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CONII~IONVVEALTH OF N~i~SSACHUSETTS ~
COUNTY OF MIDDLESEX CITY OF CAMBRIDGE
The fallo~ring is a c~py from the Recoi•d of Tk•aths iii said City:
Itecord Number. l~?3O Date of neath, i~pV'6~~J01' - Y7~+
~d~.~urd J. ~orkins ~oc. sec. ==o. 07~+-C'1-GE'10
Name of Deceased, - - - - - - - _ _ - - -
Husband ~'rC a~.1.3 v s r:aah
~ ~Tame of ~Vife - - - - - -
f
~taiden name, (if married, di~orced or a «•idoR) _
! Sex, ,!8~'~ Color l'ondition, -~rried _
F (If other than white) (Siyle, married, Nido»ed or dii>orced)
~ A e 63 pears, 3 months~ 6 ~ days
~ S~
` Disease or cause of death I'.PldQr~oid Carcinar~? or ri~ht lur~;~ ~ot~statio
; ~o ct~3iasti:~o~ %Z~ur~
;
i 362 F3c~d~o nv~., C_::~bri~ =;e ~u,~arvisor , -
, Residence, Occupation~ "
a Place of deatn, ~+t,~+ut~tiirn zio~-?. C~?~brid ;o ~c~xert~~! York
Place of birth,
' Name of father~'~•~`'~ 'T' ~~~r'~:ins g~r~,}~ ~a~ of fathe~'~t~~3c'~ :'A~ York _
" ~ p
; iialon Cole F~c~~r ~ork
~ Maiden name of mother Birthplace of mother~
' t. ~.lry' F ort Jotinson~ staw Yark
} Place of burial
~
' Date of Record . i'~Ct3~3~a3r 1~1 -
~
; I do hernby certify that the abo~e is a true copy fr~m the Record of death3 in the cvstody of the City Clerk as
entered in Volame Folio
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~ l~+r I~~`t~t~~
5 In witness ~hereof, I herennto set my hand and the seal of said Citq, this
; f~l~u ~ '.,=^EC~ - _I.Zt'•}1 daq of 9~'J;'J :Py
` ST_ ~~CS , :!c-t flA. +..~'Q1iP
~ '~A'' in the year nineteen hundred and J~
:t ~ c ~ + _ , . ~
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3 FEe 2~ I o3 ~'h ' 1~I G-~'. f
_ City Cle
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