Town of Winthrop : Record of Deaths 1919-1921, Part 143

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 143

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Permit No ..... 23%

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 Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, 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 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, ete. 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 employsd, 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 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 acceptsd term for the same disease. Examples: Cere- brospinal fever (the only dsfinite synonym is "Epidemic csrebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualifisd, 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 valvular heart disease; Chronic interstitial nephritis, ete. Ths 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 msre symptoms or terminal conditions, such as "Asthenia," "Anemia" (msrely symptomatic), "Atrophy," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition, " "Marasmus," "Old age," "Shock," "Uremia,""Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.

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: Abortlon, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscar- rlage, 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, ths disease of which he died [defined so that it can be classified under ths international classification of causes of death], where contractcd, 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 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 physlclan, or any physician employed by sald 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 psr- mit is so given and the physician who csrtifies to the use of death shall thereafterfurnish for registration any other necessary information which can be obtainsd as to the dsceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 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, Chap. 24, Sec. 8.

RULES OF PRACTICE

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

(1) Attending physiclans will csrtify 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 msdical 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 death ascd dircetly or indirectly by traumatism (including resulting septicem ), and by the action of chemical (drugs or poisons), thermal, or electrel agents, and deaths following abortion, but also deaths from disease sulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and thoss of persons found dead.

R-302

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Chelsea

(City or town)

Registered No.

(Place of death)

Registered No.

(Place of residence)

St.,

Ward

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

2 FULL NAME

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

(a) Residence. State ...... Mass ..

(Usual place of abode)

City or Town ..... Winthrop

No.58 Brookfield Ka.

St.

Length of resideoce in city or town where death occurred

years

months

days

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Fema le

4 COLOR OR RACE

white

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

single

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH (month, day, and year) Jan. 20 1921

7 AGE

Years

Months

Days

If LESS tbao

1 day, ........ hrs. or ........ min.

If STILLBORN, enter that fact bere stillborn

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

9 BIRTHPLACE (city or town)

Chelsea

(State or country) Macs .

10 NAME OF FATHER

Herbert P. Jordan

PARENTS

11 BIRTHPLACE OF FATHER (city or town) .Boston

(State or country)

Lass.

12 MAIDEN NAME OF MOTHER Pauline F.Tucker

winthrop

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

Mass .

. 19

(Address)

.. . Bost or.

14 Herbert P. Jordan

Informant

(Address)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Winthrop) Winthrop

DATE OF BURIAL

Fab. 1

Fil Jan. : 1, 19 21

Filed ...

Feb. 5, 1921

Registrar of city or town where deceased resided

19. 25,000

N. B. - WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be so that it may be properly classified. Exact statoment of OCCUPATION is very important. See instructions on back carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,

of certificate.

1 PLACE OF DEATH

County

Suffolk

State

Mass.

City or Town

Chelsxxx

Frost Hospital

---- Jordan

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and ycar)

Jan.30

1921

I HEREBY CERTIFY, That I attended deceased from

19.

Jan .: 0

1921

.. ,

that I last saw h

alive on

and that death occurred, on the date stated above, at .m. The CAUSE OF DEATH* was as follows:

* 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.)

Stillborn

.. (duration).

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

ds.

CONTRIBUTORY

(SECONDARY)

{duration)

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

ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death?

Date of

Was there an autopsy?

What test confirmed diagnosis?

(Signed)

U.U. Bragdon

M.D.

Registrar of city or town where death occurred

20 UNDERTAKER

Frank Z. Bums

ADDRESS

E.Boston

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [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 applics to each and every person, irrespective of age. For many occupations a single word or terin 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," "Forcman," "Manager," "Dealcr," 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 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 domcstie 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 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: Cerebrospinal fever (the only definite synonym is "Epidemie cerebrospinal menin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- ficd, is indefinite); Tuberculosis of lungs, meninges, peri- toneum, ctc., Carcinoma, Sarcoma, 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 (sccondary or inter- current) affection need not be stated unless important. Example: Measles (discase causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia,"

" Anemia" (mcrely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions,"" "Debility" (“Con- genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock,"Urcinia," "Weakness," ete., when a definite disease can be ascertained 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, or 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 (e. g., sepsis, tetanus) may be stated

under the head of "Contributory." (Recommendations on statement of eause 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. Deathis 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.

1-302

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

Chelsea (City or town)

Registered No ..

(Place of death)

Registered No ..

City or Town

Chelsea

No.

Frost Hospital

St.,

Ward

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

2 FULL NAME

Adolphus ). Mitchell

Mass.

City or Town.

Winthrop

No.

12 Caklard

St.

