Standard Certificate of Death
Place of Death: Montague (Farren Hospital)
Name: Nellie A. Burgess
Maiden Name / Husband: Nellie A. Atwood / George N. Burgess
Residence: Athol, Mass 1017 Chestnut St.
Sex: Female; Color: W; Condition: Widowed
Date of Birth: Dec 14 1850 [sic]
Age: 62 y. 1 m. 17 d.
Occupation: Hat Trimmer / Forelady
Birthplace: Warwick Mass
Father: Sylvanus S. [sic] Atwood
Birthplace of Father: Barre Mass
Mother: Harriet King
Birthplace of Mother: Barre Mass
Informant: Wilfred S. parker / 688 Hopgood Road
Date of Death: Jan 31 1913
Cause: Valvular Heart disease / Surgical Shock / Appendicitis & carcinoma of uterus
Place of Burial: Warwick Cem / Warwick Mass; Date of Burial: Feb 3 1913