Town of Winthrop : Record of Deaths 1939, Part 19

Author: Winthrop (Mass.)
Publication date: 1939
Publisher:
Number of Pages: 560


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 19


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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 hedside 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 Examinera 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 hy 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


R-301A


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 tion should be carefully supplied. Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH


important.


I HEREBY CERTIFY that a satisfactory standard certificate of death was tiled with me BEFORE the burial or fransit permit was issued: Www. D. Children


Signature of Agent of Board of Health of other) Health officer


2/27/39


(Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Fl 25,1939


(Month)


(Day)


(Year)


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Bror ....... Nelson


(Husband's name in full)


6 IF STILLBORN, enter that fact hare.


AGE


Years.


If less than 1 day Hours. .Minutes


OCCUPATION


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


House work


9 Industry or business in which


work was done, as silk mill,


saw mill, bank, etc ..


Own home


10 Date deceased last worked at


this occupation (month and


year)


11 Total time (years)


Feb. 12 1969 in this


occupation.


12 BIRTHPLACE (City)


(State or country)


Sweden


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Sweden


15 MAIDEN NAME


OF MOTHER


Ann Helgerson


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Sweden


17 Bror 0. Nelson


Relation, if any


(husband


(Address) 524 Boulevard Revere Mass


Informant


100m 11-36. No. 9080.F


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


Revere notifica 319/39 The Commonwealth of Alassachusetts 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.


No.Winthrop Community Hospital St., Ward give its NAME' instead of street and number)


2 FULL NAME


Edith Sophie (Johansson) Nelson ;


(If deceased is a married, widowed or divorced woman, give alsomaiden nar


(If U. S.


War Veteran


Specify JAR ...


(a) Residence.


No ...


524 Boulevard


(Usual place of abode)


Ward, ..


Revere ... Mass


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


years


months


days.


How long in U.S., if of foreign birth? 28 , years


months


dayı.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


4 COLOR OR RACE


White


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


I HEREBY


CERTIFYD That I attended deceased from


38, 10 82125, 1939


I Just saw be alive on


Jav 25


1939, death is said


to have occurred on the date stated above, at 4.40% The principal cause of death and related causes of Importance in order of onset were as follows: 1938 inoma ) Ilesting Date of Onset IMPORTANT


Contributory causes of Importance not related to principal cause:


Cholotomy


Name of operation.


What test confirmed diagnosis ? Fat


.Date of. Was there an autopsy ?. .....


20 Was disease or Injury in any way relatad to occupation of deceased?


If so, specify


(Signed)


(Address) 164 8hufand


Date ..


426


1939


21 Mt-Cuban Package Mun


Place of Burial, Creination or Removal.


(City or Town)


DATE OF BURIAL


February 28


1939


22 NAME OF


Charles R. Bennison


UNDERTAKER .


ADDRESS


Winthrop Mass


Received and filed. FEB 2 8 1939


19


(Registrar)


1


Registered No.


[ (If death occurred in a hospital or institution,


M. D.


13 NAME OF


FATHER


Carl Johansson


7


52


8


Months


15 Days


Revised United States


es Standard Certif


ucate of De Death


Statement of occupation. - Precise statement of occupation is very unportant, 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.


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, ctc.


Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- K.E.R, 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 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


Arteriosclerosis ....


1915


Chronic interstitial nephritis


1921


Cerebral hemorrhage


July 5. 1927


Contributory causes of importance not related to principal causc:


In a group of causes containing the principal cause and related causes, the causes should be given in the order of onsct, 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 he the second cause given


COMMO ONWEALTH OF MASSACHUSET GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forth- 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 hest of his knowledge and belief the name of the deceased, his sup- posed age, the discasc 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 therefroin 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 hoard 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 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 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 ahove 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 heen 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- I CENTENARY EDITION.)


Medical examiners shall make examination upon the view of the dead hodies 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 hoard 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 buried 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 disahled 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 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


M R-302


1


No.


2 FULL NAME


3 SEX


F


(or) WIFE of



12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


14 BIRTHPLACE OF


FATHER (City)


15 MAIDEN NAME


OF MOTHER


PARENTS


OCCUPATION


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17


Informant


(Address)


A TRUE COPY.


tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE


important.


OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very


j0m-11-'36. No. 9080-g


N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-


(State or country)


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Widowed


5a If married, widowed, or divorced


HUSBAND of


Anthony Cortinaame of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


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 ..


own home


10 Date deceased last worked at


this occupation (month and


year)


9/38


11 Total time (years) O


spent in this


occupation.


