USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1913-1915 > Part 64
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culosis of lungs, meninges, peritonacum, etc., Carcinoma, Sar- coma, etc., of .... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection necd not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (mercly 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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Hinthron
(No.
66 Junmendella
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Stillborn Garry
2 FULL NAME
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
66 Sunnipido Que
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
Malo White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Single
(Month)
(Day)
(Year)
6 DATE OF BIRTH
Aug
(Month)
29
(Day)
(Year)
7 AGE
If LESS than { day, ........ hrs.
yrs.
mos.
.. ds.
or ....... 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)
Rinthuof Mass.
10 NAME OF FATHER
PARENTS
11 BIRTHPLACE OF FATHER (State or country) Irelande
12 MAIDEN NAME OF MØTHER Charlotte Jolande
13 BIRTHPLACE, OF MOTHER (State or country) Liteland.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant).
(Address)
66: Lugnavida de
Filed
191
REGISTRAR
1914 17 I HEREBY CERTIFY that I attended deceased from
191 ___
, to.
.......
191
that | last saw h.
alive on
191
and that death occurred, on the date stated above, at
m.
The CAUSE OF DEATH* was as follows :
Premature (still for)
(Duration).
........... yrs.
mos.
ds.
Contributory (SECONDARY)
(Duration).
....
..... yrs.
mos. ds.
(Signed)
M.D.
any 30, 1914 (Address).
355 wochenpsy
* If doath 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.
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
la.4 31, 194
20 UNDERTAKER
ADDRESS
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.
16 DATE OF DEATH
ana
29, 1914
aug. - 1, 11/4
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, uot 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) ; 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
STANDARD CERTIFICATE OF DEATH
I PLAZE OF DEATH Winthrop
(No 45 Graves Cvc
St. :
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OP RACE White
6
8 DATE OF BIRTH
(Month)
(Day)
185 3 17
(Year)
If LESS than 1 day, ........ hrs.
7
mos.
ds.
or ..... .min. ?
8 OCCUPATION
Salesman
The CAUSE OF DEATH* was as follows :
(Duration)
yrs.
mos.
3
ds.
Contributory (SECONDARY)
(Duration)
.yrs.
mos.
.Os.
(Signed)
kept
2, 1914 (Address) 3251 With 09
* 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.
ds.
State
yrs.
In the
mos.
ds
Where was disease contracted, If not at place of death ?.
Former or usual residence.
1º PLACE OE BURIAL OR REMOVAL Nordlawn
DATE OF BURIAL
DEpt 3/1914
" UNDERTAKER
Filed 191
......
....
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
191.
4
(Month) (
(Year)
I HEREBY CERTIFY that
attended deceased from
august
.,
0
Sept ,
191
., to
4
that I last saw h . alive on
Sept
191
4
and that death occurred, on the date stated above, at.
77 m.
(a) Trade, profession, or
particular kind of work
Dry Goods
3 BIRTHPLACE
(State or country)
England
PARENTS
Scotland
12 MAIDEN NAME OF MOTHERS Thanfret Hinderlow
13 BIRTHPLACE OF MOTHER (State or country)
England
14 THE ABOVE IS TRUE TO THE BEST OF MAY KNOWLEDGE
(Informant) ...
(Address)
16
James Alfred Nation
· FULL NAME [If married or divorced woman or widow give maiden name also name of husband.] @RESIDENCE
Derved
MADDIED,
WOWED,
OR DIVORCED
(W/ the word)
18 DATE OF DEATH Sistempa 31 (Day)
7 AGE 62 ... yrs.
(b) General nature of industry,
business, or establishment in
which employed (or employer).
10 NAME OF
FATHER
Jame Sherif Hetcon
11 BIRTHPLACE OF FATHER (State or conntry)
M.D.
ADDRESS .
Hinthrop
1
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occupa- tiou 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, Sar- coma, etc., of .. (name origin: "Cancer" is less definite ; avoid use of "Tumor" for malignaut 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.
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
I PLACE OF DEATH
(No.
51
Read
St. :
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
8 SEX
m
4 COLOR OR RACE
w
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Jungle
16 DATE OF DEATH
Sept.
(Month)
(Day)
1
19121.
(Year)
$ DATE OF BIRTH
8
(Month)
27
(Day)
1914
(Year)
TAGE
If LESS than
i day, ........ hrs.
... yrs. mos.
Or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry,
business, or establishment in
which employed (or employer)
17
I HEREBY CERTIFY that I attended deceased from
aug. 27
1914, to
Sept. 1.
that f last saw h ._.... alive on
191.46.
and that death occurred, on the date stated above, at
90m.
The CAUSE OF DEATH* was as follows :
(Duration)
mos. .....
ds.
Contributory
(SECONDARY)
.(Duration)
.yrs. ..
