USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1916-1918 > Part 75
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).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104 | Part 105 | Part 106 | Part 107 | Part 108 | Part 109 | Part 110 | Part 111 | Part 112 | Part 113 | Part 114 | Part 115 | Part 116 | Part 117 | Part 118 | Part 119 | Part 120 | Part 121 | Part 122 | Part 123 | Part 124 | Part 125 | Part 126 | Part 127 | Part 128 | Part 129 | Part 130 | Part 131 | Part 132 | Part 133 | Part 134 | Part 135 | Part 136 | Part 137 | Part 138 | Part 139 | Part 140 | Part 141 | Part 142 | Part 143 | Part 144 | Part 145 | Part 146 | Part 147 | Part 148 | Part 149 | Part 150 | Part 151 | Part 152
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.
-
3 SEX 7 AGE PARENTS (Informent) (Address) 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 CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very ....
( 1 PLACE OF DEATH
STANDARD CERTIFICATE OF DEATH
(No.
St. :
Ward)
[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 361 Shirley St Wuchef Man
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Cet
(Month)
15
(Day)
,
(Year)
· DATE OF BIRTH cent
15#
1917
(Month)
(Day)
(Year)
If LESS than never
7
that I test saw hum. alive on
191
.........
and that death occurred, on the date stated above, at
m.
The CAUSE OF DEATH* was as follows :
Stilltown
(Duration). .. yrs. ............. .mos. .......... ds.
Contributory (SECONDARY)
.(Duration) . »yrs ....... ) .... mos. ................ ds.
(Signed)
Raymond
~ M.D.
Cect 16
1907 (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
In the
......... 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
lect-17
1917
20 UNDERTAKER ....
ADDRESS
15 Filed 191
REGISTRAR
...
[ day ......... hrs.
.yrs. mos.
ds.
Or ....... min. ?
& OCCUPATION (a) Trade, profession, or particular kind of work
......
(b) General nature of Industry,
business, or establishment
which employed (or employer).
9 BIRTHPLACE
(State or country)
10 NAME OF
FATHER
11 BIRTHPLACE OF FATHER (State or country) England
12 MAIDEN NAME
OF MOTHER
Clara Elizabeth Leis
13 BIRTHPLACE OF MOTHER (State or country) Implant
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
-
The Commonwealth of Massachusetts
(City or town.)
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Singer
191_
.
17 I HEREBY CERTIFY that I attended deceased from Lect 15, 1917, to. CCT 15 191
WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD.
INI
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 singlo word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it i: uccessary 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.
Statement of cause of death. - Name, first, the DIS- EASE CAUSING DEATH (the primary affection with respect to tine 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 ("Pucumonia," 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, ctc. The contributory (sccond- ary or intercurrent) affection nced not be stated unless im- portant. Example: Measles (discase 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," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," ctc.), "Dropsy," "Exhaustion," "Heart failure," "Hacmorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uracınia," "Weakness," etc., when a definite disease 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 disease, as A death upon the street, or onc supposed to be due to Alcoholism, ctc.
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) England
12 MAIDEN NAME
OF MOTHER
18 BIRTHPLACE
OF MOTHER
(State or country)
Y
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
Frederick, W. Lica
(Address)
361 Thriley Sh Winchart
REGISTRAR ....
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
Geit
(Month)
15
(Day)
7
191
(Year)
17
I HEREBY CERTIFY that I attended deceased from
leit 8
, 191.2., to.
Oct 15
1917
that I last saw h 22 alive on
Ceux 15
1917.
and that death occurred, on the date stated above, at 2 Am
The CAUSE OF DEATH* was as follows :
Puntual albini
(auth lupenitis)
.(Duration)
.yrs.
mos.
.
10
ds.
Contributory Chronic
(SECONDARY)
(Duration) 2
yrs.
............. mos.
.......
ds.
(Signed)
Raymond 3False
M.D.
