Town of Winthrop : Record of Deaths 1940, Part 27

Author: Winthrop (Mass.)
Publication date: 1940
Publisher:
Number of Pages: 494


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 27


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70


SPACE FOR ADDITIONAL INFORMATION


R-301 A Sulbolle County) Winthrop I


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. 87


Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)


Daniel Joseph Moriarty


(If deceased is a married, widowed or divorced woman, give also maiden name.) 3797 Pleasant


St.


(If nonresident, give city or town and state) In this community &Gyrs.


mos.


days.


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH.


april


30


1940


(Month)


(Day)


(Year)


19 IHEREBY CERTIFY. That I attended deceased from


apr. 23


19.9.0 .. , to .........


afer. 20


19.5.6.


I last saw h.IM alive on Cfr. 29, 1940, death is said to have occurred on the date stated above, at ................. m. Immediate cause of death .... Duration IMPORTANT Duodenal Ulcer with hasmarsha:


Due to


Due to


....


Other conditions


asthing


(Include pregnancy within 3 months of death)


Major findings : Of operations


Date of .....


Of autopsy


none


What test confirmed diagnosis ?. Clinical


20 Was disease or Injury In any way related to occupation of deceased? RO- If so, specify ....


(Signed)


Enos E. Koura


M. D.


(Address) East Borte


Thay/ 1940


Place of Bufial, Cremation or Removal.


DATE OF BURIAL ...


may


22 NAME OF


FUNERAL DIRECTOR M. OF


Kelly


ADDRESS


11 meridian Stl, JE.13.


Received and filed


19


(Registrar)


100m-10-'39. No. 8427-e


(City or Town)


379A Pleasant


No ..


2 FULL NAME


(a) Residence. No ..


(Usual place of abode)


Length of stay: In hospital or institution ...


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


4 COLOR OR RACE


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


3 SEX


Male white


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


64


6 Age of husband or wife if alive.


7 IF STILLBORN, enter that fact høre.


8


64


If less than I day


AGE


Years


Mont'as


Days


Usual


Salesman


9 Occupation:


Industry


10 or Business:


11 Social Security No.


none


12 BIRTHPLACE (City)


1902 lor


(State or country)


mass.


14 BIRTHPLACE OF


Boston


FATHER (City)


(State or country)


Mass.


16 BIRTHPLACE OF


PARENTS


MOTHER (City)


(State or country)


Deland


Informant


(Address)


379 A. Pleasant St; Whu.


information should be carefully supplied. AUE should be stated LAACILI. PHYSICIANS should state


13 NAME OF


FATHER


John M. Moriarty


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION


is very important. See instructions and extracts from the laws on back of certificate.


(write the word)


Married


Alice Corbett


years


Hours


Minutes


15 MAIDEN NAME


OF MOTHER


Delia Connora


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial oz transit permit was issued: M. D. Childrens (Signature of Agent of Board of Health ofother)


health officer 5/2/40


(Official Designation) (Date of Issue of Permit)


15 zes.


PHYSICIAN Underline the cause to which death should be charged sta- tistically.


17 Alice Moriarty Relation, 'if any 21 St Josephis Boston (City or Town) 1940


PLACE OF DEATH


St. 1


(If U. S. War Veteran, specify WAR)


years


months


days.


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forth with, after 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 regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dicd, defined as required by section one, where same was contracted. the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been huried, 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 died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the hody is huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may he, a satisfac- tory written statement containing the facts required by law to he returned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required hy law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be 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 removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hercunder. 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 appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can he obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)


No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do from the hoard of health or its agent appointed to issue such permits, or If there is no such board. from the clerk of the town where the body Is to be burled 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 observ- ance 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 ill- ness from disease unrelated to any form of injury.


(2) Board of Ilealth physicians will certify to such deaths only as those of persons who, though disahled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death Is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting scptice- mia), and by the action of chemical (drugs or poisons), thermal. or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related te occupa- tion, the sudden deaths of persons net disabled by recognized disease, and those of persons found dead.


Statement ef Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia. etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.


Statement of Occupatien .- Precise statement of occupation is very important. so that the relative healthfulness of various pursuits can be known. Make some entry in this section for cvery person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual 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. 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.


SPACE FOR ADDITIONAL INFORMATION


A R-301 A Suffolk (County) Wünscht 1


(City or Town)


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


STANDARD CERTIFICATEOF DEATH


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


Registered No ..


88


St.


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


(If U. S. War Veteran, specify WAR)


...........


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution.


years


months days.


