Town of Winthrop : Record of Deaths 1919-1921, Part 42

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 42

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).

years

months

days.

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

Female. white.

4 COLOR OR RACE

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)

7 AGE Years 82

Months

Days

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

8 OCCUPATION OF DECEASED

9 BIRTHPLACE (city or town).

(State or country)

200000-

10 NAME OF FATHER Benjamin Caben

11 BIRTHPLACE OF FATHER (city or town) Auchder (State or country)

12 MAIDEN NAME OF MOTHER

Elisa Ecage Ling 6, 1919 (Address)

13 BIRTHPLACE OF MOTHER (eity or town).

(State or country)

14 Cosa Www. Capen,

(Address) WinThis, 2000.

15 Filed auq. 30, 1919 Skalig Churchill

REGISTRAR

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH (month, day, and year) Cmq. 6, 1919

I HEREBY CERTIFY, That I attended deceased from

Anne 12

19/8

to.

Rug. 6

1919

that I last saw

alive on

aug. 4,

19/9.

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

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

Carcinoma os Face-

(duration)

.. yrs ....

mos.

ds.

CONTRIBUTORY

Cartera- Schervais -

(SECONDARY)

(duration)

.......

mcs .....

ds.

yrs ....

18 Where was disease contracted

if not at place of death ?

Did an operation precede death?

20.

Date of.

Was there an autopsy ?

200.

What test confirmed diagnosis ?

(Signed)

Willand@my

* 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 Codment Centery

Dorchester

20 UNDERTAKER RT C. F. Cleaned,

DATE OF BURIAL Lug. 8- 1919. ADDRESS Parchita

No .. 5-07 ... ,

St.,

.Ward.

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

Statement of occupation. -- Precise statement of occupa- tion is very important, so that the relative healthfulness of various pursuits ean be known. The question applies 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, Architeet, 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) Groecry; (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 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.

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," ete. 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, ete.

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

ADDITIONAL SPACE

FOR FURTHER STATEMENTS BY PHYSICIAN.

R 15. 1-'18. 100,000.

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

BOSTON ( City or town)

1 PLACE OF DEATH

Registered No.

(Place of death)

Registered No.

(Place of residence)

City or Town

Boston

No.

MASS GEN HOSPI

St., Ward

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

2 FULL NAME

SOPHIE GLASS

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

City or Town

WINTHROP

241 SHIRLEY

St.

(a) Residence. State

(Usual place of abode)

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

MEDICAL CERTIFICATE OF DEATH

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

SIN

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

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

SEPT . 1917

7 AGE

Years

Months

Days

If LESS than

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

or ........ min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work

(b) General nature of industry,

business, or establishment in

which employed (or employer)

9 BIRTHPLACE (city or town)

BOSTON

(State or country)

10 NAME OF FATHER

ISAAC

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.

, 1919 (Address)

D.D.BROUGH

Informant

(Address)

FATHER

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

WOBURN(BETH JOSEPH)

DATE OF BURIAL

AUG.7

19 19

Filed AUG. 9

1919

Registrar of city or town wbere death occorred

Sept 9 Eulalie Churchill

19 19

Registrar of city or town where deceased resided

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

AUG.6.

1919

I HEREBY CERTIFY, That I attended deceased from

AUG.6.

1919 ...... , to

AUG.6.

19.19

that I last saw h ... E.R .... alive on.

AUG ... 6

1919

....

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

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.) RESPIRATORY FAILURE OF UNKNOWN

ORIGIN

.(duration)

.. yrs ..

mos .....

23 HRS

CONTRIBUTORY

(SECONDARY)

.(duration)

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

mos .............. ds.

.....

PARENTS

11 BIRTHPLACE OF FATHER (city or town).

(State or country)

RUSSIA

12 MAIDEN NAME OF MOTHER ANNIE PRESS

13 BIRTHPLACE OF MOTHER (city or town)

(State or country)

RUSSIA

20 UNDERTAKER

MANUEL STANETSKY

ADDRESS

BOSTON

of certificate.

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

7703

County

Suffolk

MASS.

State

Massachusetts

.... ..

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 cach and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, c. g., Farmer or Planter, Physician, Compos- itor, Architcet, 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," "Dcaler," 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- eated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write Nonc.

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- toncum, 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 inportant. Example: Measles (disease causing death), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere syinp- 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- 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," ctc. 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 suclı, if impossible to de- termine definitely. Examples: Accidental drowning; Struck by railway train - accident; Revolver wound of head - homicide; Poisoned by curbolie 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.

₹ 303, 6-'18, 50,000.

The Commonwealth of Massachusetts

CERTIFICATE OF DEATH OF NON-RESIDENT

BOSTON .................

( City or town)

1 PLACE OF DEATH

County

Suffolk

State.

Massachusetts

Registered No.

(Place of residence)

City or Town

Boston

No.

115. GAINSBORO ST

St ..

... Ward

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

MASS.

City or Town

WINTHROP

No.

91 COTTAGE PK.ROADS.

(a) Residence. State

(Usual place of abode)

Leogtb of resideoce io city or town where death occurred

years

mooths

days

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

years

months

days

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

MAR.

