Town of Winthrop : Record of Deaths 1907-1909, Part 6

Author: Winthrop (Mass.)
Publication date: 1907
Publisher:
Number of Pages: 768


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 6


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


How long at


Place of Death ?


years.


. months. . days


Where was disease contracted,


If not at place of death ?


Filed


.190


Cler


* 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 of 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


Death * Winthrop Mass


Olien Olsen Seja1 6, 1907


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH Jackson


(CITY OR TOWN.)


FULL NAME


Perchã M.


Place of l


Death *


S


Winchrol Mais


Residence


235 Court Rout


20


2


.months.


.days


STATISTICAL DETAILS


SEX


Female


COLOR


Mute


SINGLE, MARRIED, WIDOWED, OR DIVORCED


Manuel


MAIDEN NAME 1


Bercha. m. allen


HUSBAND'S NAME t


albert. R. Jackson


BIRTHPLACE # Fairhaven Mars


NAME OF


FATHER


Rico. F. allen


BIRTHPLACE


OF FATHER+


Hanharen


MAIDEN NAME


OF MOTHER


Sarah, E. Dunham


BIRTHPLACE


OF MOTHER #


OCCUPATION


INFORMANT §


Husband


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Sept 1st sept 7 ... 190 .... ), 190 .... ).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 : Confinement (Incident to)


.(DURATION)


.. 0AY8


Contributory :


Septe Infection


(OURATION)


6


. DAY8


(Signed).


Birmetcalf


M.D.


Sept 8


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 "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.


ALL NAMES TO BE IN FULL


PLACE OF BURIAL OR REMOVAL !!


Fanharen mars


DATE OF BURIAL


Luft 9


>


190.


UNDERTAKER


G. R. Bensin


ADDRESS


Winitwoh Mars


1,84


Registered No.


Date of ¿


Left-


.190


Death S


Ag


.. years.


7


1


Bertha m. ackern! Sekt 7-1907


[3.'06 37-LM.]


Permit No.


RETURN OF DEATH.


Il interrato


BOSTON, MASS.


Name in full,


Date of Death


alexander Douglas


Byer 8:190mg


(If married or divorced woman give malden name, also name of husband.)


Sex, male Color, While


Condition,


Married


(Single, Married, Widowed or


Divorced.)


Age, 77 Years, Months,


Days. Occupation,


Ward,.


Place of Death,


228 main Street


Place of Birth,


Renfrew Scotland Date of Birth,


(State year, month and day.)


Name and Birthplace ! of Father,


Unknown, Sortland


Maiden Name and 1 Unknown, Scotland


Birthplace of Mother, S


Place of Interment,


Qvintual. Cemetery Winthrope Mars


Cumuler Floyd


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Diciturajo


Boston,


Sess


9


190


Name and Age ? of Deceased,


Douglas Age, 77 years.


I hereby certify that I attended deceased from ciprie 1907, to Sett


190 ,that I last saw -him


alive on the.


.day of


190%,


that. died on the 8 day of 190 ), about 9 o'clock


A.M., or P.M., and that, to the best of my knowledge and belief, the cause of me death was as follows : Multiple undanimal Cancer


Disease


S chief cause, Contributing cause,


Duration


Chief Cause, Contributing cause,


* If an Institution, state how long an Inmate and previous residence.


М. П.


(White, Black, Mixed, Chinese,


Indian, etc.)


Petired


Residence,*


Winthrop Mase


Alexander Mougla.


Sept 8-1907


[3.'06 37-LM.]


Permit No.


RETURN OF DEATH. BOSTON, MASS.


Date of Death, Dejetente 11" 1907


Name in full, Mary Elizabeth Ingalls


(If married or divorced woman give maiden name, also name of husband.)


Sex, Otimale .Color, White


(White, Black, Mixed, Chinese, Indian, etc.) Condition, Single.


(Single, Married, Widowed or Divoreed.)


Age,. 16 Years, 5 Months, 2/ Days. Occupation,


Residence, *. Winthrop mass


Ward,


Place of Death, Buchanan Steel


Place of Birth, Boston Mass


(State year, month and day.)


