USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1932 > Part 86
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5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
Agnes Hill
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here. --
7
AGE
86
Years
5
Months
O ... Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Wheelwright
9 Industry or business in which
work was done, as silk mill,
Mill
saw mill, bank, etc ..
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation ..
35
this occupation (month and
year)
.June,
1926
12 BIRTHPLACE (City)
Torrell,
(State or country) Nova Scotia
13 NAME OF
FATHER
John Braynion
14 BIRTHPLACE OF
FATHER (City)
Torrell,
(State or country) Nova Scotia
15 MAIDEN NAME
OF MOTHER
Mary Clark
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Torrell,
Nova Scotia.
17
fnformant
Sgt.Harry McTaggart, Son-in-law
(Address)
Ft. Devens, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Wm. D Childrens
(Signature of Agent of Board of Health or other)
Health Officer
Dec/31/32
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
Dec.
30,
1932
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Dec. 21,
19
32 to
Dec . 30,
.32
1 last saw h.
.im alive on
Dec. 30.
19.3.2 .. , death is said
to have occurred on the date stated above, at. 1Q; 15AM The principal cause of death and related causes of importance in order of onset were as follows:
Cato of Onset
Pneumonia, lobar , hypostatic, bilat- eral, severe. Fracture, simple, oblique, prox. 1/3, femur, right,with shortening and deformity, inc.Dec.21,1932, by fall to ... floor., atEt. . Devens ,Mass.
Contribntory canses of importance not related to principal cause: Senility, marked,manifested by physical and mental signs of de- terioration.
Name of operation Suspension & trac Date of .. What test confirmed diagnosis ?. Was there an autopsy? . No .
tion.Dec.21/32
20 Was disease or Jury in any way related to occupation of deserved No If so, specify
(Address)
USA GEORGE HORSFALL Capt., M.C. , M. D. ... Ft.Banks, Mass. Date Dec.309.32.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Ayer Cemetery, Ayer ,lass.
(Cemetery)
(City or town)
DATE OF BURIAL
19 33.
Jan. 2,
22 NAME OF
UNDERTAKER
ADDRESS
Received and filed
19
JAN 3
A TRUE COPY, ATTEST:
(Registrar) 1993
1
St., Surg ..... Ward
(Usual place of abode)
Revised 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 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.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work donc.
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 parti- cular 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, ete.
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 and not a clerk.
Statement of cause of death .- Cause of death means the disease. or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease 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 contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes! of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
I021
Cerebral hemorrhage
.
July 5, 1927
Contributory causes of importance not related to principal cause:
.
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
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 deccased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased, his supposed age, the disease of which he died, defined as required by section onc. where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, 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 satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained carly enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose. shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificatc. If the death certificate contains a recital, as requ red oy 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 transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., as amended.
Medical examiners shall make examination. upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deccased 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 ceme- tery or burial ground in which the interment is made .. .. Chap: 114. Sec. 46, G. L. as amended.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate 'of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia). and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion. but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
.
M R-302
PLACE OF DEATH
Norfolk
(County)
No. neville Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Norfolk
(City or town making return)
Registered No ... 27.3
(If death occurred in a hospital or institution,
.Ward
give its NAME instead of street and number)
2 FULL NAME
Frances Olsen nee Levis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
55 Sunnyside Avenue
.St., ..
... Ward,
inthronMoss
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
16 days.
How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
1
Norfolk
(City or Town)
(Usual place of abode)
3 SEX
Female
4 COLOR OR RACE
hito
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
59
AGE
Years
11
.Months
11
Days
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
OCCUPATION
year)
12 BIRTHPLACE (City)
Boston
13 NAME OF
FATHER
John Lewis
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Portugal
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Portugal
(State or country)
17
Hospital Necores
Informant
(Address)
A TRUE COPY.
tion should be carefully 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.
DATE FILED
Du. 30
50m-2-30. No. 7997-đ
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
(State or country)
ass.
ATTEST:
Gena F. Campbell
(Registfar of city or town where death occurred)
32
19-
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
December 30th, 1952
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
December.
13th 32 to December
50
., 1932
....