5a If married, widowed, or divorced

HUSBAND of

(or) WIFE of

FREDERICK

6 DATE OF BIRTH (month, day, and year) A UG . 2. 1 900

7 AGE

Years

Months

Days

If LESS thao

I day, ........ brs. or ........ min.

If STILLBORN, enter that fact here

8 OCCUPATION OF DECEASED

(a) Trade, professioo, or

particular kind of work

(b) General oature of industry,

business, or establishment in

which employed ( or employer )

.(duration)

yrs.

mos. ...............

.ds.

CONTRIBUTORY

BRONCHO -PNEUMONIA

(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)

OSCAR RICHARDSON

MED. EX.

M.D.

, 1919 (Address)

Informant

S. H. WEBSTER

(Address)

9| COTTAGE PK.ROAD

Filed AUG . 121919

Registrar of city or towo wbere death occurred Sept. 9

19 19 Enlabe Churchill

Qos Registrar of city or town where deceased resided

19 PLACE OF BURIAL, CREMATION, OR REMOVAL

EVERETT (WOODLAWN )

DATE OF BURIAL

AUG.II

19 19

20 UNDERTAKER

J.F.O' MALEY

ADDRESS

WINTHROP

of certificate.

PARENTS

11 BIRTHPLACE OF FATHER (city or town) ..

BOSTON

(State or country)

12 MAIDEN NAME OF MOTHER EDITH HARRINGTON

13 BIRTHPLACE OF MOTHER (city or town)

EASTPORT

ME .

(State or country)

16 DATE OF DEATH (month, day, and year) AUG . 8. 1 91 9 1919

I HEREBY CERTIFY, That I attended deceased from

, 19.[9 ....... , to 19.19 ... ....

that I last saw h. alive on 19.1.9 ... ....

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 spaee.) SEPTIC ENDOMETRITIS (MISCARRIAGE)

9 BIRTHPLACE (eity or town)

BOSTON

(State or country)

10 NAME OF FATHER

SAMUEL WEBSTER

Registered No ..

7764

(Place of death)

2 FULL NAME

HELEN DUNCAN

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

MEDICAL 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) Colton 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 .- Nanie, 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"); Typhoul fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unquali- fied, is indefinite); Tuberculosis of lungs, meninges, peri- toncum, etc., Carcinoma, Sarcoma, etc., of_

(name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart discase; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease causing deatlı), 29 ds .; Broncho- pneumonia (secondary), 10 ds. Never report mere symp- toms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Col- lapse," "Comma," "Convulsions," "Debility" (“Con-

genital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "Old age," "Slock," "Uremia," "Weakness," ctc., 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 DEATHIS 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 (c. 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 duc 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.

R-301

The Commonwealth of Massachusetts

STANDARD CERTIFICATE OF DEATH

OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS

1 PLACE OF DEATH toll County.

State. Mans

Registered No.

City or Town

No ...

30 Woodsings are

St.

Ward

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

2 FULL NAME

albert. Mulgrave Lasker

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

(a) Residence. No. 30 Wordsids are

( Usual place of abode)

St.,

Ward.

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

Length of residence in city or town where death occorred

years

2 months

days.

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

years

months days

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE, MARRIED, WIDOWED, OR

DIVORCED (write the word)

marnier

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

angelina . "I'lice Laskey

6 DATE OF BIRTH

may

( Month)

(Day)

(Year)

7 AGE 53 Years 3 Months 9

Days

# 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 kiod of work (b) General oature of industry, business, or establishment io which employed (or employer ).

Holz Clack

Holt

It Yolun M. B.

9 BIRTHPLACE (City) (State or country)

10 NAME OF

FATHER

11 BIRTHPLACE OF

FATHER (City)

(State or country)

12 MAIDEN NAME OF MOTHER 2

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

14 Wife angelina . J. Laskey

15 ed aug, 30, 1919 Eulalie Churchill (Month) (Day) (Year)

REGISTRAR

21 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the horial or transit permit was issued D. P. Ofyour

MEDICAL CERTIFICATE OF DEATH

16 DATE OF DEATH

(Month)/

.....

1419

(Year)

17 I HEREBY CERTIFY, That I attended deceased from Cuarzo 4 .,19.4.2. to .. any 9 , 1979

that I last saw h

. alive on

, 19.4.7.,

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

The CAUSE OF DEATH was as follows :

Chemie

(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.

( Address) .

200 learnt

19.19

Date

( Month)

(Day) ( Year)

DATE OF BURIAL

Quy 12

19 /5

ADDRESS

Maxx .

Official position Healthi fire 2

22 Date of issue of burial or transit permit

Aug. 1: 1919

3 SEX male PARENTS Inform (Address) should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (c) Name of employer 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.

19 PLACE OF BURIAL, CREMATION, OR REMOVAL Forest Hills Centern (Cemetery) Perla- News (City or town)

20 UNDERTAKER G. R. Benim

(Day)

1866

mes.

. .

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., Former or Planter, Physicion, Compositor, Architect, Locomotive engineer, Civil engineer, Stationory 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) Salesmon, (b) Grocery; (a) Foremon, (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 Day loborer, Form laborer, Loborer - Cool mine, etc. Women at home, who are engaged in the duties of the house- hold only (not paid Housekeepers who receive a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report spe- cifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Houscmoid, 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 he indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

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Town of Winthrop : Record of Deaths 1919-1921, Part 42

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

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