USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 17
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
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For ex- ample: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under cir- cumstances unknown."
If investigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemor- rhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
march 11. 1928 John Philip mullen
NOTICE TO UNDERTAKERS : No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Boston
City or towp)
1 PLACE OF DEATH
County
Suffolk
State
Registered No.
2424
(Place of residence)
No. MASS, HOMEOPATHIC HOSPITAL
St.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
WESLEY B. AGNEW
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
State
MASS.
City or Town
WINTHROP
No
115 SUMMIT AVE.
St.
(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
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
M.
W
5a If married, widowed, or divorced
Name of & HUSBAND
(or) WIFE
LUCY
6 AGE
Years
Monthe
Days
If LESS than 1 day,. . . . hrs, or .... min.
55
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
SALESMAN
(b) Name of employer
8 BIRTHPLACE (city or town)
(State or country)
IRELAND
9 NAME OF
FATHER
TWEEDIE AGNEW
10 BIRTHPLACE OF
FATHER (city or town)
(State or country) IRELAND
11 MAIDEN NAME
OF MOTHER
SARAH J. (UNKNOWN)
12 BIRTHPLACE OF
MOTHER (city or town)
(State or country)
IRELAND
13
Informant
CATHERINE HOCTOR
(Address)
16 DUNREATH ST. BOSTON
14 Filed MAR. 15.
, 19 28 ErMSlenen
Registrar of city or town where death occurred
Filed Mar 23, 1928
Registrar of city or town where deceased resided
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
MARCH 12
1928
(Month)
(Day)
(Year)
16
-
HEREBY CERTIFY,
That I attended deceased from
MARCH 8
19
28
to
MAR. 12
19.28
that I last saw h. | M alive on
MARCH 12
19.28
and that death occurred, on the date stated above, at The CAUSE OF DEATH was as follows: (State fully)
SEPTIC BRONCHO PNEUMONIA
.(duration)
fre ..
mos.
ds.
CHRONIC NEPHRITIS
CONTRIBUTORY
(SECONDARY)
(duration)
yrs.
mos.
ds.
17 Where was disease contracted
if not at place of death
Did an operation precede death
NO
For what.
Date of operation
Was there an autopsy
NO
What test confirmed diagnosis.
CLINICAL AND LABORA-
(Signed)
C. A. POWELL
TORY
, M. D.
(Address)
Date
MARCH 12, 1928
18 PLACE OF BURIAL, CREMATION, OR REMOVAL (PITTSFIELD) PITTSFIELD (Cemetery) (City or town)
DATE OF BURIAL
3-15
, 19 28
ADDRESS
19 UNDERTAKER
P. E. MURRAY
may be properly classified. Exact statement of OCCUPATION is very important. PARENTS
. 4312
Registered No.
( Place of death)
City or town
Boston
Wesley B. Uqueus march 1 2, 1928
2
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Boston City or town)
1 PLACE OF DEATH
County
Suffolk
State
City or town
Boston
No.
PETER BENT BRIGHAM HOSPITALS ...
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
HYMAN STONE
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
State
MASS.
City or Town
WINTHROP
No.
92 SHIRLEY
St.
(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
4 COLOR OR RACE
M.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
M
5a If married, widowed, or divorced
Name of
S HUSBAND
? (or) WIFE
BESSIE
6 AGE
Years
Months
Days
If LESS than
1 day, .... hrs.
or .... min.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work.
(b) Name of employer
BUTCHER
8 BIRTHPLACE (city or town)
(State or country)
RUSSIA
9 NAME OF
FATHER
LOUIS STONE
10 BIRTHPLACE OF
FATHER (city or town)
(State or country) RUSSIA
11 MAIDEN NAME
OF MOTHER
IDA
12 BIRTHPLACE OF
MOTHER (city or town)
(State or country)
RUSSIA
13
Informant
MAX WEINBERG
(Address)
359 DUDLEY ST.
14
Filed. MAR. 16, 1928
JUNE 23. 198
Registrar of city or town where death occurred
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
MARCH 13
1928
(Month)
(Day)
Year)
16
I HEREBY CERTIFY,
That I attended deceased from
MARCH 9
19
28
to
MARCH 13
1928
that I last saw h
I M alive on
MARCH 13
.1928
and that death occurred, on the date stated above, at.
11.30 P
m
The CAUSE OF DEATH was as follows: (State fully)
MYOCARDITIS
(duration)
3 gre.
mos
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs ..
mos.
da.
