USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 46
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
ADDRESS.
Received and fled
19
(Registrar of City or Town where deceased resided)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
(Signed)
Relation, if any (Servant ........ )
CREMATIONIDA REMOVED !!!
Duration
1936.
No. Holy Ghost Hospital
٠٠
AUG1 61013 Mi
R-302
PLACE OF DEATH
(County) BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
6277
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Irma
Grady.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
59 Beal
St.
Winthrop Mass
months
days.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
fem
4 COLOR OR RACE 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
5a If married. widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(cr) WIFE of
(Husband's name in full)
6 Ago of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE .... 1.2 .... Years.
.Months.
.Days
If less than 1 day
.Hours.
Minutes
Usual
9 Occupation:
at school
Industry 10 or Business:
11 Social Security No ...
Boston Mass
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Underline the cause to which death
Of autopsy
What test confirmed diagnosis ?..... autopsy.
20 Was disease or fajury la any way related to occupation of deceased ?
li so, specify.
(Signed)
L Rosenfeld
M. D.
(Address)
Boston
Da
0 7/13/40
21 PLACE OF BURIAL
CREMATION OR REMOVAL
New Calvary Boston
DATE OF BURIAL
22 NAME OF.
FUNERAL DIRECTOR
CH Treanor
ADDRESS
East Boston
Received and filed 19
(Registrar of City or Town where deceased resided)
Www as yya to Mac ciela of the city of 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
PARENTS
15 MAIDEN NAME
OF MOTHER
Winifred Henry
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
17
Informant.
(Address)
mother
(
A TRUE COPY.
ATTEST: (Regi (Registrar of city or town where death occurred)
DATE FILED
7/17/40
19
18 DATE OF
DEATH.
July 13 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
6/19/40
19.
That,I attended deceased from
... ,
to ...
7/13/40
19
...
I last saw h ........... alive on.
7/13/40
19
death is said
to have occurred on the date stated above, at
3/35P
m.
Duration
Immediate cause of death
carcinoma of adrenal
...
yrs
cortex with metastases
Due to
Due to
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
James W Grady
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cambridge Mass
should be charged sta- tistically.
(Cemetery)
July 16 1940
19
(City er Town)
No.
Beth Israel Hospital
.St.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution
years
Relation, if any
years
-T
6
AUG 1 4,010 AM
R-302
PLACE OF DEATH
LECTION
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
POSTON
(City or town making return)
Registered No.
6442
(If death occurred in a hospital or institution, St. l
2 FULL NAME
George W
Verdi
(If deceased is a married, widowed or divorced woman, give also maiden name.)
70 Thornton Park
St.
Winthrop
(lf nonresident, give city or town and state)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
July 20 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
7/11/40
19.
7/20/40
to .....
19.
That I attended deceased from
I last saw h .. i.m .. alive on
7/19/40 19
, death is said
to have occurred on the date stated above, at.
2/45Am
Duration
Immediate cause of death.
broncho .... pneumonia
8 dys
AGE ...
8
70
Years
Months
Days
If less than 1 day
Hours
Minutes
cerebral .... hemorrhage
3 ..... wks
Usual
9 Occupation:
tailor
Industry
10 or Business:
Boston Tailoring .... Co
11 Social Security No.
031-05-6725
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
England
George Verdi
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Ellen Taliapetia
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Greece
17
Informant
(Address)
Mrs.Helen Sheehan ( above
4. TRUE COPY.
ATTEST:
James Q. Bunke
(Registrar of city or town where death occurred) 7/23/40
DATE FILED 19
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of
Of autopsy
What test confirmed diagnosis ?
20 Was disease or injury In any way related to occupation of deceased ? If so, specify
(Signed)
L .. D. Chapman
M. D.
(Address)
Boston
Date 7/20/40
21 PLACE OF BURIAL.,
CREMATION OR REMOVAL
Winthrop Mass
DATE OF BURIAL
July 22 1940
19
22 NAME OF
FUNERAL DIRECTOR
M F Hayes
ADDRESS
Whitman Magg
Received and filed 19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
3 SEX Male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
midowed
5a lf married, widowod, or dvarete Sullivan
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.
