USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 135
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No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. . Chap. 114, Sec. 46, G. L., as amended.
State cause for which surgical operation was undertaken.
Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death : Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, orysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
305
1
PLACE OF DEATH
(County)
(City or Town)
No.
St.,
.Ward
(If U. S. War Veteran, cify WAR)
WINTHROP, MASS.
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth?
yTS.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M.
4 COLOR OR RACE
W.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
MARRIED
5a If married, widowed, or SARAH GOLDMAN
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 71 Years Months Days
If less than 1 day .Hours. .Minutes
OCCUPATION
sawyer, bookkeeper, etc.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
(State or country)
RUSSIA
13 NAME OF
FATHER
SAMUEL 1. Cohen
14 BIRTHPLACE OF
FATHER (City)
(State or country) RUSSIA
15 MAIDEN NAME
OF MOTHER
UNKNOWN
16 BIRTHPLACE OF MOTHER (City) (State or country) RUSSIA
25 M-11-'29. No. 7180-đ
17 MORRIS ROSENBERG
Informant
(Address)
96 LAWTON ST. BROOKLINE
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
JAN 10. 1930
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are
as follows:
(If an injury was involved, state fully)
FRACTURE OF THE FEMUR WITH
BRONCHO PNEUMONIA CAUSED BY AN
ACCIDENTAL FALL.
20 If death was due to external causes (VIOLENCE) fill in the following : Accident,
Suicide or
Homicide ?
Date of injury.
19
Where did
injury occur ?
WINTHROP. MASS.
Manner of
Injury.
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
GEORGE BURGESS MAGRATH
M. D.
(Address)
Date-10
19 30
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
BETH JOSEPH WOBURN
(Cemetery)
(City or town)
DATE OF BURIAL
JAN 12. 1930
19
23 NAME OF
UNDERTAKER
M ...... STANETSKY
ADDRESS
Received and filed
JAN 14 1930
A TRUE COPY, ATTEST:
(Registrar)
5:
Registered No ..
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
SIMON COHEN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
88 CUTTER
.St.,.
.Ward,
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making ret (11za)
1
8 Trade, profession, or particular
RETIRED WOOL MERCHANT
PARENTS
(City or town and State)
19
C
Jan. 10.19
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Socion
(City or town making return)
Registered Nc
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
(FEMALE`) FARRELL
deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No .....
44.DOLPHIN AVE ..
(Usual place of abode)
Length of residence in city or town where death occurred yTS.
mos.
days. How long in U. S., if of foreign birth? yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
F.
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
SINGLE
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE
Years
Months
9
Days
If less than 1 day .Hours Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years) spent in this occupation ...
12 BIRTHPLACE (City)
BOSTON
(State or country)
MASS.
13 NAME OF
FATHER
THOMAS
France!
14 BIRTHPLACE OF
FATHER (City)
(State or country)
N. H.
15 MAIDEN NAME
OF MOTHER
HELENE O'BRIEN
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
CANADA
17
Informant
(Address)
44 DOLPHIN AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
JAN 11. 1930
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
JAN
3
3Q
JAN.
30
19
19
I last saw h
ERalive on
JAN IT
19
.30
death is said
to have occurred on the date stated above, at m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
INTRAC.PAN.I.AL ... HEMORRHAGE HEMORRHAGIC DISEASE OF NEW BORN
Contributory causes of importance not related to principal cause: BRONCHO PNEUMONIA
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ..
S. E. STERNBERG
(Signed)
Date
1-11 30
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
MT. HOPE, BOSTON
(Cemetery)
(City or town)
DATE OF BURIAL
JAN 16, 1930
19
22 NAME OF
UNDERTAKER
W ..... H. GRAHAM
ADDRESS
Received and filed
JAN 16. 1930
19
A TRUE COPY, ATTEST:
(Registrar)
1
PLACE OF DEATH
(County) Boston
(City or Town)
No. EVANGELINE BOOTH HOSP ISFAL
Ward
(If U. S.
War Veteran,
specify WAR)
St.,
Ward,
WINTHROP. MASS.
(If nonresident, give city or town and state)
2-302
OCCUPATION! important. OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS
50M-11-'29. No. 7180-b
(Address)
-302
Essex
PLACE OF DEATH
(County)
Danvers
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No. 7.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Anna L. Crowe
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
24 Naple Road
(a)
Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
4
mos.
7
days .
How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDSingle
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
60
7 AGE Years Months Days
If less than 1 day
Hours
Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc. ...
10 Date deceased last worked at
this occupation (month and
year) ..
