Town of Winthrop : Record of Deaths 1910-1912, Part 5

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 5


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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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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