USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1907-1909 > Part 7
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(CITY OR TOWN.Y
FULL NAME .
Ruth Arsus Falch
.Registered No.
Place of l
Death *
S
Residence
$39 Waldemar Av Age.
.years.
.months.
.days
STATISTICAL DETAILS
COLOR
SINGLE, MARRIED; WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t 1
BIRTHPLACE +
Hiustrop. mass,
NAME OF FATHER Mathwww . Halow
BIRTHPLACE OF FATHER+ Roubury Boston
MAIDEN NAME OF MOTHER Putte Hun 28000 Ello
BIRTHPLACE OF MOTHER #
mundovilla D. Virgínia
OCCUPATION Hood Buyer
INFORMANT §
mastice to stalah
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
190.
ADDRESS Ecet abelard
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 1907 to Ot 28 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 : Convulsions
3 horas
(DURATION) DAYS
Contributory :
Brancho primaria
(DURATION) DAYS
(Signed)
M.D.
Fer 28 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 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
UNDERTAKER
1907
Date of oct 28"
Death
88
Oct 28, 1907
COMMONWEALTH OF MASSACHUSETTS
Col.
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Everett, Nule Walker
.Registered No.
Place of Į
Oct 29 €
1907
Death *
Residence
For Banks Winches
56
.years.
>
3
.months.
.days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
-
MAIDEN NAME t
HUSBAND'S NAME +
-
BIRTHPLACE #
Butter Pu
NAME OF
FATHER
nathaniel walker
BIRTHPLACE
OF FATHER#
newburyport mass
MAIDEN NAME
OF MOTHER
Sanal Later
BIRTHPLACE
OF MOTHER #
OCCUPATION Commanding offices antiring bussin of Boston"
muro
INFORMANT §
note
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Qc1-30
190./
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from 14 28 190 ... to Oct 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 :
Primary :
Chrome
Endocarditis
(DURATION)
6 95
OAYS
Contributory :
Cardica Failure
2
.(OURATION)
0AY8
(Signed).
31 Metall
M.D.
vit 30,00)
.(Address).
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.
Date of ¿
Cech 29
190 7
Death
1
Winthrop
89 Per Everett Pull Hallen Cl. 129-1707
D
[4-'07-37-I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
October 30' 100%
Stillern Infank Maringhi
Name in full,
245 B huiles 21 1
(If married or divorced woman give maiden name, also name of husband.)
Sex, Female Color,
Condition,
Surebom Infant
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, Years, Months, ~Days. Occupation,
Residence,* Hartway mars
Ward,
Place of Death, 245 Shirley & Leed
(State year, month and day.)
Place of Birth, 11 14 11 Date of Birth,
Name and Birthplace of Father,
Maringhi
Staly
Maiden Name and margaret befall Italy.
Birthplace of Mother, 5
Place of Interment, Drwithno Cometer
Summer Floyd
/Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Dovirtuo Boston, ... October 30" 1907.
Name and Age ? Dution Infant Age, ~ years.
of Deceased,
I hereby certify that I attended deceased from on Oct 30, 1907, to
never sano
alive on the.
day of
190 ,
that Ate
died on the.
30
day of.
Det
190 7, about ..
. .. 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 :
Chief cause,
Still-vom
Disease Contributing cause, ..
Chief Cause, Still-Com
...
Duration Contributing cause,. Forward 7. 9000 M. D.
· If an institution, state how long an inmate and previous residence.
190 , that I last satt
marunghi Oct 30, 1907
[4.'07-37-1.M.]
Permit No.
Wanthropo
RETURN OF DEATH. BOSTON, MASS.
Date of Death, November 3d. 190 ... 7.
Name in full, Many Kendall Smith Many Rendell
(If married or divorced woman give maiden name, also name of husband.)
Sex, Ofemale .Color, White
(White, Black, Mixed, Chinese, Indian, etc.) Condition, Shiconed
(Single, Married, Widowed or Divorced.)
Age, 84 Years, 2 Months, 15 Days. Occupation,
Residence,* Winthrop Mars
Ward,
Place of Death, 243 within &heel
Place of Birth, Waterville Me Date of Birth,
(State year, month and day.)
