Town of Winthrop : Record of Deaths 1919-1921, Part 142

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 142


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).


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(Recommendations on statement of cause of death approved by Com- mittee on Nomenclaturo 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 hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died [defined so that it can ho classified under the international classification of causes of death], where contracted, the duration of his last illness, when last seen alive hy the physician, and the date of his death. . . . - Revised Laws, Chap. 29, Secs. 10 and 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 hoard 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 tho 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 Laws, Chap. 78, Sec. 88.


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 he, 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 hy violence. - Revised Laws, Chup. 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 havo 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 ahortion, 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.


1


M R-301


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF DEATH


County.


Suffolk


State Massachusetts .Registered No. 11


City or Town


BOSTON


No. 26


Carol got Winthrop


St.,


Ward


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


Jeoni Barbara Tottler


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


(a) Residence.


No.


26


Carol Que


St.


Ward.


( Usual place of abode)


Leogth of residence in city or town where death occurred


years


3


months


days.


How lang in U. S., if af foreign birth ?


years


months days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female


4 COLOR OR RACE


Ipfuite


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


5a If married, widowcd, or divorced HUSBAND of (or) WIFE of


6 DATE OF BIRTH


October 25


( Month)


(Day)


(Year)


Years


Months Days


If LESS than


If STILLBORN, enter that fact here


If STILLBORN, state period nf uterogestation


mos.


(Father)


Salesman


9 BIRTHPLACE (City)


Winthrop


(State or country)


Robert & F attler


11 BIRTHPLACE OF


FATHER (City).


Boston mare


(State or country)


12 MAIDEN NAME


OF MOTHER


Louise B Hendricks


13 BIRTHPLACE OF


MOTHER (City)


Boston mass


(State or country)


14 Robert Father


(Address)


Winthrop mass


15 Jan. 29.1921


Filed (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH (1Month)


25 (Day)


1030 Br


(Year)


17 I HEREBY CERTIFY, That I attended deceased from


20 19. , to


25 , 19 .. 2/ ,


that I last saw h


Or alive on


2 9 2%.


and that death occurred, on the date stated above, at. 10.30 0 m.


The CAUSE OF DEATH was as follows: Gastro Enteritis acute Porbably due to progan milic


( duration) . .yrs ...... mos ... 5 as.


CONTRIBUTORY


( SECONOARY)


(duration)


yrs ....


mos ... . ds.


18 Where was diseasc contracted


if not at place of death ?


FOR WHAT ?


Did an operation precede death ?


Date of


Was there an autopsy ?


What test confirmed diagnosis ?


(Signed).


. M.D.


(Address)


Date


(Month)


( Day)


(Year)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


Boston


DATE OF BURIAL Jan 27, 1921


(Cemetery)


(City or town)


20 UNDERTAKER


C. a. Follina


ADDRESS Boston


Permit


Official . position


Secretary


Date nf issue cf permit. 1/26/21


229


7 AGE 10 NAME OF FATHER PARENTS Informant 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 should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK -THIS IS A PERMANENT RECORD. Every item of information (c) Name nf emplayer


. 150,000. -'19-X.XM.)


21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial nr transit permit was issued albert I. Smith


1 day, ...... hrs. ar ........ min.


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


1920


2 FULL NAME


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


174 honderd of 26 1921


Jan 20.1921


REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH


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


Statement of occupation. - Precise statement of oceupation 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, Locomotive engineer, Civil engineer, Stationary fircman, 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal 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 entercd 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 domestie 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 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- brospinal fever (the only definite synonym is "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pnsumonia," 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); Mcasles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) affection nced 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 ean be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," ete.


State cause for which surgical operation was undertaken.


(Recommendations on statement of cause of death approved by Com- mittee 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. . . . - Revised Laws, Chap. 29, Secs. 10 and 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 eity or town in which the person died; . . . nosuch 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- eate as hereinafter provided. If there is no attending physician, or if, for suffleient 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 thereafterfurnislı 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 Laws, Chap. 78, Sec. 88.


Medical examiners shall, in all cases, certify to the city or town clerk or to the city registrar in the place where the deceased dicd, 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, Chap. 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 thoss 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.


The Commonwealth of Massachusetts


Chelsea


STANDARD CERTIFICATE OF DEATH


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


(City or town)


1 PLACE OF DEATH


County.


Suffolk


State


Mass.


Registered No.


55


Township


or Village.


City


Chelsea


No.


Soldiers Home


St.,


.Ward


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


2 FULL NAME


William H. Churchill


(a) Residence.


No.


136 Locual


St.,


.. Ward.


Winthrop NESE


(Usual place of abode)


Length of residence in city or town where death occurred


years


mouths


3


days.


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male


4 COLOR OR RACE


white


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


married


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


6 DATE OF BIRTH (month, day, and year) Mar.24 1848


7 AGE


Years


Months


Days


If LESS than


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


or ....... min.


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work .....


DE y laborer


(b) General mature of industry,


business, or establishment in


which employed (or employer)


(c) Name of employer


CONTRIBUTORY


(SECONDARY)


(duration)


.........


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


ds.


18 Where was disease contracted


if not at place of death ?


Did an operation precede death ?


.no


Date of.


