Town of Winthrop : Record of Deaths 1940, Part 48

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 48


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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


SPACE FOR ADDITIONAL INFORMATION


R-301 A"


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 Sarah Agnes (Downey) Shattuck


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


9 ... Ocean .... view


..... ..... St.


(If nonresident, give city or town and state)


months


9


days.


In this community 37 yrs.


mos.


days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH ..


8


(Month)


27


(Day)


(Year)


19 I HEREBY CERTIFY. 4/27


19.40, to ..


127


1946


39.40, death is said


Immediate sause of death. 1 ulm


Due to


Due to antonio Silverati Heart Dusena


Other conditions (Include pregnancy within 3 months of death)


Major findings : 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 nl deceased?


If so, specify


(Signed)


‹; M. D.


(Address)


Date.


/20 1940


21


Winthrop Cemetery Winthrop Mass


Place of Burial, Cremation or Removal


(City or Town)


DATE OF BURIAL .. August ..... 30. ..... 1.9.4.0.


19


22 NAME OF


FUNERAL DIRECTOR Charles R ...... Bennison


ADDRESS


Winthrop


Mass


Received and flod


SEP 10 1340


19


(Registrar)


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


17 Informan Howard P. Shattuck ( husband) (Address)9 Ocean View St Winthrop Masa


Relation, if any


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or Hansit permit was issued: Ww. S. Childress. (Signature of Agent of Board of Health or other)


Health (Official Designation) (Date of Issue of Permit)


Offices


8/29/40


(write the word)


Married


(Give maiden name of wife in full)


(or) WIFE of Howard Porter Shattuck


(Husband's name in full)


years


If less than 1 day


Hours.


Minutes


I


Winthrop


(City or Town)


(a) Residence. No.


( Usual place cf abode)


Length of stay : In hospital or institution ...


3 SEX


Femal


4 COLOR OR RACE


White


5a If married, widowed, or divorced


HUSBAND of


6 Age of husband or wife if alive.


67


7 IF STILLBORN, enter that fact here.


8


AGE.5.8


Years


8


Months.


12 Days


Usual


9 Occupation:


At home


Industry


10 or Business:


11 Social Security No.


12 BIRTHPLACE (City)


East Boston


(State or country) Massachusetts


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


15 MAIDEN NAME


OF MOTHER


Bridget Leach


16 BIRTHPLACE OF


PARENTS


MOTHER (City)


(State or country)


Ireland


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.


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


13 NAME OF


FATHER


Edward E. Downey


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


years


No Winthrop Community Hospital


St. X


(If U. S. War Veteran. spocify WAR)


40


That I attended deceased from


I last saw h .......... alive on. 8/ 127 to have occurred on the date stated above, at


Duration LAPORTANT 2 days


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall 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- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, hls supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws. Chap. 46, Sce. 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 buricd, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there Is no such board, from the clerk of the town where the person died ; and no undertaker or other person shall ethume 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 lts agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been 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 vlolence. 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 maade 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 hereunderMf the death certificate contains a recital, as required hy section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which It has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be ohtalned as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition.)


No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do from the 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, Seo. 46. G. L., (Tercentenary Edition)


RULES OF PRACTICE


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


(1) Attending physicians will eertify to such deaths only as those of persons to whom they have given bedside care during a last III- ness from discase unrelated to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized discase un- related to any form of injury, lave dicd without recent medleal attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly hy 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 disesse resulting from injury or infection related to oreupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. As principal cause name the disease cansing death. As related causes, name carlier morbld con- ditions, if any, related to the prinelpal cause and any important complication of the principal cause.


Statement of Occupation .- Prceise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease eausing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not grinfully 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 housckseper -- private family, cook -- hotel, etc. For a person who had no oceupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


R-301 A


PLACE OF DEATH


Suffolk (County) winchính


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 ..


No.


William Jeffreys. Kershaw


St. 1


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


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


(a) Residence. No. (Usual place of abode)


Length of stay: In hospital or institution ..


(Specify whether)


years


months


days.


In this community 43yrs.


mos.


days .


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


august


31


1940


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY That I attended deceased from august 25, 1940, to august 31 19 40


I last saw h.um .... alive on Quanti 30, 1940, death is said to have occurred on the date stated above, at ............ A.m. Immediate cause of death .. Duration IMPORTANT Cerebral Hemorrhage


Due to


Generalized arteriosclerosis


lane


Due to


Other conditions (Include pregnancy within 3 months of death)


Major findings :


Of operations


Prostatectomy


Of autopsy


20 Was disease or Injury In any way related to occupation of deceased? no


If so, specity Xf (Signed).


