USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 60
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Statement of cause of death. - Name, first, tlic 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 fever (the only definite synonym is "Epidemie cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broneho- pneumonia ("Pneumonia," unqualified, is indefinite) ; Tuber-
culosis of lungs, meninges, peritoneum, etc., Carcinoma, Sar- coma, ete., 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 .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (merely symptomatie), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ete.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shoek," "Uraemia," "Weakness," ete., when a definite disease ean be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicaemia," "PUERPERAL peritonitis," ete. 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, ete
4. Deaths under circumstances unknown, as A person found dead, ete.
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.
1 PLACE OF DEATH
..... 16
St. :
................. Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME Instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
‘ COLOR OR RACE
WHITE
& SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
..
· DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
71
.. yrs. ................ mos. ....... ds.
or ....... min. ?
& OCCUPATION
(a) Trade, profession, or
. LADCHLA
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
DANIEL
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
CAPL DALTON
12 MAIDEN-NAME
OF MOTHER-
13 BIRTHPLACE ·
OF MOTHER
(State or country)
C .. PL DALTON
14 THE ABOVE IS TRUE TO.THE BEST OF MY KNOWLEDGE
(Informant)
ALNIE CAPSULA
(Address)
.12 HERNOW .T.
16
Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
17
I HEREBY CERTIFY that I attended deceased from
1916
191
to
1912
.......
that I last saw hmy alive on
1917
and that death occurred, on the date stated above, at 4 4 m.
The CAUSE OF DEATH* was as follows :
Carcinoma / domach
(Duration)
1
.... yrs.
......
.........
... mos.
.ds.
Contributory
(SECONDARY)
(Duration)
................ yrs.
............... mos. ............
ds.
(Signed)
M.D.
Jump 8, 1917
(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. ....
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 HOLY CRVEN MALDEN
DATE OF BURIAL
5/12/17
191
ADDRESS
20 UNDERTAKER
John J. O'malley
(Month)
8
(Day)
191)
(Year)
If LESS than
1 day ......... hrs.
Registered No.
2 FULL NAME
DANIEL CAMPOS
[If married or divorced, woman or widow
give maiden name, also name of husband.]
@RESIDENCE
12 hermon
St
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH (No 12 Hermon st
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 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 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 DEATHI, 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 disease. Examples: Cerebro-spinal fever (the only definite synonyın 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., Careinoma, Sar- eoma, cte., of. ... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronie valvulur 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," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "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 septieacmia," "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, ctc.
4. Deaths under circumstances unknown, as A person found dead, etc.
The Conumnonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
... (No.
10 Ocean Que
St. :.. ................ .Ward)
(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 namo, also name of husband.] @RESIDENCE 10 Ocean Que.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
¿ SEX
m
4 COLOR OR RACE
00
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
undowed
· DATE OF BIRTH
10 (Month)
15-
(Day)
1827
(Year)
7 AGE
If LESS than
[ day ......... hrs.
89
Z .... yrs. ......
6
mos.
140%.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work ...
Retired Sea captain
(b) General nature of industry, business, or establishment In which employed (or employer).
9 BIRTHPLACE (State or country)
IX Hill Boatos
10 NAME OF
FATHER
Elephas Wym
PARENTS
12 MAIDEN NAME
OF MOTHER
May Junkesbury
13 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
albert Gs. Wyman
(Address)
10 decan View avz.
16
Filed 191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
1917
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
May
1.
1917. to
May 11
..............
.
1917.
that [ last saw ha cercalive on
Mal 11
1917,
and that death occurred, on the date stated above, at
610
.m.
The CAUSE OF DEATH* was as follows :
Bronchitis
.(Duration)
.yrs.
mos.
10
ds.
Contributory.
arteriosclerosis
(SECONDARY)
midy
... (Duration)
........... yrs.
mos. ............ ds.
(Signed)
Ila Partir
M.D.
May /2, 191) (Address).
* H 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.
........
ds ...
Where was dlsease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Winthrop Cent
DATE OF BURIAL
5-13-
.......
191.Z
20 UNDERTAKER
W.C. Skaggs
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.
n BIRTHPLACE OF FATHER (State or country)
In the
.. mos. ............ ..........
16 DATE OF DEATH
May
... 2
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 enginecr, 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 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," etc., without more precise specification, as Day laborer, Farm laborer, Laborcr - 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, 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted terni for the same discasc. Examples: Cercbro-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, peritoneum, 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 nced 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," "Hacmorrhage," "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 scpticaemia," "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 dcad, ctc.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No 21 tweeluck
Samuel Wheelock
? FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.]. @RESIDENCE
Wheelock It Hurts R
St. : .....................
