USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 2
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COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME
If a married or divorced woman, or widow
Mary M. Metz
HUSBAND'S
FULL NAME
James Bucknam
BIRTHPLACE
Gire state or country ; also city, town, or county, if known
Unknown
NAME OF
FATHER
Clifford Metz
BIRTHPLACE
Give state or country ; also city, toum, or county, if known
OF FATHER
Pennsylvania
MAIDEN NAME
OF MOTHER
Sarah Hutchins
BIRTHPLACE
Give state or country ; also city, town, or county, if known
OF MOTHER
Kittery, Maine
OCCUPATION
INFORMANT 'S
Person giving statistical details
NAME
ADDRESS
Annie J. Stone, Daughter
31 Hawthorne Avenue, Winthrop
(No.)
( Street)
( Town or City)
PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
(Cemetery )
Feb. 26, 1907
Brockton, Mass.
( Town or City, and State )
UNDERTAKER'S NAME
Sumner Floyd
ADDRESS
145 Herman St. , Winthrop, Mass.
( Street )
( Town or City)
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during las illness, from. Feb. 1, 1907 to Feb. 24, 1907 that to the best of my knowledge and belief death occurred on th date stated above, and that the CAUSE OF DEATH was as follows ( If a soldier or sailor who served in the war of the rebellion both the primary an contributory causes of death must be given. )
Primary :
Aortic .. Regurgitation
Contributory :
( DURATION )
DAYS
(Signed)
Joseph F. Grainger
M. D.
(Address )
440 Cambridge St.,
Cambridg
(No.)
(Street)
( Toun or City)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, on Recent Residents.
Previous Residence
How long at
Place of Death ?
Years,
Months,
Days
Where was disease contracted, if not at place of death ?
Received
Feb ...... 26,
.190 7. Wm ... . P .. Mitchell
Agent of Board of Health, appointed to issue burial permits
Filed
Feb. 26, 1907.
Frederic M. C.
City Clerk
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COM
FREE
NOI
MUNICIPAL
FOUNDED 1042 X
A CITY 1872
ESTABLISHED
JONES IVN
.Age ...
78 years
8 months.
2
days
(No.)
(Street)
.
( DURATION ) DAY
mary m. Buckman Feb 25, 1907
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winthrop Mask (CITY OR TOWN.)
.Registered No.
Date of l
190
Death
S
.months. ............ ... days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE; MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME +
BIRTHPLACE#
Winthrop mass
NAME OF
FATHER
John H.
BIRTHPLACE
OF FATHER#
Beton Muss
MAIDEN NAME
OF MOTHER
anne G. Wilson
BIRTHPLACE
OF MOTHER #
Baton
OCCUPATION
INFORMANT § John Hlane
PLACE OF BURIAL OR REMOVAL II Holy Cross Com
DATE OF BURIAL
700-28
- 1907
UNDERTAKER This. Phan Jr.
ADDRESS
120
Havre St
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 78 27 .190) .... to 2627 1907, 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 : Promativy will
8 horas
(DURATION)
DAYS
Contributory :
.(DURATION).
.. DAYS
(Signed)
Biomet call
M.D.
71621 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 details. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME
William
Lane.
Place of )
Winthrop Mlass.
Death *
S
Residence
Cov. Beach Road+ Musthave
.Age
.. years.
220 13 William, Lance Feb 21
[3.'06-37-L.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, Gazabitte (S) outimonte
Acar. 8' 190g.
(If married or divorced woman give maiden name, also name of husband.) -
Sex,
ett.
Color,
Condition,
(White, Black, Mixed, Chinese, Indian, etc.) to home.
Age, 77 Years, 7 Months,
Days. Occupation,
Residence, *.
ro heiter che.
Ward,
Place of Death, 25 Lrester che.
(State year, month and day.)
Place of Birth Rommet Mais, Date of Birth, Aug. 8'1829. Unknown.
Name and Birthplace ! of Father, Maiden Name and Birthplace of Mother, S Paysham Mass.
Place of Interment,
,
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
1907
Name and Agel
of Deceased, Elizabeth Southworth
Age, 83 years.
I hereby certify that I attended deceased from 190 , to
190 , that I last saw alive on the day of 190 ,
that. died on the 8 4 day of 1907, about .. o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. hem her death was as follows :
Chief cause, old age.
Disease ? Contributing cause, .
Duration
Chief Cause,.
