USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1937 > Part 43
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salesman
9 Industry or business in which work was done, as ailk 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)
E Boston Mass
Charles Rollins
E Boston Mass
Josephine Baker
16 BIRTHPLACE OF
MOTHER (City) .
(State or country)
E Boston Mass
1 No. 3 SEX M (or) WIFE of OCCUPATION 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 17 Lafermant (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 (State or country) important.
byery item or informa-
(If U. S.
War Veteran,
specify WAR)
107
R-302
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town) No. Peter Bent Brigham Hospitalst.,
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
3817
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
106
2 FULL NAME
Mabel ... Farnham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
(Usual place of abode)
32 ... Irwin
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
April 8
193 7
(Month)
(Day)
(Year)
19 THEREBY CERTIFY, That I Minded deceased from
March
2
,19 .... 3.7to.
April ... 8.
, 19.3 .... 7.
I last saw h.er ..... alive on. April 8 , 19 ... 3.7., death is said
to have occurred on the date stated above, at ... 3 .. 28Pm.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
carcinoma of sigmoid resulting in perforation of sigmoid and generalized peritonitis
mos
wks
2 dys
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis?
Was there an autopsy? . yes
Date of
20 Was disease or injury in any way related to occupation of deceased? ... no
If so, specify.
(Signed)
W. W Knowlton
M. D.
(Address)
Boston
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Cedar Grove
Peabody.
(Cemetery)
(City or town)
DATE OF BURIAL
April 12
193. .. 7
22 NAME OF
UNDERTAKER
J. S Waterman & Sons
Boston
ADDRESS
Received and filed
MAY 1 4 1937
19
(Registrar of City or Town where deceased resided)
---
important.
ATTEST:
Neida Ofeditions Swings
.....
(Registrar of city or town where death occurred)
DATE FILED April 12
1937
50m-9-'31. No. 3385.0
3 SEX Female 7 AGE 57 OCCUPATIONI 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OF PARENTS MOTHER (City) (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 (State or country)
Years 3 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 ..... seamstress W PA 11 Total time (years) spent in this occupation 2
10 Date deceased last worked at
this occupation (month and
year)
1937 ..
Danvers Maws
Benjamin Earle
14 BIRTHPLACE OF
FATHER (City) ..
Peabody
Elle L Fogg
(State or country)
No Reading
17
Informant ..
Mother- Ella Earle
(write the word)
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
widowed
5a lf married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
Horace P Farnham
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
1 ... . A IMWANLITT. ALLUND. Every Item of informa- (or) WIFE of
Ward
(If U. S.
War Veteran,
specify WAR)
Date4/8/ 193 7
I R-302
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.
ATTEST :.
Aceda Ofedition Quick
(Registrar of city or town where death occurred)
DATE FILED April 12 19.37
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April9
1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
April ... 8
19.3.7,
April 9
19.3 7
I last saw her .. . alive on.
April .9 ........ , 193.7 .... , death is said
to have occurred on the date stated above, at11 ... 30Am.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Hemolytic streptacoccus infection of pharyn and larynx 4/6/37
Contributory causes of importance not related to principal cause:
Bilateral broncho pneumonia
diabetes mellitus
First found on
4/9/37
4/8/37
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy ?. no
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
M Wattles
, M. D.
(Address)
Boston
Date4/.9./.
19 37
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
(City or town)
EverettJewish Everett
(Cemetery)
April .. 11
19 3
DATE OF BURIAL
7
22 NAME OF
UNDERTAKER
M Stanetsky.
Boston
ADDRESS
Received and filed
MAY 1 4-1937
19
(Registrar of City or Town where deceased resided)
50m-9-'31. No. 3385-K
1
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town) No. Mass Eve & Ear Infirmary
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
3796
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Edith
Nitishin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
73 Marshall
.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
Fem
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Give maiden name of wife in full)
Charles H Nitishin
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 39 . .. 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. ...
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .... housewife 11 Total time (years) spent in this occupation
12 BIRTHPLACE (City)
Boston Mass
(State or country)
13 NAME OF FATHER Samuel Sumdel
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Anna -
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant
(Address)
Husband-
above
A TRUE COPY
.. sc.,
......
.Ward
(If U. S.
War Veteran,
109
specify WAR)
Winthrop
(Usual place of abode)
(write the word)
10 Date deceased last worked at
this occupation (month and
year) .
Russia
1
R-302
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.
50m-9-'31. No. 3385-g
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.
40.02
(If death occurred in a hospital or institution,
Ward
1
give its NAME instead of street and number)
2 FULL NAME
William J
Seaman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
(Usual place of abode)
188 ... Cottage Pk Rd
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
April 13
193
7
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
37
April ... 5
19.3.7, to ..
April 13
19.3.7
I last saw h .. ].m. .. alive on.
April
.13
to have occurred on the date stated above, at 6.40₽ m.
