Town of Winthrop : Record of Deaths 1938, Part 34

Author: Winthrop (Mass.)
Publication date: 1938
Publisher:
Number of Pages: 522


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 34


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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(Cemetery)


(City or towrt)


---


St.,


Ward


(If U. S.


War Veteran,


OM R-302


SUFFOLK


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No. 32.01


(If death occurred in a hospital or institution,


give its NAME instead of street and number) ~


2 FULL NAME


Mabel F King


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a)


Residence.


No.


A1 .. Centre


(Usual place of abode)


Length of residence in city or town where death occurred


yrs.


.St., ..


Ward,


Winthrop


(If nonresident, give city or town and state)


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


F


4 COLOR OR RACE


(write the word)


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Marr


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Edward RK


Esband's name to full)


6 IF STILLBORN, enter that fact here.


7 AGE56 Years4 Month& Days


If less than 1 day


.Hours


Minutes


OCCUPATION!


8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. Housewife


9 Industry or business in which work was done, as silk mill, saw mill, bank, etc. at home


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


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Boston


15 MAIDEN NAME


OF MOTHER


Julia Mahoney


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Boston


17 husband


Informant


(Address)


A TRUE COPY.


ATTEST :.


James W.Bushe


(Registrar of city or town where death occurred)


DATE FILED


4/15/38


19


MEDICAL CERTIFICATE OF DEATHI


(Month)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


3/30/38


19 ..


.... , t


[ last saw h


.. alive


19


death is said


4/18-38., 19


ör


20/12/38


to have occurred on the date stated abe9 39a


.m.


The principal cause of death and related causes of importance in order of onset were as follows: Dateofonset


hypertensive arteriosclerotio heart disease


.. 11 ... yrs


Contributory causes of importance not related to principal cause:


Name of operation


Date of


What test confirmed diagnosis?


Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


G F Houser


M. D.


(Address)


Mass General Hosp


4/12


88


21 PLACE OF BURIAL, CREMATION OR REMOVAL incTrop (Cemeter}} Winthrop (City or town)


DATE OF BURIAL


/15/38


19


22 NAME OF


UNDERTA


F ....... Brown


ADDRESS


Boston


Received and filed ..... Charles Minglow


(Registrar of City or Town where deceased resid Aty Clerk


Every item of informa- tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE MARGIN RESERVED FOR BINDING


important.


50m-9-'31. No. 3385-p


N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


1


PLACE OF DEATH


(City or Town)


No Mass General Hosp


St.,


Ward


(If U. S. War Veteran, specify WAR)


mos.


days. How long in U. S., if of foreign birth?


yrs.


18 DATE OF


DEATH


ARB11-12/38


(Day)


.......


Date


.19.


13 NAME OF


FATHER


Charles F Hooper


....


RI R-302


SUFFOTY


(County) BOSTON


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


(City or town making return)


Registered No.


3208


(If death occurred in a hospital or institution, 5 Ward


give its NAME instead of street and number)


2 FULL NAME


Alphonse J Poutas


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(If U. S.


War Veteran,


specify WAR)


(a)


Residence. No ......... 235 ... Bowdoin.


(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


3 SEX


4 COLOR OR RACE


(write the word)


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Wid


5a If married, widowed, or divorce Bfidget K efe 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 .. 80 Years Months Days


If less than 1 day Hours Minutes


8 Trade, profession, or particular kind of work done, as spinner, F, etc .. ... Monument ... dealer ... retail


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)


4/38


1 1 Total time (years)


spent in this 45


occupation.


12 BIRTHPLACE (City) (State or country) Canada


13 NAME OF


FATHER


Jacques Poutas


14 BIRTHPLACE OF FATHER (City)


(State or country) France


15 MAIDEN NAME


OF MOTHER


Lialvinia Bonufoud


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Canada


17 Informant M'rs. Julia .. Miller dau


(Address)


A TRUE COPY. Q.Burke


ATTEST:


(Registrar of city or town where death occurred) 445/38


DATE FILED 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


April 13/38


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


4/9/38


19


to ..


