USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 5
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t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
RETURN OF A DEATH
Place of l
Heston Mars
9 Henry Lee Harvey duy 2, 1907
[4.'07-37-I.M.]
Permit No.
RETURN OF DEATH.
Winthrop BOSTON, MASS.
Date of Death, any. Bild 1907 Name in full, Michael Lewis
(If married or divorced woman give maiden name, also name of husband.)
Sex, .Color, white
Condition, Warlemed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 86 Years, Months, Days. Occupation, Retired
Residence,* 265 Court Road
Ward, Winthrop
Place of Death, 265 Court Road
Place of Birth,
Ireland
(State year, month and day.)
Date of Birth, 1821
Name and Birthplace of Father,
William Lemis
.....
cheland
Ireland
Birthplace of Mother, S Holywood- Brookline.
Johnal. mario Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
-Boston,.
Written Maar. Aug HTh. 1907.
Name and Age ? Michael Lenis Age, SE years.
of Deceased,
I hereby certify that I attended deceased from fue 25-15 1907, to Aug. 22 1907, that I last saw. alive on the. ... day of Aug. 1907.
-IL .... .day of. Auf 190 7, about /1,30 o'clock that he died on the .. 30
.
t.M., w P.M., and that, to the best of my knowledge and belief, the cause of. tus death was as follows :
Chief cause, Dearchaca
Disease 1 Contributing cause, Aye
Duration
Chief Cause,
Contributing cause, .. A.B. Domman M.D.
· If an institution, state how long an Inmate and previous residence.
Maiden Name and
1
und
Place of Interment,
Michael Lewis, Quy 3. 1907
COMMONWEALTH OF MASSACHUSETTS
Minhof 13.00
(CITY OR TOWN.)
FULL NAME
Registered No.
Place of l
16 Ochan ave.
Date of ¿
Death *
S
Residence
16
Ochan ave
Age
.. years.
months. .. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Wintrop Beach
NAME OF FATHER
BIRTHPLACE OF FATHER+ Russia
MAIDEN NAME OF MOTHER Minnie & Levenson
BIRTHPLACE
OF MOTHER$
Boston Muso
OCCUPATION merchant
INFORMANT §
rather,
190
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
12/ Rox O hava Vedeck, aug.5 190}
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from aug 4 1902/ to Can ny 4 1904. 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 : Prematura Punct (5 mas)
.. (OURATION). .. 0AY8
Contributory :
1
2
(DURATION)
DAYS
(Signed)
M.D.
Jug 5
.190/ ... (Address).
SPECIAL INFORMATION only for Hospitals, Institutlons, Translents, or Recent Residents.
How long at
Place of Death ?
.years.
months ... .. days
Where was disease contracted, If not at place of death ?
Filed
Clerk
* Clty 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' Institutlon, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or countyr If known.
§ Name and address of person giving statistical detalls.
Jl Name of cemetery.
1
FILL OVI WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
....
Death
1
4
.190
2009 Qubino
Cinqet, 1907.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Frank J, La, Cotte.
Registered No.
Place of }
17 Buchanan Sti
Death *
5
Residence
Wintludz muss,
Age
2,4
.years
.months. days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED,OR
DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE
Dorchester mass
NAME OF
FATHER
Victor
BIRTHPLACE
OF FATHER#
France -
MAIDEN NAME
OF MOTHER
Catherine Delosen
BIRTHPLACE
OF MOTHER #
Tracadi, n.S.
OCCUPATION
gardener.
INFORMANT § mra Catherine Cowen.
PLACE OF BURIAL OR REMOVAL !!
mt Benedict
DATE OF BURIAL
aug 7
. 1907
UNDERTAKER
Thorof Love Ju.
ADDRESS
120 Have 871
East Boton
mass
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. July 20 amy 5 .190.3, 190.2 ... 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 : Primary :
0
One year
(DURATION).
... DAYS
Contributory :
A .: (DURATION)
DAYS
(Signed)
M.D.
any 6 1907 (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 "Speclal Information." If In a Hospital or Institution, glve Its NAME Instead of stroet 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
Withop Mas (CITY OR TOWN.)
