USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1931 > Part 88
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(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
mos.
days. How long in U. S., if of foreign birth?
Jrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
pame pogin full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
40
AGE
Years
1
Months
Days
15
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. .
Housewife
9 Industry or business in which work was done, as rilk mill, saw mill, bank, etc. At ..... Home
10 Date deceased last worked at
11 Total time (years)
spent in this
this occupation (month and year) June 1931 occupation.
12 BIRTHPLACE (City) (State or country) E Boston, Mass,
PARENTS
(State or country)
15 MAIDEN NAME
OF MOTHER
Nellie Ordway
16 BIRTHPLACE OF MOTHER (City) (State or country)
Exeter, NH
17 G E Leet
Informant
(Address)
Winthrop, Mass.
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED Oct. 15, 1931
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
12,
1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from June 2, 1931 .,19. October 12, 1031
I last saw h. .... @live on.
uct.
.9 .............. , 93.1 death is said
to have occurred on the date stated above, atL .: 3.0.Am. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonss!
Pulmonary tuberculosis
June ....... 30
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)
A G Brailey
M. D.
(Address)
Boston, Mass ..
Date 10/1219 31
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
(Cemetery)ct. (Iyor town) 31 19
22 NAME OF
UNDERTAKER
C A Rollins
ADDRESS
E Boston, Mass.
Received and filed
JAN2 .362
19
Registrat of Citrus Towhere de formare
important.
50m-2-'30. No. 7997-đ
No.
(City or Town) 198 Pilgrim Road-Channing ~Home t.,
Ward {
Sadie B. Leet
(If U. S.
War Veteran,
specify WAR)
230
Female
(write the word)
13 NAME OF
FATHER
George I. Prior
14 BIRTHPLACE OF FATHER (City) Abington, Mass.
- Dadie 13. feel Oct. 12, 1 903/
RM R-302
Suffolk
(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
8882
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Mantague Muncey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
16 Egelton Park
St.,
Ward,
Winthrop, Mass.
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred
JTs.
Dos.
days. How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Mary E Dean
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 54 Years Months Days
If less than 1 day
.Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Garage Owner
OCCUPATION
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Garage
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation .. 25. yrs
this occupation (month and
year'
9/22/31
12 BIRTHPLACE (City). (State or country)
Boston, Mass.
13 NAME OF
FATHER
Montague Muncey
14 BIRTHPLACE OF
FATHER (City) Nova Scotia
(State or country)
15 MAIDEN NAME
OF MOTHER
Ann Quinn
16 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
17 M E Muncey
Informant
(Address)
Winthrop, Mass.
A TRUE COPY.
ATTEST-Games
J. Muchas
0
(Registrar bi city or town where death occurred)
Oct. 23, 1931
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Q.c.t ... 18., @931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from Sept. .24 1931 .... , to ..... c.t .. 18. 19319
I last saw him .... alive on ...
Oct ....... 18,
183.1 .... , death is said
to have occurred on the date stated above, at9:45A ... m. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonsat
Arteriosclerotic. heartdisease
10
.. yra.
Contributory causes of importance not related to principal cause:
Cardiac decompensation
3 ... wks ..
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)
S .... Sidell
M. D.
(Address)
Boston, Mass.
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Holy Cross
(Cemetery)
Malden
DATE OF BURIAL
Oct.
21.
19 31
22 NAME OF
UNDERTAKER
J F Linehan
ADDRESS
Boston, Mass.
Received and filed
Jan 2
19
32
(Registrar of City or Town where deceased resided)
important.
50m-2-'30. No. 7997-đ
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
1
(City or Town)
No. Boston City Hospital
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
231
Male
(write the word)
PARENTS
Hantsque Muncey Och. 18, 1931
RM R-302
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
Boston
(City or town making return)
9083
Registered No.
