Town of Winthrop : Record of Deaths 1928-1930, Part 99

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 99


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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 cemetery or burial ground in which the interment is made .- Chap. 114, Sec. 46, G. L., as amended.


-


FORM R-301


DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts


Winthrop BOSTON


1 PLACE OF DEATH


Suffolk


State Massachusetts


Registered No.


City or Town


Boston Winthrop


No Winthrop Commuter


(If death occurred in a hospital or institution, give its NAME instead of street and number)


Baby Moldoff


(a) Residence.


No.


487 Beach


(Usual place of abode)


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


4 COLOR OR RACE White


5 SINGLE, MARRIED, WIDOWED, or DIVORCED (write the word) Single


5a If married, widowed, or divorced HUSBAND of (or) WIFE of


Months


Days


IF LESS than 1 day ......... hrs. or .......... min.


IF STILLBORN, enter that fact here Stilllow


7 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work


Winthrop, les


Phillip Moldoff


10 BIRTHPLACE OF FATHER (City) Russia


11 MAIDEN NAME OF MOTHER Sadie Jevinsky


200M 7-'28 No. 2787-c


13 Phillip Woldoff 487 Beach HE. Revers 20


Filed (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


12 1921


( Month) (Day)


(Year}


16 I HEREBY CERTIFY, That I attended deceased from


12


19 29


, to


19 27


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) Still Dr


(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 For what


Date of operation


Was there an autopsy. If under one year, was infant Breast Fed?


What test confirmed diagnosis


(Signed)


M. D.


(Address)


Date


18 PLACE OF BURIAL, CREMATION, OR REMOVAL Workmens Circle Cen


(Cemetery)


(City or toiva)


June 13 1929


19 UNDERTAKER Manuel Staneteles


ADDRESS Boston


20 I HEREBY CERTIFY that a satisfactory stand- ard certificate of death was filed with me BEFORE the burial or transit permit was issued


Official position


/ Vealthe Officer.


Date of issue 6/13/20 Per : 16.00


20-20A1.


County 2 FULL NAME 3 SEX male 6 AGE Years 8 BIRTHPLACE (City) (State or country) 9 NAME OF FATHER 12 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) Informant (Address) 14 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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 (State or country) N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of (b) Name of employer


STANDARD CERTIFICATE OF DEATH


(City or town)


93


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


St., .Ward,


(If non-resident, give city or town and state)


9.8.


X


DATE OF BURIAL


m.


1


محـ


12.192 1


Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)


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, Civil engineer, Stationary fireman, etc. But in many cases, es- pecially 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 ex- amples : (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 re- turn "Laborer," "Foreman," "Manager," "Dealer," etc., with- out 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 Housewife, House- work, 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 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 Caus- ing Death (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples : Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis") ; Diphtheria (avoid use of "Croup") ; Typhoid fever (never report "Typhoid pneumonia") ; Lobar pneumonia; Bronchopneumonia ("Pneu- monia," 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 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 "Asthe- nia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "'Coma,' "Convulsions," "Debility" ("Congenital," "Senile." etc. ), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," n "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 peri- tonitis," etc.


State cause for which surgical operation was undertaken.


(Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Associa- tion. )


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.


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 de- ceased, 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 dura- tion 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 ex- hume 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 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 suffi- cient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a mem- ber of the board of health, or employed by it or by the select- men for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by vio- lence, 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 trans- mit 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 common- wealth 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.


I R-303


OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts


MEDICAL EXAMINER'S CERTIFICATE OF DEATH (ISSUED UNDER THE PROVISIONS OF GENERAL LAWS, CHAPTER 38)


(City or town)


State ..


Registered No.


St.,


Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


Bruce Mus Amaid


(If in the Army or Navy of the United States, give rank, organization, etc.)


(a) Residence.


No. 259


Shirley.


(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)


Finknown


5a If married, widowed, or divorced HUSBAND of (or) WIFE of


6 AGE Years


1


Months


Days


If LESS than 1 day. ....... hrs. or ........ min.