7
Death
S
Date of l
ana 5th
190
20 60 Frank f. La balle Chequ; 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH.
Hinthup
BOSTON, MASS.
Date of Death,
august 5" 1907
Name in full, Oligareth Lawrence
(If married ør divorced woman give maiden name, also name of husband.)
Sex, Female
De Color White
Condition,
Hidom
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 86 Years, Months, 8 Days. Occupation,
Residence,* Hianthropo Mass Ward,
Place of Death, 55 Fremont Street
Del 28'1821 (State year, month and day.)
Place of Birth,
Date of Birth,
Name and Birthplace } John Gordon- Unknown
of Father, Maiden Name and Lydia Sind Unknon Birthplace of Mother,
Place of Interment,, Centre Sandwich-View Campestre
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Ofinthrop
Boston 190
Name and Age ?
of Deceased, Elizabeth Laurence Age, 86 years.
I hereby certify that I attended deceased from
July 30 190 ), to auf.
190/, that I last saw per alive on the 5.000
.... „day of 190
that 24 died on the 20 day of any. 190), about 1030 am o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. Ley death was as follows :
Disease ? Chief cause, apoplexy
Contributing cause,
Chief Cause, 6 days
Duration Contributing cause, Binetany M. D.
* If an institution, state how long an inmate and previous residence.
21
Eliza zabeth day auger, 1907.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of
110 Bourdain It Willcal
Death *
Residence
170 Baudoin It Printhead lass
Age
N
years
6
months.
28
.days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Laconia N. F6.
NAME OF
FATHER
Seare A Ment
BIRTHPLACE OF FATHER# England
MAIDEN NAME
OF MOTHER
Margaret It Jtower
BIRTHPLACE
OF MOTHER #
East Bouton Mars
OCCUPATION
INFORMANT § Margaret all Ment
PHYSICIAN'S CERTIFICATE
[ HEREBY CERTIFY that I attended deceased during last illness, from .. to 190 .190 ...... , that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary :
(DURATION)
DAYS
Contributory :
(DURATION) . DAYS
(Signed)
M.D.
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 II
Woodlawn Everett
Mar
DATE OF BURIAL
any 95
190. 5
UNDERTAKER
& B Danglars
ADDRESS
411 Broadway,
6 helaca dla1.
* 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
Registered No.
Date of ¿
ל 190.
Death 1
62
aug 8, 1907
[3.'06 37-LM.]
Permit No.
Orcintrop RETURN OF DEATH. BOSTON, MASS.
Name in full, ..
Date of Death,
auquel 16"1907
Charles to, Gillian ligiturate)
(If married or divorced woman give malden name, also name of husband.)
Sex, Male Color While Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, Years, 6 Months, 27 Days. Occupation,
Residence,* tinthope nass
Ward,
Place of Death, 10 bara & treal
Place of Birth, Watertown Mase Date of Birth;
State year, month and day.)
Jan 22"1907
Name and Birthplace Unknown
of Father,
Maiden Name and Margaret m. Gillian-
Birthplace of Mother,
Place of Interment,
Summer ofloved Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
scrittiof Boston,
any, 17Th 1907.
Name and Age ?
of Deceased, Charles E. Gillian.
Age, .. years.
I hereby certify that I attended deceased from any, 14th 1907. to Any 151h
1907, that I last saw huis alive on the. 150 day of aug. 190,
day of 1907, about ... 11 o'clock that died on the 15lt
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of Lui death was as follows :
Chief cause,
Cholera Infantum
Disease Contributing cause, Chief Cause,
Duration Contributing cause, A. B. forman M. D.
* If an institution, state how long an Inmate and previous residence.
21
mos. 127 days
aug. 16, 1907
BISPA 184
COMMONWEALTH OF MASSACHUSETTS
REVERE. Nultrop
(CITY OR TOWN.)
RETURN OF A DEATH Samuel, Hicklow
Registered No.
Date of l
aug 16
.. 190
Death
.. years.
10
months 6
days
STATISTICAL DETAILS
SEX
812.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Brighton Mass
NAME OF
FATHER
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
OCCUPATION
assessor of Boston
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from., July 15 1907 ... to
aug 15 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 :
Locomotor ataxia
(DURATION). .DAYS
Contributory:
Maphritis
4 encke (DURATION) ......... DAY8
(Signed)
M.D.
