USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 4
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July 3, 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 :
Circhorio of Liver
years
(DURATION)
Contributory :
Thomas EPigott
M.D.
W
ocattivola
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 mithope
DATE OF BURIAL
Serie 5 90
190 ...
7
UNDERTAKER : 2. Eastman
ADDRESS
25(remonts
Boston
* 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 marrled or divorced woman, or widow. t State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
RETURN OF A DEATH
Registered No.
Date of ¿
Death S
190
7
(Signed) July 3, « ... 190 ..... (Address)
DAYS
+2
Gonet Meusset
[3.'06 37-LM.]
RETURN OF DEATH. BOSTON, MASS.
Permit No.
296
Name in full,
¿ Wangan Margaret
Date of Death,.
July 12, 190%
(If married or divorced woman give maiden name, also name of husband.)
Sex, Color,
Condition, ..
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Indian, etc.)
Age, 16 Years, 11 Month Months, 2 Days. Occupation,
Residence,*
Brookline, Dass.
Ward,
Place of Death, 39 Sea Foam ave Winthrop
Place of Birth,
(State year, month and day.)
Date of Birth, Rug 10 1896
Name and Birthplace Owen of Father, Aussie Fils patrick Maiden Name and Birthplace of Mother, Holy Cross Walden
Prostor
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, July 12 1907
Name and Age ? of Deceased, margaret mc Millan
Age, years.
I hereby certify that I attended deceased from. any 1906 , to ...
190 , that I last saw Les alive on the 11 day of 190),
that died on the 12 day of
190 , about 4. SO a clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of .death was as follows : chine valvulate disease of heart. Chief cause,
Disease
Contributing cause, . .
Chief Cause, Deanalycon
Duration Contributing cause,
M. D.
* If an Institution, state how long an Inmate and previous residence.
021
Place of Interment,
the
4.3 Margaret : Fillers July 12, 190%.
[4-'07-37-I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
Name in full, Fannie
Frank
Hannie Starbest
(If married or divorced woman give maiden name, also name of husband.)
Sex, temale Color, White
(White, Black, Mixed, Chinese, Condition, married
(Single, Marrled, Widowed or Divorced.)
Age,. 32 Years, & Months, X Days. Occupation,
Indian, etc.) Housewife
Residence,* 6:51 Showmet Live
Ward,
Place of Death, 167 Short Drive Munitions
(State Fear, month and day.)
Place of Birth, Omanchester Ông, Date of Birth,
Name and Birthplace \ Solomon Stanbest Russia of Father, Russial
Maiden Name and annie Stainbert
Birthplace of Mother,
Place of Interment, Pennest Care Nowborn poort Planetiky
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, July 13. 190%
Name and Age ?
asume Frank
Age, 32 years.
I hereby certify that I attended deceased from July 13: 1907 , to.
190 , that I last saw her alive on the. 13/ day of fly 1907,
that. the died on the. 13 th
day of July 1907, About 5 o'clock
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, (Pulmonary well
Contributing cause,
..
Chief Cause, .. 16 Pers.
Duration Contributing cause, Uncertama
M. D.
* If an Institution, state how long an Inmate and previous residence.
2
July13
David
190 M
of Deceased,
4.4 6 + annie Frank - July 18, 1901
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Coaswell
.Registered No.
Place of
128 Barcheet Road
Date of ¿
Suche 15-
190
Death
Residence
Age
.years.
.. months ............... .days
STATISTICAL DETAILS
SEX
7
termale
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE #
122 Burchett Road
NAME OF
FATHER
Loving R. Cogswell
BIRTHPLACE OF FATHER$ aylesford n.f.
MAIDEN NAME
OF MOTHER
mary. a. fullerton
BIRTHPLACE OF MOTHER # Grand Paris U.S.
OCCUPATION
INFORMANT § Loving R. Corpweek
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 1907 to July IS 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 : will form
(OURATION)
DAYS
Contributory :
mudutal & Bull.
.. (DURATION).
..... DAY &
(Signed)
1ml 18 190) (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
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
>
190 ..