If STILLBORN, enter that fact bere


7 OCCUPATION OF DECEASED {a) Trade, profession, or particular kind of work


(b) Name of employer


Inknown


8 BIRTHPLACE (City)


(State or country)


@inter.un


9 NAME OF


FATHER


. ----


PARENTS


11 MAIDEN NAME


OF MOTHER


12 BIRTHPLACE OF MOTHER (City) (State or country)


Medical Examiner for


Date


(Month)


(Day)


( fear)


18 PLACE OF BURIAL, CREMATION, or REMOVAL


(Address)


aurons it


14 21,00


Filed


(Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH.


(Month)


(Day)


19.14


(Year)


16 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows:


(See reverse side for description for unknown person)


17 Where was injury sustained


if not at place of death?


winthing


(Signed)


., M.D.


(Address)


18


1939


DATE OF BURIAL


18/29 29


Monthi (Day) ( Year)


(Cemetery)


(City or town)


ADDRESS


19 UNDERTAKER 4 vous


20 Burial permit issued by


Official position


21 Date of


issue.


Permit No.


N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information for extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,


1 PLACE OF DEATH


County


Winship


City or Town


No.


269 Show St.


143


St.,


Ward.


( If non-resident give city or town and State)


14


58


10 BIRTHPLACE OF FATHER (City) (State or country)


13 Informant .


EXTRACTS


FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an 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 so that it can be classified under the inter- national classification of causes of death), 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. . . . - General Laws, Chapter 46, Section 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 containing the facts required by law to be returned and recorded, which shall be accompanied . . . by a satis- factory certificate of the attending physician, if any, as re- quired 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 phy- sician who is a member of the board of health, or em- ployed 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 regis- tration 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. - General 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. If a medical examiner has notice that there is within his county the body of such a person, he


shall forthwith go to the place where the body lies and take charge of the same. . . . Gen. Laws, Chap. 38, Sec. 6.


. . . He shall in all casos certify to the town clerk or regis- trar in the place where the deceased died his name and resi- dence, if known; otherwise a description as full as may be, with the cause and manner of death. - General 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 discase 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 discase unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths 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 in- jury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


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 example: "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, homi- cidal." " Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."


If investigation shows the death to have been due to dis- ease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"


DESCRIPTION (for unknown person)


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, Sect. 14.


THIS CERTIFICATE CONSTITUTES SUCH PERMIT


June 14. 1929.


tice yac oual of


02


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


Boston


1 PLACE OF DEATH


County


Suffolk


State


Registered No.


(Place of residence)


St.,


Ward


(If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


LUIGI MADONA


(If in the Army or Nayy of the United States, give rank, organization, etc.)


No.


30 SEAFOAM 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


M.


4 COLOR OR RACE


5 SINGLE, MARRIED, WIDOWED, OR


DIVORCED (uite the word)


M.


5n If married, widowed, or divorced


S HUSBAND


Name of ? (or) WIFE


FILOMENA CICCARELLI


6 AGE


Years


37


Months


2


Days


If LESS than 1 day, ... brs. or .... min.


If STILLBORN, enter that fact here


7 OCCUPATION OF DECEASED


(a) Trade, profession, or


particular kind of work


LABORER


(b) Name of employer


8 BIRTHPLACE (city or town)


(State or country)


ITALY


9 NAME OF


FATHER


FILIPPO MADONA


PARENTS


10 BIRTHPLACE OF


FATHER (city or town)


(State or country)


ITALY


11 MAIDEN NAME


OF MOTHER


ROSARIA MAIENZO


12 BIRTHPLACE OF


MOTHER (city or town).


(State or country)


ITALY


13


Informant


GIUSEPPI MADONA


(Address)


F. BOSTON


14


Filed


JUNE 28, 1929 ENUMSlenen


Filed


,19


Registrar of city or town where death occurred


Registrar of city or town where deceased resided


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


JUN 15, 1929


(Month) (Day)


(Year)


16


I HEREBY CERTIFY,


That I attended deceased from


JUN 13


19


29 to.


JUN 15


.1.29


that I last saw h


IM alive on


JUN 15


29


19


7 A


and that death occurred, on the date stated above, at.


The CAUSE OF DEATH was as follows:


(State fully)


PERFORATED PYLORIC ULCER


(duration)


yrs ..


mos.