Char. 16. 190% (Address)
Winthrop, mars.
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 I
Forest Hills
DATE OF BURIAL
190 .......
UNDERTAKER
Leurs Jones & Sun
ADDRESS
50
* 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. JI Name of cemetery.
ALL NAMES TO BE IN FULL
FULL NAME
Place of ) Death * 20 Voltage Que Urenthanks.
Residence n. . Age 72
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
aug 1 6 th 1907
Date of Death, Name in full, Samu nel Lichborn
(If married or divorced woman give maiden name, also name of husband.)
Sex, Male
Color White
Condition, Widowed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 7 2 Years, 10 Months, 6 Days, Occupation, assessor
Residence,* 20 Cottage ar Winthrop Ward,
Place of Death,
. Brighton Ması Date of Birth, ,
(State year, month and day.)
Jeorge R. Hickborn Billerica Max
Name and Birthplace of Father, Maiden Name and Eliza a. Herrick Brighton Man.
Place of Interment,
Birthplace of Mother, S Forest Hills Cemetery.
EWIS JONES & SON, UNDERTAKERS,
O La Grange St., Boston.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, .... ...... 190 ...
Name and Age ? of Deceased,
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 :
Chief cause,
Disease
Contributing cause,
Duration
Chief Cause, Contributing cause,
* If an Institution, state how long an inmate and previous residence.
M. D.
21
Lewis Jours & How
Undertaker .-
Place of Birth,
Samuel Machbar Aug 16, 1907
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Thomas Kennedy
.Registered No.
...
Date of
Death
17 .. 190
months ...
(days
STATISTICAL DETAILS
SEX
mala White
COLOR
SINOLE, MARRIED, WIDOWED; OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME +
mary
BIRTHPLACE # IrEtanol
NAME OF FATHER Edward
BIRTHPLACE OF FATHER$ Irefund
MAIDEN NAME
OF MOTHER
Mary Murphy
BIRTHPLACE
OF MOTHER $
Ireland
OCCUPATION Laborar
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. Que 17 190,2 .... to aug 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 : Berbral Hemorrhage
6. hrs
. (DURATION)
DAYS
Contributory :
Pulmonary
2.
3 hrs.
(DURATION) .. DAYS
(Signed).
M.D.
Que 18 1907
(Address
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, of 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 !!
Holy Cross Maletencing 199
7
.... 130.
UNDERTAKER
ADDRESS
Frank S. Maloney 350 Winthrop 20
DATE OF BURIAL
* 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.
§ Name and address of person giving statistical detalls. { Name of cemetery.
ALL NAMES TO BE IN FULL
Minthah (CITY OR TOWN.)
Place of 30 Main St. Mantheah
Death *
...
Residence
30 main St. Winthrop
Age.
51
.. years.
65 Thomas Revisedy aug 17, 1907
NORTH C
COMMONWEALTH OF MASSACHUSETTS
REVERE. Winthrop (CITY OR TOWN.)
Registered No.
Date of ¿
190
Death
1
Residence
67 blackwood St Dor,
Age
.. years
1
.. months. ...... .days
STATISTICAL DETAILS
SEX
m.
COLOR
w
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
67 blankuvedl
NAME OF
FATHER
Samuel & Neugroschl
BIRTHPLACE OF FATHER$ austria
MAIDEN NAME
OF MOTHER
Rosa Levy
BIRTHPLACE
OF MOTHER $
Syracuse n.Y.
OCCUPATION
INFORMANT §
The
father
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. aug 20.
1902 ... to Cup 21. 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 : Cholera Infantário
. (DURATION)
m
DAYS
Contributory :
(DURATION). .............. DAY9
.
(Signed).
M.D.
Que 2%.
.. 1907 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents. How long at ............ months days Place of Death ? years.
Where was disease contracted,
If not at place of death ?
Filed
190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, givo Its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
ALL-NAMES TO BE IN FULL
RUS
RETURN OF A DEATH Milton neugroschl
FULL NAME
Place of )
Death *
S
11 Ready St Winthrop
DATE OF BURIAL
190 ..
