Town of Winthrop : Record of Deaths 1939, Part 86

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 86


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NOV 141939 年


Si


8


ERK


GL


٢٠٠


1.12


110


0211-023


R-302


1


PLACE OF DEATH


(County) Boston


(Cificos BoKroneral Hosp


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


BOSTON


(City or town making return) 1757


2 Registered No


(If death occurred in a hospital or institution,


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


Ward


give its NAME instead of street and number)


2 FULL NAME


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


GS1 Winthrop


St.,.


......


Ward,


Winthrop


(If nonresident, give city or town and state)


Length of residence in city or town where death occurred


JTs.


mos.


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


JTI.


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


Louise Dolan


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IFASTILLBORN, enter that fact here.


7 AGE Years Months Days


If less than 1 day


Hours


Minutes


pipe Titter


OCCUPATION


8 Trade, profession, or particular


kind of work done, as spinner, Hosp


sawyer, bookkeeper, etc ....


9 Industry or business In which work was done, as silk mill, saw mill, bank, etc.


10 Date deceased last worked at


11 Total time (years)


spent in this 15


10/39


occupation


12 BIRTHPLACE (City).


Boston


(State or country)


13 NAME OF


FATHER


Patrick Sheerin


14 BIRTHPLACE OF


FATHER (City)


Iroland


(State or country)


15 MAIDEN NAME


OF MOTHER


Susan Sheehy


16 BIRTHPLACE OF


MOTHER (City)


Ireland


...... (State or country)


17 Frances Monti


Relation, if any sister


Informant


(Address)


A TRUE COPY. ATTEST: James Q. Binche


Registrar of city or town where death occurred)


DATE FILED 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Oct 13/39


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from 10/8/39 ........


.19


to ...


10/13/39


19


I last saw h.1.m .... alive on10/13/.59


19


death Is said


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


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


Daleofonsel


"dissect.aneuris of the sorta


with rupture


of the pericardial


cavity


Sdys


Contributory causes of importance not related to principal cause: coronary heart dis. 1yr


Name of operation


Date of.


What test confirmed diagnosis?


Was there an autopsyt.es ..


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


If so, specify.


(Signed)


.C .... Bakor


(Address) Hace Con Hosp


Date.


Dat 10/12/20


.. 19.


21


Place of Burial, Cremation of


(City or Town)


DATE OF BURIAL


10/16/39


19


22 NAME OF


J . O'laley


UNDERTAKER


ADDRESS


winthrop


Received and filed ).


20/17/20 0


1


19


(Registrar of City or Town where deceased resided)


V


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 PARENTS


important.


euHolk


No.


James J Sheerin


(L U. S.


World


War Veteran,


specify WAR)


(a)


Residence.


No.


(Usual place of abode)


50m-11-36. No. 9080-g


M. D.


this occupation (month and


year)


RECEIVE


OF TOWN


11 12


41/ M


7211


.. .


6


THROP F


NOV 2 91933 AM


R-302


PLACE OF DEATH


(County)


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


(City or town making return) 89967 218


Registered No.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Gerald Jenkins


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


51.Ingleside .Ave


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


mos.


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


JTs.


mos. days.


PERSONAL AND STATISTICAL PARTICULARS


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


5a If married, widowed, or divorced


HUSBAND of


Amelia ... M ... Swift


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


14


Days


If less than 1 dey


Hours.


Minutes


plumbing Inspector


Town Winthrop


11 Total time (years) O spent in this occupation


15 MAIDEN NAME


OF MOTHER


Martha Mallinsoon


17 Relation, if any wife


)


(Registrar of city or town where death occurred)


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


MEDICAL CERTIFICATE OF DEATHI


18 DATE OF


DEATH


Got 21/39


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I ettended deceesed from


10/20/39


,19


.... , to ...


10/21/39


, 19.


I last saw him .... alive on.


10/21/3 ....... 19.


death Is seid


to have occurred on the date stated above, at ... 5 ... 55pm. The principal cause of death and related causes of importance in order of onset were es follows:


Dateefonset


ax gangrenous appendicitis with


opr ... therefor


10/39


.localized peritonitis


bi lateto que of importance not related to principal cause: "pneumonia


chr pyelonephritis


10/20/3!


1937


appendectomy


10/29/39


Name of operation


Dete of.


What test confirmed diagnosis?


Was there an autopsy ?.


yes


20 Wes disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


C A Powell


M. D.


(Address)


Date 10/22/38


Mass Mem. Hosp


21


Place of Burial, cremathrop linthropcity or Town)


DATE OF BURIAL


10/24/39


19


22 NAME OF


UNDERTAKER


C R Bennison


ADDRESS


Winthrop


10/25/39


Received and filed.