17 Where was disease contracted
if not at place of death.
Did an operation precede death.
For what
Date of operation
Was there an autopsy
NO
What test confirmed diagnosis.
CLINICAL AND LABORATORY
(Signed)
CHARLES L. CLAY
, M. D.
(Address)
Date
MARCH 14. 1928
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
EVERETT JEWISH CEM.
(Cemetery)
(City or town)
DATE OF BURIAL
3-14
, 1928
ADDRESS
19 UNDERTAKER
MANUEL STANETSKY
Registrar of city or town where deceased resided
. 4312
Registered No.
2458
( Place of death 50
Registered No.
(Place of residence)
may be properly classified. Exact statement of OCCUPATION is very important. PARENTS
42
BRONCHITIS --- ASTHMA
Nyman Grove march 13, 1928
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Boston
1
1 PLACE OF DEATH
County
Suffolk
State
City or town
No.
MASS, HOMEOPATHIC HOSPITALSt.,
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
JEAN NELSON
(If in the Army or Navy of the United States, give rank, organization, etc.)
(a) Residence.
State
MASS.
City or Town
WINTHROP
No.
20 SEYMAN ST.
St.
(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
F.
4 COLOR OR RACE
W.
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED ¿write the word)
5a If married, widowed, or divorced
Name of
§ HUSBAND 2 (or) WIFE
6 AGE
Years
Month's
8
Days
If LESS than 1 day, .... hrs. or .... min.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED (a) Trade, profession, OF particular kind of work (b) Name of employer
8 BIRTHPLACE (city or town)
BOSTON
(State or country)
MASS
9 NAME OF
FATHER
JOSEPH A
10 BIRTHPLACE OF
FATHER (city or town)
BOSTON
(State or country)
MASS.
11 MAIDEN NAME
OF MOTHER
JEAN SMITH
12 BIRTHPLACE OF
MOTHER (city or town)
(State or country)
SCOTLAND
13
Informant
MRS. JEAN NELSON
(Address)
20 SEYMOUR ST. WINTHROP
14
Filed MAR. 19, 19 28 EMM Seinen
ed mar 23, 19 28 Registrar of city or town where death occurred
Registrar of city or town where deceased resided
4312
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH.
MARCH 15
(Month)
(Day)
(Year)
16
I HEREBY CERTIFY,
28
to
MARCH 15
, 19.28
that I last saw h
ER
alive on
MARCH 15
19.28
and that death occurred, on the date stated above, at.
1-35 A
The CAUSE OF DEATH was as follows: (State fully)
SCARLET FEVER
SEPTICEMIA
(duration).
yrs
ds.
CONTRIBUTORY
(SECONDARY)
(duration)
yrs.
mos.
17 Where was disease contracted
if not at place of death
Did an operation precede death
For what.
Date of operation
Was there an autopsy
YES
What test confirmed diagnosis
USUAL CLINICAL-AUTOPSY
(Signed) EDWARD C. SMITH , M. D.
(Address)
Date
MARCH 15, 1928
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
HOLY CROSS , MALDEN
(Cemetery)
(City or town)
DATE OF BURIAL
3-16
, 19 28
ADDRESS
19 UNDERTAKER
F. A. MAGRATH
City or town)
Registered No.
2533
(Place of death)
5
Registered No.
(Place of residence)
Boston
may be properly classified. Exact statement of OCCUPATION is very important. PARENTS
1928
That I attended deceased from
FEB. 18
19
ACUTE NEPHRITIS
1
Jean nelson march 15. 19 .25
AR-301
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town)
59
Basta
No .-
_St., _Ward (If death occurred in a hospital or institution, give its NAME instead of street and number)
2FULL NAME
(If U. S. War Veteran, specify WAR)
(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 male White
5 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word) Married.
5a/If married, widowed or divorced HUSBAND of (or) WIFE of
alice D.
Months
Days
IF LESS than 1 dey, ........ hrs. o ......... min.
IF STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
Clyde / S.S. Co
a Captain
8 BIRTHPLACE (City)
Machiasport
(State or country)
man
PARENTS
9 NAME OF
FATHER
Hezekiah Holmes
10 BIRTHPLACE OF
FATHER (City)
Machuasport
(State or country) Marie
1 1 MAIDEN NAME
OF MOTHER
Lois
2
12 BIRTHPLACE OF MOTHER (City) (State or country) maine
(Address)
Date
18 PLACE OF BURIAL, CREMATION, OR REMOVAL Winthrop Hanthron (Cemetery) (City or town)
DATE OF BURIAL
13 Informant alice D. It alves
(Address) Boxford Mass.
