USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1922-1924 > Part 46
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City or Town
Winthrop
.No.
35 Coral Que.
St., .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Rachel Sisonsky
(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
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
white
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
married
15 DATE OF DEATH
august
18-1922
(Month
(Day)
(Year)
16
I HEREBY CERTIFY, That I attended deceased from
Ime 21-
1921, to
august 18, 1922
that I last saw her alive on
august 18 - 1920.
and that death occurred, on the date stated above, at.
4.39 am.
The CAUSE OF DEATH was as follows :
Drabeter mellitus
(arterio-sclerosie)
(duration) . 11 .yrs ...
... mos. ds.
CONTRIBUTORY
artrio-sclerosis
5
(SECONDARY)
.. yrs.
(duration)
mos.
.......
.ds.
17 Where was disease contracted if not at place of death ?
Did an operation precede death ?. no Date of
Was there an autopsy ?
20
What test confirmed diagnosis ?
laboratory testa
amed
(Signed)
mitchell tissot
.. , M.D.
Date
(Address)
163 mendien St
august 18th
(Day)
(Month)
1922
( Year)
Informant
Louis Sigonsky
(Address)
35 Coral Que.
14 aug. 29 1923
Filed .. (Month]] (Das) ( Year)
REGISTRAR
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
Chevra Michnot Cem.
(Cemetery)
(City or town)
Woburn
DATE OF BURIAL
Qua . 18/1922
19 UNDERTAKER
Manuel Stanetehry
ADDRESS
Boston
Permit
0,000.
20 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
S.a. Mowry
Official position ..
Health Officer
Date of issue of permit
Lug 181920 ... 465
PraBq.
MEDICAL CERTIFICATE OF DEATH
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Louis
Months
Days
If LESS than
1 day, ....... hrs.
or ........ min.
If STILLBORN, euter that fact bere
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
ousewife
8 BIRTHPLACE (City)
K.
sia
Isreal Millen
10 BIRTHPLACE OF
FATHER (City).
Russia
Etta Cannot-
Russia
6 AGE Years 65 (State or country 9 NAME OF FATHER 11 MAIDEN NAME OF MOTHER 12 BIRTHPLACE OF MOTHER (City) (State or country) PARENTS 13 should be carefully supplicd. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (b) Name of employer 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 (State or country)
The Commonwealth of Massachusetts
35 Coral Que.
St,,
١
... Ward.
Winthrop
(Ifin the Army of Navy of the United States, give rank, organization, etc.)
(If non-resident give city or town and State )
auquel 18, 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 agc. 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 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 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.
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 "Epidemie cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified. is indefinite); Tuberculosis of lungs, men- inges, peritoneum, otc., Carcinoma, Sarcoma, ete., 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 need not be stated unless important. Example: Measles (disease causing death), 29 ds .; Bronchopneumonia (secondary), 10 ds. Never roport mere symptoms or terminai 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- mittec on Nomenclature of the American Medical Association.)
Bronchopneumonla: 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 foliowing diseases, without explanation, as the soie cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, eryslpelas, meningitis, miscar- riage, necrosis, peritonitis, phlebitis, pyemla, septicemia, tetanus.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physiclan 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 tho name of tho 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 permlt shall be Issued until there shail have been delivered to such board, agent or cierk ... a satisfactory written statement containing the facts required by law to be roturned and recorded, which shali 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 thereof a certificate as hereinafter provided. If there is no attending physiclan, 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 vioience, 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 deccased 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 wili certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from dlsease resulting from Injury or infection related to occupation, tho 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
Mass
Registered No.
113
St., .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Jane H. Clearland
(If in the Army or Navy of the United States, give rank, organization, ete.)
(a) Residence. No.
( Usual place of abode)
Withs. J. Alanes
St., ..... ..... .Ward.
( If non-resident give eity or town and State)
Length of residence ia city or towo where death occurred
10
years
mooths
days.
Ilow loog io U. S., if of foreign birth ?
years
mooths days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Hadow
5a If married, widowed, or divorced
HUSBAND of
( of) WIFE of
Orest Clearland
6 DATE OF BIRTH March
( Month)
7 AGE
Years
86
Months
5
Days
10
If STILLBORN, eoter that fact here
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work. (b) Name of employer
9 BIRTHPLACE (City)
(State or country)
10 NAME OF
FATHER
North Dickson
11 BIRTHPLACE OF
FATHER (City) ...