Name and Birthplace Sketchen Jogur- Maternitle me
of Father,
Joanna Bates - Sandwich Share Maiden Name and Birthplace of Mother
Place of Interment, Greenland Cemetery-Greenland N. 18, Summer Fløy Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston IN 4
Name and Age ? Inany Kendall Sonth
Age, 84 years.
of Deceased,
I hereby certify that I attended deceased from.
190 , That I last saw her alive on the day of 190
that died on the .. 3.9 .day of. ( member 1907, 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 :
Disease Contributing cause, Insanity (dementia Simile)
Duration
Chief Cause,
Contributing cause, 3 yrs
B )that carly M. D.
* If an institution, state how long an inmate and previous residence.
190 ...
190), to 00/54 ret
old all
Chief cause,
-
Mary Pred ate "alt- Mor 3 - 190;
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
4 Jaur & B
FULL NAME
Place of Death *
The call For bital, Hinttrop It-
Date of Death ..
Forst ~ 1907
Age
. years .months ....... .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME } -
BIRTHPLACE +
NAME OF
Fachow martin Y,
BIRTHPLACE
OF FATHER +
Exit Boston
MAIDEN NAME
OF MOTHER
elisabeth / Commons
BIRTHPLACE
OF MOTHER #
Fomareilly Mass
OCCUPATION
INFORMANT §
Martino I have
naur
PLACE OF BURIAL OR REMOVAL II
Holy Cross. Maldau
DATE OF BURIAL
7
190.
UNDERTAKER Track J. malonuy
ADDRESS
350 Furtheron
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 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 : innative bitte 1
. (DURATION). DAYS
Contributory :
(PURATION) DAYS
(Signed)
M.D.
t.v. 6
190.7 .... (Address).
17 4 atentos st-
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
* 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.
Registered No.
1
92 Ler Lane hors, 170/
١
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
area
Maria. S. Schuler
.Registered No.
Date of l
20013
7
190
Death
5
14
.. years.
.months.
.days
STATISTICAL DETAILS
SEX
Ferrari
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME t
maria
Railein
HUSBAND'S NAME t John. G. Schuler
BIRTHPLACE #
NAME OF FATHER adam. Railer
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § Daybler
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Sarl 190Q .. to. Nor13 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 :
Mitral stenosis
arterio celcrisis Reveral jiars
(DURATION).
DAY8
Contributory :
as above
.(DURATION) ..... DAYe
(Signed)
.26
M.D.
Nov15
190 ...... (Address)
Winthrop
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
PLACE OF BURIAL OR REMOVAL II
Winetinh ameting
DATE OF BURIAL
no0 15
>
190
UNDERTAKER
CR Pcmusoni
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.
ALL NAMES TO BE IN FULL
Place of
nov 13 th Wanchink
Death * 180 Bowdown the
Residence
Ag
81
73 Imaria & Schuler
[4.'07-37.1.M.]
Permit No.
2 Virtual
RETURN OF DEATH.
BOSTON, MASS.
Date of Death,
ONovember 25 1907
Name in full, Sarah Angalle
(If married or divorced woman give maiden name, also name of husband.)
Sex, Stemale Color, White
(White, Black, Mixed, Chinese, Indian, etc.) Condition, Didomed
(Single, Marrled, Widowed or Divorced.)
Age, / 05 Years, 6 Months, ~Days. Occupation,
Residence,* QVinthrop. Mars
Ward,.
Place of Death, 59 Fremont Street
(State year, month and day.)
Place of Birth, Harwich Mase Date of Birth, June 20 "1802 Unknown
Unknown
Place of Interment,
Name and Birthplace ? of Father, Maiden Name and 1 Birthplace of Mother, Harmony Grace Emnets Salem DummerHoud Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Diritto Boston, nov 25 190%.
Name and Age ?
of Deceased, Sarah Ingalle .Age, 105/2 years.
