USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 41
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19
I last saw h
ilive on
4/4/31
19
death is said
to have occurred on the date stated above, at ....:. 00.a.m. The principal cause of death and related causes of importance in order of onset were as follows:
Datesfonset
Acute pancreatitis 3/25/31
Contributory causes of importance not related to principal cause: Acute cholelithiasis
4 yrs
Chronic cholecistitis
4 ... yr.s
Cholangitis, .chr ..... myocarditis
Name of operation Cholecystotomy
Date of .4/3/31.
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)
T E Brown
M. D.
(Address)
St Eliz Hosp
Date
4/4/379
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross
Malden
(City or town)
DATE OF BURIAL
(Cemetery)
4/7/31
19
22 NAME OF
UNDERTAKER
J F O' Maley
ADDRESS
Winthrop
Received and filed 4/7/31
Samo J. Mulvey.
A TRUE COPY, ATTEST:
(Registrar)
1
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston (City or town making return) Registered No. 3251
No. St Elizabeth's ... Hospital St.,
Ward {
give its NAME instead of street and number)
Joseph T Kelley
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
236 Lincoln
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?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX M
4 COLOR OR RACE
N
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorcedElizabeth Enois
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
57
7 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 ....
master plumber
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. own business
10 Date deceased last worked at
this occupation (month and
year)
3/17/31
11 Total time (years)
spent in this
occupation .. 40
12 BIRTHPLACE (City)
(State or country)
Bo ston
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Hannah Meehan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
50M-11-'29. No. 7180-b
(If death occurred in a hospital or institution,
(If U. S.
War Veteran,
102
specify WAR)
(a)
Residence. No.
(Usual place of abode)
18 DATE OF
April 4 1931
13 NAME OF
FATHER
John Kelly
٢
арч. 4, 193) 1
RM R-302
Suffo lk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston (City or town making return)
Registered No .... 3339
(If death occurred in a hospital or institution,
Ward
give its NAME instead of street and number)
2 FULL NAME
Eleanor ... Janes ... Bresee
(If deceased is a married, widowed or divorced woman, give also maiden name.)
37 Siren
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 TEX
4 COLOR OR RACE
5 SINGLE
MARRIED
Married
(write the word)
WIDOWED
or DIVORCED
18 DATE OF
DEATH
April6 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That ! attended deceased from
3/10/31
19
4/6/31
19
.. , to ...
I last saw her .. ... alive on.
4/6 31
19
., death is said
to have occurred on the date stated above, at
6 :a
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
Rt ovarian cyst (6" x 6" ¥ 6")
6 mos
Acute dilatation of heart
6 hrs
Contributory causes of importance not related to principal cause:
? Chronic myocarditis
Name of operationT ovariotomy
Date of3/31/31
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)
LRG Crandon
(Address) .366 Comm .... Ave
M. D.
Date
4.6/391
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mit Hope
Boston
(Cemetery)
4/9/31
(City or town)
DATE OF BURIAL
19
22 NAME OF
UNDERTAKER
R & EF Gleason
ADDRESS
Boston
Received and filed 5- 4/9/37 19
(Official Designation)
(Date of Issue of Permit)
one 24, 19.31
MEDICAL CERTIFICATE OF DEATH
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Giye maiden name of wife in full)
Karl Bresee
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
34
Years
Months 24 Days
If less than 1 day Hours. .. Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .. at home
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)
(State or country) Somerville
13 NAME OF
FATHER
John M Sutherland
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country Scotland
15 MAIDEN NAME
OF MOTHER
Lillian V Edgings
16 BIRTHPLACE OF MOTHER (City) (State or country)- N Y
17 Informant (Address)
husband
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
50M-11-'29. No. 7180-b
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
PLACE OF DEATH
(County)
1
Boston
(City or Town)
No. Bay State Hospital
St.,
103
(If U. S.
War Veteran,
specify WAR)
(a)
Residence. No.
(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?
yTs.
MARGIN RESERVED FOR DINVING
important.
AEC
(Signature of Agent of Board of Health or other)
4/7/37
A TRUE COPY, ATTEST:
(Registrar)
RM R-302
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
boston ... (City or town making return)
Registered No.
4357
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
104
2 FULL NAME
- Belson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
52 Wave Way Ave
.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?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE Years Months 1 Days
If less than 1 day Hours .Minutes
OCCUPATION
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)
(State or country)
Chelsea
13 NAME OF
FATHER
Benjamin Belson
14 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
15 MAIDEN NAME
OF MOTHER
Blanche Landy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant
father
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: NEC
(Signature of Agent of Board of Health or other)
5/7/37
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 6 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
5/5/31
,19
to
5/6/37
19
I last saw h .... imalive on
5/6/1
19
death is said
to have occurred on the date stated above, at.
6:50pm
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Prematurity.