Contributing cause, 3. Hneteals .. M. D.
* If an institution, state how long an Inmate and previous residence.
721
(Single, Married, Widowed or Divorced.)
Elizabeth Southworth Man 8. 190%
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full, Harriet Deupshuy
Date of Death, ..
March 11"1907
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, White
Condition, Wider
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Indian, etc.)
Age, "y 6 Years, 9 Months, 29 Days. Occupation,
Residence,*
Mass Ward,
Place of Death, Pleasant Avenue of Pleasant Street
(State year, month and day.)
Place of Birth Moultonborough MA Date of Birth, May1 3.1830
Name and Birthplace ) John Richardson = Mouetultringhìn Of
of Father, Maiden Name and Elizabeth Surbank= newfield me Birthplace of Mother, S
Place of Interment,. Winthrop develey Hintof Mass @ unner Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
much 12
1907.
of Deceased, Harnet Leukebury. Age, 76 years.
I hereby certify that I attended deceased from. Jan 3 1907, to Zuda 12.
190), that I last saw Les alive on the 11 day of Zuch 190),
that the died on the 11 day of Zuch
1907, about / 0,36 o'clock
.A.H., or P.M., and that, to the best of my knowledge and belief, the cause of .death was as follows :
Chief cause,
Carcinoma A Great
Disease Contributing cause,
Chief Cause, about 3 yrs
Duration Contributing cause, ......... ...
M.D.
...
* If an Institution, state how long an lomate and previous residence.
Coach Bestic
21
Name and Age ?
Harriet Leukeburg 20 Man 11, 1907
relations
174,3
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
alice. S. Day
Registered No.
Place of l
62 College are younatureto Mars
Date of l
Death S
mar 12
190 Z
Death *
S
Residence
Lowell mass
Age
61
.. years.
10
>
.months ..
.days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Urdan
MAIDEN NAME +
alice . S. Harmon
HUSBAND'S NAME +
Chas. Day
BIRTHPLACE #
Brunswick me
NAME OF
FATHER
BIRTHPLACE OF FATHER $ Scarlow me
MAIDEN NAME
OF MOTHER
Marcha R. Smith
BIRTHPLACE
OF MOTHER $
Lisbour me
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL Il Lowell mass
DATE OF BURIAL
mar 14
7
190 ..
ADDRESS
UNDERTAKER 9.D Depuis
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Mar 1. Mch. 12 1902: that to the best of my knowledge and belief death occurred on the 190.7 ... to date stated above, and that the CAUSE OF DEATH was as follows : Primary : Bright's Discoe
Limeira (DURATION)
DAYS
Contributory :
Mitral Insufficiency
DURATION DAYS
(Signed)
M.D.
Mch. 13
.. 190.2 ... (Address).
Járesp Manchmal Marco.
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 o 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 details. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
220 17 alice 8. hay Than 12. 1907
J
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Chizzzz alarmis
Registered No.
Place of l
Death *
1
41 Double Avr.
Date of ¿ mar. 12 1
Death
190
Residence
Age
.. years ..
.... .. months .................... .. days
STATISTICAL DETAILS
SEX
F
COLOR
w
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
FC122222.
Davis
HUSBAND'S NAME t
William Robertono
BIRTHPLACE# Herbert England
NAME OF
FATHER
Willing Hlavis
BIRTHPLACE
OF FATHER#
England
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT §
Filed
.. 190
Clerk
PLACE OF BURIAL OR REMOVAL II
2,21
DATE OF BURIAL
Bran. 15 90>
UNDERTAKER
Chelsea
1a21
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. mch. 2 190.7 ... to Mah 12 190%. 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 : burbank & comorrhage
(DURATION) ... /O
. DAY8
Contributory :
Interstitial Netegratis
.(DURATION) DAYS
(Signed).
HI Parte
M. D.
Mch. 12 1907 (Address)
Hanthrow, Mais.
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, 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. I[ Name of cemetery.
ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
no 18
anne Dans Gaberlow Mar 12, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
Hinttrop
BOSTON, MASS.
Date of Death,
March 131 1907
Name in full, Rebecca Copley
(Sonopeley)
James Capelay
(If married or divorced woman give malden name, also fame of husband.)