Murray


. M. D.


(Address) Winthrop Mais Date &// 1941


21 Nuttlich


Place of Burial, Cremationo Removal.


DATE OF BURIAL


elk City of Town)


22 NAME OF


0 1 Demini


FUNERAL DIRECTOR ADDRESS


19


Received and filed SEP 10 1940


(Registrar)


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


17 alfred, 4, Kershaw


Relation, if any


Informant .. (Address) 58 Bellevue are within


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE ihe buridi ot transit permit was issued: Www. D. Children (Signature ofAgent of Body of Health or other) Health officer 9/3/40 (Official Designation) (Date of Issue of Permit)/


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


5c If married, HUSBAND of .....


widowed, or di fices Cena. noxon


(Give maiden name of wife in full)


(Husband's name in full)


6 Age of husband or wife if clive.


74


.years


7 IF STILLBORN, enter that fact here.


Years


X


Months X


Days


Hours


Minutes


Retired HS.


9 Occupation Manosw


Industry 10 or Business:


11 Social Security No


220-03 - 3747


12 BIRTHPLACE (City)


(State or country)


England


13 NAME OF


FATHER


unable & oflaw Hathan


14 BIRTHPLACE OF


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


4


1


?


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


4


PARENTS


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.


1 3 SEX 8 AGE Usual ALPH OVER DE OtGICK LAVILT. ILIDICIANO Should state (or) WIFE of


(City of Town)


55 Bellevue avenue


2 FULL NAME


(If deceased is a married, widowed of divorced woman, give also maiden name.) 55 Bellevue are


.S :.


(If nonresident, give city or town and state)


4 COLOR OR RACE


White


If less than 1 day


1 week


PHYSICIAN Underline the cause to Date of 1930 which death should be charged sta- What test confirmed diagnosis ?. clinical findings


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- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the discase of which he died, defined as required by seetlon one. where same was contracted. the duration of his last illness, when last scen alive hy the physician or officer and the date of his death ... Gen. Laws, Chap. 45, Sce. 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 received a permit from the board of health, or its agent appointed to issue such permits, or if there Is no such board, from the clerk of the town where the person died : and no undertaker or other person shall exhume a hun:an body and remove It from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomb to another in the same cemetery, until he has received a permit frem 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 been de- Ilvered 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 accompanled. in case of an orlginai 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 hy 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 phtalned early enough for the purpose. the certificate of death maade 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 auch body has heen sooner ohtalned 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 fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the elerk or registrar may require .- Chap. 114, See. 45, G. L., (Tercentenary Edition.)


No undertaker or other person shall bury a human body or the ashes thereof which have heen brought Into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to iasuc 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 hurlal ground in which the Interment Is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition)


RULES OF PRACTICE


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


(1) Attending physicians will certify to such deaths only as theae 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 certlly 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 death is needed.


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


Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying. e. o., heart fallure, asphyxla, asthenia, etc. As principal cause name the disense causing death. As related causes, name earlier morbid con- ditlons, if any, related to the principal cause and any important complleation of the principal cause.


Statement of Occupation .- Precise statement of occupation is very Important. so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual occupation prior to retirement. Children not galnfully 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, &s housekeeper --- private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


R-302


1


PLACE OF DEATH


Norfo (County) Foxborough


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


Foxborough


in.


(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


MedHideceased isDowirstihre godtman, give also maiden name.)


(a) Residence. No .......


23-Neptune


Se


Minthron.a.s .......


(If nonresident, give tity or town and state)


Length of stay : In hospital or institution ..... Hst


years 1


day2.3


In this community


20 13ays.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


F


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


18 DATE OF


DEATH


August


31


1940


(Month)


(Day)


(Year)


19 HEREBY CERTIFY. That I attended, deceased fra:


19.


... ,


to


AUS.


31


19.


.......


I last saw h ........... alive on ...


August 31


19 ...


death is said


to have occurred on the date stated above, at.


9 35 P


Duration


Immediate cause of death ....


Chronic Myocarditis


Unk


8


AGE


Years


9Months.


