Town of Winthrop : Record of Deaths 1939, Part 9

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 9


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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