USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 45
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No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth untli 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 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, Soo. 46, G. L., (Tercentenary A'dition)
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 these of persons to whom they have given hedslde care during a last ill- neas from disease unrelated to any form of Injury.
(2) Board of Health physiclans will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of Injury, have died without recent medical attendance or whose physiclan is absent from home when the certificate of death is needed.
(3) Medieal Examiners will investigate and certify to ali death« supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortlon, but also deathe 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 clead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, rot the mode of dying. c. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earller morbid con- ditions, if any, related to the principal cause and any important complication of the principal eause.
Statement of Ocenpatien .- Precise statement of occupation Is very Important, mo 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 usnal occupation prior to illness. If the deceased had retired from busi- nesa, 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, coolo-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R- 303 B
Suffolk.
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No ..............................
death oc arred fn
Hospital or institution, wd of strect and number)
{If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and s.a.c)
months
3
days.
In this community 2
yrs.
mos.
days.
t
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE| 5 SINGLE
(write the word)
white
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
WillianGire maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive .Years
7 IF STILLBORN, enter that fact here.
8 78 5
AGE
Years
Months
If less than 1 day
Hours.
.Minutes
Usual
At Home
11 Social Security No.
12 BIRTHPLACE (City)
Barrington
(State or country)
Nova Scotia
13 NAME OF
FATHER
not known
14 BIRTHPLACE OF
FATHER (City)
(State or country)
not known
15 MAIDEN NAME
OF MOTHER
not known
16 BIRTHPLACE OF MOTHER (City) (State or country)
not known
17 Mrs. Mary Pollard Del igh For
71 Buchanan St.,.Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit) 202%
18 DATE OF
DEATH.
MEDICAL CERTIFICATE OF DEATH
July 31, 1940
(Month)
(Day)
(Year)
19 IHEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER theresi are as follows: (If an injury was involved, state fully.)
1070-7
Was there an autopsy ?....
(See reverse side for description for unknown person)
20 Where did
injury occur ?.
(City or town and State)
21 Was discase or Injury lo any way related to occupation of deccased? If so, specify.
D.
22
Mr. Hollaston
Quincy,
Ma
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL .... August 2 1940
19
23 NAME OF
FUNERAL DIRECTOR-
Richard 26. What
ADDRESS
147 Winthrop St., Winthrop
Received and filed. .19
(Registrar)
5m-10-'39. No. 8427-j
3 SEX Female (or) WIFE of 9 Occupation: PARENTS Informant .. (Address) of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry 10 or Business:
PLACE OF DEATH
2 FULL NAME
(IL d based is a married, widowed or divorced woman, give also maiden name.) Buchanan st ..... Winthrop Gt.
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution
(Specify whether)
years
beit Etelle Dai
·
Date
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 authorized person or of any member of the family of the deccased, furnish for regls- tration a standard certifieate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contraeted, 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 a human body which has not been buried, until he has rceeived 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 body is buried. No such permit shall be issued until there shall have heen de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing 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 required by 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 by 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 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 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 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 .- Chap. 114, Sec. 45, G. L., as amended.
DESCRIPTION (for unknown person)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the comnionwealth 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 funcral is to be held, or from a person appointed to have the cars of the cemetery or burial ground in which the internient is made .... Chap. 114, Sec. 46, G. L. as amended.
Medical examiners shall make examination upon the vlew of the dead bodies of only such persons as are supposed to have dicd by violence. If a medical examiner has notice that there is within lia county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same ; ... - General 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 man- ner of death .- General Laws, Chap. 38. Sec. 7.
. . The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.
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 Health physicians will certify to such deaths only as those of persons who, though disabled 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 deatlı is needed.
(3) Medieal Examiners will Investigate and certify to all deaths mpposably due to Injury. These include not only deaths caused directly or Indirectly by traumatism (including resulting septice- 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 to occupa. tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examinera In certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an injury and of its consequences ; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway ac- cident." "Pistol shot wound of the chest with associated hemor- rhage, homicidal." "Asphyxiation by suspension, suicidal." "Syn- cope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal Injury sustalned under circumstances unknown."
If disease or injury was related to occupation, specify. If Inves- tlgation shows the death to have been due to disease, specify: (1) Under cause, its known or presumable nature : and (2) under man- ner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the brain (basal ganglia) (found dead in bed) ." "Heart disease, presumably coronary sclerosis. (Sudden death)."
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
R-302
50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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 PARENTS
1
PLACE OF DEATH
Suffolk (County)
Chelsea (City or Town) U.S.N.Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cholsea
(City or town making return)
Registered No
328
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Frederick ........ umel ...... 0600
(If deceased is a married, widowed or divorced woman, give also maiden name.)