5/5/31
Contributory causes of importance not related to principal cause:
Date of
Name of operation
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)
J F Binns
M. D.
(Address)
Infant's Hosp Date 5/6/31 19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Beth Joseph
Woburn
DATE OF BURIAL
(Cemetery)
1/8/31
(City or town)
19
22 NAME OF
UNDERTAKER
M Stanetsky
ADDRESS
Boston
Received and filed
5/9/31
19
A TRUE COPY, ATTESTE
important.
50M-11-'29. No. 7180-b
1
No. The Infant's Hospital
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
(a)
Residence. No.
(Usual place of abode)
(Give maiden name of wife in full)
PARENTS
may 6, 1931
RM R-302
Suffolk
(County) Boston
(City or Town)
No.
Peter Bent Brigham Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston
(City or town making return) 4406
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Charles Patrick McManamin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
57 Crest Ave
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
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Edith A Ford
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE
Years Months Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
Chemist
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Dye work
10 Date deceased last worked at this occupation (month and year) ..
5/7/31
11 Total time (years)
spent in this! O
occupation ..
12 BIRTHPLACE (City)
(State or country)
Boston
13 NAME OF FATHER - Hughes
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME
OF MOTHER
Flynn
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 wife
Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: HEI (Signature of Agent of Board of Health or other) 5/9/31
JUL
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 9 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
5/8/31
5/9/31
19
„, to.
19
{ last saw
h.i.m .... alive on
5/9/31
19
death is said
to have occurred on the date stated above, at
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Coronary thrombosis
dys
Contributory causes of importance not related to principal cause:
Gen arteriosclerosis
.yrs ...
Name of operation
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
(Signed)
C .... L ..... Clay.
, M. D.
(Address)
Peter Bent Brigh. Hosep 5/-/Sol
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holyhood ....... Brookline
(Cemetery)
(City or town)
5/12/31
DATE OF BURIAL
19
22 NAME OF
J F O'Maley
UNDERTAKER
ADDRESS
Winthrop
5/12/31
Received and filed
19
A TRUE COPY, ATTEST:
(Registraf)
OCCUPATION| tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE important. 50M-11-'29. No. 7180-b N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS
1
PLACE OF DEATH
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
165
(write the word)
11:358
may 9, 1931. anamin
RM R-302
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
4806
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(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
yTs.
139 Washington Ave
.St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 17 1931
(Month) (Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
5/17/31
19
to ..
5/17/31
19
I last saw him .... alive on
5/17/31
19.
death is said
to have occurred on the date stated above, at.
8:30pm.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonsat
Premature non viable
5/17/31
Toxemia of pregnancy
5/17/31
Contributory causes of importance not related to principal cause:
Name of operation
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.
(Signed)
J .T. Williams
M. D.
(Address)
429 Beacon St
Date
5/17/9 31
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Woodlawn
Everett
(Cemetery)
(City or town)
DATE OF BURIAL
5/22/31
19
22 NAME OF
UNDERTAKER
R C Kirby
Boston
ADDRESS
Received and filed
5/25/31
.. 19
(Signature of Agent of Boa 2 1931
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY, ATTEST:
(Registrar)
1
PLACE OF DEATH
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
important.
50M-11-'29. No. 7180-b
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Manchester N H
15 MAIDEN NAME
OF MOTHER
Mary Kingston
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Barre Vt
17 Hospt records
Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
CS
(write the word)
3 SEX M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
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 Years Months Days
If less than 1 day
Hours20.
.. Minutes
OCCUPATION
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)
(State or country)
Boston
13 NAME OF
FATHER
Arthur E Boudreau
1
No. Richardson.House Boston Lying-In Hospital - Boudreau
.St.,
Ward
(If U. S. War Veteran, specify WAR)
days. How long in U. S., if of foreign birth? yrs.
mos.
may 17,1931
RM R-302
Suffolk
(County)
Boston (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston (City or town making return)
Registered No ... .4926
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S.
107
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
(Usual place of abode)
58 Cottage Ave
St., .............
Ward,inthrop
(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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 24 1931
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
Charlotte Mountpleasant
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 46 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.
laborer
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) .
general work about boats
11 Total time (years)
spent in this
1/?/31
10
occupation
12 BIRTHPLACE (City) (State or country)
Boston
13 NAME OF
FATHER
James F Purcell
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Louisa Potter
16 BIRTHPLACE OF MOTHER (City) (State or country)
Nova Scotia
17 John T Purcell
Informant
(Address) 961 Broadway Somerville
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: HFR
(Signature of Agent of Board of Health or other) 5/25/31
JUL 1
(Official Designation)
(Date of Issue of Permit)
19 I HEREBY CERTIFY, That I attended deceased from
2/25/31
19
5/24/31
.to
19
I last saw him .... alive on
5/24/31
19
death is said
to have occurred on the date stated above, at.
