Town of Winthrop : Record of Deaths 1928-1930, Part 197

Author: Winthrop (Mass.)
Publication date: 1928
Publisher:
Number of Pages: 1296


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 197


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).


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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; otherwise a description as full as may be, with the cause and manner of death .-- Gen. Laws, Chap. 38, Sec. 7.


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do 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 body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. . Chap. 114, Sec. 46, G. L., as amended.


State cause for which surgical operation was undertaken.


Bronchopneumonia: If primary cause, write the word "primary"; 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, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.


R-301


Suffolk


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Winthrop (City or town making/return)


Registered No.


(If death occurred in a hospital or institution,


give its NAME instead of street and number) (If U. S. War Veteran, specify WAR) Revere mass


(If nonresident, give city or town and state)


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR BACE


Himall white


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


married


5a If married, widowed, or divorced


(or) WIFE of


Viradite den na Casinoli


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7 28 AGE Years. Months .Days


If less than 1 day


Hours


Minutes


OCCUPATION!


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.


Housewife


-


9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..


10 Date deceased last worked at


this occupation (month and


year)


11 Total time (years) spent in this occupation ...


14


12 BIRTHPLACE (City)


Boston


(State or country)


mass


13 NAME OF


FATHER


Gaetano abate


PARENTS


(State or country)


15 MAIDEN NAME


OF MOTHER


Futurata


16 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


mass


17


Father Gaetano abate


Informais


(Address)


78 Park av. Reveremas


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bufial or transit permit was issued: Na. S. Childress


(Signature of Agent of Board of Health or other)


Healthe Officer


10/6/30


(Official Designation) (Date of Issue of Permat)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


er (Month)


5


1930


(Day)


(Year)


19


I HEREBY CERTIFY, That I attended deceased from


Sept


Oct 5


1980


1910 to


I last saw het alive on


5, 19 30, death is said


to have occurred on the date stated above, at.


12:10Pm


The principal cause of death and related causes of importance in order of onset were as follows


Date ofonset


Contributory causes of importance not related to principal cause:


Operation for pelas


inflammation!


Name of operation


Salpingeotany huesos/20/30


What test confirmed diagnosis Consultations was there an autopsy? 4.


20 Was disease or injury in any way related to occupation of deceased? 2


If so, specify.


,


(Signed)


Louis


, M. D.


(Address)


72 shirley Com Date 1/5


19.3.0


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Brookdale Dedham


DATE OF BURIAL


Oct. 8th


22 NAME OF


R. D. Guarente


UNDERTAKER


ADDRESS


416 Hanover St Martin


Received and filed


.19


A TRUE COPY, ATTEST: (Registrar)


CAUSE OF DEATH 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.


200M-11-'29. No. 7180-a


1


PLACE OF DEATH


gunty) Winthrop City or Town


No Winthrop Comunity Hospital Francesca Criscuali


2 FULL NAME


(a) Residence. No .... (Usual place of abode)


Length of residence in city or town where death occurred yrs.


(If deceased je a married, widowed or divorced woman, give also maiden name.)


78 Park av Revere ways


Ward


mos.


10


days.


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


yrs.


(Cemetery)


(City or town)


19.30


14 BIRTHPLACE OF


FATHER (City)


Italy


Cor. 2. 1930 Revised United States Standard Certificate of Death


Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.


To be complete, an occupation return must state:


8 .- The trade, profession, or particular kind of work done.


9 .- The industry or business in which the work was done.


10 .- The month and year the deceased last worked at the occupation.


11 .- The number of years the deceased followed the occupation ....


In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.


In stating the industry or business, avoid the use of such general terms as "store, "factory, " "mill." etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.


Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.


Statement of cause of death .- Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contri- butory causes of importance not related to principal cause, name other important diseases or injuries.


Example


The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis


Date of onset


1915


Chronic interstitial nephritis


1021


Cerebral hemorrhage


July 5. 1927


Contributory causes of importance not related to principal cause: Fracture of arm


Automobile accident


May 3, 1927


In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.


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 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 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, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, 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 satis- factory 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 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 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 certificate 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 state- ment and certificate, shall forthwith countersign 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 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 .- Chap. 114, Sec. 45, G. L., as amended.


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; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do 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 body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. . Chap. 114, Sec. 46, G. L., as amended.


State cause for which surgical operation was undertaken.


Bronchopneumonia: If primary cause, write the word "primary"; 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, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.


-302


PLACE OF DEATH


(County)


Cambrid"e


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Cambri . ce


(City or town making return) Registered No. 192


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Elizabeth Clifford


(If deceased is a marfied, widowed or divorced woman, give also maiden name.)


(a) Residence.


No. ¿ UL winthrop .t.


(Usual place of abode)


St.,.


...........


