Town of Winthrop : Record of Deaths 1940, Part 7

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 7


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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Lawrence Cousine


14 BIRTHPLACE OF


FATHER (City)


(State or country)


St John


15 MAIDEN NAME


OF MOTHER


Ellen Nugent


16 BIRTHPLACE OF


MOTHER (City)


St. John


(State or country)


17 Newfoundland


Relation, if any


A TRUE COPY.


150 Circuit Ha Winthrop


ATTEST:


Jan 1.6 1940


(Registrar of city or town where death occurred)


DATE FILED Fasterich H Burke 19


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


none


Date of ..


should be charged sta- tistically.


Of autopsy What test confirmed diagnosis ? Thys Exam


20 Was disease or Injury in any way related to occupation of deteast ??


If so, specify. no


M. D.


(Signed)


(Address)


Christopher E Igan


19


21 PLACE OF BURIALS8 Rx


CREMATION OR REMOVAL upalo Rd Bel. 1/14 40


19


Informant ....


(Address)


Helen Cousin


( ...


daughter


DATE OF BURIAL


Holy cross


Mala Et or Town)


Jan 16


-1940


22 NAME OF


FUNERAL DIRECTOR


John F-O-Marley


ADDRESS


Winthrop


Received and filed


19


(Registrar of City or Town where deceased resided)


V


we Tung a due to the clerk of the city of town in which the deceased resided 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


...


Hypostatic Pneumonia


1wk


Due to


Chronic Myocarditis


Chronic Puesivo congestive-yr


Due to


I last saw h .......... dative on .......... J.a. 13 19 ...... 4 Death is said to have occurred on the date stated above, at ......... 5 ........ m. Duration Immediate cause of death ..


6 Age of husband or wife if alive


Widowed 19 I HEREBY CERTIFY.


That I attended deceased from


19.


40


Jan ... 12


.....


... , 19 ..... 50


Underline the cause to which death


Newfound land


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


(a) Residence. No .. (Usual place of abode) 145 Bartlett Rd.


FEB161940 MM


R-302


PLACE OF DEATH


(County)


1


(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. 19


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


2 FULL NAME


Baby Amarena Girl


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


(a) Residence. No ...


71 Paine Street


St. Winthrop ....... MASS.


(Usual place of abode)


Length of stay: In hospital or institution


(Specify whether)


years


months


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX female


4 COLOR OR RACE| 5 SINGLE


MARRIED


white


WIDOWED


or DIVORCED


(write the word)


single


5a 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, enter that fact here.


stillborn


8


AGE


Years


Months.


Days


If less than 1 day Hours. Minutes


Usual


9 Occupation:


Industry 10 or Business:


II Social Security No.


12 BIRTHPLACE (City)


Boston


(State or country)


Mass.


13 NAME OF


FATHER


Domenick Amarena


14 BIRTHPLACE OF


FATHER (City)


Boston


(State or country)


Mass.


15 MAIDEN NAME


OF MOTHER


Mary Dente


16 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


Mass.


Relation, if any


Domenick Amarena ( Father


A TRUE


ATTEST:


James Q.Burke


(Registrar of city or town where death occurred)


DATE FILED


19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Jan


20


1940


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY.


That I attended deceased from


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


............


to have occurred on the date stated above, at ...


.......... m.


Daration


Immediate cause of death.


Premature


Stillborn


(6 months).


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


Of autopsy


What test confirmed diagnosis ?.


20 Was disease or Injury in any way related to occupation of deceased ?


If so, specify


T. V. Canepopia


(Signed)


M. D.


(Address).


195 Bay State


Date


1/20


.1940


21 PLACE OF BURIAL,


CREMATION OR REMOVAL.


Mt. Benedict Cem.


(Cemetery)


Boston(City or Town)


DATE OF BURIAL


Jan 22


22 NAME OF


FUNERAL DIRECTOR


Thomas D. Russell


ADDRESS


1409 Dor. Ave. Dor


Received and filed.


Jan .... 23, ..... 1940


19


(Registrar of City or Town where deceased resided)


w wie Wein of ruc chy of town ff which the deceased resided 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


NoAudubon ... Hospital


(If U. S.


