Town of Winthrop : Record of Deaths 1919-1921, Part 27

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 27


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 | Part 153 | Part 154 | Part 155 | Part 156 | Part 157 | Part 158 | Part 159 | Part 160 | Part 161 | Part 162 | Part 163 | Part 164 | Part 165 | Part 166 | Part 167 | Part 168 | Part 169 | Part 170 | Part 171 | Part 172 | Part 173 | Part 174 | Part 175 | Part 176 | Part 177 | Part 178 | Part 179 | Part 180 | Part 181 | Part 182 | Part 183 | Part 184 | Part 185 | Part 186 | Part 187 | Part 188 | Part 189 | Part 190 | Part 191 | Part 192 | Part 193 | Part 194 | Part 195 | Part 196 | Part 197 | Part 198 | Part 199 | Part 200 | Part 201 | Part 202 | Part 203 | Part 204 | Part 205 | Part 206 | Part 207 | Part 208 | Part 209 | Part 210 | Part 211 | Part 212


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, Suicidle, Homicide, etc.


2. Deaths supposedly eaused by violence, as Criminal abortion, Poisoning, Starvation, Suffocation, Exposure, ete.


3. Sudden deaths of persons not disabled by recognized discase, as A death upon the street, or one supposed to be due to Alcoholism, ete.


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


ADDITIONAL SPACE FOR FURTHER STATEMENTS BY


PHYSICIAN.


.


R 303. 6.'IS. 50,000.


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


City or Town Winthrop


State Mass.


Registered No.


St .. .Ward


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


2 FULL NAME Penjamdn Augustine Lantigua


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


(a) Residence. No. 9 Cliff Ave.


(Usual place of abode)


St.,


Ward.


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


Length of residence in city ar town wbere death occurred


10


years


mouths


days.


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (write the word)


Male


White


Married


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of Mary Mccloskey


6 DATE OF BIRTH Cannot be learned ( Month) (Day)


Year)


7 AGE 45


Years


Months


Days


If LESS than


1 day,


brs.


or min.


8 OCCUPATION OF DECEASED (a) Trade, professinn, or particular kind of work Stock Broker


(h) General nature of industry,


business, or establishment in


which emplayed (nr emplayer).


(c) Name of employer


9 BIRTHPLACE (City)


(State or country)


Cambridge


Mass


18 Where was disease contracted


if not at place of death?


Did an operation precede death ?


200.


Was there an autopsy ?


What test confirmed diagnosis ?


(Signed)


Willia


0


antes


, M.D.


(Address).


Mathias mars.


Date


May 16.


1918


(Month)


(Day)


() car)


14


Informant


Mary Lantigua


(Address)


Cliff Ava


15 Play 24 919 Filed (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


May


15.


(Day)



1919.


(Year)


17


HEREBY CERTIFY, That I attended deceased from


may


16.


may 15.


, 19 / ...... , to ..


, 1949,


that I last saw hr


« alive on


May 15.


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


9 .. m. The CAUSE OF DEATH was as follows :


yrs ....


mos. . .


ds.


arteriosclerosis


CONTRIBUTORY (SECONDARY)


(duration)


yrs (2)


mos. .


ds.


10 NAME OF


FATHER


Andrer


PARENTS


11 BIRTHPLACE OF


FATHER (City)


(State or country)


Cuba


12 MAIDEN NAME


OF MOTHER


Elizabeth Byrne


13 BIRTHPLACE OF


MOTHER (City)


(State or country)


Newfoundland


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


St. Pauls


Arlington


DATE OF BURIAL


6/18/19


19


(Cemetery)


(City or town)


ADDRESS


20 UNDERTAKER John & O Maley Hintench


Official (position .. 0


Health vince?


22 Date of issue of burial or transit permit


May 17, 1919


100,000. .


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


No ....... 9 Clic Ave


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


(duration)


Date of


clinical


If STILLBORN, enter that fact here


If STILLBORN, state period of nterngestatinn


mos.


16 DATE OF DEATH


(Month)-


may 15 1919


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 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, 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 forin part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," ete., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, ete. Women at home, who are engaged in the dutics 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 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 occupation whatever, write None.


Statement of cause of death. - Name, first, the DISEASE CAUSING DEATII (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 ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, men- inges, peritoneum, ote., Carcinoma, Sarcoma, ete., of ... .. (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant ncoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. 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," ete.), "Dropsy,""Exhaustion,""IIcart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," ete., when a definite disease can be ascertained as the cause. Always qualify ali diseases resulting fromn childbirth or miscarriage, as "PUER- PENAL septicemia," "PUERPERAL peritonitis," etc.


State cause for which surgical operation was undertaken.


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


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


Certificates wili be returned for additional information which give any of the following diseases, without explanation, as the solo cause of death: Abortion, celiuiitis, 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 deecased, 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 shali 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 shali be issued until there shail have been delivered to such board, agent or cierk, . . . 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 thercof 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 seiectmen for the purpose, shail upon application make such certificate as is required of the attending physician. If death is caused by vioience, the medicai 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 ean 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. 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 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 ealls 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, thoughi 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 necded.


(3) Medical examiners will investigate and certify to all deaths sup- posabiy 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.


R-301


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


100,000.


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF DEATH


County.


