USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 101
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mr.
this occupation (month and
year)
V
WINTHROP :
M R-303 B
Suffolk.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 250
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Sauce. M- Comecker
(If deceased is a married, widowed or divorced woman, give aby maiden name.)
St.
St.
Ward,
Heathrole
(If nonresident, give city or town and state)
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE 0 Grad 9/1001, 1935
(Month)
(Day)
(Year)
19 1 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.)
Duits Cardiac Failure
Niceats- found dead
(See reverse side for description for unknown person )
20 IN WHAT CITY OR TOWN
WAS INJURY SUSTAINED }.
(Signed)
., M. D.
Headacheeine Date /16/199
21 PLACE OF BURIAL,
CREMATION OR REMOVAL?
Forest Villa Cemetery
(Cemetery)
DATE OF BURIAL
193/
22 NAME OF
Kathleen , Kuriningham
UNDERTAKER
ADDRESS ..
379 Market St, Suighton
19
Received and filed.
JAN 2 0 1939
(Registrar)
(write the word) Sidamed.
If less than 1 day .Hours. Minutes
17 ChristopherC, Mitchell, P ..
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: ADRIAN;F. CHAMPION ignature of Agent of Board of Health or other) HAI L 1939 1334 BOSTON HEALTH DEFT.
" Retired Messenger probabledorouges
(County) 1 (City or Town) 877. Shirley No .... 2 FULL NAME 877 Shirley (a) Residence. No.& (Usual place of abode) Length of residence in city or town where death occurred yrs. mos. PERSONAL AND STATISTICAL PARTICULARS 3 SEX 4 COLOR OR RACE 5 SINGLE MARRIED WIDOWED or DIVORCED Male 5a If married, widowed, or divorced HUSBAND of March (Give maiden name of wife in full) (or) WIFE of (Husband's name in full) 6 IF STILLBORN, enter that fact here. 7 AGE 70 Years Months .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 1 1 Total time (years) this occupation (month and spent in this OCCUPATION year) Cannot be less occupation 12 BIRTHPLACE (City) Scotland (State or country) 13 NAME OF FATHER Cannot be learned 14 BIRTHPLACE OF FATHER (City) annat be learned (State or country) 15 MAIDEN NAME Cannot be learned OF MOTHER Cannot be learned PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Infor mant (Address) 25 Minberton Square Daston (Official Designation) (Date of Issue of Permit? 5m-12-'34. No. 2938-g N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF Superior Court
PLACE OF DEATH
St., ....
Ward
(If U. S. War Veteran, specify WAR)
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 regis- tration 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 con- tracted, 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-such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired 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 statement 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. (Tercentenary Edition.)
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 cemetery or burial ground in which the interment is made ....- Chap. 114, Sec. 46, G. L. (Tercenten- ary Edition.)
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ;...- General 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; other- wise a description as full as may be, with the cause and manner of death. -General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
RULES OF PRACTICE
The fulfilment 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 unrelated to any form of injury, have died without recent medical attendance 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.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anæsthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorr- hage spontaneous, of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.) "
DESCRIPTION (for unknown person).
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec, 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
ORM R-305
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
No. Hass General Hosp
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.
9928
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Joseph A Francis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
355 Winthrop
St., .........
Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Harried
5a If married, widowed, or divorced
HUSBAND of
Carrie Ingersol.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE. .47 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
painter
job
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
11/38
occupation 3.5
12 BIRTHPLACE (City)
(State or country)
Truro Hass
13 NAME OF FATHER Alexander Francis
PARENTSI
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Azores
15 MAIDEN NAME
OF MOTHER
Mary Jocoph
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Truro
17 Informant (Address)
............... Trifo
A TRUE COPY
Heide Stedetions Quick
ATTEST :.
(Registrar of city or town where death occurred)
DATE FILED
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Dec 4/38
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully) traumatic intracranial hemorrhage
compound fracture left lower leg-crush of left lowor leg-said to have been in-
Jured by an auto at Provincetow Mass
20 If death was due to external causes (VIOLENCE) fill in the following : Accident, Suicide or Date of injury Mow .24.38 Homicide ?
19
Where did
pedestrian -Provincetom Mass
injury occur ?
(City or town and State)
Manner of
Injury.