War Veteran,


specify WAR)


(If nonresident, give city or town and state)


19


...... , to ...


19.


19.


death is said


Date of.


Underline the cause to which death should be charged sta- tistically.


17 Informant. (Address) 71 Paine St. Winthrop


5


6


ITI


FEB171940 AM


R-302


PewnegosisteM Wig & Ving Rove to the Clerk of the city of town in which the deceased resided as soon as possible


8 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


PLACE OF DEATH


(County)


Boston


(City or Town)


Beth Israel Hospital


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


BOSTON (City or town making return) 2.20


Registered No.


793


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


2 FULL NAME


Hyman Goldstein


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


54 Sea Foam Ave


......


months


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH.


Jan. 25,1940


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY.


1-10-40


19


That I attended deceased from


I last saw h


imalive on


1-25-40


.. ,


to.


1-25-40


19


19


., death is said


to have occurred on the date stated above, at.


11:10A


.m.


6 Age of husband or wife if alive.


years


7 IF STILLBORN, enter that fact here.


54


AGE


53


Years


Months.


Days


If less than I day


Hours


Minutes


Usual


9 Occupation:


Broken


Industry


10 or Business:


Insurance


1I Social Security No.


Boston Mass


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


Samuel Goldstein


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Ida Goldstein O.K


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


17


Informant


(Address)


M Goldstein RBrother


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED 19


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


David Vicur Choulim-


DATE OF BURIAL


Jan ..... 26. 1940


19


22 NAME OF


FUNERAL DIRECTOR


B F Solomon


ADDRESS


Brookline Mass


Received and filed.


Jan .... 27 1940


19


(Registrar of City or Town where deceased resided)


PHYSICIAN


Major findings: mesentery


Underline


Of operations Carcinoma .. of .... recto.sigmoito cause to


and mesentari nodes


.. Date of.123-40


which death


should be


charged sta-


tistically.


Of autopsy ..


What test confirmed diagnosis ?.


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


If so, specify


D Kopans


(Signed)


(Addres


Beth Israel Hospt


Date


1-25 - M.


40


19


Other conditions ...


Carcinoma of recto sigmo!


(Include pregnancy within 3 months of death)


with .. metastases .... to .... liver ... and


Daration


Immediate cause of death


Overwhelming infection


2 Days


Due to


B.Welchii


Due to


3 SEX


Male


4 COLOR OR RACE 5 SINGLE


White


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


Dora Lebovich


(II U. S.


War Veteran,


specify WAR)


(a) Residence. No ..


(Usual place of abode)


Length of stay: In hospital or institution.


(Specify whether)


St.


WinthropMass


(If nonresident, give city or town and state)


years


No.


Suffolk


1


(Cemetery)


(City or Town)


4


1


....


-


.


WITH


6


FEB171300 44


Suffolkx


PLACE OF DEATH


(County) Bouton


(City or Town)


No. Mass General Hospital


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.


893


S (If death occurred in a hospital or institution, St. 1


give its NAME instead of street and number)


2 FULL NAME


Richard Dana Carpenter


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


271 Winthrop


.St.


Winthrop


(If nonresident, give city or town and state)


months


2


days.


In this community 35'rs.


mos.


days.


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)


Married


18 DATE OF


DEATH.


Jan. 26,1940


(Month)


(Day)


(Year)


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


58


.years


7 IF STILLBORN, enter that fact here.


AGE.


8 60 Years 4 Months .:


12


Days


If less than 1 day Hours Minutes


Usual


9 Occupation:


Printer(Retired)


Industry


10 or Business:


Printing Business


11 Social Security No.


12 BIRTHPLACE (City)


South Boston Mass


(State or country)


13 NAME OF


FATHER


Jerome B Carpenter


14 BIRTHPLACE OF


FATHER (City)


(State or country)


-- Maine


15 MAIDEN NAME


OF MOTHER


Lesina ---


16 BIRTHPLACE OF


MOTHER (City)


.....


-- Maine


(State or country)


17


Informant


(Address)


Wife


(


Relation, if any


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


Of autopsy


What test confirmed diagnosis ?