199 Winthrop
St.
Winthrop.
Hospital
years
mons
days O
(If nonresident, give city or town and state's
LOthis community
yrs.O
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4 COLOR OR RACE 5 SINGLE
MARRIED
White
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH.
Juno 2,
(Month)
(Day)
(Ycar)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
to have occurred on the date Stated above tensivem.
Unk.
Immediato causarof deathphathry
2.Nophritis,chronic with . ponadünk.
Duration
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8 44 7 Months
13 Days
If less than 1 day Hours Minutos
Usual
9 Occupation:
Mechanic
Industry
Elevator Constructor
IO or Business:
012-05-1345
Due to
Hypertensive Heart Disease.
11 Social Security No.
East Boston,
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
Goo.William Reese
FATHER
Baltimore,
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maryland
15 MAIDEN NAME
OF MOTHER
Emma Marie Koulett
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Last Boston,
17 Geo.W.Reese
Relation, O tre 21 PLACE OF BURIALLOL
Informant
.199inthrop St. (Winthrop Mass.
(Address)
A TRUE COPY.
Deseple a. Vier
ATTESTI
(Registrar of city or town where death occurred)
DATE FILED
June 4,
.. 19 ..
40
CREMATION SR REMOVAL OM.Winthrop Mass
(Cemetery)
June 4
DATE OF BURIAL
(City or Town)
19
40
22 NAME OF
Chas.R.Bennison
FUNERAL DIRECTOR
ADDRESS
inthrop, Mass.
Received and filed.
19
(Registrar of City or Town where deceased resided)
Underline the cause to which death
Of autopsy
Clinical.
should be
What test confirmed diagnosis ?
Laboratory
charged sta-
tistically.
20 Was disease or Injury in any way related to occupation of deceased ?
If so, specify.
F.r.Latham,Lt. (MC)USN
(Signed)
(Address)
USN Hosp.
Date
6/2
40
M. D.
Other conditions are end Zurand puts PHYSICIAN
(Include pregnancy within 3 thon
alterhans
Major findings :
Töne
Of operations
Hone
Date of.
2 .... days
...
Unk
Malignant Hypertension
19.
I last saw h ...
.. alive on.
05 death is said
.Years
Due to
5.Broncho pneumonia terminar ......
AGE
Years
I9
I HEREBY CERTIFAO
TheSunttende@ deceased front O
1940
Single
(If U. S.
War Veteran,
specify WAR)
world
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
No.
AUG1 41:40 PM
R-302
Vi wedtd Jurtrung be transmitted on Form K-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. (See Chap. 46, Sec. 12, G. L.)
50m-10-'39. No. 8427.f
ATTEST:
organes 1. 0 5um)
(Registrar of city or town where death occurred)
DATE FILED 7/3/40
...... 19
.....
.....
St.
.Winthrop ... Mass
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
(write the word)
18 DATE OF
DEATH.
June 30 1940
(Month)
(Day)
(Year)
19 |
IHABEBY CERTIFY
19
to
19.
...
I last saw h ..... e.malive on
6/30/40 19
..... ,
death is said
to have occurred on the date stated above, at 4/40Pm.
Immediate cause of death.
cerebral
hemorrhage
Duration 48 hrs
3 61
AGE
Years
Months
Days
If less than 1 day
Hours.
Minutes
Usucl
9 Occupation:
at home
Due to hypertension chronic nephritis
7 yrs
Due cardiac hypertrophy
arteriosclerosis7 yrs
7 yrs
Other conditions
diabetes mellitus
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related to occupation af deceased ? If so, specify.
(Signed)
A P ... Joslin
, M. D.
(Address)
Boston
Date
6/301040
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Holy Cross Malden
(Cemetery)
(City or Town)
DATE OF BURIAL
July 3 1940
19
22 NAME OF
FUNERAL DIRECTOR
R .... C .... Kirby.
ADDRESS.
Boston
Received and filed.
19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
SUFFOLK TRENTON ....
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOS TON
(City or town making return)
Registered No
5907
....
5
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Katherine
Mc.Cormick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
years
months
days.
In this community
yrs.
MEDICAL CERTIFICATE OF DEATH
female
white
Or DIVORCED
widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Austin, 5 McCormick Jr
6 Age of husband or wife if alive.
.years
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
East Boston
13 NAME OF
FATHER
Simon J Donovan
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Southampton England
15 MAIDEN NAME
OF MOTHER
Mary A Harrington
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17
Informant.
