USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 29
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Hemorrhage of lungs.
Was this not due to pulmonary tuberculosis? If so, the primary cause should be reported without fail.
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.
Was it typhoid fever? Was it malarial fever? A: ture of these diseases rarely occurs, the great majo of cases of so-called "typho-malarial fever" being n ing more nor less than typhoid fever.
Give disease causi
Was this not pulmonary tuberculosis?
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Mary
E. Bonvie
Registered No
649
Place of Death *
Metcalf Hospital
Date of Death
1 et 24 +, 1909
Age
26
years
.months .days
STATISTICAL DETAILS
SEX F
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE #
new France (V. I.
NAME OF
FATHER
Edward Bonnie
BIRTHPLACE
OF FATHER #
new France 11:8.
MAIDEN NAME
OF MOTHER
Unknown
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT §
Mrs. lowan
PHYSICIAN'S CERTIFICATE
190 .. 7 .. to
oct 24
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 :
Gallstones
Contributory :
operation
Exhausting
(DURATION) 2 DAYS
(Signed)
31 milcao
M. D.
04/25
1909 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
sergent st
Former or
Usual Residence
Home work
How long_at
2 ms
Place of Death ?
Dayı
Where was disease contracted,
if not at place of death ?
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL !!
Mit. Baudiet
DATE OF BURIAL
Ort 26
190.9
UNDERTAKER
Av. J. Lane.
ADDRESS
120 Havre St.
2. Basta
* City or town, street and number, if any. If death occurs away from USUAL RESI- · DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
ALL NAMES TO BE IN FULL
I HEREBY CERTIFY that I attended deceased during last illness, from ... June
(DURATION)
DAYS
. 1.12
Cect 25,1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of l
Death * 5
Residence
45 Jam Ro
Age
days
STATISTICAL DETAILS
SEX
COLOR
w.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
marks
BIRTHPLACE#
Metall Normal
NAME OF
FATHER
ER // T. Marks
BIRTHPLACE
OF FATHER
Provincetown Mas
MAIDEN NAME
OF MOTHER
Annie R. Ryan
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT §
gn F. Maks
PHYSICIAN'S CERTIFICATE
190 ..
I HEREBY CERTIFY that I attended deceased during last
illness, from
Oct 291
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 :
Premature
Still Com
(DURATION).
....
. DAYS
Contributory :
1
(DURATION).
. DAY8
(Signed).
M.D.
of 30 1909 (Address).
170 mallofal
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months.
days
Where was disease contracted,
If not at place of death ?
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Cal-2
19041
UNDERTAKER
CR Bannon
ADDRESS Wanting
* 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.
f 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.
TILL VUI WIIR INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Martes
Registered No ..
Metrael Hospital
Date of ¿
Oct 29
190
Death S
113 marke Och 29-1909,
14.'07.37-1.M.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Por. 10' 1909.
Name in full,
Downsbra
(If married or divorced woman give maiden name, also name of husband.)
Sex,
Color
Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.
Age, / Months, 9 Days. Occupation,
a
Residence,* 226.
10
Ward, ..
Place of Death, 226
Place of Birth, Lacolle P.2
Date of Birth,
(State year, mouth and day.) Die. 1' 1840. England
England
Nordlara Faust. Errete Man
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, NOVIO 190 9
Name and Age? George Lownatri
of Deceased,
Age, 29 years.
I hereby certify that I attended deceased from 1
190 9, to.
190 9, that I lust saw
alive on the. 10 day of. 1909,
that e died on the .. 10 .duy of .. 1909, about o'clock
4 30 am
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death was as follows :
Chief cause,
Pneumonia
Disease Contributing cause, ..
Chief Cause, 7 days
Duration
Contributing cause,
M. D.
· If an Institution, state how long an Inmate and previous residence.
Jarabe Duck
Name and Birthplace \ james of Father, Maiden Name and Birthplace of Mother, Place of Interment,
59 Years,
Date of Death,
Deve DE Lowna bio 200 10-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A . DEATH
(CITY OR TOWN.)
FULL NAME.
Charles Hastings Phillips
Registered No ..
Place of l
133 Cliff are
Date of
2000 10
190 ₴
Death *
S
0
Residence
"
Штевор
Age
66
.years.