PLACE OF BURIAL OR REMOVALI
UNDERTAKER
-
ADDRESS
7
66 milton Neugrasche aug 21, 1907
[4.'07-37-LM.]
Permit No.
It inthrop
RETURN OF DEATH.
BOSTON, MASS.
Dat& of Death,
august 22" 190 7.
Name in full, .. Danach
Elizabeth Grown
2 Female .Color,
(If married or divorced woman give maiden name, also name of husband.)
Condition,
Widowed
(Single, Married, Widowed or
Divorced.)
(White, Black, Mixed, Chinese, Indian, etc.)
Age, 74 Years, Months, Days. Occupation,
Residence,*
Mark
Ward,
Place of Death, 30 Marshall Street
(State year, month and day.)
Place of Birth, Sv Martins N 13 Date of Birth,
James Marke Chew Bommet Name and Birthplace of Father, Maiden Name and Birthplace of Mother,
Place of Interment, Cinthiap Gemeten
Number Gloved Underfaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Drenthrojo Boston,
23. 190.7.
Name and Age ! Sarah Elezobich Braden
Age, 24 years.
of Deceased,
I hereby certify that I attended deceased from.
1906, to. aug 22
190 /, that I last saw
alive on the 22 day of. 1905,
1800 that ale died on the. 22 day of. 1907, about .o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. tim death was as follows:
Chief cause,
Cancer 01 B reach
Disease Contributing cause, ...
Chief Cause, .. wellant two years
Duration
Contributing cause,
M. D.
· If an institution, state how long an inmate and previous residence.
Sarah Elizabeth Drown Cùng 22, 1907
Permit No.
RETURN OF DEATH.
Printerof BOSTON, MASS.
Date of Death,
august 23 "1907
Name in full, Eleanor Gertrude ailen
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female ...... Color, Ot hile~
(White, Black, Mixed, Chinese, Indian, etc.) Condition,
(Single, Married, Widowed or
Divorced.)
4 L Years, / O Months, ~Days. Occupation,
Age,
Residence,*
mass
Ward, ....
Place of Death, 211 inthe Street
(State year, month and day.)
Place of Birth, Tuttiof mass Date of Birth,
Name and Birthplace Harry Dr. aiken East Somenice.
of Father,
Maiden Name and Eleanor S. Patek no Cambridge
Birthplace of Mother,
Place of Interment, Hauthop Cemetery
Cuminer floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston
any- 23
1907.
Name and Age
of Deceased, Elancy
Age, 5 years.
I hereby certify that I attended deceased from. 190% , to. .... Chuy 23
1900, that I last saw her alive on the 23 day of. 190),
that died on the. 23 day of. any 190 ), about 4 o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
death was as follows : Dirilitis
Disease ? Chief cause,
Contributing cause,
Chief Cause, one year
Duration Contributing cause, 315hat auf
M. D.
* If an institution, state how long an Inmate nnd previous residence.
৳21
Cleaned Testude UMMin
Cinq 23, 1907
COMMONWEALTH OF MASSACHUSETTS
..
(CITY OR TOWN.Y
FULL NAME
.Registered No ..
Place of )
Date of
Death *
S
Residence
· Age
.years.
.months.
.. days
STATISTICAL DETAILS
SEX M
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED .
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Tuttiop, maso,
NAME OF FATHER
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER Saman MiDonald
BIRTHPLACE OF MOTHER # Judico Capra Pastor
OCCUPATION Depool Bil
INFORMANT § Better and Mother
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. InName of cemetery.
350Hruwhen
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jan
190.la.to aug 23 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 :
Tuberculous Peritonit
(DURATION). ........... DAYS
Contributory :
Tuberculosis
(DURATION) .. DAYS
(Signed)
M.D.
Ung 24
190 ..... (Address)
0
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 ?.
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Sly Cover Cory Malden 8419 2.6. 907
UNDERTAKER franck & Maloney
ADDRESS
Death S
190
7
110
ALL NAMES TO BE IN FULL
RETURN OF A DEATH Mary Aguas MiDonald
69 Mary agree ne Howald. cinq 24, 190"
COMMONWEALTH OF MASSACHUSETTS
CHELSEA.
