Town of Winthrop : Record of Deaths 1916-1918, Part 44

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 44

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).

Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebro-spinal fcver (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 usc of "Tumor" for malignant neoplasms) ; Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (second- ary or intercurrent) affection nced 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" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or" miscarriage, as "PUER- PERAL septieaemia," "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 diseasc, 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.

12-1

The Commonwealth of Massachusetts

1 PLACE OF DEATH

"inthron

......

STANDARD CERTIFICATE OF DEATH (No I71 Ecwdoin St.

(City or town.)

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

2 FULL NAME

Michael Francis Thomas

......

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

Nale

White

6 SINGLE,

MARRIED.

WIDOWED.

OR DIVORCED

(Write the word) Married

16 DATE OF DEATH

Jan

. 191 >

...... ..........

(Month)

(Day)

(Year)

* DATE OF BIRTH

(Month)

(Day)

(Year)

7 AGE

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

.yrs. .............. mos. .............. ds.

or ........ min. ?

· OCCUPATION

(a) Trade, profession, or

Foreman

particular kind of work

(b) General nature of industry,

business, or establishment in

which employed (or employer) ..

Car Inerector

9 BIRTHPLACE (State or country)

Quebec

10 NAME OF

FATHER

Francis Thanas

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

Quebec

12 MAIDEN NAME

OF MOTHER

Elizabeth Hawley

1ª BIRTHPLACE

OF MOTHER

(State or country)

Quebec

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Mrs. Thomas

(Address)

170 Bordoin St

Filed 191

......

REGISTRAR

.. (Duration)

.yrs.

........... mos ..

ds.

Contributory

Pulmonar OrZes

(SECONDARY)

......

.(Duration).

....... yrs. .............. mos.

ds.

(Signed)

M.D.

Jun 23, 1919 (Address) 200 Thingauthi

.....

(* 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).

In the

At place

of death

...... yrs.

mos. ...........

„ds.

State ............ yrs.

mos.

.........

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

Former or usual residence

19 PLACE OF BURIAL OR REMOVAL

Holy Cross Malden

DATE OF BURIAL

1/24/99

.....

191

........

20 UNDERTAKER John w. 0'Maley

ADDRESS winthrop

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.

17 I HEREBY CERTIFY that I attended deceased from DEC 17 191_C ... , to Sauce 2.2, 1912 that I last saw him alive on 22,1917 and that death occurred, on the date stated above, at. 5 P.m. The CAUSE OF DEATH* was as follows : . Cirrhosis

[If married or divorced woman or widow give maiden name, also name of husband.j @RESIDENCE Fowdoin Et.

St. ;..................... .Ward)

STANDARD CERTIFICATE OF DEATH.

Statement of occupation. - Precise statement of oecu- pation 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 nceded. 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," "Forcman," "Manager," "Dealer," etc., 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same discase. Examples: Cerebro-spinal fcver (the only definite synonym is "Epidemie 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," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL scpticaemia," "PUERPERAL peritonitis," etc. State eause 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, 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 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

(No.

Deal

St. ;.......... .Ward)

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

Mary & Mason

* FULL NAME

Lacour

[If married or divorced woman or widow

give maiden name, also name of husband.]

aRESIDENCE 42 Qual dr Winthrop

Rose- Octavione Main.

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

& SEX

Female

4 COLOR OR RACE

White

6 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Married

$ DATE OF BIRTH

2.0

(Month)

(Day)

(Year)

7 AGE

................ .......

mos.

ds.

........ min. ?

& OCCUPATION

(a) Trade, profession, or

particular kind of work

is Home.

(b) General nature of industry,

business, or establishment

which employed (or employer)

9 BIRTHPLACE

(State or country)

England

.(Duration)

........

.yrs.

.........

.. mos. ..............

.ds.

Contributory

arterio Salensie

(SECONDARY)

.. (Duration)

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

mos .. ........... .ds.

(Signed)

Dr. a. morrison

M.D.

Jan 23, 197

(Address).

80 Princeter AV.

..........

* 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.

.........

Where was disease contracted,

if not at place of death ?.

42 Sene Di uretin

Former or

usual residence

42 Bene At. Winchne

" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant).

the todaon

(Address)

12 Bennington de 8. 3.

Filed

191

REGISTRAR

16 DATE OF DEATH

Jan

....

(Month)

(Day)

(Year)

1836

I HEREBY CERTIFY that I attended deceased from

For some mettre of intervalo

191

....

that I last saw her alive on

Jan 21

1917

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

40 m.

The CAUSE OF DEATH* was as follows :

10 NAME OF

FATHER

Samuel ver:

PARENTS

11 BIRTHPLACE

OF FATHER

(State or country)

England.

12 MAIDEN NAME

OF MOTHER

Farah Unknown

1ª BIRTHPLACE

OF MOTHER

(State or country)

England.

In the

mos ..

........... ds.

19 PLACE OF BURIAL OR REMOVAL Woodlawn Cemeting

DATE OF BURIAL /-30 Pm Jan 26 1917

ADDRESS

20 UNDERTAKER

E. G. Brown Km East (Boston-

Nuittrol (City or town.)

If LESS than day ......... hrs.

.....