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
W.J. Brickley
M. D.
(Address)
Boston
Dat 12/4/389
22 PLACE OF BURIAL,
CREMATION OR REMOVAL Winthrop Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
12/6/38 19
23 NAME OF
UNDERTAKER .R.H.White
ADDRESS
Winthrop
Received and filed
12/7/38
19
JAN.2.4 1939
(Registrar of City or Town where deceased resided)
MARGIN RESERVED FOR BINDING
25m-2-'30. No. 7997-e
1
St.,
Ward
(If U. S.
War Veteran,
251
specify WAR)
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
(write the word)
6 5
1.1 WITHRICE
JAN2-1933 AM
-
RM R-305
1
PLACE OF DEATH
SUFFOLK
(County)
BOSTON (City or Town) No. Homo .. Par Aced Non
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.10.123
(If death occurred in a hospital or institution, give its NAME instead of strect and number)
2 FULL NAME
Francis George
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 919 ... Shirley
(Usual place of abode)
.St.,
......
.Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
MEDICAL CERTIFICATE OF DEATHI
18 DATE OF
DEATH
Doc 10/38
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of when THIS
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE Months .7.0 Years 19 .. Days
If less than 1 day Hours. Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ...
gen.work
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)
12/38
11 Total time (years) spent in this occupation.
12 BIRTHPLACE (City)
(State or country)
Euriund
13 NAME OF
FATHER
PARENTS.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
ife
17
Informant
(Address)
000
A TRUE COPY
Hulda Sedition Links
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
19
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)
coronary sclerosis-treated therefor
fall from table-No evidence of injury
20 If death was due to external causes (VIOLENCE) fill in the following :
Accident,
Suicide or
20 Homicide ?
Where did
injury occur ?
Manner of
Injury.
Nature of
Injury
21 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address)
Boston
Dati2/10/39
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mintiro .Winthrop
(Cfty or town)
DATE OF BURIAL
(Cemetery)
12/13/38
19
23 NAME OF
UNDERTAKER
C R Dernison
ADDRESS
Winthrop
Received and filed
12/14/38
JAN-2-4.1039
19
(Registrar of City or Town where deceased residcd)
MARGIN KESENYEU FOR DINDING
St.,
.Ward
(If U. S.
War Veteran,
specify WAR)
250
(write the word)
25m-2-'30. No. 7997-e
Date of injury.
19
(City or town and State)
1.
3
6. 5
THROP
JAN2 &1930 AM
RM R-302
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
OCCUPATION 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.
50m-11.'36. No. 9080-g
A TRUE COPY.
James Q. Burke
ATTEST:
........
(Registrar of city or town where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
3 SEX M
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowod
5a If married, widowed, or divorced
Bertha Basch
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
75
7 AGE Years Months Days
If less than 1 day
.. Hours.
.Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc.
post office
letter carrier
9 Industry or business In which
work was done, as silk mill,
saw mill, bank, etc.
10 Date deceased last worked et
this occupation (month and
year)
1928
11 Total time (years) 35 spent in this occupation
12 BIRTHPLACE (City).
(State or country)
Boston
13 NAME OF
FATHER
Meyer Adams
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17 Frances Baxter
Relation, if any dau.
1
PLACE OF DEATH
SUFFOLK BOSTON
ing General Hosp
The Onmmamaralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
St.,
.............
Ward
BOSTON
(City or town making return) 10149
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 Mermaid Ave
.St., ..
..........
Ward,
(If nonresident, give city or town and state)
mos. days.
18 DATE OF
DEATH
Dec .... 11/38
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I ettended deceesed from
12/11/38
19
.... , to
12/11/38
19
I last saw him ..... alive on
12/11/38.
., 19.
death Is said
to have occurred on the date stated above at_3p.
... m.
The principal cause of death and related causes of importance in order of onset were es follows:
Dateofonset
.. carcinoma .. of ... the .. sigmoid
?
intestinal ... obstruction
5dy.s.
Contributory causes of importance not related to principel cause:
Name of operation.
attomptod cecostomy
02:2 9/11/38
What test confirmed diagnosis?
