Standard Certificate of Death
Place of Death: Taunton, Mass. (State Hospital)
Name: Mary A. Smith
Maiden Name/Husband: Mary A. Greed [sic] / William F. Smith
Residence: Leominster, Mass.
Sex: Female; Color: White: Condition: Widowed
Date of Birth: ? ? 1851
Age: 65 y. ? m. ? d.
Occupation: None
Birthplace: Warwick, Mass.
Father: Ivers Creed
Birthplace: Fitchburg, Mass.
Mother: Unknown
Birthplace: Unknown
Informant: Mrs. Delias A. Lear / Leominster, Mass.
Date of Death: Oct. 6, 1916
Cause: Broncho-pneumonia
Place of burial: Evergreen Cemetery; Date of Burial: Oct. 8, 1916
[Duplicate certificate [2]:
Place of Death: Taunton, Mass (State Hospital)
Name: Mary A. Smith
Maiden Name/Husband: Mary A. Green, husband unknown
Residece: 47 Hammond St. Providence, R.I.
Sex: f; Color: W; Condition: widow
Age: about 65
Occupation: Domestic
Birthplace: Massachusetts
Father: Ivers Green
Birthplace: Massachusetts
Mother: Nancy Dodge
Birthplace: Massachusetts
Informant: Hospital Records / Taungton, Mass.
Date of Death: Oct. 6, 1916
Cause: Broncho-pneumonia / General arterio-sclerosis & involution psychosis
Place of Burial: Leominster, Mass. / Evergreen Cem.; Date of Burial Oct. --, 1916]