John ..... Donovan
Relation, if any son.
(Address)
A TRUE COPY.
by
former marriage
Date of.
should be charged sta- tistically.
PARENTS
(City or Town)
No New ... England ... Deaconess .... Hospital
St. 1
(If U. S. War Veteran, specify WAR)
5 .... Shore ... Drive
7 IF STILLBORN, enter that fact here.
:6/30/2 nded deceased from
1 yr
AUG1 41010 AM
R-302
PLACE OF DEATH
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No ....
5.9.0.3
(If death occurred in a hospital or institution,
St. 1 give its NAME instead of street and number)
2 FULL NAME Thomas .... O. McEnaney .... 2d
(If deceased is a married, widowed or divorced woman, give also maiden name.)
29 Washington Ave
St.
Winthrop Mass
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE, 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
white
gingle
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
18 DATE OF
DEATH.
July 1 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
That I attended deceased from
6/22/40
19
to 7/1/40.
19 ......
I last saw h ........ malive on
7/1/40
to have occurred on the date stated above, at.
4/40A
n.
Immediate cause of death ..
pulmonary embolus
Duration 7/1/40
....
AGE
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
attorney at law
Due to
thrombosis of deep
veins .... of .... legs
dyg ....
Due to
Other conditions .. appendical abscess (Include pregnancy within 3 months of death)
June
PHYSICIAN
12
Major findings :
Of operations
Underline
drainage of appendici tause to
abscess
Date of.
6/23/40
which death
Of autopsy
What test confirmed diagnosis ?..... auto.psy ..
tistically.
20 Was disease or injury In any way related to occupation of deceased ?
If so, specify
W B Osgood
(Signed)
M. D.
(Address)
P .... BB Hosp
Date
7/1/19 40
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ...
.Holy Cross
Malden
DATE OF BURIAL
(Cemetery)
July 4 1940
19
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
M .......... Kelly
ADDRESS.
EastBoston
Received and filed
19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) V! WWWWWW would of wengiftttd on Form K.Jos to the clerk of the city or town in which the deceased resided as soon as possible PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass
15 MAIDEN NAME
OF MOTHER
Lucy E Martin
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick
17 Informant ... Ro.se ..... E ... MoEnane.y ...
(Address)
above
A TRUE COPY. /
ATTEST:
(Registrar of city of town where death occurred)
7/3/40
DATE FILED 19
years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8 59 Years
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
E-Boston Mass
13 NAME OF
FATHER
James P McEnaney
Relation, if any
sister .... )
1
No. Peter.Bent .... Brigham ... Hospital
$
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
years
months
days.
In this community
yrs.
(If U. S.
War Veteran,
specily WAR)
19 ........ ,
death is said
should be charged sta-
-
AUG1 4 1310 AM
R-302
50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (Sce Chap. 46, Sec. 12, G. L.) of ucath should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible PARENTS
PLACE OF DEATH
Middlesex
(County)
Cambridge (City or Town)
The Commonlocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
(City or town making return).
Registered No. (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Elisabeth ........ Crowe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
.....
24.Maple ... Rond
St.
(11 U. S.
War Veteran.
specify WAR)
Winthrop
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
years
Imonths
d3s.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Singl
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
years
6 Ago of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
9 AGE98. Years8
Months Days
If less than 1 day Hours Minutes
Usual 9 Occupation:
none
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Boston
(State or country)
13 NAME OF
FATHER
Dennis Crowe
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Elizabeth Royan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
zreland
17 Ellen if Fitzgerald
Informant
(Address)
Same
A TRUE COPY. 7
Frederick 4. 2.
ATTEST:
(Registrar of city or town where death occurred)
July 11, 1940
DATE FILED 19
18 DATE OF
July 9, 1940
DEATH
(Month)
(Day)
(Year)
19
-
FLEREPY CERTIFY.
TheFik attend& deceased Al
40
19 ......
I last saw h ............ alive on ....
4 ... ,45 .... ]2, death is said
to have occurred on the date stated above, at .......
.. m.
Immediate cause of
Arteriosclerosis
Due to
Due to
Olu Fracture Pomir
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
Date of ..
What test confirmed diagnosis ?.
20 Was disease or injury la any way related to occupation of deceased ?
If so, specify.
Jeremiah . 30yle
M. D.
(Address).
1446Camb St Cab
7/9,40
21 PLACE OF BURIALHOL Vhood
rookline
Mass.
DATE OF BURIAL
Jul Semgp) , 1940
19
(City or Town)
22 NAME OF
william H no Kenna
FUNERAL DIRECTOROO Medford St. Som
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