......
mos.
............
ds.
(Signed)
Multand
M.D.
LA-2, 1914 (Address)
118 Primaion
....
* If death followed injury or violence the certificate of death must be made ont by the Medical Examiner.
18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OR RECENT RESIDENTS).
At place
of death ............ yrs.
mos. ........
ds.
State
In the
mos.
„ds.
Where was disease contracted, If not at place of death ?.
Former or usual residence
1º PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
4-2
$91
4
D UNDERTAKER
ADDRESS
Filed. 191
10 NAME OF
FATHER
Raymond Eroch
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
VraiBale Mars
12 MAIDEN NAME
OF MOTHER
Douglas
1ª BIRTHPLACE
OF MOTHER
(State or country)
Winthrop
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Raymond , Coches
(Address)
Si Readst
REGISTRAR
Raymond G. Crocker
2FULL NAME.
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE ghiniluok
9 BIRTHPLACE
(State or country)
Wintheok
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of occu- pation 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, 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 linc 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," ctc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ctc. 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 occu- pation whatever, write None.
Statement of cause of death. - Name, first, the DIS- LASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. 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 tungs, gs, meninges, pertionalum, coo.
coma, etc., of ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronie 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- acmia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracmia," "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 provi- sions of chapter 24 of the Revised Laws deaths under the fol- lowing 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, ctc.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1914.
CITY OF BOSTON.
8077
Registered No.
Place of Death and Residence S
Boston
Date of Death
SEPT.4
1914.
Age
I
years
8
months
days.
STATISTICAL DETAILS.
SEX.
COLOR.
SINGLE, MARRIED, WID., DIV.
F
W
SIN.
Maiden Name
Husband's Name
WINTHROP
Birthplace
Name of Father
EDWARD W. BERCHTOLD
Birthplace of Father
CLEVELAND. OHIO
Contributory · ? (Duration)
1
Maiden Name of Mother
NELLIE F. SPILLANE
Birthplace of Mother
IRELAND
(Signed)
M.D.
SEPT.4
1914
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen! Residents.
Place of Burial or removal
MALDEN (HOLY CROSS)
C. R. BENNISON
Undertaker
WINTHROP
Usual Residence
WINTHROP ( 16 BILLOW AV)
Filed
SEPT.5 1914.
A true copy.
Attest
ErMSlenen
Registrar.
IS
RAR'
T PATRIEUS
Primary SEPTICEMIA - 17 DYS
ICU (Duration)
OBIS
FFICE
LLAL? BOSTONIA
1.A.1822.
CONDITAAL
S REGIMINE DONATA A 1830.
MASS.
C. H. DUNN
Occupation
Informant
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1914, to 1914, that to the best of my knowledge and belief death occurred, on the date stated above, and that the CAUSE OF DEATH was as follows :
CITY
STON
FULL NAME
HELEN BERCHTOLD
ROTCH MEMORIAL HOSPT.
Sept. 4, 1914
-
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.
PARENTS
11 BIRTHPLACE OF FATHER (State or country)
Russia
12 MAIDEN NAME OF MOTHER Lemie Frank
BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Harring
Frank
(Address)
Filed . 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Sept
(Month)
594
(Day)
(Year)
I HEREBY CERTIFY that I have investigated the death of the deceased.
The CAUSE OF DEATH* was as follows : Incised wounds of the
week, with resulting
haemmage, Suicidal
.(Duration)
.. yrs.
mos.
ds.
Contributory. (SECONDARY)
(Duration)
.. yrs.
mos. ...
.ds.
Sell V. 1914 (Addre
MEDICAL EXAMINER
* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.
:8 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
DATE OF BURIAL
10 am Sex 6. 1914
20 UNDERTAKER
Jacob Poyour
St. , ......... Ward)
6319 (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
Ray
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 1318 Commonwealth are:
Manyhands ale Silva Emerson
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Kemal
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Married
6 DATE OF BIRTH
1889 17
(Month)
(Day)
(Year)
7 AGE
If LESS than I day. ..... hrs.
25 yrs .... mos.
ds.
or min. ?
8 OCCUPATION (a) Trade, profession, or particular kind of work
X
(b) General nature of Industry, business, or establishment In which employed (or employer).
9 BIRTHPLACE
(State or country)
Barton Mass
10 NAME OF
FATHER
Lewis Frank
(Signed)
Lunge Burgers Magneto,
M.D.
19 PLACE OF BUNIAL DR REMOVAL Hakfield class 2
ADDRESS
39. Capelan of Du
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH
( No. 46 Pearl are
STANDARD CERTIFICATE OF DEATH.
Statement of occupation. - Precise statement of oceu- pation 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, 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 cxamples: (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 oeeu- pation whatever, write Nonc.
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