USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 9
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(If death occurred in a hospital or institution, give its NAME instead of street and number)
21
2 FULL NAME
(HB deceasedina married, widoved or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
St., ..
.....
Ward,
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Marriod .
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Mary Chisholm
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 64
AGE
Years
.Months
Days
If less than 1 day Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
carpenter
9 Industry or business In which work was done, as silk mill, saw mill, baak, etc.
10 Date deceased last worked at this occupation (month and year)
12/38 11 Total time (years)GO spent in this occupation.
12 BIRTHPLACE (City)
(State or country)
New Brunswick
13 NAME OF
FATHER
George Hyslop
14 BIRTHPLACE OF FATHER (City) New Brunswick ..
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Smith
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick
17 Hosp Records
Relation, if any
Informant
( Address)
(
A TRUE COPY.
ATTEST: James Q. O Banho
(Registrar of city or town where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Jan 7/39
DEATH
(Month)
(Day)
(Year)
1912/5/58 BY CERTIFY/ That d attended deceased from
I last saw h
.alive on
19
death Is said
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
1
"perforated duodenal ulcer.
12/10/38
"puim, embolus 1/8/89 ...
Contributory causes of importance not related to principal cause:
post opr pulm.atelectasis
Name of operation repair of ulcer
12/10/38
What test confirmed diagnosis?
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
CR Souders
(Signed)
(Address)
605 Comm.Avo
1/8/39
19
Date
21
Winthrop-Winthrop
Place of Burial, Cremation/qr Reggval.
(City or Town)
DATE OF BURIAL filialey
19
22 NAME OF
UNDERTAKER
Winthrop
ADDRESS
Received and filed
1/11/39
19
(Registrar of City or Town where deceased resided)
No.
Robort B Hyslop
.St.,
.......... ...... .Ward
(If U. S.
War Veteran,
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
11/7/319
19
11.15p
., M. D.
Regi
17
1
٠٠
(٢)
3
محـ
المـ
١٧
6
HROP
MAR-9 1939 AM
RM R-305
PLACE OF DEATH
SUFFOLK County) BOSTON
(City or Town)
No ..... Boston City Hosp
St.,
Ward
BOSTON (City or town making return)
Registered No. 196
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME.
hardled, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
(Usual place of abode)
138-Bowdoin
Length of residence in city or town where death occurred
nos.
.St.,.
Ward, Winthro
"nonresident, give city or town and state)
mos. dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, er divorced
HUSBAND of
Mary Gavin
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE.
58
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ...
OCCUPATION
9 Industry or business in which
motorman
work was done, as silk mill,
saw mill, bank, etc .......
10 Date deceased last worked at B E RY
11 Total time (years)
spent in this
occupation.
this occupation (month and
year)
1/39
30
12 BIRTHPLACE (City)
(State or country)
Chelsea
PARENTS
14 BIRTHPLACE muel Terry
FATHER (City)
(State or country) Nova Scotia
15 MAIDEN NAME
OF MOTHER
Elizabeth Hurburt
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Har Scotia
17 Informant (Address)
Relation, if any wife
A TRUE COPY.
ATTEST:
James Q. Burke
(Registrar of city or town where death occurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Jan 8/39
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
20 If death was due to external causes (VIOLENCE) fill in the following:
Accident,
Suicide or
Date of Injury
.19
Homicide?
Where did Injury occur?
{City or town and State)
Manner of
Injury
Nature of Injury
Was there an autopsy?
21 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D.
19
Boston
1/8/39
22
Place of Burial. Cremation or Removal.
(City or Town)
DATE OF BURIAL
1/11/39
28 NAME OF
UNDERTAKER
ADDRESS
R H White
Received and filed
Winthrop
19
(Registrar of City or Town where deceased resided)
25m-11-36. No. 9080-h
1
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(L U. S. War Veteran,
22
specify WAR)
days. How long in U. S., if of foreign birth?
yrı.
.Years. Months .Days
If less than 1 day Hours. .Minutes core, hemorrhage -treated for hypertensio "admitted in coma died in 4 hours
13 NAME OF
FATHER
(Signed)
(Address)
T Leary
Date
Winthrop-Winthrop
19
0
IM R-302
1
SUFFOLK BOSTON
(CityesToysheral Hospt
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON (City or town making return) 426 23
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
JEGceasedfre]married, widowed or divorced woman, give also maiden name.)
Wineit JAR)
(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?