I hereby certify that I attended deceased from June 6 1907, to. nov 25
1907, that I last saw her alive on the. first day of July. 1907, that she died on the. 25 day of. 200 1907, about 12,50 o'clock
v.M., or P.M., and that, to the best of my knowledge and belief, the cause of .. death was as follows :
Senility
Disease -
Chief cause, ... Contributing cause,
Duration
Chief Cause, Contributing cause,
Several years 4 ....
M. D.
· If an Institution, state how long an Inmate and previous residence.
Sarah's Sugallx har 25, 1907
[4.'07-37.I. M.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
November 26" 1907 Date of Death, ... Blittlow Infant (nelley) Name in full,
(If married or divorced woman give maiden name, also name of husband.)
Sex, male Color, White
Stilllow
Age, Years, Months,
Indian, etc.) Days. Occupation,
Residence, *.
I havetrop mass
Ward,
Place of Death, 54. Shuley Street
(State year, month and day.)
Place of Birth,
54, Shuley Street Date of Birth, Mir 2671907
Name and Birthplace } of Father, Maiden Name and Birthplace of Mother, S
Joseph fr nulloy ='
Elizabeth Morgan - East Berlin
Place of Interment, Multiop Cemetery
Suntner Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Northrop
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, Sull Br
Disease ' Contributing cause, Incidelay to Both
Chief Cause,
Duration Contributing cause,
M. D.
* If an institution, state how long an inmate and previous residence.
(White, Black, Mixed, Chinese,
Condition,
(Single, Married, Widowed or
Divorced.)
Mulloy nr. 26, 1907
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Ruby Frances Por francia
Registered No.
Place of l
freteall Hospital White Date of
....
Death
Dec 241
190
Death *
..
5
Residence
50 0310212720608 Road Somenice Age
25
.. years.
2
months. .days
STATISTICAL DETAILS
SEX female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1
Ruby. frances 13 orders
HUSBAND'S NAME t
BIRTHPLACE #
Chelsea 221020
NAME OF
FATHER
Zum Perry Bardana
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Marilla y. Lleven.
BIRTHPLACE
OF MOTHER#
Cebola-
OCCUPATION
INFORMANT § the tran €
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 1 1907 to bea, 2 .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) . DAY 8
(Signed)
M.D.
190.
... (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death ?
1
days
Where was disease contracted, If not at place of death ?
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
190.
UNDERTAKER
CR. Pernium
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. || Name of cemetery.
ALL NAMES TO BE IN FULL
96 July Frances Lackmore. Ace 2, 190%.
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Du. 5'1900.
Name in full,
Gran - Charles 2L.
(If married or divorced woman give maiden name, also name of husband.)
Sex, ... Color,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Marrled, Widowed or
Divorced.)
Age, 66 Years, / Months, 26 Days. Occupation,
Residence,* 150 Juinton, St. Coast Boston Ward,
Place of Death, 17 Dont Road Winthrop mann.
(State year, month and day.) Place of Birth, Baston mais, Date of Birth, Oct.10'1841. Name and Birthplace Thomas S. Evar of Father,
Bustine
Maiden Name and Amanda M. M, Laug hlin Birthplace of Mother, S Place of Interment, Novelaum Esme, Avete Haus. ES Brown
Belfast me.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, DEc. 5~ 1907
Name and Age
of Deceased, Mary E. Fodbold
Age, 66 years.
I hereby certify that I attended deceased from. 100 30 1907, to Dics-
day of. Die 1907, 1907 that I last saw
sher
that died on the. day of 1907, about 2 o'clock
P.M., and that, to the best of my knowledge and belief, the cause of ..
Chief cause, Double Lobar Pneu mia. was as follows :
Disease Contributing cause,
Chief Cause, six days.
Duration
Contributing cause, Jean H. Lietas,
M.D.
* If an Institution, state how long an Inmate and previous residence.
alive on the. 5.00
Die
her death
Date of Death, Fodbold
Condition, Ma
Mary E. Fodbold tre. 5. 1104
[4.'07.37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
December 9" 1907.
Name in full,
Date of Death, amaziah W. Hile
(If married or divorced woman give maiden name, also name of husband.)
