RHODE ISLAND PUBLIC HEALTH COMMISSION

CERTIFICATE OF DEATH

1. Place of Death: Providence R. I., 168 Wood Street

2. FULL NAME: Adelard Paquette

War Record: None

Residence: 168 Wood Street, Providence, R.I.

3. SEX: Male

4. RACE: White

5 STATUS: Widower

5a. If married (if wife, FULL MAIDEN name): ~~Katherine~~ Kate Murphy

6. DATE OF BIRTH: June 14-1871

7. AGE 69 years 0 Months 2 days

OCCUPATION:

8. Trade: Weaver (in)

9. Industry: Worsted Mills

10. Date last worked: June 1931

11. Total time (years) in this occupation: 32

12. BIRTHPLACE: Quebec Canada

13. FATHER: Louis Paquette

14. Birthplace: Quebec, Canada

15 MOTHER: MAIDEN NAME: Angelique ~~Angelina~~ Paquette

16. Birthplace: Quebec Canada

17 INFORMANT: Thomas Paquette (168 Wood Street) RELATION: Son

18 BURIAL in CRANSTON, R.I. at St. Ann's

MEDICAL

21. DATE OF DEATH: Jun 16, 1940

22. Condition: Diabetes, Myocardia,