Town of Winthrop : Record of Deaths 1910-1912, Part 4

Author: Winthrop (Mass.)
Publication date: 1910
Publisher:
Number of Pages: 956


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 4


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).


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3 whose


(DURATION).


Contributory :


X


(DURATION) ... DAYS


M.D.


(Signed)


Rue /4 1960


(Address)


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at


Place of Death ?


Days


Where was disease contracted, If not at place of death ?


Filed


190


Clerk


* 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. t 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


28 Februar a Beach may 1 3-1910


COMMONWEALTH OF MASSACHUSETTS


Welcherof (CITY OR TOWN.)


RETURN OF A DEATH


FULL NAME


Many Sinclair Tewksbury


Registered No.


Date of


March 15th


1960


Death


1


2


months ..


11


.days


STATISTICAL DETAILS


SEX


COLOR


1.


SINGLE, MARRIED,


WIDOWED, OR


DIVORCED


widow


MAIDEN NAME +


Mary. Sinclair Smith


HUSBAND'S NA


E Martina Granville


Tentesting


BIRTHPLACE # Bastón mass


NAME OF


FATHER


Horace Bear


BIRTHPLACE


OF FATHER $


New Hampshire


MAIDEN NAME


OF MOTHER


achsah. Holl- Smith


BIRTHPLACE


OF MOTHER $


New Hampshire


OCCUPATION Retired


INFORMANT §


Daughter


-


PLACE OF BURIAL OR REMOVAL !!


DATE OF BURIAL


1960


UNDERTAKER & R. Bennison


ADDRESS


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last iliness, from 1 190.6 ... to Mah. 15 1900 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 :


Cardiac Dropsy


(DURATION) 3 2000.


DAYS


Contributory :


Mitral Stenosis


(DURATION).


DAYS


(Signed)


M.D.


...


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, 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 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


Place of l


9


altantic Street


Death *


S


Residence


Age


63


.. years ..


Inch. / 1900 (Address).


29 mary Suetain Tewksbury man 15 -igio


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME Marylaubt Buce


Death *


Residence


Age


51


... years.


4 .months.


.days


STATISTICAL DETAILS


SEX


FEM


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME + HUSBAND'S NAME t


BIRTHPLACE #


Ellamonth MS


NAME OF


FATHER


Charles & Hackell


BIRTHPLACE OF FATHER#


MAIDEN NAME


OF MOTHER


Mary It Black


BIRTHPLACE


OF MOTHER#


Ellsworth ME


OCCUPATION Housewife


INFORMANT §


Edward N Buss


PLACE OF BURIAL OR REMOVAL ! fui ra Hyde Park Mari


DATE OF BURIAL Man 19. 95 0


UNDERTAKER Oliver N ferralla Wake field ADDRESS


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from 1914 to Melilla 1980, 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 : Mitine Regurgitate


Contributory :


Dilatation og hurt


8 min


(DURATION) ... . DAYS


, W.KI.M.D.


(Signed) ..


Mehra


.1910


(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


19


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.


ALL NAMES TO BE IN FULL


Place of Venithned Than 133 Washington 260


Registered No. Mar 17 19/0


.. (DURATION).


.DAYS


30 many labb Buck mek 17-1960


31 h


--- -


COMMONWEALTH OF MASSACHUSETTS


f


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Frederick Temple Seof


.Registered No.


Place of l


Death * )


Metaal Hospital


Date of ¿


Mar 15


1960


Death


Residence


15


Age


1


.years.


months. 22. .days


STATISTICAL DETAILS


SEX


COLOR


20.


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME +


HUSBAND'S NAME t


BIRTHPLACE # Somerville Mas


NAME OF


FATHER


Frederick Temple Scott.


BIRTHPLACE OF FATHER$ Salafox U.S.


OF MOTHER Newark England


antescelen want.


OF MOTHER $


Eliza Person


OCCUPATION


INFORMANT § -fachen


PHYSICIAN'S CERTIFICATE


tc I HEREBY CERTIFY that I attended deceased during last illness, from nº16 196. Mich 19' 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 :


acute. Cappillan


(DURATION).


DAYS


Contributory :


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


.M.D.


(Signed)


Ih 19 190


.(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


DATE OF BURIAL


Olav 20


1960


UNDERTAKER


€ 12. Benimsoia.


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


31 Frederick amples Seatt .- mich 11-1410


.


1630$


INCORPORA


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


Registered No.