1/15/38


19


19


death is said


1 last Saw h


.alive on


im


4/13/38


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: Daleofonset


thrombosis of coronary arteries bronchopneumonia 4/10/38


Coutributory causes of importance not related to principal cause:


Name of operation


Date of


What test confirmed diagnosis?


Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased? If so, specify.


M. D.


(Signed)


(Address)


W B Osgood


Date.


19


P.Bont Brigham Hosp


4/13


58


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Calvary


Waltkeometery)


(City or town)


DATE OF BURIAL


4/15/30


19


22 NAME OF


UNDERTAKER


C ........... Roade


ADDRESS


Waltham


MAY 1-9-1938


Received and filodie


MAY1#38 Charles Antina Low


(Registrar of City or Town where deceased resided) City Clerk


tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE MARGIN RESERVED FOR BINDING


PARENTS important. 50m-9-31. No. 3.385. N. B .- WKIIt. PLAINLY, WITH UNFAVING INIATIL INA !! OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATIONI


PLACE OF DEATH


1


(City or Town)


No. Peter ... Bont .. Brigham ... Hosp ............ St., .........


.St.,.


Ward,


Winthrop


(If nonresident, give city or town and state)


OR 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


1


PLACE OF DEATH


ISUFFOLK


(County) BOSTON


(City or Town) Strong Hosp


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


ROSTON


(City or town making return)


Registered No.


3661


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Peter Anthony Tirrell


(If deceased is a married, widowed or divorced woman, give also maiden name.)


specify WAR)


(a) Residence. No.


62 Marshall


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


3 SEX


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


DEATH


Sing


(Month)


(Day)


(Year)


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7 AGE 1


Years


12


6


Months


Days


OCCUPATION |


8 Trade, profession, or particular kind of work done, as spinner. sawyer, bookkeeper, etc.


none


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)


(State or country)


E Boston


13 NAME OF


FATHER


Henry E Tirrell


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Boston


15 MAIDEN NAME


OF MOTHER


Alice " Harrington


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Somerville


17


Father


laformant


(Address)


50m-9-31. No. 3385-p


A TRUE COPY.


ATTEST: ..


James Q.Burke


Registrar of city or town where death occurred)


DATE FILED


4/29/38


19


19 I HEREBY CERTIFY, That I attended deceased from


4/19/38


19


to


1/27/38


19


I last saw


... alive on ..


1/27/38


19 death is said


to have occurred on the date stated above3 &t30am m. The principal cause of death and related causes of importance in order of onset were as follows:


Dateofonsel


Contributory causes of importance not related to principal cause:


Name of operation


Date of


What test confirmed diagnosis?


Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


G.L Gately


M. D.


(Address)


624 Bennington St.


.. Date.4./2.7


.19


-58


21 PLACE OF BURIAL


CREMATION OR REMOVE LAW.


Everett


Woodlawn (Cemetery)


(City or town)


DATE OF BURIAL


1/29/38


19


22 NAME OF


UNDERTAKER


R.C .... Kirby.


ADDRESS


Boston


Received and Thed


1938 MAY 1 9 1938 19


(Registrar of City or Town where deceased resided) . cavity clark


...


important.


No.


St.,


Ward


(If U. S.


War Veteran,


00


(Usual place of abode)


18 DATE OF


April 27/38


If less than 1 day Hours Minutes .... lobar pneumonia. G.da .....


PARENTS


.


MR-301


PLACE OF DEATH


Suffolk (County)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Winthrop


(City or town making return)


Registered No.


S (If death occurred in a hospital or institution,


St.,


Ward ( give its NAME instead of street and number)


2 FULL NAME


Maroy (Cady) Peebles


(If deceased is a married, widowed or divorced woman, give also maiden name.)


.St.,


.Ward,


(If nonresident, give city or town and state)


months


days.