CONT 16, 1997 (Address)
Winthrop De
* 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
lech 175
1917
16 Filed 191
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
-
(No.
Elana. Elizabeth LEES.
? FULL NAME
[If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 361 Shirley So.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
muito
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Manuel
· DATE OF BIRTH Lay-14-1882 (Month) (Day)
1
(Year)
7 AGE
If LESS than [ day ......... hrs.
min . ?
& OCCUPATION
(a) Trade, profession, or
particular kind of work
(b) General nature of industry.
business, or establishment in
which employed (or employer).
Housekeeping
9 BIRTHPLACE
(State or country)
England
10 NAME OF
FATHER
Fresh Rawson
WRITE PLAINLT, WETTT ONFADING INK - THIS IS A PERMANENT RECORD.
Whichof
Ward)
(City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
....
wife of Frederick. W. Lies
Registered No.
20 UNDERTAKER
ADDRESS NunchuT
27
2
mos. .....
.............
.ds.
IHL - XNI ONIOVANA HLIM ·A INIVI ..
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, ete. 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," "Forcman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. Women at home, who are engaged in the duties of the household only (not paid Ilousc- 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 Servant, Cook, Housemaid, ete. 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 110 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 synonyın is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never re- port "Typhoid pneumonia"); Lobar pneumonia; Broncho- mmcumonia ("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 discase; Chronic interstitial nephritis, ete. The contributory (second- ary or intercurrent) affection necd 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," ete., when a definite disease can be asecrtained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL scpticaemia," "PUERPERAL peritonitis," ete. 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, 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) Ceciand.
12 MAIDEN NAME OF MOTHER Alice The Landtalin
13 BIRTHPLACE OF MOTHER (State or country)
Atland
14 THE ABOVE IS TRUE TO THE BEST OF MY/KNOWLEDGE
(Informant)
Margaret Koster
(Address)
4st Jerever St.
16
Filed
191
......... REGISTRAR ........
MEDICAL CERTIFICATE OF DEATH
3 SEX
Fromale White
4 COLOR OR RACE
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
Widowra
· DATE OF BIRTH
(Month)
(Day)
1831
(Year)
7 AGE
If LESS than
i day ......... hrs.
86
„yrs.
mos.
ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
At Home.
(b) General nature of Industry, business, or establishment. In which employed (or employer) ...
9 BIRTHPLACE
(State or country)
rtland
Contributory (SECONDARY)
{Duration)
.mos.
mymccall
...........
ds.
M.D.
Och. 17
1917
(Address).
31 Manmetly Bisher
* 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 Cross malder
DATE OF BURIAL
Det 19, 1917
20 UNDERTAKER John F. Comaler
ADDRESS
1
...... ........
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
PLACE OF DEATH
Winthrop
(No ....
45 Locust
Bridget monday mr Wally.
St. :..
Ward)
[If death occurred in a hospital or institution, give its NAME instead of street and number.]
' FULL NAME
nondan
window of teten morally
......
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
16 DATE OF DEATH
Octobu
(Month)
(Dáy)
17.
1917
(Year)
17
I HEREBY, CERTIFY that I attended deceased from
/20
1917
to
alive on
och, 175)
,
Oct. 17"
1917
that I last saw her
.............
1917
and that death occurred, on the date stated above, at ]/m.
The CAUSE OF DEATH* was as follows :
C
Culinary Frelama and
(Signed),
mos.
ds.
(Duration)
.yrs.
6
10 NAME OF FATHER
Winthrop
(City or town.)
[If married or divorced woman or window give maiden name, also name of husband.] @RESIDENCE 45 Locust St Q
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 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 forin part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Lahorer - 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, ctc. 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 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., Carcinoma, Sar- coma, etc., of .... ......... (name origin: "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms) ; 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: 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 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 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, 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.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH-1917.
CITY OF BOSTON
FULL NAME
EUGENE F.HART
Registered No.