Name and Birthplace of Father,


Moses Angades = Carlisle Masz


Maiden Name and Elizabeth C. Mansfield- Massachuset


Birthplace of Mother,


Place of Interment,


Summer Flatych


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Winthrop Boston, Bff 12th 190%.


of Deceased, Mary Elizabeth Ingalls Age, 76 years.


I hereby certify that I attended deceased from May 1712 .. 190/ , to


Sfr. 111h


1907, that I last saw her alive on the 1115 day of Seff 190/,


the


that died on the day of Sift 190/, about 4 o'clock


I.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, Apoplus


Contributing cause,. age !


Chief Cause, ..


Duration Contributing cause,


M. D.


* If an institution, state how long an inmate and previous residence.


621


Name and Age ?


Date of Birth, Mar 21"


mary Elizabeth vieralle Sept 11-1907


[3.'06 37-LM.]


Permit No.


RETURN OF DEATH.


BOSTON, MASS.


Name in full,


Date of Death, Novace PP. Sentching


Sepet 15.1907


(If married or divorced woman give maiden name, also name of husband.)


Sex, Male .Color While


Condition,


Married


(Single, Married, Widowed or Divorced.)


Age, J2 Years, 5 Months,~


Days. Occupation,


Ward, ....


Place of Death, 18, Warehace Street


Place of Birth,


Nathrop, Mass Date of Birth,


(State year, mouth and day.)


ajanie 16"18:55


Name and Birthplace of Father,


Maiden Name and adaline Richardson Moultonbrought


Birthplace of Mother, )


Place of Interment, Printtrop Centery Lt intuito mass Qunner Cloud


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Name and Age ?


of Deceased,


Age, 6 2 years.


I hereby certify that I attended deceased from 1906 190 , to Sept 15


1907, that I last saw he


- alive onthe. 15ª day of Sept 190),


that died on the. 15


day of Sept 190) , about . .o'clock


945


A.M., or P.M., and that, to the best of my knowledge and belief, the cause of his death was as follows : Persitions anaemias Chief cause,


Disease Contributing cause,


Chief Cause, one year


Duration Contributing cause,


M. D.


* If an institution, state how long an inmate and previous residence.


(White, Black, Mixed, Chinese, Indian, etc.) Salesman


Residence,* Winthrop Mass


Thomas & Jerkshun - Chelsea


Boston,


Sept 17


190) .


Traces. Tewksbury Sepet 15-1907


-


[4.'07-37-I.M.]


Permit No.


RETURN OF DEATH.


Winthrop


BOSTON, MASS.


1


Date of Death,


Dejeli 21" 190%.


Name in full, Drue 6. Milchese


(If married or divorced woman give maiden name, also name of husband.)


Sex, Female Color,


Black


Condition,


(White, Black, Mixed, Chinese, Indian, etc.) (Single, Married, Widowed or Divorced.)


Age, Years,


Months, 15 Days. Occupation,


Residence, *.. Sinttuoto Mars


Ward,


Place of Death, 19, Oakland Street


Place of Birth, Afinthrop


Date of Birth, June 6"1907


adolphus a. Mitchele=Stor mare


Name and Birthplace } of Father, Maiden Name and Birthplace of Mother,


Florence Y, Janow- Boston mass


Place of Interment, Winthrop Cemetery- Vinttusk mass Summer floyd Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Winthrop Boston, Seht 22 1907 .


Name and Agel


of Deceased, Doris E. Mitchell


Age,3/2 Myear


I hereby certify that I attended deceased from Aug 19 1907, to. Sel221


1907, that I last saw per alive on the. 18 day of Self 1907,


that Ale died on the 21 day of .. Selt 190 , about. 2 o'clock


¿t.H. or P.M., and that, to the best of my knowledge and belief, the cause of.


Chief cause,


Cholera Infantum


Disease Contributing cause,.


Chief Cause, cholera Infantun


Duration Contributing cause, hraniti.


EZY M. D.


· If an Institution, state how long an Inmate and previous residence.


mouths.


herdeath was as follows :


(State year, month and day.)


Doris &. Mitchell Leti 21-1907


[3.'06-37-LM.]


Permit No.


RETURN OF DEATH. Handtuch BOSTON, MASS.


Date of Death,


261907


Name in full,. Georgi anna


Heargianna Sial


(If married or divorced woman give maiden name, also name of husband.)


