USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 201
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 | Part 213 | Part 214 | Part 215 | Part 216 | Part 217 | Part 218 | Part 219 | Part 220 | Part 221 | Part 222 | Part 223 | Part 224 | Part 225 | Part 226 | Part 227 | Part 228 | Part 229
No undertaker or other person shall bury a human body. .. until he has received a permit from the hoard of health or its agent. .. or ... from the clerk of the town where the person died ;. . . No such permit shail be issued untii there shall have been delivered to such board, agent or cierk. .. a satisfactory written statement con- taining the facts required by iaw to be returned and recorded, which shall he accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the pur- pose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shaii upon application make the certificate required of the attending physician. If death is caused by violence, the medicai examiner shail make such certificate. .. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Gen. Laws, Chap. 114, Sec. 45.
Medical examiners shall make examination upon the view of the dead hodies of only such persons as are supposed to have died hy violence .- Gen. Laws, Chap. 38, Sec. 6.
. .. He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may he, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
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 hedside 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 unre- lated to any form of injury, have died without receut medical at- tendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to, occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
The Commonwealth of Massachusetts
withhersh OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
BOARD OF HEALTH PHYSICIAN'S CERTIFICATE OF DEATH
1 PLACE OF DEATH
To be used only in case there is no attending physician or if for sufficient reason the attending physician's certificate cannot be obtained early enough for the purpose of granting a burial permit, as provided by Revised Laws, Chapter 78, Section 38. State
County
City
wichit
No.
63 Balls and
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
albert. Grace.
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
No.
63 Bakes-care.
(Usual place of abode)
Length of residence in city nr two where death occurred
years
mooths
days
How long io U. S., if of foreign hirth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Marcial
5a If married, widowed, or divorced
HUSBAND of
( or) WIFE of
Forças
6 DATE OF BIRTH (month, day, and year) Feel- 6 1861
7 AGE
Years
63
Months
Days
If LESS thao 1 day, ........ hrs. or ........ min.
8 OCCUPATION OF DECEASED
(a) Trade, professinn, or
particular kind of work
Shoe Salesman
(h) General nature of industry,
business, nr establishment in
which employed (or employer )
(c) Name of employer
9 BIRTHPLACE (city or town)
Jackelle
n.13.
(State or country)
10 NAME OF FATHER alexander Sinth
PARENTS
11 BIRTHPLACE OF FATHER (city or town) Jackville (State or country) new Brunswick 12 MAIDEN NAME OF MOTHER Henvatta: Harper
13 BIRTHPLACE OF MOTHER (city of town) Santurce (State or country)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
Gary 27 19 24
15
Filed aug 29 , 1924.
(Month) (Day) (Year)
REGISTRAR
20 UNDERTAKER
Chas . R. Be
Health officer 8/26/21
so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions on back
of certificate.
14 wife Focus, Junit
Informant (Address) 6 3 Baths are virultivo/
(duration)
yrs.
mos.
ds.
18 Where was disease contracted
if not at place of death?
athome.
Did an operation precede death ?.
40
. Date of
Was there an autopsy?
no
What test confirmed diagnosis?
Personal inquy
(Signed
R. B. Parken
M.D.
( Address)
man
Date ...
25
19 ZY
ionthi)
Dayj
( Ycar)
mos.
5
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs.
25
1924
(Day)
( Year)
17 I HEREBY CERTIFY, That I have ascertained the nature of the disease from which the person above-named died, and that the CAUSE OF DEATH* was as follows: * State the DISEASE CAUSING DEATII. (Sce reverse side for additional space and instructions. ) Probably.
La
If STILLBORN, eoter that fact here
19
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
St.,
Ward.
(If non-resident give city or town and State)
ADDRESS Winthrop
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of information should be
carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms,
Registered No.
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 stand- ard 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, Sects. 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 itsagent, ... 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 containing the facts .
required by law to be returned and recorded, which . shall be accompanied by a satisfactory certificate of the attend- ing physician, if any, as required by law, or in lieu thereof a certificate 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 appli- cation 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 permit 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 of cause of the death, which the clerk or registrar may require. - Revised Laws, Chap. 78, See. 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 sup- posed to have come to their death by violence. - Revised Laws, Chap. 24, Sce. 8.
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 supposably 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.
Notice to Undertakers: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have come to his death by violence, until a permit in writing, signed by the Medical Examiner, has first been obtained. - Revised Laws, Chap. 24, Sec. 20.
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 ior the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal inenin- gitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite) ; Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sareoma, etc., of (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neo- plasms); Measles: Whooping cough; Chronie valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection necd 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," " "Collapse,"
" Coma." " Convulsions,"
" Debility" (" Congenital, "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure,' "Hemorrhage," "Inanition," " 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 v ich 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 determine definitely. Examples: Aceidental drowning; Struek 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 "Contribu- tory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the Amcrican Medical Association.)
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN.
.
R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS)
gosto notifie
The Commonwealth of Massachusetts
Winthrop 1.100
-BOSTON (City or town)
1 PLACE OF DEATH County.
Suffolk
State
Massachusetts
Registered No. Wishlist
St.,
Ward
(If death occurred in a hospital or Institution, give its NAME instead of street and number)
2 FULL NAME
Jose A Ohnwill
(If in the Army or Navy of the United States, glve rank, organization, etc. )
St.
& Ward.
Boston- Mars
(a) Residence. No.
