The volume, 1907–1909
Town Clerk, Winthrop · from the Internet Archive · 766 pages · 36.0 MB
open the file ↗ · original at the source ↗
Digitized by the Internet Archive
in 2016 with funding from
Boston Public Library
https://archive.org/details/townofwinthropre1907wint
FILL OUT WITH INK. -THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of )
Death * )
Residence
l£.£fy...sd±
^ - /- Date of) _
ueath 190/
Age .years months. ■4*
STATISTICAL DETAILS
SEX
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED /, /' .
HUSBAND’S NAME
’ 'fycrVUjt "jF- TtPcrZ^
BIRTHPLACE* Jit £
NAME OF
FATHER
Qs&and&o CL
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER*
OCCUPATION
informant!
7t/s-zrz£_
PLACE OF BURIAL OR REMOVALll DATE O
Cheviot £ru
UNDERTAKER
DATE OF BURIAL
A „cZ
ADDRESS
'J.
EHYSICIAN’S CER TIFICA TE
I HEREBY CERTIFY that I attendet decease^ during las
s, 1rom.3J<k<....l.2: I90r4..to 190../
that to the best of my knowledge and belief death occurred on th
illness
date stated above, and that the CAUSE OF DEATH was as follows
Primary:
Contributory:
!Si'"d' a
./j’TN.. - 190. y. (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at 1
Place of Death? rA years months days
Where was disease contracted, \A JA I Vm/WY1
If not at place of death?....! Y^.L....
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 oi
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.
YZS/fc '“m°’
I
FILL OUT WITH INK. — THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN
FULL NAME
DEATH
{CITY OR TO WN.)
'r/L
IWN.)
£& f
Residence Age.
w
Registered No
Date of l / / ZZ
Death S Z ■ ••■■*•••• ^ f
A* s
years tZ. months T“."TT. days
STATISTICAL DETAILS
SEX COLOR *
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE*
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER t.
OCCUPATION - ■ /'•'“'v
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
fa £&*>*>*
UNDERTAKER ^~\ ADDRESS
I - -"*• T
DATE OF BURIAL
'Z4.. ,
90 .
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 1.Xo 190 ,
that to theTsest of my knowledge and , belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
Contributory:
(Signed).
C ,.\90y. (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents,
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If in a Hospital or
Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county, If known,
§ Name and address of person giving statistical details,
II Name of cemetery.
FILL OUT WITH INK.— THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
[12-16-1903-1,000]
,T 223
COMMONWEALTH OF MASSACHUSETTS
~ CITY OF SOMERVIL
RETURN OF A DEATH
..Ann...HundaV Registered No.
.3.4.
D3t6 of *r* «i ru
Death 190 7 •••
PDeathof 1 .6.Q...Eellsmy... WesXV- Somerville , -Mass-,
Residence I A7±n.thrQ:&*...]^ Age .7.6. years .....4. months. .14 days
(j\7o.) ( Street ) [Town or City ana State )
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
divorced Wider -e
MAIDEN NAME V a married or divorced woman , or widow
T'.iney
HUSBAND’S
FULL NAME . _ _ . Tr ,r ,
ri1 1 i am Henry i.nri
BIRTHPLACE Give state or country ; also city , town, or county, tf known
NAME OF
FATHER
Shaploigh, Me...
BIRTHPLACE
OF FATHER
John Eaton Tiney
Give state or country ; also city, town, or county, if known
Shanlci-y"! . He ,
MAIDEN NAME
OF MOTHER
BIRTHPLACE Give state or country ; also city, town, or county, i f known
OF MOTHER . , , ,
Shaplei.o-h , Tie.
| OCCUPATION
Tone
INFORMANT’S Person (firing statistical details
NAME
Ur. W. F. L.unday
ADDRESS
( No.)
W i - i t, ■ ] r car, . -Ha r s .
(Street) ~ (Town, or (Hi
ity)
PLACE OF BURIAL OR REMOVAL
-TQpafl.alcL
' ( Cemetery )
.iss ,
( Town or City, and State )
DATE OF BURIAL
Jan. 16
I 90,
UNDERTAKERS
NAME
Jo^n ~Ri
ADDRESS
. 3 53 Zledfo rd
rp yi T- c*
(Ho.)
( Street )
iQHS
Son.
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from...Jail.»...13 j.....l90.7. to. J.ail *....13--j 190.. 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 :
(If a soldier or sailor who served in the war of the rebellion both the primary and
contributory causes of death must be given,)
Primary : Lobular... .pneimionia.
( DURATION ) .
Contributory : Cardiac ...f 3.1 lU.I'e
( DURATION ) .
F. Patterson m.d.
(Signed)
(Address) .. 4.0. D MEL i H ... S. t . OhcL 1* l.C. 3 1 .0 87 i 1
(IFo.) ( Street ) ( Town or City)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or
Recent Residents.
Previous Residence
How long at
Place of Death? Years, Months, Days
Where was disease contracted,
if not at place of death?
(Town or City)
Received
Jan.. . 1.5... 190 7... Win. P. Ilit.chell
Agent of Board of Health, appointed to issue burial permits
Ti C.
City Clerk
Jan. ...1.7., i9o?
FILL OUT WITH INK. — THIS IS A PERMANENT RECORD
.J
J
3
b.
LU
to
O
I-
V)
111
S
<
-I
-i
<
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Registered No
{CITY OR TOWN.)
9
Place of ;
Death *
\ Death 1 190 ^
Date of (
Residence Age.
<T?
..years..
..months Z.Q. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE*
NAME OF
FATHER
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHE
i « m c. . . .
^4=L- /J
<£_
BIRTHPLACE
OF MOTHER*
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
£rt^re'
UNDERTAKER
0 fev $
\/Z-±
^7.'
-
DATE OF BURIAL
. 190,
z
ADDRESS
o4w
PHYSICIAN’S CERTIFICATE
ided deceased during last
....... I90..X
I HEREBY CERTIFY that I attended deceased dp
illness, from ...T 190 to / ' /
that to the best of my knowledge and belief death occurred ofi the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary :
(duration) DAYS
f
Contributory: •.
. (duration) DAYS
(Signed). ....VrT..Y. M.D.
.7/^r....l90.vT(Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county. If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
—
MARGIN RESERVED EOR BINDING.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1907.
CITY OF
BOSTON.
FULL NAME...Jennet..te Q Maringhi Registered No. 49.5
P1 n de Residence } Boston M&©e G*en Ho sp-i t al
Date of Death JaH-15 I 907 . Age years. months ^ days.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1907, to 1907,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Usual Residenc29 5 Sli-irlsy St Winth.Fop>
Jan 17
Registrar.
_
/<; //* 7
Q
K
O
O
111
oc
COMMONWEALTH OF MASSACHUSETTS
{CITY OR TO WN.)
RETURN OF A DEATH
FULL NAME '/!*£&=>. Registered N
p,ace /£..., 90
Death '
Residence ^ » Age.....*^..)^.
..ye ars
.months «. days
H
Z
111
Z _J
< J
12
U1
0. 5
< 111
u
(0
“ O
to H
Z (0
H 111
I i
it
_i
z -J
h <
h
3
O
_l
STATISTICAL DETAILS
SE
COLOR
<U^!X
SINGLE, MARRIED,
winnu/cn no /
WIDOWED, OR / „ ,
DIVORCED
-c
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE t
’'f
NAME OF
FATHER
x//{yU&iy~ fy/cJ&tsL
BIRTHPLACE
OF FATHER t V
/ i *
t *<1 <- * ■** L tv— z t
MAIDEN NAME
OF MOTHER
THER
BIRTHPLACE
OF MOTHERt
1^02^2-
OCCUPATION
jf S* s
INFORMANT §
(f’tiyZiC.
PLACE OF BURIAL OR REMOVAL I
r D T A l/CD
UNDERTAKER
yytn/2)
DATE OF BURIAL
J/ J !L
190.
ADDRESS
^yi'lO'7
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased Joking last
illness, from 190 .^..to 190 /
nd belief death occur
occurred on'thi
that to the bi^t of my knowledge and
date stated above, and that the CAUSE OF DEATH was as follows
Primary :
Contributory:
Ltho
.(duration)
-3
#2
3
. (duration) DAY8
(signed) ..../. .y.....'^rr...j.r ..., - m.d.
b- a^-a— v
(Address)..
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
♦City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
[3-’06 37-LM.]
Permit No.
RETURN OF DEATH.
Name in full,
(I£ married or divorced woman give maiden name, also name of husband.)
Sex, ~22dJaJ&. ... Color, . OhiL/Jg
iju.
(White, Black, Mixed, Chinese,
Indian, etc.)
.Condition,
(Single, Married, Widowed or
Divorced.)
Age, ,(C. "N:... Years,
Residence,* Cs
; Months , y/ Pays. Occupation, /
Ward,
Place of Death, 7 t/yj., 9A. pn/JiaAp/Q
A • >$tete- vea^ month and day.;
Place of Birth a)Al I'idfAXX. Date of^ Birth, '/yo y
Name and Birthplace
of Father, ) a JX y ^
Maiden Name and > //' ig.i/P /Yr r /UP t£xP. PFP^ Ufis XN
Birthplace of Mother, f t . ^ X/ . s' X
iyd£iy.c£f..
/
Place of Interment,^^^^f/Mx//lA/^i.a>.
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston , ,, 190.
Age,j
Name and Age) fL/f . ^ , , [A
of Deceased. ) J
^^3
of Deceased, ) A^(. ..
I hereby certify that I attended deceased from. ../WX/\... ]px) 190 J,
10(T\ that I last saw <uLxrr>. alive on the day of df/P/PX 190 , ,
J / ' ( J rf) y
that... dpss......died on the day of/.. 190 J, about 'o’clock
API., or P.M., and that, to the best of my knowledge dnd belief, the cause of.. death
was as follows: f—
DAyyy\PLA^y\A
4
Disease
i
Chief cause,
Duration
| Contributing cause,
J Chief Cause,
I/M
Contributing cause,
»If an institution, state how long an Inmate and previous residence.
XI. D.
S‘2t
/
FILL OUT WITH INK. -THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
, ffcvriu:.
FULL NAME
Place of
Death
RETURN OF A DEATH
? } . . . . . °olltb
xOP. C? 6
( CITY OR TOWN.)
Registered No..
Residence/.. Age.
<^i\..3i//.... 1907
/ 7 ?
' . +
, .months — TTTr^L/. days
STATISTICAL DETAILS
T A°) 1 /-y
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED /na^t^yC
MAIDEN NAMEt
HUSBAND’S NAMEt
BIRTHPLACE t
W
NAME OF
FATHER
A
BIRTHPLACE
OF FATHER t
icE /f
ERt /7
/c-y-yi y y
MAIDEN NAME
OF MOTHER
PLACE OF BURIAL OR REMOVAL II
fr-tr
DATE OF BURIAL-
Ci
Q^ys.^0. i9o7
addf
(DDRESS
i
/Zo j^juu^CA^'
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ... Hi ua* 190 4.tO .£U^v^...^r^.l90...^.,
that to the best of my knowledge and belief death occurred oryrhe
date stated above, and that the CAUSE OT DEATH was as follows:
.. .. 0
Primary:
Contributory :
.(duration) /
(K/ffr * ' J
(Signed).
.,:.‘T^..r^.^..l90..{£{Address) W'
rsjn::
T
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
•City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information." If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country) also city, town or county, If known.
§ Name and address of person giving statistical details.
_|| Name of cemetery.
[3-’06 37-LM.]
Permit No.
RETURN OF DEATH.
MASS.
Name in full ,
(If married'or divorced woman give maiden name, also name of husband.)
Sex, ..
Color,
(White, Black, Mixed, Chinese,
Indian, etc.)
Condition,
(Single, Married, Widowed or
Divorced.)
Age, Years, -Y Months, .../x^bays. Occupation,
Residence,* ; t/Vif </ ' I-'k/ J )■ Loi/pl Ward,
Place of Death,. J&/:// & ffTcZ
Place of Birth, cl&t, ID: \7. .. 0/ J Date of Birth, ^ S &
Name and Birthplace \ y USt?.. “7: . .^A CP / Cy L
(Statayfear, month and day.)
of Father,
Maiden Name and ////-
Birthplace of Mother, ) , _j/'\ / f
Place of Inter7nent,..Nc.M.C.AALlh/P^
A) / fit?
A.X. 190/
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Rkrstun,
Name and Age ) w - ' / rj
of Deceased, f Age, <£>/ years.
V.
I hereby certify that I attended deceased from. ^ 190&, , to
x ■
190/, that I last saw .... alive on the 'Sr/.. ...day of F-S/ 190/,
that /A~r. died on the Ay/.. day of / CSrrrFr^tf. 190/ about... At^/o’clock
\S /gf / ■
AtvM i, (**■ P.M., and that, to the best of my knowledge and beMef, the cause of. death
was as follows: _
( Chief cause, Sr.CYPPS-. ■ X'Sf.fA.
Disease \
( Contributing cause,
f Chief Cause, T*rr.fr.-tPS<l,
Duration \ /f _ _
) .. . N
Contributing cause,
•If an Institution, state how long an inmate and previous residence.
M.D.
[3.’06-37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of DecAh^ff/'^? ^ ^ / / /
Name in full,
(If married or/*fij^fi‘ced woman ai^e maiden name, also name of husband.)
f
i r
(Single, Married, Widowed or
Divorced^
'exffgf. S - / /. . Color, Condition
(White, Black, Mixed, Chinese, »
yw yp Indian, etc.) / OivorcedJ
Age, (T... ' Years. ^ .Months, v Days. Occu patiojz, ^ ri/^ ^ — "
Ay Ward,
Residence,
Place of Dearth,
ass/
Name and Birthplace
of Father,
Maiden Name and
Birthplace of Mother
Place of Interment,
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston , r . C 190
Name and Age )
of Deceased, ) ^
Age, if. years.
I hereby certify that I attended deceased from 190 , to
190 , that I last saw alive on the day of 190 ,
that died on the day of 190 , about o’clock
J
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of <Y\SAy death
was as follows :
j Chief cause, C
I disease
Contributing cause,
<5*
Permit JVo.
RETURN OF DEATH.
'(PiaIJ/LA^ Vo ^PQgTOfV, MASS. s
/ Dag#- of DeaDif ^
Name in full, . . . ^
(If married or divorced woman give maiden name, also name of husband.)
£ex, .. ItfaaApj Color, Condition, .... f. 4U2j2^J
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) Divorced.)
Age, ..Co^ Years, / Month f, ^ Days. Occupation,
<2x2A.
f
Ward,
7 r
ItsLk
tate year, month and day.)
Residence, * )^gA / L A4 A PVXS&N. O
Place of Death,. ...$b /aai/
Place of Birth, , ■'<AD..U./.Yhi Date of Birth, Aj.g.pjlJ 8A
Name and Birthplace ) IgA gL, Q..Qk k.lA g. J^Q..
it.- \ d*?'. - Nc/P.
of Father,
Maiden Name and
Birthplace of Mother, ) ^(ff
Place of Interment
, /j i
U......
ci
rJ^T.udL)..
A Undertaker.
FHYSICiAN’S CERTIFICATE OF THE- CAUSE OF DEATH.
Q/ i b 'BnsPmM:. X/cfjgHdA. /Z.4A/.. v-~f. / I r 190 yS.
AcIM m,MAAlc ^ge,..£g.yearsy >H
I hereby certify that I attended deceased from 190^,
J9Q that I last saw alive on the S-f. J.'K day of .. 190^,
that died on the s? g ^ day of " 190 f, about A ...o’clock
/ *
A.M., wrPr^f., and that, to the best of my knowledge and belief, the cause of death
was as follows: J J + a .
| Chief cause, j I i
| Contributing cause, Ca-/ yt
J Chief Cause,
Disease
Duration
Contributing
cause,
driNtyviyC,
M. D.
•If an Institution, state how long an Inmate and previous residence.
*1/
FILL OUT WITH INK. — THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
(i CITY OR TOWN.)
OF A DEATH
FULL NAME Registered^No.
r, & »„ t
" ' 3/
..years..
j> <«r
..months .".....days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR (/; ,
DIVORCED
MAIDEN NAMEt ^
HUSBAND’S NAMEt ^ ^ ^ ^
BIRTHPLACE X * _
NAME OF
FATHER ry-/
BIRTHPLACE
OF FATHER! ^
/3
MAIDEN NAME
OF MOTHER ?
BIRTHPLACE
OF MOTHERt ,
V.
OCCUPATION . *
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
?_ -o
DATE OF BURIAL
UNDERTAKER
/is./ „
— ( — L * — — i
JL
ADDRESS
PHYSICIAN’S CER TIFICA TE
I HEREEY CERTIFY that I attended deceased during last
illness, from
190 .p.-to 190 y,
i The
that to the West of my knowledge and belief death occurred on The
date stated above, and that the CAUSE OF DEATH was as follows :
Primary:
±L. 5^jrh^..
Contributory:
.(DURATION).....™... DAYS
(Signed)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
Where was disease contracted,
If not at place of death?
Filed
.QtytfLA.J.h..
.190.
-
Clerk t
— — 1
iPITYJ IjJ i
•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.
II Name of cemetery.
FILL OUT WITH INK. — THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
Stoneham
RETURN OF A DEATH ( CITY OR TOWN.)
FULL NAME .-dfv.IllfcZ ii.h&.l Registered No.
PDea*h<*f }^e:R -EHglaM.
Residence Age .5.7. ....years months days
STATISTICAL DETAILS
PHYSICIAN'S CERTIFICATE
SEX , .. COLOR... . , SINGLE, MARRIED,. ,
Male r. i e widowed, or Married
DIVORCED
1 HEREBY CERTIFY that 1 attended deceased during last
illness, from ... 1 9 0.7. . .t o F .? .^?. • 4 .*. 7 9 0 ,
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 : ... .C. a n.C.er. ...0.£...£ QW.e.1
MAIDEN NAMEt
HUSBAND’S NAME f
BIRTHPLACE?
Quincy, Mass.
Two. years.. (duration) .... 0ay«
NAME OF
FATHER
Howard Vinal
Contributory :
BIRTHPLACE
OF FATHER?
Scituate, Mass.
(Signed) » ... J'Li.C.O. .1 ri M.D.
MAIDEN NAME
j OF MOTHER
Claris Wentworth
,.Zeb.....4 i90..7.(Address)- i elrose Jtess .
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?..
BIRTHPLACE
OF MOTHER ?
Unknown
OCCUPATION
Shoe Manufacturer.
INFORMANT §
A. H. Vinal
Feb, .4... JUUUJL
\ f clerk
PLACE OF BURIAL OR REMOVAL II
V/aterman & Son
Boston. Mass.
DATE OFJfiiMttAL
removal
Feb-.. -4 190.7..
* 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.
§ Namo and address of person giving statistical details.
It Name of cemetery.
UNDERTAKER
JMr.& Mrs.F.T. Churohil
ADDRESS
L Melrose, Mas
*
[3-’06 37-LM.J
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
(f N ^ Date of Death, AA~f. A iNgll
Name in full, fryN.
(If married or divorced woman give maiden name, also name of husband.)
Age, ,^/v:. Years,
Residence ,* y
Place of Death, Zf / ,
(White, Black, Mixed, Chinese,
Indian, etc.)
Months , ~^—-Days. Occupation,
r
(Single, Married, Widowed or
Divorced.)
ZZUzg. ,N-. Ward,
(State year, month and day.)
Place of Birth, 4^ (Z ^ ^ Date of Birth,
^ ~
Name and Birth-place ) Zl/iflJlN^/r..ZzZcZ
of Father, J
Maiden Name and [
Birthplace of Mother, )
Place of Interment
cL-.l 1
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
<£\
Name and Age )
of Deceased, )
A'J'cAZ&Ziy .J -Boston, c
fNtfpAA /vu </ Age, JA
*/
190
years
I hereby certify that I attended dyeceased from —
190 , that I last saw ..ACL^. alive on the 2*
that ('■. iZ. died on the /...4? day of DN'A.PN. ^ 190 1, about. -d clock
2, y 190/ , to.,.y*} > Y J 7
\ „ c/
day of .....WN~Y]. 190 j,
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of.. death
was as follows ; - *
( Chief cause,
Disease \
| Contributing
cause,
M.D.
K.
[S.’06-37-LM.]
Permit No.
RETURN OF DEATH.
iBOSTOiN, MASS.
Name in full,
Sex, ....
Age, ^3..
(If married or divorced woman give maiden name, also name of husband.)
Color, AffA.....*. Condition, ...fA.N..
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Years, ^ Months,.. Days. Occupation,
Residence, * .{N/. ~N(P , Ward,
Place of De ath, NA>. *?. . . .ffff?... 7
(Staro*-¥^ar, month and day.)
Place of Birth Date of Birth ffAAAy. / */:.
Name and Birthplace )
of Father, )
Maiden Name and
Birthplace of Mother,
Place of Interment,
*-■* .
0~.
