Death Certificate data transcriptions

Oconto County WIGenWeb Project
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DEATH CERTIFICATE TRANSCRIPTIONS
____________________
* The entries have been transcribed exactly from the original so that any
misspelling or errors of a person's name, place name, date, or any other
entry is intentional AND FOUND ON THE ORIGINAL.

McLean

Gertrude Mary McLean
August 23, 1914
contributor: Richard A. McLean
PORTLAND, OREGON
BUREAU OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.    130
1 PLACE OF DEATH
County    Multnomah
Town of    Portland or
City of.. No. St Vincent Hospital
Street
[If death occurred n a Hospital or
Institution, give its
NAME instead of
street and
number
and fill out No.
18.]
2 FULL NAME    Gertrude Shaw.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
OR DIVORCED
(Write the Word)    Married
6 DATE OF BIRTH
......1..........
(Month)        (Day)        (Year)
7 AGE
about 27 years,...months,...days
If   LESS
than 1 day,
.......hrs. or
.......min.
8 OCCUPATION
(a) Trade, profession, or
particular kind of work.    Housewife
(b) General nature of Industry,
business, or establishment in
which employed (or employer)    ----        ----
9 BIRTHPLACE
(State or country)Wisconsin
PARENTS
10 NAME OF
FATHER    John McClean*
11 BIRTHPLACE
OF FATHER
(State or country)New Brunswick
12 MAIDEN NAME
OF MOTHER    Lizzie
13 BIRTHPLACE
OF MOTHER
(State or country)    New Brunswick
13a LENGTH OF RESIDENCE
At Place of Death....years    10 days    months
In Oregon One years     1              months
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)    Geo K. Shaw.
(Address)    c/o Highland apts
15
Filed 8/27 1914 Turner
Registrar or Deputy.
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
August           23           1914
(Month)        (Day)        (Year)
17    I HEREBY CERTIFY, That I attended deceased from
Aug 14 19 14 , to Aug 23 19 14
that I last saw her alive on Aug 23 19 14
and that death occurred, on the date stated above, at 2P.M.
The CAUSE OF DEATH was as follows:
.
Purpura hemmoragia*
.(Duration) ....yrs........mos.   4   dys.
Contributory...
Secondary
..(Duration) ........yrs........mos.........dys.
(Signed)    John M. (unreadable)M. D.
..........................191...... Address    412 Eilus Bldg
State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT
CAUSES, state (1) MEANS OF INJURY and (2) whether ACCIDENTAL,
SUICIDAL, or HOMICIDAL.
18 SPECIAL INFORMATION only for Hospitals, Institutions,
Transients, or Recent Residents.
Former or
Usual Residence    City.
How long at
Place of Death?    10    Dys.
Where was disease contracted,
if not at Place of Death?..
19 PLACE OF BURIAL OR REMOVAL DATE OF BURIAL
Lone Fir Cemt 8/28    1914
20 UNDERTAKER ADDRESS
ERICSON UNDERTAKING PARLORS City

Gordan Douglas McLean
February 10, 1926
contributor: Richard A. McLean
Washington State Board of Health
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
Record No.    3
Registered No.    11
PLACE OF DEATH
County of    Snohomish
City or Town of    Monroe
Registration Dist. No. 8... No.. Monroe General Hospital..
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2. FULL NAME....Gordon Douglas McClain*...
(a) Residence No... N Madison.. St.;
(Usual place of abode)
(b) If non-resident, give city or town, and state..
(c) How long in
Registration Dist.     yrs.     mos.     ds.;
how long in U. S. if of foreign birth yrs. mos. ds.
Personal and Statistical Particulars
3. Sex
M
4. Color or Race
W
5. Single, Married, Widowed
or Divorced (Write the word)
child
5. (a) If married, widowed or divorced:
Husband of
or
Wife of
6. Date of birth
Feb             10           1926
(Month)        (Day)        (Year)
7. Age
0 yrs.   0   mos.   0   ds.
If less than one day
hrs.       or min.
8. Occupation of deceased:
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer)

