Date: APR 17 2007

I certify that this is a true copy of the certificate received for record at the Middletown Health Department in Middletown, Connecticut

ATTEST: /s/ Lydia D. Guere
Lydia D. Guere
Assistant Registrar of Vital Statistics
Middletown, CT

{Document bears embossed seal of Middletown CT Registrar of Vital Statistics.}

Not valid without seal of Registrar of Vital Statistics. Any alteration to this copy renders it void.

This Certificate Received For Record On The 8th Day of November 1912

State of Connecticut Bureau of Vital Statistics

Medical Certificate of Death

  1. Full name of deceased Mary Ashton
  2. Primary cause of death Cerebral Hemmorage
  3. Duration 5 Mo
  4. Secondary or contributory Hepatitis
  5. Duration 3 Mo

Remarks _____________

I hereby Certify that I attended the deceased in her last illness, and that the cause of death was as above stated.

Signature Thos. P. Walsh M.D.

Dated {illegible month and day} 1912

Address 569 Main St.

Undertaker's Certificate Personal and Statistical

  1. Full name of deceased Mary Ashton
  2. Place of death—Town Middletown No. 35 Grand Street _____ Ward
  3. Number of families in house One
  4. Residence at time of death Middletown Conn
  5. Occupation None
  6. Condition (sate whether single, married, divorced or widowed) Widow
  7. If wife or widow, give name of husband Patrick Ashton
  8. Date of death—year 1912, month 11 November, day 6
  9. Date of birth—year 1838, month _______, day ________
  10. Age 74 years, _______ months, _______ days
  11. Sex Female
  12. Color White
  13. Birthplace—Town Queens County State or Country Ireland
  14. Father's name in full Patrick McEvoy
  15. Father's birthplace—Town Queens County State or Country Ireland
  16. Mother's maiden name Do Not Know
  17. Mother's birthplace—Town ____________ State or Country ________
  18. Place of burial Middletown Cemetery St. John's
  19. Name of informant T. W. O'Keefe Jr. Address M'town
  20. Was body embalmed Yes If so name of embalmer R. Fage Newton {hard to read emblamer's name} License No. 628
  21. Signature of Undertaker [or person in charge]. T. W. O'Keefe Address Middletown Ct

Statement of transcriber

I, Gerard Ashton, great-great-grandson of the deceased, have transcribed this from a photocopy which I ordered from the Middletown CT Registrar of Vital Statistics, and I have converted it from paper to HTML, this 19th day of April, 2007. Material within curly braces are my transcriber's notes.

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