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,.. ,2zf..2-'.l 190
I hereby certify that I attended deceased from 19(f) , to
190 ~), that I last saw alive on the. NNNf... AP day of AA 190 J,
/ / ^ ^ ✓ 7
^.M., or F.M:, and that, to the best of my knowledge and belief, the cause of .
was as follows: fj
Chief cause, (l
N
death
Disease
J
| Contributing cause,
f Chief Cause,.
Duration , ^ c\J
( Contributing cause, o ..P /f '
M.D.
•If an institution, state how long an Inmate and previous residence.
— , —
'
-i 9 It 'r*
FILL OUT WITH INK.-THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
[12-16-1903-1,000]
J 223
COMMONWEALTH OF MASSACHUSETTS
" ' ~ CITY OF SOMERVILLE
RETURN OF A DEATH
FULL NAME Mary IT... Buclcnam Registered No 154..
PDecathof}. .5.7 Beech Street., Somerville.,., mss.. DDeathof....P.eli.. ...2.5.,... 190 7
Residence i Winthj?.O.p.,...Ma.S.S.* Age . 7.8.. years ...&■■ months ...7... day
(No.) ( Street ) 1 (Town or City ana State) 1
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
divorced Widowed
MAIDEN NAME If a married or divorced woman, or widow
Marv M. Metz
HUSBAND’S
FULL NAME
-Tamps ‘RnoVnam
BIRTHPLACE
Give state or country ; also city, town, or county, if known
Unknown
NAME OF
FATHER
Cl if ford Metz
BIRTHPLACE
OF FATHER
Give state or country ; also city, town, or county, if known
Pennsylvania
MAIDEN NAME
OF MOTHER
- Sarah Hutchins
BIRTHPLACE
OF MOTHER
Give state or country : also city, town, or comity, if known
Kittery, Mai ne
OCCUPATION
INFORMANT'S
NAME
Person giving stat ist ical deta ils
nniP 1. St.nnft . TYmarVt ter
ADDRESS
31 Hawthorne Avenue. Winthron
(No.)
(Street) ' ( Town or City f
PHYSICIAN’S CERTIFICATE
PLACE OF BURIAL OR REMOVAL
(Cemetery)
Brockton. Mass
/ ..... . ..
( Town or City, and State j
DATE OF BURIAL
J 90_
I HEREBY CERTIFY that I attended deceased during las
illness, from Feb. 1, 190 7 to Feb. ....... 2.4., 190...'
that to the best of my knowledge and belief death occurred on th
date stated above, and that the CAUSE OF DEATH was as follows
(If a soldier or sailor who served in the war of the rebellion both the primary an
contributory causes of death must be given.)
Primary: Aortic Regurgitation.
( DURATION ) .
Contributory :
( DURATION )
(Signed) J o s eph F . G rai ng.e r M. d
(Address) 440 Cambridge. .St . , Ganbridg
(No.) ( Street ) (Town or City)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or
Recent Residents.
Previous Residence
How long at
Place of Death ? Years, Months, Days
Where was disease contracted,
if not at place of death 7
UNDERTAKER'S
NAME
ADDRESS
Sumne r Floyd .
—145 Herman St., Winthrop. Mass, il Fe o . 26 , i9o7
(No.) ( Street ) ( Town or City)
Received
Feb., .26.., i9o 7. Wm. P. Mitchell
Agent of Board of Health, appointed to issue burial permit!
Piled
I Feh.....,26 1 9 o 7 • . —7 ‘
City Clerl
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
Q
£C
O
O
U1
tc
H
Z
U!
*
I-
D
O
_l
-I
iZ
RETURN OF A DEATH
FULL NAME : Registered No.
-
{CITY OR Jf OWH.)
Place of |
Death * i
Date of (
Death ' '90
.years. .
..months days
STATISTICAL DETAILS
PHYSICIAN’S CERTIFICATE
SEX
COLOR
SINGLE', -himuhilu,
MyiUlx
•AVtvU
WHUU'i'ILU, 1ST
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE?
NAME OF
FATHER fX
Ns
BIRTHPLACE 1 1
OF FATHER?
MAIDEN NAME
OF MOTHER ~
BIRTHPLACE
OF MOTHER?
r
OCCUPATION
I HEREBY CERTIFY that I attended deceased during last
illness, from ^ 190^ ...to 190^ . ,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows :
Primary:
(DURATION; DAY 8
Contributory :
on) DAYS
SPECIAL INFORMATION only for Hospital, 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
^^^!^.T,!.^...l90...\(Address)
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.
II Name of cemetery.
AS
V
[3.’06-37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of Death ,
Name in full,
rrr. <Y^b... ...
rried or divorced woman give maiden name, also name of husband.)
/ y' ^
(If married <
(Single, Married, Widowed or
Divorced.)
Sex, Color, Condition,
(White, Black, Mixed, Chinese, (Single, Marr
Indian, etc.) Dh „
Age, Years, ^ ,gl onths, Days. Occupation,
Residence, * P'ef ' .Y • Ward, v
Place of Death, Tf;.. f
V-" J / (State year, montii and i
Place of Bi rthfg(Z*^ 'y Date of Birth,
Xante and Birthplace \ S.
of Father,
Maiden Xante and )
Birthplace of Mother, )
Place of Interment,.
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston 1 90
Age, ... years.
I hereby certify that I attended deceased front WO , to
Xante and Age j
of Deceased, )
190 , that I last saw alive on the
<S»
day of 190 ,
that ...died on the Y day of 1907, about o’clock
P
A.M., or P.M., and that, to the best of nty knowledge and belief, the cause of death
was as follows :
( Chief cause, %-•
Disease -
( Contributing cause,
M.D.
A
[3-'06 37-LM.]
Permit No.
RETURN OF DEATH.
eeksro'N, mass.
Name in full,
Y~^
(If married or divorced woman give maiden nairyg, also name of husband.)
Sex, . CX 'P Color, ^Z/:/ If.. So Condition, ..Zh.
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, ..y^. Z. Years, ^ Months,^ ^ Days. Occupation,
Residence,* Ward,.
Place of De adh, CZrhAIYI
Place of Birth/2lfi ~Cy l Zlt fCA.ggJL Date of Birth, <1 */^’An6
(State year, month and day.)
Name and Birthplace I f /\ y l
of Father, )
Maiden Name and
Birthplace of Mother
Place of Interment,. gjgf
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/ ■' ( (H^t >' - 'rBedm, /J~. 190 y .
^ofYcmsed‘e\ 7 Age, fk years.
Disease
J
Chief cause,
| Contributing cause,
3 190?, to ZdC/N '..
alive on the /./... day of 190*?,
//.. day of. 19 O'?, about / d, 3 6 '.o’clock
my knowledge and belief, the cause of. nL.
(3*.t
I hereby certify that I attended deceased from
190*^, that I last saw
that.JlZtL^ died on the
. j. M-., or P.M., and that, to the best of my knowledge and belief, the cause of.
was as follows :
death
FILL OUT WITH INK. -THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH (CITY OR TOWN.)
FULL NAME Registered No.
p^eth°.f } DDa:;t°f l ,90?
Residence Age ^fT....(.. .years months days
STATISTICAL RETAILS
SEX C7 —
COLOR
SINGLE, MARRIED,
WIDOWED, OR rf, ^ h
DIVORCED
MAIDEN NAMEt
* S
-
HUSBAND’S NAMEt X) /
BIRTHPLACEt
NAME OF ,
FATB"
BIRTHPLACE
OF FATHERf
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER!
OCCUPATION
INFORMANT §
__
PLACE OF BURIAL OR REMOVAL II
UNDERTAKER
j
DATE OF BURIAL
‘fo-'-Hxv' /
190
7
ADDRESS
t&f '7-4AxUt_^,
TJTYSICIA N’S CERTIFICATE
illness, from
I HEREBY CERTIFY that I attended deceased during last
'.axyr.. I90^.to.??^..c 2L..../.Z. 190'
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
/
Primary:
DURATION; DAYS
Contributory: .
(Signed)
^t'^T?T?rr ..CrTfr^c^r: 'fciTRAVioNjl^.
r.-CZ^rr^r*^^ .M.D.
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 RESlI
DENCE, give facts called for under "Special Information.” If In a Hospital oj
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.
II Name of cemetery.
fibn; / £ , 3 7
FILL OUT WITH INK. -THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH ( CITY OR TOWN.)
FULL NAME Registered No.
rr- 1 DDa::,r s a ,80>
■
Residence l...v S. Age
..years..
..months days
STATISTICAL DETAILS
SEX
COLOR
Us
si ngle,marrie d,
WIDOWED, CR»
DIVORCED
MAIDEN NAMEt 1 T T. L t JU2 1 £
HUSBAND’S NAME t l"i. «a-A“* 1
BIRTHPLACE*
/t
<Sl Tt \ srA
NAME OF / (/
FATHER v *
Z/A/4^— rML&t-'t' *
BIRTHPLACE
OF FATHER*
/
MAIDEN NAME
OF MOTHER
P /J T- 1. L'l.
BIRTHPLACE
OF MOTHER*
d^jL, -
0
..J
OCCUPATION
^ a_/\
INFORMANTS
4 IV. H f 1
PLACE OF BURIAL OR REMOVAL!
is ~ /'. ij X
UNDERTAKER
-
hi
DATE OF BURIAL
\S.cLa.
L.i... 190yP....
ADDRESS
L,i>J *
PHYSICIAN’S CERTIFICATE
I HERESY CERTIFY that I attended deceased during last
illness, from Ik. 190 y.to ..pL^AU^k....l..2r....\90'^..,
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:
. ctfst. u<rr9r*r~rr. ?TT?rfL.
Primary: ..\
Contributory
(duration). jo
...DAYS
:
(duration) .7. T .... 0AV8
(Signed) m.d.
PZLcjL^. Jrr.. 190 ^?y/d dress). .v.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents,
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
* City or town, street and number, If any, If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country | also city, town or county, If known,
S Name and address of person giving statistical details.
|| Name of cemetery.
Hn /S'
(yk
[3-’06 37- LM.]
Permit No.
RETURN OF DEATH.
BOSTtJN; MASS.
Date of Death, yy//CggZNQMN / o * d
Name in full, /) (f^flYfLO^Nl ^
Sex,
(If married or divorced w^dian give maiden name, also ^ame of husjfaud.)
fflccl&AU-
. Color, Y.flYzYYY. Condition, .
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, Years, — Months,.. c^-rfDays. Occupation,
Warder.
Residence,'
Place of Death, yd i C l •L@ T' Cdl£svc^
£ J ^ (State year, monthfcnd day.)
Place of Birth, Dade of Birth,
Name and Birthplace
)> y^o jd 7y
of Bather, ) \ r/
Maiden Name and I lAslfiyl ddl/MyOc^L^
Birthplace of Mother, )
Place of Interment,
Name and Age )
of Deceased, )
PH YSICJ AN’S CERTIFICATE OF THE CAUSE OF DEATH.
r ' TYu.eJl /•' '' 190.
Age, 7 L years.
I hereby certify that I attended deceased from 7 ^ 190 L , to <4
190dj, that I last saw ...dh** s ..alive on the LAN.,... day of ktA QNK,. 190 y,
that QaLsjl died on the day of \c\YlNS - 190 7, about \?-3. Q .o’clock
A.M., or BrM., and that, to the best of my knowledge and belief, the cause of. jL. death
was as follows: ■
j Chief cause, ..Yd. CZl^YLzxjZ.Y
( Contributing cause,
I
f Chief Cause, 'Y Y'X-
Duration ^ /
Contributing cause, v ./.
Disease
K
? cyxi-
*If an Institution, state how long an Inmate and previous residence.
Q
li
JZ^_
M.D.
7
^SSS’S'i, ’I
[3-’06 37-LM.]
Permit No.
RETURN OF DEATH.
MASS.
(If married or divorced woman give maiden name, also name of husband.)
r
Age,:'./. Years,
y
Residence ,*
Place of Death,
Place of Birth,
Name and Birthplace
Color, Condition,
(Single, Married, Widowed or
S / Divorced.)
Months. ' ' Dans. Occur) ation.NyP /
(White, Black, Mixed, Chinese,
Indian, etc.)
4/
Occupation,
f/. .' Yy Ward,
(State year, mouth and day.)
Date of Birth
of Father, '///
Maiden Name and
«: /
Birthplace of Mother
Place of Interment,
uff.
Undertaker.
/
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
U!Yg/h..... /...*/(.. 1 90~J
Name and Age
of Deceased,
a
1 'NPrN].. AteJ.1...
years.
I hereby certify that I attended deceased from, S 190 ^to fh Afs / ^
' 1
lOO/j, that I last saw .../yjyy^: ...alive on the day of. 190
died on the u ... day of.
that
.190 , about ...NZN^7..o’ clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of.. M~Q. death
was as follows :
j Chief cause,
Disease
— -j Iffy^jApC^ V~
Contributing cause,
Duration
j Chief Cause, .f'TT. 1.
| Contributing cause,
M.D.
• If an institution, state how long an Inmate and previous residence.
,1
[3-’06 37-LM.]
Permit No.
Sex , .i/Zf
(If married or divorced woman give maiden name, also name of husband.)
(Single, Married, Widowed or
Divorced.)
Color, /m./P/MPp. Condition,
} (White, Black, Mixed, Chinese,
Indian, etc.)
Age,.. / Year*, ^ Months, /(I . Days. Occupation, fZr.
Residence, * (Nd. Ward,
Place of Death, / / Ltf'Wd'l Z C~7~~
Place of Birth, ff. .. ...M ^ .... Date of Birth, ..../)/ /.J''
B
(Stiff year, month and day.)
Name and Birthplace
of Father,
Maiden Name and
Birthplace of Mother, j
Place of Interment
V..lL&pt.P.^?.. /Ji.&J-/
CUd.:
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, ^ /.. 190./..
years.
*7ne7easeT 1 A«e,^
I hereby certify that I attended deceased from '//.Pflrr. 2® 190/ , to ^ /o
190 / , that I last saw ..^S^L^rrr alive on the ^ day of. 190/,
that. .rNlJl/rrrr.. ...died on the 25Z... ...day of 19 Of , about .. ?,Y° o’clock
J
A. Mr, m: F.M., and that, to the best of my knowledge and belief, the cause of. ~~D-r^rrrrr. ..death
was as follows :
Disease
Contributing cause, ~
f Chief cause,
I
2 1
\
ft
V
[3-’06 37-LM.]
Permit No.
(If married oj^divorced woman give maiden name, also name of husband.)
...Condition,
Sex, ' 7'"' i- (■' i o Color,..
(Wlrite, Black, Mixed, Chi
Indian, etc.) - v unxw ;
Age,* / Years, ^ Months, /d Days. Occupation, . .
(Single, Married, Widowed or
. Divorced?)
Residence, * ' a
Place of Death,
Place of Birth,..
Name and Birthplace
of Father, ) ( / I
Maiden Name and ^ (
Birthplace of Mother, )
Place of Interment,
Ward,
d^deZ7.
nontu ana aa^r.)
Date of Birp^fSfAAM 'J
dl ,...
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
i o- Boston , 4a.. ...{..fa.. 19 Of
■V:"!N" 1 Age, 8±. ...years.
of Deceased,
I hereby certify that I attended deceased
from . rL^- • v ...]9(P/ , to. {
19 61, that I last saw alive on the If!.. day of ANcu^e. f/\^_ . 190l,
that.. ...died on the l...J...{dl6... day of 190f, about o’clock
A.M., yrr-FrMr, and that, to the best of my knowledge and belief, the cause of death
was as follows :
Chief cause, ,
,, f d
Kr
/ZY
Disease
Duration
j Chit
( Contributing cause,
j Chief Cause,
Contributing cause,
d
id' JdL YPl.PNPC:. M.
D.
• If an Institution, state how long an inmate and previous residence.
jr-rz *>/ r
FILL OUT WITH INK.— THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
f RETURN OF A DEATH (CITY OR TO WN.)
FULL NAME - C'- Registered No
} -? .>\i: r,r 1
Age years .SsTT.... months Sc?!? days
.190 "/
Residence
r
j
3
Li.
Ill
CD
O
H
O)
til
s
<
z
STATISTICAL RETAILS
SEX
COLOR
&n^ru
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE !
NAME OF
FATHER
BIRTHPLACE
OF FATHER!
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER!
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
190 .
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.. ^3. . f^rrT. ./.Z.. . 190 .}...■ 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:
. . .^TCTrVTTrr:-
Primary:
(duration) DAYS
Contributory:
(Signed) >f/ 7^ >/
(DURATION) DAY8
^V...I90.7.(Address)ij
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted.
If not at place of death?...
Filed
.190.
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information." If In a Hospital or
Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
|| Name of cemetery.
v
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1907.
CITY OF
BOSTON
FULL NAME Susan A Haslasi Registered No... 29.6.9.
Bos ton. ..Boston. ..Insane. . Hospital
Date of Death 1907. Age .3.8. years months days
Place of Death
and Residence
STATISTICAL DETAILS.
PHYSICIAN’S CERTIFICATE.
SEX
COLOR
F
SINGLE, MARRIED, WID , DIV.
W M
Gillcoly
Samuel J
Bedford Mas
... Bedf ord Mas
Maiden Name
Husband's Name
Birthplace
Bernard
Ireland
Margaret Boyle
Ireland
Occupation :,...Ho.USe.W.if e
Informant
Name of
Father
Birthplace
of Father
Maiden Name
of Mother
Birthplace
of Mother
S“m0ofv!i.^. Be rnard ' s C one o rd Mass
Undertaker
F S Maloney
I HEREBY CERTIFY that I attended deceased during last illness,
from 1907, to 1907,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows
...Gen, .Paresis.. 1 yr
Contributory :
(Duration)
(Signed) S .W. Crittenden m.d
-Mar -27- 1 907
SPECIAL INFORMATION from Hospitals. Institutions, Transients, or Recent
Residents.
Usual Residence 181 Shirley St W inthrop .
Filed Mar. ...30
1907.
A true copy.
Attest :
Registrar.
< 1 . 4 - •
.[3.'06-37-LM.]
Permit JVo.
RETURN OF DEATH.
/U’ivti' • 1' BOSTON, MASS.
Date of Death, Ll...
I i /) a !\ /-i l
Name in full,...
Sex,
(If married or dWorced woman give maiden name, also name oI husband.)
Color, .IviWiC' Condition,..: ~
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) Divorced.)
Age, Years, — — Months, Days . Occupation,
Residence,* Ward,
Place of Death, ) khb iJJ
Place of Birth, Date of Birth, f /....( (
Name anci Birthplace ) LftUiL <)
(State year, month and day.)
~ J “ ’ — 7 -W f-
.A.Dm£imaIIc. L]/\MSAA...
Maiden Name and ) 3
Birthplace of Mother, ) I i \ Q f) f) 0 l U
Place of Interment, VUgRiL
]A/NvyaAi. £±t tlMN&C:.:
Undertaker.
Name and Age )
of Deceased, )
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston , N.p..'r^.s Nri 1 90
!. Age, year si
I hereby certify that I attended deceased from rr " 190 , to
190 , that I last saw alive on the day of 190 ,
that died on the day of 190 , about o clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death
was as follows :
J Chief cause,
Disease
| Contributing cause,
M.D.
■
'N^s} f
x
[3-’06 37-LM.]
Permit JYo.
RETURN OF DEATH.
c) ovja-wrv, MASS.
Name in full,
Sex, Color,
Date of Deafhj CL/adjJ. 6~''/Nf
•• * Qj n/n/ > vV )
(If married or divorced woman give maiden name, also name of husband.)
.Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, .YY Years, ~~NMonths, crrNDays. Occupation,
Residence,* 9*3 ^ Cf/LA/<-NtQs W'ardr;
Place of Death, #... P rr
N
r s
Name and Birthplace 1 ^
of Father, ) r / ^ r p f/
Maiden Name and ^ . ^/■...£n.(.lAD^ 04:7a, . IN.
Birthplace of Mother, ) 1 J r A - Y Y < f n.
Place of Interment, id/.t ^
Undertaker.
PHYSICIAN’S CERTIFJC^ATE OV THE CAUSE OF DEATH.
''■NInL-I i5^rr... 190 ft.
ge, .7^- . years.
Name and Age
of Deceased, ) S^L-Ui
I hereby certify that I attended deceased from \ £TL*~ . . %1.190 /
19 Of , that I last saw....' alive on the . day of l_^ 190/',
that .ygyl^ died on the day of. 190 g, about / Cl o’clock
A.M., or ■ i\ M~, and that, to the best of my knowledge and belief, the cause of death
was as follows:
j Chief cause, ^
Contributing cause,
A
Disease
J Chief Cause,
Contributing cause,
Duration
*If an Institution, state how long an Inmate and previous residence.
6-Tyi.A^^~
.... M. D.
AjJ 2 1
V
COMMONWEALIH ut- MASSACHUSETTS
y/'
RETURN OF A DEATH ( CITY OR TOWN.)
FULL NAME * Registered No.
r,;' i g* rr ! ..^^. .£ 7
^ 4 * Z” ^ ^
. Age years .c. months .yT.. days
Residence £.
STATISTICAL DETAILS
SEX
COLOR
fylr&X:
SINGLE, MARRIED,
WIDOWED, OR . ' .
