USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1910-1912 > Part 5
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months.
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
widow
MAIDEN NAME +
Emilini
Thomas
HUSBAND'S NAME t
BIRTHPLACE #
Eden me
NAME OF FATHER Comfort- Thomas
BIRTHPLACE OF FATHER $ Eden me
MAIDEN NAME
OF MOTHER
ER Melinda Parker
BIRTHPLACE
OF MOTHER$
OCCUPATION
INFORMANT § Som I Frank P. March
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
4/13
19 / u
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. hou 1909 to april 11 1970, 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 : Senile anaemia
4 minutes
(DURATION). .. DAYS
Contributory :
Cerebral apoplexy
(DURATION). DAYS
(Signed).
M.D.
april 1/ 19/10
(Address)
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Piace 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. Suffott
ALL NAMES TO BE IN FULL
murch
Registered No.
4 0
Date of l
4.11
19/ 0
Death
40 Emeline Murch april 11, 1910
instructions on back of certificate. OF DEATH In plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See 15 N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE PARENTS
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH
Winthrop
..
(No.Z. Metcalf Hospital
St .:
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
+COLOR OR RACE
White
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
6 DATE OF BIRTH
1856
(Month)
(Day)
If LESS than
I day, ........ hrs.
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Undertaker
(b) General nature of Industry. business or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
") Batavia
n. y.
10 NAME OF
FATHER
frank.
11 BIRTHPLACE OF FATHER (State or country) Ireland
12 MAIDEN NAME
OF MOTHER
Kathrine Gallagher
13 BIRTHPLACE OF MOTHER (State or country)
Java, n.M.
14 THE ABOVE IS TRUE TOTHE BEST OF MY KNOWLEDGE
(Informant)
Maria I. Maloney
(Address)
350 Winthrop Sq.
Filed
..... 191 .....
.....
REGISTRAR
17 I HEREBY CERTIFY, That I attended deceased from
(Year)
March
1910 .... , to
april 11
that I last saw him.
alive on
april 11
1976
and that death occured, on the date stated above, at
1 p.m.
The CAUSE OF DEATH* was as follows :
Cerebral Embolism
(Duration) .. yrs. .mos.
.....
.. ds.
Contributory ...
persecond anlauf, gangrene + amputations
(Duration)
Prs.
mos.
15 ds.
(Signed) ..
april 1300
(Address)
M. D.
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
In the
of death
......... yrs.
mos.
.....
.ds.
State
......... yrs.
.mos. ........ ds .....
Where was diseasa contracted, If not at place of death ?
Former or usual residence
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Holy Cross, Malden april 14, 1910
20 UNDERTAKER Edward J. Dando
ADDRESS
123 Mavere
10 "EBoston
16 DATE OF DEATH
april
(Month)
(Day)
1910
(Year)
7 AGE
54
.. yrs. .mos.
ds.
or ........ min .?
BOSTON -
2 FULL NAME
Thank f. Maloney
[If married or divorced woman or widow give maiden name, also name of husband.]
Registered No.
41
>
Standard Certificate of Death.
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, c. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional linc is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housckecpers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at begin- ning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia;
Broncho-pneumonia ("Pneumonia," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritonacum, etc., Carcinoma, Sarcoma, etc., of. . .... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Broncho-pneumonia (second- ary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " Anaemia" (mcrcly symptomatic), "Atrophy," "Collapse," "Coma," "Con- vulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemor- rhage," "Inanition," "Marasmus," "Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUERPERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Exam- iners :
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
apr. 11, 1910
3. S. Maloneyy.
41
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Calvin Tage Low
Registered No.
4 2
Place of )
Death *
5
60 cliff are Wnichot
Date of l
4/14
1980
Death
S
Residence
le
cc
Age
63
.. years.
months. ... days
STATISTICAL DETAILS
SEX
m
COLOR
20
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Manuel
MAIDEN NAME T
HUSBAND'S NAME +
BIRTHPLACE $
Boston
NAME OF
FATHER
Francia Low
BIRTHPLACE OF FATHER$ Barre Mais
MAIDEN NAME
OF MOTHER
Lucinda y ates
BIRTHPLACE
OF MOTHER $
I ingham Mas
OCCUPATION Rigger
INFORMANT §
Wife & Listen
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Rec. 30.1909 to apar, 14 1919 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 :
In def
(DURATION) .. DAYS
Contributory :
Baute nephritis
1 200. 1
(DURATION) DAYS
(Signed)
S.t. Porter
M.D.