Sex, Male Color White
Condition, Married
(Single, Married, Widowed or Divorced.)
Age, 81 Years, ~ Months, ~Days. Occupation,
Residence, *.
Masz Ward,
Place of Death, 59 Fremont Sheet
Place of Birth, Calais Marie
(State year, month and day.)
. Date of Birth, Cet 18"1826
Name and Birthplace ) of Father,
Ohman Stile = Calais manico
Maiden Name and Unknown = Calais marine
Birthplace of Mother,
Place of Interment, The Cemetery Tutuof Mass
unimed atloud
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Dea. 9 1907
Name and Age ? of Deceased, Unazial It. Hill Age, 81 years.
I hereby certify that I attended deceased from Dre. y. 1907, to c.q.
190 , that I last saw him alive on the.
day of Die. 1907 that died on the. .day of . 1907, about +3 ....... o'clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. his death was as follows :
Disease
Chief cause, .. Contributing cause,
Suppresative layetités
Duration Contributing cause,
Chief Cause, _ 4 years.
M. D.
· If an Institution, state how long an lumate and previous residence.
(White, Black, Mixed, Chinese, Indian, etc.) Locksmith
Craziaun Hall A.08. 1407
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Which May Dartous
Registered No.
Place of l
melquel Har fithe
Death *
S
Residence
22 De a Fivan. Un
Age
34
.years.
1
.. months.
10)
days
STATISTICAL DETAILS
SEX Fernale
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Manuel
MAIDEN NAME +
HUSBAND'S NAME +
Leo .W. Darloro
BIRTHPLACE #
Waterville Canada
NAME OF
FATHER
Franklin D. Frisk
BIRTHPLACE
OF FATHER +
Carrillón Canada
MAIDEN NAME
OF MOTHER
Minnie Enchan
BIRTHPLACE
OF MOTHER +
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 .. ) ... to out Dec 10 190 .... , 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 :
abdominal aparations
(OURATION).
9
.. DAYS
Contributory :
Grippe, Heart Failure
3
(DURATION)
. DAY 8
(Signed)
Bitmet calf
M.D.
lec
199
(Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death 2
.years.
months
9
days
Where was disease contracted,
If not at place of death ?
mass
Filed
190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclai 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 porson giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !!
Winterof
DATE OF BURIAL
12/
190 ... 7
UNDERTAKER
CMX 13 cmsó
ADDRESS
Winkel
Date of l
Dec 10
190
Death
1
19 alice may har low Aac 10, 1 40%
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Piace of Death *
Date of Death
DEC 10 4 1907
Age
76
.years
months
days
STATISTICAL DETAILS
SEX
COLOR
Muito
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Meland
NAME OF FATHER Bernard M. bater
BIRTHPLACE
OF FATHER
Island
MAIDEN NAME OF MOTHER Margaret' Merican
BIRTHPLACE
OF MOTHER $
Island
OCCUPATION
INFORMANT §
2
1 vivere No Clueword Aver
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during las illness, from 190 6. to Tec 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 : Breast caven
3 years
(DURATION). DAYS
Contributory :
Exhaustun
.(DURATION). .. DAYS
(Signed)
Thomas 7. Scene
M.D.
.190 ... .. (Address)
322 /Passen Pr
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usuai Residence
How long at Place of Death ? .Days
Where was disease contracted, If not at place of death ?
Filed
.190
Cierk
* 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 dotails.
Frank & malony os ithought
-
PLACE OF BURIAL OR REMOVAL JI DEF 10911 E dict
DATE OF BURIAL DEC12 90'7
UNDERTAKER
ADDRESS
Registered No. 351
ALL NAMES TO BE IN FULL
100 many are m'a leave FEc. 10, 1907
[4.'07.37-LM.]
Permit No.
RETURN OF DEATH.
Shirttrop
BOSTON, MASS.
December 11" 190%.
Name in full,
Date of Death, Roger Cincolu Belcher
(If married or divorced woman give maiden name, also name of husbaud.)
Sex, male Color, White
Condition,
(White, Black, Mixed, Chinese, Indian, ete.)