Sex, termale Color, White Condition, Zidane ~ (White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)


Indian, etc.)


Age, 65 Years,. 1 Months, 22 Days. Occupation, Hotel Keeper


Residence, *. Hatie Shirley Ward,.


Place of Death, Hotel Schinken Winthrop (State year, month and day.) Date of Birth, any 4 18 42


Place of Birth, assique


Name and Birthplace \ William Sias Greifer V. H.


of Father, Maiden Name and Belinda B. Thurston arefree UN Birthplace of Mother,


Place of Interment,


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Bostono Left 26 1909 Name and Age Georgionna Thestone of Deceased,


I hereby certify that I attended deceased from


Sef 17 1907 , to ..


Self 26


190/, that I last saw her alive on the. 25 day of Left 1907, that she died on the ... 26 day of Seft 190 7, about. 10.1o'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, ..... Cerebral Embolism


.


Disease ?


Contributing cause,


Chief Cause, nine days


Duration Contributing cause,


M. D.


* If an Institution, state how long an inmate and previous residence.


C


21


65


Age, years.


11 Seargentina Thrustoria Sepet 26-1909


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Mari I. Nadeau


Registered No.


Death *


5


Residence


54 Buchanan St Winthrop Age.


823


years


.... months. .............. days


STATISTICAL DETAILS


SEX


COLOR


CHOLE,MARRIED, WIDOWED, OM DIVORCED


MAIDEN NAME +


Sunknown


HUSBAND'S NAME + Damos M.


BIRTHPLACE #


Montreau Canada


NAME OF FATHER Emknown


BIRTHPLACE OF FATHER$


Sunknown


MAIDEN NAME OF MOTHER


Unknown


BIRTHPLACE OF MOTHER $ Unknown


OCCUPATION


INFORMANT §


PLACE OF BURIAL OR REMOVAL II


Woodlawn burs Everett


DATE OF BURIAL bet. 6 7


190.


UNDERTAKER ADDRESS E. G. Brown . Boston


PHYSICIAN'S CERTIFICATE


| HEREBY CERTIFY that I attended deceased during last iliness, from. cep. 2%. 1907 .... to Oct. 4 190 .. 2, 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 : Cerebral Hemostage


(DURATION).


DAYS


Contributory : arteria- Aclerosis


(OURATION) . 0AY3


(Signed)


H.J. Partir


M.D.


Oof. 5. 1907 (Address)


Nietrafi, Mais


SPECIAL INFORMATION only for Hospitais, 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.


A


ALL NAMES TO BE IN FULL


Place of 54 Buchanan St Winthrop


Date of l


Oct 4


190


Death 1


78 mais de hadean Data-1901


[4.'07.37.I.M . ]


Permit No.


RETURN OF DEATH. BOSTON, MASS.


Date of Death, ....


190


Name in full, Erna. I.


Whichan anden names. Jina. M. Main wife of Jesse 13. Whicham


(If married or divorced woman give maiden name, also name of husband.)


Sex, ...... Color,


Condition Himmel


(White, Black, Mixed, Chinese, Indian, etc.)


(Single, Married, Widowed or Divorced.) .


Age, 25 Years, / Months, x Days. Occupation,


Residence,* 15 Marshack for


Place of Death, Initially tothelat


Place of Birth, It Solens new foundland Date of Birth, 1882


Name and Birthplace of Father,


Maiden Name and Birthplace of Mother, Wwechiit Contains Wincent Mars Place of Interment,


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston, october 7th 7 190


Name and Age !


. la mit han


Age, 25 years,


I hereby certify that I attended deceased from .. Myml 2/ 190 7, to. 5/-


1907, that, I last saw


She


5


day of


octotu


1907, about 4 o'clock


JE, or P.M., and that, to the best of my knowledge and belief, the cause of her her death.


was as follows :


auto refection incidental to comment 1 Disease ‹ Chief cause,


Contributing cause,


Chief Cause,


Duration


Contributing cause, 6 week


0 3:„Вигля 7


M. D.


· If an Institution, state how long an Inmate and previous residence.


C


-


of Deceased,


alive on the. sth


day of october 190 7


that


died on the.