Ward, winthrop


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred yrs.


mos.


days. How long in U. S., if of foreign birth?


yTs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


widowed


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


mes Clifford


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7


AGE


68


Yea 11 Months .? Days


If less than 1 day Hours Minutes


OCCUPATION|


8 Trade, profession, or particular


kind of work done, as spinner,


sawyer, bookkeeper, etc. .


House ife


9 Industry or business in which


work was done, as silk mill,


saw mill, bank, etc.


At home


10 Date deceased last worked at


this occupation (month and


year)


11 Total time (years) spent in this occupation ..


12 BIRTHPLACE (City)


Toronto


(State or country)


Canada


13 NAME OF


FATHER


Martin Reardon


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Canada


15 MAIDEN NAME


OF MOTHER


HARMaret clark


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Canada


17


James E Clifford


Informant


(Address)


¿Ul winthrop st. winter


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


mor 14


............


ك.19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


Oct 7 19.30


DEATH


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


Oct 1


1930, 10ct 7


19,30


I last saw h.e.r ..... alive on ..... o.t .... 6


1930 ... , death is said


to have occurred on the date stated above, at ... 5 .... 45.m.


The principal cause of death and related causes of importance in order of onset were as follows:


Dateofonset


Cerebral


8 m23


lefthemulezia


Contribatory causes of importance not related to principal cause:


Diwortes


before sent


Name of operation


What test confirmed diagnosis?


Date of


Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased?


If so, specify


M. D.


(Signed) ++


(Address)


Holy Ghost Fon Date Vet 7 1930


21 PLACE OF BURIAL,


ITew Calvary Cem. Boston


CREMATION OR REMOVAL


Oct g'Compte


DATE OF BURIAL


(City or town) 19


22 NAME OF


Ettard & Gaffery


UNDERTAKER


ADDRESS


Medfora, Majs.


Received and filede7.


vet 8 19:00


Frederick H. Burke


19


(Registrar of City or Town where deceased resided)


important. OF DEATH In plain terris, so that it may be properly classified. Exact statement of OCCUPATION IS Very PARENTS


50m-2-'30. No. 7997-1


1


(City or Town)


No ..


Ward {


St.,


( Reardon )


(If U. S.


War Veteran,


specify WAR)


-


Oct. 7. 1930


R-305


PLACE OF DEATH


...


Suffolk (County)


Revere


(City or Town)


No. Vars' near Muelleris Ficlist.,


Ward


S


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME John Francis OUTpole


(It deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


34 Pleasant


(Usual place of abode)


St., ...........


Ward,


winthrop


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


yrs.


mos.


days.


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


yra.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Lale


4 COLOR OR RACE


ite


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Single


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7


AGE


20


Years Months Days


If less than 1 day


Hours


Minutes


OCCUPATION


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.


Manager


9 Industry or business in which , as ailk mill Airport saw mill, bank, etc ..


10 Date deceased last worked at


this occupation (month, and.


year)


Oct. 1930


11 Total time (years) spent in this occupation 0 40 Homicide ?


12 BIRTHPLACE (City)


Winthrop


(State or country)


Mass.


PARENTS,


14 BIRTHPLACE OF


FATHER (City)


(State or country) Ireland


15 MAIDEN NAME


OF MOTHER


Flore A. Macdonald


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Nova Scotia


17


Informant


Edward O'Toole


(Address)


54 Flowsant at., Wint ry


1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


Francia Tic. to (Signature of Agent of Board of Health or other)


Chair on -0. Health Oct. 14, 1270 (Official Designation) (Date of Issue of Permit) Revere Vass


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


October


17


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)


Treineration, partial incidental to the fall of an


aeroplane


Aviation accident;


20 If death was due to external causes (VIOLENCE) fill in the following :


Accident,


Suicide or


Date of injury Cat. 12


19.5.0


Where did


injury occur ?


Rovere, 1nas.


Manner of


Injury


Nature of


Injury


21 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


(Address).


Led. Exc. Suf. CO . Date 10/ 1219 36.


M. D.


1


22 PLACE OF BURIAL,


CREMATION OR REMOVAL


Holy Cross


(Cemetery)


(City or town)


DATE OF BURIAL Catover IN


197~


23 NAME OF


UNDERTAKER


Thing 2. Cluale;


ADDRESS


79


All. tic et.,


Received and filed.


19


A TRUE COPY, ATTEST:


(Registrar)


1


Revere (City or town making return)


Registered No.


(If U. S.


War Veteran,


specify WAR)


1


1


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


- 25M-11-'29. No. 7180-đ


021 1930


(City or town and State)


13 NAME OF


FATHER


Timothy O'Toole


V Oct. 11. 1930.


-302


OCCUPATION important. OF DEATH in plain terimis, so that it may be properly classified. Exact statement of OCCUPATION IS Very PARENTS


50m-2-'30. No. 7997-đ


17


Informant


John H. Townsend


(Address)


Winthrop, Mass.


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


Novi 7.


19


30


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


October


11,


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


Aug. 12,


129


to


not


17


193.0 ..