10
.. months
20
.days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
.
manuel
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
London
NAME OF
FATHER
Joseph
BIRTHPLACE
OF FATHER
London England
MAIDEN NAME
OF MOTHER
Marquette moore
BIRTHPLACE
OF MOTHER +
Lowdown Ewy
OCCUPATION
Flow ofy
INFORMANT § wife
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
20 12
190.7
UNDERTAKER
CR Pensioni
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ..... July 15 190.9 ... to 10010 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 : Cancer of Prostate
Primary :
blond + Bladder
one year+
(DURATION).
. DAYS
Contributory :
(DURATION). . DAY8
(Signed) ...
H. E. Brandon
M.D.
200, 10
190 ..... (Address).
3) 17 Central San
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 ?.
* 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.
TILL VVI WIIN INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death
115 Charles Festungs Philips Nov 1 0-09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
le ecil Earl Waldron
.Registered No.
Place of l 56 Lincoln Street Winthrop
Death *
5
Residence
56 Lincoln Street ".
Age
22
3
.years
.months.
23
days
STATISTICAL DETAILS
SEX
mare
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
-single
MAIDEN NAME + ;HUSBAND'S NAME +
BIRTHPLACE #
Madison
Maine
NAME OF
FATHER
- E. 4 idiana
BIRTHPLACE
OF FATHER$
Hartland maine
MAIDEN NAME
OF MOTHER
man Withus
BIRTHPLACE
OF MOTHER #
Harmon Maine
OCCUPATION
Chauffer
INFORMANT §
Ova noe E. Nandras
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
Forest Hale Male NOV 1 4 904)
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 1 Horaantes 1909 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 : muslectura Leukämie
(DURATION) ........... DAYS
Contributory :
Hearorages out.
.(DURATION) . . DAY 3
8
(Signed)
M.D.
190 .... (Address)
110 )Remonter . Sto
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.
IA .
-
-
t
6
:
..
..
8
·
BE HagenBurger
'S
k
-
I-
190
9
Death
S
Date of l
nov 11
116 · Cecil Carl Haldrow 20-11- 09
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH f
(CITY OR TOWN.)
FULL NAME
Imenasuis Morgan
Registered No.
Date of
20018
190
Death *
Residence
minthaof Man
32
1
.. months.
27
.days
STATISTICAL DETAILS
SEX
Fermer
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + ..
HUSBAND'S NAMET
2
BIRTHPLACE # New Brighton Cherlentes
NAME OF
FATHER
Thomas
BIRTHPLACE
OF FATHER$
Jouet Wales Ing
MAIDEN NAME
OF MOTHER
Mary Jane Hughes
BIRTHPLACE
OF MOTHER #
Brighton- Charleston
Sag
OCCUPATION
INFORMANT §
Machen.
Mary Jane Morgan
PLACE OF BURIAL OR REMOVAL II
Winthrop
DATE OF BURIAL
200 28
190 .. 9
UNDERTAKER
Chas RodBenson
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. oct .190.7 ... to /5~ 18 .19000 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 : Patties
6 mois
(DURATION), DAYS
Contributory :
1. (DURATION) DAY8
(Signed)
10 20
M.D.
190 (Address) 17 4 Withy st
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at
Place of Death ?
years.
.......
.......
months. days
Where was disease contracted,
if not at place of death ?
Filed
.190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number. t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemetery.
TILL VVI WIIn INK .- INIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Place of
#54 Shirley Street
Death )
Age
.. years.
ADDRESS
117 Munice margare 200- 18 - 1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH.
(CITY OR TOWN.)
FULL NAME
Registered No.
Date of ¿
Death
Residence
Steel Bom
Age ..
×
.years.
.months ..
.days
STATISTICAL DETAILS
SEX male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Mataiof Hospital
NAME OF FATHER Rudolph Bennett
BIRTHPLACE OF FATHER$ Erold. n. H.
MAIDEN NAME OF MOTHER Sarah E Fare 1
BIRTHPLACE OF MOTHER $ Hopingta
OCCUPATION
INFORMANT § Sarah. I. Frode
noche
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
190
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Nov23 1909 to KN 23 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 : Presaline Primary : Still born
(DURATION).
....... .. . DAYS
Contributory :
(DURATION) ..... .. DAY8
(Signed)
M.D.
INN 2) 1909 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Placo of Death ? years.
months
.... days
Where was disease contracted, If not at place of death ?
Filed
190
Clerk
* Clty or town, stroot 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, glvo 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,
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Slut 19 cm
Place of } metcall forhalat
Death S
190 9
117 Munice Margare 200-18-1909
118 Bennett
nov 24, 1909.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Catherine Tiver Hardie
.Registered No.