утв.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
Colored
5 SINGLE
(write the word)
Marriod
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced Blanche Smith
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 65
9
10
AGE
Years
Months
Days
If less than 1 dey .Hours .. .. Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. building
9 Industry or business in which
work was done, as silk mill.
saw mill, bank, etc ..
10 Date deceased last worked at11/38
this occupation (month and
year)
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
(State or country)
Hamilton Bermuda
13 NAME OF
FATHER
Richard Boan
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Hamilton-Dormuda
(State or country)
15 MAIDEN NAME Abilena Smith OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
Tanilton Bermuda
(State or country)
Rolftion, if any (
-
A TRUE COPY.
ATTEST:
James Q. Burke
Registrar of city of town where death occurred)
DATE FILED 19
19 I HEREBY CERTIFY, That I attended deceesed from
1/9/39
I last sawian
alive on
1/13/39
19
death is seid
to have occurred on the date stated above, f.p. .m. The principal cause of death and related causes of Importance in order of onset were es follows:
Dateofonset
cardiac hypertrophy & dilatation
syphilitis aortitis with cong
failure
Contributory causes of importance not related to principal cause:
pulm.infarction .. bilateral
4dys.
Name of operation
Date of
What test confirmed diagnosis?
Was there en autopsy?es
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Sigile@ ...... Baker
(Address)
ss Gen.Hosp
1/14/30
.. 19.
M. D.
21
Winthrop Winthrop
Place of Burial, Cremation br Removal.
(City or Town)
DATE OF BURIAL
1/16/39
19
22 NAME OF
R H White
UNDERTAKER
ADDRESS
Winthrop
Received and filed
1/17/39
19
(Registrar of City or Town where deceased resided)
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa-
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.
50m-11-36. No. 9080-g
PLACE OF DEATH
No.
Robert Bean
St.,.
..........
.Ward
(If U. S. War Veteran,
.St.,.
..........
. Ward,
(If nonresident, give city or town and state)
18 DATE OF
DEATH
Jan 13/39
(Month)
(Day)
(Year)
,19 ........ , to ..
1/13/39
19
Janitor
17 Informant ( Address)
7 6 5
N
IROP MAS
MAR-01939 /H
Middle sex
PLACE OF DEATH
Cambiare
Chorizoegate Hosp.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Cambridge
(City or town making return)
Registered No.
45
(If death occurred in a hospital or institution,
Ward
give its NAME instead of street and number)
(L U. S.
War Veteran,
21
(a)
Residence.
No
(Usual place of abode)
Length of residence in city or town where death occurred
yTs.
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
Jan 15 1939
DEATH
(Month) (Day)
(Year)
19
JaHEISEBY CERCAFY . That! attended deceased f
im
19.
Jun 15
39
, 19
19
death Is said
I last saw h ..
alive on.
10 10
m.
to have occurred on the date stated above,
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Atelectases
2days
Contributory causes of importance not related to principal cause:
Prematurity
2 .... days
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)
Joseph H Meger
M. D.
(Address) 270 Commonwealth Live. 1/15/39
21
Kennesetty Israel Cem.Woburn
Place of Burial, Cremation or
Removal.
(City or Town)
DATE OF BURLAYan 16 1939
19
22 NAME OF
Manuel Stanetsky
UNDERTAKER
10 Washington St. Dor.
ADDRESS
Jan 17 1039
Received and filed
.19
(Registrar of City or Town where deceased resided)
1
No.
2 FULL NAME
3 SEX
(or) WIFE of
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
PARENTS
OCCUPATION
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Informant
(Address)
A TRUE COPY.
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.
50m-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)
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.
2
7 AGE Years Months Days
If less than 1 day Hours Minutes
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 at
11 Total time (years)
spent in this
occupation
Cambridge
Mass.
13 NAME OF
FATHER
Lewie
Cambridge
Mass.
Ethel Herman
Cambridge
Mass .
17 Lewis Kasonof
ATTEST :.
Jan 17 1939
(Registrar of city or town where death occurred)
DATE FILED 19
St.,
Kasonof
( & ces of phim. whiredor divorced woman, give also maiden name.)
.St.,
Ward,
(If nonresident, give city or town and state)
IM R-302
this occupation (month and
year)
5
6
FEB1.00079 AM
RM R-302
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
PLACE OF DEATH
SUFFOLK BOSTON (County)
(Citypps Jeon City Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
BOSTON
(City or town making return)
601
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Augusta Porter
(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?