- Feenan


Tonry


Relation, if any son


(


ATTEST:


James Q.Burpe


ames


(Registrar of city or town where death occurred)


DATE FILED 2/14/39


-19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


(Day)


(Year)


1/ HEREBY CERTIFY, That haftended deceased from


19


2/20/30


19


I last saw h


alive on


19


death is said


8.150


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:


Dateofonset


chr myocarditis


yrs ..


coronary thrombosis.


Gros.


...


broncho pneumonia 10dy&


Contributory canses 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)


WB Osgood


(Address)


Peter ....... B ... Hosp ..


Date2/12/399


Winthrop-Winthrop


21


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


19


22 NAME OF


UNDERTAKER


Jr Of'aley


ADDRESS


Winthrop


Received and filed


19


BOSTON


(City or town making return) 1352


Registered No.


(If death occurred in a hospital or institution,


-


give its NAME instead of street and number)


ElizabethA Corinna


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


242 Lincoln


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


Ward,


(If U. S.


War Veteran,


specify WAR)


48


(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.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


PLACE OF DEATH


SUFFOLK (County)


BOSTON


(CitoEErment Brigham Hosp


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


St.,


.....


........


.Ward


Winthrop


(If nonresident, give city or town and state)


Pob 10/39


...


(Registrar of City or Town where deceased resided)


M. D.


2/13/39


RECEIVED


TOWN


OFFICE O


11 12. 1


10


CLERK


1


5


6


AS


APR-41939 AM


M R-302


PLACE OF DEATH


Middlesex


(County)


No. Malden Hospital


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


Malden


(City or town making return)


Registered No. 19


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


2 FULL NAME


Donald Kay Marston


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


35 Sagamore Ave


St.


Ward,


Winthrop


(If nonresident, give city or town and state)


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF.


DEATH


Feb ...


14.


1.9.39


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


Jan.


26.


1939


Feb. 14,, 19 39


I last saw h


im


Feb ...... 13, 19 .39 death Is said


to have occurred on the date stated above, at ... 5 .... a .... m.


The principal cause of death and related causes of importance in order of onset were as follows: Broncho Pneumonia 2/9/39 Dateofonset


Contributory causes of importance not related to principal cause:


Py.loro .... s.pa.sm


1/26/38


What test confirmed diagnosis?


Clinical, was there an autopsy?


no


20 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


Kenneth K. Day


M. D.


(Address)


Malden, Mass ..


Date .. 2. 1.4. 193.9


21


Mt. Auburn


Cambridge


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


2/16/39


19


22 NAME OF


UNDERTAKER


C.R ...... Bennison


ADDRESS


winthrop, Mass.


Received and filed 19


(Registrar of City or Town where deceased resided)


1 Malden (City or Town) 3 SEX 4 COLOR OR RACE White Male (or) WIFE of 6 IF STILLBORN, enter that fact here. 7 AGE 9 Industry or business In which work was done, as silk mill, saw mill, bank, etc. this occupation (month and year) OCCUPATION 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 16 BIRTHPLACE OF PARENTS MOTHER (City) 17 ATTEST: 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 important. 30m-11-'36. No. 9080-g N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country) Mass,


(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)


(Husband's name in full)


If less than 1 day


- Years. . .. ... Months 1.9. Days


.Hours Minutes


8 Trade, profession, or particular


kind of work done, as spinner,


sawyer, bookkeeper, etc ....


-


10 Date deceased last worked at


11 Total time (years)


spent in this


occupation


12 BIRTHPLACE (City).


Ma.ld.en


(State or country)


Mass.


Edward Alton Marston, r Name of operation


Malden


15 MAIDEN NAME


OF MOTHER


Verna Kay


Passaic


(State or country)


N. J.


Relation, if any


Informant Ruth Wilson


( Address)


23 Charles St.


Winthrop


A TRUE COPY. asie L. Holdes


(Registrar of city or town where death occurred)


DATE FILED


Feb. 21, 1939


19


St.,


Ward


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


(a)


Residence. No


(Usual place of abode)


Length of residence in city or town where death occurred


yrs.


mos.


19 days.


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


yTs.


to ..


Date of


TON


1


6 5


HROP MAS


MAR111039 AM


IM R-302


SUFFOLK


ifUs General Hosp


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


BOSTON


(City or town making return) 1507


Registered No.


