USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1933 > Part 43
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Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.
.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the 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.
RM R-301
MARGIN RESERVED FUR DINDING
1 3 SEX 4 COLOR OR RACE Female white 5 SINGLE MARRIED WIDOWED or DIVORCED 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 ......... Days 70 AGE ... Years ........ ..... Months 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. (mbat) and this occupation year) May 201933 OCCUPATION (State or country) 14 BIRTHPLACE OF FATHER (City) Ireland (State or country) PARENTS 16 BIRTHPLACE OF MOTHER (City) st John (State or country) nit 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 200M-11-'29. No. 7180-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 12 BIRTHPLACE (City) Cambridge
Suffolk. (County) Southof (City or Town) No 30 Magitle ave St., PLACE OF DEATH Elizabeth R. Ireland 2 FULL NAME
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return ....
Registered No. 106
1 (If death occurred in a hospital or inst!' ution, Ward 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.)
(a)
Residence.
Q30 Mette ave
St.,
Ward,
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth? Lifey's.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
Single
If less than 1 day
Hours
Minutes
House Work at Home.
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
40 years
mass
13 NAME OF
FATHER
Robert W Ireland
15 MAIDEN NAME
OF MOTHER
Letitia Mc Tavish
17 miss minnie Ireland Informant (Address) 30 Myrtle are musthave my
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued: Vi-L- alixares gnature of Agent of Board of Health or other) .-. health Prices
0/22/03
(Official Designation)/
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
21
1433
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
19
to
19
I Jast saw h ........... alive on
19
death is said
to have occurred on the date stated above, at.
7:45 Am.
The principal cause of death and related causes of importance in order of Dateofonset onset were as follows: Natural Causes Probably
1933
Contributory causes of importance not related to principal cause:
Provales
1932
Name of operation
nome.
Date of
What test confirmed diagnosis? kunstyatay
Was there an autopsy? 200
20 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
(Signed)
Payment 3 Pakker
., M. D.
(Address Worthing Brand of thatth
Date May 21 19 3.3.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Mt Walliston
mass
Quincy
DATE OF BURIAL
May 2
22 NAME OF
Lewis Jones Hon hc
UNDERTAKER
ADDRESS
30 La Grange St Boston
Received and filed
32
19
A TRUE COPY, ATTEST:
(Registrar)
(Cemetery)
(City or town)
1933
(Usual place of abode) Length of residence in city or town where death occurred /3 yrs. mos.
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, rook -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 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 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, 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 and not a clerk.
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 contri- butory causes of importance not related to principal cause, name other important diseases or injuries.
Example
The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis
Date of onset
1015
Chronic interstitial nephritis
1921
Cerebral hemorrhage
July 5, 1927
Contributory causes of importance not related to principal cause:
Fracture of arm
Automobile accident
May 3. 1927
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 deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, 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 early 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 certificate. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health or its agent, upon receipt of such state- ment and certificate, shall forthwith countersign it and 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 deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .. . Chap. 114. Sec. 46, G. L., as amended.
State cause for which surgical operation was undertaken.
Bronchopneumonia: If primary cause, write the word "primary"; if secondary, give primary cause.
Certificates will be returned for additional information which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, mis- carriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus.
IM R-302
Suffolk
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Chelsea
107
(City or town making return)
Registered No.
334
(If death occurred in a hospital or institution,
No. Chelsea ... Memorial ... Hosp .. .St.,. ....... Ward give its NAME instead of street and number)
2 FULL NAME
Josephine Johannessen Herland
(If U. S.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
38 Madison av.
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
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 22,19 33
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
Feb.
19 33, May 22
.19 ..
3.3
I last saw her
alive on.
May 22
193.3
death is said
to have occurred on the date stated above, at
4.20 p.m.
The principal cause of death and related causes of importance in order of
onset were as follows:
Myocarditis
1 9 Brefonset
Diabetes
1932
Contributory causes of importance not related to principal cause:
Name of operation
none
What test confirmed diagnosis?
lab. & clin.
