USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 26
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
OCCUPATION
INFORMANT §
Augh J. Tham
PLACE OF BURIAL ÓR REMOVAL !!
It michaela Com! UNDERTAKER Thong Lane
DATE OF BURIAL
au 925 190 9.
ADDRESS
130 Have It EBoston
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from on Que 25 190.9 ... 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 :
Sived 20 minutes after
bitte.
.(DURATION). DAYS
Contributory :
(DURATION) .. OAYS
(Signed)
Edward J. Franger
M.D.
Our 25 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
Clerk
* City or town, street and numbor, 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 clty, town or county, if known.
§ Namo and address of person giving statistical detalls. Il Name of cometery.
ALL NAMES TO BE IN FULL
86 Baley Show aug 25- 1909
COMMONWEALTH OF MASSACHUSETTS
PERMIT NO.
RETURN OF A DEATH
FULL NAME
Elizabeth Gertrude Fussell
Registered No ...
Date of ?
Death
aug. 15
190
11
12
-days
STATISTICAL DETAILS
COLOR
SEX
temale White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Jungle
MAIDEN NAME +
BIRTHPLACE İ Winthrop
NAME OF FATHER Bergs N. Russey
BIRTHPLACE OF FATHER +
Booten Haas.
MAIDEN NAME OF MOTHER
Bertha G. Bourke
BIRTHPLACE OF MOTHER I Cambridge maas
OCCUPATION
MATE OF BURIAL, Cung 17, 100 9
PLACE OF BURIAL OR REMOVAL II St. Paule Een arlington
INFORMANT ៛ Father.
UNDERTAKER
REG. NO.
ADDRESS 219 Bowdoin Of
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness
from she
190 9
to any 15 9
190 ...
am
that ... died on date stated above, about .. 4 o'clock. . M. HUSBAND'S NAME t
and that, to the best of my knowledge and belief, the cause of death was as follows :
Chief Cause :
Gastro Enteritis
(DURATION)
DAY'S
Contributing Cause :
(DURATION) DAYS
(Signed)
M. D.
190 q (Address)
SPECIAL INFORMATION ouly for Hospitals, Institutions, Transients or Recent Residents.
How long at Place of Death ? years .
1101ths days
Where was discase contracted, if not at place of death ?
Filed
190
C1e1k
* City or towu, street and unmber, if any. If death occurs away from USUAL RESIDENCE, give facts called for under "Special information.' If in a Hospital or Institution, give its NAME instead of street and mulher In case of married or divorced woman, or widow.
* State or country ; also city, town or country, if knowu.
§ Name and address of person giving statistical details.
"Il Name of cemetery.
.....
ALL NAMES TO BE IN FULL ..
City of QUINCY Town of Winthrop
Place of ?
Death *
Winthrop masa.
Residence
138 Bowdoin It.
Age
years
· months .. .
George 08. Bence
Char . V. Russell 1107
87 Elizabeth Bestunde Quence Queg 15-1909
The Office of the Board of Health will be open for the granting of permits for burial as follows : Saturdays, 8 A. M. to 12 M., Sundays and Holidays, at the home of the Secretary . Other days from 8 A. M. to 11.30 A. M. and 1 P. M to 5 P. M.
[1-'09-37-XXXM.]
Permil
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, august 29 19.09. Eliga Jane 2Vymah=(Hoyes) Desme 3, Human
(If married or divorced woman give maiden name, also name of husband.)
Sex, efemale Color,
1 Condition, mamère
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age,
82 Years,
8
Months,
9
Days. Occupation,
Housemio
Residence, *. Oantropo Mass
Ward,
Place of Death, Point Shilly
Place of Birth,
Date of Birth,
Stretch troyes-Weed newbury-Mass.
Maiden Name and Elizabeth Hojes= Newbury Palmas
Birthplace of Mother,
Place of Interment, Hinstrap Cemetery
* If an institution, state how long an inmate and previous residence.
Dunnerefloyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, august 29- 1909
Name and Age? Eliza Jane Hyman Age, 82 years.
of Deceased,
I hereby certify that I attended deceased from .. Chung 24 1909, to
19 , that I last saw
alive on the. 29. day of. auqi 1909,
that the died on the .. 29 day of aug 1904, about. 12 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 :
Disease Chief cause,
acheter
Contributing cause,. Senility
Chief Cause, .. one call ,
Duration Contributing cause,.
