USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 63
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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 rc- port "Typhoid pucumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," 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, ete. The contributory (second- ary or intcreurrent) 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" (mercly symptomatic), "Atrophy," "Collapsc," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Haemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uraemia," "Weakness," ete., 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," 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, 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.
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
try Bridge Water U. S.
12 MAIDEN NAME
OF MOTHER
Elena Millo
13 BIRTHPLACE
OF MOTHER
(State or country)
chester 4.13.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Chas. H. Runer.
(Address) Itmerck RK
16
Filed ..... , 191
REGISTRAR
17
I HEREBY CERTIFY that I attended deceased from
191
.,
to
191
.........
that I last saw himen alive on
never
191
.
........
and that death occurred, on the date stated above, at
1
m
The CAUSE OF DEATH* was as follows :
( bora dlead )
.(Duration)
.............. yrs. ............... mos. ..............
ds.
Contributory.
(SECONDARY)
.. (Duration)
.............. yrs.
............... mos. ..............
ds
(Signed)
Koran) Soule
...... .
M.D
Hierro 20, 1917 CA
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.
............ mos.
In the
............ .ds .............
Where was disease contracted, If not at place of death ?
Former or usual residence ....
19 PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Winthrop Cent 6-21, 1912
20 UNDERTAKER W.C. Skaggs
ADDRESS
Winthrop
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
, SEX
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
10 DATE OF DEATH
france
/ (?)
(Month)
(Day)
1917
.......
(Year)
' DATE OF BIRTH
6
19
(Month)
(Day)
.1917
(Year)
' AGE S.B.
If LESS than
I day ......... hrs.
mos. de.
... in. ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work.
(b) General nature of industry.
business, or establishment in
which employed (or employer) ...
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
Winthrop
( No
..................
....
Ward)
albert Reeves
*FULL NAME
........
[If married or divorced woman or widow
give maiden name, also name of husband.]
@RESIDENCE
Registered No.
9 BIRTHPLACE
(State or country)
Winthrop
10 NAME OF
FATHER
Charles F Reeves
ORD
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 occupation 3 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, 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 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," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. Women at home, who arc engaged in the duties of the household only (not paid House- 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 domestie 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: Cercbro-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 ("Pneumonia," unqualificd, is indefinite) ; Tube
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 septicacmia," "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, 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.
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
12 MAIDEN NAME
OF MOTHER
Leggie Foliumson
13 BIRTHPLACE
OF MOTHER
(State or country)
greatal
" THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
(Address)
16
Filed 191
......
REGISTRAR
.......
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
alexander, francis B. Hall
2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
(No 43 Salchemin
St. ;.........
Ward)
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
a
3 SEX
Male
{ COLOR OR RACE
the
5 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
· DATE OF BIRTH
7 1885
(Month) (Day)
7 AGE
25.
.yrs.
10
mos.
26
ds.
.....
Or ....... min. ?
B 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)
neuerto mars
Contributory
(SECONDARY)
(Duration)
.yrs.
mos. ................
ds.
(Signed)
M.D.
4
.... , 191 ....... (Address)
worthy
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 Neutr Camely
DATE OF BURIAL
June 5
191
17
20 UNDERTAKER ....
ADDRESS
3º
...
(Month)
(Year)
17 I HEREBY CERTIFY that I attended deceased from
.......
(Year)
1916
191
to
tom 30
191 1
that I last saw him alive on
30
1912.
.. .
and that death occurred, on the date stated above, at
9$ m.
m.
The CAUSE OF DEATH* was as follows :
Chronic interstitial nephritis
praemia
(Duration)
1 yrs.
......
..... mos ..
......
ds.
10 NAME OF
FATHER
Eche. Fr. Hace
11 BIRTHPLACE
OF FATHER
(State or country)
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Day)
1917
WHILE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT KECURU.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
If LESS than I 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, Architcet, 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 domestie 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 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., Careinoma, Sar- eoma, 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 necd not be stated unless im- portant. Example: Measles (disease causing death), 29 ds .; Broneho-pncumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- aemia" (mcrely 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 septicacmia," "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.