Years
Due to
general & cerebral arterio
Due to
sclerosis.
unk
Underline the cause to which death should be charged sta- tistically.
PARENTS
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. (See Chap. 46, Sec. 12, G. L.)
No.
Glenside Hospital
give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
i.
(a) Residence. No ......
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
Relation, if any dau
(City or Town)
-
7
0
AUG1 -2140 AI
R-305
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-305 to the clerk of the city or town in which the deceased resided as soon as possible
25m-10-'39. No. 8427-g
Sutfolk
PLACE OF DEATH
(County) Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
6463
No In front of 33 Gladstone St E B 201 1 (If death occurred in a hospital or institution,
2 FULL NAME Francis Occhipinti
(If deceased is a married, widowed or divorced woman, give also maiden name.) 352 Shirley St. Winthrop Mass
(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 community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
-
5a If married, widowed, or divorcod
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.
.Years
7 IF STILLBORN, enter that fact here.
8 AGE 7 Years .. 5 .Months. Days
If less than 1 day
Hours
.Minutes
Usual
9 Occupation:
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Somerville Mass
13 NAME OF
FATHER
Santo Occhipinti
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Angelina Pace
16 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
17 Informant (Address)
father ....
A TRUE COPY.
ATTEST:
...
(Registrar of city or town where death occurred)
DATE FILED 7/24/40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 21 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named nnd that the CAUSE AND MANNER thereof nre as follows : (If an injury was involved, state fully.) Fractured skull and other
other injuries - said to have fallen from window.
20 Accident, suicide, or homicide (specify)
Date of occurronce. 19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place ?
(Specify type of place)
Manner of
Injury
Nature of Injury
While at work ?
Was there an autopsy ?.
21 Was dissese cr lajury la any way related to cccupation of deccased ?.
If so, specify.
(Signed)
G J O'Leary ..
M. D.
(Address) . Boston
7/21/40
22 .. St. Michael 's.
Boston
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
July 23 1940
19
23 NAME OF
FUNERAL DIRECTOR
J Russo
ADDRESS
Boston
Roceivod and filed 19
(Registrar of City or Town where deceased resided)
PARENTS
Italy
Relation, if any
give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
(Specify whether)
0
THRU
AUG1 413:0 AM
R-302
PLACE OF DEATH
[SUPPri" , (County) BOSTON
(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 ... 6681
- (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Olive C.
....... Helsall
(If deccased is a married, widowed or divorced woman, give also maiden name.)
33 Sewall Ave
...
St.
Winthrop .... Mass
(If nonresident, give city or town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Fem
4 COLOR OR RACE 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Ronald .... AHelsall
(Husband's name in full)
6 Age of husband or wife if alive.
48
Years
7 IF STILLBORN, enter that fact here.
8
42 Years
2
Months
1.Bays
If less than 1 day Hours Minutes
Usucl
9 Occupation:
at home
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Fred Snow
14 BIRTHPLACE OF
FATHER (City)
(State or country)
E Otis Mass
15 MAIDEN NAME
OF MOTHER
Cecilia A Theresa
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
E Canaan Conn
17 Informant (Address)
husband
Relation, if any
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED 8/1/40
.... ........... 19
18 DATE OF
DEATH.
July 27 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
7/22/40
19
I last saw h .. @ ....... alive on ..
7/27/40 19.
.... , death is said
to have occurred on the date stated above, at. 12/30P.m.
Duration
Immediate cause of death.
mesenteric ..... thrombosis
.5 .... dys?
-
Due to
cause .... unknown
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
gangrene of bowel
resection
Date of
07/25/40
Of autopsy
What test confirmed diagnosis ?..... operation
20 Was disease or Injury In any way related to occupation of deceased ? .. no
so, specify. N W Swinton M. D.
