USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1938 > Part 84
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
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 Examinera wili investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or iudirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from 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.
R-301A
PLACE OF DEATH
(County )
Il luttrap (City or Town)
2.4. Unterhalt it Winding St. 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.
208
Registered No. f (If death occurred in a hospital or institution, Ward { give its NAME instead of street and number)
2 FULL NAME
Jennie E. Wheeler
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No
24 -Underhill it thitherap St.
Ward,
(If nonresident, give city or town and state)
months
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Remate
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
ividaweck
Or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
totales S. Wheeler
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
71
Years
Months
.Days
f less than 1 day
Hours ............ Minutes
8 Trede, profession, or particular
kind of work done, es spinner,
sawyer, bookkeeper, etc ...
Hauserle
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
at home
1O Date deceased last worked at
11 Total time (years)
spent in this
occupation
this occupation (month and
year)
12 BIRTHPLACE (City)
Fitchburg
(State or country)
mais
13 NAME OF
FATHER
(unknown) Morgan
14 BIRTHPLACE OF
FATHER (City)
unknown
(State or country)
15 MAIDEN NAME
OF MOTHER
unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
unterracon
17
Charles IV Jueur
(.7
Informant
(Address)
24 Underheil Is. Wendtwap
I HEREBY CERTIFY that e satisfactory standard certificate of deeth was filed with me BEFORE the berrial os treasit permit was issued: ImoChildrens 1.0 (Signature of Agent of Hard of Healthfor other) Oct.29/38
(Oficial Designation) (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
26
1938
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY
February 10
1934 1
to
October 26 1935
That I attended deceased from
I last saw her
.. allve on
October 25 1938" death is said
to have occurred on the date stated above, at 11:150 m. The principal cause of death and related causes of Importance in order of onset were as follows:
Date of Onset IMPORTANT
acute Coronary Trombosis
10/14/38
Contribatory causes of Importance not related to principal cause: Artenosclerosis
Senility
1936 1938
Name of operation.
none
Date of
What test confirmed diagnosis Clinical I Was there an autopsy? 120
labora
20 Was disease or Injury in any way related to occupation of deceased 2
If so, specify
Jacob abramo
(Signed)
(Addres
562 Hurley St Date 10/28/938
21 Winthrop Cemetery
Vintherap
Relation, if any
Place of Burial, Creination or Removaf.
(City or Town)
DATE OF BURIAL
Det 29,1938
19
22 NAME OF
UNDERTAKER
ADDRESS
Ing Benning for Sr F. Boston
Received and filed .......................
Cel 3),
19
38
(Registrar)
100m 11 :30 No 9080 F
1 OCCUPATION PARENTS tion should be carefully supplied. important. 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. PHYSICIANS should state CAUSE OF DEATH AGE
(If U. S.
War Veteran
specify WAR)
( l'sual place of abode)
Leoxtb of resideoce in city or town where death occorred
years
months days. How long in U.S., if of foreign birth? years
M. D.
Statement of occupation. - Precisc 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 nn 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 occupatinn. 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," ctc. State the particular kind of store, factory, mill, etc., as GROCERY STORE, SOAP FACTORY, COTTON MILL, ctc.
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. . \s 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 causc, 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
1915
Arteriosclerosis
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, 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- pnscd 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 «late 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 w 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 hnard of health or its agent aforesaid or from the clerk nf the town where the hndy is buried. No such permit shall be issued until there shall nave been delivered to such board, agent or clerk, as the case may be. a satisfactory written statement con- taining 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 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 be obtained early enough for the pur- pose. 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 attend- : ing physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal nf 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 ohtained 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 nr 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 upnn 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 whn, though disabled by recognized disease unrelated tn 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 tn all deaths supposably due to injury. These include not only deathis caused directly or indirectly by traumatism (including resulting septi- cemia). and hy the actinn of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortinn, 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-301A
1
PLACE OF DEATH
Suffolk (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.
