Town of Winthrop : Record of Deaths 1940, Part 45

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


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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