(Address)
Boston
Date ..
7/27/040
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Woodlawn
(Cemetery)
July 30 1940
19
Everett
City of Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
C R Bennison
ADDRESS
Winthrop .... Mags
Received and filed
19
(Registrar of City or Town where deceased resided)
V
PARENTS 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 ww ww Jow4 city of town in case the deceased resided in another city or town at the time AGE
V
1
-
No Mass ..... Women's .... Hospital
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of ahode)
Length of stay: In hospital or institution ..
(Specify whether)
years
months
days.
In this community
yrs.
That I attended deceased from
to.
7/27/40
, 19.
Fast Otis Mass
Underline the cause to which death should be charged sta- tistically.
(Signed)
1
.
AUG1 41510 AM
R-301 A:
PLACE OF DEATH
17++671-
(County)
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. Registered No ... 4
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
In this community40
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august
9.
1940
Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
Thai I attended deceased from
ifune 3
9
19.45.4 to ...
7 ...
.. +
19.
40
I last saw Am alive on Cung 9
19.55 Odeath is
to have occurred on the date stated above, at .. m
3.45a
....
.m.
Duration IMPORTANT
Immediate cause of death ... Coronary occlusion Carcinoma / Stomach Due to
aug 9-1940 mardi. 1939 -
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline
Carcinoma
...
the cause to
of Stomach
Date of Man1. 25.39 which death
Of
F autopsy
more.
should be
charged sta-
What test confirmed diagnosis ?.
Clinical
tistically.
20 Was disease or Injury In any way related to occupation of deccased?
If so, specify
(Signed)
(Address) Winthrop Mare Date Cung 9, 1940.
21
inthron Cemetery
inthron
Place of Burial, Cremation or Removal.
DATE OF BURIAL
august
17
(City, or Town)
....
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennsion
ADDRESS
inthron
lass
Received and filed. 19.
(Registrar)
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other)
agent
(OficialDesignation)
(Date of Issue of Permit)
aug, 9/42
St.
(If deccased is a married, widowed or divorced woman, give also maiden name.)
56 Thomton Park
St.
months
days.
inthron
(City or Town)
No ..
16 Thornton Fark
2 FULL NAME
James Lawson Kelso
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Thite
5 SINGLE
(write the word)
Hurried
MARRIED
WIDOWED
or DIVORCED
Male
5a If married, widowed, or divorced
HUSBAND of
Inns nn Tarkin
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
70
years
6 Age of husband or wife if alivo.
7 IF STILLBORN, enter that fact here.
8
li less than 1 day
AGE
.7.6Years. . 2.
Months .. 22. . Days
Hours
Minutes
Usual
9 Occupation:
Ormer
Il Social Security No.
12 BIRTHPLACE (City)
ringfield
(State or country)
New Brunswick
13 NAME OF
FATHER
alexander Kelso
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Elizabeth Brown
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
scotland
17
( son
Relation, if any
Informant.
Walter Velso
(Address)
36 Thornton
inthron
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Industry
J. I. Velso for 20 erehouse
10 or Business:
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.
M. D.
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 deceased, furnish for regis- ration 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 died. defined as required by section onc. where same was contracted. the duration of his last illness, when last seen allve hy the physician or officer and the date of his death ... Gen. Laies, Chop. 46, Sec. 9.