Place of Death *
10/ Sumit, tvar L'intero| 2 Mart
Date of Death
DEc.b. 1969
Age
77 years.
8
.months
9
days
STATISTICAL DETAILS
SEX
COLOR
10
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME T steelton
HUSBAND'S NAME + Geo. Hardie.
BIRTHPLACE # England
NAME OF FATHER
Cast Edward Hartie
BIRTHPLACE OF FATHER+ England.
MAIDEN NAME
OF MOTHER
Bolton
BIRTHPLACE OF MOTHER +
Gingland.
OCCUPATION at home
INFORMANT § nuno. S. Floyd
PHYSICIAN'S CERTIFICATE
Dec. | HEREBY CERTIFY that I attended deceased during last iliness, from 25
190.9 .. to 5 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 : faundial
.(DURATION)
8
OAYS
Contributory :
Sentite
(OURATION) .DAYS
(Signed)
M.D.
DEc. S. 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 !!
DATE OF BURIAL 12.7- .1909
UNDERTAKER
H. C. Skaggs.
ADDRESS
7 Hermon SK
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, glve facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of marrled or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. ¡¡ Name of cemetery.
-
ALL NAMES TO BE IN FULL
118 Bennett
nov 24, 1909.
N
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Catherine Tiver Hardie
.Registered No.
Place of Death *
10/ Sumiteve Il'intheol VIhar2
Date of Death
DEc.b: 1960
Age
77 years
8
months
9
.days
STATISTICAL DETAILS
SEX
COLOR
10
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + Hilton
HUSBAND'S NAME Ť Geo. Hardie
BIRTHPLACE $ England
NAME OF FATHER Cast Eduard Hartie
BIRTHPLACE
OF FATHER+
England.
MAIDEN NAME
OF MOTHER
Bolton
BIRTHPLACE
OF MOTHER $
Gengland.
OCCUPATION at home
INFORMANT § miro. S. +loyal
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 7200, 25 1909 to Dec. 5 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 : -Jaundice
. (OURATION)
8
.DAYS
Contributory :
Senility
(OURATION). DAYS
(Signed)
M.D
DEC, 5. 1909. (Address Minitrak
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
Former or
Usual Residence
How long at
Place of Death ?
Days
Where was disease contracted, If not at place of death ?
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
12.7-
1909.
UNDERTAKER
H.C. Skaggs
ADDRESS
7 Hermon SX
* 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. I 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
119 Catherine anno Hardie DE0-05-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
John morgan
Registered No.
Place of Death *
199 Hemmbu of Winthrop mass
Date of Death
Dsc q.
1409
Age
29
. years months days
STATISTICAL DETAILS
SEX
m
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # Nuithof Mana.
NAME OF
FATHER
William Morgan
BIRTHPLACE
OF FATHER$
England.
MAIDEN NAME
OF MOTHER
Ellen MalGuy
BIRTHPLACE OF MOTHER $ Freland.
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from Heca 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 :
Fally de generation of Heart
(DURATION).
2
DAYS
Contributory :
(DURATION) . . DAYS
(Signed)
M.D.
Decid 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 U
Holy cross Car
DATE OF BURIAL DEC12 190.
ADDRESS
UNDERTAKER H.C. & Ragg
68, Jennon
* 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.
120
Dec-9-1409
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1909.
CITY OF BOSTON. 10304
FULL NAME
Hugh Trainer
Registered No.
Place of Death }
Boston
Infants Hospt.
and Residence S
Date of Death
Dec.10
1909.
Age ................... years 1
months. days
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
S
Maiden Name
Husband's Name
Birthplace Winthrop
Name of
Thomas Trainer 18 80.
Father
Birthplace
of Father
E. Boston
Maiden Name Annie Murphy
of Mother ..
Birthplace
Winthrop
of Mother
Occupation
Informant
....
Place of Burial or removal.
Malden"Holy Cross"
Undertaker
F S Maloney
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
1909,
from 1909, to 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 :
T
RAR'S
PATRIBUR SITP PATRON (Dura bond
Spina Bifida - congenital
AFICE
CIVITATISR
TIS REGRMINE
DONATA A.
. MA S.S. Contributory : ! (Duration)
(Signed)
J S Stone
M.D.
Dec.10
1909
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence.
Winthrop (229 Shirley st )
Filed
Dec.14
1909
A true copy.
Attest :
Registrar.
CITY
BOSTONIA CONDITAA
A. 1822.
BOSTO
High Fracion SOFT-Dec-10-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
...