(State year, month and day.)


Verna m. Withan Caro- 190%.


-


1)


[4.'07-37-LM.]


RETURN OF DEATH. BOSTON, MASS.


Date of Death,


October 7" 1907


Name in full,. Gelten Jane Gray Marin


Pe Kin's


(If married or divorced woman give maiden name, also name of husband.)


Sex, Female. Color,


(White, Black, Mixed, Chinese, Indian, etc.) Condition, Maned


Age, 80 Years, ~ Months, ~Days. Occupation,


Residence,* Mantrap mars


Ward,


Place of Death, 95 Sommeset Chence


(State year, month and day.)


Place of Birth, Jaunton Mass Date of Birth,


Name and Birthplace of Father,


John Perkniz - Beckley Mass


Maiden Name and Betsy Hastings Heeton Mars


Birthplace of Mother, 1 Place of Interment, Withup


Demeter


Dimmel Iloud


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston, Oct, 7th 1907.


of Deceased, Esther Y. , Masau


Age, 80% yearx.


I hereby certify that I attended deceased from. Oct 5 1907, to Cat. 7


190 Mthat I last saw


alive on the. 6th


day of. Ocl 190 7


that sie . died on the. 7 th Oct


day of 1907, about 9 o'clock


A.M., or E.AR, and that, to the best of my knowledge and belief, the cause of. her death was as follows :


Disease - S Chief cause, Softening of Brain Contributing cause, .. old age


Duration


Chief Cause, 2 years


Contributing cause, George A French. M. D.


* If an institution, state how long an inmate and previous residence.


Name and Age


Permit No.


11


(Single, Married, Widowed or Divorced.)


leather Janne Gray masow Oct-7, 1907


: NORTH CHE 1788 :


CHEL


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME Susan C. foster


.Registered No.


Place of ) Metcalf Hos.


Death *


S


Residence


Bellingham are


Age


42


.years


months.


.days


STATISTICAL DETAILS


SEX FI


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVOPGED


MAIDEN NAME + Susan la Marks


HUSBAND'S NAME t


Lekel I Foster


BIRTHPLACE # Nova Scotia,


NAME OF


FATHER


reich Weeks marks


BIRTHPLACE


OF FATHER#


O Viva Leolía


MAIDEN NAME >


OF MOTHER


Rejeiali Wake


BIRTHPLACE


OF MOTHER#


Nova Scotia


OCCUPATION


INFORMANT §


Herand


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from .. Sept 30 190.7 to Ocx 9 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 : Pulmonary Embalus


1


(DURATION).


.. DAY8


Contributory :


Had been operated


hoeide (ii) litern,


(DURATION)


17


DAYO


(Signed) W& Winelink


M.D.


04. 12


1907 (Address) 398 Wirdborndet, Borla


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 detalis. Il Name of cemetery.


TILL VVI WIIN INK. - INIS IS A PERMANENT RECORD


ALL NAMES TO BE IN FULL


PLACE OF BURIAL OR REMOVAL I


Woodlawn Ceni.


DATE OF BURIAL


act. 12


1907


UNDERTAKER


ADDRESS


WalterT. White 368 B way Revere


COMMONWEALTH' OF MASSACHUSETTS


REVERE.


Winthrop


Date of ¿


Oct 9


190


Death


81 Susan to Foster Lect 9 :- 1907


[3.'06-37-LM.]


Permit No.


RETURN OF DEATH. BOSTON, MASS. Wultrik main


Date of Death,


Qct 18-190M


Name in full, William de. Barter


(If married or divorced woman give maiden name, also name of husband.)


Sex, male Color, White


Condition, Pringle


(White, Black, Mixed, Chinese, Indian, etc.)


(Single, Married, Widowed or Divorced.)


Age,~ Years, /


.Months,


18 Days. Occupation,


Residence,* 5 lebarles St


Ward,


Place of Death,


5 lacharles Se


Place of Birth,


Mancherfa Hass Date of Birth,


(State year month and day.) Sept 11907


Name and Birthplace of Father, Maiden Name and Birthplace of Mother,


William of Bacter Boston


Margaret le CallahanBoston


Place of Interment,


Calvary Boston


/ Kg leacids


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Nurthu Mas Cleb. 18/1 1907 -Boston,


Name and Age William N. Barter fr. Age, 48 da years


I hereby certify that I attended deceased from. .... 190 , to 6. 17th


190 7, that I last saw


died on the 18th-


alive on the. 17th day of. cech. 1907,


day of . Och. 1907, about .. .. o'clock that he


death was as follows :


Contributing cause,. malnutrition.