M. D.
. PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
(State year, month and day.)
Name and Birthplace Į of Father,
Permit No.
Aug 30.
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."
Asphyxia. 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 ?
Asthenla. 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 poisoning. Do you mean septicemia, syphilis, or any other definite disease ? If septicemia, what was the cause? Was it puerperal ?
Chronic pneumonia.
Was this not pulmonary tuberculosis ?
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. Name the disease in which the "dropsy" occurred.
Dyspepsia. Was there organic disease of the stomach or other organs ? If so, name the disease causing death.
Eclampsia. Give cause of convulsions. Were they puerperal?
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. Be par- 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.
Name the disease causing the passive or hypostatic con- gestion.
Imperfect nutrition.
State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.
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 precisi to an indefinite statement.
Infantile atrophy. See "Atrophy."
Malassimilation.
What disease caused the malassimilation?
Malnutrition. What disease caused the malnutrition ?
Marasmus. What disease caused the "marasmus" ? Was it due tuberculosis, syphilis, or cholera infantum? St fully, as this return in itself is practically worthless compilation.
Meningitis. Was it epidemic cerebro-spinal meningitis? If so, wr exactly in this form. Did it follow scarlet fever, pne monia, or some acute infection ? If so, name the p mary disease. Was it traumatic? If so, state t nature of the violence which caused the meningit Was it tuberculous meningitis ?
Nephritis. Was it acute or chronic ? If acute, occurring in the cour of some disease, name the disease causing death.
Old age. This is not a satisfactory return. The influence of age shown by the statement of age in years, months, a days. To this the statement of "old age" as a cause death adds nothing of value. Name the disease which the old person succumbed.
Peritonitis. What was the cause of the peritonitis ? "Idiopathic pe tonitis" should be rarely returned. Was it puerper or traumatic? In the latter case, state mode of injur
Pernicious anemia.
If any definite cause can be assigned for the anemia,
should be reported. Anemia due to tuberculosis, syp
ilis, etc., should be returned under the primary diseas
Pneumonia. Specify definitely whether broncho-pneumonia or lob pneumonia. If sequel to influenza, state that fact.
Pyemia. What caused the pyemia? Was it puerperal or tra matic? If traumatic, state nature of accident causi injury.
Senile asthenia. See "Old age" and "Asthenia." Give disease causu
death.
State disease causi
Senile decay.
See "Old age." State disease causing death.
Senile decline.
See "Old age." Name the disease, if any, that caused tl
decline.
Senile marasmus.
See "Old age" and "Marasmus." Name disease causir
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.
}
Always state the disease or injury requiring operatio Unless the operation was improper or unskilfully p formed, it should not be given as the primary cause death.
Teething. Name the disease affecting the teething child. See "De tition."
Toxemia. Was this acute or chronic poisoning due to some exter agent? Was it auto-intoxication, due to poisons ge erated in the body by disease? If so, state the nan 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 fs to specify organ or part of body affected.
Typhoid condition. Avoid this term as it is likely to be mistaken for typho fever.
Typhoid pneumonia.
Was the primary disease typhoid fever or pneumonia?
Typho-malarial fever.
Was it typhoid fever? Was it malarial fever? A mi ture of these diseases rarely occurs, the great majori of cases of so-called "typho-malarial fever" being not ing more nor less than typhoid fever.
Inanition.
Was this not due to pulmonary tuberculosis? If so, the primary cause should be reported without fail.
Senile atrophy. See "Old age" and "Atrophy." death.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
alma a Banta
Registered No.
Place of ( Dz Metcalf's Hospital, Winthrop
Date of l
Death
aug. 31
1909
30
.. years.
.. months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť
alma, a Claflin
HUSBAND'S NAME +
Harry D. Santa
BIRTHPLACE#
Hopkinton
NAME OF
FATHER
Clarence
BIRTHPLACE
OF FATHER+
Hopkinton
MAIDEN NAME
OF MOTHER
alma
BIRTHPLACE
OF MOTHER #
Hopkinton
OCCUPATION
INFORMANT §
Mr Harry 2 Banta
PLACE OF BURIAL OR REMOVAL !!
Milford Ware
DATE OF/BURIAL
190.9.
UNDERTAKER
8th Coff
ADDRESS
Charleston
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Cluj 30 190 ..... to Cling 31 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 :
Calampara
. (DURATION).