Date of
Was there an autopsy?
n
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify,
(Signed)
R.W. Layton
M. D.
(Address)
270 Commonwealth aofte 5/23/9
Boston
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mt.Hope
Boston
DATE OF BURIAL
May 25,1933
(City or town)
19
22 NAME OF
Richard H.White
UNDERTAKER
151 Pleasant st. Winthrop
ADDRESS
Received and filed
JUN 1 0 1933
19
(Registrar of City or Town where deceased resided)
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
1
Chelsea
(City or Town)
(a)
Residence. No
(Usual place of abode)
3 SEX
female
4 COLOR OR RACE
white
5a If married, widowed, or divorced
HUSBAND of
6 IF STILLBORN, enter that fact here.
7
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)
OCCUPATION
12 BIRTHPLACE (City)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Norway
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Norway
Informant
A TRUE COPY.
important.
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
(State or country)
Norway
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
(Give maiden name of wife in full)
(or) WIFE of
Amel Herland
(Husband's name in full)
AGE
55
Years
9
Months
.Days
If less than 1 day
.Hours.
.Minutes
Housewife
at home
Mar.19333 35
al time ( spent in this occupation
Cannot be learned
Cannot be learned
17 ( son) Edwin Agrell Herland
(Address)
38 Madison av. Winthrop
ATTEST: (Registrar of ' tyw Cherath occurred)
DATE FILED
May 24 1933
19
(Cemetery)
33
50m-2-'30. No. 7997-đ
PLACE OF DEATH
-
specify WAR)
M R-302
SUFFOLK
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No. 4772
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Dunham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
95 Fremont St Winthrop St.,
Ward,
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
Ma.y.
.2.3.
1.9.33
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
May
6
19 .... 33to.
.. Ma.y.
.23.
19 .. 3.3.
I last saw h .... im.alive on.
May.
2.3. 19 ... 3.3., death is said to have occurred on the date stated above, at 1 ... A .... m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
auricular .. filbrillation
& acute cardiac decompensation
1.dy
hypertrophied prostate
2yrs
Contributory causes of importance not related to principal cause:
Ist & 2d stage
5/8/33
Name of operation ........ prosteetony What test confirmed diagnosis? Was there an autopsyn.Q.
Date of ....
5/19/33
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
HV Byrne
M. D.
(Address)
BGH
Date
5/23/19 33
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
(Cemetery)
Winthrop.
(City or town)
DATE OF BURIAL
May ...
25
19.33.
22 NAME OF
UNDERTAKER
C R Bennison
ADDRESS
Winthrop
Received and filed
JUN 8
1933
19
I
(Registrar of City or Town where deceased resided)
ATTEST:
James J. Mulvey
(Registrar of city town where death occurredh
May
25
33
19.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
If less than 1 day Hours .Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ... salesman
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
year)
spent in this
April : 5/32 occupation
5 yrs
Lzira R Dunham
14 BIRTHPLACE OF
FATHER (City)
Abington
15 MAIDEN NAME
OF MOTHER
Mary Bartlett
Paris
Me
8
109
PLACE OF DEATH
No. Bos ton City Hospital
St.
Ward
(L U. S. War Veteran,
specify WAR)
(If nonresident, give city or town and state)
1
BOSTON
(City or Town)
2 FULL NAME
Albert
(a)
Residence. No.
(Usual place of abode)
3 SEX
M
4 COLOR OR RACE
W
(or) WIFE of
6 IF STILLBORN, enter that fact here.
7
AGE
.72
Years
2
Months
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
12 BIRTHPLACE (City)
Bos ton
13 NAME OF
FATHER
(State or country)
Mass
PARENTS
17
Informant
Wife
A TRUE COPY.
tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
OCCUPATION
important.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
(Address)
Winthrop
DATE FILED
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
(State or country)
Mass
4 Days
1 R-302
SUFFOLK
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
1.09
BOSTON
(City or town making return)
Registered No.