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 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 fircman, ctc. 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 statcment; 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 Housc- keepers who receive a definite salary), may be entered as Housewife, Houscwork, 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 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 indicated thus: Farmer (rctired, 6 yrs.). For persons who have no occu- pation whatever, write Nonc.

Statement of cause of death. - Name, first, the DIS- EASE 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 lungs, meninges, peritonaeum, etc., Carcinoma, Sar- coma, ctc., 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 need not be stated unless im- portant. Example: Mcasles (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," "Hacmorrhage," "Inanition," "Marasmus," "Old agc," "Shock," "Uraemia," "Weakness," etc., when a definite disease can be ascertaincd 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- posurc, 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 dcad, 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.

(City or town.)

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

? FULL NAME

[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 462

Shirley Sh

PERSONAL AND STATISTICAL PARTICULARS

& SEX mule

{ COLOR OR RACE

White

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

1845

(Write the word)

Widowed

' DATE OF BIRTH

(Month)

(Day)

(Year)

7 AGE

I day ......... brs.

.. yrs. 4 mos 24 ds

or ........ min. ?

& 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

PARENTS

12 MAIDEN NAME OF MOTHER

13 BIRTHPLACE OF MOTHER (State or country)

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

(Address)

Filed 191

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH lau. 230

(Month)

(Day)

191.7 (Yéar)

I HEREBY CERTIFY that I attended deceased from Denise, 1912

If LESS than to ... . ...... facce. 23 .. 1917 that I last saw h Leck alive on. face, 239 .... and that death occurred, on the date stated above, at .. .m. The CAUSE OF DEATH* was as follows :

Cerchiat themarshall

(Duration) .. yrs.

.mos. ds .

Contributory.

Chracias Intertitid nephritis

(SECONDARY)

.(Duration) .yrs.

.........

M.D.

(Signed)

fru. 2- 191/

Hinthurt, Mary

/ 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. .......

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

Former or usual residence.

19 PLACE OF BURIAL OR REMOVAL

DATE OF BURIAL

1/26/97

........

20 UNDERTAKER

ADDRESS

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

462

Sheldon. W-Cost

St. : Ward)

Registered No.

.mos. ds.

11 BIRTHPLACE OF FATHER (State or country)

SIANDARU CERTIFICATE OF DEATH.

Statement of occupation. - Precise statement of oecu- 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 engincer, Civil engineer, Stationary fircman, 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) Salcs- man, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Forcman," "Manager," "Dcaler," ctc., without more precise specification, as Day laborcr, Farm laborcr, 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 occu- pation whatever, write Nonc.

Statement of cause of death. - Name, first, the DIS- DASE CAUSING DEATII (the primary affection with respect to time and causation), using always the same accepted terin for the same diseasc. 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 (sccond- 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" (mcrely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hacınorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," etc., when a definite discase can be ascertaincd as the cause. Always qualify all discases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "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 Conmmwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH Stinthrop (No. 14) .. christin avEst .: .Ward)

................ (City or town.)

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

? FULL NAME Betsy 2. Are Freeman.

[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE Wunschrojo 14 chester aux.

Colline- Desceman Ent sem.

............

Registered No.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

' COLOR OR RACE

6 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Widowed

· DATE OF BIRTH

4- (Month)

1827

(Year)

7 AGE

If LESS than

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

89 yrs.

ds.

or ........ min. ?

* OCCUPATION

(a) Trade, profession, or

particular kind of work

athome

(b) General nature of industry,

business, or establishment in

which employed (or employer).

9 BIRTHPLACE

(State or country)

"Timo. ) nass

10 NAME OF FATHER 1 Benjamin Collina

PARENTS

12 MAIDEN NAME

OF MOTHER

Tamoin Snow-

Betsy De Collare

18 BIRTHPLACE

OF MOTHER

(State or country)

Timo, mass

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

Men Jamein Rich

(Informant) ....

(Address) 14 cheater Cioz.

REGISTRAR .....

I HEREBY CERTIFY that I attended deceased from

Jan 17

.191.2 .... , to

Jan 23

1917

...

that I last saw her alive on

Jan 23

191

and that death occurred, on the date stated above, at//.30A.m.

The CAUSE OF DEATH* was as follows :

arterio - Scleroseo

(Duration)

.yrs.

mos.

ds.

......

Contributory

mitral Requergitation

....

(SECONDARY)

(Duration)

yrs.

mos.

da.

(Signed)

Robert A. French

M.D.

Jan. 25, 1917

(Address).

malden

* 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

In the

of death ............ yrs. ............ mos. .....

ds.

State.

......... yrs.

mos. ............ d ..............

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

Former or usual residence

19 PLACE OF BURIAL OR REMOVAL Fumo Mara.

DATE OF BURIAL

1-27,1917

20 UNDERTAKER D. C. Skaggs.

ADDRESS

Wirsching,

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.

Filed

191

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

11-30-a.m.

1917

(Month)

(Day)

(Year)

(Day)

11 BIRTHPLACE

OF FATHER

(State or country)

Timo, Mass

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. Tlic 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, Stotionary 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," "Dcaler," 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 liousehold only (not paid Housc- 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.

Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.

Town of Winthrop : Record of Deaths 1916-1918, Part 44

Author: Winthrop (Mass.) Publication date: 1916 Publisher: Number of Pages: 1316

Author: Winthrop (Mass.)
Publication date: 1916
Publisher:
Number of Pages: 1316