Town of Winthrop : Record of Deaths 1938, Part 57

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 57


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102


yrs.


mos.


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


JTs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE


(write the word)


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


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 42 .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.


Bar ...... tender


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)


New Bedford


Mass .


13 NAME OF FATHER Alfred Sylvia


PARENTSF


14 BIRTHPLACE OF FATHER (City) (State or country)


Azores


15 MAIDEN NAME


OF MOTHER


Mary Simmons


16 BIRTHPLACE OF MOTHER (City) (State or country) Azores


17 InformaAlfred ..... Sylvia


(Address) Orchard St. How Bed ford


A TRUE COPY.


Aug 2 1938


.ATTEST:


(Registrar of city or town where death occurred)


DATE FILED Frederick, 1 13


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


July ... 31.1938


(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)


Fracture of skull


......


Struck by an automobile


Accident


20 If death was due to external causes (VIOLENCE) fill in the following :


Accident,


Suicide or


Date of injury.


Homicide ?


Accident


7/31


19


38


Where did


injury occur ?


Watertown


Mase.


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)


David .C .DOw.


Date


19


1587 Mass . AVE


7/31


38


22 PLACE OF BURIAL,


CREMATION OR REMOVAL


St Contas


New Bedford


DATE OF BURIAL


19


23 NAME OF


Aug 2 1938


UNDERTAKER


Chas. a Frates


ADDRESS


265 County St.


Received and filed.


19


(Registrar of City or Town where deceased resided)


25m-2-'30. No. 7997-e


1


PLACE OF DEATH


No .. Cambridge ... Hospital St.,


..... Ward


(If U. S.


War Veteran,


specify WAR)


-


(City or town and State)


RECEIVE


TOM


11 17


-


5


7 6


HRO


AUG-81938 **


F301


ATIEE AC NEA TU


JEVACTI V. DUVCICIANC .L .-. 1J -4.UN are very


in plain terms, so that it may be properly classihed, Date of onset and exact statement of UL


PLACE OF DEATH


Suffolk (County)


Winthrop


(City or Town)


Revere nouque 0/10/58 The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


(City or town making return)


Winthrop Community Hospital No. Baby Boy Thurston (Premature)


(If death occurred in a hospital or institution,


St.,


.Ward \ give its NAME instead of street and number)


(If U. S.


War Veteran


specify WAR)


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


(a) Residence.


N8.


154 Cresant Ave Revere


St.


.Ward,


(If nonresident, give city or town and state)


(Usual place of abode)


Length of residence in city or town where death occurred


years


months


days.


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


years


months


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


taly


3/


1938


38


A last saw h ..... i.allve on.


·


......


1.55PM


to have occurred on the date stated above, at ...


Dale of Onset


The principal cause of death and related causes of Importance la order of onset


were as follows:)


Prematurity


Tum


Contributory causes of importance not related to principal cause:


Name of operetion ..


June


What test confirmed diagnosis ?.


Was there an eutopsy ?.


20 Was disease of Injury in any wey related to occupation of deceased?


If so, specify.


(Signed)


(Address) Cescuhas Date 8/1


........ , M. D.


1938


Woodlawn


Everett


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL. August 3 1938


............. .... . ... . 19


22 NAME OF Bicha UNDERTAKER


ADDRESS


......


147 Winthrop St Withrop Mass


SI HEREBY CERTIFY that a satisfactory standard certificate of death was Med with me BEFORE the burial. or transit permit was issued: Wm. D. Clusarea


(Signature of Agent of Board of Health or other)/


/Health Affiche


8/2/38


.....


Received and flied ...


AUG - 1938


19


(Oficial Designation) (Date of Issue of Permit)


····· 19. 19 / I HEREBY CERTIFY.) That f attended deceased from tiology 31 19.2 .... 19. 31 ....... 19 death Is sald July 31 3)


(Month)


(Day)


(Year)


6a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter thet fact here.


7 AGE .. Years. Months.


.. Days


if less than 1day .Hours. Minutes


8 Trede, profession, or perticular kind of work done, es spinner. sawyer, bookkeeper, etc ......


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


10 Date deceased last worked at


11 Total time (years)


spent in this


occupation ....


this occupation (month and


yeer)


12 BIRTHPLACE (City)


Winthrop


(State or country) Massachusetts


13 NAME OF


FATHER


Franklin D Thurston


14 BIRTHPLACE OF


Medford


FATHER (City)


(State or country) Ja ss


Tatten


Malden


(State or country)


Mass


17 Franklin Thursten


Informant (Address) 154 Cresent Ave Revere Mass


21 ..