No undertaker or olhor 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 received a permit 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 person dled ; and no undertaker or other person shall exhume a human hody 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 ts agent yforesaid or from the clerk of the town where the body is buried. No such permit shall be Issued until there shall have been de- Ivered to such hoard, agent or clerk, as the case may be, a satisfac- ory written statement containing the facts required by law to he 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 licu thereof a certificate es hereinafter provided. If there is no attending physician, or If. for Fuffielent reasons, his certificate cannot be ohcained 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- ending physician. If death is caused by violence, the medical exam- ner shall make suco certificate. If such a permit for the removal of 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 skall 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 snch hody 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 own for registration. The person to whom the permit 13 30 given and the physician certifying the cause of death shall thereafter fur- aish for registration any other necessary Information which can be obtained as to the deceased, or as to the manner or cause of the leath, which the clerk or registrar may require .- Chap. 114, Sco. 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 its agent appointed to Issue such permits, or If there is no such hoard, 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 burial ground in which the interment is made .... Chap. 114, Sac. 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 physiclans will certify to such deaths only as those of persons to whom they have given bedside care during & last ill- ness from disease unrelated to any form of Injury.
(2) Board of Hoalth physicians will certify to such deaths only as those of persons who, though disabled by recognized dlaease un- related to any form of injury, have died without recent medical attendance or whose physlelan Is ahsent from home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to aff deaths supposably duo to injury. These include not only deaths caused directly or indirectly by trawunatism (Including resulting septice- mia), and by the action of chemical (drugs or polsons), thermal, or elcetrical agents, and deaths following shortlon, but also deaths from disease resulting from injury or infection related to orcupa- tion, the sudden deatha of porsons not disabled by recognized disease, and those of persons found dead.
Statoment of Course of Doath .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. v., heart fallure, asphyxia, asthenia. etc. As principal cause name the disease causing death. As related causes, name earlier morhid con- ditions, If any, related to the principal eause and any important complleatlon of the principal cause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative bealthfulness of various pursuits ean he known. Make some entry in this section for every person ared 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 buai- 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, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
.
PLACE OF DEATH
Suffolk (County)
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.
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Dudley Watson Hook
(If deceased is a married, widowed or divorced woman, give also maiden name.)
56 Locust
......... St.
years
months
days.
In this community 4
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mal
4 COLOR OR RACE
Whit
5 SINGLE
MARRIED
WIDOWED
(write the word)
Widower
or DIVORCED
Sa It married, widowemind Morton Battis HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
years
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
8
AGE 7.6Years. 5 Months. 21 Days
Hours
Minutes
Usual
9 Occupation:
Police officer, Signal Service
tired)
10 or Business:
1I Social Security No ..
12 BIRTHPLACE (City)
Boston
(State or country)
"Massachusetts
13 NAME OF
FATHER
William Hook
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Boston
(State or country) Massachusetts
15 MAIDEN NAME
OF MOTHER
Anna Hart
16 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain
100m-10-'39. No. 8427-e
17 Russell Hook
Relation, if any son
Informant .. (Address) 56 Locust St Winthrop Mass
I HEREBY CERTIFY that, a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued: Wm. A. Childrens (Signature of Agent of Board of Heahl/ or other) Health Office
(Date of Issue of Permit) 8/12/40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
august
10
1940
((Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
any &,
19.40, to.
aug 10, 1990
That I attended deceased from
... m. I last saw heim alive on Chung 9, 1, 394 5%, death is said to have occurred on the date stated above, at .. S ............ Immediate cause of death .. Carcas decompensation
Duration UNSPORTANT 2 days
Hypertensive Heart Weread 3 yrs
7
Due to
Other conditions
old Cerebral hemontage
(Include pregnancy, within 3 months of death)
5 curves
-
Major findings :
emling
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
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?
(Signed)
lf so, specify ..
G.Nathan Cupler
. M. D.
(Address) 19 menare Withingate aux 10 1941
21
DATE OF BURIAL
Duxbury Cemetery Duxbury 'Mass
Place of Burial, Cremation or Removal
August 12, "1940
19
FUNERAL DIRECTOR
22 NAME OF
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed 19
(Registrar)
MR-301 A
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 information should be carefully supplied. is very important. See instructions and extracts from the laws on back of certificate.
1
Winthrop (City or Town)
No. 56 Locust
St. {
(If U. S. War Veteran.
specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of stay : In hospital or institution ...
(If nonresident, give city or town and state)
(Official Designation)
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.