USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1917-1918 > Part 37
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County ....
Middlery
Registered No. 36
Township
... or Village.
Vynasboro Road
St ..
Ward
(If death oecarred in « hospital or institution give its NAME instead of street and number)
2 FULL NAME
Elisabeth Verla rickles
Ward.
(If non-resident give city or town and State)
Leogtb of residence in city or towo where death occorred
years
months
days.
How long io U. S., if of foreigo birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Vingler
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH (month, day, and year)
Dev. 11.1917
7 AGE
Years
Months
Days
1\27
If LESS thao I day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or particular kind of work
-
(b) General nature of industry, business, or establishment in which employed (or employer) ... (c) Name of employer
9 BIRTHPLACE (eity or town)
With Cheliosford
(State or country) Mass
PARENTS
10 NAME OF FATHE Steffen N. Tregles
11 BIRTHPLACE OF FATHER (eity or town) ... carlisle
(State or country) mars
12 MAIDEN NAME OF MOTHER Ellen Tina
13 BIRTHPLACE OF MOTHER (city or town) ... (State or country) Theland
State Youth Cheleus ford ..... or
City
No.
(a) Residence.
No Vylegaber Forth Cheluitings
(Usual place of (bode)/
MARGIN RESERVED FOR BINDING
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of oceupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive cngincer, Civil engineer, Stationary fireman, ctc. But in many cases, especially in industrial employments, it is neecssary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobilc factory. ~ The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- eifieally the occupations of persons engaged in domestic serviee for wages, as Servant, Cook, Housemaid, etc. If the oeeupation has been changed or given up on aeeount of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that faet may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no oceupation whatever, write None.
Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affeetion with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, etc., of.
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affeetion need not be stated unless important. Example: Measles (disease causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," ""Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of hcad - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, ctc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under eireumstances unknown, as A person found dead, ete.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS
BY
PHYSICIAN.
R 15. 1-'18. 100,000.
7 AGE PARENTS of certificate. 15 N. B. - WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, 16
The Commmuralth of Massachusetts STANDARD CERTIFICATE OF DEATH
115 Chelmsford (City or town) ....
1 PLACE OF DEATH
County .......
Middlesex
Township
Chelmsford
or Village.
.. or
St.,
.Ward
(If death occurred in a hospital or institution, give its NAME instead of strect and number)
2 FULL NAME
arthur Gordon Ellier
(a) Residence. No. Minim Ss.
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days.
How long in U. S., if of foreign birtb ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Sing 6
5a If married, widowed, or divorced HUSBAND of (or) WIFE of
6 DATE OF BIRTH (month, day, and ycar)
aug 30,1901
Days
16
16 DATE OF DEATH (month, day, and year) Aug. 16, 2018,
17
I HEREBY CERTIFY, That I attended deceased from
may
, 1918 to Lina, 16, 1918.
.
that I last few h MMM alive on
and. 15, 1918.
and that death occurred, on the date stated above, at
The CAUSE OF DEATH* was as follows :
If LESS than 1 day, ........ hrs. or ........ min. Drobaley mellitus -
8 OCCUPATION OF DECEASED
(a) Trade, profession, or particular kiod of work student
(b) General nature of industry, business, or establisbmneot in which employed (or employer) ... (c) Name of employer
9 BIRTHPLACE (city or town).
Chelmsford
(State or country)
10 NAME OF FATHER Chas. HElene
11 BIRTHPLACE OF FATHER (city or town).
(State or country) Rochdale Eng.
12 MAIDEN NAME OF MOTHER mabel & Oliver
13 BIRTHPLACE OF MOTHER (city or town) ..
(State or country)
Marchitill
14 Chao H Ellison
Informant .....
(Address)
Chelateral
Aug 19, 1918/2 devard J. Roffing
REGISTRAR
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
WWW, Date of.
-
Was there an autopsy ?.
no.
What test confirmed diagnosis ?.
Mime texts
(Signed)
Autun G. Scolaria
M.D.
* State the DISEASE CAUSING DEATH, or In deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (Sce reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Pine Ridge Com
DATE OF BURIAL Cluq 19:98
20 UNDERTAKER Walter to
ADDRESS
Chelmsford
about 3
(duration)
... yrs ...
mos ..
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
... yrs .....
.. mos ..
ds.
State
mass
.Registered No.
57
City
No.
St., ...
Ward.
(If non-resident give city or town and State)
MEDICAL CERTIFICATE OF DEATH
9:15.
....
Years
Months
11
MARGIN RESERVED FOR BINDING
Filed.
0
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
{Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive enginecr, Civil engincer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager,' "Dealer," etc., without more precise specification, as Day laborer, Farm laborcr, Laborer -Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housckeepcrs who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At homc. Carc should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Houscmaid, etc. It the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indi- catcd thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death. - Namc, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fevcr (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meningcs, peri- toneum, etc., Carcinoma, Sarcoma, etc., of_
(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronie valvular heart disease; Chronie interstitial nephritis, etc. The contributory (secondary or inter- current) affection necd not be stated unless important. Example: Measles (discase causing death), 29 &s .; Broneho- pneumonia (secondary), 10 ds. Never report merc symp- toms or terminal conditions, such as "Asthenia," "Ancmia" (merely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," "Debility" (“Con- etc.), genital," "Senile," " Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably such, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Rcvolver wound of head - nomicide; Poisoncd by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may bc stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under circumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
4 PHYSICIAN.
R 15. 1-'18. 100,000.
N. B. - WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,
-
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County.
Midere
State
mass.
· Township
Chelmsford
City
No.
or Village ...
Town Farm
St.,.
Ward
(If death oeenrred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Squire Wilson
(a) Residence Chelmsford
St.,
„Ward.