28 Was disease or Injury In any way related to occupation of deceased ?


If so, specify.


l"J"Rhees


(Signed)


M. D.


(Address)


Mass General Hospt Date 1-


.. 19 ....


40


21 PLACE OF BURIAL.


CREMATION OR REMOVAL ..... Forest Dale Malden Mass


(Cemetery)


(City or Town)


19


DATE OF BURIAL


Jan. 29.1940


22 NAME OF


FUNERAL DIRECTOR


A N Ward & Son


ADDRESS


Malden Mass


Received and filed


Jan. 31.1940


19


(Registrar of City or Town where deceased resided)


V


R-302


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 weeknd Wmich occurred in your city of town in case the deceased resided in another city or town at the time


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


PARENTS


Due to


Due to


to have occurred on the date stated above, at.1.Q .: 08P Immediate cause of death Hypertensive heart disease


.m.


Duration


6 Age of husband or wife if alive.


Lottie M Newton


19 I HEREBY CERTIFY,


Jan.


.26


14.0


to


Jan. 26


19 ... 40


That I attended deceased from


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


Jan.


26


1940


death is said


years


.......


.....


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution.


(Specify whether)


1


Underline the cause to which death should be charged sta- tistically.


Date of.


2 Yrs


...


P


FEB17104001


IR-302


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. I .. ) Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time


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


PLACE OF DEATH


Essex


(County)


Danvers (City or Town) Danvers State Hospital


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


Denvers


(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 Christine Patterson


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


44 ..... illow ... Ave ..


...........


.St.


month6


days'3


In this community


yTs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


female


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


white


Or DIVORCED


(write the word)


married


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE ot


William Patterson


(Husband's name in full)


6 Age of husband or wife if allve .... cannotbe ..... learnedars 7 IF STILLBORN, enter that fact here.


8


AGE


6.4ears


Months ..


Days


If less than I day


Hours


Minutes


Usual


9 Occupation:


housewife


Industry IO or Business:


II Social Security No.


cannot be learned


12 BIRTHPLACE (City)


(State or country)


Nova Scotia


13 NAME OF


Willie: P.Grant


FATHER


14 BIRTHPLACE OF


Nova scotia


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Christina Gray


15 BIRTHPLACE OF


MOTHER (City)


(State or country)


Nova cotia


17


Informant.


(Address)


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred) 2/5/40


DATE FILED 19


18 DATE OF


Jan. 26, 1940H


DEATH


(Month)


(Day)


(Year)


IS I HEREBY CERTIFY,9 That htendes Cleteased from


, 19.


19.


I last saw h ....


... alive on ..


to have occurred on the date stated above, at ...... ................. Duration


ImBelliate mutecof deathrounds tis


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


Date of.


clin ..


Underline


the cause to


which death


should be


charged sts-


tistically.


Of autopsy


What test confirmed diagnosis ?


no


20 Was disease or iojury in any way related to occupation of deceased ?


If so, specify .... detvin Goodman


(Signed)


(Address)


Dato


2/2/ 40


21 PLACETOE BURKAELIN


CREMATION- UR REMOVAL


Winthrop


DATE OF BURIAL


(Cemetery)


1/26/40 ity or Town)


22 NAME OF


FUNERAL DIRECTOR


Boston


ADDRESS


Received and filed


19


(Registrar cf City or Town where deceased resided)


1


No


(II U. S.


War Veteran,


specify WAR)


(2) Residence. No ..


(Usual place of abode)


Length of stay : In hospital or institution.


(Specify whether)


years


(If nonresident, give city or town and state)


25.10()52., death is said


...


PARENTS


Mary


Morhillkafn, if any


al researchas


501


IVINT


IP MASS


FEB131940 AM


A R-301 A;


1


PLACE OF DEATH


Suffolk (County) Winthrop (City or Town)


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)


(If deceased is | married, widowed or divorced woman, give also maiden name.) 35-More


....... .........


.St.


Winthrop Muss


(If nonresident, give city or town and state)


Length of stay: In hospital or institution ..


years


months


days.


