USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1919-1921 > Part 41
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10 NAME OF FATHER Patrick Mulvaney.
PARENTS
11 BIRTHPLACE OF FATHER (city) or town)
(State or country) Ireland
12 MAIDEN NAME OF MOTHER Delia Ferrino
13 BIRTHPLACE OF MOTHER (city )or town). (State or country) Eveland.
14
Informant
Patrick mulvaney.
(Address)
18 Asmany St.1
15 Queg. 30,199 Eulalie Churches
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH (month, day, and year) Ing. 3
19 14
17 HEREBY CERTIFY, That I attended deceased from July 31 1919, to Many 3 1965.
that I lastisaw her alive on
1919
and that death occurred, on the date stated above, at
m. The CAUSE OF DEATH* was as follows :
(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)
M.D.
F/3 . 19 (Address)
* 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
St Patricks Watertown
DATE OF BURIAL aug 4 1919
ADDRESS
20 UNDERTAKER John F. CO. maley.
1
of certificate.
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 statement 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,
City
(Usual place of abode)
3
nuci:Lau rLouc 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 caclı 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- ilor, 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, ctc. 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 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 "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, 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 (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing death), 29 &s .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapsc," "Coma," "Convulsions," ""Debility" (“Con-
genital,"
"Senile," ete.), "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 discases resulting from ehild- 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
unuer the head of""Contributory." (Recommendations on statement of cause of deatlı 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.
1
R 15. 1-'18. 100,000.
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 Mass.
Registered No.
City or Town
Winthrop
No. 97 Lowell Rd.
St ....... ... Ward
(If death occurred in a hospital or institution, give its NAME instead of strect and number)
1
2 FULL NAME
Daniel James Shechen
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
St.,
.Ward.
(If non-resident give city or town and Statc)
Length of residence 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
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Me.le
Thito Married
5a If married, widowed, or divorced HUSBAND of (or) WIFE of Elizabeth A. Cody Sheehan
6 DATE OF BIRTH
( Month)
(Day)
( Year)
7 AGE
61
Years II
Monthis
24
Days
If LESS than
If STILLBORN, enter that fact bere If STILLBORN, statc period of nterogestation
m os.
or
min.
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work (b) General nature of industry, business, or establishment in wbich employed (or employer). (c) Name of employer
Tine Merchant
9 BIRTHPLACE (City) Boston Mass.
(State or country)
10 NAME OF FATHER Mortimere
PARENTS
11 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
12 MAIDEN NAME OF MOTHERCONT he learned
13 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
14
Informant Mrs. Elizabeth Sheehan
(Address) 97 Lowell Fd.
15 Filed eng. 30 1919. (Month) (Day) (Year)
Eulalie Churchill
einst REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issned - 1 "oury
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
CuqueT 4Th
(Day)
1919
(Year)
17 I HEREBY CERTIFY, That I attended deceased from
June
26
, 1919
.. , to.
Cung 4th
, 19/9,
that I last saw h wy alive on
, 1919,
and that death occurred, on the date stated above, at .
8.A
.. m.
The CAUSE OF DEATH was as follows :
Carcinoma of stomachround
intest ines
(duration)
1
yrs ..
6
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 ?
20
What test confirmed diagnosis ?
(Signed )
R. B. Parken , M.D.
(Address)
Winthrop
mass
Date
14.
1919.
(Yenv)
19 PLACE OF BURIAL CREMATION, OR REMOVAL
Holy Cross Malden
(Cemetery)
(City or town)
DATE OF BURIAL
8/8/19
19
20 UNDERTAKER
John f. 0' maley
ADDRESS
Mintunde
position
Official Lealthe office2 or transit 22 Date of issue of burial
Rug 4, 1919
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. in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See
100,000.
(Month)
(Day)
aug. 4th
1 day, brs.
07 Lowell Fd.
(Usual place of abode)
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 he 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 cxamples: (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 preciss 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 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 heen changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may 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- brospinal 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 indefinits); 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, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (diseass causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Nevsr 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 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 certificats of death, stating to the best of his knowledge and belief ths 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 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 ohtainsd 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, eertify 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 hodies 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 bsdside 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 diseass unrelated to any form of injury, have disd 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 includs 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.
