Town of Winthrop : Record of Deaths 1913-1915, Part 5

Author: Winthrop (Mass.)
Publication date: 1913
Publisher:
Number of Pages: 1094


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 5


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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Feb. 3, 1913


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of ...... . (name. origin : "Cancer" is less definite ; avoid use of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example : Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy,""Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," " Uraemia," "Weakness," etc., when a definito disease can be ascertained as the cause. Always qualify all discases resulting from childbirth or miscarriage, as " PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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.


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


important. See instructions on back of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


winthrop .(No ... 69, Orhun Que St. : Ward)


2 FULL NAME Mary Julia gryce


[If married or divorced woman of widow


give maiden name, also name of husband.] ..


@RESIDENCE


69 Johnson ave.


nee Carroll wife of Frank P. Joyce


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


w


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


married


6 DATE OF BIRTH


(Month)


(Day)


7 AGE


If LESS than


1 day, ........ hrs.


37 .. yrs. mos.


ds.


min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


tousente


(b) General nature of industry, business, or establishment in which employed (or employer)


9 BIRTHPLACE


(State or country)


Boston


10 NAME OF


FATHER


Carroll


geremialo ml


II BIRTHPLACE OF FATHER (State or country) Ireland


12 MAIDEN NAME OF MOTHER Catherine Connelly


1ª BIRTHPLACE OF MOTHER (State or country)


Ireland


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


Frank P. Joyce


(Address)


69 golinson aro.


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH Fel. 7, 1913 (Year)


(Month)


(Day)


17 I HEREBY CERTIFY that I have investigated the death of the deceased.


The CAUSE OF DEATH* was as follows :


Poisoning by illumin. ating gas Suicidal.


(Duration)


.. yrs.


mos.


ds.


Contributory


...


(SECONDARY)


(Duration)


yrs.


... mos.


ds.


(Signed)


Lenge Burgers Magnets,


M.D.


71.8, 193 (Address)


1.3 va.in


MEDICAL EXAMINER


* State the DISEASE CAUSING DEATHI, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


. yrs.


mos.


ds.


State.


yrs.


In the


.mos.


ds.


Where was disease contracted, if not at place of death ?


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Feb. J. 1913


ADDRESS


10 UNDERTAKER If La


4829 Winthrop (City or town.)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


WRITE PLAINLY, WITH UNFADING INK -THIS IS A PERMANENT RECORD.


PARENTS


Filed ., 191


1


(Year)


INANYWaad V ST STAHL - ANT ONIUVANIE


Feb. 7, 1913


STANDARD 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 singlo word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive 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, (3) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material 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 House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, 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 indicated 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 affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of " Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, 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 (second- ary or intercurrent) affection need not bo stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), "Atrophy," " Collapse," "Coma," " Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," " Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," " Uraemia," " Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL 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 determine definitely. Examples: Accidental drowning; Struck by railway train - accident ; Revolver wound of head-homicide ; Poisoned by carbolic acid - prob- ably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of " Contributory."


Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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.


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very N B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH Wichit (No. 64 Nachos View Cesse Ward)


(City or town.)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


Mary Lina, Townsend


Char. L. Townsend- Domey.


2 FULL NAME


[If married or divorced woman or widow


give maiden name, also name of husband.]


@RESIDENCE


64 Harbour View are Wruchu Registered No. La


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


17 I HEREBY CERTIFY that I attended deceased from Ichmany 16, 1913, to February 17, 1913. that I last saw h .... alive on any (2, 1913, and that death occurred, on the date stated above, at 4 Pm. The CAUSE OF DEATH* was as follows : nechma


(Duration)


yrs.


mos.


.ds.


Gute Dilatation Heat


Contributory.


(SECONDARY)


(Duration)


.yrs.


mos. ds.


(Signed)


Charles 7 mahoney


M.D.


26.14


191.3. (Address)


365 Withof SE


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


.yrs. ..


mos.


In the


ds.


State


.. yrs.


mos.


ds.


........


Where was disease contracted, If not at place of death ?.


Former or usual residence


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


2


20


191.3


20 UNDERTAKER


ADDRESS


Filed


191


..... REGISTRAR


16 DATE OF DEATH


February


17


. 1913


(Year)


Month)


(Day)


6 DATE OF BIRTH Jan (Month)


19


(Day)


(Year)


If LESS than I day, ........ hrs.


.. yrs.


mos. 28 ds.


Or ........ min. ?


A


Horas Nogle


at


10 NAME OF


FATHER


Saa Homey


11 BIRTHPLACE OF FATHER (State or country) Jouet Erea Ut


12 MAIDEN NAME OF MOTHER Julia Tebo


13 BIRTHPLACE


OF MOTHER


(State or country)


It albums Ut


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informent)


Celas. L. Pounsere


(Address) 64 Harla Vici are


16


3 SEX


7 AGE


30


& OCCUPATION


(a) Trade, profession, or


particular kind of work


9 BIRTHPLACE


(State or country)


PARENTS


WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.


(b) General nature of industry,


business, or establishment in


which employed (or employer)


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


marné


A PERMANENT RECORD.


Feb. 17, 1913


STANDARD 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, Compositor, Architect, Loco- motive 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) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material 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 House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, 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 indicated 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 affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia ; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sur- coma, 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 (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), " Dropsy," " Exhaustion," "Heart failure," "Haemorrhage," " Inanition," "Marasmus," " Old age," "Shock," " Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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.


UNFADING INK - THIS


HLIM


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very N B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state important. See instructions on back of certificate.


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH пиктер


(No ....


Meteoof Horjutal


St. : Ward)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE


Wintherte Mars Willshow 5 %


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


16 DATE OF DEATH


Job 17


<


1913


(Month)


(Day)


(Year)


6 DATE OF BIRTH


17


1913


(Month)


(Day)


(Year)


7 AGE


yrs. mos. ds.