PERSONAL AND STATISTICAL PARTICULARS


1


Winthrop


(City or Town)


No.


434 Revere


(a) Residence.


No.


434 Revere


(Usual place of abode)


Length of residence in city or town where death occurred+


3 SEX


4 COLOR OR RACE


White


Female


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


James D Peebles


(Husband's name in full)


(or) WIFE of


6 IF STILLBORN, enter that fact here.


7


AGE


Years


9


Months


Days


81


5


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,


Own home


OCCUPATION


12 BIRTHPLACE (City)


Philadelphia


(State or country)


Pennsylvania


13 NAME OF


FATHER


Robert Cady


14 BIRTHPLACE OF


Unable to obtain


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Mary


Patton


PARENTS


16 BIRTHPLACE OF


MOTHER (City)


Phildelphia


(State or country)


Pennslyvania


See instructions and extracts from the laws on back of certificate.


Informant


in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very


saw mill, bank, etc.


important.


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


100m-12-'35. No. 6156E


N R WRITE PI AINLY WITH UINFADING BLACK INK. THIS IS A PERMANENT RECORD, .FRATARtom SE DECATS


...


(Official Designation)


(Date of Issue of Permit)


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Autral or Hansit permit was issued: Www. S. Childress .......... XSignature of Agent of Board of Health or other)


Health effects 5/3/38


MEDICAL CERTIFICATE OF DEATH


(Month)


(Day)


1938


(Year)


19 I HEREBY


CERTIFY, That I attended deceased from


may 15


1937, to May 1


1938


I last saw be alive on


may 1


19.5, death Is said


to have occurred on the date stated above, $ 4 am The principal cause of death and related causes of Importance In order of onset were as follows: Date of Onset Broncho pneumonia


Contributory causes of importance not related to principal cause: arteriosclerosis


1936


Semlety


1937


Name of operation.


une


What test confirmed diagnosis @ freuenet Was there an autopsy?


laboratory


20 Was disease or Injury in any way related to occupation of deceasedy.


if so, specify ..


Jacob Dlucasus


(Signed)


., M. D.


(Address) 562 Stanley It


. Date


may 2 3%.


21 ..


Winthrop


Winthrop


Place of Burial, Cremation


or Removal.


(City or Town)


19 38


DATE OF BURIAL.


May 3


22 NAME OF


Charles R ..... Bennison.


UNDERTAKER


ADDRESS


Winthrop .... Mass


1930


Received and filed.


MAY -6 ....


19


A TRUE COPY ATTEST . (Registrar)


(write the word)


18 DATE OF


DEATH


may


/


Married


If less than 1 day


.Hours ....... .Minutes


House work


10 Date deceased last worked at


11 Total time (years)


this occupation (month andApril 1937spent in this


year)


....


occupation.


47


17


James D. Peebles


Relation, if gny


(husband


(Address)


.. Date of.


Ro


(If U. S.


War Veteran


specify WAR)


years


months


days.


How long in U.S., if of foreign birth?


years


4/25/38


Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pur- suits 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 bus- iness, 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-IIOTEL, etc. For a person who had no occupation whatever write NONE.


To be complete, an occupation return must state :


8 .- The trade, profession, or particular kind of work done. 9 .- The industry or business in which the work was done.


10 .- The month and year the deceased last worked at the occupation.


11 .- The number of years the deceased followed the occupation.


In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the partic- ular kind of work done and return that, as SPINNER, WEAVER, etc.


In stating the industry or business, avoid the use of such gen- eral 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 ENGIN- EER, 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, ctc. 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:


Date of Onset


Arteriosclerosis ....


1915


Chronic interstitial nephritis


1921


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.