In this community


byrs.


mos.


days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


(write the, word)


MARRIED


WIDO WED


Mamed


or DIVORCED


5a Ii married, widowe HUSBAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


G Age of husband or wife if alive.


54


.Years


7 IF STILLBORN, onter that fact here.


8


AGE 58 Years Months. Days Hours Minutes


Usual


9 Occupation:


Pr


10 or Business:


Industry


Boston american Hempel


11 Social Security No .......


023-03-5094


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


JaRae Savel


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Rena- Cannot be.


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


17 Informant (Address) 35- Une


1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with cto BEFORE the burial or transit permit was issued: Nm. D. Children (Signature of Arenyod Board of Health ofother) Health affiche (Official Designation) (Date of Issue of Permiitt 2/3/40


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH.


Navog: 1 February-1-1940


(Month)


(Day)


(Year)


19


LHEREBY CERTIFY.


That ! attended deceased from


JUNE. 25,


19.39, to January 36, 1940 I last saw b.IM alive on JAN vary, 19.HA, death is said to have occurred on the date stated above, at. S .- 45. G.m. Immediate cause of death Cerebral Thrombosis


Duration IPIPORTANT 2.wks-


5 ielos.


6 /2 MOS


PHYSICIAN


Major findings :


Of operations


GENEral CarcinoMatosis


.Date of ...


Of autopsy


-


What test confirmed diagnosis ?.


20 Was disease or injury in any way related to occupation of deceased?


If so, specify ...............


/04


(Signed) Edward X' Hanger (Address) 200 Warth With with DeFeb.2 1940 verent


21


.... (City or Town)


Place of Burial, Cremation or Reagoval. ู€ูู€ DATE OF BURIAL. 19. 40


22 NAME OF


FUNERAL DIRECTOR


Manuel Stantilly


ADDRESS


10-Wash. SX.W


Received and filed.


19


(Registrar)


information should be carefully supplied.


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.


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


Saral Sauel


Relation, if any


St. 1


2 FULL NAME


No 35- W to.


Savel


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


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


white


Of divorced


Sedar


If less than 1 day


Due to


Migrating Thrombo Probiti's


Due to - Following Accident to lower.


Other conditions


back


GENEral CarcinoMatos15


(Include pregnancy within 3 months of death)


Underline the cause to which death should be charged sta- tistically.


, M. D.


PARENTS


AGE should be stated EXACTLY. PHYSICIANS should state


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 helief the name of the deceased, his 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 hy 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 hody 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 human 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 from the hoard of health or its agent aforesaid or from the clerk of the town where the body is huried. No such permit shall he 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 hy 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 hy 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 madc 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 he 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 hody has been sooner ohtained 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 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 issuc such permits, or if there is no such board. from the clerk of the town where the hody is to he huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial 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 those of persons to whom they have given bedside care during a last ill- ness from diseasc unrelated to any form of injury.


(2) Board of Heaith physicians will certify to such deaths only as those of persons who, though disabled hy 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 supposabiy due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury on 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 .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.


Statement of Ocenpation .- 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 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


1 R-301 A|


I


Winthrop


(City or Town)


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. 24


Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


Ralph Sherman Johnson


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


22 Upland Road


St.


(If nonresident, give city or town and state)


years


months


days.


In this community 32 yrs.


mos.


days


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Male


4 COLOR OR RACE


White


5 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


(Month)


(Day)


(Year)


That I attended deceased from


5a If married, widowed, or dig drie Dimock 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


74 Years


8


Months


26


Days


If less than 1 day


AGE


Hours.


Minutes


Usual


Manufacturing dept (retired)


9 Occupation:


Industry


10 or Business:


U. S. Rubber Co


Due to


Other conditions


arquia Pectoris


2 years


12 BIRTHPLACE (City)


Framingham


(State or country)


Massachuse


13 NAME OF


FATHER


John Johnson


Major findings :


Of operations


none


14 BIRTHPLACE OF


Unable to obtain


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Mary Thompson


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Unable to obtain


I7 Relation, if any Informant Barbara Johnson daughter (Address)22 Upland Rd. winthrop




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