Date of Death Mar. 21, 1910


Place of


Death


125 Monument Street Medford


NAME OF HOSPITAL OR INSTITUTION, IF ANY


NO.


STREET


Place of


Residence.


51 Winthrop Street, Winthrop, Mass.


NO. STREET


CITY OR TOWN


Age ..


48 .. years ..


3


months


6


days


STATISTICAL DETAILS


SEX


COLOR


SINGLE, MARRIED


WIDOWED, OR


DIVORCED


I HEREBY CERTIFY that I attended deceased during last


illness from


March ... 18,


19 10,


to .......... March 21,


19 10. 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


Alcoholism


Duration


Many ... y.r.s ..


Contributory C rdiac Asthenia


Duration


Many ... we.cks. ..


(Signed)


James .... S ..... Kennedy.


M D.


(Address) Medford


Date Mar. 219 10


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Where was Disease Contracted? Withroo


How long at Place of Death ? Days


Recorded


Mar. . 22,. 19


10 A. R. Reed


Clerk of Board of Health


UNDERTAKER'S NAME


ADDRESS JJoh .. .. E. Maulor


Filed


34 Lincoln St., Somerville Mars. Fr. 26,


19


Allatón A. Joyce


NO.


STREET


PHYSICIAN'S CERTIFICATE


Male MAIDEN NAME


White


widowed .....


HUSBAND'S FULL NAME


BIRTHPLACE AND DATE OF BIRTH


Portsmouth, N. H. Dec. 15, 1861


NAME OF FATHER George ... W ..... Sanborn


BIRTHPLACE OF FATHER Portsmouth, N. H.


MAIDEN NAME OF MOTHER Kate ... Andrews


BIRTHPLACE OF MOTHER


Lowell, Mass.


OCCUPATION


Clerk


FULL NAME OF INFORMANT


Adelphus .... Leavitt


OFFICIAL TITLE


ADDRESS


Medford


PLACE OF BURIAL


Cemetery


City or Town


Fair View, Dedham Mais.


City Clerk


ALL NAMES TO BE IN FULL


CITY OF MEDFORD


FULL NAME WARREN SAMUEL SANBORN


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH (CITY OR TOWN.)


FULL NAME


Lydia. Walden Lunch


Registered No.


......


Place of l


Death *


41 Cutler fr


Residence


Age


... years.


1


.months.


.days


STATISTICAL DETAILS


·


SEX-


Female


COLOR


SINGLE, MARRIED, WIDOWED, OR DIVORCED


cordon


MAIDEN NAME +


Lydia. w. 5 off.


HUSBAND'S NAME Ť


Williami H. Lynch


BIRTHPLACE #


Bustol R.J.


NAME OF


FATHER


Sylvanus. Goff


BIRTHPLACE


OF FATHER#


Rehoboth R.P.


MAIDEN NAME


OF MOTHER


arm. Davis Gray


BIRTHPLACE


OF MOTHER #


Bristol R.V.


OCCUPATION


INFORMANT §


dangbeen -


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Sehr. 17 1906 .. to Heh. 21 1950, 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 : Bronchitis


(DURATION).


×3


DAYS


Contributory :


· Senile atrophy


(DURATION) .. DAYS


(Signed)


M.D.


Puch. 221


1900 (Address)


Winthrop


1


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


Providers R.C.


DATE OF BURIAL


3/23


1960


UNDERTAKER


C. R Bensó


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. li Name of cemetery.


ALL NAMES TO BE IN FULL


Date of l


march 21


Death


83


22


32 mydia stalden Lynch mah 21 - 1/10


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME Coduran (


3. Уиванов


.Registered No.


Place of Death


30 8 Doudou St. Winthrop


Maru.


Date of Death


March 24-19'0-


Age


58 years


............._ months 12 days


STATISTICAL DETAILS


SEX


COLOR


white


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME Ť


HUSBAND'S NAME +


BIRTHPLACE #


NAME OF FATHER John Vreeland


BIRTHPLACE OF FATHER# Staten Island 414-


MAIDEN NAME OF MOTHER Elizabeth Littlefield.


BIRTHPLACE


OF MOTHER #


OCCUPATION Insurance


INFORMANT §


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from, w20 190 .9 ... to March 23 1900. 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 :


Clivenina Paren lesmatins


Suplintos


....... (DURATION). -... DAY8 Urgencia


Contributory :


1 ( DURATION). 10 . DAYS


(Signed).


Hallan Het Land


M.D.