Ward)
[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
3 SEX
Male
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Diclowes
$ DATE OF BIRTH
Que 2 4 1829
(Month)
· (Day)
1
(Year)
7 AGE 87
If LESS than
1 day ......... hrs.
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)
Torbrook, n.S.
10 NAME OF
FATHER
Samuel Wheelock
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
12.5.
12 MAIDEN NAME
OF MOTHER
Mary Willeis
1ª BIRTHPLACE OF MOTHER (State or country)
27.5
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
CR. Seven
-
(Address)
16
Filed
....
...... 191
REGISTRAR
16 DATE OF DEATH
may
(Month)
12
.1917
(Day)
(Year)
17
.I HEREBY CERTIFY that I attended deceased from
may 14
1912
may 12
1917
to
that I last saw h
.....
alive on
May 12'
191)
and that death occurred, on the date stated above, at
3
/m.
The CAUSE OF DEATH# was as follows :
General arteriosclerosis
myo carditis
Chanie interstitial de visites
(Duration)
......
.yrs. ................ mos.
.............
ds.
Contributory.
(SECONDARY)
.(Duration)
... yrs.
.mos. .
.......
ds.
(Signed)
(2) malcael
M.D.
(Jun, 13, 1917 (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
in the
of death.
. yrs. ............ mos. ............. ds.
State ............ y:s. ............ mos. ..........
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Micagia, 1917
20 UNDERTAKER.
ADDRESS
(City or town.)
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.
N. B .- Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
1
1
.. yrs.
4.
mos.
Pelust
18.
ds.
AJVAJ
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 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 statement; it should be used only wlicn 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," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Day laborcr, Farm laborer, Laborer - Coal mine, etc. Women at home, who are engaged in the dutics of the household 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 homc. Care should be taken to report specifically thic 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same diseasc. Examples: Cerebro-spinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid usc of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pucumonia," unqualificd, 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 nced not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-pneumonia (sccondary), 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 ascertaincd 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, ctc.
2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Ex- posure, etc.
3. Sudden dcatlıs 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.
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
"inthron (No 28 Hawthorne Ave. ......
St. ;................ Ward)
(City or town.) [If death occurred In a hospital or institution, give its NAME instead of street and number.]
2 FULL NAME.
OLIVIA F. MCKENNA LENNON
[If married or divorced woman or widow TIPOW OP THOMAS T. LENNON give maiden name, also name of husband.J. @RESIDENCE 21 HA THOFNE AVE.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
¿ SEX
WENALE
4 COLOR OR RACE
WHITE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
IDOWED
* DATE OF BIRTH
(Month)
(Day)
1
(Year)
7 AGE
If LESS than I day ........ hrs.
.yrs.
mos. ds.
or ........ min. ?
& OCCUPATION
(a) Trade, profession, or
AT HOME
particular kind of work
(b) General nature of Industry, business, or establishment 3 which employed (or employer).
9 BIRTHPLACE
(State or country)
FOSTON MASS.
PARENTS
12 MAIDEN NAME
OF MOTHER
UNKNOWN
1ª BIRTHPLACE
OF MOTHER
(State or country)
IPELAND
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Mrs. Agnes Cronin
(Address) 22 Hawthorne Ave.
REGISTRAR
16 DATE OF DEATH
Les (Month)
13
(Day)
(Year)
17
I HEREBY CERTIFY that I attended deceased from
3
1916 __ , to
13, 1911.
that 1 last saw h
alive on
May 12. 197.
and that death occurred, on the date stated above, at
78 m.
The CAUSE OF DEATH* was as follows:
Cucinone of Stomach
(Duration)
............... yrs.
... mos. ..............
.ds.
Contributory
(SECONDARY)
.(Duration)
) ................ yrs.
mos.
ds.
(Signed)
M.D.
May 14, 19) (Address) 2001 theos
Sif 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 dlsease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL
Calvary Cem. Foston
DATE OF BURIAL
5/15/17
... .
191
20 UNDERTAKER
John Fill makey
ADDRESS
INTHROP, MASS
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
1917
....
....
10 NAME OF
FATHER
FEPNAPD MCKENNA
11 BIRTHPLACE
OF FATHER
(State or country)
IRELAND
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 eachı 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 rceeive 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 oceu- pation whatever, write None.
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