(c) Name of employer
9. Birthplace (City or town)    Monroe
(State or country)    Washington
PARENTS
10. Name of
Father    Gordon McClain*
11. Birthplace of Father
(City or town)
(State or Country)    Wisconsin
12. Maiden name of
Mother    Ida Agres*
13. Birthplace of Mother
(City or town)
(State or Country)    Virginia
14. Informant    Mr G. McClain*
Address    Monroe Wash
15. Filed    Feb 11    , 1926    E.T. Bascom
Registrar.
Medical Certificate of Death
16. Date of death        Feb 10 ,   1926
(Month)    (Day)    (Year)
17.         I HEREBY CERTIFY, That I attended deceased
from , 192     , to , 192
that I last saw h   alive on   , 192
and that death occurred on the date stated above,
at m.
(State the disease causing death,
or in deaths from violent
causes, state: (1) Means and nature of injury: and (2)
whether ACCIDENTAL, SUICIDAL or HOMICIDAL).
The CAUSE OF DEATH was as follows:
(Primary)    Still Birth
due to diabetes of mother

(Duration) yrs. mos. ds.
CONTRIBUTORY
(Secondary)
(Duration) yrs mos. ds.
18. Where was disease contracted
if not at the place of death?
(a) Did an operation precede death? X Date of
(b) Was there an autopsy?    No
(c) What test confirmed diagnosis?    Clinical
(Signed)    M Allison    M. D.
Feb 11th 1926        Address    Monroe Wash
19. Place of Burial, Cremation or    Date of Burial
Removal        2/11    , 1926
IOOF Cem. Monroe Wa
20. Undertaker Address
Purdy & Sons Monroe Wash
I HEREBY CERTIFY, upon honor, That I have made the
effort but was unable to secure answers to questions
(Insert numbers of unanswered questions)
MAR 5    1926     (Signature of Undertaker)

Ida Dillillion MCLEAN
March 7, 1947
contributor: Richard A. McLean
Washington State Department of Health
VITAL STATISTICS
CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE
BUREAU OF THE CENSUS
State File No. 89
Registrar's No. 21
1. PLACE OF DEATH:
(a) County    Snohomish
(b) City or town   Monroe
(If outside city or town limits, write RURAL)
(c) Name of hospital or institution:
No. Blakely St.
(If not in hospital or institution write street number-on-location)
(d) Length of stay: In hospital or institution
(Specify whether*
In this community (Years, months or days) 35 yrs.
2. USUAL RESIDENCE OF DECEASED:
(a) State    Wash   (b) County    Snohomish
(c) City or town        Monroe
(If outside city or town limits, write RURAL)
(d) Street No.    No Blakely St.
(If rural give location)
(c) If foreign born, how long in U.S.A.? years
3. (a) FULL NAME    MCLEAN, Ida Dillillion
3. (b) Was decedent ever a member of the Army,
Navy or Marine Corps of the
United States?   Name of organization in
which such
service was rendered:
Rank    no   Period of service
3. (c) Social
Security
Number    no
4. Sex
female
5. Color or race
white
6(a) Single, widowed, married,
divorced    widow
6. (b) Name of husband or wife
Gordon McLean
6(c) Age of husband or wife if
alive   years
7. Birth date of deceased July 7   1882
(Month)    (Day)    (Year)
8. AGE:    Years    Months    Days
64           8             0
If less than one day
hr.              min.
9. Birthplace   Gladsboro* Virginia
(City, town or county) (State or foreign country)
10. Usual occupation    House keeper
11. Industry or business
Father
12. Name    Thomas A Ayers
13. Birthplace   Virginia
(City, town or county) (State or foreign country)
Mother
14. Maiden Name    Louvina Marshall
15. Birthplace   Virginia
(City, town or county)    (State or foreign country)
16. (a) Informant's own signature    John Brashler
(b) Address    1005 Rockefeller St
17. (a)    Burial   (b) Date thereof    3-11-47
(Burial, cremation, or removal) (
Month) (Day) (Year)
(c) Place: burial or cremation    Monroe Cemetery
Purdy & Kerr
18. (a) Signature of funeral director    Cecil Kerr
(b) Address    Monroe Wash.
19. (a) Mar 13 1947    (b)    E.T. Bascom
(Date received local registrar)
(Registrar's signature)
MEDICAL CERTIFICATION
20. Date of death: Month    March        day    7
year    1947        hour    10        minute    30 pm.
21. I hereby certify that I attended the
deceased from
March 5    , 1947, to    March 7    , 1947;
that I saw her alive on    3    7    , 1947;
and that death occurred on the date and
hour stated above.
Duration
Immediate cause of death
Coronary Thrombosis
Due to    Arteriosclerosis
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physicians
Major findings:
Underline
Of operations the cause to which death
should be charged statistically
Of autopsy              .
22. If death was due to external causes,
fill in the following:
(a) Accident, suicide, or homicide (specify)
(b) Date of occurrence
(c) Where did injury occur?
(City or town)      (County)      (State)
(d) Did injury occur in or about home,
on farm, in industrial place, in
public place?
(Specify type of place)
While at work?              (e) Means of injury
23. Signature    Minard Allison MD
(M. D. or other)
Address    Monroe        Date signed    3    12   '47

