USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 77
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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 atten lance 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 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.
(
R-302
OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS
important.
50m-9-'31. No. 3385-g
A TRUE COPY.
ATTEST :..
James Q. Burice
(Registrar of city or town where death occurred) 9/7/38
DATE FILED
.19 ..
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Div
18 DATE OF
DEATH
September 2/38
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
to
3/1/33
19
0/3/38
19
death is said
., 19.
I last saweh ....
alive 10.30
to have occurred on the date stated above, : af 5a
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset,
3737
....
Contributory causes of importance not related to principal cause:
.pyelonephross.s.
.... secondary anemia
8/38
ynteacetamny 12/14/37
What test confirmed diagnosis?
Was there an autopsy ness-
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D.
(Address) .... 264-209.con 86
Dat@/3
188
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
19
22 NAME OF
UNDERTAKER
C RBennison
ADDRESS
Vinthrop
Received and filed 19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
SUFFOLK BCountyTON
(City or Town)
No.
Palmer Memorial Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
COSTON
1
(City or town making return)
Registered No
7325
(If death occurred in a hospital or institution,
..... Ward give its NAME instead of street and number)
2 FULL NAME
Virginia Rohrman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
144 Circuit
Rd
.St., ..
. Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yTs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
5a If married, widowed, or divorced
HUSBAND of
Hosti's ingiddy nates lof wife in full)
6 IF STILLBORN, enter that fact here.
39 5
7
AGE
Years
Months
Days
25
If less than 1 day Hours Minutes carcinoma of cervix
clerk
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 ..
Radio Store
10 Date deceased last worked at2/37
this occupation (month and
year)
11 Total time (years) 5
spent in this
occupation.
12 BIRTHPLACE (City)
(State or country)
Beverly
13 NAME OF
FATHER
Clarence N Mundy
14 BIRTHPLACE OF
FATHER (City)
Plainfield-N-J
(State or country)
15 MAIDEN NAME Sarah E Addis OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Plainfield N J
17 mother
Informant
(Address)
(Cemetery)
9/6/38
(City of town)
(If U. S.
War Veteran,
specify WAR)
1.5.nthrop
191
(or) WIFE of
(Husband's name in full)
PERSONAL AND STATISTICAL PARTICULARS
St.,
TOWE
11 12 60 L
2
1
9
11
1
11:
6
MASC.
Н
1
OCT 221938 AM
R-305
PLACE OF DEATH
Plymouth (County)
Scituato (City or Town) Off Gannett Street
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Scituate
(City or town making return)
Registered No.
31
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Edward R. Clarke
(If deceased is a married, widowed or divorced woman, give also maiden name.)
115 Lowell Road
St.,
.Ward,
Winthrop, Mass.
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
Ibelle P. dott
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE
58
Years
4
Months
17Days
If less than 1 day Hours .Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner. sawyer, bookkeeper, etc .... Superintendent
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Public Schools
10 Date deceased last worked at
11 Total time (years)
this occupation (month and Oct. 1958spent in this
year)
11
occupation.
12 BIRTHPLACE (City)
Naples
(State or country)
New York
13 NAME OF
FATHER
Edmund C. Clarke
14 BIRTHPLACE OF
FATHER (City)
Naples
(State or country)
New York
15 MAIDEN NAME
OF MOTHER
Caroline Richards
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
New York
17 Mrs. Edward R. Clarke (Wife) Informant .... f North Scituate, Dass. (Address)
A TRUE COPY.
ATTEST:
(Registrar of city or towh where death occurred)
DATE FILED November 4 .19 .. 38
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
15
1938
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-ramed and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
Dromming (Suicide)
20 If death was due to external causes (VIOLENCE) fill in the following :
Accident,
Suicide or
Suicide
Date of injury.
19
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)
T. D. Alexander
(Address)
Scituate, Lass.
Date
10/19: 38
22 PLACE OF BURIAL,
CREMATION OR REMOVAL
Groveland
Scituate
October
2 (City or town)
38
DATE OF BURIAL
19
23 NAME OF
Ernest H. Sparrell
UNDERTAKER
ADDRESS
forwell, Mass.
Received and filed. 19
(Registrar of City or Town where deceased resided)
25m-2-'30. No. 7997-e
1
No.
St.,
..... .Ward
(If U. S.
192
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.
(Cemetery)
(City or town and State)
PARENTS
RECEIVED
OF
TOWN
OFFICE
11 1.2
10
203111
9-
8
CLERK
WI
5
6
P MAS
NOV-51938 AM *
2-302
OCCUPATIONI OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very PARENTS
important.
A TRUE COPY. af Shimmera.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
October ... 29
.19 ..
3.8
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October.
2.8
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Chester Furbish
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
42
Years
10
Months
22
Days
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 .....
At home
10 Date deceased last worked at
11 Total time (years)
spent in this
occupation
this occupation (month and
year) ..
12 BIRTHPLACE (City)
Revere
(State or country)
Mass.
13 NAME OF
FATHER
Louis Mckenzie
14 BIRTHPLACE OF
FATHER (City)
Portland
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Ella May Benjamin
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
50m-9-'31. No. 338€ _~
PLACE OF DEATH
NORFOLK (County)
BROOKLINE
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BROOKLINE (City or town making return)
Registered No.
477
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
AGNES F. FURBISH
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence.
No.
51 ... BUCHANAN.
St.,
Ward,
WINTHROP, MASS.
(Usual place of abode)
(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
SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
(write the word)
1938
19 I HEREBY CERTIFY, That I attended deceased from
October 20
193.8 ... to.