Juffolle


Mass


Registered No. 1184


City or Town


No.


State. melcute Nor Intal St.


Ward


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


2 FULL NAME


Cette LEE Bumps.


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


(a) Residence. No.


( Usnal place of abode)


Maderas are


St.,


.. Ward.


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


Length of residence in city or town where death occurred


×


years


X


months


14 days.


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


X


years


months


14 days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Florale


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


2


6 DATE OF BIRTH


( Month)


(Day)


(Year)


7 AGE


Years


Months 14 Days


If LESS than


If STILLBORN, enter that fact here If STILLBORN, state period of uterogestation


1 day, .. hrs.


or


min.


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


N


2


(c) Name of employer 2 2


9 BIRTHPLACE (City)


(State or country)


10 NAME OF


FATHER


Charles. H. Bumps.


PARENTS


11 BIRTHPLACE OF


FATHER (City)


(State or country)


albany


Vermont


12 MAIDEN NAME OF MOTHER


Mary, S. Hawkins,


Pensa colici


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


14


Informant


Mary, H. Pumps


(Address)


maderio ave


15 Fil May 24, 1919 (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


May


(Month)


160


(Day)


(Year)


17


I HEREBY CERTIFY, That I attended deceased from


May 2nd


, 19 19, to


May 15th


19


, 19


May 15th


that I last saw her


alive on


, 19 /9,


and that death occurred, on the date stated above, at / 2:05 am


The CAUSE OF DEATH was as follows :


Febricula, convalusono


infantile


Cause interiores


(duration)


yrs ..


.mos.


ds.


CONTRIBUTORY


mother during pregnancy


( SECONDARY)


had influenza


(duration)


yrs ...


mos.


dis.


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).


M.D.


( Address ) ..


17.4 mmil est, during


$19


Date


may


( Month)


(Year)


19


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


windhoffna-


(Cemetery) 20 mituit


(City or town)


DATE OF BURIAL


22/1/2019


20 UNDERTAKER


ADDRESS


21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was bled with me BEFORE the hurial or transit permit was issued


Official Position 2 atzinumu


22 Date of issue of burial or traosit permit


1914


.


2 1919


. mos.


may 16, 1919


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, irrespectivo of age. For many occupations a single word or term on the first line will be sufficient, e. g., Former or Plonter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary 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) Solesmon, (b) Grocery; (a) Foremon, (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 loborer, Laborer - Coal mine, etc. Women at home, who arc 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 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 inay he 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 pneumonia; 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); Meosles; Whooping cough; Chronic valvulor heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Meosles (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," 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 opsration 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, Sccs. 10 and 1, as amended by Acts of 1910, Chop. 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 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 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 parsons not disabled by recognized disease, and those of persons found dead.


R-301


The Commonwealth of Massachusetts


STANDARD CERTIFICATE OF DEATH


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


1 PLACE OF DEATH


County


City or Town


Winthrop


No.


1.01


State. Cutter


Registered No.


St ..


.. Ward


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


2 FULL NAME


Baby Finkelstein


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


(a) Residence. No.


17 Cutter


(Usual place of abode)


Length of residence in city or town where death occurred


years


months


days.


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


years


months


days


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Plemale


4 COLOR, OR RACE


W.


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)


(Year)


7 AGE


Years


y


Months


7


Days


If LESS than


If STILLBORN, enter that fact here


If STILLBORN, state period of nterogestation


mos.


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


.. (duration)


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


seit bom


.mos .....


ds.


CONTRIBUTORY


(SECONDARY)


(duration)


.. yrs M


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)


M.D.


(Add


Date


(Month)


( Day)


1919.


(Year)


19 PLACE OF BURIAL, CREMATION, OR REMOVAL


DATE OF BURIAL Wobury Betts Joseph May 20% (Cemetery)


20 UNDERTAKER


ADDRESS Manuel Standby Boston


Official Health Officer position


Date of issue of permit. May 20


Permit No: 498-3


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


instructions and extracts from the laws on back of certificate.


PARENTS


14


Hannie Finkelstein


Informant


(Address)


17 Puller It.


15


Filed Maw 24 1919


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


16 DATE OF DEATH


May


20


1419


(Year)


(Month)


(Day)


17 I HEREBY CERTIFY, That I attended deceased from


19


., to


19


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 :


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


or ....... min.


Primitivo Title


9 BIRTHPLACE (City)


Winthrop, Maso


(State or country)


10 NAME OF


FATHER


Harry Finkelstein


11 BIRTHPLACE OF


FATHER (City ).


Russia


(State or country)


12 MAIDEN NAME


OF MOTHER


J'annie Mendelar Russia


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


150,000.


21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was Gled with me BEFORE the borial or transit permit was issued I. a. Maury


St.,


Ward.


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


May 200 1919


May 20, 1919 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 wili be sufficient, e. g., Former or Planter, Physicion, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fircman, etc. But in many cases, especially in industrial employments, it is necessary to know (o) 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: (0) Spinner, (b) Cotton mill; (o) Salesmon, (b) Grocery; (a) Foreman, (b) Automobile foctory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dcaler," etc., without more precise specification, as Doy laborer, Form loborer, Laborer - Cool mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Ilousekeepers who receive a definite salary), may bs 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.




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.