14
128
Filed (Month) (Day) (Year) REGISTRAR
20 | HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit wa- issued
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH Branch
(Month)
(Day)
1925
(Year)
16 I HEREBY CERTIFY , That I attended deceased from
19 to
19
that I last saw h alive on 19
and that death occurred, on the date stated above, at. The CAUSE OF DEATH was as follows: (State fully)
m.
trow
(duration)
yrs
mos.
ds.
CONTRIBUTORY
(Secondary)
(duration) _.
.. yrs
mos ds.
1 7 Where was disease contracted
if not at place of death
Did an operation precede death For what
Date of operation
Was there an autopsy under one year, was infant Breast Fed ? What test confirmed diagnosis
(Signed)
M. D.
March 25
L
ADDRESS
1 9 UNDERTAKER Charlie
Official position.
Date of Issue of permit
Permit No.
Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. plied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified-
200.000. 9-26. NO. 6373
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County City or Town
Suffolk
Massachusetts Bami Honda
Registered No/2
_St .. Ward,
(If non-resident give city or town and state)
4 COLOR OR RACE
6 AGE
Years
55
EXTRACTS
FROM THE LAWS OF THE
COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, 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 registra- tion a standard certificate of death, stating to the best of his knowl- edge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required 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 or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, or from one cemetery to another, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, 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 ob- tained early enough for the purpose, 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, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If the death certi- ficate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such statement and certificate, shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying he cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as o the manner or cause of the death, which the clerk or registrar nay require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination upon the view of the ead bodies of only such persons as are supposed to have died by iolence .- Gen. Laws, Chap. 38, Sec. 6.
.. He shall in all cases certify to the town clerk or registrar in the ace where the deceased died his name and residence, if known; herwise a description as full as may be, with the cause and manner death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the hes thereof which have been brought into the commonwealth until has received a permit so to do from the board of health or its agent pointed to issue such permits, or if there is no such board, from the rk of the town where the body is to be buried or the funeral is to held, or from a person appointed to have the care of the cemetery burial ground in which the interment is made .- Chap. 114, Sec. 46, L., as amended.
........
County Dade
STATE BOARD OF HEALTH OF FLORIDA BUREAU OF VITAL STATISTICS
Permit No
/
Precinct.
(Write name, not number) or
Inc. Town
or
City.
Miami.
Removal and Burial Permit
Reg. Dist. No ..
Full name Millia
taler
:
Age
5-5
; Sex
Color,
Disease causing Death
Date of death
4
., 19 28
Removal to Undertaker
...... , viac.
Address ..
A Certificate of Death having been filed in my office in accordance with the Laws of Florida, Ihereby authorize the removal and burial of the body of said deceased person as stated above. vier -19.19 28 Dated Registrar's Signature
Burial Permits must be delivered by the undertaker to the sexton or other persons in charge of the burial ground or cemetery where burial takes place. When the body is to be shipped to a distant point, requiring the service of a common carrier, in addition to the Removal Permit, the body must be accompanied by a Transit Label as required by the State Board of Health. For full particulars see Rules and Regulations governing the transportation of dead bodies.
Sexton's Signature.
Date of Interment 19
This permit must be endorsed by the sexton and returned to the Local Registrar of his district within ten days. If there is no sexton or person in charge of burial ground, the undertaker or person acting as such, shall sign same as sexton, giving date of interment. Write across face of permit the words, "No person in charge," and return to Local Registrar of the district in which interment is made within ten days.
..........
INSTRUCTIONS TO PASSENGER ACCOMPANYING REMAINS
This Burial and Removal Permit must be filled out by the Local Registrar of the registration district in which the death occurred from in- formation stated on the Death Certificate, over his signature.
The transportation company's agent or baggagemaster must detach this portion of the permit and hand it to the person authorized to accompany the remains.
If the body is shipped by express, the express agent must detach this portion of the Transit Permit and attach it to the Waybill, as it must accompany the remains to its destination. The receiving agent to turn over this Permit to the receiving undertaker, or person to whom the body is delivered.
The passenger accompanying the remains must deliver this Permit to the undertaker or person having charge of the burial of the body.
This Permit authorizes the burial of the body of the deceased named on the reverse side of this Permit at any place in the State of Florida.