DIVORCED
MAIDEN NAME t
HUSBAND’S NAME t
BIRTHPLACE*
NAME OF
FATHER yp / ^
6-
BIRTHPLACE
OF FATHER*
/?. 9 •
MAIDEN NAME * . - ,
0F“°TH
BIRTHPLACE
OF MOTHER*
OCCUPATION y*)
INFORMANT §
p(/
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
9 C i;,>
UNDERTAKER
ADDRESS
r.f .
*T
)ys2t. ■<-.<-
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I ^ttended deceased during last
illness, from ..A
4
l90lj..tO..TT
.190.
!■
that to the b^4t of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
(Signed).
O.P.
(Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
V
1
[3-’06 37- LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
(If married or divorced woman give maiden name, also name of husband.)
Sex, '"fysfycy f f I Color, Condition, J
(White, Black, Mixed, Chinese, (Single, Married, WidfSwed or
Indian, etc.) , Divorced. y7
Age, ...s/'tj.. Years, c — Months, Days. Occupation, (2:N: . .
Residence, * ^ V / Ward,
Place of Death, t WL ' ' '-**■ >
Place of Birth, (Q).Q fU ^aeJl fU. \:)i , Date of Birth, f ’ 4 "/. g
Place of Interment,
(*tate year, month and day.)
Name and Birthplace ) lL/QAJ^.(pJUD
of Father,
Maiden Name and , LdPSjKCC -ta.,/ "'N ,
Birthplace of Mother, ) ^ __ ^
V£lJ.QJUL> /?JAA>.^S.
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
C$..QA±JLj. 190 f/f.
Name and Age
of Deceased,
,...C^'^.A.i/g.. Age, f'/j years.
I hereby certify that I attended deceased from. 7 wop, to ^ 7
/ A ^
190 ), that I last saw alive on the / ..day of.
190 2
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death
was as follows : y\ 1
( Chief cause,
Disease \ J
( Contributing cause,
rwi
f Chief Cause,
Duration
Contributing
cause,
•If an Institution, state how long an Inmate and previous residence.
M. D.
FILL OUT WITH INK.-THIS IS A PERMANENT RECORD
D
Ll.
lii
m
o
h
w
u
<
z
[2-1-1900-5,000]
J 429
COMMONWEALTH OF MASSACHUSETTS
CITY OF SOMERVHjIiE-
FULL NAME
Place of I
Death
RETURN OF A DEATH
Q> H
Registered
Date of
{Name of Hospital or Institution if any)
Residence
(No.)
( Street )
_Place of fJJ . . .cli. Age Jr/f.. k
■ - - / ni \ /Toiim mc'A'ifii niirf Rtn+e>\
Death *. 190
years . ./? months day$
STATISTICAL DETAILS
MAIDEN NAME
HUSBAND’S
FULL NAME
S4NSTE, MARRIED,
MODOMAEe Frr
Divonoeo
icrf or dU'oeyed ujoonan, or widow *
If. nbHKwfecM/,
BIRTHPLACE Q^ee Mate or country ; also city ^trn, or county , if known
‘yy^tLeCMS.
£ (jd):e state or country ; also cit
AjP t^y
NAME OF
FATHER
BIRTHPLACE Hire state, or country : also city, Iowa. or county, if known
OF FATHER
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER
(c ^ 1/ xjJ!<a/
Owe 8t(^e or country ; also city, town, or county, if In
OCCUPATION
INFORMANT’S Jf°rfPn yiviny statistical (fpLeflUs . >
fff KOlaJUaj *^v - !
ADDRESS AD, j ->-? . & If
ADDRESS (A r / -"I . . P /
(No,) ( Street ) ( Tuli n or City)
PLACE OF BURIAL OR REMOVAL
A (Tv^JiouuyW.
DATE OF BURIAL
. — ^ (Cemetery)
Cj '\yc\jAA
Up ft
A^IAclaUP
9
( Toicn. or City , a ml State )
UNDERTAKER1 S
NAME
ADDRESS
H Q
(No.)
Ttr.Pvti.
PHYSICIAN' S CERTIFICATE
I HEREBYv CERTIFY that I attended deceased during last,
illness, from 190 ^ . ..../.&. 190.^?.. J
that to the brfst of my knowledge and belief death occurred on the.
date stated above, and that the CAUSE OF DEATH was as follows :
(If a soldier or sailor who served in the war of the rebellion both the primary and’
contributory causes of death must be given.)
Primary :
I I I I Ul J • ’ ’ 1 ’^|L
£c
( DURA
- ■
vAt <<rvA-e^
Contributory :
,«r. J
/’i <u , Lt.P..ji.., ........ . lAd{AtlNf^sk
( r> -l., JLA\ /, /
xj Kms.AmL(_
(Signed)
Address)
(No.)
M.D.
( Street )
(Town or City)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or
{Recent Residents.
Previous Residence j
How long at
Place of Death? Years, . ... Months, Days
Where was disease contracted, ’’
| if not at place of death 7 1
Received
Filed
I.
190 ,r
Agent of Board of Health, appointed to issue burial permit;
190
( Street )
( Toii n or City)
City Clerl
FILL OUT WITH INK. — THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
(CITY OR TOWN.)
„ RETURN OF A DEATH <«*
FULL NAME Registered No
1 | 3 ,90?
Age /...#.... years ./^.months tu?..days
Residence
U
m
o
H
O)
LU
s
<
-I
J
<
STATISTICAL DETAILS
SEX
/^7^C
COLOR
/j'r'
SINGLE, WAfOUse^
wi DQyyertv&R
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACES
NAME OF
FATHER
BIRTHPLACE
OF FATHER
9r
O-^sTT.
<2h.
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER t
frklYV-'Jr
OCCUPATION
INFORMANT 5
PLACE OF BURIAL OR REMOVAL D
M/c U
DATE OF BURIAL
i9o.?
UNDERTAKER
b<0i /^ud
ADDRESS
‘fjHKFt-.
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY thatj attended deceased during last
illness, 190^ . ,
it of rmr
that to the best of fny knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
rk. £dA<kt^C. . .
Primary:
A (duration) DAYS
Contributory:
* tty. <
■ (duration) DAY8
m.d.
(Signed) .yi.k&M.
I90y?... (Address)..
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 .
•/A
years
Where was disease contracted,
If not at place of death 7
>
months
days
Filed
.4?2Z&y...
190,?..
Clerk
•City or town, street and number. If any. If death occurs away from USUAL RESfg
DENCE, give facts called for under "Special Information.” If In a Hospital
Institution, give Its NAME Instead of stroet and number,
t In case of married or divorced woman, or widow,
t State or country) also city, town or county, If known.
5 Name and address of person giving statistical details.
|| Name of cemetery.
[3-’06 37-LM.]
Permit No.
'9 6 V
/?
(If married or divorced woman give maiden name, also name of husband.)
(Single, Married, Widowed or
Divorced.)
Sex, . . ..Color, .. ...Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, Tears, 3 Months, .3 ^ Days. Occupation,
Residence, * /t> Ward,
Place of Death,
^0^333. /SLcan/s.
(State year, month and day.)
Place of Birth, 'TJflzfiglg Date of Birth, _.(2aN.<A 3.77. ./.33 3
Name and Birthplace } . C
of Father, ) ' (X) f t\ r- Tgga A
Maiden Name and ) {2mWU. u/Lddtp. ......
Birthplace of Mother, ) t 7 //
Place of Interment, .(^RNAM/l£AdW.../ ~ * ' 7 *
Name and Age )
l, f
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
' Z 190j .
of Deceased, ) . NX... Age, ?7f7 years.
I hereby certify that I attended deceased from. 3 19(X , to A
f 37/ Pk /,
190 A, that I last saw ...Zkrtr^r. alive on the ft.. .?.v..j day of tit Sfg
( n C^t &
died on the S'.....**.....
190
that**
0f7,
day of shrtttf 190g , about 33 o' clock
<7 / J
A.M., or—FrMt, and that, to the best of my knowledge and belief, the cause of ..tDrf-trrr..... death
was as follows: „ — . . • . — .
( Chief cause,
Disease \
Contributing cause, ~
aJL_ i -
f Chief Cause,
Duration
Contributing cause,
•2- A
3
•If an institution, state how long an Inmute and previous residence.
M.D.
[3 *06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
r >
- Date of Death,
cl
N''Vfo. 2
(If married or divorced woman give maiden name, also name of husband.)
Sex, Color, . Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, (o ff Years, p — Months, Days. Occupation,
(DifHyotcfaA
(Urc Date of Birth,
Residence,* .
Place of Death,
Place of Birth,
Name and Birthplace 1 fff \£ dplAjfsfQ N^.r
of Father, i ‘jAj
Maiden Name and ) (-! i.JlCl
Birthplace of Mother, ) . „
Place of Interment,
Ward,
(P\ (DjfM^stcfaffleg/ (state >'ear* moilth and day-)
si if
~
r^. l/pt/ (jypPMPiN.
yu-D^
&£ffU.c{N.
4
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE £AUSE OFJDJJATH.t
190'/,...
RfDeAsfdf I P.~ Age,. 4D .years.
I hereby certify that I attended deceased iron) ' ^ 'C HHhC , to ' '"''f * * ***
190/ , that I last saw ApP.: alive on the...^/1/r^W.-. day of.. 2 007^
that Ht/u- ....died on the...ff^fl<^.. day of 190V, about o’clock
^tM\~y*r P.M., and that, to the best of my knowledge and belief, the cause of. death
was as follows :
j Chief cause
Disease
Contributing cause,
[3.’06-37-LM.]
Permit No.
RETURN OF DEATH.
* 4
BOSl^JN, MASS.
Name in full,
Sex,
Afk.pT.
(If married or divorced woman give maiden name, also name of husband.)
r. Color, Condition, Y*
A (White, Black, Mixed, Chinese, (SingMr Married. Widowed or
Indian, etc.) Divorced.)
Age, Years,
Residence,* .
Place of Death
Place of Birth,.
Days. Occupation,
JVard,
State year, month and day.)
Date of Birtlrffr-f^ffC-S/ /
Name and Birthplace }
of Father, )
Maiden Name and
Birthplace of Mother,
Place of Interment,..
Undertaker.
PHYSICIAN’S CERTIFICATE* OF, THE CAUSE OF DEATH.
K^rm, Of±^JA 190f ...
I X A^r. __ Age, >F... years.
I hereby certify that I attended deceased from lOO'J , to ^ M J V
. s, vrrx alive on the Iff. day of....,
A
190 y that I last saw .
that.
.4*.
died on the /. s5^.
Qm
day of /NNj 190 , about’ \
190 >
o’clock
A.M., or -B. M. , and that, to the best of my knowledge and belief, the cause of.. "9 death
was as follows: , J/ ' ,
( Chief cause,
Disease '
( Contributing cause,
f Chief Cause, *
Duration '
( Contributing cause, -
.CA£uff2
* If an Institution, state how long an Inmate and previous residence.
M.D.
£>21
/
/
[3-’06 37-LM.]
Name in full,
Permit No.
RETURN OF DEATH.
^ MASS.
—
Date of Death, /?A'V /&. 7.
(If married or divorced jftOman give maiden name, also name of husband.)
Sex, .. fr/ o 4 ... Color, .. % /v A. ...Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Marrieclz/Vidowed or
Divotyed.)
Age,u>.^.%^Years, Months, Days. Occupation,
Residence, * Ward, .
Place of Death, ff :
y , \ (State year, mouth and day.)
Place of Birth, 7.AN-I. M/.M f M.NClJl.P.... Date of Birth, nr. UCIN. —
Name and Birthplace
of Father,
Maiden Name and ^
Birthplace of Mother, 3 fMlNyi/ f~"
^uny7"<.
Birthplace of Mother, • Yf ) J< G , ,
Place of Interment, /^rtecllAfp^r-r^, x
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
N'UCtL^dttgg. / 6 190 .
.CMrrr...
Name and Age ) OS ' a / ^
of Deceased. I Age, Al./.Ly ears.
I hereby certify that I attended deceased from /'V‘*y. /A Hat /. to
H.
/
day of y 190 t
190 , that I last saw fPFNrN. alive on the '....U> day of ^ ^
that ^A-<....died onthe /....Of?.. day of *^77 Cl. 19 67 , about . 7 o’clock (Tbry
<7 S-
A.M.) or P.M., and that, to the best of my knowledge and belief, the cause of .... death
was as follows : Cr /
( Chief cause, n7.s<rtr.7. r .
Disease -
FCd. /F.
( Contributing cause,
f Chief Cause,
Duration
Contributing cause,
*If an Institution, state how long an Inmate And pr^foa^ residence
/3 0u4vh)
v *
M.D.
I
MARGIN RESERVED FOR BINDING.
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1907.
full name George Handley Registered no.
CiTY OF
BOSTON.
4635
place of Death ) Boston. Em.ergen.ey... Hospital
and Residence ^
Date of Death.
May 16 1907. Age 78
. months. -
14
f ...days.
STATISTICAL DETAILS.
PHySICIAN’S CERTIFICATE.
SEX
COLOR
M
Maiden Name
Husband's Name
Birthplace
w
SINGLE, MARRIEO, WIO., DIV.
s
I HEREBY CERTIFY that I attended deceased during last illness,
Name of
Father....
Birthplace
of Father..
Maiden Name
of Mother
Birthplace
of Mother..
Occupation .
Informant
Acton Mass
Abraham
. — - .-Mass
Susan Winn
Salem Mass..
Retired
from 1 907, to 1 907,
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:
. Uraemia 5 days. .
(cDr.‘,i:?,“*ory ; ! Enlarged Prostate
(Signed). J C. X) Clark
M.D.
Place of Burial g0 Acton MaSS
or removal.
Undertaker
Lewis Jone3 & Son
.May .16 1907
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recont
Residents.
Usual
Wi&tkrop Mass
Filed.
A true copy.
Attest :
May 20
1907.
Registrar.
\
-\
A
[3-’06 37-LM.]
Permit JVo.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
Date of Death, Iff
(If married orjilvorced woman give maiden name, also name of husband.)
Sex, Color, Condition, It C/N I f Q -
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
ivorced.)
Age, P Years, ( \^j}Tonths,C Days. Occupation,
Residence, * /'it # / ti> ‘ /3't.YI'CP. J Yard,
Place of Death,
PP.
Y
(State year, mouth and day.)
Place of Birth, ^DtDe of JRrlJi,^
Name and Birthplace )
of Father, i " ■ A, < \ Pfj f
Maiden Name and [ - - - 'NZ. ^ .
Birthplace of Mother, ) ^ „ . sT\ _Jl — - r\ t
/ //- ' —t-fi y if) f „ \ ) As / j-jl . y
Place of Interment
ndertaker.
PHYSICIAN’S CERTIFICATE OF^THE C<vljSE OF DEATH.
(9 Boston , . / FL (u,. ft- ,VNS 190 /
PINY } d4hNU Age, fl years.
f hereby certify that I atteiided deceased from\...//tNHly, (.*7... 1 9 0 Pi h>
190 *J, that I last saw 7 alive on the dajj of. . V. IRQ 7 y
that. .died on the' Hay . 190 7, a(J>ut A? - o’clock
A.M., or P.M., and that, to the best of my knowledge and belief) the^ cause of.
was as follows:
j Chief cause,
. death
Disease
Duration
| Contributing cause,
j Chief Cause,
t-f- — ,
Contributing cause,
Ptpr,
•If an Institution, state how long an Inmate and previous residence.
... M. D.
[3-’06 37-LM.]
Permit JVo.
(If married or divorced woman give maiden name, also name of husband.)
Sex,
Color, /^.....A ./..fi. Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Marpihid, Widowed or
Divorced.)
Age,. ^ Years, — Months, rrrr. Days. Occupation,
Residence, * ^ C ‘ ' (y W ard,
Place of Death, •/ ppX. ' « . * > *Q77....<?^N,. yM...
j „ ' <r . L (State year,
Place of Birth, Date of Birth,
Name and Birthplace
of Father, J
Maiden Name and \
Birthplace of Mother, ) fT f
Place of Interment
' (APPlPPZ-rlNU. 7
month and day.)
C/ INF I ^ t A-^- 1 7 y ^ M W '
' rfi A /)
Undertaker.
PHYSICIAN’S CERTIFICATE OJ THE CAUSE OF DEATH.
SoJ/n. /A>. r? 190. J
*:r»::LT i ^ — 4*.
years
I hereby certify that I attended deceased from. Ay./.. 1907 , to S'
190 , that I last saw 7/LPMT^. alive on the ^....f.'. day of ... 190
that died on the Xy...cCZ/. day of ^ 190? , about J Nu^o’ clock
A.M., (rr—P-rM r, and that, to the best of my knowledge and belief, the cause of. death
was as follows: a A-C*. h A
j Chief cause, ?.. A
Disease
Contributing cause,
M.D.
3
COMMONWEALTH OF MASSACHUSETTS
( CITY OR TOWN.)
Registered No.
RETURJ^ OF A DEATH
FULL NAME
D,~““ i } .. rr i 190>
x dC <r ' s i
Place of
Death
Residence ?. Age.
..years..
/ 9
months ... ...... days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR 7 , s
DIVORCED /< / ' ‘ *
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE!
C^r.
NAME OF
FATHER
<5^ ~ ^ /*
BIRTHPLACE
OF FATHER!
MAIDEN NAME
OF MOTHE
<rr~. ^ i
z. 'C-^. -dL
BIRTHPLACE
OF MOTHER!
Si
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
UNDERTAKER
DATE OF BURIAL
190.. ^
ADDRESS
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ... !.9'.o...w. ooorr to..<2)y.^j....X-6 190.^...,
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:
Contributory:
...(duration) DAY8
(Signed)
..}r..6.l90^f Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
‘City or town, street and number. If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information." If In a Hospital or
Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county. If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
7*
'7°'/
[3-’06 37-LM.]
JVame in full,
Sex, Color, ^3JjP.JoA^Le7ZI7....^ Condition, .DA.CiL.
Permit JVo.
RETURN OF DEATH.
o
F, MASS.
Bute of Death, A-CI.J. fAAA. . CCSl.. . . ". J.fp.f y
(If married or divorced woman give maiden name, also name of husband.)
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
rWard,
Age, 7' Years, off Months, Cs,. Days. Occupation,
Residence,
Place of Death, 7.7? /Cb (AAAaCiaaJa. . QffA^Sr.
* * - (State year, month and day.)
Place of Birth, .AA/.CZ. . Pate of Birth, 7 <3
JVame and Birthplace ) 'fAf
of Father, i
Maiden JVame and [
Birthplace of Mother, ) f^r f
Place of Interment, j . .f. Aba. . I./fAJ ^
Undertaker
u
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
^Ay 3 p, Bnsfmi , . .
' Age, years.
JVame and Age )
of Deceased, )
190*p...
I hereby certify that I attended deceased from ...A.Y^rr~:: 190^ , to
190^J that I last saw A. alive on the. lAVhiday of.. yi/L&tg 190*7
that
SB- .died on the ... .2^....fJLfl..day of 190y, about *3 o’
'JTrM., or P.M., and that, to the best of my knowledge and belief, the cause of..
was as follows :
j Chief cause,
| Contributing cause,
Cc
Disease
/
iuse
clock
death
f Chief Cause,
Duration .
I Contributing cause,
♦If an institution, state how long an inmate and previous residence.
2jT- CL ■
fo ol
M. D.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Pl3Ce ,°: } A
( CITY OR TOWN.)
Death '
Residence
ip C A ^ Age ^ o
Registered No.
Date of I /f
Death \
.190
. years.. &.
.months days
STATISTICAL DETAILS
SEX
COLOR
MAIDEN NAME
)r*Y°
siNL.Lt, wjurmtu}
WIDOWED, Oft-
WMWWSB •
1/o^tsu lJ
HUSBAND’S NAME t
BIRTHPLACEt
* ^ >» *
NAME OF
FATHER
BIRTHPLACE
OF FATHER t
Itn + yp -
^ Sp
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER X
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL!
UNDERTAKER
DATE OF BURIAL
ADDRESS
PHYSICIAN’S CERTIFICATE
HEREBY CERTIFY Lliul I ul'ti'fltluU Uuuuutud UurlllgTast
400 te~
-rerr
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:
: AjUAlCwWVt
.VjLo^Cfc ’cLjLo ~
.(DURATION) DAYS
Contributory :
..(duration) DAYS
(Signed)
M.D.
/2^*jH .I90.p.. (Address) . - _ - - - ,
ON only for Hospitals, Institutions, Transients,
SPECIAL INFORMATION
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information." If in a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country | also city, town or county, if known.
§ Name and address of person giving statistical details.
II Name of cemetery.
V
FILL OUT WITH INK. — THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
FULL NAME ...JxQf.Z.,
Place of > tj
Death* ) +/• d J?- ^
Residence . . . £v. . <(/. . /. . / / .c. . >. .„ L. .
months ..days
-j
j
D
U
U1
ea
o
k
co
ui
E
<
_j
j
<
STATISTICAL DETAILS
PHYSICIAN’ S CERTIFICATE
SE
b
COLOR
S
SINGLE, MARRIED. , S'
WIDOWED, OR / 7/ ,
divorced rCi/t/ALTr-
MAIDEN NAME
HUSBAND’S NAME t
BIRTHPLACE*
NAME OF
FATHER
t Prf* t ]/*(&
f yff?a
/0 ,/y /h
/ft tq/j j /(< / let 1 1
OCCUPATION
INFORMANT §
ft (771 <f >JC. J J ,
Filed
- U. UL
A £A
PLACE OF BURIAL OR I DIVALlI
UNDERTAKER
DATE OF BURIAL
, 190...
