Town of Winthrop : Record of Deaths 1919-1921, Part 10

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192

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2. Deaths supposedly caused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, etc.

3. Sudden deaths of persons not disabled by recognized discasc, 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.

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY PHYSICIAN.

R 15, 1-'18. 20,000.

WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.

1 PLACE OF DEATH 8 SEX 7 AGE (b) General nature of Industry, business, or establishment in which employed (or employer). 9 BIRTHPLACE (State or country) 11 BIRTHPLACE OF FATHER (State or country) PARENTS 1ª BIRTHPLACE OF MOTHER (State or country) (Informant) important. See instructions on back of certificate. (Address) N B. - Every Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very ... ........... yrs.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

044 Belcher

St. :...

.......... .Ward)

Laura

M Frost.

Laura M. Samman

Drach

.... Registered No.

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH

(Month)

20/ 1919

(Day)

(Year)

I HEREBY CERTIFY that I attended deceased from

76-10

1914 to

26. 20

1919

that I last saw her alive on

7b. 14

1919

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

2.1. Am.

The CAUSE OF DEATH* was as follows :

Mbostatio pneumonia

Hyl

.. (Duration)

...... yrs.

.........

mos.

„ds.

Contributory.

Cerebral Hammlas

(SECONDARY)

.(Duration)

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

mos. ...

ds.

(Signed)

M.D.

15. 2.2. 1919, (Address)

360 w mitih Ht

* 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.

In the

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 Harrison Tamne

DATE OF BURIAL

.. 1914

20 UNDERTAKER

Bollino

ADDRESS

Filed 21/1919

REGISTRAR

(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

5 SINGLE,

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

Widow

(Day) (Year)

If LESS than

I day ........ hrs.

.14

yra. 5 mos. 4

ds.

or ...... min. ?

& OCCUPATION

(a) Trade, profesaion, or

particular kind of work

at Home

Harrison me

10 NAME OF

FATHER

Gammon

12 MAIDEN NAME

OF MOTHER

Unkurum

"THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

2 FULL NAME

[If married or divorced woman or widow

give maiden name, also name of husband.]

@RESIDENCE

44 Belever St

$ DATE OF BIRTH

aug 16

(Month)

1884

February 20, 1919 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 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- EASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cercbro-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; 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); Mcaslcs; 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 .; 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," "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- posurc, 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, etc.

4. Deaths under circumstances unknown, as A person found dead, etc.

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH County

State .. ...

Registered No.

St.

Ward

(If death occurred in a hospital or institution, give its NAME instead of street and number) Jackson

( If in the Army or Navy of the United States, give rank, organization, etc.)

(a) Residence.

No.

(Usual place of abode)

Length of residence in city or town where death occurred

years

St.,

Ward.

(If non-resident give city or town and State)

months days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

manuel

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Bertha. Jackson

6 DATE OF BIRTH June 20 ( Month)

(Day)

Months 8

Days

I day,

hrs.

If STILLBORN, state period of uterogestation

mos.

min.

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work. (b) General nature of industry, business, or establishment in which employed (or employer)

Rituel

9 BIRTHPLACE (City)

Warshaw (Warsaw)

(State or country) Patand, Russiai

10 NAME OF

FATHER

Mathew Jackson

11 BIRTHPLACE OF

FATHER (City)

(State or country)

Porland

Warbeau

Rosa X

13 BIRTHPLACE OF

MOTHER (City)

Markhow

(State or country)

Poland

14 Ches. R. Bennison

Informant

(Address)

warchest mars

.....

Feb. 28.1919

(Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Montho

Jelly

1919

(Year)

17 I HEREBY CERTIFY, That I attended deceased from 2000 1 , 198 ,to 7 el 22 ,19 19.,

that I last saw heen alive on

, 19

and that death occurred, on the date stated above, at 10

Decease

mos. ... .... ds. arterio abbraccia

CONTRIBUTORY

( SECONDARY)

Secundariae

yrs ..........

mos.

.ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death ?

200

Date of.

Was there an autopsy ? .

What test confirmed diagnosis ?.

Clinical

(Signed) ..

Owiele E fol insan

(Address) 123 Utilices

1919

Date

(Month)

(Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

Ohrabri Shalom East 13 aston

(Cemetery)

(City or town)

DATE OF BURIAL

2/24

1919

20 UNDERTAKER

@ Las. 12. 13 e mesini

ADDRESS

Winterok

21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issned S. A. Manu

Official

22 Date of issue of burial or transit permit

Jul 24 1919.

City or Town 2 FULL NAME 3 SEX male 7 AGE Ycars (c) Name of employer 12 MAIDEN NAME OF MOTHER PARENTS instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See If STILLBORN, enter that fact here

M R-301

N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information

should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH

18. 100,000.

Mars

No. 53

mark

53 Tudent are

months

days.

How long in U. S., if of foreign birth ?

years

(Day)

1853 ( Year)

If LESS than

The CAUSE OF DEATH was as follows :

, M.D.

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

[Approved by U. S. Census and American Public Health Association]

Statement of occupation. - Precise statement of occupation 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 Plonter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stotionory firemon, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile foctory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day loborer, Farm laborer, Loborer - Cool mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servont, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death. - Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinol fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonio; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ... . .. ... (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic volvulor heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemio," " PUERPERAL peritonitis," etc.

State cause for which surgical operation was undertaken.

(Recommendations on statement of cause of death approved by Com- mittce on Nomenclature of the American Medical Association.)