UNDERTAKER CR Bereuen
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, 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
Death *
-
M.D.
115 Logannell Пиву , 5, 190%.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Marcha Fonseca
Registered No.
Place of
Death *
319 Radde St Withnot Muss
Death
S
Date of l
July 15
1907
Residence
Age
€5
.. years.
.months.
.days
STATISTICAL DETAILS
SEX
Ferah
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME T
marcha Bulgaro
HUSBAND'S NAME t
Costura Fonseca.
BIRTHPLACE # German
NAME OF
FATHER
Chilik Belgard
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Para. Greenlung
BIRTHPLACE
OF MOTHER #
OCCUPATION
.
INFORMANT § Husband
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ... June 1906 to July 15 907, 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).
365
DAYS
Contributory :
(Signed).
It. It. Sawyer
(DURATION). . DAY8
M.D. July /6 1907 (Address) 155 Mars Ury 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
PLACE OF BURIAL OR REMOVAL
Leadhan mars
DATE OF BURIAL
190 ..
UNDERTAKER
C.R. Brzmicon.
ADDRESS
* 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
Marcha Fonseca, July, 15, 1900
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
Finiturap BOSTON, MASS.
Name in full, James
Date of Death,. Bowater
July 16" 1907-
(If married or divorced woman give maiden name, also name of husband.)
Sex, noul Color
(White, Black, Mixed, Chinese, Indian, etc.) Condition, married
(Single, Married, Widowed or Divorced.)
Age, 71 Years, Months, ~ Days. Occupation, Laitmaster Darget
Residence,*
Minttrope marz
Ward,
Place of Death,
24 Cherry @heet
Place of Birth, Carrol Co Smany land Date of Birth, (State year, month and day.)
Name and Birthplace ? of Father,
John Bonate- Bathinae med
Maiden Name and dane Willoughby-
11
Birthplace of Mother,
Place of Interment,
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, July 16th 1907.
Name and Age?
James Bowater
Age,.
years.
of Deceased,
I hereby certify that I attended deceased from ... July 4 th007, to ... July 16th
1907, that I last saw ·him
alive on the. 16 th
- day of July 190%,
that Le
died on the 16 th
day of July. 1907, about 6 o'clock
LA P.M., and that, to the best of my knowledge and belief, the cause of. his death was as follows : Nephritis, Chronic Interstitial Chief cause,
Disease Contributing cause,
Chief Cause, a number of years .
Duration
Contributing cause,.
Ernest F. Slater
M. D.
* If an Institution, state how long an inmate and previous residence.
(Fort Banks).
47
James " Soi aler )
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full, Willian
Date of Death, E Noyce
July 16/ an
(If married or divorced woman give maiden name, also name of husband.)
Sex, Sale Color, White
Condition, Married
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 59 Years,.
+ Months, ..
+ Days. Occupation, Jeamster
Residence, *
Shirley At Point Shirley Ward,
Place of Death,
(State year, month and day.) Place of Birth, Portland Mais Date of Birth, Unknown
Name and Birthplace \ Charles Naves
Unknown
of Father, Maiden Name and Birthplace of Mother, Place of Interment,
Mary Russell Gloucester Iname
Lincoln maine James W ODonnell &s. Zhausenrar oton
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Pmthoop Boston, July 17 th 1907.
Name and Age? of Deceased, Hiniciam
V Age, 59 years.
I hereby certify that I attended deceased from June ish 1907, to July 16 th
1907, that I last saw him .. alive on the 16th
day of freky 1902, that. died on the the 16 th
day of. July 1907, about /2-5 o'clock
his death
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of was as follows :
Disease Chief cause, Carcinoma of fans Contributing cause, arteriosclerosis.
Chief Cause, about two years
Duration Contributing cause, Unknown.
Cubrir Ce, JaHn M. D.
* If an Institution, state how long an inmate and previous residence.
021
48
Williams &hayes July 1 6, 1901
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Edward
Gross
Registered No.