.ds.


CONTRIBUTORY


(SECONDARY)


(duration)


yrs.


mos.


17 Where was disease contracted


if not at place of death


Did an operation precede death


YES


For what


ABOVE


Date of operation


6-13-29


Was there an autopsy


What test confirmed diagnosis


(Signed)


H. A. KELLEY


(Address)


Date


JUN 15, 1929 /


18 PLACE OF BURIAL, CREMATION, OR REMOVAL ST. MICHAEL. BOSTON (Cemetery) (City or town)


DATE OF BURIAL


6-17


, 19


29


ADDRESS


19 UNDERTAKER


C. D. PIETRO


-No. 4312


fully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important.


(City or town)


Registered No.


6196


(Place of deathy 0


City or town


Boston


No .-


STRONG HOSPITAL


(a) Residence.


State_


MASS


City or Town


WINTHROP


M. D.


GENERAL PERITONITIS


4


June 15. 1929.


FORM R-301


DIVISION OF VITAL STATISTICS


The Commonwealth of Massachusetts STANDARD CERTIFICATE OF DEATH


1 PLACE OF DEATH


County Suffolk


State ...... Tags


Registered No. 05


City or Town winthrop


No .... 18anthropCommunityHospital ...... Ward (If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME Katherine .......... Sullivan


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


(a) Residence.


No ... 88 Brookfield Rd


(Usual place of abode)


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


4 COLOR OR RACE


white


5 SINGLE, MARRIED, WIDOWED,


or DIVORCED (write the word)


Married


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


John R.


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. Housewife


(b) Name of employer


8 BIRTHPLACE (City)


East Boston


Mass


9 NAME OF


FATHER


Walter Cody


10 BIRTHPLACE OF FATHER (City) (State or country) Ireland


11 MAIDEN NAME


OF MOTHER


Elizabeth Scott


12 BIRTHPLACE OF MOTHER (City) (State or country) Ireland


200M 7-'28 No. 2787-c


Filed Twee 11/04 (Month) (Day) (Year)


REGISTRAR


MEDICAL CERTIFICATE OF DEATH


15 DATE OF DEATH


June


17


1929


(Month)


(Day)


( Year)


16 I HEREBY CERTIFY, That I attended deceased from.


June


15


19.


29


., to


June


17


19 29.


that I last saw h.A.


alive on


June


17


, 1929


.


7.30 P.


m.


auch Pancreatitis


(duration)


.yrs.


3


ds.


CONTRIBUTORY


(Secondary)


(duration)


yrs ..


.. mos.


.


ds.


17 Where was disease contracted


if not at place of death


Did an operation precede death yes


For


face drainage .


Date of operation


0 12


1929.


Was there an autopsy


no


What test confirmed diagnosis


Personal Observation.


(Signed)


Raymond B Parker


, M. D.


(Address)


1


Wieting man


Date


June 18


1929.


18 PLACE OF BURIAL, CREMATION, OR REMOVAL


LYNN


St. MARYS


DATE OF BURIAL 6/20/29


(Cemetery)


(City or town )


ADDRESS


29 I HEREBY CERTIFY that a satisfactory stand- ard certificate of death was filed with me BEFORE the burial or transit permit was issued. TX Children Official Healtre Sauces permit


Date of issue


10/17/24 N


Permit 1601


3 SEX Female 6 AGE Years (State or country) PARENTS 13 Informant ( Address) 14 1 1 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state L N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 56


John P. .. Sullivan


88 Brookfield Rd


19 UNDERTAKER


ihn 9 0 maly


(City or town)


St.,


Ward,


(If non-resident, give city or town and state)


-


and that death occurred, on the date stated above, at


The CAUSE OF DEATH was as follows: (State fully)


mos ..


June 17. 1929


Revised United States Standard Certificate of Death (Approved by U. S. Census and American Public Health Ass'n.)


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, Civil engineer, Stationary fireman, etc. But in many cases, es- pecially 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 ex- amples: (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 re- turn "Laborer," "Foreman," "Manager," "Dealer," etc., with- out 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 Housewife, House- work, 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 occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.




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