I last saw h
alive on
.
to have occurred on the date stated above, at. 9:40
The principal cause of death and related causes of importance in onset were as follows:
If less than 1 day
Hours
Minutes
Carcinoma
But.rue sith
order of Dateofogsct
extensive net stasos to
Liver, lunes and regional
noces
Contributory causes of importance not related to principal cause:
Name of operation
Tone
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)
(Address)
(OS) It.1 Date 11/2/19
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
inthrop
inthro )
(Cemetery)
(City or town)
19
22 NAME OF
Cho s. H. Ronnison
UNDERTAKER
ADDRESS
Winthrop, Fars.
Received and filed
JAN 10 100
19
(Registrar of City or Town where deceased resided)
(If U. S.
War Veteran,
specify WAR)
218
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
arricd
5a If married, widowed, or divorced
HUSBAND of
Cher (Give maiden name of wife in full)
Torremaker
11 Total time (years)
spent in this
occupation
15 MAIDEN NAME
OF MOTHER
runces bimons
DATE OF BURIAL
Jamu rr
čno,
CI eccmber 50 19/0 death is said
DEATH
St.,
.....
M R-302
PLACE OF DEATH
Suffolk
(County)
Mag's TowGeneral Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
St.,
......
Ward {
Boston
219
(City or town making styre 3
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
39 Grovers Ave.
.St., ...
Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
Boston
1
No
Samuel W Culver
2 FULL NAME
(a) Residence. No ..
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
3 SEX
4 COLOR OR RACE
White
Male
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorcedhelen Dennison
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
74
11
23
AGE
Years
Months
Days
8 Trade, profession, or particular
kind of work done, as spinner,
Attorney
sawyer, bookkeeper, etc.
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc
12 BIRTHPLACE (City)
(State or country)
Toledo, Ohio
13 NAME OF
FATHER
Wm. Culver
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Roselle Boree
PARENTS
OCCUPATION
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nashuai, N H
17
Informant
Helen ... Culver
(Address)
Winthrop, Mo68
A TRUE COPY.
: 20pm
tion should be carefully 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.
3
2-30. No. 7997
DATE FILED
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
(State or country)
Colchesterm Conn
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
7
1932
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from May 23, ,19 32 to June 7, 19 ..... 32 I last saw h ... j.m.alive on June ... 7 , 19 32 death is said
to have occurred on the date stated above, 20:26Am. The principal canse of death and related causes of importance in order of onset were as follows:
Dateofonset
Strangulated umbilical hernia
2 wks
Contributory canses of importance not related to principal cause:
Uraemia
4
dys .
Herniotomy-herniorrhophyte
5/23/32
What test confirmed diagnosis?
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
L V Ragsdale
(Signed)
M. D.
(Address)
Boston, Mass.
Date 6/7/
.19 ..
.. 32
21 PLACE OF BURIAL, Greenwood
CREMATION OR REMOVAL
Brooklyn, NY
(Cemetery)
(City or town)
June
1.0.
.. 19 ...
.32
DATE OF BURIAL
22 NAME OF
UNDERTAKER
J & Waterman & Sons
ADDRESS
Boston, Mass
HATTEST: "(Regime of city oproti wieantall occurred) ....... Received and filed JAN 2-5 .... 1933 19
June 10 4
19
32
(write the word)
Married
If less than 1 day Hours Minutes
Own Business
10 Date deceased last worked at
11 Total time (years)
this occupation (month ant une
year)
spent in this 1932 occupation .. 40 yrs .
mos.
days.
How long in U. S., if of foreign birth?
yrs.
(Registrar of City or Town where deceased resided)
Name of operation
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)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
220
Boston
(City or town making return)
Registered No.
5734
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
William Henry
Palmer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
5.7 ... Ocean ... View
St.,
.......
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
74 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
June 24
1932
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
June
,19 .. 32 to ...
.June
24 ...... , 19.3.2 ...
I last saw h ... 1m .. alive on ..... Jume .... 24
19.32 .. , death is said
to have occurred on the date stated above, at. 9.25 ... An.M The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Hypertrophy of prestate
2 ... yrs
Vesicle.calcul1
2 ... yrs
general arterior sclerosis
yrs ·····
Contributery causes of importance not related to principal cause:
pulmonary ... embol.i.(mass.i.v.e.)
.
2 ... mos
Name of operation
litholapaxy
Date of.6. 3./32 ..
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)
LO.Nagsdalo
M. D.
(Address)
Asst Director
Date 6.25.19.32 ...