Gordon Francis McLean
July 18, 1929
contributor: Richard A. McLean
Washington State Board of Health
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
Record No.    233
Registered No.    250
PLACE OF DEATH
County of    Snohomish
City or Town of    Everett
Registration Dist. No.....2...... No.....
Everett General Hospital..
(If death occurred in a
hospital or institution,
give its NAME instead of
street and number)
2. FULL NAME....Gordon Francis McLean...
(a) Residence No.. St.;
(Usual place of abode)
(b) If non-resident, give city or town,
and state....Monroe Wash.
(c) How long in
Registration Dist.     yrs.     mos. 2 ds.;
how long in U. S. if of foreign birth
yrs. mos. ds.
Personal and Statistical Particulars
3. Sex
Male
4. Color or Race
White
5. Single, Married, Widowed
or Divorced (Write the word)
Married
5. (a) If married, widowed or divorced:
Husband of    Ida Boyde*
or
Wife of
6. Date of birth
May            30           1886
(Month)        (Day)        (Year)
7. Age
43 yrs.   1   mos. 18 ds.
If less than one day
hrs.       or min.
8. Occupation of deceased:
(a) Trade, profession, or
particular kind of work    Logger
(b) General nature of industry,
business, or establishment in
which employed (or employer)
Blodell-Donovin*
(c) Name of employer
9. Birthplace (City or town) Wisconsin
(State or country)
PARENTS
10. Name of
Father    John McLean
11. Birthplace of Father
(City or town)
(State or Country)    Canada
12. Maiden name of
Mother    Elizabeth Morey*
13. Birthplace of Mother
(City or town)
(State or Country)    Canada
14. Informant    Mrs Ida McLean
Address    Monroe Wash.
15. Filed    July 2 , 1929 Berdie Rasmussen
Registrar.
Medical Certificate of Death
16. Date of death July 18, 1929
(Month)    (Day)    (Year)
17. I HEREBY CERTIFY,
That I attended deceased
from   July 16 , 1929 , to July 18 , 1929
that I last saw him alive on July 17 , 1929
and that death occurred on the date stated above,
at 5:38 Am.
(State the disease causing death, or in deaths
from violent
causes, state: (1) Means and nature of injury: and
(2) whether
ACCIDENTAL, SUICIDAL or HOMICIDAL).
The CAUSE OF DEATH was as follows:
(Primary)    Caught between logs at -
Blodell Donovin Log Camp -
Skykomish. Fracturing 3 dorsal vertebrae
severing spinal cord.
(Duration)   yrs. mos.   ds.
CONTRIBUTORY
(Secondary)
(Duration) yrs.    mos.     ds.
18. Where was disease contracted
if not at the place of death?    Skykomish
(a) Did an operation precede death?
No Date of ---
(b) Was there an autopsy?    No
(c) What test confirmed diagnosis?
Clinical
(Signed)    (unreadable)    M. D.
July 19    , 1929        Address    Everett Wash
19. Place of Burial, Cremation or    Date of Burial
Removal   July 21, 1929
I.O.O.F. Monroe
20. Undertaker Address
E.E.Purdy & Sons    Monroe
I HEREBY CERTIFY, upon honor, That I have made the
effort but was unable to secure answers to questions
(Insert numbers of unanswered questions)
Kenneth Walters
(Signature of Undertaker)