19


(Registrar of City or Town where deceased resided)


1 (City or Town) (a) Residence. No .... (Usual place of abode) 3 SEX 4 COLOR OR RACE M 141 6 IF STILLBORN, enter that fact here. 7 AGE Yeers 66 1 Months 8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .. 9 Industry or business In which work was done, es silk mill, saw mill, bank, etc. 10 Date deceased last worked at this occupation (month end 10/39 OCCUPATION year) 12 BIRTHPLACE (City) (State or country) England 13 NAME OF FATHER Henry Jenkins 14 BIRTHPLACE OF FATHER (City) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) England Informant (Address) A TRUE COPY. 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. DATE FILED 50m-11. 36. No. 9080-g ... D. WRITE THATINEK, WITTE ONPAVING INA ITIS IS A PERMANENT RECORD. Every Item of informa- (State or country) England


No .. Mass. .Memorial .Hosp.


.......


.......


.St.,


.Ward


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


.St.,.


Ward,


Winthrop.


(If nonresident, give city or town and state)


0


11 17


GL7


OF


7


6


NOV 291023 AM


M R-302


PLACE OF DEATH


(County) Roston


(CitparTom)City Hosp


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


BOSTON


(City or town making return)


Registered No. 219


give its NAME instead of street and number) - (If U. S. War Veteran, -


(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


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Single


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


AGE Years Months Days


If less than 1 day


Hours


.Minutes


at home


8 Trade, profession, or particular


kind of work done, as spinner,


sawyer, bookkeeper, etc ...


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


10 Date deceased last worked at8/39


this occupation (month and


year)


11 Total time (years)


spent in this


occupation.


12 BIRTHPLACE (City).


Clifton Springs NY


Petor Lavolle


14 BIRTHPLACE OF


FATHER (City)


Ireland


15 MAIDEN NAME


OF MOTHER


Cavanaugh


Ireland


17 Mrs Ida McDermott


Relation, if any (


V


(Registrar of city or town where death occurred)


DATE FILED 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Oct 23/39


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


7/2/05


,19


10/23/39


19


I last saw h


... alive o


19


death is said


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


The principal canse of death and related causes of Importance in order of onset were as follows:


Dateofonset


"Ert.setor heart die. with


auriculrr fibrillation


decompensation cardiac asthma


yr


Contributory causes of importance not related to principal cause: art.solor.gangrene 12wks


ampt.rt ler-mid thich


Name of operation turmo9/9/59-shin


2/39


Daty/of


What test confirmed diagnosis?part ..... Was there an autopsy?


20 Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


J V Sacchetti


M. D.


(Address)


City Hosy


Dat20/23/39


21


Holy Cross Malden


Place of Burial, Cremation or


10/23/39


(City or Town)


DATE OF BURIAL


19


22 NAME OF


UNDERTAKER


F F Hill


ADDRESS.


Everett


10/26/39


Received and filed


19


(Registrar of City or Town where deceased resided)


1 No. 2 FULL NAME 3 SEX (or) WIFE of 7 OCCUPATION (State or country) 13 NAME OF FATHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Informant ( Address) A TRUE COPY. ATTEST: important. 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 50m-11.'36. No. 9080-g N. B .- WRITE PLAINLY, WITH ONFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country)


Suffolk


Julia Lavolle


St.,


Ward


gigigreased is a married, widowed or divorced woman, give also maiden name.)


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


Ward,


Winthrop


(If death occurred in a hospital or institution,


specify WAR)


(If nonresident, give city or town and state)


.. , to


- FEIVE


OF


11 12


6


IRGP


NOV 291033 AM


1 R-301A


PLACE OF DEATH


Suffolk (County)


Winthrop


(City or Town)


258 Court Road


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


CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Registered No.


220


XX


f (If death occurred in a hospital or institution,


St.,


Ward ( give its NAME' instead of street and number)


2 FULL NAME


Emily Lurenda (Brewster) Newton


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


(If U. S.


War Veteran


specify WAR)


(a) Residence.


No ...


258 Court Road


(Usual place of abode)


Ward,


(If nonresident, give eity or town and state)


Length of residence in city or town where death occurred


50


years


months


days.


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


years


months


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Nov


(Month)


(Day)


(Year)


5a If married, widowed, or divorced


HUSBAND of


Edward Bartlett


(Give maiden name of wife is full on


(Husband's name in full)


6 IF STILLBORN, enter that fact here.


7


86


2


Months


Days


22


If less than 1 day


Hours


.Minutes


8 Trade, profession, or perticular


kind of work done, as spinner,


sawyer, bookkeeper, etc ..


House work


9 Industry or business in which


work was done, as ailk mill,


saw mill, bank, etc.


Own home


10 Date deceased last worked et


1 1 Total time (years)


this occupation (month asdept. 1939


spent in this


65


year)


occupation.


12 BIRTHPLACE (City) ..


East ..... Boston


(State or country)


Lassachusetts


13 NAME OF


FATHER Daniel Brewster


FATHER (City)


Tamworth


(State or country)


New Hampshire


15 MAIDEN NAMESarah Marden OF MOTHER


16 BIRTHPLACE OF


MOTHER (City)


Portsmouth


(State or country)


New Hampshire


17 Allen E Newton


Relation, if any


Place of Burial, Cremation of Remove 19zgor


DATE OF BURIAL


November


19


22 NAME OF


Charles R. Bennison


UNDERTAKER


ADDRESS


Winthrop Mass


Received and filed ... 19


(Registrar)


100m 11-36. No. 9080-F


I HEREBY CERTIFY that a satisfactory standard certificate of deeth was filed with me BEFORE the burial or grensit permit wes Issued:


...