Was there en eutopsy?
yes
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
UJRheos
M. D.
(Address) ..... Mess Gon Hosp
Date1.2/3.2.198
21
Place of BurCheratinadushevar."obukny or Town)
DATE OF BURIAL
19
22 NAME OF
UNDERTAKER
B ........ Solomon
ADDRESS
Brookline
Received and filed
12/14/38
19
JAN 2 : 1939
(Registra
gistrar of City or Town where deceased resided)
(L U. S.
War Veteran,
253
specify WAR)
Winthrop
(a)
Residence.
No.
(Usual place of abode)
Length of residence in city or town where death occurred
yTs.
mos.
days. How long in U. S., if of foreign birth?
yTs.
PERSONAL AND STATISTICAL PARTICULARS
No.
Joseph Adams
Informant
( Address)
12/14/38
JAN201930 AF
RM R-302
PLACE OF DEATH
( SUBGALE BOSTON
(chetenwBont Brigham Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
10507
(If death occurred in a hospital or institution, 5
give its NAME instead of street and number)
(If U. S.
War Veteran,
254
specify WAR)
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?
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
James J(Qugülden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
AGE Years Months Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ..
housewife
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc ..
own home
10 Date deceased last worked
this occupation (month and
year)
10/38
11 Total time (years) 9
spent in this
occupation
12 BIRTHPLACE (City)
Boston
13 NAME OF James Bowen FATHER
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME lary Donlon OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
Ireland
17 Elizabeth Bowon
Belattorif any
(
ATTEST:
James Q. Burhan
(Registrar of city or town where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 24/38
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
10/31/38
19
to
19. death is said to have occurred on the date stated above alzba m.
The principal cause of death and related causes of importance in order of onset were as follows:
Daleofonset
carcinoma of descending colon.
.peritonitis
7./38 ...
Contributory causes of importance not related to principai cause:
tramaventa colostomy.
Date b: 1/58
ex cencor of colon
What test confirmed diagnosis?
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
ves
If so, specify
(Signed)
W B Osgood
(Address)
Peter B D Hosp
Date
12/24/58 .19
21
Place of Burial. Cremation or Removal.
(City or Town)
DATE OF BURIAL
12/26/08
19
22 NAME OF
UNDERTAKER
ADDRESS
Winthrop
Received and filed
12/28/38
JAN 27 1939
19
(Registrar of City or Town where deceased resided)
1 No. 2 FULL NAME 3 SEX 7 50 (State or country) PARENTS 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 OCCUPATION important. 50m-11.'36. No. 9080-g N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country)
Mary G Egan
St.,
Ward
(If degensedis a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No.
St.,
Ward,
(If nonresident, give city or town and state)
12/24/38"
.. ,
., 19.
I last saw h ........
.. alive on ...
12/24/38
M. D.
1
6
JAN241009 AM
RM R-302
1 No. 2 FULL NAME 3,SEX HUSBAND of (or) WIFE of OCCUPATION (State or country) 13 NAME OF FATHER PARENTS (State or country) 17 Informant (Address) important. 50m.11.'36. No. 9080-g 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 (State or country)
PLACE OF DEATH
( SUFFOLK (County) BOSTON
PiterToDent Brigham
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Hosp
BOSTON
(City or town making Uur Registered No. .....
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, dinAtrop -
255
(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?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 26/38
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attendad daceased from
12/24/38
12/26/38
19
19
..... , to.
I last saw
.im
.. alive on 12/26/58 19 daath Is said
to hava occurred on tha date stated above, at.O.p.
m.
Tha principal canse of death and related causes of importance in order of onset were as follows:
Dateofonset
diabetes mellitus
1930
brain tumor-typo undotermined
7/58
Contributory causes of importance not related to principal cause:
Nama of operation
Date of
What test confirmed diagnosis?
Was there an autopsy?yes
20 Was diseasa or injury in any way related to occupation of deceased? If so, specify
(Signed)
W.B. Osgood
(Address) .Peter B-B-Hosp
Date2/27/58
21
Winthrop-Winthrop
Place of Burial. Cremation or Romoval.
(City or Town)
DATE OF BURIAL
12/29/38
19
22 NAME OF
J F O'laley
UNDERTAKER
Winthrop
ADDRESS
12/30/38
Recaivad and filad
JAN 241434
19
DATE FILED .19
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorceAnna E Barter
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
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