209
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
Minnie Clayton (Macleod) Gibby
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No
30 Orlando Avenue
(Usual place of abode)
33 yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Length of residence in city or town where death occurred
3 SEX
H'emale
4 COLOR OR RACE
White
6 IF STILLBORN, enter that fact here.
7
AGE
Years.
8
Months
.15 .... Days
7.6
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.
12 BIRTHPLACE (City)
wareham
13 NAME OF
FATHER
Donald Macleod
14 BIRTHPLACE OF
FATHER (City)
OCCUPATION
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
cape Breton
17
Informatir.S ...... Laura Sears
is very important. See instructions and extracts from the laws on back of certificate.
(State or country)
Scotland
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of .George
.Hamilton .... Gibby
(Husband's name in full)
If less than 1 day Hours Minutes
House work
Own home
10 Date deceased last worked at
11 Total time (years)
this occupation (month and September sangintis
year)
occupation.
56
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Isabelle Mackay
(State or country)
Nova Scotia
Relation, if any
neice
(Address)
30 Orlando Ave.
winthrop
Ma's
I HEREBY CERTIFY that a satisfactory standard certificate of death was Aijed with me BEFORE the burial or transit permit was issued:
SSignature of Agent of Board of Health or other)
Health Placek 11/1/38
(Official Designation) (Date of Issue of Permut)
MEDICAL CERTIFICATE OF DEATII
13 DATE OF DEATH OstobEl 29
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
September-1, 1935, to.
0
1938
I last saw h ............ allve on
005- 29
19.3 %, death Is sald
to have occurred on the date stated above, at 11:304 m.
The principal cause of death and related causes of Importance In order of onset
were as follows:
Date of Onset IMPORTANT
Carcinoma o. Braas. Lives+
1935
1
Contributory causes of importance not related to principal cause:
Fracture - Shaft of FeMur
10-1-3-28
Name of operation.
Mint SION
Date of UCF-29-35
What test confirmed diagnosis? La oratory Was there an autopsy wy g.
20 Was disease or injury in any way related to occupation of deceased?
No
If so, specify.
Edward . Franger
(Signed)
.M. D.
(Address).
200 Washerunter Av Date OCT30938
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Winthrop Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL.
November 1,
1938
NAME OF
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed. 19
1938
(Registrar)
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 information should be carefully supplied.
100m-12-34. No. 2938-f
(City or Town) No.inthrop Community Hospitalst.
Ward
(If U. S.
War Veteran,
specify WAR)
.Ward,
(If nonresident, give city or town and state)
1938
UNDERTAKER
UNITED STATES STANDARD CERTIFICATE OF DEATH
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 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 housewife 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 servant-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
To be complete, an occupation return inust 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 particular 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 engincer, stationary engincer, 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 discase, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury 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 other contributory causes of importance, name other important discases or injuries. Examples:
Examplo I
Examplo II
The principal cause of death and related causes of importance were as follows:
Date of onsel
The principal cause of death and related causes of importance were as follows:
Date of onset
Arteriosclerosis
1915
Attack of epilepsy
1 week ago
Chronic interstitial nephritis
1921
Run over by street car
1 week ago
Cerebral hemorrhage
July 5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1923
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
:
U. S. GOVERNMENT PRINTING OFFICE: 1930
c11-3134
A R-305
1
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town) No Rite Corleto ..... lotol
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
8435
2 FULL NAME
Semuel Shafto
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..... 338Devore ... St
(Usual place of abode)
Length of residence in city or town where death occurred
yrs,
St.,
..........
Ward,
„Inthron.
(ff nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED L'arrLed
5a If married, widowed, or divorced
HUSBAND of
Emmo, Baille
(Give maiden name of wife in full)
(or) WIFE of
(llusband's name in full)
6 IF STILLBORN, enfer Ihal facl here.
7 42
AGE
Years
2 Months 23 Days
If less Than 1 day
Hours
Minutes
OCCUPATION
8 Trade, profession, or parlicular kind of work done, as spinner, sawyer, bookkeeper, etc.
Turn.Finisher
9 fndusfry or business in which work was done, as silk mill. saw mill, bank, efc .....