Pkn 15 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
PLACE OF BURIAL OR REMOVAL IT Woodlawn Crewet man
DATE OF BURIAL
4/17
1976
ADDRESS
UNDERTAKER & R Bennison
* 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. li Name of cemetery.
-
ALL NAMES TO BE IN FULL
4 2 Calvin Page Low april 14, 1910
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
FULL NAME
Emeline G Hemenway
Registered No.
Faulkner Hospt
Place of Death ¿
Boston
and Residence
Date of Death
pr. 14
1910.
Age
43
years
5
months.
24
days.
STATISTICAL DETAILS.
SEX
COLOR
F
SINGLE, MARRIED, WID., DIV. M
Maiden Name
Webber
Edwin A Webber
Husband's Name
Monroe, Me.
Birthplace
Name of
Horace C Webber
Father
Birthplace
Boston
of Father
Maiden Name Eliza A Goldsmith
of Mother
----- Me.
Birthplace of Mother
Occupation Housewife
Informant
.......
Place of Burial
or removal
Mass. Crematory
Undertaker
J S Watorman & Sons
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:
ST
AR'S
PATRIBU
SIT DE
Peritonitis - 7 days
Primar (Duration) FFICE
BOSTONTA CONDETA AD.
A. 182
DONATA A.
Contributory : 2
Hysterectomy for Fibroid
(Duration)
cancer of Uterus
F. Coggeshall
(Signed)
M.D.
Apr. 15
1910
.......
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Usual Residence
Winthrop
Filed
Apr. 20
1910.
A true copy.
Attest :
ErMSlenen
Registrar.
CITY.
CİVITAT
IS REGIMEN
BOSTON. MASS. 133 D.
3722
COMMONWEALTH OF MASSACHUSETTS
Winthrop Mass.
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
George Perkins Jackson
Registered No.
+ 3
Place of }
11 Revere St Winthrop
Date of l
april 19
1900
Residence
11
Revere It
11
Age
66
.years.
2
months.
3
.days
STATISTICAL DETAILS
SEX
Male
COLORO '
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
,
married
MAIDEN NAME Ť HUSBAND'S NAME +
BIRTHPLACE #
Boston Muss.
NAME OF
FATHER
George
BIRTHPLACE OF FATHER$ Charlestown Mass ,
MAIDEN NAME
OF MOTHER
Catherine Bean
BIRTHPLACE
OF MOTHER $
Boston
OCCUPATION
Ship Caulker
INFORMANT §
Mary Jackson
11 Revele St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jan/ 196Q ... to apr: 19 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 :
Carcinoma of intestines
+ cmentar
(DURATION) ...
3% 6400.
Contributory :
(DURATION) ....... . DAYS
(Signed)
Edward J. granger
M.D.
apr . 21
1960
.. (Address).
304 W willing Sr.
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
PLACE OF BURIAL OR REMOVAL Il
Holy leroas Malden
DATE OF BURIAL
april 22
1910
UNDERTAKER
Nhos.f. have
-
ADDRESS
120 Have st
E, Boston
* 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 details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Death *
.
5
Death
11 3 george Perkins Jackson april 19, 1910
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1910.
CITY OF BOSTON.
FULL NAME
Majorie Dickson
Registered No ... 3.9.52
Place of Death
3
Boston
and Residence
Date of Death
Apr. 22
1910.
Age
19
years
3
months
16
days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
S
Maiden Name
T
'S PATRIBUS
SIT :- Primary: ! (Duration)
Pulm. Tuberculosis - 1 yr
FFICE:
MAS.S. Contributory : 2 Ivocardial ... dogeneration
(Duration)
Maiden Name Margaret F Wilson
of Mother
Birthplace Minico. Ont. (Can)
of Mother
Occupation At Home
Informant
.......