Father any


1


8 SEX Male (or) WIFE of OCCUPATION 1 16 BIRTHPLACE OF PARENTS MOTHER (City) important. See instructions and extracts from the laws on back of certificate. N. D-WNIE FLATNET, WITTT WANT AUNTS DEVE BOTTEN BUT TOS DE 15 MAIDEN NAME OF MOTHER 100m-12-'35. No. 6156E


4 COLOR OR RACE


White


5 SINGLE


(write the word)


Single


MARRIED


WIDOWED


Or DIVORCED


2 FULL NAME


Registered No.


140


(Registrar)


A TRUE COPY ATTEST :


Date of.


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 ovcr. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deccased 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, ctc. 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, etc. Distinguish carefully between RETAIL MERCHANTS AND WHOLESALE MERCHANTS. A person who sells goods should be called a SALESMAN and not a CLERK.


Statement of Cause of Death. - Cause of death means the disease, 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: Arteriosclerosis


Date of Onset


1915


......


Chronic interstitial nepbritis


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.


A physician or registered hospital medical off


with, alter 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 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 hoard, 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 hody is buried. No such permit shall be issued until there shall nave been delivered to such board, agent or clerk, as the case may bc. a satisfactory written statement con- taining the facts required hy 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- anired 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 hody 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, CHAP. 38, SEC. 6.


.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- GEN. LAWS, CHAP. 38, SEC. 7.


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be 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 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 hy traumatism (including resulting septi- cemia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following ahortion, 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.


AV R-302


PARENTS tion should be carefully supplied. AGE should be stated LAACILI OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION


important.


A TRUE COPY.


James Q. Burke


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED 6/28/38 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


June 25/38


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


6/25/38


,19


.. , to.


3/25/38


.. , 19


I last saw h ... g.


im


6/25/38


.. alive on.


19


death is said


to have occurred on the date stated above at .. m.


10:10p The principal cause of death and related causes of importance in order of onset were as follows: Dateefonset prematurity 6-mos


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)


C-A-Powell


M. D.


(Address)


Mags Memorial Hosp


. Date.


0/209 33


21 PLACE OF BURIAL,


CREMATION OR REMOVALnthrop


Linthrop


DATE OF BURIAL


0/28/33


19


22 NAME OF


UNDERTAKER


C RBennison


ADDRESS


Winthrop


Received and filed 19


AUG 17 1938


(Registrar of City or Town where deceased resided)


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


PLACE OF DEATH


SURPOLE BOUWYON


(City or Town) Mass Memorial Hosp


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


BOSTON


(City or town making return),


141


Registered No .... 5402


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


-


Costonis


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


173 Shirley


.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


(write the word)


Sing


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


Years 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.


10 Date deceased last worked at


this occupation (month and


year)


11 Total time (years) spent in this occupation


12 BIRTHPLACE (City)


Boston


(State or country)


13 NAME OF


FATHER


Arthur Costonis


14 BIRTHPLACE OF


FATHER (City)


Albania


(State or country)


15 MAIDEN NAME


OF MOTHER


Sylvia Bonaccarco


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Chicago Ill


17 mother


Infor mant


(Address)


A MENT PATSICIANS snou


1


No


St.,


....... Ward


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


(a)


Residence.


No.


(Usual place of abode)


Length of residence in city or town wbere death occurred


yrs.


mos.


days.


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


yrs.


(Cemetery)


(City or town)


MR-302


CRIAREventuem of informa-


THIS IS A PERMANENT


tion should be carefully supplied. ALL should be stateu CAMCILI, MIAMI OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION


important.


A TRUE COPY.


ATTEST:


James Q. Burine


fRegistrar of city or town where death occurred)


- 19 ..


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


Jun 27/38


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


6/26/38


19


to


6/27/38


., 19


I last saw hor


.alive on


6/27/38


,19.


death is said


to have occurred on the date stated above, Ott .m.


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


Dateofonset


arbasclerosis-hypertension


·cerebralhemorrha go.


10hrs


.yre ...


Contributory causes of importance not related to principal cause:


laceration .. of ... forchead


6 26/38


Name of operation suturo of lecoration Dats /26/38 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)


RIT Wallace


M. D.


(Address)


269 Bencon St


Date


6/27/38


21 PLACE OF BURIAL


CREMATION OR REMOVWinthrop Winthrop


(Cemetery)


6/29/38


19


DATE OF BURIAL


22 NAME OF


UNDERTAKER


P .... C .... Kirby


ADDRESS


Boston


Received and filed


6/30/38


AUG . .


(Registrar of City or Town where deceased resided)


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


PLACE OF DEATH


SUFFOLK


1 (County)


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


DOSTON


(City or town making return)


Registered No.