(If nonresident, give city or town and state) In this community3


mos.


days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


White


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Female


5a If married, widowed, or divorced HUSBAND of


(or) WIFE of


(Husband's name in full)


55


.years


If less than I day


.Days Hours Minutes


Usual


9 Occupation: Industry 10 or Business:


...............................


1I Social Security No.


12 BIRTHPLACE (City)


(State or country)


Birmingham


13 NAME OF


FATHER


francis. A. Davis


14 BIRTHPLACE OF FATHER (City) (State or country)


15 MAIDEN NAME


OF MOTHER


Elizabetto Goademás


16 BIRTHPLACE OF MOTHER (City) (State or country)


17 Chelf.J.Quinlan


Relation, if any


Informant (Address) 123 Burg are writing


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Man. D. Children (Signature of Agent of Board of Health or other) Realthe fficer 5/2/40 (Official Designation ) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH.


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY That I attended deceased from


19. J .. . , to ...


20, 19144


hla alive all 28, 1944, death is said .m. to have occurred on the date stated above, at &,YSP. Immediate cause of death


Duration IMPORTANT


3 cm


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


Major findings : Of operations


PHYSICIAN Underline the cause to Date of .. Of autopsy which death should be charged sta- What test confirmed diagnosis ?. -


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


If so, specify


(Signed)


,


M. D.


(Address)


Lake Vicio. Cochituate


21


Place of Burial, Cremation or Removal. DATE OF BURIAL 19.2.


NAME OF FUNERAL DIRECTOR


ADDRESS


winther


Roceived and filed 19


( Lake View- Com


(Registrar)


100m-10-'39. No. 8427-e


information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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


PLACE OF DEATH


123 Queries cover No. marlon. Goodwin


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden namey) 123 @umay Cuer Wind Max


30 1940


(Give maiden name of wife in full)


6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.


AGE


8 76 Years Months


PARENTS


England


......


1940


2 me(City or Town)


tistically.


...


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other anthorized person or of any member of the family of the deceased, furnish for regls- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dicd, 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, Chap. 46. Sec. 9.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom & human body which has not heen 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 died ; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until therc shall have been de- livered to such board, agent or clerk, as the case may be, a satisfao- tory written statement containing the facts required by law to he returned and recorded, which shall be aceompanled, In case of an original interment, hy a satisfactory certificate of the attending physiclan. If any, as required by law, or in lieu thereof a certificate as hercinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or Is insufficient, a physician who is a member of the board of health, or employed hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy violence, the medical exani- iner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enongh for the purpose, the certificate of death made as above provided and In the possession of the undertaker desiring to make such removal shall constitute a permit for sucb removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six bours after such removal, nnless a permit in the usual form for the removal of such body has been sooner ohtalned hereunder. If the death certificate contains a recital, as required by sectlon 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 appear upon the permlt. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign It and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Ses. 45, G. L., (Tercentenary Edition.)


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 Ita 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 hurled or the funeral is to be held, or from a person appointed to have the care of the cemetery or burlal ground in which the interment is made .... Chap. 114, Soc. 46. G. L., (Tereentenary Edition)


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the ebserv- ance of the following rules of practice :


(1) Attending physiclans will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness 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 discase nn- related to any form of Injury, have died without recent medieal attendance or whose physician is absent from home when the certificate of death Is needed.


(8) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or Indirectly by traumatism (including resulting septice- mia), and by the actlon of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortlon, but also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. Az principal cause name tbe disease causing death. As related causes, name earlier morhld con- ditiona, if any, related to the principal cause and any important complieation of the principal cause.


Statement of Occupatien .- Precise statement of occupation 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 discase causing death, report the usual occupation prior to Illness. If the deceased had retired from husl- ness, report the usual occupatlon 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. For a person engaged In domestic service for wages, however, designate the occupation by the appropriate terms, as howcokesper-private family, cook-hotel, etc. For a person wbo bad no oceupation whatever write nonc.


SPACE FOR ADDITIONAL INFORMATION


R-302


PLACE OF DEATH


WORCESTER


(County)


RUTLAND


(City or Town)


No. Rutland State Sanatorium


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


RUTLAND (City or town making return)


Registered No.


68


(If death occurred in a hospital or institution,


..... St. { give its NAME instead of street and number):


2 FULL NAME


John Thomas Bradley


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


24 Dolphin Avenue


St.


Winthrop, lass.


Length of stay: In hospital or institution.


1


years


1


months 20 days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


fale


4 COLOR OR RACE 5 SINGLE


MARRIED


White


WIDOWED


or DIVORCED


(write the word)


Single


18 DATE OF


DEATH.