(State or country)
12 MAIDEN NAME
OF MOTHER
Hannah Martin
13 BIRTHPLACE OF
MOTHER (City)
(State or country)
G.IL Card Mass
14 T. S. Clearland Informant (Address) Charles gate East Boston.
15
Clueg. 2/1922.
(Month) (Day) (Year)
REGISTRAR
21 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or traosit permit was issued
Official position ..
DATE OF BURIAL Cambridge Aug 21
(Cemetery)
(City or town)
M.D.
(Address) ...
Date
( Month)
(Das)
(Year)
19 PLACE OF BURIAL, CREMATION, OR REMOVAL
2% .ds.
(duration)
... yrs ....
mos.
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 ?
3
CONTRIBUTORY
Cerchal
(duration)
mos ... ds.
(SECONDARY)
If LESS thao 1 day, ........ hrs. or ....... min. Brancho Pneumonia
17
y HEREBY CERTIFY, That I attended deceased from
Jan
22
, co ..
19
amy 19
19
22
What I last saw her
alive on
Omul 19
1922
and that death occurred, on the date mated above, at
11-404
The CAUSE OF DEATH was as follows :
MEDICAL CERTIFICATE OF DEATH
19
16 DATE OF DEATH
(Montly
(Day)
(Year)
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
00.000
1 PLACE OF DEATH
County.
City or Town
Hans th1 1/1
.No
State
Winther. / (City or Towny
Marblehead
PARENTS
(Sigoed)
1922
20 UNDERTAKER
ADDRESS
Kelley Mawer Winchester
HealtheOfficee ang. 19:"#466
9
"(Day)
1836 (Year)
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 he 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 preciso 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 Ilousekeepers 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 hecn changed or given up on account of the DISEASE CAUSINO DEATH, stato 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 CAUSINO NEATH (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," unqualificd, 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 (discase causing death), 29 ds .; Bronchopneumonia (secondary), 10 da. 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 disease can be ascertaincd as the causc. Always qualify all diseases resulting from childhirth 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, hemorrhago, 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 undertakeror otherauthorized 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, tho duration of his last illness, when last seen alive by the physician or officer and the date of his death. ...- Gen. Laws, Chap. 46, See. 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 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 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 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 requirod 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 tho 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 caro 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 diseaso unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificato of death is needed.
(3) Medical examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
A R- 301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
1 PLACE OF DEATH
County.
Tu Ctollal
State mass
(City or town)
Registered No.
114
City or Town.
Minttuato
.No.
103
Sargent
St .. Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(a) Residence.
No.
103 Sargent
St.,
......
.. Ward.
(If non-resident give city or town and State )
(Usual'place of abode)
Length of residence in city or towa where death occorred
years
months
days.
How long in U. S., if of foreign birth ?
years
months
days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
nale
4 COLOR OR RACE
trute manced
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Isabel
6 AGE
Years
74
Months
11
Days
18
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
ED merchant
8 BIRTHPLACE (City).
Wellfleet
(State or country
masa
PARENTS
10 BIRTHPLACE OF
FATHER (City)
(State or country)
(Hellikeit.
11 MAIDEN NAME
OF MOTHER
ME Lutlos Kopen
12 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ymaci
17 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 Fleurant
21
2.2
Date
(Month)
(Day)
(Year)
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
/ Woodlawn Everett tud
DATE OF BURIAL
3
(Cemetery)
(City or town)
19 UNDERTAKER
-
John-Maken
ADDRESS
Official position.
Health Offic Date of issue face of permit
Permit
20 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was fled with me BEFORE the burial or transit permit was issued
,000.
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH 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
14 Fil ed Past. 1, 1922B (Month) (Day) ( Year),
REGISTRAR
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
(Month)
20
22
(Day)
(Ycar)
16 I HEREBY CERTIFY, That I attended deceased from
1922
to
aug 20
., 19 .. 2.3.
aux 20
19 22
that I last saw h ............... alive on
If LESS than
1 day, ....... brs.
Gr ........ min.
and that death occurred, on the date stated above, at - ....... m. The CAUSE OF DEATH was as follows : nema
.(duration)
... Anos .. ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs ..
.. mos ...
......
ds.
9 NAME OF
FATHER
John neal
13
Inform
(Address)
100 Jardeux RX
(If in the Army or Navy of the United States, give rank, organization, etc. )
aug 21,192 No. 467
at -20, 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 varieus 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) 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 domestie service fer 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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