Ida Arlene M McLean
August 21, 1907
contributor: Richard A. McLean
DEATH CERTIFICATE
No.    32
00913
1. Full name of deceased,    McLean    Ida    M
2. Maiden name (If wife or widow),    ---
3. Color and sex,    White    Female
4. Race,    Caucasian
5. Occupation of deceased,    Compositor
6. Age (years, months and days),    22 yrs.    5 mo.    10 Days
7. Name of father,    John McLean
8. Birthplace of father,    New Brunswick
9. Name of mother,    Elizabeth Morrisey*
10. Birthplace of mother,    New Brunswick
11. Birthplace of deceased,    Spruce Wis
12. Date of birth of deceased,    Mar. 11-1885
13. Condition (single, married, widowed, or
divorced),    Single
14. Name of wife or husband of deceased,    ---
15. Date of death,    Aug 21-1907
16. Cause of death, Primary,    Appendicitis
Secondary,    Heart Failure from shock
17. Duration of disease,    5 Days
18. Place of death,    Oconto Falls
19. Residence at time of death,    Oconto Falls
20. Was deceased ever a U. S. soldier or sailor?    No.
21. Name of physician, coroner or justice,    H. F. Ohswaldt
22. Residence of such person,    Oconto Falls Wis.
23. Name of undertaker or other person conduct-
ing burial,    Chas. McCune
24. No. and date of burial permit,    35 - Aug 23 - 1907
25. Place of burial,    St Anthonys Cem. Oconto Falls
26. Date of certificate,    Aug 23 - 1907
27. Date of registration,    "   31 -    "
28. Other important facts not related, 90