Duration Contributing cause,.


L.R. Dovulan M.D.


· If an Institution, state how long an Inmate and previous residence.


021


of Deceased,


A.M., or HH, and that, to the best of my knowledge and belief, the cause of L Disease " 1 Chief cause, Premature birth


Chief Cause, ..


Willeauer 76. 1 Farten Qat 18-1907


{4-'07-37-L.M.]


Permit No.


Winthrop


BOSTON, MASS.


Date of Death,


7, Co Lober 20"


1907.


Name in full, Robert Bruce Grail


(If married or divorced woman give maiden name, also name of husband.)


Sex, male Color, White Condition, Widower


(White, Black, Mixed, Chinese, Indian, etc.)


(Single, Married, Widowed or


Divorced.)


Age, 52 Years, 10 Months, ~ Days. Occupation, Mechanical Engineer


Residence,* It cuittrop mass


Ward,


Place of Death,. 2kg Pleasant Street


Place of Birth, Borel Canada


(State year, month and day.)


Date of Birth,


Jan 31 " 1854


Name and Birthplace of Father,


William Corail=Perth Scotland


· Maiden Name and Mary D. Duggan = Ireland (Not)


Birthplace of Mother, S


Place of Interment,


Edson Cocheley


Candle Mass


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Winthrop Boston. oct 212 190


of Deceased, Robert Bruce Crail


Age,. , 32 years.


I hereby certify that I attended deceased from .. 1906 , to oct 20'


1907 that I last saw


alive on the.


day of Gatily 190 ),


that Le died on the .. 201 .day of .. 190), about 10.30' clock


A.M., or P.M., and that, to the best of my knowledge and belief, the cause of .. his death. was as follows :


Chief cause,


Lo camentos ataxia


Disease Contributing cause, .


General Parasis


Chief Cause, .. Several years


Duration Contributing cause,


M. D.


· If an institution, state how long an inmate and previous residence.


21


..


Name und Age ?


RETURN OF DEATH.


Oct 20 .- 1901 Arbeit Bruce lerait


1


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITTY OR TOWN.)


FULL NAME Joseph Mardi


.Registered No ..


Place of )


150 Sea forum are


Date of l


Get- 22ª


.190


Death


1


2


.. years.


.months .....


11 .days


STATISTICAL DETAILS


SEX mall


COLOR


White


SINGLE, MARRIED, WIDOWED, OR DIVORCED


Maria


MAIDEN NAME +


HUSBAND'S NAME Ť


BIRTHPLACE #


NAME OF FATHER


BIRTHPLACE OF FATHER$


-


MAIDEN NAME OF MOTHER - 0 24 190) (Address)


BIRTHPLACE OF MOTHER #


OCCUPATION myr -


INFORMANT §


Wife


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from 190.7 ... to


at 22 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 : Chrmic Guesswhat Thefun


nephites


.... (DURATION)


3ay yen 2 ... DAYS-


Contributory :


(DURATION). .. DAY8


(Signed)


M.D.


SPECIAL INFORMATION only for Hospitals, Institutlons, 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 callod for under "Special Information." If In a Hospital or Institution, glve 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 details. Il Name of cemetery.


ALL NAMES TO BE IN FULL


PLACE OF BURIAL OR REMOVAL !!


DATE OF BURIAL Cecr 24.


1907


UNDERTAKER C.R Denman


ADDRESS


7


Residence


11


Age


358


Death *


1.


84 Josepho Mardi. Oct 22-197


JORT


LSEA 1849


REVERE LOT


COMMONWEALTH OF MASSACHUSETTS


REVERE.


(CITY OR TOWN.)


FULL NAME Benjamin G. Palfrey


Place of )


Death * 5


..


100 Sargent


Residence


100 Sainget St


Age


82


.. years.


months. days


STATISTICAL DETAILS


SEX Male


COLOR White


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


..