5467


(If death occurred in a hospital or institution,


5


Ward


give its NAME instead of street and number)


2 FULL NAME


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


(a)


Residence. No ...


6.Washington Ave


St.,


Ward,


Winthrop


(Usual place of abode)


Length of residence in city or town wbere death occurred yrs.


mos.


days.


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


yrs.


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX F


4 COLOR OR RACE


W


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


5a If married, widowed, or divorced IIUSBAND of


(or) WIFE of


Patri Give maiden name of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7.66 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.


10 Date deceased last worked at


this occupation (month and


year).


6/38


11 Total time (years) spent in this occupation.


0


12 BIRTHPLACE (City)


(State or country)


Boston


PARENTS


(State or country)


15 MAIDEN NAME


OF MOTHER


Margaret Ilyde


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


17 Informant (Address)


husband


1


(City or Town)


No


Mass Gen Hosp


St.,.


Catherine Lane


(If U. S.


War Veteran,


specify WAR)


142


(If nonresident, give city or town and state)


(City or town)


19


DATE FILED


13 NAME OF


FATHER


William Pomfret


14 BIRTHPLACE OF


FATHER (City)


Ireland


MR-302


tion should be carefully supplied. AUL snoulu De OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS


important.


A TRUE COPY.


James Q. Burke


ATTEST:


....


(Registrar of city or town where death occurred)


DATE FILED


6/30/38


.. 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


June 27/38


(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.


55


7


AGE


Years


3


Months


Days


8


If less than 1 day .Hours .Minutes


OCCUPATION


8 Trade, profession, or particular


kind of work done, as spinner,


sawyer, bookkeeper, etc ...


steward


9 Industry or business In which


work was done, as silk mill,


saw mill, bank, etc.


SS


10 Date deceased last worked at


this occupation (month and


year)


/35 11 Total time (yea1) spent in this occupation


12 BIRTHPLACE (City)


(State or country)


England


13 NAME OF


FATHER


Thomas Young


14 BIRTHPLACE OF


FATHER (City)


Ehg land


(State or country}


0


15 MAIDEN NAME


OF MOTHER


---


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17


Informant


(Address)


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


PLACE OF DEATH


SUFOLK


(County) DOSTON 1


(City or Town) Nass General Hosp


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


BOSTON


(City or town making return). 5471 143


Registered No.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Samuel H Young


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


(a)


Residence.


No.


(Usual place of abode)


33 Court 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


3 SEX


M


4 COLOR OR RACE


W


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Marr


Jennie 5 Peterson


19 IHEREBY CERTIFY, That I attended deceased from


6/27/38


19


6/27/38


19


I last saw hi.ya ...... alive on ...


6/27/38


19


death is said


to have occurred on the date stated above,latp.


m.


Datesfonset vrs The principal cause of death and related causes of importance in order of onset were as follows: cirrhosis.of.the liver esophageal varices, with


rupture


1"da"


Contributory causes of importance not related to principal cause:


Name of operation


Date of


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)


M .J .... Rheos


M. D.


(Address)


Mass Gen Hosp


Date .6. 28 .19.38.


21 PLACE OF BURIAL,


CREMATION OR REMOVALOodlawn.


Everett


(Cemetery)


6/29/38


(City or town)


DATE OF BURIAL


19


22 NAME OF


UNDERTAKER


CJ Berglund


ADDRESS


Arlington


Received and filed


AUG 1 7 1938


19


(Registrar of City or Town where deceased resided)


IS A PERMANENT RECORD. Every item of informa- aluu


1


No.


St., ...........


Ward


(If U. S.


War Veteran,


specify WAR)


to


الدرجـ


F301A


PLACE OF DEATH


Sauffrolle notifica (County) Keithap/9/38 (City or Town)


No. 264 River Road


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.


144


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


2 FULL NAME


Bassie Bergen


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


(a) Residence.


No. 33 Grove 87


(Usual place of abode)


Leogth of residence in city or town where death occurred


years


months


days.


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


years


months dayı.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Temple


4 COLOR OR RACE


White


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


widowed


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


If less than 1 day


Years.


Months


Days


Hours ..... .Minutes


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


at home


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


10 Date deceased last worked at


11 Total time (years)


this occupation (month and


spent in this


occupation.


12 BIRTHPLACE (City) (State or country)


Russia


13 NAME OF


FATHER


Jacob Seltzer


14 BIRTHPLACE OF


FATHER (City)


(State or country) Russia


15 MAIDEN NAME


OF MOTHER


Gastrucha Kirschick




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.