(Single, Married, Widowed or Divorced.)
Age, ~ .. Years, L Months, 17 Days. Occupation,
maso
Ward,
Residence,* 305, Winthrote Sheet
Nov 24 "1907 1 (State year, month and (uy.)
Place of Birth, Vintrop mass Date of Birth,
Name and Birthplace of Father,
James alfred Belcher = Winttuos?
Maiden Name and Birthplace of Mother, S
Mary 6. Greening= New Foundland
Place of Interment, Hinter Cemetery
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Dec 12
1907.
of Deceased, Rogn & Belcher Age, 17 days
.years.
I hereby certify that I attended deceased from Dec 10" .. 190 , to. Dec 115
190 , that I last saw he
alive on the. 10- .day of Dic 1907.
that „.died on the .. 11 day of Dic 190 ,about. 9 .o'clock
.1.M., or P.M., and that, to the best of my knowledge and belief, the cause of ..
S chief cause, La Grippe
Disease Contributing cause, use, Pneumo na
Duration
Chief Cause,.
Contributing cause, & Soule M. D.
· If an Institution, state how long an inmate and previous residence.
his death was as follows :
Name and Age !
Place of Death,
roger Lincoln Belcher Aac 11, 1907
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME.(
Catherine . Crowley
.Registered No.
Place of Death *
Metcalf Atify Ninthich /111a22
Date of Death
LEC 11Th 1907
.Age
47
... years
months - .days
STATISTICAL DETAILS
SEX
COLOR
Milita
CINOLE, MARRIED,
DIVORCED
MAIDEN NAME
Catharina. Murray
HUSBAND'S NAME t
George It.
BIRTHPLACEİ
Borton Mars
NAME OF
FATHER
John away
BIRTHPLACE
OF FATHER$
Ireland
MAIDEN NAME
OF MOTHER
Maria Witharna
BIRTHPLACE
OF MOTHER +
Ireland
OCCUPATION
Housework
INFORMANT § Daughter
PLACE OF BURIAL OR REMOVAL II
1
Calvary LEvity.
DATE OF BURIAL
DEC 13"19
1907
UNDERTAKER
Thank AMalmay
ADDRESS 350 Winthrop 1.4.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Dec. 8 190 ..... to Dec 11 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 : appendicitis
(DURATION)
3
DAYS
Contributory :
18 hrs.
(DURATION).
... DATO
(Signed)
Ihr Porter
M.D.
190
.(Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
33Hutchinson Af.
How long at
.. Place of Death ?. / ..
Days
Where was disease contracted,
If not at place of death ?
33 Hutchinsonthe
Filed
.190
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
ALL NAMES TO BE IN FULL
102 Catherinef Crowley Are. 11. 1907
COMMONWEALTH OF MASSACHUSETTS
womthron
...
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Hrung Brachwaite ashton
Place of
Death *
Residence
9 "
Age
55
.. years.
6
months.
14.
.days
STATISTICAL DETAILS
SEX
Hace
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
t
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Preston Lancucles Ing
NAME OF FATHER Thomas Cisalon
BIRTHPLACE
OF FATHER#
Blackhun Iny
MAIDEN NAME
OF MOTHER
Lydia luncher
BIRTHPLACE
OF MOTHER #
OCCUPATION
Salesman
INFORMANT §
8000
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. Drc. a. 17 to Dec. 13 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 : .
(DURATION)
4
.. DAYS
Contributory :
Pulmonary forum
1
(DURATION) DAY8
(Signed).
M.D.
Dec. 15 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
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
14/5
7
190 ...
UNDERTAKER
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 detalls. Il Name of cemetery.
Registered No.
Date of ¿
De = 13
190
Death
10€ Henry Frathwaite achton! DEC13, 1907
[3.'06 37-LM.]
Permit No.
RETURN OF DEATH. Winthrop = BOSTON, MASS.
Date of Death,Q
th. December 13 " 1907
Name in full, ahrend Oliver.
Paper
(If married or divorced woman give maiden name, also name of husband.)
Sex,
Male
Color,
arhite
Condition,
Single
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