Bronchopneumonia: If primary cause, write the word "pri- mary" ; if secondary, give primary cause.

Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.

EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can be classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive by the physician, and the date of his death. . . . - Reviscd Lows, Chop. 29, Secs. 10 ond 1, as amended by Acts of 1910, Chap. 322.

No undertaker or other person shall bury a human body . . . until he has received a permit from the board of health or its agent, . . . . . or ... from the clerk of the city or town in which the person died; ... no such permit shall be issued until there shall have been delivered to such board, agent or clerk, . . . a satisfactory written statement con- taining the facts required by law to be returned and recorded, which ... shall be accompanied by a satisfactory certificate of the at- tending physician, if any, as required by law, or in lieu thereof a certifi- cate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician. If death is caused by violence, the medical examiner only shall make such certificate. . . . The person to whom the per- mit is so given and the physician who certifies to the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Lows, Chop. 78, Sec. 38.

Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased died, his name and residence, if known, otherwise a description of such person as full as may be, with the cause and manner of his death, and shall make examination upon the view of the dead bodies of only such persons as are supposed to have come to their death by violence. - Revised Laws, Chop. 24, Sec. 8.

RULES OF PRACTICE

The fulfilment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health Physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

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.

3 SEX Male 6 DATE OF BIRTH 7 AGE 8 OCCUPATION PARENTS CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very particular kind of work

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

1 PLACE OF DEATH

.(No. 57 Read

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

Richard W. Brown 2 FULL NAME [If married or divorced woman or widow give maiden name, also name of husband.] @RESIDENCE 17 Read St.

PERSONAL AND STATISTICAL PARTICULARS

5 SINGLE,

married

MARRIED,

WIDOWED,

OR DIVORCED

(Write the word)

1834

(Year)

If LESS than 1 day, ....... hrs.

35 .yrs.

mos. -

ds.

or.

min. ?

(a) Trade, profession, or

Clerk

(b) General nature of industry,

business, or establishment in

which employed (or employer).

B+A. R.R.

9 BIRTHPLACE

(State or country)

" East Boston Mask

10 NAME OF

FATHER

Charles &. Brown

11 BIRTHPLACE OF FATHER (State or country) Rotterdam & land

12 MAIDEN NAME OF MOTHER Margaret Melvin

13 BIRTHPLACE OF MOTHER (State or country)

Ireland

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant)

Charles J. Brown

(Address) 16 With an der

Filed Feb. 28, 1919

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

(Month)

(Day)

1 HEREBY CERTIFY that I have investigated the death of the deceased.

The CAUSE OF DEATH* was as follows :

Sunscope

following the

administration of etter as Sugiere anaesthetic. Presumably oedema of

the Larynx Gadocio mos. ds.

CarubTory.

peritonsillas

(SECONDARY)

cad.)

(Duration)

ds.

(Signed)

Burgers Magnet,

M.D.

Tele 22 1610 (Address) ... MEDICAL EXAMINER

* State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS of INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL.

18 LENGTH OF RESIDENCE (FOR HOSPITALS, INSTITUTIONS, TRANSIENTS, OF RECENT RESIDENTS).

In the

mos.

ds ..

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

Former or usual residence.

13 PLACE OF BURIAL OR REMOVAL

DATE OF BURIAL

tièle se

. ,

191

20 UNDERTAKER

ADDRESS

4 COLOR OR RACE

White

(Month)

(Day)

16 DATE OF DEATH

22, 199

(Year,

Registered No.

10,304 Writing (City or town. [If death occurred in a hospital or institution, give its NAME instead of street and number.]

WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD.

At place

of death.

... yrs. ..

mos.

......

ds.

State

......

.. yrs.

February 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 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, 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 uceded. 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 - Ccal 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 DEATII, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, G yrs.). For persons who have no occu- pation whatever, write None.

Statement of cause of death. - Name, first, the DIS- KASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the sante 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; Broneho- 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 .; 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," 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 septicaemia," "PUERPERAL peritonitis," ctc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qualify as ACCI- DENTAL, SUICIDAL, OF HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Aceidental drowning; Struck by railway train -accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suieidc. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis tetanus) may be stated under the head of "Contributory."

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, Homieide, 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 discase, as A death upon the street, or onc supposed to be due to Alcoholism, etc.

4. Deaths under circumstances unknown, as A person found dead, etc.

R 16. 10-'17. 10,000.

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

(City or town)

1 PLACE OF DEATH

Registered No.

(Place of death)

Registered No.

(Place of residence)

No.

amy State

HostN.

St.,

Ward

(If death occurred in a hospital or institution, give its NAME instead of street and number)

2 FULL NAME

Maas.

City or Town Winthrop

.......

St.

Length of residence io city or town where death occurred

years

mooths

days

How long io U. S., if of foreign birth?

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

3 SEX

Malı

4 COLOR OR RACE

whiti

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

Married

Sa If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Louise Zanbach

6 DATE OF BIRTH (month, day, and year)

1867.

7 AGE SA Years

Months

Days

If LESS thao

1 day,

If STILLBORN, enter that fact bere

pr ...... min.

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) General nature of indostry, business, or establishment in which employed (or employer ) ....

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Town of Winthrop : Record of Deaths 1919-1921, Part 10

Author: Winthrop (Mass.) Publication date: 1919 Publisher: Number of Pages: 1192

Author: Winthrop (Mass.)
Publication date: 1919
Publisher:
Number of Pages: 1192