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
AĞ
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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