ADDRESS
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 to 190 .,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
(duration) OATS
Contributory:
(duration) DAYS
(Signed) M.D.
190 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death7 years months days
Where was disease contracted,
if not at place of death?
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.
II Name of cemetery.
/> ^ ■ f-y p y &-yy y/ &-t? Jy? V -/^7
[3-’06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of Deaths ^ f
Name in full, c2U/m
(If married or divorced woman give maiden name, also name of husband.)
Color, Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) Divorced.)
Sex, ..
Age, fXX. Years, CN Month s, Days. Occupation,
Ward,
(State year, month and day.)
Residence,*
Place of Death, XX {p 3
Place of Birth, yiAp.CIrYYf. Date of Birth,
Name and Birthplace 1 fpJ/h:f)A/L.OL£„.. . 'X.JX. CJ<€f/Ay. ZZ.
of Father,
l JL
Birthplace of Mother, ) . K
Place of Interment,.
Maiden Name and ) ( Nf /fY ffY /FZJA/)NL-
ye/paas.. yfr. pwa
, findertaffer .
* /-AAr/v* fXi/tOr* yf f^J) PfX~
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
jc osisn, hyyAyr- /$.. 190j? .
of Deceased, ) Age,. years.
I hereby certify that I attended deceased from...Cf^Ni-fr ^190? , to^^ C^t.'cJL.. / X
19 Of that I last saw alive on the X day 0f. 19 Of",
that. yy died on the /.XL day of. 19 Of7, about /ft. J Q 'o’ clock
_a ■
A.M., or- I1. Mr, and that, to the best of my knowledge and belief, the cause of. death
was as follows : £-\ ^ / j *
( Chief cause, /fjL^A
QO X
Disease
Duration
| Contributing cause,
j Chief Cause,
Contributing cause,
M.D.
♦If an institution, state how long an Inmate and previous residence.
•/Cjajaujaa jo auie^ ||
•s|!8)9p |83{)Sj)E)S Su|ai3 uosjad jo ssajpps pue auie|q §
*uMou)j j| ‘/Cjunos jo umo) 'Xjp os|i !£ijunoo jo ajetg f
'MOpjM JO ‘UBUIOM pOOJOAip JO paiJJElU JO 8SE0 U| J
•jaqiunu pue jssjjs jo peajsuj 3y\|VK| s}| oai.S ‘uojjnjijsui
* u! il „'uoj}eujjoju| lepadg,, Japun joj payea spej oa|3 '33N3Q
vnsn wojj Aemb sjnooo qpjap JI ‘Cue j| ‘jequinu pue ioojjs ‘umoj jo C}|3 t
061
P«>I!J
iq)eap jo 9DE|d je }0U jj
'papcjjuoo aseasip sem ajaq/y\
imeaa 10 aaeid
}e 3uo
3uo| mop)
■aauapisay |ensf|
JO J3UJJ0J
•sjuapjsay juaaay jo
jj. ‘suo|}n}|jsu| 's|ej|dsoH joj X|uo NOIXVWdOJNI *lvio3dS
(ssajppv) /oeig ^
" (P3u3!S)
...
:Xjojnqu;uoo
(NOixvana)-
/ : Xjeiuud
I j SB SBM HXV3Q JO 3SOVO oqj Pub 'aAoqs pajBjs ajBp
i pajjnooo qjeap jayaq puB e3pa|AA0u>| Alu jo jsoq aqj o; jeqj
V <H /06I g Y’ ft/jC' UJOJJ *SS9U||!
lunp pasBaoap papuaue I »eqj AdlXd^O A93H3H I
ax voiaix naa s,x viois.ur.i
■
sssaac/vl
Wv
a3xvxa3aNn
iviang jo 3xva
nvAowga ao nviang jo govnd
§ XNVWaOJNI
Noixvdnooo
$a3HX0W JO
sovTdHxaig
a3HX0W JO
3WVN N30IVW
• SWfV *
0
ja3HXVd JO
govidHxaig
B3HXVd
do 3WVN
t govTdHxaig
j 3wvn s.aNvgsnN
J 3WVN N3CIIVW
trrrwm rmTTTTTT
iux ‘a3MoaiM
‘a3iuu»w ‘diowts
<3
tc ' ^
TTCTVTJ^—
X3S
sairxaa avoixsxxvxs
Z
>
3
m
CO
H
O
n
m
■n
c
r
r
9
*je»X-
a3\/'
u
t'T
ON pajajS|2ay
fw'v
•’Ff'Hpj THJV
Hxvaa v jo Nanxaa
MJBaa jo ajBa
* qjB*a JO aoBid
31/MVN llfld
S113SnH0VSSVIAI 30 H±“IV3MNOIAmOO
FILL OUT WITH INK. -THIS IS A PERMANENT RECORD
r
[3-’06 37-LM.]
Permit No.
Age, Years, /o Months, Pays. Occupation,
Residence,*
Place of Death, ....
Place of Birth, /Z
Name and Birthplace ) \/ / j 9 LAN.
of Father, i '''A? ,
Maiden Name and )i fAyfl.A.
Birthplace of Mother, ) /(TAfy
Place of Interment,.:
Ward,
(State/year, month and day.)
/t... Date of 'Birth, ...C./hg/f.. AA.A.Zf.g'
^JfPP^Z'.....
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
\ Vt? Btttrm. f)
190
Xa^BeceLtd,G } Age, $Z A years.
I hereby certify that I attended deceased from^^.flAArY. yF J 90 , to^^PNN*-'
190 f , that I last saw. .alive on the /£... .day of yf 190^7,
that.'rN&h* died on the /... bz.day of 190^?, about ,Jf o’clock
A.M., or -P.M’., and that, to the best of my knowledge and belief, the cause of - death
was as follows :
( Chief cause, ...
Disease -s
( Contributing cause,
A? ZZjjzAA^a-Jf
Ye
Duration
*If an Institution, state how long an inmate and previous residence.
o
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME ///j Registered No.
Place of ) / X Z '/s !/^L_Z”"7S Date of ) i ^ . / . "t?
* \ i 2*V- ^ / > ^ ^ Death \>^'UsC/ U
J Age Ifi yea 1^.. X
Death
Residence
A
.months
/f-
190
. . . .days
?
STATISTICAL DETAILS
SEX
COLO
.E, MARRIED
WIElfflllilCD, CT
RIECL /
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE?
NAME OF
FATHER
BIRTHPLACE
OF FATHER?
A
MAIDEN NAM^i
OF MOTHER
BIRTHPLAC
OF MOTHER
z^cumit
(Bj24-
^ fC / /Z>
OCCUPATION
INFORMANT
b/AcoC'. '//,j^yxu/i,Lcc
PLACE OF BURIAL OR REMOVAL!
4-
UNDERTAKER
DATE OF BURIAL
A^iL^. 190 *)...
ADDRtSS__
X 5y VAMturi' tA»'
PHYSICIAN’S CERTIFICATE
that I attendecL.decea6ed during last
I HEREBY/
illness, from 190 to JKi4f 3^ 190
that to the brat of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF D^/tTH was as follows:
Primary
:BY49ERTiFY thi
rat of my knowled
ted above, and ttat the CAUSE OF D^\T
.(duration)..
—
Sontributory :
(Signed!
a/
.190 ^(Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, |
or Recent Residents.
How long at
-Place of Death? years months days I
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerkl
L;fi
•City or town, street and number. If any. If death occurs away from USUAL RESI-I
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.
1
tf—Oj
[3-’06 37-LM.]
Permit No. f
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
Date
N
Death^sP .. f t ' V lfr//f
Sex, f
(If married or divorced woman give maiden name, also name of him
Color, A//
Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) S1 > Divorced.)
Age, Years, ^ Months, .... ^^Days. Occupation
Residence,* r Ward,
Place of Dcuthf9 *7^0
Place of Birth, Date of Birth,
(StMe year, month and day.)
V^CL-
Name and Birthplace ) }a/^NN
of Father,
Maiden Name and
Birthplace of Mother,
Place of Interment,
PHYSICIAN’S CER
CATE OF THE CAUSE OF DEATH.
Name and Age )
of Deceased, 1
Boston,
'k'rkti
IF-r <190 7...
Age, years.
I hereby certify that I attended deceased from 190^ , to
190 ^ that I last saw alive on the I f day of .. 190
that...'AA^~:. died on the [fkrC7. day 190 , about . . S.^a’cZocfc*
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death
was as follows : (J ' /) / / f
j Chief cause, OU^c^f
Disease
Contributing cause,
f Chief Cause,
Duration
Contributing cause,
Lo-^7
‘If an institution, state how long an inmate and previous residence.
M.D.
S>21
'V
-
{4-’07-87-LM.]
Permit No.
RETURN OF DEATH.
B^S3Bpb&^ MASS.
Name in full,.
Dq,te of Death,.
eZi^ls.
(If married or divorced woman give maiden name, also name of husband.)
3...190
Sex, 7N. <?;*:. r^r^C.. Color,... (k
...Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed c
Indian, etc.) Divorced.)
Age, S.^rr. Years, A Months, ^ Days. Occupation, fy^t*** t
Residence,* ^tjf ? _ CllfN <2L ] Yard,
Place of Death, / Cp ff. c.
Place of Birth, . ,. Date of Birth,
(State^year, month and day.)
Name and Birthplace ) ( r l _.
of Father, ) ^ ^ ,
M aiden N ame and \ f^).yyL^e_ \J
Birthplace of Mother, ) ^ f)
Place of Interment, , y _
UNde
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
A^mh>h M^.U.y. 190.
Name and Age) Z . Ifr (_/ // _
of Deceased, ) / Age,. <ft?.. years.
I hereby certify that I attended deceased from. .. • ^ /.3..}. 100 f ,~hr
190 , that I last saiu
ihat.^c&'.fLiS... died on the
.alive on the /rSf...-. day of jf ^ UN, 190f,
/.'3..fC^.~. day of J^L I y. POO'f, ffoout A. o’clock
or P.M., and that, to the best of my knowledge aim belief, the cause of IN. death
was as follows:
( Chief cause,
Disease { pN .
fr
( Contributing cause,
.xt, ....
Duration
f Chief Cause, /C ^
f /IT) ^
1 Contributing cause, • c - ‘ ' <"
?/:
•If an Institution, state how long an inmate and previous residence.
M.D.
\
\
r
I
ALL'
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME tSiCy
°! | /A£.
(CITY OR TOWN.)
Place
Death
Registered No.
Date of
Death J —
190
?
..years.
ft.. months days
STATISTICAL RETAILS
SEX
COLOR
2^rztzt
SINGLE, MARRIED, -s.
WIDOWED, OR
' DIVORCED X
MAIDEN NAMEt
HUSBAND’S NAME t
Bl RTHPLACE *
NAME OF
FATHER y? v s?
r-/
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHER ^
BIRTHPLACE
OF MOTHER*
/tL
'K>«. S'.
OCCUPATION
>
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
V^.^,9o;...
UNDERTAKER
ADIJfi^SS
j
ui
DJ
O
H
0)
Ui
S
<
z
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last
illness, from 190 .^..to 190^..,
that to the best of my knowledge and belief death occurred on the
date stated above, and ^hjkt the CAUSE OF DEATH was as follows :
Primary :
Contributory :
(duration).”.
(duratk
(DURATION) DAYS
M.D.
It .190. .^J
(Address)..
ijUA^v • l tyyy.tth.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, give its NAME instead of street and number,
f 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.
II Name of cemetery.
Q
tc
O
o
Ul
K
h
Z
bl
Z -l
< J
S 3
K L-
U Z
(L 5
(0
»
x
H
I
■
*
Z
X
h
h
3
0
111
£S
O
H
CD
ui
s
<
z
ji
-i
<
COMMONWEALTH OF MASSACHUSETTS
0$
( CITY OR TOWN.)
RETURN OF A DEATH
,°*f I °Death l • J... I90/7
Residence fS. CA.. !.!...
Age &.A.
..years..
. .months ^ days
STATISTICAL RETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR /U. * ,
DIVORCED //YAaaA^^
MAIDEN NAM
HUSBAND’S NAMEt CA ^ 'Z
BIRTHPLACEt
^ — .2-^ / .
NAME OF
FATHER
BIRTHPLACE
OF FATHER!
MAIDEN NAME
OF"OTHER(yC(^ .
BIRTHPLACE
OF MOTHER!
^ — J —
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
>ZA C -2 2
UNDERTAKER
^ /t/7
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ^.LAAtAr^A..... igo (^Xo^YN^>^r^r1.../A.. 190 .Z ,
that to the List of my knowledge and feefief death dccurred on the
date stated a
Primary:
e, and that the CAUSE OF DEATH was as follows:
.(DURATiONX.y./X.Wf...
Contributory:
(duration) DAYS
Z^ll9<^(Address)/^
M.D.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
If not at place of death 7
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.
II Name of cemetery.
V
[3-’06 37-LM.]
Permit No.
Name in full,
Sex,
RETURN OF DEATH.
MASS.
Bate of Death,
ClNNlNA. /B <nAr.CL/jUU.
/ (p / ^0 ^ '
(If married or divorced woman give maiden name, also name of husband.)
Color, Ql filjJo, ^ Condition, 1 1 1 U 1 ‘ cl
Age, 7/ Years, f ^-Afonths, . Days. Occupation,
Residence,* l ’ ^ ° ^ Ward,
Place of Death, & Up fV
Place of Birth,. /^d.OlAA^P IZMmAAJ. . faucA}.. Date of Birth,
JVame and Birthplace ) v ' /°V, ClU <-
of Father, ) /U \ i ( C j
Maiden Xante and ) S^.C/hldf^-' J' v L ' t II DPI H /‘ / / 'f
Birthplace of Mother, ) / p-' , ^ n / ydf/ ——
Place of Interment, Ut.P.PldZfU- #/• -1- . C.. PisLLs UsXf ^r~\
W
Undertaker.
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.) . '
(State year, month and day.)
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/TiA llPZift Duitun. Jpfjfg l.(N 190
*:r»::LT \ % 7/
years.
•IZ
*
I hereby certify that I attended deceased from.. ...jf......l90j , to /.. — -
»T, that I last saw alive on the .... //3. day of 1907,
r 4 it-* ¥ V £ /
h-t died on the L .*?.... ■ rr. day of AfPrlrd. 1907, about . *> o clock
’P.M., and that, to the best of my knowledge and belief, the cause of.
was as follows : ^7* n r> . ft . ^ °
f Chief cause,
on P
death
ThjLNftio few iNzNufcJL .
Disease
( Contributing cause,
f Chief Cause,
Duration - P
( Contributing cause,
•If an Institution, state how long an inmate and previous residence.
M. D.
\
V
[3.’06-37-LM.]
Permit No.
RETURN OF DEATH.
(If married or divorced woman give maiden name, also name of husband.)
f
Sex, Color, Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed c
Indian, etc.) Divorced.)
Age,(J>~~^ Years, Months, Bays. Occu pation.^Z^^^^
Residence,* .
Place of Death,.
Place of Birth, ..777pn7.. Bate of Birth,
Name and Birthplace )
of Father, i
Maiden Name and
Birthplace of Mother,
Place of Interment,
Jr-*.
TJnderiaherr-
PHYSICIAIM’S CERTIFICATE OF THE CAUSE OF DEATH.
^ Of
*7Y:LT I <£
1907-
years.
I hereby certify that I attended deceased
fiJm..^N..::-. N..../.A.^...190J , to. *
ldOl , that I last saw.
Y /s P.
IP .CCIhr. alive on the /.£....?/. 7 day of.
7
/ /r 4
that... Af died on the day of
190
’/■
190 7, about / 2. ' <5 o'clock
JkM., or P.M., and that, to the best of my knowledge and belief, the cause of.
was as follows: ^
death
f Chief cause,....
Disease J
*7^
fa flstt 77
Duration
Contributing cause, '^L.PCP t£-z- fg.
j Chief Cause, ^ far 7 PI ..fa-.
| Contributing cause,. . .-. fNlCPi. — — ..r
/ C(U' tPi M. D.
*If an institution, state how long an Inmate and previous residence.
n*!^g§Sv>-1
PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
fits*
( CITY OR TOWN.)
RETURN OF A DEATH
FULL NAME /. TZ2&-A. Registered No
tj- f ' -/vz. a*. * .»« >
Residence Age years months .rfl?. . $.
days
3
U.
u
03
o
I-
(0
til
Z
<
z
-j
j
<
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAMEt ^ '
BIRTHPLACE!
/i—
^ —
NAME OF
FATHER ^
yj^crt £ .
BIRTHPLACE
OF FATHER!
ZZ
MAIDEN NAME ^
OF MOTHER [/ y <■
BIRTHPLACE _
OF MOTHER! yy
*
OCCUPATION
— c ZZ:
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
^ A* / •*• ~o^
UNDERTAKER
C^./k. ? .i't
DATE OF BURIAL
&SUp-«..Y
ADDRESS
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from (XAfk ... 190 to 190.7.,
that to the best of my knowledge and belief death occurred on the
date stated aboye, and that the CAUSE OF DEATH was as follows:
Primary : . . . . . U
Contributory :
.(duration
(Signed).
.ezLrf. |.
,/ ( nnpTr inn)
.190 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted.
If not at place of death 7
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 Stato or country; also city, town or county, If known.
S Name and address of person giving statistical details.
II Name of cemetery.
7
Lf2
3
A
[3 ’06 37-LM.]
r^yh cbjCU^crJi
Permit No.
RETURN OF DEATH.
MASS.
Date
of Death, yujLj /g " /p y
Name in falli
Sex, Kl/ Pl'l'UXbz' Color, Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, t5~yd. Years, ^ Months, Days. Occupation,
(Single, Married, Widowed or
Divorced.)
^?VUx^>
Ward,
Residence,*
Place of Death, Op Ot
XW (State year, mouth and day.)
Place of Birth, C ^ /JCLIL, Date of Birth, Cf) /.^..'r/ f ^ ^
Name and Birthplace )
•J/aamaav . — ' 2H&>
of Father, )
Maiden Name and ^
Birthplace of Mother, )
Place of Interment,
U/LdAPkV.OiS.. a c//^fkt4..^Lz...
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE QF DEATH.
Name and Age )
of Deceased, ) -
190^ .....
^Q'V' AgeJ(i2j. years ,f ^ZpLo
I hereby certify that I attended deceased from.. 1. /±0f) : 190 , to. j'Aj / v V)
190j, that I last saw.. iL*. alive on the H" day of Kr-Us 190 ,
that •PA~A^M..died on the. .. day of....jghCC~fl 190^ , about../. .^.f*.6*ctock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. fhtA^r.... death
was as follows :
j Chief cause,
Disease
Contributing cause,
Chief Cause,
Duration
I
Contributing cause,
tfy^L -'ix
(fY\f
•If an Institution, state how long an Inmate nnd previous residence.
M.D.
»21
)
k
[3*06 37-LM.]
Name in full,
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date
of Pea, th, y/ CxJ-fJ 77^ ' ^
Sex, 7 TlAAOJj^
(It married or divorced woman give maiden name, also name of husband.)
Color, Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Ward,
(State year, month and day.)
Age, ..(oy^.. Years, 3 Months, J Days. Occupation,
/ DA1 Si
Residence,* Jr 7}PrAN.y
Place of Death, / S~ y 0 T-kgL&eJ
Place of Birth,.. .... JjfLPj Date of Birth,
Name and Birthplace )
Maiden Name and ) .3)0/LC*Aa-CD /^1/lWZuJ/ -==~- Ct£jrx77
Birthplace of Mother, )
Place of Interment,
PHYSICIAN’^ CERTIFICATE OF THE CAUSE OF DEATH.
/i7 -Rustling Jj.“£.. ZJ. 190 z
Name and Age
of Deceased,
Age, .
years.
I hereby certify that I attended deceased from IAiPAPnJ' 1900 , to
190^, that I last saw. .<&*. ..alive on the
that....:?J-4~r. died on the < ^ day of.
7 to
. day of.
.190 7, about ..o'clock
AM-., or. P.M., and that, to the best of my knowledge and belief, the cause of. ~h^Srr... death
was as follows:
j Chief cause,
jQ—C CkJzJlygJ
Disease
Duration
Contributing cause,
J Chief Cause,
| Contributing cause,
77
M.D.
•If an Institution, state how long an Inmate and previous residence.
[3-’06-146-VM.]
(FOR POST-MORTEM EXAMINATIONS ONLY.)
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in fall ,
Sex,
Date of Death,
/fo )
(ll married or diverted woman give maiden name, also name of husjfand.)
(White, lilack, Mixed, Chinese,
Indian, etc.)
Color, l/[/ — Condition f // eg
(Single, Married, Widowed or
Divorced.)