(Signature of Agent of Board of Health of other)


11/3/39


( Date of Issue of Permit )


19 I HEREBY CERTIFY, That i attended deceased from


Mar


14


1929


., to ..


NN


1939


1


I last saw her allve on


No


1939, death is said


to have occurred on the date stated above, at 2:25 P. m.


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


were as follows:


Date of Ontet IMPORTANT


Mar 14 1929


Contributory causes of Importence not related to principal cause:


Name of operation


home


What test confirmed diagnosis Obratio.


.. Was there an eutopsy ?.!


No


20 Was disease or Injury in any way related to occupation of deceased? No


If so, specify Samand B Parker


(Signed)


M. D.


(Address).


Withund Man


Date Nov 2 1939.


21 ...


Woodlawn .Cemetery


Everett


Town)


Informant


(Address)


258 Court Rd, Winthrop Mass


Healthe Officer


1 No 3 SEX Female (or) WIFE of AGE Years OCCUPATION PARENTS 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 tion should be carefully supplied. Age should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH (Official Designation) N. B .- WRITE PLAINLI, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of informa- 14 BIRTHPLACE OF


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widowed


1939


.Date of.


VMMONWEALTH OF MA SACHUISETT


Statement of occupation. Precise statement of occupation is very Important, so that the relative healthfulness of various pur. suits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changel 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 OF 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 deecased 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," ete. Find out the partic- ular kind of work done and return that, as SPINNER, WEAVER, CtC.


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 M11.L, etc.


Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as CIVIL ENGINEER, MECHANICAL ENGIN- K.E.R. MINING ENGINEER, STATIONARY ENGINFER, etc. . Avoid the term "laborer" when a more precise statement of the occupation can be seeured. 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 earher morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.


Example


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


Date of Onset


Arteriosclerosis


1915


....


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 canse may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.


RETURN OF CERTIFICATES OF DEATH A physician or registered hospital medical officer shall forth- with, aber the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his sup. posed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . GEN. LAWS, C'HAP. 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 hody 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 die; 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 afoirsaid or from the elerk of the town where the body is huried. No such permit shall be issued nntil there shall nave been delivered to such board, agent or elerk, 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. amired 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 violenec, 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 he 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 he 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 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 .- CHAF. 114. SEC. 45, G. L. (TER- CENTENARY EDITION. )


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. . .- GEN. LAWS, CHAP. 38. SEC. 6.


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


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


Every item of informa-


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


1


PLACE OF DEATH


Suffolk (County)


Iinthrop (City or Town)


No. 105 Ocean View St.


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.


Registered No.


221


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


2 FULL NAME


Charles Alfred Roberts


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


(If U. S.


War Veteran


specify WAR)


(a) Residence.


No.


105 Ocean View


St.,


Ward,


(If nonresident, give city or town and state)


Leoxtb of residence in city or town where death occorred


54


"years


months


days.


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


years


months


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATHI


8 SEX


Male


4 COLOR OR RACE


/hite


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


ba If married, widowed, or divorced


HUSBAND of


Jane argaret McDonald


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 IF STILLBORN, enter that fect here.


7 54


AGE


.Years


7


Months


2.1 .. Days


If less than 1 dey


Hours.


.. Minutes


OCCUPATION


sawyer, bookkeeper, etc.


9 Industry or business in which Boston. Revere Beac work was done, as ailk mill, & Lynn 'RR saw mill, bank, etc.


10 Date deceased last worked at


11 Total time (years)


this occupation (month and v. 1939


yeer)


spent in this


occupation


36


12 BIRTHPLACE (City)


East Boston


(State or country)


Massachusetts


13 NAME OF


FATHER


Hugh William Roberts


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Liverpool


(State or country)


England


15 MAIDEN NAME


OF MOTHER


Margaret Edwards


16 BIRTHPLACE OF


Liverpool


MOTHER (City)


(State or country)


England


17 Ann Jane Roberts


Informant


(Address)


105 Ocean View St Winthrop


I HEREBY CERTIFY that e satisfactory stendard certificate of deeth was Med with me BEFORE The burial or transit permit wes issued: Nam-D' Auldress (Signature of Agent of Bortd & Health or other)


The alte officer


(Official Designation) (Date of Issue of Permit) 11/9/39


21.


Winthrop Cemetery Winthrop


Relation, if any


Place of Burial, Cremation or Removal


(City or


Town)


( ..... sister


DATE OF BUR


November 10 1939


19.


22 NAME OF


Charles R. Bennison


UNDERTAKER ....


ADDRESS


Winthrop Mass


Received and , flød.


19


(Registrar) V


18 DATE OF


DEATH


Nov


7


1939


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That I attended deceased from


Nor


4


1939, to ..


7


1939


I last saw h.k .......... alive on.


,


7


1939, death Is said


to have occurred on the date stated above, at11: 25 Pm. The principal cause of death and related causes of Importance In order of onset were as follows:


Nov4 1999


Contributory causes of Importance not releted to principal cause:




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