The principal cause of death and related causes of importance in order of onset were as follows: Dateofonset
chronic myocarditis with hypertension 10yrs chronic vascular nephritis 10 yrs
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis? .
autopsy
Was there an autopsy? yes
no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
W. W. Knowlton
M. D.
(Address)
Boston
Date
4/14/19.3.7.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop. Winthrop
(Cemetery)
DATE OF BURIAL
April 16
(City or town) 19 3. 7
22 NAME OF
UNDERTAKER
W. H Graham
ADDRESS
Boston
Received and filed
JUN & IaMl.
19
(Registrar of city or town where death occurred)
...
DATE FILED April 17 19 7 2
fej above
A TRUE COPY.
ATTEST:
Darcus Babcook
16 BIRTHPLACE OF
MOTHER (City)
(State of country)
Canada
18 NAME OF
FATHER
William Seaman
14 BIRTHPLACE OF
FATHER (City)
PARENTS
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
olevator ... operator
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 about occupation3.1 .... yrs
12 BIRTHPLACE (City)
(State or country)
Canada
If less than 1 day Hours Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
(write the word)
mele
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced
HUSBAND of
Mae Phelan
(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
3 SEX
1
No ... Peter ... Bent .. . Brigham .. Hospital St.,
1
(If U. S.
War Veteran,
specify WAR)
110
17 Fr ( July 200 Informant (Address)
(Registrar of City or Town where deceased resided)
19. death is said
R-302
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 406.7
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
William K
Young
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence.
No
583.Shirley
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
утв.
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)
married
5a If married, widowed, or divorced HUSBAND of
Mary Mac
(Give madden nam
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE
73
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 ...
salesman
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc ...
10 Date deceased last worked at this occupation (menth and year) ..
1920
11 Total time (years) spent in this occupation
30
12 BIRTHPLACE (City) (State or country) E Boston Mass
13 NAME OF FATHER James W Young
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Christina Ross
16 BIRTHPLACE OF
MOTHER (City)
Scotland
(State or country)
17
Wife-
lafermant (Address)
above
A TRUE COPY.
ATTEST:
Falda Stedetcom
(Registrar of city or town where death occurred) April 21 7
19.3
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April 16
193 7
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
April 6
19 3.7, to.
April 16
.. , 19.3.7.
| last saw h .. 1m alive on.
April ... 15 ..
....
19 .... 3.7, 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
general.arteriosclerosis (vascular)
192.02
cerebral.hemorrhage
4/6/37
Contributory causes of importance not related to principal cause:
Name of operation
What test confirmed diagnosis?
Was there an autopsy ?.... no
20 Was disease or injury in any way related to occupation of deceased? .
no
If so, specify.
(Signed)
EDLeete
M. D.
(Address)
Boston
Date 4/17/ .. 19.3.7.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Wyoming
Melrose
DATE OF BURIAL
(Cemetery)
(City or town)
April .18
19 3
7
22 NAME OF
UNDERTAKER
R. H White
Winthrop
ADDRESS
Received and filed 19
(Registrar of City or Town where deceased resided)
50m-9-'31. No. 3385-g
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 PARENTS important.
1
No.
MoCreight .. San.
St.,
Ward
5
(If U. S.
War Veteran,
111
(Usual place of abode)
DATE FILED
Date of
1 R-302
PLACE OF DEATH
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 .. 4265
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Charles Joseph
Harvey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a)
Residence.
No.
190. Pauline
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.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April ... 20
1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
April 16
,19.3.7., to .... April 20
19 .. 3 ... 7.
I last saw him ... alive on.
April 16
19 ... 3.7., death is said
to have occurred on the date stated above, at8.15P .... m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
general arteriosclerosis
yrs.
coronary occlusion
...
2 .. mos.
Contributory causes of importance not related to principal cause:
Date of
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)
W.W ... Knowlton
Boston
(Address)
Date
4/31/193 ... 7.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross
Malden
DATE OF BURIAL
(Cemetery)
(City or towu)
April 23
19 37
22 NAME OF
UNDERTAKER
J F O'Maley
ADDRESS
Winthrop
Received and filed
JUN 8 1937
19
(Registrar of City or Town where deceased resided)
WWWVIWI
1
(City or Town)
(Usual place of abode)
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
Male
white
WIDOWED
or DIVORCED
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
46
Years
Months
Days
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
editor
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)
Feb 1937
12 BIRTHPLACE (City)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
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
(State or country)
Waltham
important.
(write the word)
married
(Give maiden name of wife in full)
If less than 1 day Hours. Minutes
11 Total time (years)
spent in this
occupation.
30
Charles Harvey
Waltham
Ellen Lona gan
Waltham
50m-2-'30. No. 7997-d
17 Son- Joseph Harvey
above
ATTEST:
Haita Pedition Varte
(Registrar of city or town where death occurren)" ~*~
DATE FILED April 24
193 7
PERSONAL AND STATISTICAL PARTICULARS
No.