2


HUSBAND'S NAME +


BIRTHPLACE +


NAME OF


FATHER


BIRTHPLACE OF FATHER# Unknown


MAIDEN NAME


OF MOTHER


Unknown


BIRTHPLACE


OF MOTHER #


Unknown


OCCUPATION


INFORMANT §


PHYSICIAN'S CERTIFICATE


1 HEREBY CERTIFY that I attended deceased during last


illness, from .. ......... 190


... 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 :


Pois ani


illuminati


(DURATION). .............. DAY8


Contributory :


(DURATION). .. DAYS


(Signed)


Senza Gruppen Mano


.. M.D.


a41 22 1907 (Address) 224 Boylston 88


SPECIAL INFORMATION only for Hospitais, MAstitutions, Transients, or Recent Residents. Lid


How long at Place of Death ? . years.


months. Sufolded


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.


§ Namo and address of person giving statistical details. || Name of cemetery.


PLACE OF BURIAL OR REMOVAL I


DATE OF BURIAL


Cect-24 1907


UNDERTAKER


& R. Bennison:


ADDRESS


Registered No.


Date of l Oct 22. .190


2


Death S


390


RETURN OF A DEATH


85 Benjamin lo Valfray Oct 22-1907


7


COMMONWEALTH OF MASSACHUSETTS


Monthoh


(CITY OR TOWN.)


FULL NAME


amne & mccarthy


Registered No.


Date of


Oct 24 th


Death


.190


8


.months.


ys


STATISTICAL DETAILS


Female Mitista


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


annia E


Rower


HUSBAND'S NAME +


BIRTHPLACEİ


South Boston


NAME OF


FATHER


Francis Power


BIRTHPLACE


OF FATHER$


New Foundland


MAIDEN NAME


OF MOTHER


Margaret Rowe


BIRTHPLACE


OF MOTHER #


n. 1fr


OCCUPATION


INFORMANT §


PLACE OF BURIAL OR REMOVAL I Hob, Crow Maldau


DATE OF BURIAL


..............


ADDRESS


123Marsruchs


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from oct.18 190% to Oct 24 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 : Vreamoura-


.(DURATION). . DAYS


Contributory :


(Signed)


HE Pragdom.


(OURATION). .. OAYS


M.D.


oct 24


Address) Of Central Ay


SPECIAL INFORMATION only for Hospitais, 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 "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 detalis, Il Name of cemetery.


ALL NAMES TO BE IN FULL


Place of


Withich Ia22


Death *


5


Residence


92 Marshall


Age


29


years.


UNDERTAKER Frank of Maloney?


RETURN OF A DEATH


86 Come to mis learthay (let 24, 1307


[4.'07-37-I.M.]


Permit No.


RETURN OF DEATH.


Timetro fo


BOSTON, MASS.


Date of Death,


October 2.5"


190.7 ...


Name in full, Margaret freeman ........


(If marrled or divorced woman give malden name, also name of husband.)


(White, Black, Mixed, Chinese, Indian, etc.) Condition, Sex, Female Color While


(Single, Married, Widowed or


Divorced.)


Age, 1 Years, 6 Months, 21 Days. Occupation,


Residence,* Winthrop Mass Ward,


Place of Death, Hy Summit avenue


Place of Birth, Winthrop Mass Date of Birth,


(State year, month and day.)


Dean G. Freeman-Acra Sortia


Name and Birthplace of Father, Maiden Name and Birthplace of Mother, 5


Jena Hayden - Heuttrop Mass


Place of Interment, Stintinoto banetery - Dumider Floyd


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Winthrofs


Boston


oct 26


190)


Name and Age ?


of Deceased, majoret "fueman Age,. years.


I hereby certify that I attended deceased from. oct 12 190) , to


1 190 ,that I last saw


alive on the .. 25 day of 190 ,


that she died on the. 25 day of .. oct. 190 ), about. 6 Proclock


.A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death was as follows : Parmians. anaemia Chief cause,


Disease Contributing cause,


Chief Cause, 2 mois


Duration


Contributing cause,


M. D.


· If an Institution, state how long an Inmate and previous residence.


21


margaret Freeman Clar 25-1907


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH




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