October 28 19 38
I last saw h .... @.r ... alive on
October 28
19 38
death is said
to have occurred on the date stated above, a
7:15 P
The principal canse of death and related causes of importance In order of onset were as follows: Dateofonset
Osteomyelitis femur left
Oct ..... 1938
Staphylococcus septicaemia
Oct. 1938
Contributory causes of importance not related to principal cause:
Name of operation
Osteotomy
Date of
10/22/38
What test confirmed diagnosis?
Clinical
Was there an autopsy ?..... no
20 Was disease or injury in any way related to occupation of deceased? ..... no
If so, specify.
(Signed) .N.Brooks Morrison
(Address).126 Harvard St. Brkln Date 10/28.19 38
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop,
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL
October 30
19.38
22 NAME OF
UNDERTAKER
R.H ..... White
ADDRESS
Winthrop
Received and filed 19
(Registrar of City or Town where deceased resided)
1
No
TRUMBULL HOSPITAL
St.,
...... Ward
(If U. S.
War Veteran,
193
17
Chester Furbish
(Husband).
Informant
(Address)
51 Buchanan St ,Winthrop
If less than 1 day
AGE
RECEIVED
TOWN
OFFICE OF
11 16
10
8
5
SS
7 6
WIN
THROP
NOV -41938 AM
01A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
2
To be filed for burial permit with Board of Health or its Agent.
Registered No.
191.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Walborg Olivia (Svensson) Peterson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ....
51 Birch Road
Ward,
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred 24
mos.
yrs.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Carl Gustave Adolph Peterson
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 70
AGE
Years
8
Months
.Days
23
If less than 1 day Hours. Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
Masseuse
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
Homes of patients
10 Date deceased last worked at
11 Total time (years)
this occupation (month ansept. 1938 spent in this
18
year)
occupation
12 BIRTHPLACE (City)
Stockholm
(State or country)
Sweden
13 NAME OF
FATHER
Jonas Svensson
14 BIRTHPLACE OF
FATHER (City)
s.t.o.ckhoihm
(State or country)
Sweden
15 MAIDEN NAME
OF MOTHER
Johanna Christina Alm
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
Relation, if any
17
InformatiS. Anna 0. Nylin
(
neice
(Address) 90 Winchester St Brookline
! HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of, transit permit was issued:
(Signature of Agent of Board of Health or other)
10/5/38
(Official Designation) (Date of Issue of Permit)
5 SINGLE
(write the word)
DEATH
18 DATE OF
October
3
1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
October
-
1938 to October 3 1938
I last saw her alive on
October 2 19300
, death is said
to have occurred on the date stated above, at. 4:304x !. The principal cause of death and related causes of Importance In order of onset were as follows: acute Coronary Thrombosis Date of Onset IMPORTANT
10/1/38
Contributory causes of importance not related to principal cause: augura Pectoris
Chabete Mellitus
1937 I don't know
Name of operation
score
What test confirmed diagnosis Pluscalk
Was there an autopsy ?...
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
brot alcamo
., M. D.
(AddressY
542 Plumley ST Date
act 3 1938
21 PLACE OF BURIAL,
CREMATION OR REMOVAL .M.t ....... Hope
(Cemetery)
(City or town)
38
DATE OF BURIAL
October 5.
.19
22 NAME OF
UNDERTAKER
Charles R. Bennison
ADDRESS Winthrop Nass
Received and filed 19
O.C.I ... 1 0 1938
(Registrar)
100m-12-'34. No. 2938-f
OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. PARENTS
Date of
no
Boston
1
NoWinthrop .... Community .... Hospitals ...................... .Ward
(If U. S.
War Veteran,
specify WAR)
(Usual place of abode)
Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits 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 business, 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 what- ever 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," ctc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.
In stating the industry or business, avoid the use of such general 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 engineer, 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 discase, 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 causo of death and related causes! of importance in order of onsct werc as follows: Arteriosclerosis
Date of onset
1915
Chronic interstitial nephritis
1021
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 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 registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deccased, his supposed agc, the disease of which he died, defined as required by section one, where same was contracted, the duration of liis 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 witliin thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sconer 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 appcar 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.)
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. Lows, 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 sucli 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 ceme- tery 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 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 un- related to any form of injury, have died without recent medical attend- ance 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 clectrical agents, and deaths following abortion, but also deaths from diseaso resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
01A
1
PLACE OF DEATH
(County)
Winthrop
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. (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Adolphus Brown Beeching
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
106 Bellevue av ..
.St., ..............
Ward,
(If nonresident, give city or town and state)
(Usual place of abode)
Length of residence in city or town where death occurred 8
yrs.
mos.
days. How long in U. S., if of foreign birth? IL & fs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
DIVO
DWidower
6a If married, widowed, er dimrgdzabeth P. Parsons
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 78
Years
1
Months
12
.Days
If less than 1 day Hours. .Minutes
8 Trade, profession, or particular kind of work done, as spinner, zawyer, bookkeeper, etc ....
Book-keeper
9 Industry or business in which
work was done, as sålk mill,
saw mill, bank, etc ..
Little Brown Co.
10 Date deceased last worked at
11 Total time (years)
spent in this
1926
occupation ...
40
12 BIRTHPLACE (City)
East Boston
(State or country)
Mass.
13 NAME OF
FATHER
Richard Beeching
14 BIRTHPLACE OF
FATHER (City)
......
Great Chart
(State or country) England
15 MAIDEN NAME
OF MOTHER
Elizabeth Jane Brown
16 BIRTHPLACE OF
MOTHER (City)
New York City
(State or country)
New York
17 William H.Beeching
Relation, if any
brother)
Informant.
(Address)
106 Bellevue av. Winthrop, Mas
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued:
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