Hotel
10 Data deceased last worked at
this occupalion (month and
year) ..
10/50
11 Tofal lime (years) spent In fhis occupation .. 10
12 BIRTHPLACE (City)
(State of country)
13 NAME OF FATHER Richand Shaftoo
14 BIRTHPLACE OF
FATHER (City)
(State of country)
England
15 MAIDEN NAME
OF MOTHER
Bertha Hewitt
16 BIRTHPLACE OF
MOTHER (City)
(State of country)
England
17 Informant (Address)
vifo
A TRUE COPY
ATTEST:
...
(Registrar of city of town where death occurred)
DATE FILED 19.
MEDICAL CERTIFICATE OF DEATII
18 DATE OF
DEATH
(Day)
(Ycar)
10 | HEREBY CERTIFY that I have invesligaled the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (ff an injury was involved, stato fully)
"Natural causes"
probably
organic heart disease
20 If death was due to external causes (VIOLENCE) fill In the following :
Accideni,
Suicide or
Homicide ?
Date of Injury
19
Where did
Injury occur ?
(City or town and State)
Manner of
Injury
Natura of
Injury
21 Was diseasa or Injury in any way relaled fo occupation of deceased? If so, specify
(Signed)
, M. D.
(Addrass)
Boston
10/15/8
22 PLACE OF BURIAL
CREMATION OR REMOVAL
"inthecopy /inchrapy or town)
DATE OF BURIAL
10/10/38 19
23 NAME OF
UNDERTAKER
ADDRESS
R H White
Received and filed
10/17/53
Winthrop
19
(Registrar of City of Town where der caved resided)
25m-2-30. No. 7997-0
1
(If death occurred in a hospital or institution.
{ give ita NAME instead of street and number)
(ff U. S.
War Veteran,
211
specily WAR)
days. How long in U. S., if of foreign birth?
yrs.
mos.
St.,.
........
Ward
YT Watters
PARENTS
fany
....
71 1%
6
HRODI'
NOV231938 ANT
1
R-302
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Chelsea
(City or town making return)
212
Registered N5.9.1
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Milton Eugene Taylor
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran
specify WAREN
x
(a) Residence. No.
164 Pauline
.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
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced
HUSBAND of
Lila C. (Borden)
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Years X Months Days
If less than 1 day Hours Minutes
Poster Artist
9 Industry or business in which
, as silk mill, Forbes Litho. Co.
saw mill, bank, etc.
11 Total time (years)
spent in this
occupation
13 NAME OF
FATHER
Samuel Taylor
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Maria Estelle Fraizer
17
Informant
Lila C. Taylor
(wife)
(Address)
164 Pauline St. Winthrop Ma
A TRUE COPY.
ATTEST:
Irene EPunch
1 un
/ (Registrar of city or town where death occurred)
DATE FILED
Oct. 15
19
38
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct.
13
19.38
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY, That I attended deceased from
Oct. 13
13.8 .. , to.
Oct. 13
19.38
I last saw him.
... alive on
Oct ....
13
19.38, death is said
to have occurred on the date stated above, 12,45p.m. The principal cause of death and related causes of importance in order of onset were as follows: Coronary thrombosis
Dateofonset
Oct .13
1938
Contributory causes of importance not related to principal cause:
Name of operation
none
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)
A ... C ... Benjamin
M. D.
(Address) 816 BI Way Chelsea Date 10/2419 38
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Puritam LawnMemorial
(City or town)
Park Peabody (Cemetery)
DATE OF BURIAL
Oct. 1.6
19 38
S- NAME OF
·UNDERTAKER
Geo ... P.Merwin
ADDRESS
305-307 Beach St. Revere Hass
Received and filed 19
(Registrar of City or Town where deceased resided)
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.