USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 4
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11. Name of Father, Edwin a, Carney
12. Name of Mother, . Nellie , Carney 13. Birthplace of Father, . Rschonand marine Gael Bolon mars
14. Birthplace of Mother, .
15. Place of Interment. Winthrop Town Cemetery Len Harmane Lay Ar
Signature of Undertaker or other person makin !!
Summer Floyd)
the Return, .
DATED at. Northrop , On
1881
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
August 1el 1881 Alice m, Barney
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof- or report these facts-to said 1 Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
any 1ª 1851
PHYSICIAN'S CERTIFICATE.
ime of Deceased,*
te and Place of Death, - died at.
mole Alice M. Carney 2. 1.
187.,
isease or Cause of Death, - of
Ar Dura Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
me and Residence of Certifying Physician
Date of Certificate,
187
* (): Sex of Infant (not mamed).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Fill out in ink.
When married, erase "single" and "widow"; when widowed, erase "single" and "married."
RETURN OF DEATH TO THE CITY REGISTRAR. CITY HALL, BOSTON.
7
75
Date of Death,
2
Name,
anne
Melleay
Color, + While-
Age
years
8
month days
Place of Death ?
Sea side Home Withup WARD
Street and No.
Residence,
Boston
Sex, From Single,
Married
Occupation,
Wife of
Birthplace,
Boston
Widow of
Name of Father,
Unk nun
Name of Mother,
mary
melleay
Birthplace of Father,
Birthplace of Mother, *
Bastion
Cause of ) Primary,
Duration,
Death
Secondary,
Duration,
Place of Interment,
134 Central Samma Boston
Date of Interment or Removal,
, Jang
Undertaker or Informant,
Loeuro
*Insert Town and State.
#State whether white or black.
1887.
12
SWIS JONES & 905, UNDERTAKERS, 50 La Grange St, Boston.
Boston, ang.
15 1881.
This Certifies, That annie Millean
died on the
7% 8 months,
day of any. 1881, agd .... -- years,
days.
CAUSE OF )
Primary,. Cholera Infantuna Duration
DEATH. Secondary, Duration
Benj. J. Blanchard Physician.
1871
Commonwealth of Massachusetts.
No. 9 RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Age,
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence, ·
8. Place of Death,
9. Occupation, .
Winthrop S. Winthrop Antropo DE. Winthrop
10. Place of Birth, . Winthrop
11. Name of Father,
Emma Belcher
Winthrop mare
13. Birthplace of Father, . . claveworth England)
14. Birthplace of Mother, .
15. Place of Interment, Anthropo o Jour bemelorig
Signature of Undertaker
makin !! Summer Floyd)
the Return,
DATED at.
, on August 12 18:81.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
0 Auquel 11 "1881 Gallie A. Belcher elcher
ofirmale While.
Years, ... 3 Months, 19 Days. Cholera Entantum
Belcher
12. Name of Mother, .
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, withont the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTIWITH GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased, . . /.
1
Date and Place of Death, .
Winthrop Heaps
Disease, or Cause of Death,
First or Primary,
Chaleur instantes
Duration of * 20 temas
Secondary, .
Duration of, 37 trommes
I certify that the above is a true Return, to the best of my recollection and belief.
Name, Professional Title, and Residence,
Dated at.
1881.
[Be very particular to fill all Blanks.]
* Reckoned to the time of death.
..
. . .. . . . . . . .
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. ]
The attending Physician is requested to make out his Certifieate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTII.
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),'
august 12 Walter a Kerry
3. Sex, and whether single, Married, or Widowed,
Ziale
While
4. Color, t .
.... Years, ..
5 Months,
././.Days.
6. Disease or | First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residenee, .
8. Place of Death,
9. Occupation,
Cart / Bortas
1 022
Sea Shore Herr
...
10. Place of Birth, Carl Portón
11. Name of Father,
Walter IN Jerry
12. Name of Mother, .
11
13. Birthplace of Father,
14. Birthplace of Mother, ·
Clubea
15. Place of Interment, . 11/11.200
Signature of Undertaker or other person making the Return, .
Warrows
rowerz.
DATED at ..
C
.. , on
12th Que
18751
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Parlons
5. Age,
The Undertaker, or other informant, is requested to report the facts - together with the Physician's Certificate of the Causes of Death - to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided,) having first been obtained, the person having charge of such Interment must FORTHWITHI GIVE NOTICE thereof- or report these facts - to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased,
Wallin Ce Perry
Date and Place of Death, .
Cuquil 12
Disease, or Cause of Death, Secondary, .
First or Primary,
Cholera Infantuna Duratio five days.
Duration of,
I certify that the above is a true Return, to the best of my recollection and belief.
Name, Professional Title, and Residence, ...
Benj. S. 13 larichard
Dated at ......
Wirthun
1881.
[Be very particular to fill all Blanke.]
· Reckoned to the time of death.
Any Physician having attended a person during his last iliness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1839.]
The attending Physician is requested to make out his Certificate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTH.
-
1
No. 10
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
Augus +13 " 1881 Sophia P. Willie
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Age, .
female (Vidow) While. 87 Years Months. . . Days.
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
For Main & Pleasant Ste Ministro
8. Place of Death,
Cor Main + Reacant OR Winthrop
9. Occupation, .
10. Place of Birth, . (Balon mars,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father. .
14. Birthplace of Mother, .
15. Place of Interment,
Mount Autumn Cemetery Cambridge Mare
Signature of Undertaker orother person making the Return,
Summer efloyd
DATED at. Minitrope
, (1] Aluguel 13 1881.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
Ane Co 11-12-13-14 .- Unknown.