Date of l
Death *
5
Death 1
190
Residence
Age
35
years
.months. 25 .days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
NAME OF FATHER GeorgE. V. Gross
BIRTHPLACE OF FATHER# Juro Mass
MAIDEN NAME OF MOTHER Julia. Fr. Critéfick
BIRTHPLACE OF MOTHER $
OCCUPATION Medical Sindcant
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
19
. 190)
UNDERTAKER
ADDRESS
.
PHYSICIAN'S CERTIFICATE
190. .. to I HEREBY CERTIFY that I attended deceased during last illness, from 1904 July 17 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 : Chronic Valvular Heart dnes
(DURATION) / 5 yes
DAYS
Contributory :
(DURATION) .. DAYS
(Signed)
M.D.
190
.. (Address)
SPECIAL INFORMATION only for Hospitals, Institutlons, Transients, or Recent Residents.
How long at Place of Death ? .. years ..
......... ...... .months. ..... days
Where was diseaso 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.
# Stato or country; also city, town or county, If known,
§ Namo and address of person giving statistical detalls. || Name of cemetery.
FILL VUI WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Place of )
49 Edward B Cross, July 17, 1807
11
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of Death,
July 19"1907
Name in fulln. Ella Mo Campbell Ella me Leighlow - (If married or divorced woman give maiden name, also name of husband.)
John Q. Competière
(White, Black, Mixed, Chinese, Indian, etc.) Condition, Married Sex, Female Color,
(Single, Married, Widowed or Divorced.) -
Age, 57 Years, 9 Months, Days. Occupation,
Residence,*
mass
Ward,
Place of Death, 60. Main Street
Place of Birth,
Peinture me
(State year, month and day.)
Date of Birth, (oct 19"1848
Ducting Leichten-Pembroke sure
Name and Birthplace of Father, Maiden Name and Lydia Hersey- Venteke me
Birthplace of Mother, )
Place of Interment, Pembroke The - Forest Hills amely Summa Flend Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston July 19th 190) .
years. 9 months of Deceased, Ella M. Campbell, Age 37 1905 190 ,to July 19703
I hereby certify that I attended deceased from
190 7, that I last saw her alive on the 19'
day of 190 ,
that the .died on the 19
day of July 190}, about. com ..... o clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of her death was as follows :
Disease ? Chief cause,
melancholia
Contributing cause,
Chief Cause, one withthe
Duration
Contributing cause, . one much
Smetany M. D.
* If an Institution, state how long an Inmate and previous residence.
521
Name and Age ?
50 tella, M. Completes July 19, 1907
,
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. Ninthup BOSTON, MASS.
Date of Death,
July 26"1907
Name in full, ... Louisa Franche Prole
Sex, èmale Color While
Condition,
tidamed
(Single, Married, Widowcd or Divorced.)
Age, 67 Years, 3 Months,
Residence,*
Hintlook may
Ward,
Place of Death,
187 Hinttrop Sheel
Place of Birth,
Oldtim The
Date of Birth, .
Name and Birthplace
of Father,
Arace Brad -aliin The
Maiden Name and maria Broad = aletria me
Birthplace of Mother,
Place of Interment,
Dedham mask,
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Drietrop.
Juf 27
1907.
Name and Age ?
of Deceased,
Lamisa Francis Poole
Age, 67 years.
I hereby certify that I attended deceased from ........ about 1900 , to July 26
1907, that I last saw
alive on the. 26 day of 190₺,
that she died on the. 26 day of July 190 7, about 8 o'clock
her death
A.M.,or P.M., and that, to the best of my knowledge and belief, the cause of was as follows : Diabetes mellitus
Chief cause,
Disease ? Contributing cause,
Chief Cause, Several years
Duration Contributing cause, Salmon ...... M. D.
* If an Institution, state how long an Inmate and previous residence.
1
(If married or divorced woman give maiden name, also name of husband.)
(White, Black, Mixed, Chinese, Indian, ctc.) 18 Days. Occupation,
(State year, month and day.)
51 Louisa Frances Gaal
July, 26, 1907
263
: 3.'06-146. VM. ]
(FOR POST-MORTEM EXAMINATIONS ONLY.) Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
July 28, 1907
Name in full, Harry a. Bro -
(If married or divorced woman give maiden name, also name of husband.)