3/24


1900 ... (Address)


SPECIAL INFORMATION only for Hospitals, institutions, Transients, or Recent Residents.


Former or Usual Residence


How long at


Place of Death ?


Days


Where was disease contracted, If not at place of death ?


Filed


.190


Clerk


* 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


PLACE OF BURIAL OR REMOVAL II


fut unou


DATE OF BURIAL Fuck 261000


ADDRESS


UNDERTAKER It. C. Skaqql


33 Edward a Vreeland much 24-1990


COMMONWEALTH OF MASSACHUSETTS


Munchrol (CITY OR TOWN.)


RETURN OF A DEATH Statt B


FULL NAME


Baby Juin


Registered No.


Date of l


mar 25


1980


Death *


S


Residence


I ocean view LL


Age


×


. years ..


X


.months.


2


.days


STATISTICAL DETAILS


SEX


Female


COLOR


-


white


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME t HUSBAND'S NAME +


-


BIRTHPLACE #


wencheof mars


NAME OF


FATHER


James . King


BIRTHPLACE


OF FATHER$


Windsor n. S.


MAIDEN NAME


OF MOTHER


Clara. Talbott


BIRTHPLACE


OF MOTHER #


Foxobow man


OCCUPATION


INFORMANT §


factur


- James King


PHYSICIAN'S CERTIFICATE


.to I HEREBY CERTIFY that I attended deceased during last illness, from Nh 23 190 Much 25 .. 196. .. , that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :


Primary :


Premature


(DURATION)


2


.. DAY8


Contributory :


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


(Signed).


M.D.


Juk 28


.190 ..


.. (Address)


-


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at


Place of Death ?


.. years.


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


Where was disease contracted, if not at place of death ?


Filed


190


Clerk


* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal information." if in a Hospital or Institution, give Its NAME Instead of street and number.


t In case of marrled or divorced woman, or widow.


# State or country; also city, town or county, if known.


§ Name and address of person giving statistical detalls. Il Name of cemetery.


:


PLACE OF BURIAL OR REMOVAL !!


DATE OF BURIAL


3/200


196.9


UNDERTAKER


ADDRESS


ALL NAMES TO BE IN FULL


Place of l


Metall Hospital


Death 1


34


.


Breley.


Durch 25: 1910


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Samma. Almina adams


.Registered No.


....


Place of l


Death *


S


Residence


15 Thorton Park Wurstel


66


.years.


3


9


.months.


.days


STATISTICAL DETAILS


SEX7


Terreca


COLOR


white


SINGLE, MARRIED, WIDOWED, OR DIVORCED


manuel


MAIDEN NAME: Emma. Elmin Cishley


HUSBAND'S NAME Ť


Celas. S. a doma


BIRTHPLACE #


NAME OF


FATHER


James . Maryum ashley


BIRTHPLACE


OF FATHER$


Sandy Hill 11. 4.


MAIDEN NAME


OF MOTHER


Emma. Elimina Ballum


BIRTHPLACE


OF MOTHER #


OCCUPATION


INFORMANT §


Filed


190


Clerk


PLACE OF BURIAL OR REMOVAL II


Winthings cometing


DATE OF BURIAL


3/28£


1960


ADDRESS


.


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that | attended deceased during last illness, from Mch 1 9 190 to


Ich 26 ıgo .. 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 :


Menun vitis from mastordite


(DURATION).


Contributory :


acute nephritis


(DURATION).


3


DAYS


(Signed)


Mek 28 19%.


(Address)


M.D.


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 ?


* 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. I{ Name of cemetery.


ALL NAMES TO BE IN FULL


UNDERTAKER C. K. Benim.


Date of l


Mar 26


1960


Death


3.5 nech 26-1910


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


France Myrick nichukon


„Registered No.


Place of Death *


72 Pleasant st Gut/role


Date of Death.


March 28, 1910.


Age


76 years


months .days


STATISTICAL DETAILS


SEX


COLOR


10


SINGLE,MARRIED, WIDOWED, OR- DIVORCED


MAIDEN NAME +


martha w. Norton


HUSBAND'S NAME + Anam B. Muchason


BIRTHPLACE #


NAME OF FATHER ihn Horton


BIRTHPLACE OF FATHER# Easthai, Maso


MAIDEN NAME


OF MOTHER


Enrabeth Gould


BIRTHPLACE


OF MOTHER #


Easthan Dicawo


OCCUPATION


INFORMANT §


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from mar 1 war 28 1920, 1900 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 : Curvature à S'ème


V


(DURATION).


