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221
Register of Deaths
in the City of Watertown, County of Jefferson, State of New York
Registered No.: 247
No.: Mercy Hospital
(If death occurred in a hospital or institution, give its NAME instead of street and number)
St.:
Ward:
2. Full name: Anthony Webert
3. Residence (Usual place of abode) No.:
St.,:
Ward, City or Village:
State: N.Y.
County: Jefferson
Town: Hounsfield
Is residence within limits of city or incorporated village?: No
4. Length of residence in district where death occurred:
Years:
Months: 1
Days: 21
5. How long in U.S., if of foreign birth?
Years: 53
Months:
Days:
PERSONAL AND STATISTICAL PARTICULARS
6. Sex: Male
7. Color or Race: white
8. Single, Married, Widowed, or Divorced (write the word): widowed
8a. If married, widowed or divorced
Husband of (or) Wife of: Eva Biggers
9. Date of Birth (month, day, year): April 11, 1875
10. Age:
Years: 64
Months:
Days: 19
OCCUPATION
11. Trade, profession, or paticular kind of work done, as spinner, sawer, bookkeeper, etc.: retired farmer
12. Industry or business in which work was done, as silk mill, sawmill, bank, etc.: farm
13. Date deceased last worked at this occupation (month and year): Dec. 1938
14. Total time (years) spent in this occupation: 40 yrs.
15. BIRTHPLACE (City or Town)
(State or Country): Germany
FATHER
16. Name: Phillip Webert
17. Birthplace: (City or Town)
(State or Country): Germany
MOTHER
18. Maiden Name: Elizabeth Stienmuler
19. Birthplace:(City or Town)
(State or Country): Germany
20. The above is trueto the best of my knowledge:
(Signature of informant) Caroline Webert
(Address) Watertown, N.Y.
21. Place of burial, cremation or removal: Glenwood, Watertown, N.Y.
Date of Burial: May 3rd, 1939
22. Undertaker (License No.) 4730
W. P. Cummings
Address: Watertown, N.Y.
23. Filed: 5/2, 1939
E. Pound, Registrar
MEDICAL CERTIFICATE OF DEATH
24. Date of Death: (month, day, year): April 30, 1939
25. I HEREBY CERTIFY, that I attended deceased from March, 1939, to April 30, 1939. I last saw him alive on April 30, 1939. To the best of my knowledge, death occurred on the date stated above, at 11 P.M.
CAUSE OF DEATH
Strep pneumococ blood stream
CONTRIBUTORY CAUSES
(a) no fiction
(b)
(c) pneumonia both lungs
(d) Bronchial type about 5 weeks
26. Where was disease contracted, or injury sustained?:
27. Name of operation, if any:
Date:
Condition for which performed:
Organ or part affected:
28. What laboratory test assisted diagnosis?: usual
29. Was there an autopsy?: no
(Signed) H. L. Smith
May 1, 1939 (Address) Watertown, N.Y.
Burial or Transit: Permit Issued By: E. Pound
Date of Issue: 5/2/39 |