Peter ... Bent .. Brigham.Hospital .. St.,
Ward
(If U. S.
War Veteran,
112
M. D.
I R-302
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.
4223
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Maurice
Isenberg
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
(Usual place of abode)
36. Hawthorne .. Ave
SA.,. 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
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Male
white
married
5a If married, widowed, or divorced HUSBAND of Gertrude M Goodman
(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
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
wholesale fish
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc .....
10 te deceased l this occupation (month year)
Ap1 1937
11 Total time (years)38 spent in this occupation
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF FATHER
Robert Isenberg
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Mable Roso
16 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
17 Informant (Address)
Wife-
above
TRUE COPY
ATTEST:
(Registrar of city of town where death occurred)
DATE FILED
April 23
193 7
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April 20
1937
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
April ... 4
19.3.7., to ........... April ... 20
19 .. 3 ... 7.
I last saw him ... alive on
April .20 ........ , 19 ... 3.7., death is said
to have occurred on the date stated above, at8.38P .... m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
carcinoma of cecum peritonitis
5 mos 1 dy
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy?no
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M .J. Rhees
M. D.
(Address)
Boston
Date
4/21/193.
7
21 PLACE OF BURIAL
CREMATION OR REMOVAL
Temple Israel
DATE OF BURIAL
April 22
193. 7
22 NAME OF
UNDERTAKER
J H Levine
ADDRESS
Boston
Received and filed JUN 8 1937
19
(Registrar of City or Town where deceased resided)
50m-2-'30. No. 7997-đ
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 PARENTS important.
1
No.
Mass General Hospital
St.,
Ward
(If U. S.
specify WAR)
113
(Cemetery)
(City or towu)
---
٠
R-302
Worcester
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Rutland
(City or town making return)
Registered No
61 4 4 1
(If death occurred in a hospital or institution,
Ward give its NAME instead of street and number)
2 FULL NAME
Lee Andrew Davis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Ocean Spray
.St., ..
.......
Ward,
Winthrop, lass.
(If nonresident, give city or town and state)
mcs. days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
Mary Welch
(Give maiden name of wife in full)
If less than 1 day
Hours
Minutes
Trucking
11 Total time (years) spent in this occupation
17
State Sanatorium Records
(Address)
Rutland Mass
ATTEST:
L'owith Hand
(Registrar of city or town where death occurred)
.19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April 21
1937
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from April 20 37 to. 19. April 21
19
37
im
I last saw h
alive on
April 21
1937
death is said
to have occurred on the date stated above, at.
2:40 m.P.M.
The principal cause of death and related causes of importance in order of
onset were as follows:
Date ofonset
Pulmonary tuberculosis
years
Contributory causes of importance not related to principal cause: None
Name of operation
Date of
What test confirmed diagnosis?
X-ray
Was there an autopsy? NO
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
nknown
(Signed)
Gabriel Nadeau
(Address) .!
utland State
San.
· Date
4/2119 37
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Forestdale, Malden, Mass
(Cemetery)
(City or town)
DATE OF BURIAL
April 25.1937
19
22 NAME OF
Thomas D.Russell
UNDERTAKER
ADDRESS
1419 Dorchester Ave. orcheste
Received and filed MAY 1 & 1937
19
(Registrar of City or Town where deceased resided)
1 mitland (City or Town) 3 SEX Małe 4 COLOR OR RACE Black MARRIED WIDOWED or DIVORCED (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 9 Yours Months AGE 56 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) (State or country) North Carolina 13 NAME OF FATHER Squire Davis 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER Roaa Rovster 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) North Carolina Isfermant A TRUE COPY. No. 3385.₪ 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 April 23 1937 50m-0.'31. N. B .- WRITE PLAINLY, WITTE UNFADING INA-THIS DD A PERMANENT ALVORD. Every Item er informa- (State or country) North Carolina
PLACE OF DEATH
(County)
No.
Rutland State Sanatorium St.,
(I 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. 1
days.
How long in U. S., if of foreign birth?
yrs.
M R-305
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town) No .. 818 Harrison Ave
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No ... 4350
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
James F
Conley
(If deceadd is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ...
163 Cottage Pk Rd
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
8 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word).
Male white
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
19
Years
7
Months
17 Days
If less than 1 day Hours. Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. asst ... shipper
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Curtin Co
10 Date deceased last worked at
this occupation (month april 1937
year)
11 Total time (years)
spent in this
occupation
2
12 BIRTHPLACE (City)
(State or country)
E Boston Mass
13 NAME OF
FATHER
Francis J Conley
PARENTS
(State or country)
15 MAIDEN NAME
OF MOTHER
Mildred L Glynn
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Bangor Me
17 Father- Informant (Address) above
A TRUE COPY
- Frente
ATTEST:
Frank J O'toole
(Registrar of city or town where death occurred)
DATE FILED Apr11-27
1937 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April 23
1937
(Month)
(Day)
(Year)
19 | 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) Crushed chest & abdomen.
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