.... min. ?


8 OCCUPATION


(a) Trade, profession, or


particular kind of work


(b) General nature of industry.


business, or establishment


in


which employed (or employer).


9 BIRTHPLACE


(State or country)


10 NAME OF


FATHER


" forest: " Munday


PARENTS


11 BIRTHPLACE OF FATHER (State or country) Célarlació Mass


12 MAIDEN NAME


OF MOTHER


13 BIRTHPLACE


OF MOTHER


(State or country)


Brighton-mars


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant)


(Address)


16 Filed


----- 191


REGISTRAR


17 I HEREBY CERTIFY that I attended deceased from



191


3


to


76/2"


1913


If LESS than


1 day, ....


.hrs.


that I last saw h M


alive on


191


and that death occurred, on the date stated above, at


& G.m.


The CAUSE OF DEATH* was as follows :


Still born.


macerated


(Duration)


.. yrs.


mos.


200


ds .


Contributory


(SECONDARY)


(Duration)


.. yrs.


mos.


ds.


(Signed)


M.D.


7617, 1913 (Address)


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death.


.. yrs.


mos.


no ds.


State


........... yrs.


In the


mos.


ds.


.........


Where was disease contracted, If not at place of death ?.


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


2/21


1913


20 UNDERTAKER


ADDRESS


(City or town.)


Sunday


RECORD.


A PERMANENT


PLAINLY, WITH UNFADING INK -THIS IS 3.LUM


0


Feb. 17, 1913


STANDARD 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, Compositor, Architect, Loco- motive 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) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," " Manager,""Dealer," etc., without more precise specification, as Day laborer, Farm taborer, Laborer - Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, 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 indicated 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 affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never re- port " Typhoid pneumonia ") ; Lobar pneumonia; Broncho- pneumonia (" Pneumonia," unqualified, is indefinite) ; Tuber-


culosis of lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, etc., of. (name origin: "Cancer" is less definite ; avoid use of " Tumor" for malignant neoplasms) ; 1 Measles; Whooping cough; Chronic valvular heart disease ; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection need not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broncho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as " Asthenia," " An- aemia " (merely symptomatic), " Atrophy," "Collapse," "Coma," "Convulsions," "Debility " ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," " Inanition," " Marasmus," " Old age," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," " PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken.


Cases for the Medical Examiners. - Under the provisions 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, Ex- posure, 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.


N. B. - Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


important. See instructions on back of certificate.


The Commonwealth of Massachusetts


1 PLACE OF DEATH


STANDARD CERTIFICATE OF DEATH Winther (No .. 1) Hawthorne CAVE .*: Ward)


BOSTON (City or town.)


[If death occurred in a hospital or institution, give its NAME instead of street and number.]


2 FULL NAME


Mary Bartlett Praze


[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 11 Hawthorne ve


Widow of Harrison b.


Winthrop


NEE-Sale


Registered No.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


5 el.


(Month)


18 (Day) (Year)


If LESS than


day, ..


hrs.


that I last saw h


~alive on


191-


and that death occurred, on the date stated above, a


The CAUSE OF DEATH* was as follows : natural causes probably carcinoma of stomach- (Attending physician our


of town )


.(Duration)


.. yrs. ..


mos.


ds.


Contributory ..


(SECONDARY)


.. (Duration) ..


.. yrs. ..


mos.


.ds.


(Signed)


Edward & Frange (Sin of Board of Health)


Feb. 19, 1913. (Address).


49 Bartlett Jord


* If death followed injury or violence the certificate of death must be made out by the Medical Examiner.


18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).


At place


of death


.yrs


mos.


In the


ds.


State


.... yrs.


...


mos.


ds.


Where was disease contracted, If not at place of death ?


Former or usual residence.


19 PLACE OF BURIAL OR REMOVAL


DATE OF BURIAL


Linwood Bem. Haverhill Feb. 2.2, 1913


20 UNDERTAKER Thomas & Lane E.A.L.


ADDRESS 120 Havresti 6 Botas


4 COLOR OR RACE


5 SINGLE,


MARRIED,


WIDOWED,


OR DIVORCED


(Write the word)


WidowEd


(Month)


(Day)


(Year)


78. yrs.


mos.


ds. .


or min. ?


.


9 BIRTHPLACE (State or country) .


Amaston


CV. A.


10 NAME OF


FATHER


Ezra B. Sale


11 BIRTHPLACE OF FATHER (Statc or country) Kingston C. A.


12 MAIDEN NAME OF MOTHER Ruth It hits


13 BIRTHPLACE OF MOTHER (State or country) } South Hampton ONA


14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE


(Informant).


Florence G. Praisons


( Add


3) 11 Hawthorne CAva Vinthrow


Filed 191.


REGISTRAR


17


I HEREBY CERTIFY that I attended deceased from


191 to 191 ...


..... M.D.


3 SEX 6 DATE OF BIRTH 7 AGE 8 OCCUPATION (a) Trade, profession, or particular kind of work PARENTS WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD. (b) General nature of industry, business, or establishment in which employed (or employer).


PERMANENT RECORD. A IFADING INK - THIS IS


VANA HLIM 'AINIVTHI -


Feb. 18, 1913


STANDARD CERTIFICATE OF DEATH.


Statement of occupation. - Preciso statement of occupa- tion is very important, so that the relative healthfulness of various pursuits can be known. The question applics to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, o. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive 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 providod for the latter statement ; it should bo used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Sales- man, (b) Grocery ; (a) Foreman, (b) Automobile factory. The material 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 House- keepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gain- fully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, 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 indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.




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