Sex, Female .Color,
Indian, etc.) Condition, ridona
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Age, 76 Years, ~ Months, Days. Occupation,
Residence,'
mass
Ward~
Place of Death, yo Somerset avenue Monttrop Mars
Place of Birth,
England
Name and Birthplace of Father,
Maiden Name and 1 UnRun England
Birthplace of Mother,
Place of Interment,
1
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop
Boston March 13 " 1907
Name and Agc \ Rebecca 6 rowley
Age,. 76 years.
of Deceased,
Janja L 1906,to march 12
190 7, that I last saw
alive on the 125 day of Mar 1907,
that she
died on the / 3 day of Man 190 7, about 3.30 o'clock
A.M., or RAL, and that, to the best of my knowledge and belief, the cause of .death was as follows :
Disease S Chief cause,
Cerebral hemorrhage
Contributing cause, artéria sclerosis
Duration
Contributing cause,
3 days,
M. D.
* If an Institution, state how long an Inmate and previous residence.
(State year, montirand day.)
Date of Birth,
alene 15
I hereby certify that I attended deceased from ..
Chief Cause, 2 years (abril)
Rebecca Cropley Mar 13, 190 7
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. HeAnthro BOSTON, MASS.
Date of Death, Mar 13"1907
Name in full, mary Nowway Donisly
(If married or divorced woman give maiden name, also name of husband.)
Sex, Color Phili Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.) ichool til
Age, 11 Years, ~ Months,
Days. Occupation, LL
X
Residence,*
22, Woodside Av Ward,
Place of Death, Winthrop, mass.
Place of Birth,
Date of Birth,
Name and Birthplace ? of Father, Maiden Name and Birthplace of Mother, Place of Interment,
Mary & rockword, Charlestown
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
HinstaroBoston Ich 14
190).
Name and Age ? Age, | | of Deceased, years. Trans Lumin Doherty 1 190 5 man 13º 2, to
I hereby certify that I attended deceased from
190 ), that, I last saw
alive on the.
day of 190),
she that died on the. 13 day of Mek 190 ,about o'clock
les A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows:
Disease S Chief cause,
Contributing cause,
Chief Cause,
Duration Contributing cause,
5
M. D.
* If an institution, state how long an Inmate and previous residence.
(State year, mouth and day.)
-
Mary Louise hoherly Man 13, 1907
[3.'06 37-LM.]
Permit No.
Winthropo
RETURN OF DEATH. .BOSTON, MASS.
Date of Death
March 15+ 1907
Name in full, Priscilla allen Griffin
(If married or divorced woman give maiden name, also name of husband.)
Sex, OFemale .Color, It hite Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, 1 Years, 6 Months, 10 Days. Occupation, -
Residence, *. Of internal mass
Ward,
Place of Death, 19 Sargent Sheet
Place of Birth, "
// Date of Birth, Sejet 5.1998
Ermel Grissin= Hinttrop mass Name and Birthplace of Father, Maiden Name and PAellie Floyd Griffin= Winthrop mass Birthplace of Mother, )
Place of Interment,
@ univer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, March 17 190.7.
Name and Age ? Pricilla allen Griffin Age, 1 1/2 years.
I hereby certify that I attended deceased from mar /0 1907, to mar 15
190), that I last saw
alive on the. 15 day of mar
1907,
that.
plu
died on the.
15
day of
1907, about ) 40 o'clock
4.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows :
Double Prun · Disease - Chief cause,
Contributing cause, ..
Chief Cause, 5 day
Duration
Contributing cause, I.E faluson M. D.
* If an Institution, state how long an Inmate and previous residence.
of Deceased,
(State year, month and day.)
riccilla aller Griffin. Mar 15, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full, Darren Belcher
Date of Death,
Warchiny "1904
(If married or divorced woman give maiden name, also name of husband.)
Sex, Nale .Color Arhite Condition, udover
(White, Black, Mixed, Chinese, Indian, etc.)
(Singie, Married, Widowed or Divorcegy.)
Age, 8, Years, 9 Months,. 14 Days. Occupation,
Residence,* Ofinterior. Mass Ward, ٢٠٠
Place of Death, 15g Simbole Sheet
(State year, month and day.) Place of Birth,. Winthrop Mass Date of BirthSeme 3 " 1825
Aseth Belcher = Chelsea Mass
Oraney Selcher = Chelsea Mass
Place of Interment,
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, OVinthat Ofmeter Streuthrop Mass Dumper Lloyd! Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Drintho . Boston, March 18th 1907.
of Deceased, Warren Belcher Age, 81 years.