Age, 3 *4 Years . / Months 1 Days. Occupation .
r - ’
Residence, / 6
Place of Death, ~ ‘1 Cd *7. * ^ ^ 7
Place of Birth, iN t <--■<? l / nA Date of Birth,
c../' 1 c 7 f ^
P ' - N-,S ' *
Name and Birthplace )
of Father, 1
Maiden Name and )
Birthplace of Mother, )
Place of Interment ,
Undertaker.
MEDICAL EXAMINER’S CERTIFICATE OF THE CAUSE OF DEATH
so
90S .
Boston,
I hereby certify that I viewed the body of
Name, C Age, 3 S years,
who died on th%_J 2.VtU day of 190
and to the best of my knowledge and belief, the cause Of death was
as follows:
Autopsy 'irSsi0> ‘J . „ u „
j Chief cause,
Disease,
Contribu ting cause,
V
1
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of Death,
Name in fall, . A (ffh t/jxjhr
(If married or divorced woman give maiden name, also name of husband.)
Sex, IdAcJUj. Color, tthLff.. Condition,.
(White, Black, Mixed, Chinese,
Indian, etc.)
Age,. 1a Years, (j Months, Days. Occupation,
SftUNZ.X'
(Single, Married, Widowed or
Divorced.)
Residence, * 'ti. fy/Ccx 1 Ward,
Place of Death, hAJ
/ / (State year, month and day.)
Place of Birth, UJ.Ia8.<UjuI^ ». Pate of Birth, (viA J. /Aff'A
Name and Birthplace J
Maiden Name and {_ \j NLcL/1 AtHC.. '
Birthplace of Mother, ) * / . J "f / i/l *
Place of Interment
&...
Undertaker.
PH YSICI AINLLS CERTIFICATE OF THE CAUSE OF DEATH.
Name and Age )
of Deceased, >
Boston,.... hrf~\ 2). .0 190 ..) ....
aJ !''*4U CuvK u ••
QJ
Age, ^ PC' A years.
A> 190^ , to asAA\ Or "j
I hereby certify that I /attended deceased from
190 f that I last saw alive on the IrA. 7 day of.. ijy^rrj 1&0 J,
that..
....died on the
&
day of
. 19 Oj , ab oiof^s) L /.. Q. Vpclock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death
was as follows : Li a l~ .
Disease
( Chief cause, .
“1
Contributing cause,
f Chief Cause, . ^^A
Duration
| Contributing cause,
M.D.
•If an institution, state how long an Inmate and previous residence.
[3-’06 37-LM.]
Permit No.
RETURN OF DEATH.
Sex, . ...Color,
.Condition
(White, Black, Mixed, Chinese,
Indian, etc.)
ition, *
(Single, Married, Widowed or
Divorced.)
Age,. (5/ Years, Mr. Months, . / \ Days. Occupation,
Residence,* cvaJJUm- Offc?
Place of Death, di~p
Place of Birth,. ^/lASL Date of Birth, . /f't.QsL . gf. "/.fT<$~.4»
(State year, month and day.)
Name and Birthplace
of Father,
Maiden Name and
Birthplace of Mother
Place of Interment,
l ^nIcxsqa-
A / . . * / x - - ^
'£/ MddAfM:. . Qj.'£ind. oLf.
Undertaker
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, .Xr~l.
*1
N am g and Age )
of Deceased, )
I hereby certify that I attended deceased from Chi g .190 , to
JNrO alive on the 2dt.
ft 190
...Age, N../.. years.
190 ffhat I last saw
that Of?. died on the
H'
....alive on the f day of.^j^fn. 190 J,
'j!rr..ty. day of 190 J, about o’clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death
was as follows:
j Chief cause,
| Contributing cause, .... L/
Disease
COMMONWEALTH OF MASSACHUSETTS
RETURN OF.
( CITY OB TOWN.)
FULL NAME
Place of
Death *
Registered No
Date of l
Death l
years.
>■.^..190 7"
months.: days
STATISTICAL DETAILS
COLOR
07.
SINGLE, IHAflWEt),
_CLlY©«0£Tr'
MAIDEN NAMEt ' — — ^
HUSBAND’S NAMEt
BIRTHPLACE!
NAME OF
FATHER II
/P
BIRTHPL/^OE^
OF FATHER!
N
MAIDEN NAME
OF MOTHER >
BIRTHPLACE
OF MOTHER!
OCCUPATION
INFORMANT §
PLA^E OF BURIAL OR REMOVAJ.
UNDERTAKER A
Ty.
DATE? OF /BURIAL
PHYSICIAN’S CEBTIEICATE
I HEREBYx CERTIFY that I attended deceased during last
illness, from 190 .^..to./..^^'7?^...Jk.‘7. 190..
that to the best of my knowledge and bejjef dearth occurred or
date stated above, and that the CAU^E OF DEATH was as follows:
)0j,
otrThe
Primary:
Contributory :
. ( D U RAT I on). .^^TTT.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
ALL NAMES TO BE BN FULL
FULL NAM£
Place of ) “\kT ' ‘ * * * §
Death * \ vNj
Residence ..
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
Registered No.
Age
.0..
Date of
Death i
.years.
STATISTICAL DETAILS
SEX
COLOR ,
<^tALVaJL L- I
tilNOLL~ WIMHIIIllD,
WIDOWED,
-DIVBrtCfcP.
MAIDEN NAMEt
HUSBAND’S NAMEt'^K ' ^ A "V 7" t\ 0
BIRTHPLACE*
NAME OFr'-'N. ( \ A
^4rvrV
BIRTHPLACE ^ C 0
OF FATHER t \ K^.. (\
MAIDEN NAME
OF MOTHER
^ G ]/Cr-^rA^ *2^
BIRTHPLACE
OF MOTHER t
-V
OCCUPATION
INFORMANT §
' c// ,
DATE OF BURIAL-*.
TT *
190..
UNDERTA
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attendee^ deceased during last
/k>iO (N-CJA
< iv +
illness, from J<7 190/?.. .to
.190^
that to thqfjafest $/my knowledge and ‘frelief'^cleath occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary: O^i^MaoJL
"Ml* -
Contributory :
. CdURATIOn) DAY8
(Signed) L/' . r* *.<?M . D.
u . 190 y?. (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 7
Filed
.190.
Clerk
* City or>town, street and number, if any. If death occurs away from USUAL RESI-
DWJCE, 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,
II Name of cemetery,
h
, ,C)° 7 '
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME, Registered No.
*£$ } r.r \J^. a/
Residence ft fX .Vv..Age 25S
>
STATISTICAL DETAILS
SEX
%o4l.
COLOR
lit
SINGLE, MARRIED,
WIDOWED, OR X
DIVORCED
MAIDEN NAMEl
HUSBAND’S NAME t
Bl RTH PLACE !
NAME OF
FATHER
BIRTHPLACE
OF FATHER!
OQ^-C.
MAIDEN NAME
OF MOTHER , J n
' IcCCl'l
BIRTHPLACE
OF MOTHER!
OCCUPATION
INFORMANT §
/.
PLACE OF BURIAL OR REMOVAL [
Jk
UNDERTAKER
DATE OF BURIAL
&L
190 .
ADDRESS
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 to V^f®£V.1S.I....I90 71.,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
(duration) DAYS
Contributory :
..(DURATION) DAY8 t
(Signed) .
3.... ..190.71. (Address) *«*— *^"*- Q*-
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,]
or Recent Residents.
How long at
Place of Death? years months days s
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.
II Name of cemetery.
£ A. -
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
OF A DEATH
(CITY tin TOWN.)
Registered No. 7
RETURN
FULL NAME
1 ^ ™ \ ^ - ^ ^
Age /A years ZZ7../..m0r
Residence
.months days
STATISTIC AY YET AITS
SEX
jJL
COLOR
SINGLE. MARRIED,
WIDOWED, OR
DIVORCED
<3
MAIDEN NAMEt
HUSBAND'S NAME t
BIRTHPLACE!
NAME OF
FATHER
hA
w.o
OA
BIRTHPLACE
OF FATHER!
'^OJyPtl.aA'Piy yilTtdy)
MAIDEN NAME
OF MOTHER
tiUtyrv rf’o
&2i£i-Ga/>is
BIRTHPLACE
OF MOTHER!
■7)/J,any
7
OCCUPATION
INFORMANT!
= LACE OF BURIAL OR- REMOVAL II £
txM_ Zc/7jyi $ oy
foaluatof 6^./ra/^L
AKE^r
UNDERTAKER
<-L
DATE OF BURIAL
190..
ADDRESS
PHYSICIAN’S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last
illness, from 190 \q.. 190^
/<M?
lief death
that to the best of my knowledge and belief d#ath occurred on the
date stated above, and that the CAUSE OF DEATH was as follows
Primary:
h.
.(duration) DAYS
Contributory:
. (duration) DAY8
Or
' WrD.
C&y#.. ..£. 19 0/^..(Ad dress)..
(Signed).. . . Tfaftyk. A . Tkzyt. Sx2.
U-.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
if not at place of death?
Filed S
i9^.
^^2^,^/fclerlc
* 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.
II Name of cemetery.
1
7<Y
■v
,\A
=
V
{4-’07-37-LRl.]
Permit No.
RETURN OF DEATH.
TDN, MASS.
* ~ 8 Nl.
Bate of Death, • >3r
Name in fall,
.190 J .
(If married or divorced woman give maiden name, also name of husband.)
Ccm.d.itinn. ^ (
(Single, Married, Widowed or
Divorced.)
Sex, Color, ^ Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, ?(p Years, Months, Bays. Occupation, /‘^AlA+TSSt: r&A.
Residence ,* 2 L 5~ Ward^A^th*^
Place of Death, 2 S' C*n^£
(State year, month and day.)
Place of Birth, Bate of Birth, / S /
Name and Birthplace j
of Father,
Maiden Name and
Birthplace of Mother
Place of Interment,
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
190j, that I last saw alive on the /./. day of..
* o^ Deceased^6 1 Age, Jr& yea/s.
I hereby certify that I attended deceased from .../^ftP^S.A 190^7 , to Ahf . A
looy!
Ail ...died on the day of 19 0*y, about o’clock
kP.M., and that, to the best of my knowledge and belief, the cause of. death
was as follows : . 7
{Chief cause, ASuI A
Disease !
( Contributing cause,
that
f Chief Cause,
Duration ,
I Contributing cause,
M.D.
• If an Institution, state how long an inmate and previous residence.
WITH INK. — THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
{CITY OR TpWN.)
FULL NAME Registered No.
PDe»th* 1 /6 °Deathf i !■/■■■ 190 ^
Residence .T Age years months days
Jk
-I
3
Ik
LJ
fi)
O
H
(0
UJ
2
<
z
-I
-j
<
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
Bl RTH PLACE +
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
CZi
illness, from..4rr 4^. I90^/.to .Cc.^^~*r . . 190
that to the best of my knowledge and belief dearth occurred on the
date stated aboye, and that the CAUSE OF C(|?ATH was as follows :
Primary :
M (duration) DAY 8
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
br/Recent Residents.
OCCUPATION
ow long at
Place of Death? years .
months
days
Where was disease contracted,
If not at place of death?
INFORMANT §
Filed
..190.
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
% fit* C. 0 A A ij A. QuA&A yb:
----- - (-\S ADDRESS f
UNDERTAKER
I'TKjtlPfc // A? €Tcj3_£ 1 Ctl
•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.
J| Name of cemetery.
COMMONWEALTH OF MASSACHUSETT
Mom
{CITY OR iro WN.)
RETURN OF A DEATH
FULL NAME . MfcL
i ... in • °Da::,r \ ...<&** r •,
An Aw,. &A as. 0
Registered No.
Residence
Age
years .
.months..
. .days
STATISTICAL RETAILS
SEX
COLOR
MJLbu
SINGLE, NMrfrrrTEXlf'
WIDQViL£J>i-eft-
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE?
NAME OF
FATHER
"0 Mvhrvy
BIRTHPLACE
OF FATHER?
MAIDEN NAME
OF MOT
t'ULr .'. . Un
M
BIRTHPLACE
OF MOTHER?
OCCUPATION
INFORMANT §
AAjA Si
(^Ajda/LuAX (VvlK^v^
PLACE OF BURIAL OR REMOVAL II
' uaaA-
UNDERTAKER ADDRE51
ERTAKER ,
DATE OF BURIAL
a
190
a...
w y ,
nrwAo^
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended^deceased $luring last
illness, from I90^...to....^r?<vr1...>5 190 'J ,
that to the best of my knowledge and belief deatw occurred on the
date stated above, and Jhat the CAUSE OF DEATH w# as follows:
2
Primary:
Contributory :
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 7
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,
ADDRESS . t State or country | also city, town or county, If known.
(^0 I 0 t § Name and address of person giving statistical details.
Name of cemetery.
[3-’06 37-LM.]
Permit JVo.
Age,. O k?.. Years,
ru;
Residetice,* ^ f 1/
Place of Death, <
Place of Birth, /
Name and Birthplace )
of Father,
Maiden Name and ^
Birthplace of Mother, )
Place of Interment,
Months, Days. Occupation,
7 ■' ( -uL J-* Ward
trnZ
MM Date of Birth,
— llwTYi
(State year, month and day.)
UAMldAAAy.(M^/..
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
f
Boston, 190
Age, years .
Name and Age )
of Deceased, f •
I hereby certify that I attended deceased from
Mr &
190^ , that I last saw 'tArSl alive on the ^ /:i
that.
[MfA. died onthe 'S. day of - 19 0^, about /& 33. o’ clock
A.M., or P.M., and that, to the best of my knowledge and, belief, the cause of death
was as follows :
Disease
j
Duration
Chief cause,
j Contributing cause,
Chief Cause, (p
Contributing cause,
J
•If an Institution, state how long an Inmate and previous residence.
M.D.
■adii^pw-i
V i
'J ,51 !
...
CL
h '
*■— 'i**y -*. -— * t . . rri —
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME J as “Jy.. 2? ItLtZZ J Registered No.
i DDa::«r s <**? .. .m ,90 >.
Age X- year. 6.. months ..days
Residence
STATISTICAL RETAILS
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE!
NAME OF
FATHER
BIRTHPLACE
OF FATHER!
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER!
OCCUPATION
IN FORM ANT §
PLACE OF BURJAL OR REMOVAL II
''X'f
/^L/-
UNDERTAKER
X J3
DATE OF BURIAL
190.^.
ADDRESS
li / 1
/V'/'T />
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 to 190 ,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary: .
(duration) , DAYS
Contributory:
(duration) DAYS
(Signed) M.D.
190 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months. days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
* City or town, street and number, if any, If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country | also city, town or county, if known.
§ Name and address of person giving statistical details.
II Name of cemetery.
—
[3-’06 37-LM.]
Permit JVo.
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Bays. Occupation,
Age, ears, (o Months,
Residence,* .O
Ward,
, „ X ( /—. 7
Place of Death,
i ji^tatife year, mouth and day.)
Place of Birth, . Bate of Birthrp^CjfjAJ O^yf'/Af <f) y
Xante and Birthplace ) •
of Father, 1
Maiden Xante and
Birthplace of Mother,
Place of Interment,...
' (JA/tAAfLAxt...
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
j ..
Boston-, £. , / X 190.X-.
/, //. 1 . /
J ' ,/cv.
J hereby certify that I attended deceased from T'. ^.ff.i../ j 90 f' , to. ....
190 J, that I last saw alive on the day of { ^ y 190^),
that ...died on the day of 190 7, about. / J. .. o’clock
* /
A.M., Tn f*rM?, and that, to the best of my knowledge and belief, the cause of death
was as follows :
Disease
( Chief cause
yo J
Contributing cause,
f Chief Cause,
Duration
( Contributing cause,
, Af/ i .-Ah- -i ± n m. d.
•If an Institution, Btate how long an Inmate and previous residence.
\
... Y* • *>A
A
j -1
/
■ V
NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
FULL NAME <
Place of ) _ - f
Death* S •
RETURN OF A DEATH
U*l£:>
R -EWRE.
(.CITY QIC TOWN*.)
Residence . ■h % n *v
•Age.
XI
Date of (
Death S
..years
Registered No.
/(
months..^..
.190 f
days
STATISTICAL DETAILS
SEX
COLOR
hi. Iia
SIWTMTE, M^RRlCtl,
WIDOWED, oa~
DmtlRCEX)
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACEt
cU_.
NAME OF
FATHER
'f
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHERt
OCCUPATION y
A AjiAAA^ tri [ /?) KxU/
FORMANT §
IN
PLACE OF BURIAL OR REMOVAL II
UNDERTAKER
'tfeoLhci JryuLA P //T
DATE OF BURIAL
190..
ADDRES
sv
TIIYSICIA F’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
that to the best q j my knowledge and belief d^Eth occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary :
fix
(duration) DAYS
Contributory
^ (DURATION) 0AY8
(Signed).
M.D.
77!
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If in a Hospital or
Institution, give its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t State or country! also city, town or county, If known.
iHajne and address of person giving statistical details.
" Name of cemetery.
[3’06-37-LM.J
Permit JVo.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
ate of Death,
, L <o Nl?0 /
(If married or divorced woman give maiden name, also name of husband.)
Sex'fjffi.Q^rA' Color, Condition, fl
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, ./...X... Years, /. P Months, 0 .Days. Occupation, .
Residence, * ..X *■ ' ^(A.N 1 A t"'hSyCJ 4 Ward,
Place of Death, - v a ’ 1
s' \ . jj j J/J / (State year, moutli and day.)
Place of Birth, aJIAPl. Date of Birth,
Name and Birthplace ) fjgt IWCkaAsfUA fit
of Father,
Maiden Name and ^ £
Birthplace of Mother, )
Place of Interment, ..yf...dNNJIrgNL
EWIS JONES & SON,
UNDERTAKERS,
10 La Grange 9t_ Boston.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
f
U ndertaher.W
Boston, 190
Name and Age )
of Deceased, f ASe’ Vears-
I hereby certify that I attended deceased from 190 , to
190 , that I last saw alive on the day of 190 ,
that died on the day of 190 , about o’clock,
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death
was as follows:
( Chief cause,
Disease
| Contributing
cause,
f Chief Cause,
Duration
Contributing cause,
M.D.
* If an Institution, state how long an Inmate and previous residence.
I
\
fV
•
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
EATH
- RETURN OF A
FULL
Tea8,;'
Residence
Death
.years.
Registered No
Date of j
STATISTICAL DETAILS
PLACE OF BURIAL OR REMOVAL I]
UNDERTAKER
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from . 190/!. ..to 190 y?,
that to the best of /ny knowledge and belief d^ath occurred on the
date stated abowfand that the CAUSE OF/DfEATH was as follows:
Primary: .. ... . C&C? ^
Contributory: ..C^Lt^^rr-.o
(Signed)
.190^. .(Address)
, / SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
o£/Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
If not at place of death?
Filed
190
Clerk
190.71
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,
t State or country | also city, town or county, If known.
S Name and address of person giving statistical details.
Name of cemetery.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
l/iJ
(CITY OR TO H'-V.)
FULL NAME Registered No
pbAV* i // JIloUU U.j LO ! Ci^f
Residence .Cc?..^ . . Age years months.
u
.190
1
months days
STATISTICAL DETAILS
SEX
TK
COLOR
tU
SINGLE, MVYftFtrE’D,
WIDOWED, OR
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE!
(g V Anrvr*/
NAME OF
FATHER
Scks^aaajJ |
ITH PLACE W
BIRTHPLACE
OF FATHER
Ulaa^JIaaS^
OCCUPATION
INFORMANT §
biAX
PLACE OF BURIAL OR REMOVALB
UNDERTAKER
ADDRESS*
(p<U+sA
DATE OF BURIAL
Zl
ttUA
addre/sb
190 .1
RlIYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, \90^..to.(A^s^r...^.A.t.....\90^..T
that to the bestj^f my knowledge and belief ^ath occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
— f ■ ■ i r ■ N
(duration) 7~, DAYS
Contributory
..(duration) DAYS
(Signed)
^<rtrr^f....^r./,-...l90^KAddress) SJ
M.D.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
If not at place of death? ”
Filed
.190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, glvo Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or countryi also city, town or county, If known.
§ Name and address of person giving statistical details.
I Name of cemetery.
£1
[4-’07-37-1jM.]
Opt
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Breath
Name in full,
/N
(If married or divorced woman give maiden name, also name of husband.)
Color, Condi tion^Y f^^^..^
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, y //"Years, C/ Months, Days. Occupation,
Residence,* V A/AfldA
Place of Death,
Place of Birth,
(Single, Married, Widowed or
Divorced.)
oaAm/j?
/AtA n£ Date of Birth,
(State year, month and day.)
Name and Birthplace )
of Father,
Maiden Name and )
Birthplace of Mother, )
Place of Interjnent,
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH
Name and
of Deceased
AS
190
years.
O Boston
T 1 ££*4 £ Age, . ,.-:V
l hereby certify that I attended deceased from .<^rN^r<AL.. 190 £ , to.
