Town of Winthrop : Record of Deaths 1940, Part 46

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


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).


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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)




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