Town of Winthrop : Record of Deaths 1928-1930, Part 56

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 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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