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Will iamo. allen 2
.Registered No. 54.2
Death *
5
Chelsea Froot Hospital
Date of Una 29. 1907
Death
Residence
Winthrop masa
Age 31
.years.
months. .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
m.
MAIDEN NAME + HUSBAND'S NAME Ť
BIRTHPLACE # So Paris me
NAME OF
FATHER
James Williams
BIRTHPLACE
OF FATHER+
Halten me
MAIDEN NAME
OF MOTHER
Esebelle
BIRTHPLACE
OF MOTHER
So. Paris me
OCCUPATION Telephone mar
INFORMANT §
J. F. Woodbury
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Una 20. . 1907 to aug 29-190% 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 tiol Primary :
(DURATION)
9
DAYS
Contributory :
appendicitis
C
(DURATION)
DAYS
(Signed)
0. 8. Johnson
M.D.
aug 29-1907 (Address)
Winthrop
SPECIAL INFORMATION only for Hospitals, institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years
months.
8
days
Where was disease contracted, If not at place of death ?
Filed Sept 1- 1907 Charlottbleed
Clerk
PLACE OF BURIAL OR REMOVAL II
auburn me
DATE OF BURIAL
Sept 2 - 1907
UNDERTAKER
0.76.700
e den
ADDRESS
Wakefield
* 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. # 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
Place of )
Cung. 29, 1907
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Janus Gerard hong
.Registered No ..
Date of l
Salut.1.
Death )
190
months.
2%.
.. days
STATISTICAL DETAILS
SEX 21.
MAIDEN NAME +
HUSBAND'S NAME +
1
BIRTHPLACE #
Charlistini Mass
NAME OF FATHER Patrick l.
BIRTHPLACE
OF FATHER#
Izland
MAIDEN NAME
OF MOTHERIL
Calfinir Donovan
-
BIRTHPLACE
OF MOTHER #
Irland
OCCUPATION
INFORMANT §
Patrick & Long
28 Sidan, Charles town
PLACE OF BURIAL OR REMOVAL !!
Holy Cross. Maldin
DATE OF BURIAL
190.
UNDERT AKER 1. Hallahan
ADDRESS
30152 Hansmyst
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from
190) ..
Sept pet
.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 :
Intestinal Indigestion
with malnutrition
(DURATION)
3mis
DAYS
Contributory :
1
.DURATION) .. DAYS
(Signed).
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
* Clty 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.
Pharkatrin.
ALL'NAMES TO BE IN FULL
.
SINGLE, MARKTENT
WIDOWED, PR DIVORCED
Place of }
4 31 Revere St.
Death *
1
Residence
28 VEdar St. Sharbatnon
1
Age ......
.. years
REVERE
.
MO 1 James Guardi Your Sekt 1- 1PCT
₱
VOLS
;A
18
ENVERE 1871
COMMONWEALTH OF MASSACHUSETTS
REVERE, Winthrop .....
(CITINTOWN.)
FULL NAME
Place of
Celien
RETURN OF A DEATH Olsen
.Registered No.
Date of ¿
Seful-6th
1907
Death
Residence
72037 Banks & Winthrop Muy, Age ..
33
.years
months
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
houvay
NAME OF
FATHER
Celien Olsen.
BIRTHPLACE
OF FATHER#
Norway.
ray.
AIDEN NAME
MOTHER
Bertha Menudson
BIRTHPLACE
OF MOTHER #
Norway.
vay.
OCCUPATION
mariner
INFORMANT §
Rasmus Gelsen
PLACE OF BURIAL OR REMOVAL !!
Winthrop Cemeter
DATE OF BURIAL
Sept-800
190 .. 7.
ADDRESS
120 Merchan
UNDERTAKER
John W Seraque East Bastion m
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from any 190 .... to Sept 6" 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 : Phthisis
(DURATION)
27
. DAYS
Contributory :
(DURATION)
. DAYS
(Signed
Sep1 6
190.) .... (Address).
M.D.
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
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