10342
Place of Death l and Residence §
Boston
CHARLES RIVER BASIN
Date of Death
OCT.21 (FOUND)
1917, Age 28
years
months days.
STATISTICAL DETAILS.
SEX.
COLOR
SINGLE, MARRIED, WID .. DIV.
M
W
M
Maiden Name
Husband's Name
Birthplace
BOSTON(EAST)
Name of Father
EDWARD HART
Birthplace of Father TEWKSBURY
Maiden Name of Mother
MARY E. FOLEY
Birthplace of Mother
BOSTON
Occupation
LABORER
OCT22
1917
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial or removal
ST.MARYS CEM.
Undertaker R.C.KIRBY
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness, from 1917, to
1917, 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:
RAR'
PATRIC
DROWNING UNDER CIRCUMSTANCES
+ (Durat
W MOBIS DOFFICE
UNKNOWN
TVITA
BOSTONIA
CONDITAA
5. 1822
TO SAP 163. EGIMINE DONATA D. N. MASS.
Contributory: (Duration)
(Signed) G.B.MAGRATH MED.EX. M.D.
Usual Residence WINTHROP (317 WINTHROP ST)
Filed
OCT.26
1917.
A true copy.
Attest :
Registrar.
Informant
CITY
C
Oct. 21, 1917
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.
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 CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very
[12-'15-XXM.]
The Comumnonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH Winthrop
(No. 77 Harbor Vier avc. St. :
..... Ward)
BOSTON (City or town.) [If death occurred in a hospital or institution, give its NAME instead of street and number.]
'FULL NAME
augusta manter Watson
[If married or divorced woman oy widow
give maiden name, also name of husband.]
albert In. fration
aRESIDENCE Clarki Island Plymouth Mass
Registered No. ....
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
October
(Month)
(Day)
2%, 1917.
( Year)
17
I HEREBY CERTIFY that I attended deceased from
Och, 15, 1917, to
Och. 2%.
1917-
that I last saw her alive on
Oct. 21., 1917.
and that death occurred, on the date stated above, at
20 m
The CAUSE OF DEATH* was as follows :
arterio - acledoris
Did a surgical operation precede death ?
Date
(Duration) yrs. mos.
......
.ds.
Contributory ...
Interstiti neppreto
.....
(SECONDARY Inder.
......... (Duration)
Cyrs.
......
... mos.
ds.
(Signed)
Det. VV.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).
In the
At place
of death ....
yrs.
mos.
ds.
State ............ yrs. ............ mos.
ds .............
Where was disease contracted, If not at place of death ?.
Former or usual residence.
19 PLACE OF BURIAL OR REMOVAL Sudbury mass
DATE OF BURIAL
Oct 24. 1917
20 UNDERTAKER
ADDRESS
& Str atermant Samma Boston
1
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE,
MARRIED,
WIDOWED,
OR DIVORCED
(Write the word)
married
" DATE OF BIRTH
Sepr
14
1834
(Month)
(Day)
(Year)
" AGE
If LESS than
I day ......... hrs.
83
......
.........
1
mos.
6
ds.
or ......... min. ?
8 OCCUPATION
(a) Trade, profession, or
particular kind of work
Housewife
(b) General nature of industry, business, or establishment in which employed (or employer)
9 BIRTHPLACE
(State or country)
Plymouth Lass.
10 NAME OF
FATHER
Prince manter
PARENTS
11 BIRTHPLACE
OF FATHER
(State or country)
Plymouth mass.
12 MAIDEN NAME
OF MOTHER
Wealtha Burgess
13 BIRTHPLACE
OF MOTHER
(State or country)
Plymouth mass.
14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)
hun Theodor metcall
3) 73 Harbour View Que Mulheres
1
Filed 191
REGISTRAR
Hl Parter
M.D
wct 22, 191/
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, 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 "Laborcr," "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, 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 (retircd, 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.