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross ..
Malden
(Cemetery)
(City or town)
DATE OF BURIAL
June
.2.7
.1932 ...
22 NAME OF
UNDERTAKER
Michael ... J .... Murphy
ADDRESS
329 Bunker Hill -St Chas
Received and filed
FEB 8 1933
19
BATE FILED
June 28
19
32
-50m-2-30. No. 7997-
PARENTS
(State or country) Va
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
-
(State or country)
Chelsea
17 Informant (Address)
Mrs Bacher
Winthrop
A TRUE COPY.
important.
OCCUPATION!
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. carpenter
9 Industry or business in which
work was done, as silk mill
saw mill, bank, etc ..
April
1924 ..
... 15 ... yrs
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
this occupation (month and
year)
12 BIRTHPLACE (City)
Charlestom
(State or country)
13 NAME OF
FATHER
William G Palmer
1
14 BIRTHPLACE OF
FATHER (City)
Richmond
Widow
5a If married, widowed, or divorced HUSBAND of Catherine White (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
If less than 1 day .Hours Minutes
7 AGE 74 Years Months Days
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
3 SEX
M
4 COLOR OR RACE
1
No. Mass ... General ... General ... Hospital.St.,
Ward
(If U. S.
War Veteran,
specify WAR)
(Usual place of abode)
Kegistrar of city or town where death occurred)
(Registrar of City or Town where deceased resided)
RM R-302
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
No. Mass ... General .. Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
221
Boston
(City or town making return)
Registered No. 5690
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Dora
Hazel
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No ....
97 ... Grover Ave
.St., ...
Ward,
Winthrop
(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
W
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
single
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.
7 AGE 60 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.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation.
12 BIRTHPLACE (City)
Cambridge
Mass
William Fazel
14 BIRTHPLACE OF
FATHER (City)
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Holen Harrington
16 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
Mrs G E Hazel
(Registrar of city or town where death occurred)
June
27
19 32
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
24
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That ! attended deceased from
Jun
.2.0.
19 ... 32 to ...... June ..
.. 24
19.32 ..
! last saw h
er alive on
June
24
19 .. 3.2 .. , death is said
to have occurred on the date stated above, at.4.30A.m. The principal cause of death and related causes of importance in order of onset were as follows:
Daleefonsel
thrombosis ... of ... basilar .. artery.
9
Contributory causes of importance not related to principal cause:
left subtemporal craniotomy
Name of operation
Date of.6 /22/32
What test confirmed diagnosis? autopsy
Was there an autopsy ?..... yo
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
H . P. Wood
M. D.
(Address)
Asst ... irector
Date 6/24 . 19.32 ...
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
(City or town)
DATE OF BURIAL
June
26
19 32 ..
22 NAME OF
97 Grover Av Winthrop UNDERTAKER G.F .... McKenna ... Son
ADDRESS
407 Medford St.
Received and filed
FEB à 1000
19
"Registrar of City or Town where deceased resided)
MARCIN REDERYSY FOR ONLINE
1 2 FULL NAME 3 SEX Fem (or) WIFE of OCCUPATION| 13 NAME OF FATHER PARENTS 17 Informant (Address) A TRUE COPY. ATTEST: tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE important. DATE FILED 50m-2-'30. No. 7097- 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 (State or country)
.St.,
Ward
(If U. S. War Veteran,
specify WAR)
(If nonresident, give city or town and state)
1932
Calvary Boston
-22
STANDARD CERTIFICATE OF DEATH
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County
State
Registered No.
Township
araf
affeeloo village
City
No. St.,
Ward
Li death occurred in a hospi est or institution, give its NAME instead of street and number)
Length of residence In city or town where death occurred 2- mos. ds. How long In U. S. If of foreign birth? yrs. . . mos. ds.
2. FULL NAME March, Mellie @thel
(a) Residence: No.
St.,
Ward.
Winthrop Mas.
(If nonresident give city or town and State)
(Ueual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
3. SEX
4. COLOR OR RACE |5. SINGLE, MARRIED. WIDOWED.
OR DIVORCED (write the word)
0
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6. DATE OF BIRTH (month, day, and wear) . 251887
7. AGE
45
Years
Months
3
Days
If LESS than 1 day, _____ hrs. or ___._ mln.
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 teacher
10. Date deceased last worked at
this occupation (month and
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