Agnes Esther McLean McNulty
April 7, 1970
contributed by Richard A. McLean
STATE OF WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DI VISION OF HEALTH ORIGINAL CERTIFICATE OF DEATH STATE FILING DATE
APR 23 1970
   STATE DEATH NO.    '70 007179
   LOCAL FILE NUMBER
   DECEASED--NAME    First
Middle    Last
   1. AGNES   McNULTY
   SEX
   2.    Female
   DATE OF DEATH    Month Day    Year
   3.    April 7, 1970
   RACE--White, Negro, American
Indian, Etc.
   4.    White (Specify)
   Age Last Birthday Years
   5a.    93
    Under One Year Months     Days
   5b. Under One Day
    Hours   Minutes
   5c.
   DATE       Month    Day    Year
   OF BIRTH
   6.    March 29, 1877
   COUNTY OF DEATH
   7a.    Dane
   NAME OF CITY, VILLAGE
(If Neither, Name Township)
   (Location of Death)
   7b.    Madison
   Inside City or Village Limits
   7c. X Yes       No
   HOSPITAL OR OTHER
INSTITUTION--NAME
   (If Not in Either Give Street and
Number or Location)
   7d.    603 Charles Lane    (Home)
   STATE OF BIRTH
   (If Not in U.S.A., Name Country)
   8.    Wisconsin
   CITIZEN of What Country
   9.    U.S.A.
Married        Never Married
   10. X Widowed & Divorced
   SURVIVING SPOUSE
(If Wife, Give Maiden Name)
   11.    - - - - - - - - - - - -
   SOCIAL SECURITY NO.
   12.    393-14-4549
   USUAL OCCUPATION
Give Kind of Work During Most
of Working Life Even if Retired
   13a.    HOUSEWIFE
   KIND OF BUSINESS ORINDUSTRY
   13b.
   RESIDENCE: STATE
   14a.    Wisconsin
   COUNTY
   14b.    Dane
   NAME OF CITY, VILLAGE
   (If Neither, Name Township)
   14c.    Madison
   Inside City or Village Limits
   14d. X Yes     No
   MAILING ADDRESS (Home
Address at Time of Death)
   14e.    603 Charles Lane
   FATHER--NAME    First
Middle    Last
   15. Mac Lean*
   MOTHER--MAIDEN NAME
First    Middle    Last
   16. ELIZABETH       MORRISSEY
   INFORMANT--NAME
   17a.    Mrs. N. A. Herald
   MAILING ADDRESS    Street or
R.F.D. No.
City or Village State    Zip
   17b.    603 Charles La. Madison,Wis.
   WAS DECEASED EVER IN U.S.
ARMED FORCES?
(If Yes, Give War or Dates of Service)
   17c.          Yes XX No
Unknown
   18. PART I    DEATH WAS
CAUSED BY -
Enter Only One Cause Per Line
For (A),
         (B), and (C)
   Conditions, If Any,
   Which Gave Rise to
   Immediate Cause (A)
   Stating the Under-
   Lying Cause Last.
   Approximate Interval Between
Onset and Death
   A. Immediate Cause:
Cerebral Thrombosis      minutes
       Due to, or as a
   B. Consequence of:
Cerebral Arteriosclerosis 2 yrs
       Due to, or as a
   C. Consequence of:
         PART II    OTHER
SIGNIFICANT CONDITIONS:
Conditions Contributing to Death but not Related to Cause Given in
Part I (A)
         Generalized
Arteriosclerosis.
   AUTOPSY (Specify)
   19a.       Yes X No
   WERE FINDINGS CONSIDERED IN DETERMINING CAUSE OF DEATH?
   19b. Yes   No
& ACCIDENT SUICIDE
   20a.       HOMICIDE
   DATE OF    Month    Day    Year
   INJURY
   20b.
    Hour   M.
   20c.
   HOW INJURY OCCURRED
(Enter Nature of Injury in Part I
or Part II, Item 18)
   20d.
   INJURY AT WORK
; Yes           No
   20e.
   PLACE OF INJURY (Home, Farm, Street, Factory, Etc.
   20f.   (Specify)
   LOCATION
Street or R.F.D. No. City or
Village    State    Zip
   20g. CERTIFICATION--Month    Day Year
   PHYSICIAN
   I Attended The   Deceased From    7-11-69
   21a. To   Month   Day   Year
   21b.     4-7-70
     AND LAST SAW HIM/HER ALIVE ON
Month   Day Year
   21c.      1-15-70
   DID YOU VIEW THE
   BODY AFTER DEATH
   21d.      X Yes         No
   DEATH OCCURRED    At The Place, on The   (Hour) Date, and, To The Best To The Cause(s) Stated.
   21e.       7 15 PM.
   CERTIFICATION--MEDICAL
EXAMINER OR CORONER:
\On The Basis of The
Examination of The Body and/or The Investigation, In My Opinion, Death Occurred on
The Date and Due To The Cause(s) Stated.
HOUR OF DEATH
   22a.   M.
   THE DECEDENT WAS
PRONOUNCED DEAD
     Month   Day Year Hour
   22b.    M.
   CERTIFIER--NAME (Type or Print)
   23a.    Wm. P. Crowley, Jr.M.D.
   SIGNATURE--CERTIFIER Title
   23b.    Wm P. Crowley, Jr, MD.
   DATE SIGNED    Month    Day Year
   23c.    April 8, 1970
   MAILING ADDRESS--CERTIFIER
   Street or R.F.D. No.    City or
Village    State    Zip
   23d.    20 S Park St.
Madison,    Wisconsin    53715
        X BURIAL CREMATION
   24a.         REMOVAL
   CEMETERY OR CREMATORY--NAME
   24b.    CATHOLIC CEMETERY
   LOCATION    City    State
   24c.    OCONTO, WISCONSIN
   BURIAL--DATE    Month    Day Year
   24d.    April 10, 1970
   FUNERAL HOME--NAME AND ADDRESS
   Street or R.F.D. No.    City or
Village    State    Zip
   25a.    PINKART FUNERAL HOME
553 MAIN ST OCONTO WIS 54153
   FUNERAL DIRECTOR--SIGNATURE
   25b.    RPinkart
   REGISTRAR--SIGNATURE
   26a.    Harold K. Hill.
   DATE RECEIVED By Local
Registrar
   Month    Day Year
   26b.    4-21-70