YTI.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Larry Portof
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE Years Months Days
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,
At Home
10 Date deceased last worked at
11 Total time (years).
spent in this
occupation.
this occupation (month andSept 1938 year) Boston Lass
Theodore Hellberg
Swoden
Augusta Andereon
Sweden
Harry Portor
Relation, if any JAIST
(Address)
211 Cliff Ave Winthrop
ATTEST: James Q. Quanto
(Registrar of city or town where death deCurred)
DATE FILED 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jan.20 1939
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
September .... 9 ......
19.3.3, to.
Jan.20
19 .... 39
I last saw h ............ alive on .. 19 death Is said to have occurred on the date stated abovepat1.5p ....... m. The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonsel
Carcinoma of cervix
Contributory causes of importance not related to principal cause:
"Kotustasis
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)
M 17"O"Connell
(Address)
Boston City Hoopt
Date
1-21
19 ..
21
Place of Buffel, Cremation yor Removal.
(City or Town)
DATE OF BURIAHAT -- 23
19 g
22 NAME OF
Edward M Fitzgibbon
UNDERTAKER
ADDRESS
1428 Dorchostor Avo Dorchestor
Received and filed
Jan.24
13.9
James A Burke
(Registrar of City or Town where deceased resided)
(If U. S.
War Veteran,
specify WAR)
Winthrop
25
(If deceased is a married, widowed or divorced woman, give also maiden name.)
211 Cliff Ave
.St.,
........
Ward,
(If nonresident, give city or town and state)
St.,
.Ward
1 No. 2 FULL NAME 3 SEX Female (or) WIFE of 50 12 BIRTHPLACE (City) (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) (State or country) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) 17 Informant A TRUE COPY. tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE saw mill, bank, etc ..
If less than 1 day
Hours.
Minutes
M. D.
6
THROP
TAR-91939 AR
RM R-305
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No ..
826 25
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
George ...... Tensley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S. War Veteran, specify WAR)
(a) Residence. No949-Shore Drive
(Usual place of abbder
Length of residence in city or town where death occurred
mos.
days. How long in U. S., if of foreign birth?
yra.
moI.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Worried
18 DATE OF
DEATH
Jan .26/39.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
cerebral hemorrhare-said to have
collapsed suddenly
natural .... causes
20 If death was due to external causes (VIOLENCE) fill in the following:
Accident,
Suicide or
Homicide?
Date of Injury
.19
Where did
Injury occur?
(City or town and State)
Manner of
Injury
Nature of
Injury -
Was there an autopsy?
21 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Address)
Boston
1/28/39
.. 19
22
Place of Burial. CremationthPop Winthropy or Town)
DATE OF BURIAL
1/20/30
19
23 NAME OF
UNDERTAKER
HI white
ADDRESS
winthrop
Received and filed.
1/00/39
19
(Registrar of City or Town where deceased resided)
25m.11.'36. No. 9080-h
A TRUE COPY.
ATTEST
(Registrar of city or town where death occurred)
DATE FILED
...... .......... 19
MEDICAL CERTIFICATE OF DEATH
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of nee full)
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 57 .Years Months 20 .. Days
If less than 1 day Hours .. .Minutes
OCCUPATION
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ......
RR Machinist
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
1/39
11 Total time (years)
spent in this
occupation .....
12 BIRTHPLACE (City) (State or country)
England
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Harriet Judkins
Borland
17
Informant
(Address)
Relation, if any
- wifo
M. D.
(Signed)
CJ O'Leary
Date ...
1
(City or Town)
No ..... EnRouteto ... Boston City ...... Hosp ....... St.,
Ward
.St.,.
...........
.. Ward,
(Ir nonresident, give city or town and state)
13 NAME OF
FATHER
John Tansley
VI
6
HROP. MASS
MAR -91039 AM
RM R-305
PLACE OF DEATH
SSUFFOLK BOSTON (County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON (City or town making return) 900 22
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME. ... Rome .Lecours dif deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence.
No .. 63.Sea View Ave
St.,
Ward, Winthrop
(If nonresident, give city or town and state)
mos. dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month) 27/39 (Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
coronary sclerosis
natural causes
20 If death was due to external causes (VIOLENCE) fill in the following:
Accident,
Suicide or
Homicide?
Date of Injury
.19
Where did
Injury occur?