A CV s fA
190 ' that I last saw alive on the fZ £..day of 190p>,
thatrNF^-N-. died on the £.*L day of 19 Op, about o’clock
2- Z_
A.M., or-frM'., and that, to the best of my knowledge and belief, the cause of
was as follows : ^9
( Chief cause, ^ ^
Disease
death
I
Contributing cause,
f Chief Cause,
Duration ,
( Contributing cause,
■c^N)
M.D.
1 If an Institution, state how long an inmate and previous residence.
■ftJgjsgSsk. 1
J
^ '
u
u
'v
I ■
(If married or divorced woman give maiden name, also name of husband.)
Sex, &~C vYLaJU^ Color,
.Condition,
cf"
Ige, V1 Years, / O Months, Days. Occupation,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Ward,./.:
(State year, month aud day.)
Residence, ^ f ^
Place of Death,. 32/ / / ^ ^
Place of Birth, ^ Bate of Birth,
t sdT r7 i
Undertaker.
Name and Birthplace ) C3&
of Father, I
Maiden Name and [
Birthplace of Mother, )
Place of Interment,.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Name and
of Deceased
J ^ &&&** 5 190 J .
,jfC | Age, ,r
years.
I hereby certify that I attended deceased from 190£ , to 13
19(T), that I last saw alive on the ?rr..^ day of... j i9oy
that died on the Okr. ..r3. day of 3. pNPl. 190 about. o’clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. /PS. death
was as follows: f\ j t
Disease
1
Chief cause,
Duration
| Contributing cause,
j Chief Cause,
Contributing cause,
•If an Institution, state how long an Inmate and previous residence.
M. D.
. \
* .
V
Coo
" , ^ •*'
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
DEATH .
Place
Death
RETURN OF A
Reg istered N o
y' rrs
• Age ..years. ...^
''TYS.
( CITY OR TOWN.
days
STATISTICAL DETAILS
SEX
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t - "
/'
HUSBAND’S NAMEt ^
♦
BIRTH PLACE t ^ .
NAME OF y/ /.
FATHER ^7/
BIRTHPLACE " S
0F#TH%- ' d .
*y, s
MAIDEN/NAME Sf
OF MOTHER y/y
BIRTHPLACE jSy/*
OF MOTHERt / /
OCCU PATTON
informant!
PLACE/OF BURIAL OR REMOVAL II
UNDERTAKER
ADDI^SS
PHYSICIAN’S CER TIFICA TE
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 (o.to . . .CLl*wC3. *2. 3. J 9 0 . 'r?
that to the best of my knowledge and belief death-occurred on the
date stated above, and that the CAUSE OF DEA'
Primary
ted above, and that the CAUSE OF DEATH was as follows:
: . . . "7 ^ ^ t-'vo y.
.(duration) DAY
Contributory:
(Signed).
^...l90..^(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 A.
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 womao, or widow,
t State or country; also city, town or county. If known. *
^Name and address of person giving statistical details.
'lame of cemetery.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
Chelsea.
(CITY OR TOWN.)
FULL NAME
Place of
Death *
.Registered No.
RETURN OF A DEATH
[v....QX1j^v...Aj.,
} °Deathf 1 190 j
Residence Age >?..!.
..years..
..months days
STATISTICAL DETAILS
SEX
J20
N NAME'
COLOR
1 0'
OIHOLE, MARRIED,
IDOWCD, OR ■
Divoneeg
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTH PLACE +
TTv^l
NAME OF
FATHER
birthplace!
OF FATHER^
rTY\
t
~TTV.J
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER t
XjCtt ^
OCCUPATION
TT1
INFORMANT §
jCTTfVft—
o') . <rV. ”\_\3 £rtr
PLACE OF BURIAL OR REMOVAL li
Quj, IrvxJVrY^ HfYLjB
UNDERTAKER
^ . >f). tK.* ^ a,ry\jri t
DATE OF BURIAL
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during las
illness, from ..k^Ja-^.SLQ..... 190^ | . to V . X-A . . Cl . “SU^. rr. 1 90r
that to the best of myKnowledge and belief death occurred on th
date stated above, and that the CAUSE OF DEATH was as follows
Primary : .. \ ...CV V..£..>.....VTl.To..\
(durat ion) Sj... ..DAYS
Contributory : . .CL^p ,,.. . . cA.s JL_x_j£. v,.A0..
(duration) )rf DAYS
(Signed) . . T.\. £l£TT)C\
M.D
QjjL^..^.7.l90...jf..(Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients
or Recent Residents.
How long at
Place of Death? years..
.months.
.0 days
Where was disease contracted,
If not at place of death?
Filed
Cle.x
* City or town, street and number, if any, If death occurs away from USUAL RESL
DENCE, give facts called for under “Special Information.” If in a Hospital
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.
II Name of cemetery.
A
*f, /?°7
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of | //
Death * > y ~
Residence ...T?
Z
<t -J
5 £
t
L E
4 Ui
C2
0
“ O
n H
C <0
- UJ
I 2
* <
-I
E ^
- <
_
STATISTICAL DETAILS
SINGLE
WLGOiAL6'E>7-f>
r»c n *
6U4eiTCf
HUSBAND’S NAME t
birthplace!
M3
OCCUPATION
INFORMANT §
oik/
/Mtriv
DATE OF BURIAL
190..
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY^ that I attended depe^sed^uring last
illness, from 190^.. ..to . 19(0..,
that to the best of my knowledge and belief death occurred onThe
date stated above„and that the/CAUSE OF DEATH was as follows :
Primary
ted above-and that the^AUSE OF DEATH was as
Q-v-\ ctic
: * ::o
l3j/K
.(duration)
Contributory :
(Signed).
duration) DAYS
" T
1 190../. (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 "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,
^|| Name of cemetery.
ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX I COLOR
JvL'Ci/jl \
SINGLE, MARRIED, #
WIDOWED, OR ’
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACE*
Id
FATHE" 72^ .
BIRTHPLACE — 7
OF FATHER* /
'iAlDEN NAME S)
^”0THER ^w?d.
PHYSICIAN’S CElt TIFICA TE
I HEREBY CERTIFY that I attended deceased during last
eased du
E..U1
?
illness, from 190^... to. 190 .
that to the best of my knowledge and belief d'eath occurred on the
date stated aboy£, smd that the CAUSE OF DEATH was as follows
Primary:
■' 7‘
.(duration) J. ..DAYS
Contributory:
{Signed.
■' ..190.7... (Address) i.
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
ADDRESS / /
|?o ’}syL£AA-CA-jOi*r v"
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 0
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.
II Name of cemetery.
V
■?,/,/ C, >f‘]
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN DEATH (CITY OB. TOWN.)
FULL NAME . . Registered No /C...!?...t!?..
r,;' i -jzx !
190 "7
..years..
/5l
months t....7T. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR^~, r
DIVORCED ‘A&tecSl
MAIDEN NAMEt
HUSBAND’S NAME t
^3
BIRTHPLACEt
NAME OF
FATHER
^ca> . 7<T
BIRTHPLACE
OF FATHER +
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER t
OCCUPATION '\//f
INFORMANT?
//'
PLACE OF BURIAL
. — ,
c—
OR REMOVAL II
o — » >
DATE OF BURIAL
UNDERTAKER
ADDRESS
PHYSICIAN’S CEBTIFICATE
I HEREBY CERTIFY that I attended deceased ^luring last
illness, from I90..T,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
(duration)., !^L.. DAYS
Contributory: .....S^&fc 3^*5 _
J. (duration) io DAY8
(Signed)..... M.D.
..& 190..!). (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death?
Where was disease contracted
if not at place of death?
.months days
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.
II Name of cemetery.
/
y
. .• -7 «. v,
JLu /- /?°i
*#
v k
♦ « .«
[3.’06 37-LM.]
Of
Name in full,
Permit No.
RETURN OF DEATH.
(If married ^pr-divorced woman give maiden name, also name of husband.)
Sex, .
Age, .71. Years,
Color, AsNlltDAL Condition, ^ j&fj
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) ^Divorced.)
Months, Days. Occupation, / '\ iiNl.'i As
Residence,'
Place of Death, £7 £L S* ■
Place of Birth,
Name and Birthplace
of Father, 3 s
Maiden Name and l ,. pn)
Birthplace of Mother, ) — ^ ‘
Place of Interment,...
&L..
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
O Boston
Name and Age )
of Deceased, )
/ hereby certify that I attended deceased from
190 f that I last saw UYPNNP. alive on the
, Y 190/7.
Age, . years.
( /
y/7 day of 190^ ,
that.
IUL, ..died on the Sz. day of K/f 190 about /f . o’clock
A.M., rrr-BrM'., and that, to the best of my knowledge and belief, the cause of JsLr>r4A1..... death
was as follows :
Disease
Duration
T Chief cause,.
)
( Contributing cause,
j Chief Cause,
£
7Y
Contributing cause,
*Q
, ^ liNC u l ^
M. D.
C
21
♦If an institution, state how long an Inmate and previous residence.
- ■
'
i
"
[3-’06 37-LM.J
Permit JVo.
RETURN OF DEATH.
^ BUHT-^N, MASS.
Name in full,
Date of Deat]Cr^ "./ty 6 /
(If married or divorced woman give maiden name, also name of husband.)
Sex, Color, ... Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married/>v idowcd or
Divoyfeed.)
Age, Years, (SlL Months, Days. Occupation,
Residence, * ^ ^ 2 . Ward,
Place of Death, t < tl't I ht.D.oW
(St. .
Place of Birth, /I'ijiltjW . Date of Birth,.. <*L/..'J
Name and Birthplace ) ..C^r
(State year, mouth and day.)
of Father, )
Maiden Name and )y
Birthplace of Mother, )
Place of Interment,
y)LawAcm^^
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Busteh, 190/'..
Age,.. IC years.
. , f) r\ / y
Name and Age
of Deceased, ^ ^ ^
I hereby certify that I attended deceased from ^ -^.Wf7... ..//. 190/? , to &//-, ///A—
190 J, that I last saw .. .. alive on the //it:
..day of.. i9o y,
that..t^/fsJls _.. died on the //it. day of 190*7, about 5^ o’clock
death
ArM., P.M., and that, to the best of my knowledge and belief, the cause of.
was as follows :
^ Chief cause,
Disease
Duration
| Contributing cause,
j Chief Cause,
| Contributing
cause,
... M. D.
b2l
*If an institution, state how long nn inmate and previous residence.
/
[3-’06 37-LM.]
Permit JYo.
RETURN OF DEATH.
MASS.
^ate ofpDeath,
Name in fall, @$2 / .
/N'/?c y
Sex
(If married or divorced woman give maiden name, also name of husband.)
, '/ 14 a. Jjl .. .Color, . Oflu'N
(White, Black, Mixed, Chinese,
Indian, etc.)
.Condition,
(Single, Married, Widowed or
Divorced.)
Age,Kj<z*f. Years, CJ Months, ..A,. Days. Occupation, 1^,2 i^yLCUi^..
Residence, * o ^ A J Ward, .
Place of Death, Cly^^lNR.A>. ^ /A^/NjP.AJ
(St
Place of Birth,. ... C Date of Birth,... CX^a iM-'lXL'/. /Sfb 5^
Name and Birthplace
of Father, )
(State year, month and day.)
Maiden Name and )
J
Birthplace of Mother
Place of Interment,
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
CDlDNNWf™ Bm&m, .WSl 12 1902 ....
*7°N1T\ TWX K U ASeW^years.
I hereby certify that I attended deceased from..! ft X X?.. 190 , to /5
190 2> that I last saw r^V-vrr*^. alipe on/the / \> day of. 190
atijpe
(J r.
v.
. death
that Ty^rr. died on the 15 day of .190 ) , about .2 ^ ~ o’clock
U JL»
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of.
was as follows: Nf —l _
( Chief cause, (j...
Disease !
( Contributing cause,
Duration
j Chief Cause,
Contributing cause,
M. D.
~X.r-. iV
♦If an institution, state how long an inmate and previous residence.
[4-’07-37-IjM.]
Permit No.
RETURN OF DEATH.
r
OH.
ROTvTTHsl, MASS.
Name in full,
f Date^f Death,
i?cicL <Q?....nx£N)-'
(If married or divorced woman give maiden name, also name of husband.)
Sex, ki
Color,
Condition,
Age, ..(CfNCTears, \w Months, SiNDays. Occupation,
Residence,* ^ C < & :/<a> t j/ A Ward,
Place of Death, M
/ f (State year, raoniu anu uay.)
Place of Birth, C^.x.C Date of Birth, £>y
Name and Birthplace I p/4 ■
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Itr, month and day.)
Maiden Name and l
Birthplace of Mother,
Place of Interment, A
CNN,
'?CKaNz
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
iN^/lr csifffiiyL&A />£e3^rr^ nL 190? .....
Name and Age ) n\ ' CC
of Deceased, )
AgeNti. NZCCN
I hereby certify that I attended deceased from / f* 1 90? , to
190^, that I last saw alive on the / JZ day of..£e^^rr.- 190? ,
190?? about o’clock
that I last saw
that. .died on the ?— / day of
A.jf^ i»u P.M., and that, to the best of my knowledge and, belief, the cause of
was as follows : — . ^ _
CNNuk
eath.
j Chief cause
Contributing cause
Duration
I
Chief Cause,
I Contributing caus
/^P,
M.D.
< if an Institution, state how long an Inmate and previous residence.
cdg=g&*-i
[3’06-37-LM.]
Permit No.
ETURN OF DEATH*
BOSTON; MASS.
Name in full,
Sex,
Date of Death.,
ttL 9.7
" J
(If married or divorced woman give maiden name, also name of husband.)
Color, , Condition,.
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, J? Jf Years, / Months, Days. Occupation,
Residence,* Ward,
Place of Death,.
(State year, mouth and day.)
Place of Bi rth, . Date of Birth, *f t f
Name and Birthplace |
" ^ ' "
vCjZf
of Father,
Maiden Name and
* Birthplace of Mother,
Place of Interment,..
.CUA
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
.Jiff... XA 190 X-
Name and Age } f/ * /fy / — ■ • ft-
of Deceased, ... Age,. Jo. ° years.
././. 72(9^, to . Jf/f fl (o
I hereby certify that I attended deceased from.
19of , that I last saw. /I...
alive on the x*r... day of 19 Of,
. died on the
that died on the ■< f> day of JCUfJ 19 Of, about f'Jygo' clock
A.M., or -B.M., and that, to the best of my knowledge and belief, the cause of. — - death'
was as follows :
( Chief cause,
o n J
Disease
Duration
| Contributing cause,
j Chief Cause,
Jz^mxL C3?t
I Contributing cause,
k.
... M.D.
• If an Institution, state how long an Inmate and previous residence.
c
21
COMMONWEALTH OF MASSACHUSETTS
STATISTICAL DETAILS
\
PHYSICIAN’S CERTIFICATE i|
Jj ! Q/f/' WIDOWED,-^
1 HEREBY CERTIFY that 1 attended deceased during last
illness, from l90^T..to ..^^0^7. ■*/ , 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:
MAIDEN NAMEt
HUSBAND'S NAMEt fa .
BIRTHPLACE + /7 In /
Contributory:
Tv*^£r^G-r1 (duration) *.’... .77” days
(Signed) M.D
NAVE OF /O X
FATHER
BIRTHPLACE v") /
°F FATHERt
MAIDEN NAME /
I OF MOTHER JK, /-
^ •.... 1 9 0 7' (irfdress )...
BIRTHPLACE /O /
oFMOTHERt
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years month? days
Where was disease contracted,
If not at place of death?
OCCUPATION
INFORMANTS
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL# j DATE OF BURIAL
tyfcirttPcMJfT* & L\H 1* 190 7..
•City or town, street and number, If any. If death occurs away from USUAL RESU
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 II Name of cemetery,
UNDERTAKER ~| ADDRESS
'XL)' X^J /t^CA/ *y
604^+-/ 7°
l-t ’07 37-I>M. |
; >
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Pate of Death, .... 1
Name in full, ' . ’N/Se. <• • sTfl.
.f&. trf /&&-&■ //■/&.
Sex, . 'w ^N.C. Color
(If married or divorced woman give nra ame of husband.)
(White, Black, Mixed, Chinese,
ludian, etc.)
Age,. .2- J .. Years, Months, ,>SC Days. Occupation,
Resideyice,*
Place of Death,..!
Place of Birth, uAL Date of Birth, p N &nL
(State year, month and day.)
Name and Birthplace
of Father,
Maiden Name and
| '.
J-
Birthplace of Mother,
Place of Interment,.. ItlAN
5^0
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE C^U$E OF DEATH.
Boston ,
■ f- - ’ '
Name and Age ) J - , ' ^ / ,
of Deceased, I ■ , Age,. ...AN. years y
I hereby certify that I extended deceased from .//fAfDWM 7, to 'P' ^ '
n // 0 A a
/
/
190/ , that I last saw
ojUys-
that
U
qdive on the S/. .... flay of
OJL. died on the
t
190
about .Pf NU... o’ clock
.S. * day of 190f7,
best of my knowledge and belief, the cause
or P.M., and that, to the best of my knowledge and belief, the cause of.. death
was as follows :
j Chief cause,
Disease
Contributing cause,
f Chief Cause,
Duration /”
I Contributing cause, I? PPN..PPPP. .7?. g. .......
. / / r //
;. M. D.
•If an Institution, state how long an inmate and previous residence.
V
v y
.
l4.’07-37-LM.]
[ ’
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
ft Date of Death, . *^....f. 190.
>
ji Q a %/bo..
/> (If married or divorced woman give maiden name, also name of husband.)
, Color, ... ";.... .Condition,
B"o
Name in full
Sex
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Ward,
(State year, month and day.)
Age, O N Years, x — ^Months, Days. Occupation,
Residence,*
Place of Death, ^ W lABAZfyft ftftftt-giAlAg.
Place of Birth, ory<- ^ftftftL .... Pate of Birth,
and l . C/ftf. cMfttftZftc
other, ) ft\ 1 I f J,
Name and Birthplace
of Father,
Maiden Name
Birthplace of Mother
Place of Interment,
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF. DEATH.
of
Boston
*am»::LT } ‘Wa/i f.A ' Age.Sk
I hereby certify that I at^fnded deceased from i^.y.£.. ...19oft ,
190 that I last saw r.l.f.r.. alive on the ft ...:■,. day of
loo y.
year %
ft,
190 ft
that.. egg. :\lIrN.. died on the ft Nft day of L. WL 190 ft, about ft o’clock
A.M., or~-RzM2, and that, to the best of my knowledge and belief, the cause of death
was as follows :
| Chief cause,.
Disease \ //
Contributing cause,
f Chief Cause,
Duration J
\
, £
Contributing cause,
-ft g* ; ft v yiyifti...,
'If an Institution, Btate how long an Inmate and previous residence. //
M.D.
COMMONWEALTH* OF MASSACHUSETTS
REVERE.
FULL NAME
Place of )
Death * 5
RETURN A DEATH
iaA
( CITY OR TOWN.)
.Registered No.
/7~
I,
r,: i t ,90 /
OiyyZ
Residence /. . . Age
ol
.years..
..months days
STATISTICAL DETAILS
EMYSICIAN’S CERTIFICATE
SEX
j a
MAIDEN NAME
HUSBAND’S NAMEt
5, MARRIED,
ID, OR
JED
BIRTHPLACEt
'^eidkux ,
BIRTHPLACE
OF FATHER
\ p /?
I .HEREBY CERTIFY that I attended deceased during last
illness, from..Sx^../L...'^2 190.^..to...^2fr./!^. ^ 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:
tn. •
^ ^
t^U>.
MAIDEN NAME
OF MOTHER
BIRTHPLACE i
OF MOTHER t
(duration) DAYS
Contributory : . /ZtN. f(...
^ II..CLA. Ca. (duration) L£. days
(Signed). M.D.
l9oT.(Address).I^X..../l.^.'^^?t?r^^..(^...X^.f^^
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVALII
UNDERTAKER
DATE OF BURIAL
(Mujl
ADDRESS
36^
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
‘City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, give its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county. If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
/
[3-’06-37-LM.]
Permit No.
RETURN OF DEATH.
Name in full,.
S*
fti,, MASS.
CUvci*. *
Date of Death, (fA
(If married or dirorcejLwoman give maiden name, also name of husband.)
Sex, Color, Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, Years, / Months, /± Days. Occupation, —
Residence,* . ? f Ward,
Place of Death,.
y a — y (Stsf^yeaiyiiioBth and da
i} Dade of Birth . 7 7 / ^
Place of Birth,
Name and Birthplace )
0/ Father, )
0/ Birth,
Maiden Name and
Birthplace of Mother
Place of Interment,
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/£// 190. y.
Name and
of Deceased
T 1 2Tr^.. jV...... Age,.ytdyg.
I hereby certify that I attended deceased from iTrrr. WO , to G. c/s, 7*7/
19 o'*/, that I last saw.. .^kw^.... alive on the . day of GGl/f * 190/7,
7 ' rUeri nn.t.k.p. /..$r/^7... day of t 190*7, about ^ o’clock
that CNrC. ':.....died on the.