1
The Commonwealth of Massachusetts
CERTIFICATE OF DEATH OF NON-RESIDENT
BOSTON ...........
(City or town) 7646
1 PLACE OF DEATH
Registered No.
(Place of death)
Registered No.
City or Town
Boston
No.
HILLSIDE HOSPT.
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
GERTRUDE M. MAINS
MASS
City or Town
WINTHROP
No.
39 PEARL AVE
St.
(a) Residence. State.
(Usual place of abode)
Length of residence io city or towo where death occurred
years
months
days
How long in U. S., if of foreigo birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE
W
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
M
16 DATE OF DEATH (month, day, and year)
AUG.4.
199
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
ERNEST C.
6 DATE OF BIRTH (month, day, and year)
FEB.8. 1 876
7 AGE
43
Years
Months
Days
If LESS than
5
22
1 day, ........ hrs.
Dr ........ min.
17
I HEREBY CERTIFY, That I attended deceased from
JAN . 9
1919 ....... , to.
AUG . 4.
19.1.9
that I last saw h.
ERalive on
AUG .. 4
1919
and that death occurred, on the date stated above, at
1.2
.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.)
RECURRENT CARCINOMA OF UTERUS
9 BIRTHPLACE (city or town)
NEW GLASGOW
CONTRIBUTORY
(SECONDARY)
(duration)
-yrs.
mos.
ds.
10 NAME OF FATHER
ROBERT F .FRASIER
18 Where was disease contracted
if not at place of death ?
11 BIRTHPLACE OF FATHER (city or town) ... NE.W ..... GLASGOW Did an operation precede death?
(State or country) NS
12 MAIDEN NAME OF MOTHER CHRISTIE E .MC IN
OSH
test confirmed diagnosis ?
(Signed)
H.V.ANDREWS
M.D.
, 1919 (Address)
14
Informant
(Address)
HUSBAND
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DANVERS
DATE OF BURIAL
AUG.6 1919
15
Filed.
AU6 .6919
Filed
Sept. 9
1919
Registrar of city or town where death occurred
20 UNDERTAKER
C.R.BENNISON
ADDRESS
WINTHROP
80 that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
of certificate.
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,
PARENTS
YES Date of.
....... FEB.12 & 17
Was there an autopsy?
NEW GLASGOW
13 BIRTHPLACE OF MOTHER (city or town)
(State or country)
N.S.
.(duration)
mos ...
(State or country) N.S.
If STILLBORN, coter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
AT HOME
(b) General nature of industry,
business, or establishment io
which employed (or employer )
(c) Name of employer
(If in the Army or Navy of the United States, give rank, organization, etc.)
County
Suffolk
State Massachusetts
(Place of residence)
Registrar of city or towo where deceased resided
DETDED UN TIED 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 engincer, 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. 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 saine disease. Examples: Cerebrospinal fever (the only definite synonym is "Epideinic 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- toncum, etc., Carcinoma, Sarcoma, etc., of_
(naine origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial ncphritis, 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 syınp- toms or terminal conditions, such as "Asthenia," "Aneinia" (inerely symptomatic), "Atrophy," "Col- lapse," "Coma," "Convulsions," " Debility " ("Con-
"Exhaustion," genital," "Senile," etc.), "Dropsy,"
"Heart failure," "Hemorrhage," "Inanition," "Maras- inus," "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 sueli, 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.
.
-
-
R 303. 6-'18. 50,000.
Township City 2 FULL NAME. (a) Residence. (a) Trade. professino, or particular kind of work ..... PARENTS Informant so that it may be properly classified. Exact statement 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. N. B. - WRITE PLAINLY, WITH UNFADING INK - THIS IS A PERMANENT RECORD. Every item of information should be (b) General nature of industry, business, nr establishment in which employed (nr employer) (c) Name nf emplnyer
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(City or town)
1 PLACE OF DEATH Attack,
County.
State
2020ve.
Registered No ....
or
Viplegs2 Placent A
. St.,
......... .Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Sophia Bortnic Casas
J
(If in the Army of For the United States rive rank , organization, etc. )
(Usual place of abode)
Length nf residence in city nr town where death nccnrred
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