Town of Winthrop : Record of Deaths 1931, Part 41

Author: Winthrop (Mass.)
Publication date: 1931
Publisher:
Number of Pages: 540


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 41


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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