A.M., hi fTiTT . and that, to the best of my knowledge and belief, the cause of
was as follows : y~\ / t
death
Disease
Duration
{ Chief cause,
*z> 7
Contributing cause,
j Chief Cause,
| Contributing cause,
/)
/
/«
M.D.
•If an institution, state how long an inmate and previous residence.
l4-’07-37-LM.]
S r
Name in full,
Permit No.
RETURN OF DEATH.
MASS.
Date of DeatnCQfd^^a 100
(If married or divorced woman give maiden name, also name of husband.)
Sex, *2llaljLr. Color, Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) Divorced.
Age, Years, /0 Months, ; Days. Occupation)/] Ik d pUJt/lM
Residence,* ^ ^ J IWLNW2- Ward,
Place of Death, d^ j/o f/) 7 CulIZ
' xr (otata ) cal , uiimi/ii auu KAuy.;
Place of Birth,.../)) frXfJt /gtidAfZc/zp Date of Birth , ./aPNu/)... " f tfS*/
Name and Birthplace ) '//()') (. .Q/l.l.i ///) /l/2t
of Father, i /\ x-\
• Maiden Name and ^ ‘//(jGL
Birthplace of Mother, ) At
Place of Interment, A
, month and day.)
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, 100 ...
WAP Age.NNyears.
Crd) X~d
of Deceased,
I hereby certify that I attended deceased from 190C, . to
190 ). that I last saw
alive on the /. x day of
Cr^/ri/
too
,t /{a/ died on the P day of 19<T^ , about /^,H^’ciock
that
A.M., or F.M., and that, to the best of my knowledge and belief, the cause of
was as follows : . if —-V
death.
| Chief cause, ....
| Contributing cause,
j Chief Cause, r)<AJILD. ?/... .
| Contributing cause,
Disease ■{ /^J f
Duration
'If an institution, state how long an lDmate and previous residence.
M.D.
'
■
'
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Registered
1 } ! c:.;/ *•
M* x X y /
5P.....x7S. years Cs. months... days
FULL NAME .
Place of
Death
Residence ~.C — —
Age.
STATISTICAL DETAILS
SEX
COLOFK. _
SINGLE, MARRIED,
r0°RWclDD’ 0R
MAIDEN NAMEt
HUSBAND’S NAME t.
BIRTHPLACEf
NAME OF
FATHER
BIRTHPLACE
OF FATHER!
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHERt
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
UNDERTAKER
DATE OF BURIAL
- <£=A^„:,7
ADDRESS
PHYSICIAN’S CEE TIFICA TE
I HEREBY CERTIFY that I attended deceased during last
illness, from Xa.X. 1907— to - 190 Ti
that to the best of my knowledge and belief death occurred oathe
date stated above, ^.nd that the CAUSE OF DEATH was as follows:
Primary:
3»-
ry
(duration)..
Contributory:
..^(duration) DAYS
(Signed) I T . . L 7 . V}r^r\. . .G*r*rt M.D.
.Cm fCJl.
190..). (Address)..
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7 years months days
Where was disease contracted,
If not at place of death?
Filed
.190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information." If In a Hospital or
Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
Gut
COMMONWEALTH OF MASSACHUSETTS
E
RETURN OF A DEATH
3JJcT
(CITY OR TOWfV.)
FULL NAME.
P'aceon I Q
Death* )■ (U.V.
Residence . |C~0 <3
Registered No.
r
.190
t
months days
STATISTICAL DETAILS
SEX
LA COLOR OliiOLt) nmnnibu.
di'vorcId’ °R fa~l rtZvcs*--
SINGLE, MARRIED,
MAIDEN NAMEt
HUSBAND’S NAMET
BIRTHPLACE X
.CEJ
NAME OF
FATHER
BIRTHPLACE
OF FATHER
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER t
OCCUPATION
INFORMANT 5
PLACE OF BURIAL OR REMOVAL II
/ ■ ( C /fT
UNDERTAKER
DATE OF BURIAL
ADDRESS
1
TITYSICIAN’S CERTIFICATE
I HEREBY CERTIFY ttvU I wHimlml i.lu UUTI.I liming 1 1 sJL
ilLnogef ffnnrv,— — » —
1 -r.rrreo m ~ ibid
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: ^.CAX3...C^\A/Vrv.
Ait^WVvvviX.i
(duration) DAYS
Contributory :
(duration) OAYS
SPECIAL INFORMATION only for
or Recent Residents,
How long at
Place of Death? years .
1 hospitals, jAstitul Ions, Transients,
h &
months . ^4
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.
|| Name of cemetery.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
Death '
RETURN OF
FULL NAM E Registered No
Place °f } Y&tf- 2-^
...Age .years S...
Residence
months days
STATISTICAL DETAILS
9+WqfeC, MARRIED,
WTDtW&Sy-Ofl
PIVORCr&D
MAIDEN NAMEt
BIRTHPLACE*
L ct, n CK2y
l/°
BIRTHPLACE
OF FATHER*
MAIDEN NAME /)
OF MOTHER A,
-./ r
Cr viA £..
BIRTHPLACE
OF MOTHER*
(T
4.
OCCUPATION
/</ f ^
PLAC& OF BURIAL OR REMOVALU
UnlAL Urt ntMUVALU y
f Mfy,
UNDERTAKER
€T7^
A c^J\. c/{/
l
'M*
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from l9oZ..to 190^!.,
tat to the best of my knowledge and belief death occurred on the
date stated above^STH that the CAUSE DEATH was as follows:
c «(_ ^ ~
Primary:
.(duration) DAYS
Contributory :
(Signed)
2*Clt
ISO ...(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?
.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.
II Name of cemetery.
|>’07-37.LM.]
Permit JVo.
<ypi
Name in full,
RETURN OF DEATH.
c BOSTON, MASS.
^ Date oJ^Death,
.CMlU.
c£/&
1 190.7
/?
(If married or divorced woman give maiden name, also name of husband.)
-IJ/iA-
Sex, %£5rM44MJJU. Color, Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, 7 Year 'ft, ^ Months, y /. Days. Occupation,
Residence ,* Ad (?^ ?. ~ TTjWA- Ward,
Place of Death, f7 A/ 77a P<4/A .W.
(Single, Married, Widowed or
Divorced.)
Place of Birth,
(State year, mouth and day.)
Date of Birth,
WIana.: ...^^d.777.
Xante and Birthplace
of Father, J //) 0 A) / „
Maiden Xante and ) ^jTpyIFZ/. UMDfZl-f c/faA-s.. . . =?: . /y .
Birthplace of Mother, )
Place of Interment, AAf.P.rsPlAJl/l.lf/ a.... {f' \.
[/ Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Xante and
of Deceased
'QlW%XN 2™*™’ tRUUA. . 190J .
Af } .... \pA. ziful. Age, /
years.
I hereby certify that I attended deceased from
(ref
't
(.%rr. 190) , to
190 jthat / last saw ^ alive on the 2^) day of.
that ..died on the DN7.. day of (t Wl 190^, about
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
was as follows : f.) ^
?> (Aa^jxDvw^- ^
Insease
f
Chief cause,
Contributing cause,
f Chief Cause,
Duration ,
I Contributing cause, .
1 If an institution, state how long an Inmate and previous residence.
M.D.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
f /r
( CITY OR TOWN.y
FULL NAME
Place of
Death
ETURN OF A DEATH
Registered No
DDa::,r i
veara V '
• Age .years .YrrC. months rrTTT'Tr. days
STATISTICAL DETAILS
SEX j coyoR ,
SINGLE, MARRIED;
WIDOWED, tJR
DIVOROED
MAIDEN NAME t ' — —
HUSBAND’S NAME t
BIRTHPLACE*/ ^
mJ,
NAME OF
FATHER '
d>. 7^/gJ-/ _
BIRTHPLACE
OF FATHER
R
MAIDEN NAMEtr — s, /
OF MOTHER iR
BIRTHPLACE
OF MOTHER*
2^
PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last^
illness, from .. 190 y?..to . . 0. *'.7 . . 9 0 y?,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
(duration) DAYI
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 7
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.
II Name of cemetery.
COMMONWEALTH OF MASSACHUSETTS
..IdJ.Zt: ZdZZfZ..
RETURN OF A DEATH
(CITY OR TOWN.)
FULL Registered No
Place °.f } Z.±.A.2. TJ 1 <90>
years ^ months <^. days
Death
Residence
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, t
WIDOWED, OR „ [
DIVORCED C/^1 LaiA
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACEt
NAME OF
FATHER
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHER
AME
A — "Z-*-
Bl RTH PLACE
OF MOTHER*
OCCUPATION
sf/S trr'ZfS'
IN FORM ANT §
PLACE OF BURIAL OR REMOVAL I
UNB£R'r,l'rn '
RTAKER
date of BLrfrnrr-
"i
190..
ADDRESS
j /Q
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY ^hat I attended deceased during last
illness, from ... 190 J).. to. jSs^Li^l I90.Z.,
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:
s.tfYuvC^.
.(duration)..
Contributory:
::m
(duration) ?..^....DAY8
(Signed),.
kU..M*ol..
(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 7
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.
II Name of cemetery.
±- .
[4-’07-37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
190 y.
years.
I hereby certify that I attended deceased from. ..rK/7 190r~' , to
' 190 , that I las&saw^ alive on the day of ^ — 190 ,
that.f2yj~*<L~ died on the ^ 0 day of V. 190 about o’clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of death
was as follows : (J /L * _ f
| Chief cause,
Disease
Duration
( Contributing cause,
j Chief Cause,
Contributing cause,
M.D.
' If an Institution, state how long an Inmate and previous residence.
s»>-i
■At
Y
v*
1 4-’07-37-I<M.]
Name in full ,
r '
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
late of Death, 100 f.
' ..J.f.a%ohlL.. N<rn. UlAJ.
If married or divorced woman give maideiyfiSrne, also name of husband.)
Sex
■, Color , Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, ..MjC. Years, Months, Afj Days. Occupation,
Residence ,* 'T'MsOJZft* Ward, C
kfuU..
Place of Death, 3L// 3
Place of Birth, O^CIImuv^ Date of Birth,
Name and Birthplace ) oS . .rTTTT.
(State year, mouth and day.)
of Father,
Maiden Name and
Birthplace of Mother ,
Place of Interment,.../
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
S) Bnsian, 11.
* TnZtsT } tfc?- l^JLA Age,.&M
T
90
years.
I hereby certify that I attended deceased from 190 'J , to cnf/S
190 fiat. 1 last sale ^7 alive on the day of
190 ")
that. died on the day of 1/Nl 1903j, about —ft — -a’-dock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of /f\N~^ death,
was as follows : bjjLd....
Disease
( Chief cause, .
to 3
| Contributing cause;
f Chief Cause,
Duration , ^ /
( Contributing cause,..
1 If an institution, state how long an Inmate and previous residence
M.D.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME ^ Sy. ,... r egistered No
Place of Death * " 'y c
Date of Death ^7 Age
.years .
.months days
STATISTICAL DETAILS
S§2^ COLOp ,
SINGLE, MARCHED;
WIOQWEOh-CLR
pmrmrca
MAIDEN NAMEt
HUSBAND’S NAME t
birthplace
OF FATHER +
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER t V f\
OCCUPATION
INFORMANT §
t/* *7^
PLAC
z
E^OF BURIAL <^( REMOVAL
DATE OF BURIAL
u
UNDERTAKER
PHYSICIAN’S CPU T I PICA TP
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 to 190 ,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows :
Primary:
\. . \Xfi-. . .Wl/I. ,U<
(DURATION) DAYS
Contributory:
T^URATIOn). DAYS
(Signed).
.lOh'.T / .
.(?. 190.7.. . (Address) Y:
t:
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
Former or How long at
Usual Residence 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.
Name of cemetery.
-»
</ ] ^ /
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
RETURN OF A DEATH
(CITY OR TOWN.)
Place
Death '
°.f } ZtZNttJ.. 6.d. r,r 1 i9o 7
Registered No.
Residence
ZlA <£
0 / — / zZ
Age TL .years months days
STATISTICAL DETAILS
COLOR
WZ?z
SINGLE, MARRIED,
WIDOWED, OR „ /
DIVORCED ^<Lvu^y(
MAIDEN NAMEt/^?2
HUSBAND’S NAME t
BIRTHPLACE t
NAME OF
FATHER
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER*
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
UNDERTAKER
DATE OF BURIAL
XT >
190..'...
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from A.-cJ ... I9o(e>...to i9oT ,
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: YV\A(t^..
. . Qj\.M\zZ. .... C. . <L A)
■ (duration) DAYS
Contributory: Qz>.
. (d
riON)..
Mo.
(Signed).... M.D.
. 19 O.^.TAd dress)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death? years months days
Where was disease contracted,
if not at place of death?
Filed
.190.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under “Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow.
* State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
[4-’0737-LM.]
S r
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
PaUf bfj Peat
aAaJ.iu: L
190 j/.
(It married ocdivouced woman give maiden name, also name of husband.
Sex,
Color,
.Condition
(White, Black, Mixed, Chinese,
Indian, etc.)
husband J
, J r uyLvpff&Ls
(Single, Married, Widowed or
Divorced.)
Age,/ ears, (d Months, O. Pays. Occupation,
Residence,* ... j/^ C/IaA^v^^^ q. Ward,
Place of Peath, (\.. iAp 9 A-Aa/piapp '\Jr.. QJLicaJ
J I / /(State year, month and day.)
Place of Birthf '=/A/L£LAAe Pate of Birthc^AAMW O 2->
Xante and Birthplace ) ^LdAsJ t/vV (TWIN
of Father, ) a J
Maiden Name and ) fyCAA fr C MNrlAsl^s
Birthplace of Mother, ) V j
Place of Interment, 1
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
r +4 y A<Zrz/ XA'
fJ> Boston, ywACPr.....'^:.A.. 190 /A..
^nceastd,6 1 Age, /“W/jjjears.
I hereby certify that I attended deceased from . PlPlX. ^ 190/ , to Airly ^ S
190 that I last saw N. alive on the ^jArXpA'.day of yj/x*- ^ 190^,
that 'db— died on the day of Alztij 190y, about AX APo clock
7^
A.M.,
hy and that, to the best of my knowledge and belief ', the cause of PWSrr.. death
was as follows :
j Chief cause,..
Disease
| Contributing cause,
Chief Cause,
Pu
f ChU
ration \
( Contributing cause,
c
•If an Institution, state how long an Inmate and previous residence.
o-PL
I t,
M.P.
- 1
— - ■ — - — - — «
[4-’07-37- li.M.]
V
'1 rj
V
s r
Permit No.
Sex, Jfl/LPL^A-, Color, J oW Condition,
. (White, Black, Mixed, Chinese,
Z / 1 — J-s. , — Indian, etc.)
Age, CSS Years, — ^ Months, Bays. Occupation, ....
Residence,* JP v 7c2pUSC^P> Ward,
(Single, Married, Widowed or
Divorced.)
Place of Death, -6 'A Shu.2&.^
/ (State year, mouth and day.)
Place of Birth, Bate of Birth, Z^/k J i /f/O
A \
> h
7?
Name and Birthplace I
of Father, )
Maiden Name and
Birthplace of Mother
Place of Interment
Name and Age 1
of Deceased, >
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/jwgiiifl drf^ Boston?; 190
Age, years.
I hereby certify that I attended deceased from 190 , to
190 , that I last saw alive on the day of
that died on the day of 190 , about
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
was as follows :
j Chief cause,
190 ,
o’clock
death
Disease
Contributing cause
„ vAi (w
f Chief Cause,
Duration ,
Contributing cause,
• If an Institution, state how long an Inmate and previous resilience.
M.D.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
■££ } ! jS^£^3JA ,9o )
^/v
( CITY OR TOWN.)
Registered No.
Residence
.3...Q... .('. 'rr^.'^X. Itt. I.Ur. 3... Age
..years..
..months days
STATISTICAL DETAILS
SE^
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED //*.
<
MAIDEN NAMEt
HUSBAND’S NAME t
'I 't /S- yC * t -
BIRTH PLACE t
(?Z\
NAME OF
2-i
BIRTHPLACE
OF FATHER*
/3
<n.
2-Z v-
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER*
OCCUPATION
INFORMANT §
SW4t- ^
PLACE OF BURIAL OR REMOVAL I
UNDERTAKER
DATE OF BURIAL
^190.?..
ADDRESS
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from lO * (. 190 to .. lyngJZ. .».....??. 190. .‘y?
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
.(DURATION) DAYS
Contributory:
M.D.
(DURATION) DAYS
.190 (Address)..
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death 7
■day f
Where was disease contracted,
if not at place of death 7
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.
II Name of cemetery.
t
%
0’06-37-LM.J
s s
Permit JYo.
RETURN OF DEATH.
B08T9N, MASS. _
Pute^rf Death, J / f a -r.
Name in full , ■ "Cs *-£>C&-cr-£ aC, .
/
""<r
(If married or divorced wonj^gfive maiden name, atsITname of husband.)
Sex, Color, Condition, ~/k±.Q^.
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, ..Jok Years, / Months, Days. r Occupation ,
Residence, * SJM> *^.*T*^rrW' %rd, .
Place of Death, zgla^w-.
Place of Birth, ?.... Date of Birth, Af- S'.
Name and Birthplace [ gfL****. '
(St;*fe year, month and day.)
of Father, ) ~ cN
Maiden Name and t.. P-**+~*
Birthplace of Mother, ) ^ ^ p/ / ^
Place of Interment,..
Undertaker.
PH YSiCI AN’S CERTIFICATE OF THE CAUSE OF DEATH.
l /Boston,.. & 190 f.
T— fl ~-.y Age,. (p years.
I hereby certify that I attended deceased from /h v 2 <? .190? , toS^VC^:
f\ — ^A. n li.i ip. rm. t.h.p. ^
190*~1 that I last saw
day of
1907,
l
that...
Sd^-Asdi
fhF....died on the D day of
6'~ U&is-
7
* 190^ , about £=- o’clock
j^l , *gi P.M., and that, to the best of my knowledge and belief, the cause of
was as follows : , ^ ^ Js /? - U
Aj ^ '
death
( Chief cause,
Disease \
( Contributing cause,
f Chief Cause,
* nil run. .
9^r
Duration
Contributing cause,
V2'
N
M.D.
* If an Institution, state how long an Inmate and previous residence
[4-’07-37-LM.]
S r
Permit Aro.
(If married or divorced woman give maiden name, also name of husband.)
2A0.aI.Qj. ...Color, . lAAhsD. Condition, /Pla-iuldJ
Sex,
Age, .07 Years,
(White, Black, Mixed, Chinese,
Indian, etc.)
(single, Married, Widowed or
Divorced.)
Residetice,*
Months, ~A—Days. Occupation,
^ (A A ItCIIA. 2~. Ward,.
Place of Death, lA/lATTidA ./ItaI.......
(State year, month and day.)
Place of Birth, WCDUXai A. /O.JPUUMJL Date of Birth, (O fl
Name and Birthplace I /load ^JlodwcA
of Father, )
Maiden Name and J_
Birthplace of Mother*
Place of Interment,
'.ptn.lvA .
c
~ ... /Coizf-O/tX 7lt7YgAAJQ
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
C
a**-. <? t 190 {2...
*TCDe*easeT I .Age,. 11. years.
7T*
I hereby certify that I attended deceased from ■ 1' 1907 ,
to.
T
190 , that I last saw alive on the day of „ 190 f,
a -cJC ^
that. h-^rr. died on the *j. *— : day of 7^2^?.. . 190^ about 7 3 • o’clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of . death
was as follows :
j Chief cause,. .^r:
Disease
| Contributing cause, 1
f Chief Cause,
Duration J
c*^r7 .
I
Contributing cause,
m.
M.D.
• If an Institution, state how long an Inmate and previous residence.
- 1
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME.. <2jYcl <^.:±L
(CITY OR TOWN.)
Place of
Death
?}
Residence
.Registered No..
TJ 1 -t&es^cL ».
YYAAt. Age years /...
Y..SL
..months.. ...r. days
STATISTICAL RETAILS
SE*.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
c-'\
DIVORCED
MAIDEN NAMEt
tX&AY Y'
HUSBAND'S NAMB . ^ , )jj _
BIRTHPLACE*
NAME OF
FAT
HER ^ jYA •
BIRTHPLACE
OF FATHER*
Y crTst* - (Y* c^ t i
rv
MAIDEN NAME
OF MOTHER
fa
/ t.<lXL
XL tSY\
6^-* v
BIRTHPLACE
OF MOTHER*
OCCUPATION
INFORMANT §
Ah ZhC^,
PLACE OF BURIAL OR REMOVAL II
\u \ywAJhYfL ^
UNDERTAKER
•c a YD
Y\, / \)
DATE OF BURIAL
h/jl.
190
A
ADDRESS
%{/ (44/cYL
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from(TU^L 190}.. .to .. JJ&e-../. .0 190.}..,
that to the best of my knowledge and belief death occurred orr the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
Contributory
-. (duration) .r4 DAYS
:
GA
(duration) TTT DAYS
(Signed) 1 ZT.y .U 1 M . D.
19$ (Address)..X.^...^....Vrf?L^.^!^..^..,.....WLiL!ir
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Deathl years months / days
3.