HAZEL MARION McLEAN SINNETT
May 16, 1970
contributor: Richard A. McLean
STATE OF OREGON--STATE BOARD OF HEALTH
Vital Statistics Section
CERTIFICATE OF DEATH 70-007711
State File Number 2762
Local File Number
DECEASED--NAME    First    Middle    Last
1.    HAZEL MARION SINNETT
DATE OF DEATH (month, day, year)
2.    May 16, 1970
RACE White, Negro, American Indian,
etc. (specify)
3.    White
SEX
4.    Female
AGE--Last
birthday (years)
5a.    77
Under 1 year mos.     days
5b. Under 1 day hours    min.
5c. DATE OF BIRTH (month, day, year)
6.    November 27, 1892
COUNTY OF DEATH
7a. Multnomah CITY, TOWN, OR LOCATION OF DEATH
7b.    Portland Inside City Limits
(specify yes or no)
7c.    Yes
HOSPITAL OR OTHER INSTITUTION-NAME
(if not in either, give street and number)
7d.    Providence Hospital
STATE OF BIRTH
(If not in U.S.A., name country)
8.    Wisconsin
CITIZEN OF WHAT COUNTRY
9.    U.S.
MARRIED, NEVER MARRIED,
WIDOWED, DIVORCED (specify)
10.    Married
NAME OF SPOUSE
11.    Otis Sinnett
SOCIAL SECURITY NUMBER
12.    544-07-7871
USUAL OCCUPATION (give kind of work done during
most of working life, even if retired)
13a.    Housewife
KIND OF BUSINESS OR INDUSTRY
13b.    Own Home
RESIDENCE--STATE
14a.    Oregon
COUNTY
14b.    Multnomah
CITY, TOWN, OR LOCATION
14c.    Portland
Inside City Limits
(specify yes or no)
14d.    Yes
STREET AND NUMBER OR R.F.D.
14e.    8101 S.E. Wing St.
FATHER--NAME    first    middle    last
15.    John McLean
MOTHER--Maiden Name    first    middle    last
16.    Elizabeth (Unknown)
INFORMANT--NAME and relationship to deceased
17.    Otis Sinnett - Husband
PART I. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR
(a), (b), and (c))
18. Conditions, if any, which gave rise to immediate cause (a), stating the unde lying cause last approximate interval mmediate caus between onset and death
(a)    Myocardial decompensation, chronic severe
8 years due to, or as a consequence of: over
(b)     Arteriosclerotic heart disease   4 years
due to, or as a consequence of:
(c)
PART II. OTHER SIGNIFICANT CONDITIONS: conditions contributing to death
but not related to cause in Part I (a)
Idiopathic thrombocytopenic purpura
AUTOPSY
(yes or no)
19a.    No
If YES were findings considered
in determining cause of death
19b.
ACCIDENT
(specify yes or no)
20a.
DATE OF INJURY
(month, day, year)
20b.
HOUR
20c.     M.
HOW INJURY OCCURRED (enter nature of injury in Part I or Part II, item 18)
20d.
INJURY AT WORK
(specify yes or no)
20e.
PLACE OF INJURY at home, farm, street, factory,
office bldg., etc. (specify)
20f.
LOCATION (street or R.F.D. No., city or town, county, state)
20g.
CERTIFICATION--    month    day    year
PHYSICIAN: I attended the deceased from    Feb. 18, 1969
21.   TO month    day    year
May 16, 1970
And Last Saw Him/Her Alive
on:    month    day    year
May 15, 1970
I Did/Did Not iew the body after death (specify)
Did not
DEATH OCCURRED at the place, on the
(hour) date, and, to the best of my knowledge, due to the 6:55 P:M.    cause(s) stated.
PHYSICIAN--SIGNATURE
22a.    D J Molenkamp
NAME (type or print)   degree or Title
22b.    D. J. Molenkamp     M. D.
DATE SIGNED (month, day, year)
22c.    May 20, 1970
MAILING ADDRESS--PHYSICIAN        street        city or town        state        zip
23.    9501 S. E. Foster Rd.    Portland, Oregon    97266
BURIAL, CREMATION, REMOVAL,
MAUS. (specify)
24a.    Burial
CEMETERY OR CREMATORY--NAME
24b.    Gethsemani
LOCATION        city or town        state
24c.    Portland    Oregon
DATE (mo., day, year)
24d.    5-19-70
FUNERAL DIRECTOR-SIGNATURE
25a.    (unreadable)
FUNERAL HOME--NAME AND ADDRESS (street, city or town, state, zip)
25b.    Cascade Funeral Chapel, 9106 S.E.Foster Rd. Portland, Oregon 97266
REGISTRAR--SIGNATURE
26a.    (unreadable) DATE RECEIVED BY LOCAL REGISTRAR
26b.    MAY 25, 1970 DATE RECEIVED BY STATE REGISTRAR
27.    JUN 1 1970 RESERVED FOR REGISTRAR'S USE
28.