Ser, mali Color Months>>
White White, Black, Mixed, Chinese,
Condition Married (Single, Married, Widowed or Divorced.)
Indian, etc.) Days. Occupation,
Age, 34 Years,
Residence, /08/
Place of Death, ~
(State year, month and day.)
Goderect Ouch Date of Birth, 2 Place of Birth,
Name and Birthplace ) of Father, Maiden Name and 1 Birthplace of Mother, ) Place of Interment,
alfred Burino Sabbruch Cela
Undertaker.
MEDICAL EXAMINER'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, July 30, 190 1
I hereby certify that I viewed the body of Name, Harry a Brown who died on the 28th day of July 190
und to the best of my knowledge and belief, the cause of
te of his death was as follows :
Autopsy 30, 1907
Disease, - l'hief cause,. ante dilatation of the Heart-
Contributing cause,
Age, 34 years,
Serge Burgers Magrath
.
52
Harria Drown July 28, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. Hinttuoj. BOSTON, MASS.
Date of Death, ..
July 29 1907
Name in full, full, Joseph Kempton black
(If married or divorced woman give maiden name, also name of husband.)
Sex, Males Color White
Condition, Widower
(Single, Married, Widowed or
Divorced.)
Age, Years, 9 Months,
Residence, *.
Klasz
Ward,
Place of Death, Writtwoh.
Place of Birth, Wiscarsch. WE
Date of Birth,
(State year, mouth and day.) Ot 9 1826
Name and Birthplace Franklin Blanc
of Father,
Maiden Name and 1 Jeannette V. Shear Wayne the
Birthplace of Mother, Place of Interment, For / flat fon Deo to Moravian Penseties Summer Floyd
Staten 22-2014
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Monthist Boston, July 30
190 ... ) ....
Name and Age ) of Deceased, Joseph Kempton Clark
Age, 80-9ms years.
I hereby certify that I attended deceased from.
July 3d 190 ),to July 29'
190), that I last saw
alive on the 29
1
day of Andy 190 }
that he died on the 29" day of July
190), about 5.100 clock .death
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of .. was as follows :
Disease Chief cause,
Gastritis
Contributing cause, old age
Chief Cause, Several weeks
* If an institution, state how long an inmate and previous residence.
Duration Contributing cause, 315metal M. D.
21
(White, Black, Mixed, Chinese, Indian, etc.) Days. Occupation,
iscasse ME
53 Joseph Kempton black July 29, 1907.
[3.'06 37-LM.]
Permit No. ....
RETURN OF DEATH. BOSTON, MASS.
Date of Death, July 2,
ulu 29 "19.04
Name in full, George Edgar Loroseman !
(If married or divorced woman give maiden name, also name of husband.)
Sex, male Color, Ophile Condition, Manied
(Single, Married, Widowed or
Divorced.)
Age, 51 Years, 4 Months, Days. Occupation, mass
Residence,*
Ward,
Place of Death,
50 Summit Chenve
2
(State year, mouth and day.)
Place of Birth,
Sportland Me Date of Birth,
Mar y"1856
Name and Birthplace Charles to, Coposeman -linknom of Father,
Maiden Name and Marilea Gould-Charleston Mass Birthplace of Mother,
Place of Interment,
Winthrop planeten Cinthia mais
Dumna blond
4
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
190).
Nam and Age !
of Deceased, Gerry Eden Gorman
Age, 51 years.
I hereby certify that I attended deceased from One year 190 , to
July 29-
190 ,That I last saw
.alive on the. 28 day of me 190 ),
that died on the 29' 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 : Chief cause, Cancer ! schwach 0
Disease Contributing cause,
Chief Cause, .... .... 2 years
Duration Contributing cause, . 1
M. D.
* If an institution, state how long an Inmate and previous residence.
(White, Black, Mixed, Chinese, Indian, etc.) Printer
Georges led gar Grossman, July 29, 1907.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
...
Place of l
#H Pleasant St.
Death * S
Residence
#4 Pleasant Ly
Age 34
.. years.
months .: .. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME Ť
BIRTHPLACE# Sydney . M. B.