7:35p
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Subacute bact. endocarditis
Contributory causes of importance not related to principal cause:
...
Broncho pneumonia
days
Name of operation What test confirmed diagnosis? Was there an autopsy? yes
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
C .... I. Clay
M. D.
(Address)
Peter B Brigham HospDate 5/25/31
22 PLACE OF BURIAL, CREMATION OR REMOVAL Holy Cross Malden (Cemetery) (City or town)
DATE OF BURIAL
5/26/31
19
22 NAME OF UNDERTAKER F.A.Magrath
ADDRESS
Boston
Received and filed 5/28/31
(Registrar)
!
3 SEX
4 COLOR OR RACE
W
5 SINGLE
(write the word)
M
MARRIED
WIDOWED
or DIVORCED Widowed
OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE important. 50M-11-'29. No. 7180-b N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- PARENTS
PLACE OF DEATH
1
No.
Peter ... Bent Brigham Hospital ..... St.,
Ward
William F Purcell
specify WAR)
Date of
num M. Incell
may 34, 1931
IM R-302
Suffolk
PLACE OF DEATH
(County)
Boston
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No. 5070
(If death occurred in a hospital or institution, give its NAME instead of street and number) -
2 FULL NAME
Catherine Booth
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No.
(Usual place of abode)
88.Birch .. Rd
St.,
Ward, .. Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yTs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX F
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
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 2 Months Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. stenographer
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ...
office
10 Date deceased last worked at
this occupation (month and
year)
1/193111 Total time (years)
spent in this
occupation
2
12 BIRTHPLACE (City) (State or country) Lawrence
PARENTS
14 BIRTHPLACE OF FATHER (City) Scotland
(State or country)
15 MAIDEN NAME OF MOTHER Christina H Rennie
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
17 Informant (Address)
father
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: HFR
(Signature of Agent of Board of Health or other) 5/31/31 JÜLY
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 29 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
5/15/31
.19
I last saw h ..... er .. alive on
5/29/31
19
death is said
to have occurred on the date stated above, at ... 1.1 ... p ... m. The principal cause of death and related causes of importance in order of onset were as follows:
Datosfonset
Rheumatic heart disease
(mitral insufficiency)
mo s
Contributory causes of importance not related to principal cause:
„Adhesive ... pericarditis
mos
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy? .. yes
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed) CL. Clay Peter B Brigham Hosp 5/30/31
(Address)
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Bellevue ..... Lawrence
(City or town)
DATE OF BURIAL
(Cemetery)
6/2/31
19
22 NAME OF
C A Rollins
Received and filed 6/2 /31
19
A TRUE COPY, ATTEST:
(Registrar)¿
1
(City or Town)
No.
Peter Bent Brigham Hospital
St.,
Ward 1
f U. S. War Veteran,
108
193
ADDRESS
Boston
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE important. 50M-11-'29. No. 7180-b N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION
13 NAME OF FATHER Thomas Booth
(write the word)
to
5/29/3
May 29, 1931
M R-303 B
Suffolk. County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
18,22: 3
To be filed for burial permit with Board of Health or its Agent. Registered No .. 108
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(H U. S. War Veteran, specify WAR)
.Ward,
(If nonresident give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
OF DIVORCED
(write the word)
Jingle
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years 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 ....
Steen filler
Nechen
10 Date deceased last worked This occupation (month and en af Total time (years) year) ......
spent in this occupation.
Cambridge
(State or country) -
13 NAME OF
George W. Stewart
Chink
(State or country) / Maini
15 MAIDEN NAME
OF MOTHER
Cucina. & armstrong
16 BIRTHPLACE OF MOTHER (City) (State or country) Gabe Brilian
17 Conclui Le Devant
Informant (Address, 39 Fui View that
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D . Culdress 1
(Signature of Agent of Board of Health or other)
He alte Officer (Official Designation) (Date of Issue of Permit)
6/9/31
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Ana
30121 1931
(Month)
(Day)
(Year)
19 I 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.) Drowning, Suicidal
den tidenata, heavily wayhotel
1
1
(See reverse side for description for unknown person)
20 IN WHAT CITY OR TOWN WAS INJURY SUSTAINED?
M. D.
(Signed)Z.
até
.19
21 PLACE OF BURIAL. CREMATION OR REMOVAL
(Cemetery) Fini 8/31 19
DATE OF BURIAL
22 NAME OF
UNDERTAKER
ADDRESS
Received and filed.
JUN 10 1937|
19
(Registrar)
1 2 FULL NAME. 3 SEX Male (or) WIFE of 7 AGE OCCUPATION FATHER 14 BIRTHPLACE OF FATHER (City) PARENTS of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 12 BIRTHPLACE (City) 5m-2-'30. No. 7997-c
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