Thomas James McNulty, Jr.
December 18, 1923
contributor: Richard A. McLean
STATE OF WISCONSIN
Department of Health--
Bureau of Vital Statistics
ORIGINAL CERTIFICATE OF
DEATH
   Registered No. 4
           1 PLACE OF DEATH
   County    Oconto
   Township    Townsend
           or
   Village .......................
           or
   City ............................
(No........................St.,............Ward)

(If death occurred in a hospital
or institution give its NAME
   instead of street and number.)
   2 FULL NAME    Thomas
McNulty
          (a) Residence. No.......
St.,..Ward. .......................
           (Usual place of abode)
(If nonresident give city or town
and state)
   Length of residence in city
or town where death occurred
yrs.     mos.     ds.
   How long in U. S., if of foreign
birth?     yrs.     mos.     ds.
   PERSONAL AND STATISTICAL
PARTICULARS
   3 SEX
      M.
   4 COLOR OR RACE
      W.
   5 SINGLE, MARRIED,
WIDOWED
      OR DIVORCED (Write the
word)
      Single
   5a If married, widowed, or
divorced
        HUSBAND of
        (or) WIFE of

   6 DATE OF BIRTH (month, day
and year)    March 6-1904
   7 AGE    Years    Months    Days
         19       12
      If LESS than 1
      day, .........hrs.
      or ............min.
   8 OCCUPATION
      (a) Trade, profession, or
      particular kind of work.
Day Laborer
      (b) General nature of industry,

      business, or establishment in
      which employed or
(employer)
   9 BIRTH PLACE
   (State or country)
      Wisconsin
   PARENTS
   10 NAME OF
       FATHER    Thomas McNulty
   11 BIRTHPLACE
       OF FATHER
   (State or country)
Massachuttes*
   12 MAIDEN NAME
        OF MOTHER    Agnes
McLean.
   13 BIRTHPLACE
       OF MOTHER
   (State or country)    Wisconsin
   14 THE ABOVE IS TRUE TO
THE BEST OF MY KNOWLEDGE
(Informant)    Thomas McNulty.
(Address)    Oconto Wis.
   15 Filed   Dec. 19    , 1923
M L Boland REGISTRAR Filed
Dec. 19    , 1923   C.W. Stoelting
   SUB-REGISTRAR
   MEDICAL CERTIFICATE OF
DEATH
   16 DATE OF DEATH    Dec 18,
1923
    (Month)    (Day)    (Year)
   17 I HEREBY CERTIFY, That I
attended deceased from
   .................................., 19........,
to................................, 19........
   that I last saw h............ alive
on............. 19........
and that death occurred on the
date stated above, at 145 P.M.
   The CAUSE OF DEATH* was as
follows:
   By falling tree striking
   and crushing skull
(Duration)        yrs.       mos.
dys.
   Contributory
   (SECONDARY)
       (Duration)        yrs. mos.
dys.
   18 Where was disease
contracted if not at place of
death? Did an operation precede
death?
Date of
   Was there an autopsy?
   What test confirmed
diagnosis?
   (Signed)    Clyde M Davis , M.
D.Coroner
   ......., 19.......... (Address)
...................
* State the disease causing
death, or in deaths from
VIOLENT CAUSES
   state (1) means and nature of
injury; and
(2) whether accidental, suicidal
or homicidal. (See reverse side
for additional space.)
   19 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL
        Cath Cem    12-21 1923
        Oconto Wis
   20 UNDERTAKER   ADDRESS
        N.J. Gagnon   Oconto Wis

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