FORM V. S. No. 12
Reg. Dist. No.
110
/
TRANSIT PERMIT
Permit No.
386
STATE OF FLORIDA STATE BOARD OF HEALTH-BUREAU OF VITAL STATISTICS Hille I filme Date of death TRANSPORTATION COMPANY'S COUPON
Name of deceased
Place of death Dade County
(Name of City, Incorporated Town or Voting Precinct)
Color or Race
; Sex.
.; Age
55
Yrs. Cause of death
Shipping Station
miami
Florida, to.
7900 ord State
I, the undertaker in charge, hereby certify, that I have prepared and shipped the body of the above named deceased in
accordance with Rule.
3
,and that I hold Embalmer's License No ..
5
2
(Signature)
A
is on file in my office for the above named deceased.
(Death Certificate or Removal Permit)
(Signature) 1
I hereby certify that I permitted the shipment of a body this. day of.
which was represented as that of the above named deceased. (Signature) " Hlouning haus
Vier,
Local Registrar 19
(Ticket Agent or Baggageman or Express Agent)
Name of Transportation Company
..........
3/15/19 28
M.
INSTRUCTIONS TO AGENT OR TRANSPORTATION COMPANY
This Transportation Company's Coupon must be filled out by the Local Registrar of the registration district in which the death occurred, over his signature, and must also bear the signature of the shipping embalmer or undertaker preparing the body for shipment.
This coupon must be detached by the agent or baggagemaster of the transportation company at the shipping station and mailed by him within twenty-four (24) hours to the State Board of Health, Jacksonville, Florida.
Mar. 15, 1928
-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
1 PLACE OF DEATH County ..... Suffolk City or TownWinthrop.
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
State Mass.
Registered No. 57
No ..... I6, NorthAve.
St., .......... Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Peleg Stetson
(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 )
Length of residence in city or town where death occurred years months
days. How long in U. S., if of foreign birth ? years
months days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED ( write the word)
Male
White
Married
5a If married, widowed, or divorced HUSBAND of (or) WIFE of Julia M. Stetson (Pinkham
6 AGE
65
Years
Months
Days
If LESS than 1 day ........ hrs. or ........ min.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED (a) Trade, profession, or Stationary Engineer particular kind of work (b) Name of employerO' Connell & Lee, Somerville
8 BIRTHPLACE (City)
Fast Bridgewater
(State or country
Mass.
9 NAME OF FATHER
Thomas Stetson
10 BIRTHPLACE OF FATHER (City) (State or country )
11 MAIDEN NAME OF MOTHER Frances Randall
12 BIRTHPLACE OF MOTHER (City) (State or country) Maine
13
Informa Mrs. Hulia M. Stetson
(Address) 16 North Ave. . Winthrop, Mass.
14
Filed 0 2 28/28
(Month) (Day) (Year)
REGISTRAR
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
DATE OF BURIAL
2I
Brookdale
De dham Mass.
(Cemetery)
19 UNDERTAKER
Long & Margeson
ADDRESS
Winthrop, Mas:
20 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued Www. D. Childress
Official position/
on Health officer
Permit
Date of issue 3/21/28 No. 1386
in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See
instructions and extracts from the laws on back of certificate.
Central Humanlage
(duration)
1
yrs.
age
1
.. mos. ..
.ds.
CONTRIBUTORY (SECONDARY)
.(duration)
.yrs.
mos .. ds.
17 Where was disease contracted
if not at place of death ?
Did en operation precede death ?
100
Date of
Was there an autopsy ?
200
What test confirmed diagnosis ?
(Signed)
R. B
.. , M.D.
(Address)
Date
march
19
1928
( Month) (Day) (Year)
15 DATE OF DEATH.
(Month)
19
1925.
(Day)
(Year)
16 I HEREBY CERTIFY, That I attended deceased from to. 76. 17 137 March 14 128 .. ,
that I last saw h.
alive on.
and that death occurred, on the datorstated above, at 2 A m. The CAUSE OF DEATH was as follows :
IO
9
PARENTS
MEDICAL CERTIFICATE OF DEATH
(a) Residence. No. 16. North Ave.
(Usual place of abode)
20
(City or town)
(City or town) 28
REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH
[Approved by U. S. Census and American Public Health Association] Peleg stetson Inarch 19. 19.28
, 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) 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 CAUBING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cere- brospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is 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 the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia," "PUERPERAL peritonitis," etc.
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.