Place of Burial
Winthrop"Winthrop Cem"
or removal
Undertaker H MI Whito
Usual Residence.
Winthrop(7 Fahent avc)
Filed
Apr 27
1910.
A true copy.
Attest :
Ermslenen
Registrar.
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
Husband's Name
Chelsea
Birthplace
CIVITA
BOSTONIA CONDITA AD.
Name of
Robert MI Dicksono TIS BE
1630.
Father
STO!
MINE
DONATA A.
A.1822
Birthplace of Father Ottawa, Can.
CITY:
I HEREBY CERTIFY that I attended deceased during last illness,
(Signed)
E D Ruggles
M.D.
Apr. 22 1910 ..... SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Cullis Cons.Home.
Instructions on back of certificate. OF DEATH In plain terms, so that It may be properly classified. Exact statement of OCCUPATION is very important. See 15 N. B. - Every Itom of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE PARENTS
STANDARD CERTIFICATE OF DEATH
I PLACE OF DEATH Avinthe,,
.(No
3.19.
Winthrop
St .;
Ward
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
Mary
Gertrude Hickey
* FULL NAME
{If married or divorced woman or widow give maiden name, also name of husband.]
319 Winthrop Ist Hintlih
2& RESIDENCE
Registered No.
44
PERSONAL AND STATISTICAL PARTICULARS
¿ SEX
4 COLOR OR RACE
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
6 DATE OF BIRTH
1
(Month)
(Day)
(Year)
7 AGE
42, yrs.
.mos.
or ........ min .?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
House- Work
(b) General nature of industry.
business. or establishment in
which employed (or employer)
9 BIRTHPLACE
(State or country)
Boston Muro
10 NAME OF
FATHER
Thomas Hickey
11 BIRTHPLACE
OF FATHER
(State or country)
Ireland.
12 MAIDEN NAME
OF MOTHER
Ellen 6 Mil
13 BIRTHPLACE
OF MOTHER
(State or country)
Ireland
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Catherine 6 Herbert
(Address)
319 Minthugh ST
Filed
191
REGISTRAR
16 DATE OF DEATH
..
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
2/20
4/25
1912 .. to
191
·
If LESS than I day, ........ hrs. that I last saw h alive on 191.0 and that death occurred, on the date stated above, at 34 .m. The CAUSE OF DEATH* was as follows :
(Duration)
........ yrs. ............. mos. .............. ds
Contributory ..
(SECONDARY)
(Duration) mos. yrs. .. ds.
(Signed) ..
M. D.
191
(Address)
* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death
3 mos.
In the
42
.ds.
Rohyrs.
.mos.
...... ds .....
Where was disease contracted,
If not at place of death ?.
32 decaturdo 6 1 votos
Former or
32 alecation et 6. Pro Ton
usual residence
19 PLACE OF BURIAL OR REMOVAL DATE OF BURIAL Hola Censo Genety april 29, 1910
20 UNDERTIKER
ADDRESS
91 Chelace !!
Catia
MEDICAL CERTIFICATE OF DEATH
20
C
1
Winthrop
Standard Certificate of Death.
-
.
44 many gertrude Arekey
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter O statement; it should be used only when needed. As o examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- So terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager"," ( "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer -- Coal mine, etc. Women at home, who are engaged in the duties of the houschold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at begin- ning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .- Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fever (the only definite synonym is " Epidemic cerebro-spinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia "); Lobar pneumonia;
Broncho-pneumonia (" Pneumonia," unqualified, is indefi- nite); Tuberculosis of lungs, meninges, peritonaeum, etc., Carcinoma) Sarcoma, etc., of .. . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles ! (discase causing death), 29 ds .; Broncho-pneumonia (second- ary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anaemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Con- vulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemor- rhage," "Inanition," "Marasmus," "Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as " PUERPERAL septicaemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.