April


30


1940


(Month)


(Day)


(Year)


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive.


7 IF STILLBORN, enter that fact here.


AGE


8


31


Years


7


6


Months


I


If less than 1 day


Hours


Minutes


Usual


9 Occupation:


Physician


Industry 10 or Business:


11 Social Security No.


12 BIRTHPLACE (City)


Winthrop


(State or country)


tas's"


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


20 Was disease or Injury In any way related to occupation of deceased ?


If so, specify


(Signed)


Paul Dufault


M. D.


(Address).


State San Jutlandbate 4/30 19 40


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Winthrop, inthrop, lass


(City or Town)


DATE OF BURIAL


(Cemetery)


lay 3,1940


19


22 NAME OF


John F. O'laley


FUNERAL DIRECTOR


ADDRESS


Winthrop ass.


19


(Registrar of City or Town where deceased resided)


50m-10-'39. No. 8427-f


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Philadelphia


(State or country)


Penn.


15 MAIDEN NAME


OF MOTHER


Margaret A. Sullivan


16 BIRTHPLACE OF


MOTHER (City)


oston


(State or country)


lass


17 State San.records


Relation, if any


Informant


(Address)


"ütland, ass,


A TRUE COPY.


ATTEST:


Frances P. Hants


(Registrar of city or town where death occurred)/


DATE FILED


April 30,1940


19 I HEREBYCERTIFY


That I attended deceased from


April 50


19.39


to ..


19.


40


...


I last saw


him


alive on


April 30


1940


to have occurred on the date stated above, at


12: 45


.m.


Immediate cause of death


Pulmonary tuberculosis


14


months


,


Due to


Due to


13 NAME OF


FATHER


Joseph Bradley


Major findings :


Of operations


Of autopsy


What test confirmed diagnosis?


Microscope


.C X-Y


Date of ..


.. , death is said


'Duration


years


(If nonresident, give city or town and state)


In this community ] yrs. 1


nos.


20 days.


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No ...


(Usual place of abode)


Janatorium


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (Sce Chap. 46, Sec. 12, G. L.)


Received and filed


.19.


ROR MASS.


MAY-1940 AS1


R-305


Suffolk


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH


ROSTOS (City or town making return)


V


Registered No.


4099


$ (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)


2 FULL NAME


Robert


Brady


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


(a) Residence. No .....


252 .... Winthrop ... Shore ... Drive


........


.St.


Winthrop


(If nonresident, give city or town and state)


months


days.


In this community 4&s.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX male


4 COLOR OR RACE 5 SINGLE


MARRIED


white


WIDOWED


or DIVORCED


(write the word)


divorced


5a lf married, widowed, or divorced HUSBAND of


(Give maid


Mary LiPonter


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife it alive.


50


Years 7 IF STILLBORN, enter that fact here.


8 48


AGE


Years


Months


Days


If less than 1 day


Hours


Minutes


Usual


9 Occupation:


longshoreman- shipping


Industry 10 or Business:


11 Social Security No.


.. 029-03-6696


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


Boston Mass


George P Brady


14 BIRTHPLACE OF


FATHER (City)


Boston Mass


(State or country)


15 MAIDEN NAME


OF MOTHER


Annie Driscoll


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


17 Informant ...... (Address)


"Mother


A TRUE COPY.


ATTEST:


James Q. Pur re


Registrar of city or town where death occurred)


DATE FILED


5/3/40


19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF DEATH April 30 1940


(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.) Massive edema of brain with multiple foci ... of traumatic. softening. Bilateral. cerebral decompression 1936for ... subdural .hematoma. Lacerated brain-accidental


20 Accident, suicide, or homicide (specify)


Date of occurrence. Where did


Injury occur ?.


Boston


(City or town and State)


Did injury occur in or about the home, on farm, in industrial place, or in


public place?cardio ... renal .. disease.


Manner of Probably acc fuefter far?


Injury


post traumatic encephalopathy with"


Injury


Nature of


epilepsy.


While at work ?


Was there an autopsy ?..... y.e.s.


21 Was disease or lajury in any way related to occupation of deceased ?


Il so, specify


(Signed)


Timothy Leary.


M. D.


(Address)


Dato5/1/409.


22. Holy .... Cross .. Malden


Place of Burial, Cremation or Removal.


May 1 fgyor Town)


DATE OF BURIAL


19


23 NAME OF


FUNERAL DIRECTOR


J .... F .... O .Maley


ADDRESS


Winthrop


Received and filed


19


(Registrar of City or Town where deceased resided)


25m-10-'39. No. 8427-g


of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)




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