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 sup- posed 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 scen 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 exhumne 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 huried. No such permit shall be issucd until there shall have been delivered to such board, agent or clerk, as the case may bc, a satisfactory written statement con- taining the facts required by law to he returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as re- quired by law, or in lieu thereof a certificate as hereinafter pro- vided. If there is no attending physician, or if, for sufficient rea- sons, his certificate cannot he obtained early enough for the pur- pose, or is insufficient, a physician who is a member of the hoard of health. or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attend- ing 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 an- other within the commonwealth 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 a removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was re- moved 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 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 ap- pear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith counter- sign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician cer- tifying 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. (TER- CENTENARY 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. . .- GEN. LAWS, CHIAP. 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 of 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 huried 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. (TERCENTENARY EDITION.)


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the ob- servance 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 hoinc 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 septi- cemia), 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.


VR-301A


1


PLACE OF DEATH


Suffolk (County) Winthrop (City or TownY 88 Cliff ave. No.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Registered No.


f (If death occurred in a hospital or institution, Ward { give its NAME' instead of street and number)


2 FULL NAME


John


(If deceased


(s a married, widowed of divorced woman, give also maiden name.)


(a) Residence.


No.


(Usual place of abode)


Length of residence in city or town where death occurred 35.


.00


years


months


days.


How long in U.S., if of foreign birth?


years


months


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


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7 74


AGE ...


.Years.


10


Months ...


13


.Days


If less than 1 day


.... Hours.


.Minutes


OCCUPATION


8 Trede, profession, or particular


kind of work done, es spinner,


sawyer, bookkeeper, etc.


Für Buyer


9 Industry or business in which


work was done, as silk mill,


saw mill, bank, etc.


Dept Store


10 Date deceased last worked et


11 Total time (yeers)


yeer)


trung 1937


spent in this occupation .....


26


12 BIRTHPLACE (City)


Boston


(State or country)


mass.


13 NAME OF


FATHER


John g. mcnutt


14 BIRTHPLACE OF


FATHER (City)


...


Truro


(State or country)


M.S.


15 MAIDEN NAME


OF MOTHER


Margaret Hall


16 BIRTHPLACE OF


MOTHER (City)


Jefferson


(State or country)


mes.


No. 6156F


I HEREBY CERTIFY that a satisfactory standard certificate of death was Wer with me BEFORE the bolial or transit permit was Issued:


Signature of Agent of Board of Health di otbe


ealth Officer 5/3/38 (Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


5


(Month)


(Day)


L


W


(Year)


19


I HEREBY CERTIFY,


Sept


193.7 ... , to ..


, 19.3.8 ..


I last saw h. las alive on


15/2


., 19.3 ... , death is said


to have occurred on the date stated above, at 1Pm. The principal causa of death and related causes of Importance in order of onset were as follows:


.....


Date of Onset IMPORTANT ...


..


1937 1


Contributory causes of Importance not related to principal cause:


?


Name of operation.


What test confirmed diagnosis?


.Date of.


.Was there an eutopsy ?.


20 Was disease or Injury in any way related to occupation of deceesed?


If so, specify ...................


(Signed)


M.D.


(Address) (191


Date.2/2. 19.30


21.9


Forest Hills Cim Boston


Place of Burial, Cremation or Removal.


may 5


19 38


DATE OF BURIAL.


22 NAME OF


F. S. Waterman


UNDERTAKER


ADDRESS


495 Commaer. Boston


Received and filed.


MAY


-1938


.... 19


(Registrar)


tion should be carefully supplied.


..........


important.


17 Mrs Harriet imsnett (wife)


Relation, if Any


Informant! (Address)


100m 1' '35


YSICIANS should state CAUSE OF DEATH See instructions and extracts from the laws on back of certificate. in plain terms, so that it may be properly classified. Date of onset and exact statement of OCCUPATION are very Age should be stated EXACTLY. PHYSIT


St.,


McNutt


(If U. S.


War Veteran


specify WAR)


88 cliff


ave.


.St.


Ward,


(If nonresident, give city or town and state)


(City or Town)


PARENTS


Harriet Wilson


That I attended deceased from


Statement of occupation. - Precise statement of occupation is. very important, so that the relative healthfulness of various pur- suits 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 bus- iness, 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 whatever write NONE.




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