(If death occurred in a hospital or institution, S
give its NAME instead of street and number)
2 FULL NAME
Maude A. Botsford
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No
(Usual place of abode)
583 Shirley St.Winthrop
.. St.,.
Ward,
(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
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
Widowed
Oct 26,1931
(Month)
(Day)
(Year)
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 59
AGE
Years
4
Months
Days
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Housework
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Own Home
10 Date deceased last worked at
this occupation (month and
year)
Sept 1933 Total time (yearsgo
Bos ton
12 BIRTHPLACE (City)
(State or country)
13 NAME OF FATHER Poore
PARENTS
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Informant (Address)
Harry G. Botsford
583 Shirley St.
A TRUE COPY.
ATTEST :..
(Registrar of city or town where death occurred)
DATE FILED Oct 29,1931
19
19 I HEREBY CERTIFY, That I attended deceased from
Oct 1
19
31
to
Oct 26
19
31
l last saw h ... Or .... alive on
Oct .25.
1931
death is said
to have occurred on the date stated above, at 12.10AM
The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Abdominal carcinomatosis
Primary in ovary Sept 1930
Contributory causes of importance not related to principal cause:
Name of operation
Removal of ovary
Date of
May 1931
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 Edward F.Bland
(Signed)
M.D.
(Address)
25 Binney St.
Date 10-27 .19
31
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Forest Hills Crematory
Cemetery) Oct 29.1931
(City or town) 19
DATE OF BURIAL
22 NAME OF
UNDERTAKER
J.S.Waterman & Sons
ADDRESS
Bos ton Mass
Received and filed 19
(Registrar of City or Town where deceased resided)
important.
50m-2-'30. No. 7997-d
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
1
PLACE OF DEATH
(County)
Boston
CERTIFICATE OF DEATH
(City or Town)
No.
House of the Good Samaritan
Ward
(If U. S.
War Veteran,
specify WAR)
237
(write the word)
Harry G. Botsford
spent in this occupation
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Mande G. Botsford Cach. 26, 1931
STANDARD CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County
Humberland State
MAINE
Registered No.
Township
2
Par pawell as Village
City
No.
Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Length of residence in city or town where death occurred@yrs. mos. ds. How long in U. S. If of foreign birth? -yrs. mos. . ds.
2. FULL NAME Chases
(a) Residence: No.
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
3. SEX
4. COLOR OR RACE |5. SINGLE, MARRIED, WIDOWED.
OR DIVORCED (writ the word)
r
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6. DATE OF BIRTH (month, day, and year) Mar. 6 1865
7. AG
66
Years
Months
7
Days
22
If LESS than
1 day, _____ hrs.
or _____ min.
OCCUPATION
8. Trade, profession, or particular kind of work done, as somner. sawyer, bookkeeper, de ..... 2
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 or town)
(State or country)
13. NAME
14. BIRTHPLACE (ity of town) Da
(State or country)
15. MAIDEN NAME
16. BIRTHPLACE (city or town).
(State or country)
Cengland
17. INFORMANT
(Address)
18. BURIAL, CREMATION, OR REMOVAL
Place
Date
19
19. UNDERTAKER.
(Address)
20. FILED 19
DEC 1 7 1931 Registrar.
MEDICAL CERTIFICATE OF DEATH
21. DATE OF DEATH (month, day, and year) lat. 28.1931.
22.
I HEREBY CERTIFY, That I attended deceased from
19_
., to
19.
I last saw h ______ allve on 19
; death Is said
to have occurred on the date stated above, at m
The principal cause of death and related causes of Importance
were as follows:
Chronic intersticial
Dencial
nephritis.
al he
Name of operation
221-20
Date of
What test confirmed diagnosis?
Was there an autopsy1
23. If death was due to external causes (violence) fill In also the following:
Accident, suicide, or homicide?
Date of injury.
19
Where did injury occur?
(Specify city or town, county, and State)
Specify whether In Jury occurred In industry, In home, or in public place.