1
DAYS
Contributory :
Hear heart
(DURATION)
. DAYS
(Signed)
M.D.
Ofot. / 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
Death *
Residence
556Shirley St Winthrop, Mass,
., Age
3
1
90 alma a Banta. aug 31-'09
e
f
r
o
[4.'07.37.LM.]
Permit No.
Minitrop
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
Sepet 3" 190.9.
Name in full,
(If married or divorced woman give maiden name, also name of husband.)
Sex, Male .Color, Arhite Condition, Married
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 92 Years, 6 Months,
Days. Occupation, etned
Residence,*
Winthrop Masz
Hard,
Place of Death,.
573 Pleasant Shrew
Place of Birth, ...
Liberaller Spani Date of Birth,
(
Name and Birthplace } of Father,
augustine Jogar- Spani
Maiden Name and Lama Fewman - Sjeani
Birthplace of Mother,
Place of Interment,
Vinylenany Deposit, Reo Tamb Finiturela
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
1909.
Name and Age?
Age, 92 years.
I hereby certify that I attended deceased from. Syst 3ª 1904, to. Sift 30
190 9 that I last saw my alive on the. 34 day of 190 9
that ne died on the. 39 day of Sujet 1909, about .. 1 oclock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows :
Chief cause, Jutros regnes pelatão
Disease ‹ Contributing cause,.
bed ag
Chief Cause, several years
Duration
Contributing cause,.
M. D.
· If an institution, state how long an Inmate and previous residence.
of Deceased, John Yoggi
(State year, month and day.)
Level 3-09
1
[1.'09-37-XXXM.]
Permit No. ....
RETURN OF DEATH.
BOSTON, MASS.
Date of Death,
Defet 4" 199.
Name in full, Emma b, flint
Lewis Flint~
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, Orhite~
(White, Black, Mixed, Chinese,
Indian, etc.)
Condition,.
Wider
(Single, Married, Widowed or Divorced.)
Age,. 66 Years,. 2 Months, 29 Days. Occupation,
Residence,* Concord Mark
Ward,
Place of Death,
27, Centre Street Winthrop, Mais
Place of Birth,
Covered Mask
Date of Birth,
Name and Birthplace\ Daniel Hund= Concord Mars
of Father,
Maiden Name and Classica Flint= Concord Mass Birthplace of Mother,
Place of Interment,
Blesky Ofreem Cemetary Concord man
* If an institution, state how long an inmate and previous residence.
Dimmed floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Hinterajo
Boston,
19.09.
Name and Age Emma lo, Flint .. Age, .. 66 years.
I hereby certify that I attended deceased from. Sept 2ª 1909, to Sejet 4 09
19 0 % that I last saw per. alive on the. day of. Synet 190% that She .died on the. day of Sept 1909, about 10 a Clock 2x 4
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death was as follows :
Chief cause,
Cardiac Failing
Disease
Contributing cause, Portuno selonses (General)
Duration
Chief Cause, 3 days
Contributing cause, Jedes
M. D.
OF PHYSICIANS BEFORE STATING CAUSE OF DEATH ARE REQUESTED TO SEE THE OTHER SIDE OF THIS BLANK.
of Deceased,
(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."
Asphyxia. 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 poisoning.
Do you mean septicemia, syphilis, or any other definite disease? If septicemia, what was the cause? Was it puerperal?
Chronic pneumonia.
Was this not pulmonary tuberculosis?
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. Name the disease in which the "dropsy" occurred.
Dyspepsia. Was there organic disease of the stomach or other organs? If so, name the disease causing death.
Eclampsia. Give cause of convulsions. Were they puerperal?
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. Be par- 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.
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.
Imperfect nutrition.
State name of disease causing imperfect nutrition. Did it follow some disease? If so, give name of disease.
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 asthenla. See " Asthenia." The term "infantile" adds no precis to an indefinite statement.
Infantile atrophy.
See "Atrophy."
Malassimilation. What disease caused the malassimilation?
Malnutrition. What disease caused the malnutrition?
Marasmus. What disease caused the "marasmus" ? Was it due tuberculosis, syphilis, or cholera infantum? St fully, as this return in itself is practically worthless compilation.