.DAYS


Contributory :


Senility


.(DURATION) . DAYS


(Signed)


Howrace & Soul


M.D.


mar 28


19 .(Address)


( Waltrop.


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 detalls. | Name of cemetery.


PLACE OF BURIAL OR REMOVAL 11


DATE OF BURIAL


Provincetown Mand Mch 3.


1900


UNDERTAKER I.T.C. Skaggs


ADDRESS


2 Hismon st


ALL NAMES TO BE IN FULL


36 martha myrick nickerson mich 28 - 1910


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


R. L. Jeddie Douglas


Registered No.


37


Place of )


8- Lincolunit


Death *


..


Residence


8H Lincoln St. Winthrop


Age


60


... years


1 month


days


STATISTICAL DETAILS


SEX


Male


COLOR


White


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME Ť HUSBAND'S NAME t


BIRTHPLACE #


Sunce Edward Island-


NAME OF


FATHER


So Douglas


BIRTHPLACE


OF FATHER$


Driver Edward Island


MAIDEN NAME


OF MOTHER


ane Coffin.


BIRTHPLACE


OF MOTHER+


Prince Edward Island)


OCCUPATION Mate Jender -


INFORMANT §


PHYSICIAN'S CERTIFICATE


HEREBY CERTIFY that I attended deceased during last


iliness, from


Jeb 15℃


19ØD .... to


1994,


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 :


bances of the Moneuch


That all, y mutter


. (DURATION). DAYS


Contributory :


(DURATION)


OAYS


(Signed)


6B.T. Campbell)


M.D.


tel.


1900 .... (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


UNDERTAKER


It.C. Shawar-


kasal-


ADDRESS


Columbia


Square


* 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. H Name of cemetery.


FILL OUT WITH INK. - THIS IS A PERMANENT RECORD


ALL NAMES TO BE IN FULL


Date of ¿


april 3.


19,00


Death


37 R.J geddie Douglas april 3, 1910


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


stoughton


(CITY OR TOWN.)


25


FULL NAME


James Freeman Drake Mason


Registered No.


Date of ¿


Apr. 3


10


Death


1


10


16


.months.


.days


STATISTICAL DETAILS


SEX


M


COLOR


W


SINGLE, MARRIED,


WIDOWED, OR


DIVORCED


W


MAIDEN NAME Ť


HUSBAND'S NAME +


BIRTHPLACE + Swansea


NAME OF


FATHER


George Mason


BIRTHPLACE


OF FATHER$


Swansea


MAIDEN NAME


OF MOTHER


Sarah E. Davis


BIRTHPLACE


OF MOTHER $


Rehoboth


OCCUPATION


Pattern maker


INFORMANT §


Mrs. H. D. M. Crane,


Stoughton


Daughter.


PLACE OF BURIAL OR REMOVAL II


Mt. Pleasant Cem.


Taunton


DATE OF BURIAL


Apr. 4, 10


UNDERTAKER


Lowe, mith & Powers


ADDRESS


Stoughton


PHYSICIAN'S CERTIFICATE


viewed


I HEREBY CERTIFY that | Xtended deceased during fast


Yillness FAX on Apr. 4 1.


19


-


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 :


Concussion of Brain


(DURATION) DAYS


Contributory :


Abscess of Brain


(DURATION). DAYS


(Signed)


W. O. Faxon, Medical Examiner


5 Norfolk isM.D.


Apr. 4


(Address)


Stoughton.


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


How long at


Place of Death ?


years.


4


months.


days


Where was disease contracted


Had a fall #211 Fountain


if not at place of death ?


S.t.,


Providence,


March 3.


191


Filed


May 6


.1910, Leo. OWentworth


Clerk


* Clty 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 person giving statistical details. || Name of cemetery.


FILL OUT WITH INK. - THIS IS A PERMANENT RECORD


ALL NAMES TO BE IN FULL


Place of l


Stoughton


Death *


5


19


Residence


Winthrop


Age


76


.. years.


COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


FULL NAME


Margarets Lane Douglas


Registered No.


38


Place of Death *


16 to bice Stuffit hol Ma22!


Date of Death ..


april y


Age


6 8 years


7 months


5 days


STATISTICAL DETAILS


SEX


COLOR


Female 2khite


SINGLE, MARRIED, WIDOWED, OR DIVORCED


MAIDEN NAME Ť HUSBAND'S NAME +


BIRTHPLACE #


Int Stuart


Prince Edward Island


NAME OF


FATHER


David Douglas.