I hereby certify that I attended deceased from. Feb. 11h 190 7,to Mck. 1755
alive on the. 17th day of March 1907,
190 , that I last saw he died on the ( that 17Th day of March .1907, about /1 o'clock
A.M., or T.M., and that, to the best of my knowledge and belief, the cause of. his death was as follows :
Disease Chief cause, Age
Contributing cause, Fracture of Mech of Fewer, Ceptials
Chief Cas ..........................
* If an institution, state how long an inmate and previous residence.
Duration Contributing cause, A. B. Forman M. D.
Name and Age !
Havrew Belcher Jan 17,1907
COMMONWEALTH OF MASSACHUSETTS
1 RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Luck Ban
Registered No.
....
Place of )
Death *
5
Residence
297
Age.
.years.
months. X .. days
STATISTICAL DETAILS
SEX
mall
COLOR
Colour
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
2
HUSBAND'S NAME t
BIRTHPLACE İ
NAME OF
FATHER
BIRTHPLACE OF FATHER$
MAIDEN NAME OF MOTHER beleña Leciò
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT § mother-
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 : Still low male infon
(DURATION) .. DAYS
Contributory :
(OURATION). .......... DAY8
(Signed)
Edward 7, 9 age
M.D.
March 26 1907 (Address) 56 Wanthuy Slag Ning
SPECIAL INFORMATION only for Hospitais, 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
............... 190 ..
ADDRESS
UNDERTAKER P.S. Semmi of.
* 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 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.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
297 Shirley the Winter
Date of ¿
Mar 17
.190
Death
1
1 Leiria
mail : 1, 1907
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1907.
CITY OF BOSTON.
FULL NAME
Susan A Haslam
....
Registered No ....... 29.6.9
Place of Death ) Boston Boston ... Insane ... Hospital
and Residence
Date of Death
Mar.27
1907.
Age .. 38
. years
months days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID , DIV.
F
M
Maiden Name Gillooly
Husband's Name
Samuel J
PA
Primary ( Duration)
Gen ... Paresis.l.yr
FFICE
BOSTONIA
CONDITA AD.
Name of
Father
Bernard
REGIMINE
MA'S.S.
Birthplace of Father
Ireland
Contributory : { (Duration)
Maiden Name of Mother
Margaret ... Doyle
Birthplace of Mother
Ireland
Occupation Housewife
Informant ...
Place of Burit Bernard's Concord Mass or removal
Undertaker F S Maloney
Usual Residence
181 Shirley St Winthrop
Filed
Mar .... 30
1907
A true copy.
Attest :
Eumylenen
Registrar.
| HEREBY CERTIFY that I attended deceased during last illness,
1907, 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: from 1907, to.
RAR'S
TRIBUS SIT DE
DOCITY:
Bedford. MasB
Birthplace
TA A. 1822
1830.
DONATA A.
BO.STO
N
PHYSICIAN'S CERTIFICATE.
(Signed)
S.W.Crittenden
M.D.
Mar .27.1907
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
6 Susan G. Heaslow Mar 27, 190%.
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, April 1, 0%
Name in full, enfant
merry
(If married or divorced woman give maiden name, also name of husband.)
Condition, Sex, male Color while
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age,~ Years, - Months, .. - ... Days. Occupation,
Residence,*
Ward,
Place of Death, Metcalf Hospital
(State year, month and day.)
Place of Birth, Winthrop
Date of Birth, April 1, 07
Name and Birthplace ! Louis of merry
Somerville mais
of Father,
Maiden Name and 1 Rose Cortan Boston 11
Birthplace of Mother,
Place of Interment,
but Auburn Com Cambridge Man
Wm A. Lockhart Camb!
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age !
of Deceased,
Boston,
....
190 7
Age, years!
I hereby certify that I attended deceased from. 190 , to ..
190 , that I last saw
alive on the. day of 190
that .. died on the day of. 190 , about o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
death was as follows : Stil For Chief cause,
Disease Contributing cause, .
Chief Cause,. ... ..
Duration Contributing cause, W. J. Portu- M. D.
* If an Institution, state how long an inmate and previous residence.
521
if we 1.1907-
[3.'06 37-LM.]
Permit No.
Hinthings
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, april 5 "1907 Creative Birth (dugh IV Roberts IN)
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, While
(White, Black, Mixed, Chinese, Indian, etc.) Condition,
(Single, Married, Widowed or Divorced.)