(If death occurred in a hospital or institution,


No.


St.,


.....


.Ward


give its NAME instead of street and number)


Margaret C O'Leary


2 FULL NAME


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


51 Birch Rd


St.,.


Ward,


Winthrop


(If nonresident, give city or town and state)


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


Or DIVORCED idowod


5a If married, widowed, or divorced


HUSBAND of


Arthur Give" garage of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7 77


6


Years


28


Days


If less than 1 day


Hours.


.Minutes


8 Trade, profession, or particular


kind of work done, as spinner,


sawyer, bookkeeper, etc.


at home


9 Industry or business In which


work was done, as silk mill,


saw mill, bank, etc ....


10 Date deceased last worked at


11 Total time (years)


spent in this


occupation.


12 BIRTHPLACE (City)


(State or country)


Boston


13 NAME OF


FATHER


Richard Leonard


14 BIRTHPLACE OF


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Margaret Cullen


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17


Informant -


Loonard A


Relation, if any


son


)


A TRUE COPY.


ATTEST:


James Q. Burke


(Registrar of city of town where death occurred)


DATE FILED 2/17/99


.. 19.


18 DATE OF


DEATH


Feb 14/39


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


12/28/38


19


.. , to .......


2/14/39


19


! last saw her ....... alive on


2/14/39


19


death Is said


to have occurred on the date stated above.cat.4.5p


... m.


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


Dateofonset


carcinoma.of ... thetransverse


colon


Enos ...


br ... pneumonia. 2dys


Contributory causes of importance not related to principal cause:


Name of operation


Laparotomy


gatesof/39


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)


J. Rhoes


M. D.


(Address)


Hass Con Ilosp


Date:/15/399


21


Winthrop-Winthrop


Place of Burial, Cremation or Remeyer /39


(City or Town)


DATE OF BURIAL


19


22 NAME OF


UNDERTAKER


R Il White


ADDRESS


Winthrop


Received and filed


19


(Registrar of City or Town where deceased resided)


1


PLACE OF DEATH


PARENTS tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE important. 50m-11-'36. No. 9080-g N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION


50


(If U. S.


War Veteran,


specify WAR)


(a)


Residence. No


(Usual place of abode)


Length of residence in city or town where death occurred


yTs.


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


yrs.


mos.


(write the word)


AGE


this occupation (month and


year)


---


(Address)


RECEIVED


OF TOWN


OFFICE


11 12


9


CLERK


6 5


ASS


ROP


APR-41939 AM


M R-302


Essex


PLACE OF DEATH


Danv (Grunty)


JaquerTomate Hospital


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


Danvers


(City or town making return)


51


Registered No.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


(If deceased Is ormerrit yriowed or divorced woman, give also maiden name.)


Win therh ;VAR).


1


19


mos.


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


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


Feb. 20, 1939


DEATH


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


Dec.


21,


., to ....


Feb. 20 39


I last saw &h.X. alive on ... 19 death Is said to have occurred on the date stated above 8.40A .m.


The principal cause of death and related causes of importance in order of


onset were as follows:


Lobar pneumonia


3 clapetpetonset


Hypertension


I VI


Hypertensive heart disease I Fr


General arteriosclerosis 4 yES


Contribatory causes of importance not related to principal cause:


Name of operation


Date of.


What test confirmed diagnosis ?.. olin ..


Was there an autopsyIO


20 Was disease or injury in any way related to occupation of deceased? .....


If so, specify,


(Signed)


Melvin Goodman


(Address)


Date/21/39


21


Winthrop


Winthrop


(City or Town)


Place of Burial, Cremation or Removal.


DATE OF BURIAL 22, 1939


19


22 NAME OF


UNDERTAKER


Charles R .Bennison


ADDRESS


Winthrop


Received and filed 19


(Registrar of City or Town where deceased resided)


1


No.


2 FULL NAME


(a)


Residence. No


(Usual place of abode)


Length of residence in city or town where death occurred


yrs.


3 SEX


female


4 COLOR OR RACE


white


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


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.


7.77


AGE


Years


Months


Days


8 Trade, profession, or particular,


kind of work done, as spinner,'t


home


sawyer, bookkeeper, etc.


9 Industry or business In which


work was done, as silk mill,


saw mill, bank, etc ..


this occupation (month and


year)


London,


13 NAME OF




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