Manner of Injury Nature of injury
24. Was disease or Injury In any way related to occupation of deceased?
If so, specify
(Signed) Carte Richards00)
(Address)
c11-3184
233
or
St.
St.
Ward.
) Winthropmass
(If nonresident give city or town and State)
OCCUPATION is very important. See instructions on back of certificate. state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every Item of FATHER
MOTHER
UNITED STATES STANDARD CERTIFICATE OF DEATH
Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housewife in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as servant-private family, cook-hotel, etc. For a person who had no occupation whatever write none. To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the particular kind of work done and return that, as spinner, weaver, etc.
In stating the industry or business, avoid the use of such general terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic," but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman
Statement of cause of death .- Cause of death means the disease, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under other contributory causes of importance, name other important diseases or injuries. Examples:
Example I
Example II
The principal cause of death and related causes of importance were as follows:
Date of enset
The principal cause of death and related causes of importance were as follows:
Date of onset
Arteriosclerosis
1915
Attack of epilepsy
1 week ago
Chronic interstitial nephritis
1921
Run over by street car
1 week ago
Cerebral hemorrhage
July 5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1923
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
L. S. GOVERNMENT PRINTING OFFICE: 1030
c11-3184
Cach 28, 1931
Gamma Chase.
and not a clerk.
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
important.
50m-2-'30. No. 7997-d
A TRUE COPY;
ATTEST:
(Registrar of city or town where death occurred) Nov. 6, 1931
DATE FILED
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Nov.3,1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Nov. 2,1931
19
Nov.3.1931
19
.. , to
31
19.
death is said
to have occurred on the date stated above, at.
1.00AM
The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Promaturity
Contributory causes of importance not related to principal cause:
1
Name of operation
What test confirmed diagnosis?
Date of
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
C. A. Powell
M.
(Address)
Mass.Memorial Hosptaba
11-3-
19
22 PLACE OF BURIAL,
Holy Cross-Malden
CREMATION OR REMOVAL
(Cemetery)
(City or towa)
DATE OF BURIAL
Nov.5.1931
19
22 NAME OF
UNDERTAKER
David J. Dooley
ADDRESS
135 London St. Bos ton
JAN 1 1 1932
Received and filed
19
(Registrar of City or Town where deceased resided)
1
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Boston 234-
(City or town making return)
9327
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
SS
Baby Glarrett
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
401 Pleasant St. Winthrop
(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.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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
3
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
Boston
12 BIRTHPLACE (City)
(State or country)
13 NAME OF FATHER Arthur Glarrett
SS
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country)
East Boston
15 MAIDEN NAME
OF MOTHER
Margaret O'Shea
16 BIRTHPLACE OF MOTHER (City) (State or country)
Newfoundland
17 Informant (Address)
Father
PLACE OF DEATH
Suffolk (County)
No. Mass. Memorial Hospitals
St.,
Ward
(If U. S. War Veteran,
specify WAR)
St.,.
....
Ward,
(If nonresident, give city or town and state)
1
1
€
I last saw h er .alive on Nov. 5
Claseatt
RM R-302
Suffolk
(County)
Bos ton
(City or Town)
No. Forest Hills Hospitals
St.,
..... Ward
Boston
(City or town making return)
Registered No.
9463
(If death occurred in a hospital or institution, give its NAME instead of street and number)
235
2 FULL NAME
--- Goldberg
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
50 Trydent Ave. Winthrop
.St.,.
..........
Ward,
(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
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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
2
Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ... --
OCCUPATION
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation.
this occupation (month and
year) ..
12 BIRTHPLACE (City)
Bo ston
(State or country)
13 NAME OF
FATHER
George Goldberg
14 BIRTHPLACE OF
FATHER (City)
Bos ton
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Bramson
16 BIRTHPLACE OF MOTHER (City) (State or country)
New York N. York
Informant
(Address)
17
George Goldberg
Winthrop Mass
A TRUE COPY.
