USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1928-1930 > Part 56
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if not at place of death ?
(Signed)
GEORGW BURGESS MAGRATH
(Address)
BOSTON
Medical Examiner for
SUFFOLK
Bate.
SEPT 27,
1928
(Month)
(Day)
(Year)
18 PLACE OF BURIAL, CREMATION, OR REMOVAL HOLY CROSS, MALDEN
DATE OF BURIAL
9-30-28
(Month) (Day) (Year)
19 UNDERTAKER
R. C. KIRBY
ADDRESS
20 Burial permit issued by
Official
position.
21 Date of issue
Registered No
8567
rank organization, etc.)
St.,
.Ward.
(If non-resident, give city or town and State)
M. D.
Sept.27,1928
2
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
Attleboro City or town)
1 PLACE OF DEATH
County
Bristol
State
Mass.
Registered No.
(Place of residence) 5
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If in the Army or Navy of the United States, give rank, organization, etc.)
No.
72 Temple 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
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH.
September
27, 1928
(Month)
(Day)
(Year)
16
I HEREBY CERTIFY,
That I attended deceased from
Sept. 8,
1:28
to
Sept. 27 , 19.
28
that I last saw h.
im
_alive on
Sept. 27,
, 19.28
and that death occurred, on the date stated above, at.
11:30 a.m.
The CAUSE OF DEATH was as follows: (State fully)
Chronic cardiac disease
Mitral insufficiency
(duration)
?
yrs.
mos .. ds.
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.
(Signed)
Frederick V. Murphy
M. D.
(Address)
Attleboro, Mass.
Date
September 28, 1928
18 PLACE OF BURIAL, CREMATION, OR REMOVAL
St. Mary's
Foxboro
(Cemetery)
(City or town)
DATE OF BURIAL
9/29/28
. 19
19 UNDERTAKER
Stephen H. Foley
ADDRESS
Att le boro.
To. 4312
Registrar of city or town where deceased resided
Registered No.
229
(Place of death)
16.3
City or town
Attleboro
No.
Sturdy Memorial Hospital
2 FULL NAME
John J. Sutton
(a) Residence.
State-
Mass
4 COLOR OR RACE
White
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Widowed
ba If married, widowed, or divorced
Name of
S HUSBAND + WIFE
Maria Sutton
Years 71
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 Manager of shoe store
(b) Name of employer
8 BIRTHPLACE (city or town)
Cleveland,
Ohio
9 NAME OF
FATHER
Robert Sutton
10 BIRTHPLACE OF
FATHER (city or town)
(State or country)
Ireland
11 MAIDEN NAME
OF MOTHER
Mary Finn
12 BIRTHPLACE OF
MOTHER (city or town)
(State or country)
Ireland
Informant
Mrs. S. W. Phelps,
(Address)
Winthrop, Mass.
14
Filed
9/28/28,19
Chimie Q. Wheeler
Filed
20.10
. 19 28 Registrar of city or town where death occurred
3 SEX Male 6 AGE PARENTS 13 may be properly classified. Exact statement of OCCUPATION is very important. Tony supplied. AGE should be stated CAAGILT. PHYSICIANS should state CAUSE OF DEATH In plain terms, so that it (State or country)
.
St.,
City or Town
Winthrop
Chronic nephritis
for J. envion Sept . 27, 1928
M R-301
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH
The Commonwealth of Massachusetts
STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town)
County
Suffolk
State Massachusetts
Registered No.
St., Ward
(If death occurred in a Hospital or institution, give Its NAME instead of street and number)
2 FULL NAME
(a) Residence. No ._
(Usual place of abode)
Length of residence in city or town where death occurred
4
months
days.
How long in U. S., if of foreign birth?
(If non-resident give city or town and state)
38
years
months days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
white
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write-ttre word)
Married
Sa If married, widowed or divorced
HUSBAND of
(or) WIFE of
Bemand
6 AGE 60 Years
Months
Days
If LESS than 1 day, __ hrs. Of __ min.
If STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
(b) Name of employer
8 BIRTHPLACE (City)
(State or country)
Russia
9 NAME OF
FATHER
Monis BerliterKofel
10 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia trauung
11 MAIDEN NAME
OF MOTHER
Mollie Cannotla
12 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
September 281928
(Month)
(Day)
(Year)
16 I HEREBY CERTIFY, That I attended deceased from September 25, 1028, to September 28, 1925.
that I last saw her alive on
September 28, 1928
and that death occurred, on the date stated above, at 1:10 p.m.
The CAUSE OF DEATH was as follows: Carcinoma of lumbar
+ Racial spinal vertebral.
(duration) .yrs. mos .... .ds.
CONTRIBUTORY.
(SECONDARY)
(duration)
yrs ..
.mos ..
..... ds
17 Where was disease contracted
if not at place of death?
no
Date of
Did an operation precede death?
no
Was there an autopsy ?.
under one year, was infant Breastfed? What test confirmed diagnosis? Jacob (Signed)
., M. D.
(Address).
562 Shirley Stillritt
Date
(Month)
(Day)
(Year)
13
Informant Bernard Promised
(Address)
52 Loucuray Pt.
14
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 was issued
W. D. Childress.
Official position
Healthe Office Date of issue
9/28/28; Permit NO. 1018
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.
27-20M1
200,000 9-25 NO. 2662- 3.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK- THIS IS A PERMANENT RECORD. Every item of information
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH
City or Town
Beston Winthrop No. Lumine Promisel
(If in the Army or Navy of the United States, give rank, organization, etc.)