Was there an autopsy ?.


no


What test confirmed diagnosis ?


(Signed).


Geo H. Maxfield


M.D.


12 MAIDEN NAME OF MOTHER


Asrreth Vickery


, 19


(Address)


Chelsea


1/25/21


13 BIRTHPLACE OF MOTHER (city or town).


Flympton


(State or country)


Mass.


* State the DISEASE CAUSING DEATH, or In deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


Colebrook Cem. Whitman


DATE OF BURIAL


1/27/2119


15 Filed 1 /28/21. 19 1/29,21


ze


REGISTRAR


16 DATE OF DEATH (month, day, and year) Jan . 25 1922


17


I HEREBY CERTIFY, That I attended deceased from


Jan. 23.


19


21, to Jen. 25


19


21


that I last saw him


_ alive on


JE n. 25


19 .. 2.1.


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


3.45 P.


m.


The CAUSE OF DEATH* was as follows :


(duration)


yrs.


Z


mos.


.ds.


9 BIRTHPLACE (city or town).


Kingston


(State or country)


10 NAME OF FATHER Prince Churchill


11 BIRTHPLACE OF FATHER (city or town)


King.s.t.o.n.


(State or country)


Mass.


PARENTS


14


Informant


Hospital Records


(Address)


20, UNDERTAKER


G. a. Allen


Boston


ME ss


ADDRESS


.


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


12


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


72


10


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


Statement of occupation. - Precise statement of occupa- tion 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, Compos- itor, Architect, Locomotive 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) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The ma- terial worked on may form part of the second statement. Never return "Laborer,"


"Foreman," " Manager,' "Dealer," ete., without inore 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 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 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 indi- cated thus: Farmer (retired, 6 yrs.). For persons who liave 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 saine disease. Examples: Cercbrospinal fever (the only definite synonym is "Epidemic cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, ete., Carcinoma, Sarcoma, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (mercly symptomatic), "Atrophy," "Col- lapse," "Comna," ""Convulsions,"" "Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertaincd as the cause. Always qualify all discases resulting from child- birth or miscarriage, as "PUERPERAL septicemia," "PUER- PERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS STATE MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, Of HOMICIDAL, or as probably such, if impossible to de- termine definitely. "Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by carbolic acid - probably suicide. The nature of the injury, as fracture of skull, and consequences (c. g., scpsis, tetanus) may be stated


11


on statement of cause of death approved by Committee


on Nomenclature of the American Medical Association.)


Cases for the Medical Examiners. - Under the provi- sions of chapter 24 of the Revised Laws deaths under the following 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, Exposure, 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 ..


ADDITIONAL SPACE


FOR FURTHER STATEMENTS BY


PHYSICIAN.


R 15. 1-'18. 10,000.


R-301


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE/OF DEATH


(City or Town)


County.


C


State No. 12Metcalfonecapital


Registered No ..


13


City or Town


Mary Lows.


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


(a) Residence.


No ..


(Usual place of abode)


Length of residence in city or towa where death occurred


35 years


months


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


months days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


White


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


5a If married, widowed, or divorced HUSBAND of (or) WIFE of


Thequick. Thebuck


6 DATE OF BIRTH


( Month>


(Dayy


7 AGE


Years


37


Months


6


Days


26


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


or ....... min.


If STILLBORN, enter that fact here


Z


z


8 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


(h) Name of employer


9 BIRTHPLACE (City)


(State or country)


10 NAME OF


FATHER


11 BIRTHPLACE OF


FATHER (City)


Pembroke


(State or country)


12 MAIDEN NAME


OF MOTHER


YÊN Lesicella, Laws


13 BIRTHPLACE OF


MOTHER (efty)


Perchoke


(State or country)


14


Informant.


Surbank.


(Address)


Frederik, Strubeck


15 Feb. 5. 1921 Filed : (Month) (Day) (Year)


REGISTRAR


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


albert J. Smith


Official position Secretary


Date of issue of permit. 1/31/21


DATE OF BURIAL


(Cemetery)


(City or town)


3+1911


ADDRESS


20 UNDERTAKER ER.


Date of.


Care 2021


Was there an autopsy ?


What test confirmed diagnosis ?


(Signed)


MM- call.


, M.D.


(Address)


174 wnutule 2


Date


fur Boni


312 1921 (Yeary


(D)ny)


yrs .....


6


mos.


ds.


CONTRIBUTORY (SECONDARY)


(duration) ... yrs ... mos ............... ds.


18 Where was disease contracted if not at place of death? operation precede d


1920


to


m 29


,19.3.{,


that I last saw h LZ alive on 2.


19


12-1


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


If LESS than The CAUSE OF DEATH was as follows : Carcinoma 01 lett over und generale food over Peritoneum C


(duration)


Pembroke


PARENTS


. 50,000.


The Commonwealth of Massachusetts


1 PLACE OF DEATH


2 FULL NAME


St., Ward (If death occurred in a hospital orfinstitution, giveits NAME Instead of street and number) Probeck


St.,


.Ward.


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


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


Jan


Month)


29


(Day)


1921


(Year)


17 I HEREBY CERTIFY, That I attended dcceased from


1883 (Year)


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


19 PLACE OF BURIAL, CREMATION, OR REMOVAL




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