* FULL NAME & SEX " DATE OF BIRTH 7 AGE 8 OCCUPATION 10 NAME OF FATHER PARENTS (Informant) important. See Instructions on back of certificate. (Address) 16 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 .... ........ .
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
(No. ....
...........
.........
Montgomery
11 711th /
(City or town.)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
6 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED<
(Write the word)
21917
(Month)
(Day)
(Year)
If LESS than I day ..... hrs.
X ....... yrs. X mos. X ds.
or ...
... min. ?
(a) Trade, profession, or
particular kind of work ........................
Buchfaut Winthe mas
(b) General nature of industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country]
Jerry. X Montgomery
11 BIRTHPLACE OF FATHER (State or country) My errez, Thorpe
12 MAIDEN NAME OF MOTHER newton Milan
18 BIRTHPLACE OF MOTHER (State or country)
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Filed
191
...
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH June 4 . 191 7 191 (Year)
(Month)
(Day)
17
7
I HEREBY CERTIFY that I attended deceased from
tuge
4
191.2.
to
191
that I last saw h low alive on
4
٦
191 .... , and that death occurred, on the date stated above, at 24 m. The CAUSE OF DEATH* was as follows : Combo
ammain ?
....
(Duration)
.yrs.
mos.
12 hrs
ds.
Contributory. (SECONDARY)
(Duration) .yrs.
mos. ds.
(Signed)
M.D.
3.Ts
* 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.
In the
... mos. ............. da.
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
0,8
1917
......
ADDRESS
20 UNDERTAKER Ducht Gemely
Ward)
[If married or divorced woman or widow give maiden name, also name of husband.} @RESIDENCE
......
Registered No.
.......
191 ....... (Address) .. 13
PERMANENT RECORD
4/1917
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, c. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive cngincer, 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) 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," "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 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the sanic accepted term for the same discasc. 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 pcumonia; Broncho- pneumonia ("Pneumonia," unqualified, is indefinite) ; T'uher-
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 .; Broneho-pneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "An- acmia" (merely symptomatic), "Atrophy," "Collapse," "Cona," "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- 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 dead, etc.
LINA HIIM
SI SIHL - XNI ĐNIOVING
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
(No. 156
.......
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
* SEX
4 COLOR OR RACE
6 SINGLE,
MARRIED.
WIDOWED,
OR DIVORCED
(Write the word)
Widowed
' DATE OF BIRTH
3. (Month)
20
(Day)
(Year)
' AGE
If LESS than 1 day, ........ hrs.
64
_... yrs. ........
2 mos.
21
ds.
or ........ min. ?
· OCCUPATION
(a) Trade, profession, or
particular kind of work
athome
(b) Generat nature of Industry, business, or establishment in which employed (or employer).
9 BIRTHPLACE
(State or country)
chester, n. S.
PARENTS
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE
OF MOTHER
(State or country)
n. 8.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
19 PLACE OF BURIAL OR REMOVAL
(Informant)
9mm. CR. Duncan
(Address)
156 Lencalust withor chester, n. S.
DATE OF BURIAL
6-14-1912
15 Filed
191
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
1ª DATE OF DEATH
7-15 9.2.
6
...
(Month)
(Day)
11, 1917
(Year)
853
17
I HEREBY CERTIFY that I attended deceased from
march
1917, to
1917
......
...
......
that I last saw him alive on
tom 10~
.
191.2 and that death occurred, on the date stated above, at (1) Am The CAUSE OF DEATH* was as follows : Diabetes mellitus
......
.(Duration)
................ mos. ...............
.ds.
Contributory.
(SECONDARY)
(Duration) ................ yrs.
mos.
ds
.......
(Signed)
M.D
し
[1], 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
mos.
In the
ds .............
of death ......
.yrs.
mos. ..
ds.
State ............ yrs.
......
Where was disease contracted, If not at place of death ?.
Former or usual residence.
20 UNDERTAKER I. C. Skaggs
ADDRESS
Winthrope
'FULL NAME
Eliza mille
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE
Hilta-Rolt, B. Mills
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT MEUUND.
10 NAME OF
FATHER
Hilty.
11 BIRTHPLACE
OF FATHER
(State or country)
n. S.
11,1911
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 occupation 3 a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architeet, 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 occu- pation whatever, write None.
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