52 Louerst
St. Ward. Winthrop
Winthrop
18 PLACE OF BURIAL, CREMATION OR REMOVAL
Beth Joseph Cay.
(Cemety.
Woburn
(City or town)
DATE OF BURIAL Eget 30 19).
19 UNDERTAKER
Manuel Stanetslag
ADDRESS
4.3.4.
Hypostolatic pneumonie
PARENTS
52 houenst
V sieht -au. 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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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," "Fore- man," "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 household only (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically 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 occupa- tion 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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, 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 intercurrent) 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," "Collapse," "Coma," "Convul- Bions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Ex- haustion," "Heart failure," "Hemorrhage," "Inanition," "Maras- mus," "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 "PUERPERAL 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 "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, miscarriage, 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 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 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 con- taining 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 pur- pose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. .. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Gen. Laws, Chap. 114, Sec. 45.
Medical examiners shall make examination upon the view of the dead 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.
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 unre- lated to any form of injury, have died without recent medical at- tendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following 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.
VR-301
200.000. 9-26. NO. 6373
City or Town
Winthrop
1
2FULL NAME
Zigmond J. Warzinski,
(a) Residence. No.
274 Broad St.
(Usual place of abode)
3 SEX
4 COLOR OR RACE
White
Male
5a If married, widowed or divorced
HUSBAND of
(or) WIFE of
Single.
6 AGE
Years
Months
21
?
Days
?
IF STILLBORN, enter that fact here
7 OCCUPATION OF DECEASED
(a) Trade, profession, or
particular kind of work
Soldier
8 BIRTHPLACE (City)
Northampton,
9 NAME OF
FATHER
Henry Warzinski.
10 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland.
12 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Poland.
13
Informant
Military Records.
(Address)
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.
14
Filed
N. B .- WRITE PLAINLY, WITH UNFADING BLAGA INA-THIS IS A PERMANENT RECORD. Every tiem of Information Should be carefully sup-
(b) Name of employer
U.S.Army.
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS 1 PLACE OF DEATH County Suffolk
The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH
State Massachusetts
(City Gr town)
160
St .. _Ward
Fort Bank (If death bceufred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
St.,
Ward,
New Britain, Conn.
(If non-resident give city or town and state)
Length of residence in city or town where death occurred
0
years O
months
6
days.
How long in U. S., if of foreign birth?
years
months
days.
MEDICAL CERTIFICATE OF DEATH
15 DATE OF DEATH
September
30
1928
.(Month)
(Day)
(Year)
16
28
| HEREBY CERTIFY , That i attended deceased from
September 25, 1928 September 30,
19
that I last saw h
im
September 30,
28.
alive on.
19
and that death occurred, on the date stated above, at
5. 45
P.M
The CAUSE OF DEATH was as follows: (State fully) Septic sore throat, acute, streptococcus, haemolytious.
(duration).
0
.yrs.
0
mos ..
ds.
6
CONTRIBUTORY
Pneumonia, broncho, streptococcus,
(Secondary)
haemolyticus.
(duration) 0
_yrs.
0 mos.
2
ds.
Did an operation precede death_
no
For what
None.
Date of operation
None.
Was there an autopsy
No.
What test confirmed diagnosis
Clinical laboratory findings.
W. N. R
(Signed)
W. K. Turner, Captain, M.C. USA : M. D.
(Address)
Fort Banks, Winthrop, Mass.
Date
October 1, 1928.
18 PLACE OF BURIAL, CREMATION, OR REMOVAL DATE OF BURIAL 10/2/28
Deer Island, Boston, Mass (Cemetery) (City or town)
John F. @ maly Thanthey
Wm. D. Children ) Health officer
Date cf Issue eof permit
10/1/28 Permit No. 1519
1
(State or country)
Massachusetts.
1 1 MAIDEN NAME
OF MOTHER
Vicenta Golambeska
Det 2/28
(Month) (Day) (Year)
REGISTRAR
20 I HEREBY CERTIFY that a satisfactory stan- dard certificate of death was filed with me BEFORE the burial or transit permit was issued
notified
No
Station Hospital.
Winthrop.
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE, MARRIED, WIDOWED, OR
DIVORCED (write the word)
Single
IF LESS than î d=y, ........ hrs. c ......... min.
1 7 Where was disease contracted
if not at place of death
Framingham, Mass.
REVISED UNITED STATESSTANDARD CERTIFICATE OF DEATH
(Approved by U. S. Census and American Public Health Association)
EXTRACTS
FROM THE LAWS OF THE
COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
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, irre- spective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Com- positor, Architect, Locomotive engineer, Civil engineer, Stationary fire- man, 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) ; (a) Foreman, (b) Automobile factory. The material worked on may form part of the second statement. Never return "Laborer," "Fore- man," "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 household ony (not paid Housekeepers who receive a definite salary), may be entered as House- wife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically 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 occupa- tion 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. Exam- ples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report "Typhoid pneumonia"); Lobar pneu- monia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, 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 intercurrent) 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 symp- tomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" .("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL 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 ."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, menin- gitis, miscarriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
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 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 cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46, G. L., as amended.
L
1
R-303
OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
The Commonwealth of Massachusetts
Medical Examiner's Certificate of Death
(City or town)
(ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)
State
No. Stinker
(If death occurred on @ hospital or institution, give its NAME Instead of street and number)
illiam
881 &1 re Army or Navy of the United States, give rank, organization, etc.) Ward.
(If non-resident, give city or town and state)
Now long in U. S., If of toreign birth?
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