7.Days


If less than 1 day Hours Minutes


Usual


9 Occupation:


Housewife


Industry


10 or Business:


Own home


11 Social Security No.


Boston


PARENTS


15 MAIDEN NAME


OF MOTHER


Katherine Dudley


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


17


Informant.


Hospital Records


Relation, if any


(Address)


A TRUE COPY.


ATTEST: Dora I. (Registrersobeity or town where death occurred)


DATE FILEDU 9/1119


Major findings :


Of operations


Date of.


Underline the cause to which death


Of autopsy


What test confirmed diagnosis ?.


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


If so, specify


(Signed)


"Grosvenor B.Pearson


M. D.


(Address)


.. Date.


21 PLACE OF BURIAL.


Foxborough


9/1 40


CREMATION OR REMOVAL .... S.t .... Pauls.Arligton


(Cemetery)


(City or Town)


DATE OF BURIAL


525-40 9-3-40


19


........


22 NAME OF


FUNERAL DIRECTOR


Napoleon Levesque & So


ADDRESS.


16 Horton St., Salem, Mass.


Received and filed. 19


(Registrar of City or Town where deceased resided)


1.99 PHYSICIAN


(Include pregnancy within 3 months of death)


13 NAME OF


FATHER


John Moore


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


Due to


Other conditions


Senile Psychosis


12 BIRTHPLACE (City)


(State or country)


1.833.


50m1-10-'39. No. 8427-f


vi wtest duvuje be toastmitted on form A-502 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.)


5a If married, widowed, or divorced HUSBAND of


Widow


(Give maiden name of wife in full)


(or) WIFE of


"AAron Gosia Sname in full)


6 Age of husband or wife if alive ..


deceased


... Years


7 IF STILLBORN, enter that fact here.


MEDICAL CERTIFICATE OF DEATH


(Usual place of abode)


No.Foxborough State Hospital


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


should be charged sta- tistically.


Due to ... Secondary .... Anemi.s.


July ..... 1940


1


2


SEP101012 AM


R-302


PLACE OF DEATH


ISUFFOLK (County).


1 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


7832


...


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


161


2 FULL NAME


William


McNulty


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


Fort Banks


.


St.


Winthrop Mass


(a) Residence. No ..


(Usual place of abode)


Length of stay: In hospital or institution ....


(Specify whether)


years


months


days.


(If nonresident, give city or town and state)


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


July 18 1940


(Day)


(Year)


Sa If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive.


.years


7 IF STILLBORN, onter that fact here.


8


AGE


51.


Years


Months ...


... Days


If less than 1 day


Hours


Minutes


Usual


9 Occupationı


Industry


16 or Business:


Plant's Shoe factory


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


"Boston Mas's


13 NAME OF


FATHER


Charles P McNulty


14 BIRTHPLACE OF


FATHER (City)


(State or country)


New Brunswick


15 MAIDEN NAME


OF MOTHER


Bridgett O'Rourke


18 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland"


17


Informant ..


(Address)


mother (


Relation, if any


A TRUE COPY.


ATTESTI


(Registrar of city or town where death occurred)


DATE FILED 9/13/40 19


19 I HEREBY CERTIFY.


3/18/40


19


to ......


That I attended deceased from


I last saw h ..... m ... alive on.


7/18/40


death is said


to have occurred on the date stated above, at.


10/10A


m.


Duration


Immediate cause of death ...


pulmonary tuberculosis


1 yr ...


Due to


Due to


23 .... yrs


Other conditions dementiaprecox naran (Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of.


PHYSICIAN Underline the cause to which death


Of autopsy


What test confirmed diagnosis ?


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


If so, specify


(Signed)


E .... Schmidhofer


M. D.


(Address)


Boston


Date 7/79/1940


21 PLACE OF BURIAL


CREMATION OR REMOVAL.


Harvard MedSchool S. P


fembury afferr BMP


DATE OF BURIAL


19


22 NAME OF


FUNERAL DIRECTOR


J S Waterman & Sons


ADDRESS


Boston


Received and filed.


9/13/40


19


(Registrar of City or Town where deceased resided)


LA WONGS Fc detcestu festuca as soon as possible


50m-10-'39. No. 8427-f after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) PARENTS


3 SEX Male


4 COLOR OR RACE| 5 SINGLE


MARRIED


WIDOWED


or DIVORCED


single


(write the word)


white


(Month)


19


(If U. S.


War Veteran,


specify WAR)


No .... Boston State Hospital




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.