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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