Meningitis. Was it epidemic cerebro-spinal meningitis? If so, w exactly in this form. Did it follow scarlet fever, pr monia, or some acute infection? If so, name the mary disease. Was it traumatic? If so, state nature of the violence which caused the mening Was it tuberculous meningitis?
Nephritis. Was it acute or chronic ? If acute, occurring in the cou of some disease, name the disease causing death.
Old age. This is not a satisfactory return. The influence of ag shown by the statement of age in years, months, days. To this the statement of "old age" as a cause death adds nothing of value. Name the disease which the old person succumbed.
Peritonitis. What was the cause of the peritonitis? "Idiopathic p tonitis" should be rarely returned. Was it puerpe or traumatic? In the latter case, state mode of inju
Pernicious anemia. If any definite cause can be assigned for the anemia should be reported. Anemia due to tuberculosis, sy ilis, etc., should be returned under the primary disea
Pneumonia. Specify definitely whether broncho-pneumonia or lob pneumonia. If sequel to influenza, state that fact.
Pyemia. What caused the pyemia? Was it puerperal or tr matic? If traumatic, state nature of accident caus injury.
Senile asthenia. See "Old age" and "Asthenia." Give disease caus
death.
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
decline.
.
Senile marasmus.
See "Old age" and "Marasmus."
Name disease caus
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.
Always state the disease or injury requiring operati Unless the operation was improper or unskilfully I formed, it should not be given as the primary cause death.
Teething. Name the disease affecting the teething child. See "D tition."
Toxemia. Was this acute or chronic poisoning due to some exter agent? Was it auto-intoxication, due to poisons g erated in the body by disease? If so, state the na of the disease.
Tuberculosis. State organ affected. Do not fail to state as pulmon tuberculosis if lungs were affected.
Tumor. Was it a cancer? Whether a cancer or tumor, do not to specify organ or part of body affected.
Typhoid condition. Avoid this term as it is likely to be mistaken for typh fever.
Typhoid pneumonia.
Was the primary disease typhoid fever or pneumonia ?
Typho=malarial fever.
Was it typhoid fever? Was it malarial fever? A n ture of these diseases rarely occurs, the great majo of cases of so-called "typho-malarial fever" being nc ing more nor less than typhoid fever.
State disease caus
Hypostatic congestion.
Inanition.
COMMONWEALTH OF MASSACHUSETTS
1626
Willnot (CITY OR TON.)
RETURN OF A DEATH
FULL NAME
May P. Story
Registered No.
Date of l
Death
1
Sept. 4,
. 1909
Residence
4
Age
66
.years.
months
.days
STATISTICAL DETAILS
SEX temal
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED werden.
MAIDEN NAME +
HUSBAND'S NAME +
ME : Climactin Leverett Story
BIRTHPLACE #
Esses ma.
NAME OF
FATHER
John Primi
BIRTHPLACE
OF FATHER$
Danses Mass
MAIDEN NAME
OF MOTHER
Mary Parker , Buhar
BIRTHPLACE
OF MOTHER#
OCCUPATION
INFORMANT §
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
Left- T
190.2
UNDERTAKER CR Bensa
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .190 ...... to
.......................... +90 ...... , 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 :
(provence)
(Sudden death at chee) home dire
Contributory :
.(DURATION). ..... .DAY8
(Signed) ..
George Bur gers Magnall
M.D.
Sept. 1909 (Address).
Med Exam . Suffolklo
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. Il Name of cemetery.
Place of )
Death *
5
60 Bates avenue-
93 mary P. Story Sepr 4-09
se
De
rr
g a
o
[4.'07-37-LM.]
Permit No.
RETURN OF DEATH.
Otinitusjo
BOSTON, MASS.
Seler 8' 1909.
Name in full,
Date of Death, Hannah Fletcher Walker Ganham H. Haller
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, White
(White, Black, Mixed, Chinese, Condition, Married
(Single, Married, Widowed or Divorced.)
Age, 114 Years, 5 Months, 28 Days. Occupation,
Indian, etc.) Homemde
Residence, *. Deuithof, mase
Ward,
Place of Death, 82 Fremont &heel
Place of Birth, Youth Hermouth
Date of Birth,
Name and Birthplace Haven deya-Weymouth of Father, Maiden Name and Temperance B. Whiting-Neumuch
Birthplace of Mother, 5 Place of Interment,.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Selel 1909.
Name and Age Hannah Fletcher Halka. .. Age, .. 14 years.
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.