ATTEST:
(Registrar of cityzor town where death occurred)
DATE FILED
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Nov.8 1931
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Nov.7
19.31
19
to
Nov.8
31
I last saw h.
imalive on
Nov ... 8
1931
death is said
to have occurred on the date stated above, at. 9 P m.
The principal cause of death and related causes of importance in order of Dataofonset onset were as follows: Double congenital atelectasia
-
1
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis?
Date of
Yes
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Benjamin Parvey
(Signed)
636 Beacon St.
11-10
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mt. Lebanon B. L.
(Cemetery)
DATE OF BURIAL
Nov. 10, 1931
(City or town)
19
22 NAME OF
UNDERTAKER
Jacob H. Levine
ADDRESS
57 Fowler St. Dorchester
JAN II
Received and filed
19
(Registrar of City or Town where deceased resided)
important.
50m-2-'30. No. 7997-d
PLACE OF DEATH
1
...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE 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
PARENTS
Was there an autopsy?
M.D.
31
(Address)
Nov. 13, 1931
(If U. S.
War Veteran,
specify WAR)
(Laley) Jacober
OCCUPATION! 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 100m-9-'30. No. 9954. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
PLACE OF DEATH
Suffolve
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
236
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Archibald Simpson W: Oarchy!
(If deceased is a married, widowed or divorced woman, give also maiden name.)
57/lead
(a)
Residence.
St., ..........
(If nonresident, give city or town and state)
Ward,
No
(Usual place of abode)
Length of residence in city or town where death occurred & 3 yrs .-
days.
How long in U. S., if of foreign birth? 5 yrs.
5
mos.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Married
5a If married, widowed, or divorced HUSBAND of
Elizabeth Murphy
(Give maiden pame of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE
7 65 . Years - Months Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ..
En meer
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Bor. Buwere Peach wynn B. P.
11 Total time (years)
10 Date deceased last worked at this occupation (month and year)
Nov. 1928 spent in this 35
occupation
12 BIRTHPLACE (City)
St. John
(State or country) N. B.
13 NAME OF
FATHER
vimolly M: Earthy
14 BIRTHPLACE OF
FATHER (City)
ximenich
Ireland
15 MAIDEN NAME
OF MOTHER
Mary De Forest
GO. POUR
16 BIRTHPLACE OF MOTHER (City) (State or country) Sheland
17 my Francia A. Martin
Informant .. (Address) K3 Bellevue Ave. W.in.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. xpress & (Signature of Agent of Board of Health or other)
Health Gaiter (Official Designation) UV
12/2/31
(Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Des
(Month)
(Day)
1931 (Year)
19
I HEREBY CERTIFY, That I attended deceased from
1926, to
12/1
193 /
[ last saw h.An ...... alive on 11/30 19.2 .. . / ... , death is said to have occurred on the date stated above, at 9:15 am. The principal cause of death and related causes of importance in order of onset were as follows: Chimi utentitid naplanta
Date of Onset 1926 1931
1926 f
What test confirmed diagnosis ?.
Charla Tel Was there an autopsy? 20
20 Was disease or injury in any way related to occupation of deceased? 200
If so, specify.
(Signed)
(Address) 270 Commonntett Twee
Date
12/1 1931
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Italy Goss Mulden
(Cemetery)
December
- (City of town) 19:51 1
22 NAME OF
UNDERTAKER
m. T. Texty
ADDRESS
11 Mendiant, 8.10
Received and filed
DEC 1
193(Registrar ) 19
1
1
1
1
Contributory causes of importance not. related to principal cause: Hypertension
Name of operation.
L
Date of
1
No.
XCounty) Winthrop (City or Town) 57 Read St., Ward
5
(If U. S. War Veteran, specify WAR)
-
DATE OF BURIAL
., M. D.
(State or country)
RM R-301A
Mer Carthy
Revised United States Standard Certificate of Death Dev. 1, 1931
Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.
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