NAME OF FATHER tolun ."
BIRTHPLAGE OF FATHER# Jhvia Leatia
MAIDEN NAME OF MOTHER Mary In Lugal
BIRTHPLACE OF MOTHER Novia Scotia
OCCUPATION at home
INFORMANT § No Gardner
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 .. ) .. to
July 29 190 ... .. , that to the best of my knowledge and beljef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Cancer Stomach
2 years (DURATION).
1. DAYS
Contributory :
A (DURATION). ....... DAY8
(Signed)
M. D. July 24 190) (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 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.
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
I Fullsoul
UNDERTAKER
m. M- niff
ADDRESS
mass.
Registered No.
Date of l
Death 1
July 29 1907
Que M: Load July 29, 190%.
4
i
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
www Jour fowler-
Place of )
Death
Wirth
Residence
152 Pheasant
Age .
70
.years.
$
.months
3
days
STATISTICAL DETAILS
SEX Female
COLOR,
While
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Amir Jaua milligan
HUSBAND'S NAME
David y diaroles
BIRTHPLACE #
NAME OF FATHER
Bort charles Milligan
BIRTHPLACE OF FATHER$ Scotland
MAIDEN NAME OF MOTHER James Cook
BIRTHPLACE OF MOTHER # Scotland
OCCUPATION Household
INFORMANT §
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
190.
UNDERTAKER Esidon & W/ Brown
ADDRESS Gast Boston
PHYSICIAN'S CERTIFICATE
190 2 ... to I HEREBY CERTIFY that I attended deceased during last illness, from. July 30 som to fuel 30 10.30 190 .. , 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 : Cereal apoplety
2 /3 hour
0AY8
Contributory :
(OURATION) . DAYS
(Signed)
OBohusau M. D.
Juf 31 1907 (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 „lastitution, 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. 4
ALL NAMES TO BE IN FULL
Registered No.
Date of July 30 Death
.190
T
no-56 Annie Jane Fowler) July 30, 190%.
Stige
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
25 mesicuci
Death *
5
Residence
Age
month
... days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
X
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
NAME OF
FATHER
Lewis I tern
BIRTHPLACE
OF FATHER+
Burton
MAIDEN NAME
OF MOTHER
Millie Castleman
BIRTHPLACE
OF MOTHER #
Revue mars
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 to July 31 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 : Styl
. (DURATION) .. DAYS
Contributory :
(DURATION). DAY8 |
(Signed)
Ir agammalkkingenleg M.D.
190 .. 2 .. (Address).
56 Sagamore
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, , or Recent Residents.
How long at Place of Death ? ... years .. ............
months. ...... . days s
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 I
DATE OF BURIAL
190.
UNDERTAKER
C.R. Benmani
ADDRESS
Registered No.
Date of l July 31 Death 1
190
flere July 231, 1907
COMMONWEALTH OF MASSACHUSETTS
Town & Heston Weston
(CITY OR TOWN.)
FULL NAME
Henry Lee Harvey
Registered No. 17
Date of ¿
Death
aug 2
190
Death *
Residence
Anthrop lass
Age
10
.years
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Omale
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Anthrop Mass
NAME OF
FATHER
Charles fHarvey
BIRTHPLACE
OF FATHER+
Waltham Mass
MAIDEN NAME
OF MOTHER
Ellen Lanagan
BIRTHPLACE
OF MOTHER +
Ireland
OCCUPATION
INFORMANT § Father
PLACE OF BURIAL OR REMOVAL II Removedtonmithropciug 307
DATE OF BURIAL
Calvary bem Nalthani
190
UNDERTAKER John J. Mooney
ADDRESS Halttrau
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from 190 aug 2 .. to 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 : Drowning
(DURATION). . DAYS
Contributory :
(DURATION). DAY8
(Signed)
George Le West ND Med Ex?
I.D.
7th middlesex District
aug 2
. 1907 (Address) Neuron Centre
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
aug 3
George H. Cutting.
Town. 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, glve Its NAME Instead of street and number.
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