I last saw h .... e.r.alive on


Oct.


2.


1950


death is said


to have occurred on the date stated above, at. 9 a. m.


The principal cause of death and related causes of importance in order of onset were as follows:


Dateofonset


Sarcoma of Neck


Aug.


.. 8,


1929


Contributory causes of importance not related to principal cause:


Sciatic Neuritis


Nov.


Name of operation


Removal right eyeDator. KG


What test confirmed diagnosis?


Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased?


If so, specify.


(Signed)


S. Willard Coy


(Address) 3.4 .... Princeton .... S.t ...


M. D.


Da@ ct. 149 30


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Waterside


Marblehead


(Cemetery)


(City or town)


30


22 NAME OF


UNDERTAKER


George E. Nichols


ADDRESS


Marblehead, Mass.


Received and filed 19


(Registrar of City or Town where deceased resided)


1


Marblehead


(City or Town)


No. Comfort Home


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Marblehead


(City or town making return)


Registered No


82.96


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Martha L. Symonds


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No ..


17 Belcher


.St.,.


........


Ward,


Winthrop .... Mass


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


yrs.


mos.


days. How long in U. S., if of foreign birth?


yrs.


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female


4 COLOR OR RACE


White


5 SINGLE


MARRIED


WIDOWED


Or DIVORCED Wido wed


5a If married,


Wildnon divorced B. Symonds


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7


AGE


88


Years


7


Months


Days


If less than 1 day


Hours


Minutes


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.


9 Industry or business in which


work was done, as silk mill,


saw mill, bank, etc.


10 Date deceased last worked at


this occupation (month and


year)


11 Total time (years)


spent in this


occupation


12 BIRTHPLACE (City)


Newburyport


(State or country)


Mass.


13 NAME OF


FATHER


Henry Ewell


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass.


Scituate


15 MAIDEN NAME


OF MOTHER


Mary Ross


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Unknown


PLACE OF DEATH


Essex


....


(County)


St.,


Ward


(If U. S.


War Veteran,


specify WAR)


1930


(Usual place of abode)


(write the word)


At home


1929


DATE OF BURIAL


October


14,


Oct. 11. 1930. ٧


-


-301


PLACE OF DEATH


Suffolk. (County) Winthrop (City or Town) 60


No.


Orlando live . St.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Kruithof ethiop (City or town making return) 8 2


Registered No. (If death occurred in a hospital or institution,


Ward


give its NAME instead of street and number)


Mary, alice Bacon Macomber!


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No ..


(Usual place of abode)


Length of residence in city or town where death occurred


40 YTS. X


mos.


days.


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


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


Female White


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


5a If married, widowed, or divorced


HUSBAND of


Harry


(Give piden name of wife in full)


Valor Macumba


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


AGE ..


65


Years


11


Months


10


Days


If less than 1 day


Hours


.Minutes


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.


none.


9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ..


10 Date deceased last worked at


this occupation (month and


11 Total time (years)


spent in this


occupation.


Boston


(State or country)


mais


13 NAME OF


FATHER


Charles, Edward Bacon


14 BIRTHPLACE OF


FATHER (City)


(State or country)


mais


15 MAIDEN NAME


OF MOTHER


arleta, Buy and Jones


16 BIRTHPLACE OF


MOTHER (City)


Dumascolla trucco


(State or country) Deveter ....


17


Harry E. Macomber


Informant


(Address)


60 orlando av.


1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: W. S. Childress


ignature of Agent of Board of Health or other) 10/15/30


Health Officer (Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


12


19.30


(Year)


(Day)


19 I HEREBY CERTIFY, That I attended deceased from


CUT 8


Cent 12


, 19 30


I last saw alive on


Can't


F


30


19


death is said


to have occurred on the date stated above, at 9 A


.. m.


The principal cause of death and related causes of importance in order of onset were as follows: Dateofonset


aut Banditi


6+ 5, 1930


Gts 19:30


Contributory causes of importance not related to principal cause:


Primary lateral sclerosis


1911


Name of operation


none


Date of


What test confirmed diagnosis?


Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased?


If so, specify


Raymane B Parker


(Signed)


..... , M. D.


(Address Mutiny Brand of Strath Datde IT 13 19.10


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Oct.


(Cemetery)


15


130


(City or town)


19.


-


DATE OF BURIAL


22 NAME OF


UNDERTAKER


handles R. Lemuson.


ADDRESS


Northrop. Mars.


Received and filed 19 ..


A TRUE COPY, ATTEST: (Registrar)


200 M-11-'29. No. 7180-a


1 3 SEX (or) WIFE of 7 PARENTS OCCUPATION| is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION year)


2 FULL NAME


60 Orlandy arest.,


Ward,


(If U. S. War Veteran, specify WAR)


(If nonresident, give city or town and state)


withrop, Winthrop


12 BIRTHPLACE (City)


.


Valor. 12. 1930 Revised United States Standard Certificate of Death


Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.




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