Length of residcoce in city or town where death occurred

years

months

days

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

years

mooths

days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

colored

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

married

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

Florence L.Mitchell

6 DATE OF BIRTH (month, day, and year) Apr. 15, 1877

Years

Months

Days

If LESS than

1 day, ........ brs. or ....... min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

Taborer

9 BIRTHPLACE (eity or town)

(State or country)

Virginia

10 NAME OF FATHER

Berry Mitchell

11 BIRTHPLACE OF FATHER (eity or town).

- -

(State or country) Virginia

12 MAIDEN NAME OF MOTHERLear Ann Barrett

13 BIRTHPLACE OF MOTHER (eity or town)

(State or country)

Virginia

14 Florence L. Mitchell

19 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop

DATE OF BURIAL

Feb.2

15 Filedfeb. 2 .1921

Filed

Feb 5

Registrar of city or town where death occurred

19 21

Registrar of city or town where deceased resided

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) Jar. . 30

1921

I HEREBY CERTIFY, That I attended deceased from

..... , to

that I last saw h ....

alive on.

19.

and that death occurred, on the date stated above, at m. The CAUSE OF DEATH* was as follows:

*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.)

Fracture of the Skull with associa-

ted hemorrhage, epidural, of the

Brain, Sustained under circumstances

unknown

.. (duration)

.. yrs ................. mos ................ ds.

CONTRIBUTORY

(SECONDARY)

(duration)

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

ds.

18 Where was disease contracted

if not at place of death?

Did an operation precede death ?.

Date of

Was there an autopsy ?.

What test confirmed diagnosis ?.

(Signed)

George Burgess Nagrath

.19 ( Address)

BOSTON

M.D.

20 UNDERTAKER

Chas. .. Bor nison

ADDRESS

Winthrop

19. 25,000

3 SEX Ma le 7 AGE PARENTS Informant (Address) carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back of certificate. N. B .- WRITE PLAINLY, WITH ONFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be (b) Name of employer

1 PLACE OF DEATH

County

Suffolk

State.

Mass.

(Place of residence)

(a) Residence.

State

(Usual place of abode)

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

REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH [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 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, 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," 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 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 Servant, Cook, Housemaid, etc. It the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired fromn 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 DEATHI (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal 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, etc., Carcinoma, Sarcoma, ete., of_

(name origin; "Cancer" is less definite; avoid use of "Tuinor" 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" (merely symptomatic), "Atrophy," "Col- lapse," "Comna," "Convulsions,"" "Debility" ("Con- genital," "Senile," etc.), "Dropsy," "Exhaustion,' "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Shock," "Uremia," "'Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases 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, or 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 (e. g., sepsis, tetanus) may be stated

under the head of "Contributory." (Recommendations 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.

A R-301

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

(City or Town)

1 PLACE OF DEATH

Suffolk

County

State

Registered No .. 19

St .... Ward

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

2 FULL NAME

(a) Residence.

No.

146 . Cliff aver

St.

Ward.

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

months days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Male

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

6 DATE OF BIRTH

tilb 3 1921

( Month)

(Day)

(Year)

7 AGE

Years

Months

Days /

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

If STILLBORN, enter that fact bere

8 OCCUPATION OF DECEASED

(a) Trade, profession, or

particular kind of work

(b) Name of employer

9 BIRTHPLACE (City)

(State or country)

10 NAME OF

FATHER

PARENTS

11 BIRTHPLACE 04 Galerii Morse. WEba

FATHER (City) ..

(State or country

Rechacon ( Versant

12 MAIDEN NAME

OF MOTHER

Gladys Elliott

13 BIRTHPLACE OF MOTHER (City) (State or country)

14 Xavie. G. Elliott

Informant

(Address)

1376 Commencement une

15 Je6.5.1921.

Filed (Month) (Day) (Year)

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)

( Day)

1921

(Year)

I HEREBY CERTIFY, That I attended deceased from

1921

76 4

1921.

to.

that I last saw h

alive on

, 19.21.

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

The CAUSE OF DEATH was as follows :

Song

Congenital malformation of Heart

(duration)

.. yrs ..

mos ..

ds.

CONTRIBUTORY.

(SECONDARY)

(duration)

.yrs .. ......... mos .......... .ds.

18 Where was disease contracted

if not at place of death ?

Did an operation precede death ?

Was there an autopsy ?

What test confirmed diagnosis ?

Personal Oberation

(Signed)

R. B. Pure

., M.D.

Date

(Address).

Winthrop man

1921

(Month)

(Day)

...... (Year)

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

(Jomb) Wielusti Jene cer

(Cemetery) Marchof

(City or town)

DATE OF BURIAL

2/5

19 2 /

ADDRESS

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 S. Aninte

Official Secretary.

Date of issue of permit. 2/5/2/ No. 232.

Permit

. 50,000.

The Commonwealth of Massachusetts

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

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Town of Winthrop : Record of Deaths 1919-1921, Part 143

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

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