittoop Cemely
DATE OF BURIAL
190.
ADDRESS
Hanitrop
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 : old age
(DURATION)
.DAY8|
Contributory :
Cardía, Jardin
(DURATION) ... DAYS .
(Signed)
315malcall
M.D.
Jul 26 1909
(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
0
UNDERTAKER
Registered No.
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