Cases for the Medical Examiners. - Under the provisions of chapter 24 of the Revised Laws deaths under the fol- lowing conditions must be referred to the Medical Exam- iners :
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas Poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal Abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or onc supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Winthrop masz
(CITY OR TOWN.)
FULL NAME
Elizabeth Richard Elliot
Registered No.
45
Date of ¿
Death
May 5
1940
Residence
62 Thornton Pk Winthrop Age 86
.years.
11
months. 16 .days
STATISTICAL DETAILS
SEX
COLOR
Female Warte
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
Elizabeth Richards
HUSBAND'S NAME t
William & Elliot
BIRTHPLACE$ Philadelphia
NAME OF
FATHER
Unknown Richarda
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
Rebecca Willis
BIRTHPLACE
OF MOTHER$
Decham Mass
OCCUPATION
INFORMANT § & I Watermant Los
PLACE OF BURIAL OR REMOVAL I
Frust Hills
DATE OF BURIAL
Mar 8
190 8
ADDRESS
2326.
UNDERTAKER # 22 Waterman xo Washingund
2
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from. 190 ...... to .
may 5 196.º ... 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 : arterio - saliraria
years (DURATION)
.DAYS
Contributory :
(DURATION) ... DAY8
(Signed)
M.D.
May 6 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 ....
Preston B Churchill
Town 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. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Place of l
Death *
$
62 Thornton PK Winthrop
ne 45 Elizabeth Richards Elliot May 5 , 1910
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary D. Morrill
Registered No ..
102-
Place of 2
Noble Hospital Westfield
Death *
5
Residence
Winthrop Hall
Age
28
.years.
/-
.months ..
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
(Married
MAIDEN NAME t
Mary D. nesbit
HUSBAND'S NAME t
Seatt W. Morrill
BIRTHPLACE # Pittsfield, Mass
NAME OF
FATHER
Thomas Nesbit
BIRTHPLACE
OF FATHER$
Scotland
MAIDEN NAME
OF MOTHER
Grace Buchan
BIRTHPLACE
OF MOTHER#
Scotland
OCCUPATION
House wife
INFORMANT §
Xeatt W. Morrill
Husband
PLACE OF BURIAL OR REMOVAL II
Pittsfield, Mass
DATE OF BURIAL
May 9.19010
UNDERTAKER
Tambien Furn Co.
ADDRESS
Westfield
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 196 illness, fro apr. 29 196 may 7 ... 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 obstruction
and peritonitis
.(DURATION).
5
.DAYS
Contributory :
child brith
2
(DURATION).
. DAY8
(Signed)
D. H. Janes
M.D.
may 9 190
.. (Address)
Westfield, Mass
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death ?
.years.
months.
...............
.days
Where was dlsease contracted,
If not at place of death ?.
Filed May 18 196 lehas n. Calle
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.
that's
Turas
ALL NAMES TO BE IN FULL
WERTFIELD, MASS.
Date of
2
may 7
196
Death
ALL NAMES TO BE IN FULL
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A. DEATH FULL NAME William . G. Aiken
(CITY OR TOWN.)
46
Registered No.
Place of }
211
Death *
5
Residence
marchof Mars
Age
69
.. years.
4
.months.
23
.days
STATISTICAL DETAILS
SEX
m
COLOR
20
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME Ť
BIRTHPLACE ¢ Boston Mass
NAME OF FATHER James. Diken
BIRTHPLACE OF FATHER$
Boston Mass
MAIDEN NAME OF MOTHER Hannah Henry
BIRTHPLACE OF MOTHER$ Dux bury Plass
OCCUPATION
INFORMANT §
R. M. aiken
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 6 may 8 19/0, . 19/6 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 :
artino Pelvisis, General!
(DURATION). 8
DAYS
Contributory :
oldage
(DURATION).
69 yrs
DAYS
(Signed)
(2) (metall
.M.D.
( myq
.19/0 (Address)
SPECIAL INFORMATION only for Hospitals, institutions, Transients, or Recent Residents.
How long at Place of Death ? . years. ........ .......
months. ................. .. day
Where was disease contracted, if not at place of death ?
Filed
june
4
19 | 0.
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
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