(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
mon' hs
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
,ACOLOR 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 AGE
Years
23
Months
Days
If LESS than 1 day ....... brs. or ........ mia.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
City of Boste
School Teacher
Boston
8 BIRTHPLACE (City).
(State or country
9 NAME OF
FATHER
PARENTS
10 BIRTHPLACE OF
FATHER (City)
(State or country }
Pelavil
11 MAIDEN NAME
OF MOTHE
12 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
13
Informant
(Address)
é / 6 2 waste uma
14 aug 29. 24 Filed ... (Month) (Day) (Ycar)
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
(Month)
16
I HEREBY CERTIFY, That I attended deceased from
Cung. 10
1924. to
aug 26
, 19 24.
that I last saw her
.alive on
26
, 19 24.
aug :
and that death occurred, on the date stated above, at. 4.30 P.m. The CAUSE OF DEATH was as follows :
Branchen Primeira
.(duration) yrs.
16
ds.
CONTRIBUTORY
Endocarditis (Cheronio)
(SECONDARY)
(duration)
( .....
mos.
ds.
17 Where was disease contracted
if not at place of death ?
FOR WHAT?
Did an operation precede death ?.
Date of.
Was there an autopsy ?
What test confirmed diagnosis?
(Signed)
Edwar J. Franinger
, M.D.
(Address)
7
Striving Sr.
Date
27
1924.
(Month)
( Day)
(Year)
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
St Josephis W. Rox
(Cemetery)
(City or town)
DATE OF BURIAL
Jung 29,1924
19 UNDERTAKER Jos. L. Bunke
ADDRESS
75 Chumientr
Permiso I tim
20 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
A. C. Daniels 9.3.9.
Official position
Healthe Office Date of issue
8/28/24, No. 793
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.
XM.
00. 3567.
in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See
City or Town
Baston
No.
162 Washington
26 Allen
( If non-resident give city or town and State )
26
(Day)
(Year) 1924
?
yrs ...
STANDARD CERTIFICATE OF DEATH
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 ean 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) tho 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 Hlousekcepers 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 spo- eifically the occupations of persons engaged in domestie service for wages, as Servant, Cook, Housemaid, ete. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (rctired, 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 discase. 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 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, etc. The contributory (secondary or inter- current) affection need not be stated unless important. Example: Measles (disease eausing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatie), "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 ean 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 eause 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- rlage, necrosis, peritonitis, phlebitis, pyemla, septicemia, tetanus.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer 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 as re- quired by section one, where same was contracted, the duration of his last illness, whou last, seen alivo by the physician or officer and the date of his death. ...- Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury a human body . . . until ha has received a permit from the board of health or its agent . . . or ... from the clerk of the town where 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 containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certi- ficate of the attending physician, if any, as required by law, or in lieu thercof a certificate 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, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certi- ficate. . .. The person to whom the permit is so given and the physi- cian certifying the eause 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 elerk or registrar may require. - Gen. Laws, Chap. 114, Scc. 45.
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.
. . . He shall in all cases certify to the town elerk or registrar in the place where the deceased died his name and residence, if known; other- wise a description as full as may be, with the cause and manner of death. - Gen. Laws, Chap. 38, Sec. 7.
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 eare during a last illness from disease unrelated to any form of injury.
(2) Board of Health Physiclans 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 homo when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These includo not only deaths caused directly or indirectly by traumatism (ineluding 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.
M R-301 OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town)
Registered No.1162
City or Town
"Boston WinthroNo.
Winthrop Community Hospital,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Male Darcy
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. No.
41 Armandine Street Borstpm
Ward.
(If non-resident give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
years
months
2
days
How long in U. S., if of foreign birth?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5
SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
White
Single
5a If married, widowed or divorced
HUSBAND of
(or) WIFE of
-
6 AGE
Years
Months
Days
2
If LESS than
1 day. hrs.
of __. min.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
At Home
8 BIRTHPLACE (City)
(State or country)
Winthrop,
lass
George F. Darcy
10 BIRTHPLACE OF FATHER (City) Chelsea,
(State or country) Mass.
11 MAIDEN NAME
OF MOTHER
Muriel Zoovas
12 BIRTHPLACE OF
MOTHER (City)
Bridgew ter,
(State or country)
Lass.
(Month)
(Day)
(Year)
Informantrge Darcy Father
( Address)
41 Armandine Street Besten
Filed Sep 2.1924
(Month (Day) (Year)
REGISTRAR
18 PLACE OF BURIAL, CREMATION OR REMOVAL
DATE OF BURIAL
Holy Cross.
(Cemetery)
Haldex
Bort Zra 192
4
(City or town)
19 UNDERTAKER
ADDRESS Bast Boston.
20 | HEREBY CERTIFY thet e satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued H. C. Daniel
Official
Health officer
Date of issue
9/2/24
Permit NO 797
.
-"+23-2081 100.000
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
(Month)
(Day)
(Year)
16
I HEREBY CERTIFY, That I attended deceased from
27
124
to any 29
1924
that I last saw h
im
alive on
and that death occurred, on the date stated above, at
IA.
_m.
The CAUSE OF DEATH was as follows: It was Premature baby
(duration)
.yrs.
mos.
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs.
mos.
ds
17 Where was disease contracted
if not.at place of death?
FOR WHAT?
no
Did an operation precede death? Date of
Was there an autopsy?
If Under One Year, Was Baby Breast Fed
What test confirmed diagnosis?
Small sujé
(Signed)
albert astim
M. 0.
(Address)
150 Shore Drive, Withers'
Date
Sept.
2, 14:24
County 3 SEX Male 9 NAME OF FATHER PARENTS 13 14 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK- THIS IS A PERMANENT RECORD. Every item of information 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 (h) Name of employer
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.