Where was disease contracted.
If not at place of death?
’ \ I U
Filed
.190.
Clerk
•City or town, street and number, If any. If death occurs away from USUAL RESI- J
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.
II Name of cemetery.
£2.
/!W t <>,'?*>[
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of Death *
Date of Death
RETURN OF A DEATH
J A *
MAIDEN NAMEt -
HUSBAND’S NAME t
BIRTHPLACf
^ Ss* <r < S'/
NAME OF
FATHER
I HEREBY CERTIFY that I attended deceased during las
illness, from 190^ to <f 190 7
that to the best of my knowledge and belief death occurred on th<
date stated above, and that the CAUSE OF DEATH was as follows
Primary: /f
1
■ (DURATION) DAY
Contributory :
/p . n (duration) days
BIRTHPLACE
OF MOTHER +
OCCUPATION
INFORMANT §
* A
PLACE OF BURIAL OR REMOVAL II
■ ;VT DATE OF BURIAL
r/j, *
(si£ned> M'IAca* /• m.d.
/^c l 0 190 > (Address) . i/lflA'UUi //{
_ S^C!^L INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
Former or
Usual Residence Place 'SfSeath 7
Days
Where was disease contracted,
if not at place of death 7
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
UNDERTAKER
ADDRESS
90 Institution, give Its NAME Instead of street and number.
f — t In
'y,
£ ^ y4'S'> y/"'//*
case of married or divorced woman, or widow.
| J State or country; also city, town or county, if known.
§^ame and address of person giving statistical details,
me of cometery.
[4-’07 37-01.]
Permit No.
RETURN OF DEATH.
«OSTOTV, MASS.
te of Dea
Name in full, !f....\..tf2L£AJ.. /. .
Sex, .. .2 Id'CUN ... Color, .. MaMN... ...Condition,
woman give maiden name, also name of husband.)
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, ' ~ Years, — - Months, /jf Pays. Occupation,
Residence,* Ward,
Place of Death, *3 o%Tf. q) tiLLf DIai
^ ^ ^ (State year, month and <Jny.) ^
Place of Birth, /Jl/RA Bate of Birth,
Name and Birthplace ) ■Xg/l£gJ> UuX f rrr. ikfa.
of Father, y _ f?j t rX
Maiden Name and i
Birthplace of Mother, ) 1
Place of Interment , ^
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/.r\
that
JL,
...died on the ’ day of
IX
rN.. 190 , about
1 *
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
was as follows: 0 Q j .
j Chief cause 4 ^ H f
’clock
death
Disease
Contributing cause,
f Chief Cause,
finn. '
Duration
Contributing cause,
Hi. I 'ktrWl
M.I).
•If an institution, state how long an Inmate and previous residence.
all
COMMONWEALTH OF MASSACHUSETTS
OF A DEATH
RETURI
FULL NAME .£ Registered No.
Place of Death
Date of Death ,/ .ec /Z£Z /7y"X Age .a...?' .years "TTZ months .^rrmT T~. days
STATISTICAL DETAILS
SEX
MARRIED,
wt'onero
MAIDE
hi
HUSBAND’S NAMEt^ ,
^ rr
BIRTH PLACE +■
pr'/^zy
;:r‘
NAME OF
FATH
Z
BIRTHPLACE
OF FATHER t
z4Z a^/zz7
MAIDEN NAME
OF MOTHER
1
f. /'/ / //Z-
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
L ft ,//l
UNDERTAKER
's/j?// /I
DATE OF BURIAL
^le./j".
90
ADDRESS
z
PHYSICIAN’S CERTIFICATE
I HEREBY CEffTlFY that I attended deceased during last
illness, fronr.*?^^^^* ...<?^ 190 to Z>^F.^ -..././. 190 ^.,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary :
.(duration)..?^ DAYS
Contributory: ....C^
(duration) .
M
iress) . . . .
(Signed).
M.D.
190 (Adc
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
Former or <r -? Dfl. — jZ JJ How long at
Usual Residence . ». .Place of Death 7./ Days
*U~>Lr
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.
II Name of cemetery,
V
I
COMMONWEALTH OF MASSACHUSETTS }i /
- - /T
FULL NAME
Place
Death
RETURN OF A DEATH
Q. 'J?k .'?.. R e 2 i
{CITY OK TOWN.)
Registered No.
°! 1 g..g*zxiz^^ .:. Dp*^f S ...<^.^./.d. .go ^
Residence Age.
S~S~
..years..
.months Jw... days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, A
Ptrtzzz
WIDOWED, OR /f^ ^ r
DIVORCED
MAIDEN NAMEt
HUSBAND’S NAME t
BIRTHPLACEt
NAME OF
FATHER
77^
t .rSt-cr
BIRTHPLACE
OF FATHERt
Z-
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER!
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
Cc 47
UNDERTAKER
<? /£_ / j Cl
DATE OF BURIAL
/\
ADDRESS
[{ /It^c.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ../Qz*$r. :...$. l9(Tp’...to ..^O«u^.L,...'C>3 190
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:
Contributory:
.(duration).
y
. (duration) DAYS
. ./ Z~l 9 0.^..(Addresg4....^7>RTr?7T444^^4^.^.<^
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death7 years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, give Its NAME instead of street and number,
t In case of married or divorced woman, or widow,
t Stite or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
[3-’06 37- LM.]
Name in full,
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Date of Death, '/....^
([ fiJjt'v . ' ofo&j.
(If married or divorced woman give maiden name, also name of husband.)
At.
'/
A
(Single, Married, Widownd or
Sex, . 2 H'oPN ...Color, . QpffJN. : ....Condition,
(White, Black, Mixed, Chinese,
Indian, etc.)
Age, Years, /O Months, / Dayj/. Occupation. /
Residence,
Place of Death,
Ward,
-
(Statq
Place of Birth, (Q Date of Birth,
Name and Birthplace l <Zetf/sJU.Tr.
of Father, i ^ /
Maiden Name and ) U2.t. .
Birthplace of Mother, )
Place of Interment, %?Z.
i and day.)
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
3 I fi 190
*7W1T l .. A H ^ years
I hereby certify that I attended deceased from. / 190) , to ^L<- / 3
190 that I last saw ... ...T^Wvo.
died on the... /3
alive on the J....Nt day of .. h&isCr. 190
day of.
.190 1, about J ~2"~N.o’ clock
L /
A.M., or P.M., and that, to the best of my knowledge and l belief, the cause of. death
JNh^cJU^ £./4
that
Disease
1
Chief cause, .
Contributing cause,
Chief Cause,
Duration
f
Contributing cause,
M.D.
•If an Institution, state how long an Inmate and previous residence.
- 1
[S-*06 37-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
0/ Death' ^ irJ 6 ^
KA--
(If married or divorced woman give maiden name, also name of husband.)
Sex
, Color, Condi lion,
(White, Black, Mixed, Chinese,
Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, Yf2/ Years, y Months, (NMIays. Occupation,
f / N ’ /
/r>. '~^2lL/tZAL£^. Ward,
Residence /
Place of Death, . . J^-pIa£nJ...
. / 7 (Slate year, month and day.)
Place of Birth,. .f-f. r Date of Birth, .
Name and Birthplace i vi 9 ll ytrA >a
of Father, i QN. , 7 ^ v
Maiden Name and | IjiMN-. Mw 7/ Q,
Birthplace of Mother, ) a j (y ^ Mf7 /
/ <C~) S?
Place of Interment,.
k.if~ ^triNOfL' r
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/rfrtA,., f fPFFr. ,/Z 190
Name and Age]^ ^ - y^lj
of Deceased, > .(^rr.. .<....:. -<srrr...r.r.- — Age,.
I hereby certify that I attended deceased from /C: 190ff , to
years.
190/ , that I last saw f'PAr^r. alive on the Sa. day of
o&I* — <£_>
190
/
that..c>ll^ 1L. died on the.
day of e>^f~Ar-r-. 19 Of?, about &?...o’<
Of!
clock
AtM., or P.M., and that, to the best of my knowledge and belief, the cause of WWrrr:. death
was as follows :
j Chief cause,
Disease
Contributing cause
f Chief Cause,
Duration
Contributing
^ iff.
A
lU
cause,
•If an Institution, state how long an inmate and previous residence.
M. D.
r
■
C* n
[3-’06 37- LM.]
(Qaa fCcUx
Permit No
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
ate of Deaths
(If married or divorced woman give maiden name, also name of husband.)
Sex, ' 2Klal&, ..Color, . WNfAlX
.Condition, ....X/Jm /TNPfJl..:...
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) ^Divorced.)
Age, Years, g " — . Month sf - Dasjs. Occupation, ..
Residence,* ..../.. f. Iff Ward,
Place of Death, /
Place of Birth,
Name and Birthplace )
of Father, )
Maiden Name and
Birthplace of Mother,
Place of Interment,
Date of Birth,.
&
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
, ~f~ ' Ssstm /Ike. , / C 190?...
"TncZlT } , ,l?e. {£ years.
I hereby certify that I attended deceased from ... ./fQr*^r...-. /..N. 190^7 , to. AQ— -e- , /A
lOCT^jbhat I last saw alive on the /.<XZ. day of 190 ,
that "^r„ g. died onthe /X> r. day of 190^about ../ f o’clock
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of. death
was as follows :
Disease
f Chief cause,
to <
| Contributing cause, S^
f Chief Cause, 0.
Duration , ,
Contributing cause, /
•If an institution, state how long an Inmate and previous residence.
6^
... M. D.
«S£§Zi.r: i
I
,
V,
i
Xj
[4-’07-37-CM.]
Permit jYo.
Name in fall,
RETURN OF DEATH.
BOSTON, MAS!
Dt^e of Deatli
uJLljDu. t'x U-vu vfieiAfo*.
190
Sex, . (OYfl/yi/UxJIjN.. Color,
(If married^Qr divprced woman give maiden name, also name of husband.)
f
(White, Black, Mixed, Chinese,
Indian, etc.)
Condition, ' J if am UN
m iuuiuu, eiu.;
Age, Years, 2 Months, \3 Days. Occupation,
(Single, Married, Widowed or
Divorced.)
Poesidence,* .
Place of Death,
Place of Birth, .. ./{jQ (PLAYaA.
Name and Birthplace I v -/
of Father, I
Maiden Marne and ) ^
Birthplace of Mother, )
Place of Interment,
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
LA....Z
^ ^ i sp B&sfdri, 190
Pa / W><. Age, 32 years.
I hereby certify that I attended deceased from 790 , to
190 , that I last saw alive on the day of
that died on the day of 190 , about
A.M., or P.M., and that, to the best of my knowledge and belief, the cause of
A,
190 ,
o’clock
death
M.D.
[3-’06 3T-LM.]
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
Name in full,
(If married or^divorced wjjman give maiden name, also name of husband.)
Sex, QsfA-
Color, CfC.Lli.. Condition, .
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) Divorced.)
Age,. /a Years, M onth s, r - .. Days. Occupation,
Residence, * ^ Ward,
Place of Death, / O O ..Jo/u^AL. RJtJJPj.
1 r " (Stat^ year, month and day.)
Place of Kirth,^:.fy/.£dDr.. \ Pate of Birth,..
Name and Birthplace ) ^ ^kC^.£/ZdAd.A ZCM./. ../... ....
of Father, ) CA /Q JJ / 1/ f A / / / f
Maiden Name and ) J/% A/tCf /.S'... NX. Af/w?/. :1'1. w/fl. /V
Birthplace of Mother, \
Place of Interment, r
PHYSICIAN S CERTIFICATE OF THE CAUSE OF DEATH.
Semn, 190.0...,
Name and Age ) P"* f ' ' C . / /
Of Deceased, f Age,. A A years.
I hereby certify that I attended deceased from.^sg/i&^Cl* 190 ^ , to ..dL,.J..Z
.../..N~.. day of. 190 f.
1907, that I last saw alive on the .
that
died on the /Af...
7
day of. AU ...190 f, about AC A ° ..o’clock
-A
A.M., 1 ’• M., and that, to the best of my knowledge and belief, the cause of. 'NN death
was as follows : , / /
( Chief cause, fA^..AjL^. .
Disease \ ^ yA? V * — ,
I P. rrn.i-ri.hu, r.nu.RP. ^v-v.
Duration
J
Chief Cause, ...
Contributing cause, /.../ A? i
•If an institution, state how long an Inmate and previous residence
... M. D.
6,21
^ s'
-
[4-’07-37-LM.]
<ro i
Permit No.
RETURN OF DEATH.
BOSTON, MASS.
-O
Name in full,
N\
Sex
Date of Death, I *-^0 C&3 190/.
CfcUzJhs.
dH r.fpAo^d'
(If married or divorced woman give maiden name, a ^\&mc of husband.)
dd <^Csbn^sxj^_.
, Color, d.hffUMi^
Condition,
(White, Black, Mixed, Chinese, (Single, Married, Widowed or
Indian, etc.) Divorced.)
Age, yf//.. Years, / Months, C~N- Days. Occupation,
Residence, * (A iX* (llsl/ P ddfAANN. Ward, (..NNu.
Place of Death, / & "fOAj UNtfXx u£Jf>. d? CdfXX .
f7 (State year, month and day.)
Place of Birth,...(<~N f jQANh )fMq^<teDate of Birth,. ‘TVlUyj
Name and Birthplace
of Father,
Maiden Name and
Birthplace of Mother
WCLAjO.JI/
mrtnpiace oj jviovner, j ^ J / c_
Place of Interment, dr d /XdN.QNAf..
'ot is'iNNif o. . . weLtnf. dh.
Undertaker.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, . . <o!L]£ 190/..
Kame and Aie } Scc^cJU ^ c K Ate
of Deceased, ) Mi-x <rvwv> ^ w years.
I hereby cei'tify that / mddunrfujti litwmsufl f\ iim* 11 • * : 1 "t&O 'rpto --- .. ... t
fLQ_, *hol T e"11' ~f*‘~" — r rl n,y nf — — — 100-
that..
dried cn the
4A!r<N iTny of AjG_ U, 19 fa about Vt, fru&tv&te
> .
A.M., 4X&SNM., and that, to the best of my 'knowledge and belief, the cause of IaJL/'N death
was as follows:
( Chief cause, Vv c*Xcvr* oJU ^ ca^xa^slJB>-=» { O^LdL (A^JL .j
1 disease \
( Contributing cause,
j Chief Cause,
Duration
l
Contributing cause,
M.D.
•If an Institution, state how long an inmate anil previous residence. \J • h t () g .
/m_dL . J^jfcfcK Uk
ALL NAMES TO BE IN FULL
SEX COLOR
COMMONWEALTH OF MASSACHUSETTS
j £
( CITY OR TOWlf.)
RETURN OF A DEATH
__ _ r Registered No.
r,r I ^JtSi^L ,90^
Residence /•• ....!. f^".'. Age .yd^^.....ysats /..S months — — - ' .. days j
FULL NAME
Place
Death
STATISTICAL DETAILS
9tNL.CE, MARRIED,
WIDOWED, OR
DLVeftCED
MAIDEN NAMEt
HU8“KD’8 MA“" /Aa£3
BIRTHPLACE*
INFORMANT §
PLACE OF BURIAL OR REMOVAL!
UNDERTAKER
DATE OF BURIAL
0 IB
190 .
ADDRESS
C
7
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from 190 to 190 ,
that to the best of my knowledge and belief death occurred on the
date stated above, and that thjp CAUSE OF DEATH was as follows:
Primary :
..^190.:.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death7 years months days
Where was disease contracted,
If not at place of death 7
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,
f 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.
II Name of cemetery.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
UH • L-i ' •
RETURN OF A DEATH (city or town.)
FULL NAME ^argueri t.e.„V. H,... Ryder Registered no.. ... 5
Death * f 3..T ark.et...S.t-..,....I<y.riri Deaths Jan. 1, l90
STATISTICAL DETAILS
PHYSICIAN'S CERTIFICATE
SEX COLOR SINGLE, MARRIED,
P WIDOWED, OR T,r
1 * DIVORCED J
1 HEREBY CERTIFY that 1 attended deceased during last
illness, from 190 to 190 .... ,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows :
Primary Proftaftly heart disease
MAIDEN NAMEt
Harding
HUSBAND’S NAME t
Elisha
BIRTHPLACE*
Chatham JJass.
NAME OF
FATHER
EliRh.q T'Prcilr’g-
Contributory :
BIRTHPLACE
OF FATHER*
I.. as s .
(Signed). J Med Exam M D
MAIDEN NAME
OF MOTHER
Patience Hard ring
Lynn
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? 1 .
BIRTHPLACE
OF MOTHER*
Pass .
OCCUPATION
. / ^
INFORMANT §
F eft . 5 . mr$
Clerk
PLACE OF BURIAL OR REMOVAL II
WirthroD Cem. Wir
DATE OF BURIAL
'■■thr-o-n iso
* 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 j also city, town or county, if known.
§ Name and address of person giving statistical details.
II Name of cemetery.
UNDERTAKER
J. D. Dennis
ADDRESS
Lynn
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
/ r
RETURN OF A DEATH ( CITY OR TOWN.)
FULL NAME yj &.X..$r^L Registered No
Place
Death
/< *c
Residence Age
.£LS
Date of
Death
..years.
l . ../" *
3
190 <P
months X?- days
STATISTICAL DETAILS
SEX-
COLOR
SINGLE, MARRIED^ */ .
WIDOWED, OR 7 - '
DIVORCED
MAIDEN NAME.
HUSBAND’S NAMEt ^ ,3
birthplace!
NAME OF
FATHER
BIRTHPLACE
OF FATHER!
/?? 4^
MAIDEN NAME
OF MOTHER
/7
BIRTHPLACE
OF MOTHER!
'I
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL!
/ <r ^ fl
UNDERTAKER
DATE OF BURIAL
.^^±^y.Ti9o..7.
ADDRESS
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from../ 5.9.'.$ 190 to 2-. 190$!..,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
.(duration)
pa,,
Contributory:
(duration).
(Signed) Q^ikdlJ/.. -M.D.
,L. v 1 ..I90S-. (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents,
How long at
Place of Death 7 years months days
Where was disease contracted,
If not at place of death?
Filed
.190.
Clerk
♦City or town, street and number, if any. If death occurs away from USUAL RESI-
DENCE, give facts called for under "Special Information.” If In a Hospital or
Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow,
t State or country; also city, town or county. If known.
§ Name and address of person giving statistical details.
II Name of cemetery.
[4-’07-37-LM .]
Permit No.
RETURN OF DEATH.
MASS.
Name in fall,
A
Date of Deajtli
190
y.
(If married or divorced woman give maiden name, also name of husband.)
Sex, (ffTZ/M/u 'idUy Color, Condition,
(White, Black, Mixed, Chinese,
Iudian,etc0
Age,/NNr.:. Y ears, N ^Months, N' .. Days. Occupation,
(Single, Married, Widowed or
Divorced.)
Residence, * Ward,
Place of Death,
Place of Birth, ^ / 72. 0A2dJlUA Pate of Birth, <z 1
Marne and Birthplace I pSy.'. CDiW rrr... ...
Maiden Marne and ) _ —
Birthplace of Mother, ) (s \ fl\ / f
Place of Interment, aaI.C/ia/.-.
o
PHYSICIAN’S CERTIFICATE OF THE d^USE OF DEATH.
° Detsion , .^r. — -7U -2 ^ 190
*7W1T \ XMi
I hereby certify that I attended deceased -franc f> A. ,/#/vv Z_ . 7 9 0 ? ,
years.
to.
190 , that I fcC5t~'s aw fv.
t 3^r p *~
that. N died anrtbe day^of.
/^V- alive on the L day of 190 ,
f\.X 19 tff , about o’clock
/
A.M., or P.M., and that, to the best of my knowledge* and belief, the cause of
was as follows : Of " /
j Chief cause,
death
ijtWvv , ^’Vr<JrVVrrv
Disease
| Contributing cause,
If
f Chief Cause,
Duration
Contributing cause, v k
i )
. / \
tA
'V.
.
rv
• If an Institution, state liow long an Inmate and previous residence.
vO.
M.I>.
21
r
!
-
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
(CITY OR TOWN.)
RETURN OF A DEATH
FULL Registered No.
p,ace ,? i .// - f<. ? <•=* r,r i ,9o 6
Death 1
Residence /..V ! Age—.^^S^.
..years..
^2 /O'
.TTTTttV.... months f. f.. days
STATISTICAL RETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t
HUSBAND’S NAME t
BIRTHPLACE*
NAME OF
FATHER
BIRTHPLACE
OF FATHER*
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER*
nn
-'•''I C
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
fas Ca-
UNDERTAKER
d rt/Zc
DATE OF BURIAL
eSZ. 1 90 V
ADDRESS
t/W C.
PHYSICIAN’S CERTIFICATE
I HEREBY CERTIFY that I attended decease^ during last
illness, from h^C,...3^P 190 ^..to ys .t/.. 190..$^.,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows:
Primary:
.(duration)....^. DAYS
(Signed) . / M.D.
!l ^ 190.^ (Address)
(duration )...<TCtr' days
M.
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 7
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 The text goes on. The rest is in the file.