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