11 Total time (years) spent in this occupation ..
Chelsea
lass
PARENTS
(State or country)
15 MAIDEN NAME
OF MOTHER
Elizabeth M. Ryan
16 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
17 Gertrude F. Smith,
Informant (Address)
Hathorne
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial, or transit permit was issued:
NO
(Signature of Agent of Board of HaftH.
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Jan. 12, 1930.
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
vep. 5.
Jan.
12,
1930
19 ....... , to
1 last saw h
er
alive on Jan.
7 death is said
to have occurred on the date stated above, at 6,15 P.M. . m.
The principal cause of death and related causes of importance in order of onset ware as follows:
ATT flosclerosis
Dateofonset
Contributory causes of importance not related to principal cause: Mitral regurgitation
Name of operation clinical Date of
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed gar C. Yerbury
Hathorne
M. D.
(Address)
Holy Cross
malden
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL
19
22 NAME OF
UNDERTAKER
John F. C'Malley
winthrop
ADDRESS Jan. 18, 1950.
Received and filed.
19
....
A TRUE COPY, ATTEST:
(Registrar)
1
Dg PJET's State Hospital No.
St.,
Ward
(If U. S. War Veteran,
specify WAR)
Winthrop
.St., ..... Ward, (If nonresident, give city or town and state)
important. 50M-11-'29. No. 7180-b
12 BIRTHPLACE (City) (State or country)
Dennis Crowe
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
Ireland
Data /16/397
JUSTrete
petery15, 199tor town)
At home
(Give maiden name of wife in full)
C C
-301
CAUSE OF DEALLT In plan terms, so that It may be properly classified. Exact Statement Of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
200M-11-129. No. 7180-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed with me BEFORE the burial of transit permit was issued:
Wm. D Childress.
(Signature grAgent of Board of Health or other)
Health Officer.
Jan. 13 /30
(Official Designation)/ (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
12
1930
(Year)
(Month)
(Day)
5a If married, widowed, or divorced
HUSBAND of
George
(Give-maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 65 Years Months Days
If less than 1 day Hours Minutes
OCCUPATION:
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Housewife
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Own Home
10 Date deceased last worked at
this occupation (month and
year) ..
11 Total time (years) spent in this occupation
12 BIRTHPLACE (City)
Boston
(State or country)
Mas's
13 NAME OF
FATHER
Andrew Haley
PARENTS
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
17
Informant
inliam wells
(Address)
178 Brdoin St
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Calvary Boston
(Cemetery)
(City or town)
DATE OF BURIAL. van. 14.
1930
19:30
22 NAME OF
UNDERTAKER
ADDRESS
Received and filed
Jan 24,
A TRUE COPY, ATTEST: (Registrar)
--
PLACE OF DEATH
suffolk. (County)
Winthrop
(City or Town) No. 410 Shirley St
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop (City or town making return)
Registered No.
8
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME Katherine E. Haley Wells
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No.
(Usual place of abode)
4ICShirley 3t
St.,
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days
How long in U. S., if of foreign birth?
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
19
I HEREBY CERTIFY, That I attended deceased from
Jan
1930, to
Jan
12
1930
X
Hast saw h.A .. L .... alive on ...
Jan 11,
198.Q., death is said
to have occurred on the date stated above, at 8 Am. The principal cause of death and related causes of importance in order of onset were as follows: myocarditis
Dateofonset 7
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis? Clinical Signs
Was there an autopsy ??? a.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
(Address) 78 Washington Fue Want Date Jan 12
193.0 ..
., M. D.
1
St.,
Ward
(If U. S. War Veteran,
14 BIRTHPLACE OF
FATHER (City)
Revised United States Standard Certificate of Death
Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, rook-hotel, etc. For a person who had no occupation what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation. 11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.
In stating the industry or business, avoid the use of such general terms as "store. " "factory, "
'mill. ", 'etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contri- butory causes of importance not related to principal cause, name other important diseases or injuries.
Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause : Fracture of arm
Automobile accident
May 3, 1927
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .. Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. . Chap. 114, Sec. 46, G. L., as amended.
State cause for which surgical operation was undertaken.
Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
301
PLACE OF DEATH
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop. (City or town making return)
Registered No 9
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Angie Maria (Bennett) Pierce
tff deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
180 Somerset Ave
Ward,
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
6
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White:/
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed.
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
David H. Pierce
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 83 .Years 9
28 Days
Hours Minutes
-
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation .
12 BIRTHPLACE (City)
(State or country)
New Hampshire.
13 NAME OF
FATHER
William Bennett.
14 BIRTHPLACE OF
FATHER (City)
Unable to obtain.
(State or country)
6 MAIDEN N
OF MOTHER
Caroline W. Fisk.
16 BIRTHPLACE OF
MOTHER (City)
Chester field.
(State or country)
New Hampshire.
17
Informant
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