USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 28
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years
months
days
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
april
(Month)
(Day)
(Year)
17 I HEREBY CERTIFY, That Latterdad deceed from
19. ..... to. , 19
that I last saw h
alive on
19
and thet death occurred, on the date stated above, at
m.
7 AGE
Years
Months
Days
3
If STILLBORN, enter that fact bere
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
(b) Name of employer
9 BIRTHPLACE (City )
(State or country)
Wintheral
(duration)
.. yrs ....
.. .
mos ..
.. ds.
18 Where was disease contracted
if not at place of death ?
FOR WHAT?
Did an operation precede death ?
200
Date of
Was there an autopsy ?
no
What test confirmed diagnosis ?
200
(Signed)
. M.D.
Date.
(Address).
Whether Brand of Health
april 28
(Month)
( Day)
1922
(Year)
14 Father
Informant
(Address)
6 Amenton Ch PR.
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
Holy Case Com. Malden
"Cemetery)
(City or town)
DATE OF BURIAL afal 29/23
ADDRESS 8.12
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
J. a. Inoury
Official Health Officer position
Date of issue
Permit 4/28 22 No 432
IV. D. "WYATTE PLAINLI, WITIT ONFADING DLAGR INA 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
XM. 00,000
STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County.
Sufiglk
State
Massachusetts
Registered No.
City or Town
2 FULL NAME
6 Thenton 1
.St.,
Ward.
(If non-resident give city or town and State)
3 SEX
(temas 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 April
( Month)
25, 1922 (Da?) ( Year)
1 day .. or ..... min. Premature Beth 6 months
wird 3 hours
.. (duration)
. yrs ....
...
.... mos ..
.ds.
CONTRIBUTORY
(SECONDARY)
10 NAME OF
FATHER
William
PARENTS
11 BIRTHPLACE OF
FATHER ( City ).
(State or country)
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE OF MOTHER (City) (State or country)
15
MAY 2 1922
(Month) (Day) (Year)
REGISTRAR
E. Boston
notified
No. detcall Hospital
St ...
25
1922
If LESS than
The CAUSE OF DEATH was as follows :
-
20 UNDERTAKER
R. C. Twee
ACVISEU UNIICU SIAIES JIANVAKU CEKILFICALE 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 singlo word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. Butin many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, 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 entercd 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 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 "Epidemio cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. 's indefinite); Tuberculosis of lungs, men- inges, peritoneum, etc., Carcinoma, Sarcoma, etc., of. . (name origin; "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, ete. The contributory (secondary or inter- current) 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," "Col- lapse,""Coma,""Convulsions,""Debility" ("Congenital,""Senile," etc.), "Dropsy,""Exhaustion,""Heart failure,""Hemorrhage,""Ina- nition," "Marasmus," "Old age," "Shock," "Uremia,""Weakness," otc., when a definite disesso can be sacertained 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, eryslpelas, meningitis, miscar- rlage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
EXTRACTS
FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician 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 undertakeror 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 contraeted, the duration of his last illness, when last seen alive 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 he has received a perinit from the board of health or its agent . . . or ... from the elerk of the town where the person died; . . . No such permit shall be issued until there shall have been delivered to such board, agent or cierk . . . a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in ease 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, shail 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 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. - Gen. Laws, Chap. 114, Sec. 45.
Medical examiners shall make examination upon the view of the dead bodies of only sueh persons as are supposed to have died by violence. - Gen. Laws, Chap. 38, Sec. 6.
.. . Ho shall in all cases certify to the town clerk 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 tho 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 observanee of the following rules of practice:
(1) Attending physiclans will certify to such deaths only as those of persens 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 ia needed.
(3) Medical examiners will investigato 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 persons not disabled by recognized disease, and those of persons found dead.
M R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
(City or Town)
70
City or Town
wiechel
No.
140
Woodverde
St ..
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
nathaniel Thomas Howland
(If in the Army or Navy of the United States, give rank, organization, etc.)
St.
Ward.
(If non-resident give city or town and State)
months days
april
27th
1922
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
nov
19.2.0, to.
april
19 22
that I last saw him alive on
april 26
1922
and that death occurred, on the date stated above, at
'11 G, m.
If LESS than The CAUSE OF DEATH was as follows : myocarditis, Chronic Endocardite arteriosclerosis
(duration)
10 yrs 7
mos ..
ds.
CONTRIBUTORY
angina pectoris
( SECONDARY)
(duration)
.. yrs ..
mos.
ds.
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)
Andrem & Swoning.
M.D.
(Address).
335 huron Que Cam und
Date
april 27th 1922
(Month)
(Day)
(Year)
makes.
19 PLACE OF BURIAL, CREMATION, OR REMOVAL Fern Hill Cemetery
DATE OF BURIAL april 29/1922
(Cemetery) Hamn
(City or town)
20 UNDERTAKER
man
ADDRESS
U
C. R., Berenson 11
Permit
Off; .position,
Health officer
Date of issue 4/27/22
No
4.31
00,000
1 PLACE OF DEATH
County.