(CITY OR TOWN.)
FULL NAME
Mary Imma Lindsay
Registered No.
Date of ¿
Dec 13
190 2
Death
4
28
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE ₺
NAME OF
FATHER
Richard Hering Sandray
BIRTHPLACE
OF FATHER$
Boston- Mars
MAIDEN NAME
OF MOTHER
Mable augustattilchey
BIRTHPLACE OF MOTHER $ Tangier U.S.
OCCUPATION
INFORMANT § Richard Henry Leniesey
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Lez 14
190 .7 ...
UNDERTAKER
6 R( Bunnen.
ADDRESS .
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Due. 11 .190% .... to Dec.13 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 :
.
.
ungilet
(DURATION)
DAYS
Contributory :
(DURATION)
DAYS
(Signed)
Dr.g. Porté.
M.D.
€ 1.9
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. 1 State or country; also clty, town or county, if known.
§ Name and address of person giving statistical detalis. || Name of cemotery.
TILL VUI WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Place of ¿
Death *
S
287 thinly the
Residence
Age
-
... years.
121 Калувина duлову Dec- 13-1909
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Kate Hade Talbot
Registered No
1389
Place of Death *
3) Villa QUE.
Date of Death
SzC 13-1909 . .
.Age
60.
. years
months days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť Mate trade-
HUSBAND'S NAME +
BIRTHPLACE# Machiar fort her.
NAME OF
FATHER
Henry grade-
BIRTHPLACE
OF FATHER İ
Enachas fort INE.
MAIDEN NAME
OF MOTHER
May Foster
BIRTHPLACE
OF MOTHER $
East Port. Tr-
OCCUPATION
INFORMANT § Dr. Donnan
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from Dec. 21, 1907 to Luce 13, 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 : Melancholia
..... (DURATION). DAYS
Contributory :
(DURATION). .. DAY&
(Signed)
Alber B. Someone
.. M.D.
Dee. 13, 1909 (Address)
Wenitrop Mari
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former_or
Usual Residence
E. Machiar Me
How long at .. Place of Death 7 2 In5 Days
Where was disease contracted,
If not at place of death ?
E. Machiar Me
Filed
190 ..
Clerk
PLACE OF BURIAL OR REMOVAL !!
East Machiar que
DATE OF BURIAL
190
ADDRESS
UNDERTAKER H.C. Skaggs
2 Немногов
· 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.
ALL NAMES TO BE IN FULL
122 Kate stade Talbot Dec-13-1909
COMMONWEALTH OF MASSACHUSETTS
2049 Winthrop (CITY OR TOWN.)
RETURN OF A DEATH
FULL NAME Caroline L. Boswell
Place of Bontriltavlor, off Writing Great Head
Death *
Residence
7.4 Lowell St. Somerèle
Age. 60 64
... years.
... months. .days
-
STATISTICAL DETAILS
SEX Femurê
COLOR
write
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Courtine I. Boswell
HUSBAND'S NAME +
BIRTHPLACE $ Fiest Maine Et
NAME OF FATHER
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER $
OCCUPATION
INFORMANT §
Caroline L. Boswell
1 HEREBY CERTIFY that I attended deceased during ta'st
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 : Drowning Suicidal.
. (OURATION). ... DAYS
Contributory :
(OURATION). . DAY®
(Signed)
Searge Burgers Magnit.
.. M.D.
dres med 2x am, Suffolk Cod 190 ...... (Addres
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 "Speclal Information." If In a Hospital or Institutlon, glvo 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 I
DATE OF BURIAL
190 9
UNDERTAKER
ADDRESS
(
L
Registered No.
Date of 16 .190 9
Death S
18
PHYSICIAN'S CERTIFICATE
123 Caroline L. Boswell. Dec 16-1909.
COMMONWEALTH OF MASSACHUSETTS
REVERE.
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of
Death *
S
Residence
Age
years
.. months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE $
conthand van
NAME OF
FATHER
Lataniel S
BIRTHPLACE OF FATHER$
-
MAIDEN NAME
OF MOTHER
Karrier biller
BIRTHPLACE OF MOTHER +
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, fro about July 1902 .... to. Que 15 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 :
Concer of abdominal.
rovall.
about 18 monetas
.. DAYO
Contributory :
(DURATION). . DAYS
(Signed)
Johnson
M.D.
Que () 1909 (Address)
Winnlegg neves
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 marrled or divorced woman, or widow,
# State or country; also city, town or county, If known.
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