(City or town and State)
Manner of
Injury
Nature of
Injury
Was there an autopsy?
21 Was diseasa or injury in any way related to occupation of deceased? If so, specify.
(Signed)
M. D.
(Address)
Date
19
22
Boston
1/28/39
Place of Burial. Cremation or Removal.
(City or Town)
DATE OF BURIAL
Winthrop-Winthrop
19
23 NAME OF
UNDERTAKER
1/31/39
ADDRESS
IT OrNaley
Received and filed
1/31/39
Winthrop 19
DATE FILED
19
25m-11.36. No. 9080-h
55
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, atc .... salomon
9 Industry or business In which work was done, as alk mill, saw mill, bank, etc ..
10 Data deceased last worked at
this occupation (month and
year)
1/39
11 Total tima (years)
spent in this
occupation ....
12 BIRTHPLACE (City)
(State or country)
Montreal Canada
PARENTS
(State or country) Canada
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
Relation, if any
17
Informant
(Addrem)
wife
A TRUE COPY.
ATTEST:
James Q. Burke
(Registrar of city or town where death occurred)
-
Ward
(If U. S. War Veteran, specify WAR)
(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? yrı.
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
5a If married, widowed, or divorced
HUSBAND of
Larried
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE. Years Months Days
If less than 1 day Hours. Minutes
13 NAME OF
FATHER
14 BIRTHPLACE op harles Lecours
FATHER (City)
Criza Dumont
(Registrar of City or Town where deceased resided)
1
No. MyRoute Boston City Hosp St., ........
1
6 5
THROP.
MAR-21032 AH
OCCUPATIONI is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state PARENTS
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
CORR. BR. 2 DEP. 0/
To be filed for burial permit with Board of Health or its Agent. Registered No. 28
- (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Isaac F. Pollard
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No. 70 Prospect
(Usual place of abode)
Ave St.,
Ward,
Length of residence in city or town where death occurred
35yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
A. MCLEAN
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
Sophia Meteod Pollard
(Give maiden name of wife in full)
If less than 1 day
Hours.
Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. Clerk
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
Dry ..... Goods
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
spent in this
year)
Jan.1919
occupation .. 4.0
12 BIRTHPLACE (City)
Rockland
(State or country)
Massachusetts
13 NAME OF
FATHER
Isaac Pollard
14 BIRTHPLACE OF
FATHER (City)
Rockland
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Lydia Stinston
16 BIRTHPLACE OF
MOTHER (City)
Rockland
(State or country)
Massachusetts
17
Florence S. Pollard (Daughter
Informant
(Address)
70 Prospect Ave Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed with me BEFORE the burial or transit permit was issued:
Wm.Nchildren
(Signature of Agent of Board of Health or other)
Jeb3 /39
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Feburary 1, 1939
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY That I attended deceased from
november 30 1938+
February 1
1939
I last saw humm alive on
February /, 1939, death is said
to have occurred on the data stated above, at.
7:39 9mm.
The principal cause of death and related causes of importance in order of onset were as follows:
Dateofonset
Intestinal Mestructuras &
operation Therefore
1/28/39
Contribatory canses of importance not related to principal causa:
Carcinoma of transverse colou
General Carcinomatoris
Senility
1938 1939. 1938
Name of operation
Colostorny
Date
Jan 31/39.
What test confirmed diagnosis? Chinicely
Was there an autopsy?o
labrating
20 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
2/3189.
Jacob abrams
M. D.
(Address) 562 Hurley 7. Date
Winthrop, Mars
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or town)
DATE OF BURIAL Feburary 3, 1939
19
22 NAME OF
UNDERTAKER
Richard N. Website
ADDRESS.
147 Winthrop St Winthrop Mass
19
Received and filed
FEB 3
-1939
(Registrar)
75m-2-'30. No. 7997-a
Winthrop
1
(City or Town)
No. 70 Prospect
3 SEX
Male
4 COLOR OR RACE
White
6 IF STILLBORN, enter that fact here.
7
AGE
87
Years
5
Months
1.3 Days
WIRD W ALIWWANLIYL ALVORD. LVery Item of
(or) WIFE of
(Husband's name in full)
(If U. S.
1
War Veteran,
specify WAR)
(If nonresident, give city or town and state)
1 R-301 A 13
...
Revised United States Standard Certificate of Death
Statement of occupation .- Precise statement of oceupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the 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 business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write 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 what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
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