Suffolk
(a) Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
years
10
months
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
white
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
may
6 DATE OF BIRTH
(Day)
( Month)
7 AGE
Years
Days
27
70
Months
10
If STILLBORN, enter that fact bere
2
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
Relevant
particular kind of work
(b) Name of employer
9 BIRTHPLACE (City)
Hunzen
(State or country)
10 NAME OF
FATHER
Léa. Howland
Hamon
12 MAIDEN NAME
OF MOTHER
13 BIRTHPLACE OF
MOTHER (City)
Itanson
PARENTS
(State or country)
14
Informant ...
Geo. Howland
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
15
MAY 2 1922
(Month) (Day) (Year)
N. D. WHITE PLAINST, WITH UNFADING BLACK TEA THIS IS A PERMANENT RECORD. Every Hem of information
11 BIRTHPLACE OF
FATHER (City )
(State or count
Plymuntele. mars.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
310-1843
(Year)
1 day, ........ hrs. or ....... min.
micas
(Address)
140 Woodride come Wurden
REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was Gled with me BEFORE the burial or transit permit was issued- S. R. mowry
MEDICAL CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
days.
How long in U. S., if of foreign birth ?
years
State
Registered No.
Date of
ALTIJEU UNLIEU DIALES SIANDAKU CEKILFICAIE OF DEATH
LApproved by U. S. Census and American Public Health Association!
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. Butin many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Foreman," "Manager," ""Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer - Coal mine, etc. 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 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, 's 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 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 tho 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 "prl- 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 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 deccased, 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, when last seen alive 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 he 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 licu 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, 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 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 .- Gen. Laws, Chap. 114, Sec. 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 clerk 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 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 dircctly 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.
M R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH
folke
County.
City or Town
2 FULL NAME
3 SEX
Female Sprite
4 COLOR OR RACE
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 DATE OF BIRTH
July
(Day)
( Montit)
7 AGE
Years
Months
Days
61
12
If STILLBORN, enter that fact here
8 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
at Home
(h) Name of employer
mettinen
FATHER
11 BIRTHPLACE OF
FATHER (City)
(State or country)
mass
PARENTS
14
Informant !.
(Address) 145 th Rand Come
t
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
15
7may 20, 1923
IV. D. - WRITE PLAINLY, WITH ONFADING BLACK INK - THIS IS A PERMANENT RECORD. Every item of Information
9 BIRTHPLACE (City)
(State or country)
mass
19 1860
( Year)
if LESS than
1 day, ........ hrs.
or ....... mio.
10 NAME OF
nedas Ungnaolia
12 MAIDEN NAME
OF MOTHER amot he leaned
13 BIRTHPLACE OF MOTHER ( Cannot be learned (State or country) mar2.
(Month) ((Day) (Year)
REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stao- dard certificate of death was fled with me BEFORE the burial or transit permit was issued. J. G. Mowry
MEDICAL/CERTIFICATE OF DEATH
16 DATE OF DEATH
(Month)
(Day)
(Year)
17
I HEREBY CERTIFY, That I attended deceased from
19L2, to
may 1
1922
that I last saw her
alive on
19 .......... ,
and that death occurred, on the date stated above, at
11 40
a .. m.
The CAUSE OF DEATH was as follows :
Cerebral Harmonhas
(duration)
.. yrs ....
mos ..
5 ds.
CONTRIBUTORY
(SECONDARY)
(duration)
Indefinite
yrs.
mos. ...... . ds.
18 Where was disease contracted
if not at place of death ?
Did an operation precede death ?.
200 Date of.
Was there an autopsy ?
What test confirmed diagnosis?
(Signed)
M.D.
(Address).
Date.
218 manin Stato
3
1922
(Year)
(Month)
(Day)
DATE OF BURIAL
19 PLACE OF BURIAL CREMATION, OR REMOVAL
Woodlawn Emelt May 41922
(Cemetery)
(City or town)
20 UNDERTAKER
ADDRESS
I to Goodrich da maths
Health Officer position
Date of issue Jof permit 5/3/22
Permit
No .... 433
.000
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH Mass
Sinthook. ....... (City or Town) State Registered No. Daca 74 No. 145 blind are
.St.
... Ward
(If dcath occurred in a Hospital or institution, give its NAME instead of street and number) Minnie M. Ingraham
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence. Nd45 tolik One ( Usual place of abode)
Length of residence ia city or town where death occurred
years
months
days. How long in U. S., if of foreign birth ? years
Juan
1922
months days
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
St.,
Ward.
(If non-resident give city or town and State)
may 1
may 1. 1,1922 REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association]
-
Statement of occupation. - Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civilengineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry, and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salcsman, (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, 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 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.
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