Age, ~Years, Months, Days. Occupation,
Residence, * 26 Sea Fram arena
Ward,
Place of Death," " 11
(State year, month and day.)
Place of Birth,
Date of Birth, Mane 5
Name and Birthplace Hugh , Roberts In= England of Father, Maiden Name and Minnie 5, houmingham = Botão
Birthplace of Mother,
Place of Interment, IV interop, bentley Vinitrion Mase Damner Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age ! Premature
Boston 1907. Hught Pint RoberlahAge, ~ years. of Deceased, I hereby certify that I attended deceased from ou Ale 51907, to anothers- 1907, that I last saw her .alive on the day of. Afune 1907, that she died on the day of Afine 190 7, about 10 o'clock A.M., or P.M., and that, to the best of my knowledge and belief, the cause of her death Disease ? - Chief cause,
was as follows :
Premative chcel being only 6%, mouth Contributing cause, . Insuffiert development to live Chief Cause, Premature buth
Duration
Contributing cause, Teuffrent development to live
Engage M. D.
* If an institution, state how long an inmate and previous residence.
22025 Roberto april 5, 1907
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Charles - Taff- aldrich
Registered No ..
Place of l
93 Groves are 20 mucho mas
Death *
Residence
K
Age
.. years.
11
months.
24
.days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manuel
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Millbury Mass
NAME OF
FATHER
Chas aldrich
BIRTHPLACE
OF FATHER $
Providence R.J.
MAIDEN NAME
OF MOTHER
atequal Taft
BIRTHPLACE
OF MOTHER#
Providencia R.J.
OCCUPATION
INFORMANT §
With ro Chas. aldrich
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from .... fre 3d 1900 to afm/ 6 1907. 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 : Diabetes
(DURATION)
. .. DAYS
Contributory :
(DURATION)
DAT 8
(Signed)
Birmetaal
M.D.
7
atm 8 1907 (Address)
100 win mag st
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. || Name of cemetery.
PLACE OF BURIAL OR REMOVAL !! Southboro Dans
DATE OF BURIAL
cuil 9ª
7
190
UNDERTAKER
ADDRESS
7
Death )
6/
Date of l april 6
190
1 Charles Saft alerich Ejemplo, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death,.
Charles S. abbott
Opere y "1907
(If married or divorced woman give maiden name, also name of husband.)
Sex, nale Color, While-
Condition,
Single
(Single, Married, Widowed or Divorced.
Age, Hg Years, Months, .. not,
Residence, * Desiree C
Ward,
Place of Death, 52, Bowdown Street Hinteny, Mas
Place of Birth, Desiree W Of, Date of Birth,
tate year, mouth and day.) Nr 2"1857
Name and Birthplace \ of Father,
Salomon abbott -
Desifree W, Or,
Maiden Name and Emily S. Lewis Ossipee D, ON, Birthplace of Mother, Place of Interment, · Despre new Stanyeshire Summer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winter Boston.
ajene
1907.
Name and Age
of Deceased, Charles S. abbott
Age, 49 years.
I hereby certify that I attended deceased from umr ) 190 ), to.
190 ), that I last saw
alive on the. ‹ day of afinal 190 )
day of abril 190), about 1030 o'clock that re died on the .71
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of Lis death was as follows : Cancer of that Chief cause,
Disease Contributing cause,
Chief Cause, The year
Duration 3 Contributing cause, ......
3/metall M. D.
* If an Institution, state how long an Inmate and previous residence.
Days. Occupation,
(White, Black, Mixed, Chinese,
Indian, etc.)
Garnier
F
Charles S. a Great April 7. 1907
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
[2-1-1906-5,000] J 429
COMMONWEALTH OF MASSACHUSETTS
Wanthof.
CITY OF SOMERVILLE
RETURN OF A DEATH
.
Registered No.
Date of
Death
April 15
.. 190 .2 ...
46
months
1
days
STATISTICAL DETAILS
SEXL vemale
COLOR White
SINGLE, MARRIED, WIDOWED. OR DIVORCED
MAIDEN NAME
Ifn married or digorged wonan, or widow Elizabeth W. Keveretoch.
HUSBAND'S FULL NAME Charles A. Brigham.
BIRTHPLACE Give state or country ; also city down, or county, if known Charlestown macs.
NAME OF FATHER Frank Beverstore
Gire state or country : also city, town, or county, if known
MAIDEN NAME OF MOTHER
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