BIRTHPLACE OF FATHER$ Vince edwards Island


MAIDEN NAME


OF MOTHER


Marguerite Dr. Clark.


BIRTHPLACE


OF MOTHER +


Clarkestorie.


Prince Edicalcoli


OCCUPATION throne.


INFORMANT §


PHYSICIAN'S CERTIFICATE


.to | HEREBY CERTIFY that I attended deceased during last illness, from april 64 190 190 .. ... 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 : Diabetes ( mellitus


(DURATION)


2.


DAYS


Contributory :


... (DURATION)


.. DAYS


(Signed)


(3) milch)


M.D.


april 8 190


.(Address)


SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.


Former or


Usual Residence


How long at


Place of Death ?


.Days


Where was disease contracted, If not at place of death ?.


Filed


190.


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, glve 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 BURIAL. OR REMOVALH


Hinttop Cem


-


DATE OF BURIAL 3-10-


19,00


UNDERTAKER H Co. f Kaque.


ADDRESS


38 Margaret Jane Douglas april 8, 1910


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH Lottie Lillian Merrill


(CITY OR TOWN.)


FULL NAME


Place of l


#19 Revere Slut


Date of l


4/9


19/0


Death 1


.


Residence


/1


"


Age


10


.years.


.months


9


days


STATISTICAL DETAILS


SEX


temala


COLOR


white


SINGLE, MARRIED, WIDOWED, OR DIVORCED


Single


MAIDEN NAME +


HUSBAND'S NAME +


BIRTHPLACE #


NAME OF


FATHER


Walter. 2.


BIRTHPLACE


OF FATHER#


Lewiston me


MAIDEN NAME


OF MOTHER


Mary Timer


BIRTHPLACE


OF MOTHER $


Lewiston me


OCCUPATION


School Sink


INFORMANT §


Machen Matter. I.


PLACE OF BURIAL OR REMOVALII


DATE OF BURIAL


4/12


19 ( 0


UNDERTAKER


ADDRESS Wucher


PHYSICIAN'S CERTIFICATE


I HEREBY CERTIFY that I attended deceased during last illness, from Maril 121 2 1910 to abril 95 1910, 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 : Pericarditis


tribiful


(DURATION).


DAYS


Contributory :


Rheumatien


(DURATION) ..


doubtful


(Signed)


Horace Soule


M.D.


19


(Address).


U


Winthrop Mass


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


19


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


Registered No.


39


Death *


5


39 Lottie Lillian Merrill april 9, 1910


COMMONWEALTH OF MASSACHUSETTS.


RETURN OF A DEATH-1910.


CITY OF BOSTON.


3571


Registered No.


Mass. Gen . Hos pt .


Place of Death ¿


Boston


and Residence S


35


2


10


Date of Death


Apr. 11


1910.


Age


years


months


days.


STATISTICAL DETAILS.


SEX


COLOR


SINGLE, MARRIED, WID., DIV.


F


Maiden Name


Smith


GIST


PATRIBUS


SIT TRE Primary : (Duration)


FICE:


struction, fol : Salpingectomy


Name of


William R Smith


Father


Birthplace


England


of Father


Maiden Name


Clara E Thretcher


of Mother


Birthplace


England


of Mother


(Signed)


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


C ... R.Lot.calf


.M.D.


.1910


SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents. Admitted to hospital for. 21 , 1910


Usual Residence


Winthrop(147 Main st)


Filed


Apr. 14


1910.


A true copy.


Attest :


ErMSlenen


Registrar.


Place of Burial


It Hope


or removal.


Undertaker


Smith & Poal:


PHYSICIAN'S CERTIFICATE.


I HEREBY CERTIFY that I attended deceased during last illness,


.1910,


from 1910, 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:


AR'S


Gen. Peritonitis, Intestinal ob-


Birthplace


England


CITY


BOSTONTA A. 1822


NYTTAT


CONDITAND.


123D.


DONATA A


and appendectomy - 11 dys


ISREGOSEINE


BOSTON


. MASS. Contributory : 2 (Duration)


Occupation


Housewife


Informant


Husband's Name


Paul Draeger


I


FULL NAME


Agnes C Draeger


THE COMMONWEALTH OF MASSACHUSETTS


RETURN OF A DEATH


(CITY OR TOWN.)


FULL NAME


Place of l


Death *


3


329 marchio IL


Residence


Age


80


.years.




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