(Usual place of abode) Length of residence io city or town where death occurred years
months
days.
How long in U. S., if of foreign hirth ?
years
mooths
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
medwed
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH (month, day, and year) Bre 291833
7 AGE 84 Years
7 Months
6 Days
If LESS than 1 day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, profession, or particular kind of work. Inmate
(b) General oature of industry, business, or establishment in which employed (or employer) .. (c) Name of employer
9 BIRTHPLACE (city or town).
England
(State or country)
10 NAME OF FATHER Wilson
PARENTS
11 BIRTHPLACE OF FATHER (eity or town) (State or country)
12 MAIDEN NAME OF MOTHER
13 BIRTHPLACE OF MOTHER (city or town) ~ (State or country)
14 Mr Burnham Supt
Informant ..
(Address)
Filed aug 26, 1918 Edward&, Robbins
REGISTRAR
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
nest Cemetery
DATE OF BURIAL aug 26 1918
20 UNDERTAKER
w.Pe
han
ADDRESS
Chelmsford
MARGIN RESERVED FOR BINDING
of certificate.
15
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?
Date of ..
Was there an autopsy ?.
What test confirmed diagnosis ?
(Signed)
un 24917 (Address) Nevet Chaquefind
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
116 Chelmsford (City or town)
58
Registered No ..
.or
(If non-resident give eity or town and State)
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year)
lug 2 4 1918
/
17 I HEREBY CERTIFY, That I attended deceased from
19.
to
.... , 19 ..
that I last saw h
alive on
.19
and that death occurred, on the date stated above, at ..
10.
.. m.
The CAUSE OF DEATH* was as follows :
Senility
1
.(duration).
yrs ..
mos.
ds.
CONTRIBUTORY (SECONDARY)
.. (duration)
........ yrs ...
.. mos ..
ds.
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. . As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. It the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indi- eated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
Statement of cause of death .-- Name, first, the DISEASE CAUSING DEATH (the primary affeetion with respect to time and eausation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, etc., Carcinoma, Sarcoma, ete., of.
(name origin; "Cancer" is less definite; avoid usc of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular hcart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- eurrent) affeetion need not be stated unless important. Example: Measles (disease eausing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia,"
" Anemia" (merely symptomatie), "Atrophy," J." "Col- lapse," "Coma," "Convulsions," "Debility" ("Con-
genital,"
"Senile,"
etc.),
"Dropsy,"
"Exhaustion,"
"Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "Weakness," ete., when a definite disease can be ascertained as the eause. Always qualify all diseases resulting from ehild- birth or misearriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, or HOMICIDAL, or as probably sueh, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - nomicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated
under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)
Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following conditions must be referred to the Medical Examiners:
1. Deaths following injury or violence, as Burns, Falls, Drowning, Gas poisoning, Suicide, Homicide, etc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.
3. Sudden deaths of persons not disabled by recognized disease, as A death upon the street, or one supposed to be due to Alcoholism, etc.
4. Deaths under eircumstances unknown, as A person found dead, etc.
ADDITIONAL SPACE
FOR FURTHER STATEMENTS BY
PHYSICIAN.
R 15. 1-'18. 100,000.
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be of certificate.
The Commomuralth of Massachusetts
STANDARD CERTIFICATE OF DEATH
Chelunsford Maso (SKy or towny ....
1 PLACE OF DEATH
County ..
Meddling
State.
Bass
Registered No. 59
Township
.. or Village ....
Chelice ford
... or
City
No ..
... ,
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(a) Residence.
No. Frtweetin St. Forth Chelev St.
Ward.
(If non-resident give city or town and State)
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
days.
How long in U. S., if of foreign hirth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
198
3 SEX
Female
4 COLOR OR RACE
That
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Benjamin
Valentine
that I last saw h
........ alive on
Il. 3
1915
and that death occurred, on the date stated above, at ..
5 30 9.
m .
The CAUSE OF DEATH* was as follows :
If LESS than 1 day, ........ hrs. or ........ min. Canciones y stomach
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
at Hos
(b) General nature of industry, business, or establishment in which employed (or employer) (c) Name of employer
CONTRIBUTORY ...
(SECONDARY)
(duration)
.yrs ..
.mos.
ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death?
„Date of.
Was there an autopsy ?
no
What test confirmed diagnosis ?
(Signed).
Ford Warney
MI.D.
21.4. 19/ 8(Address) North Chilintest This
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Xf. Galmy Country
DATE OF BURIAL Vist 7 1918
15
Filed Self. 5 1918 Edward . Batting
REGISTRAR
16 DATE OF DEATH (month, day, and year)
Seft. 4
17 I HEREBY CERTIFY, That I attended deceased from 1918 to Ref. 4 , 198
6 DATE OF BIRTH (month, day, and year)
IF58
7 AGE
Years
Months
Days
60
-
9 BIRTHPLACE (city or town)
Buffala
(State or country)
hw Gory
10 NAME OF FATHER Whowas Vita quell
PARENTS
11 BIRTHPLACE OF FATHER (city or town). (State or country)
Ruland
12 MAIDEN NAME OF MOTHER Elizabeth Trung
13 BIRTHPLACE OF MOTHER (city(or tewn) ... (State or country)
14
Clara Valentine Daughter
Informant
(Address Princeton St. Forth Cheles ford
20 UNDERTAKER,
Raven N. O Donnell
ADDRESS 324 Harset Up.
MARGIN RESERVED FOR BINDING
(duration)
2
.mos.
ds.
.yrs ...
St.,
Ward
Mary t
Valentine
REVISED UNITED STATES, TANDARE CERTIFICATE OF DEATH
Statement of occupation. - Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compos- itor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spc- cifically the occupations of persons engaged in domestic service for wages, as Scrvant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indi- cated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.
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