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHIWITHI GIVE NOTICE thereof - or report these facts -to said Clerk. Peualty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
188/
(2777
mykt PHYSICIAN'S CERTIFICATE.
Name of Deceased,* Sophia ), Hill's. died at~
Date and Place of Death,
- Cor Main + Pleasant Sle August 13 81
Disease or Cause of Death, - of
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Fancel Hyall, lift ,
Date of Certificate, . Ceux 19th 1881.
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
>Fill out in ink.
When married, erase "single" and "widow;" when widowed, erase "single" and "married."
RETURN OF DEATH TO THE CITY REGIS RAR.
CITY HALL, BOSTON. Mentros
Date of Death, ...
Aug 15
18 8/
Name,
Mabel B. Donovan
Color, t
Age.
years
5
..
month
15
days
Place of Death
Street and No.
Spray Mental
WARD
Residence,
Sex, F Single,
-Married
Occupation, Wife of.
Birthplace,
*
Somerville MasWidow of
Name of Father,
7. Donovan
Name of Mother,
Birthplace of Father,*
Birthplace of Mother,*
Cause of ) Primary, Duration,
Death.
Secondary,
Duration,
Place of Interment,
Date of Interment or Removal,
Undertaker or Informant,
*Insert Town and State.
iState whether white or black.
Madre Demum
PHYSICIAN'S CERTIFICATE.
. Name of Deceased,* - -
el. 1.
CC : L
Date and Place of Death, - died at , of Cholera Disease or Cause of Death, - Ffer Duration of Sickness
.......
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician ... Ht. I Trele 11
Date of Certificate, Arne 15 1877
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the deccase of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Commonwealth of Massachusetts.
No. RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
) Aug August 21 "185%. Dettie Hebt
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed.
female Ethété
4. Color, t
5. Age, .
Years, .
9
Months,.
Days.
6. Disease or [ First or Primary Cause of Secondary (if any)
Death,
By whom certified
7. Residence,
Besten mare)
Mainst. Der Heller
(S.S. Home
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Baton Ires
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Afghan ran
Jene feray Untermal Som Receiving. Jomb,
Signature of Undertaker other person making the Return,
Dernier Finde
DATED at. , on Arca 22d. 188%.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
2. Name,
J
The Undertaker, or other informaut, is requested to report the facts-together with the Physician's Certificate of the Causes of Death -to the Town Clerk, BEFORE THIE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof - or report these faets-to said Clerk. Penalty for neglect, twenty dollars.
Blauk forms for Returns of Deaths may be obtained from the Town Clerk.
Ilincturar Poster, Aug. 2.2 1881
This Certifies, that
Mettre Helt.
died on the 21
day of August 1881, aged - years,
months,
days.
CAUSE OF Primary, Cholera Infanter Duration 2 weeks .. Duration
DEATH. Secondary,
Eduod. T. Williams M.D.
. Physician.
No: 12
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Age, .
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certit' d
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, Sarah Stewart- Placcon Scotland
13. Birthplace of Father, .
14. Birthplace of Mother, . Canada
15. Place of Interment, montreal Canada
Signature of Undertaker on other person makin! the Return,
Summer Floyd
DATED at.
Winthrop
Auquel 22 1× 81.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (1.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
Auquel 21-1881 Robert mobile Stewart
male. (Unmarried)
While-
26 Years
8
Months,-
Days.
accidental Dronning
Montreal Canada
Ventrop (Ocean Spray Oneurance blevle! Montreal, Canada Andrew 8. Stewart
LIISSO
The Undertaker, or other informaut, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTIIWITHI GIVE NOTICE thereof- or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
- Vame of Deceased,* -
Robert Mis Sile Stewart 1
Date and Place of Death,
Disease or Cause of Death, -
Ocean Spray, Muritherplace, August 2/181. died at of Accidulat Drowning
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
I. H. L. Brand Bostan Masa
Date of Certificate,
August 22
.1881.
· Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, IS78, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performning the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Commonwealth of Massachusetts.
No. 13
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Auquel 23 "188, Walter allen
2. Name,
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed. male
4. Color, ț
5. Age, ·
Years,
8
Months,.
Days.
6. Disease or ( First or Primary
Cause of Secondary (if any)
Death,
By whom certified
7. Residence,
main, bor Herman St S. S. Home
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Baleno mais
11. Name of Father,
Walter allen maggie allen
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Temporary deposit in Joun Receiving Jomb
Signature of Undertaker the person making the Return
Summer Floyd
DATED at ..
on
aluguel 23 1881
* If a Married Woman or Widow.
If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
,
Wall alla QUE 230 188
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death -to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thercof - or report these facts - to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
Il mectuar Boston, Aug. 23 18851
This Certifies, that
Walter aller
died on the 23 day of August 1881, agal.
years,
erytil months,
days.
CAUSE OF Primary, Electora Infantun Duration
DEATHI.
Secondary,
Duration
Edward T.Williany M.D. Physician.
Commonwealth of Massachusetts. No. 14(4)
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
August 23 - 1881. Harry Namelead
3. Sex, and whether single. Married, or Widowed.
male
White
4. Color, t
5. Age,
Years, .....
Months,
Days.
Cholera Infantum
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death,
[ By whom certified
Kultury mare,
7. Residence,
1,5,8 Here
main, Con Herman St Muchup
9. Occupation, .
10. Place of Birth, . Boston mare)
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
Temporary deposit. Jour Beeiner
Signature of Undertaker or other person makin !! the Return,
Summer efloyd
DATED at.
Winthrop
, on
aluguel 24 1881.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (1.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
8. Place of Death,
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
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