4844
(If death occurred in a hospital or institution,
Ward
give its NAME instead of street and number)
2 FULL NAME
Peter ... Chardos
Peters
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
64 Prospect Ave Winthrop St.,.
(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
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced
HUSBAND of
Marion ...... Smith
(Give maiden name of wife in full)
If less than 1 day Hours Minutes
nnk
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. Shee.y .. Metal ... Wkr.
11 Total time (years)
spent in this
occupation ..
17
Informant
Ernest ... Peters
Revero
ATTEST:
James J. Mulvey
(Registrar of city (town where death occurred)
May
27
33
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH May 25 1933
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
May .1.9 19 .. 33 to .... May
25
, 19 .... 33
I last saw h ... im alive on.
May
2.5 .... 19 .... 33 death is said
to have occurred on the date stated above, at.2 ... 0.3A.m.
The principal cause of death and related causes of importance in order of
onset were as follows:
Dateofonset
primary .. carcinoma .. of lung 8-9 with.metastases ... to ... the ... brain,kidney mos .pericardium .. and ... regional ... lymphnodes
Contributory causes of importance not related to principal cause:
Name of operationsubtemp ... decompressionDate of 5/24/33 What test confirmed diagnosis? anatomical Was there an autopsy? ... ves
20 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
.L.V. Ragsdale
M. D.
(Address)
Asst Dir
(Cemetery)
Date
5/25/19 33
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Woodlawn
Everett
DATE OF BURIAL
Ma.y
27
(City or town)
1933
22 NAME OF
UNDERTAKER
T F Carroll
ADDRESS
Revere
Received and filed.
JUN 8
1933
19
(Registrar of City or Town where deceased resided)
1
(If U. S. War Veteran,
specify WAR)
Ward,
(If nonresident, give city or town and state)
(Husband's name in full)
AGE
45 ... Years
Months
Days
X
Hartford
13 NAME OF
FATHER
Minert Peters
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
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
(State or country)
Conn
1
BOSTON
(City or Town)
3 SEX
4 COLOR OR RACE
M
(or) WIFE of
6 IF STILLBORN, enter that fact here.
7
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
10 Date deceased last worked at
this occupation (month and
OCCUPATION
year)
12 BIRTHPLACE (City)
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
unk
PARENTS
(Address)
A TRUE COPY.
important.
DATE FILED
50m-2-'30. No. 7997-đ
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item or informa-
(State or country)
Denmark
PLACE OF DEATH
No. Mass ... General ... Hospital
St.,
MM R-302
SUFFOLK
(County)
1
BOSTON
(City or Town)
No. Haymarket .. Relief ... Hosp
St.,
Ward
BOSTON
110
(City or town making return)
Registered No ...
.4925
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
James J
Dolan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
52 .Center ... 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?
yTs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE
(write the word)
married
5a If married, widowed, or divorced HUSBAND of
Elizabeth Hellen
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 64 Years Months Days
If less than 1 day
Hours
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
clerk
9 Industry or business in which work was done, as ailk mill, saw mill, bank, etc.
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
year)
May 3
Spent in this Occupation 20
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
John Dolan
14 BIRTHPLACE OF
FATHER (City)
(State or country) Ireland
15 MAIDEN NAME
OF MOTHER
Unk
16 BIRTHPLACE OF MOTHER (City) (State or country)
17
Informant
(Address)
Wife
Winthrop
A TRUE COPY.
ATTEST :.
James J. Mulvey
(Registrar of city oftown where death occurred
DATE FILED
May
31
.1933
18 DATE OF
DEATH
May ..... 25
.193.3.
(Month)
(Day) (Year)
19 I HEREBY CERTIFY, That I attended deceased from
19.33 ..
May
.23
... May ..
25
19 ... 33 to.
I last saw h .... m. alive on ..... May 25 19.33., death is said
to have occurred on the date stated above, at ..... 8 .. 32.A.
The principal cause of death and related causes of importance in order of onset were as follows:
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