USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 3
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 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88
.years;
MEDICAL CERTIFICATE OF DEATH
(If U. S.
War Veteran,
specify WAR)
(Usual place of abode)
G. S.H.
37
9
months
25
(If nonresident, give city or town and state)
Il Social Security No.
None
y.rs.
"
a
FEB-SIS41 AM
M R-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 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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-10-739. No. 8427-f
1
PLACE OF DEATH
Middlesex
(County)
Melrose
(City or Town)
No. Melrose Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Melrose (City or town making return)
Registered No.
1 (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Gertrude C. Grobe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
60 Cliff Ave.
......................
.St.
(If nonresident, give city or town and state)
Length of stay: In hospital or institution
(Specify whether)
years .
months
days
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Female
4 COLOR OR RACE, 5 SINGLE
MARRIED
White
WIDOWED
Or DIVORCED
(write the word)
Single
5a lf married, widowed, or divorced
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
ÅGE
48
Years
5
Months.
5
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
School Teacher
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
Boston
(State or country)
Mass.
13 NAME OF
FATHER
Adolph Grobe
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Carrie L. DeMond
16 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country) .
Mass.
17
Informant
Adolph Grobe
Relation, if any
father
(Address)
11 Derring Ave. Braintree, Mass.
A TRUE COPY.
Raymond H. Greenlaur
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Jan. 7, 1941
19
18 DATE OF
DEATH.
Jan. 4, 1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
1925
19.
...... , to ....
That I attended deceased from
Jan. 4/41
19
I last saw h
er ... alive on ..
Jan. 3/41
19
death is said
to have occurred on the date stated above,
A: 15 A.M.
Immediate cause of death
Carcinoma of the stomach
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Exploratory Lao.
Date of.
Oct 29/40
Of autopsy
What test confirmed diagnosis ?
Clinical
20 Was disease or Injury In any way related to occupation of deceased ? no
If so, specify
(Signed)
R. W. Lavton
(Address)
Melrose, Mass.
M. D.
Winthrop
Winthrop
DATE OF BURIAL
Jan. 6, 1941
19
22 NAME OF
FUNERAL DIRECTOR
A. E. Ballantyne
ADDRESS.
Melrose, Mass.
Received and filed
19
(Registrar of City or Town where deceased resided)
-
Duration
Underline the cause to which death should be charged sta- tistically.
Dato,
1/4/41
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery).
(City or Town)
(If U. S.
War Veteran,
specify WAR)
Winthrop
(a) Residence. No.
(Usual place of abode)
9 weeks
6
JAN1009AL MI
M R-301 A
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 316 Bowdown
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.
8
Registered No.
§ (If death occurred in a hospital or institution. St. { give its NAME instead of street and number)
Jaghigh Drew Bruce
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St
Winthrop
(If nonresident, give city or town and state)
years
months
days.
In this community 29/ yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
January
6
1941
(Month)
(Day)
(Year)
That I attended deceased from
19
I HEREBY CERTIFY.
may 5 193% to January 5. 1941 I last saw I Un alive on JuQuery 6, 1941, death is said to have occurred on the date stated above, at 38' m.
Immediate cause of death .............. Coronary Trombosis
Duration IMPORTANT 1 year
Due to
arteriosclerosis
Due to.
Chuonic Interstitial Deplaintes 2 years
Other conditions.
Lemunal Broncho-
(Include pregnancy within 3 months of death) Hemning
4 days TER GATANT
PHYSICIAN
Major findings:
Of operations.
nous
Date of.
Of autopsy.
none
What test confirmed diagnosis? Clinical+
laboratory
20 Was disease or injury in any way related lo occupation of deceased ?. no
If so, specify.
Jacob ahamo
(Signed) .........
(Address) 562 Mbuley ST
M. D.
Hubo Rate Jan / 1941
aso
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
Jan 9
19 3/1
22 NAME OF
FUNERAL DIRECTOR
RIC, Kinky
ADDRESS
Boston
Received and filed 19
(Registrar)
1
No.
2 FULL NAME ...
(a) Residence. Nox
316 Bowdoin
(Usual place of abode)
Length of stay: In hospital or institution hasan
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
white
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
Many more
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.
65
7 IF STILLBORN, enter that fact here.
8
Months.
Days
AGE
70 Years
Usual
9 Occupation:
Betired
10 or Business:
11 Social Security No ......
12 BIRTHPLACE (City)
norte
(State or country)
13 NAME OF
FATHER
Solomon Bruce
14 BIRTHPLACE OF
FATHER (City) ....
Hanover
(State or country)
n.zt.
15 MAIDEN NAME
OF MOTHER
Caroline Drew
16 BIRTHPLACE OF
PARENTS
MOTHER (City).
Hammer
(State or country)
n.4.
17
hung Mary Bruce
......
Informant
(Address)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
is very important. See instructions and extracts from the laws on back of certificate.
(Signature of Agent of Board of Health or other)
Health alice
1/8/41
100m-2-'40-D-729-a
N. B .-- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Industry
Mechanic Signal service
5 SINGLE (write the word) married
.years
If less than 1 day Hours. Minutes
Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
(Official Designation) (Date of Issue of Permit)
2 years
........
Underline the cause to which death should be charged sta- tistically.
21
(If U. S.
War Veteran.
specify WAR)
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 wbom he bas 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 registration 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, definded as required by section one, where same was contracted, the duration of his last illness, when last seen alive by tbe physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such perinits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person sball exhume a human body and remove it from a town, fromn one cemetery to another, or from one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town wbere the body is buried. No such perinit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory 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 tbe 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, bis certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician wlio is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, tbe medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal sball constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six bours after such removal, unless a permit in the usual form for the re- movai of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon tbe 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 tbe physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Avaliar
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 buried 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, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deatbs only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Heaith physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, bave died without recent medical attendance or whose physician is absent from bome 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 traumatisin (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatbs from disease resulting from injury or infection related to occupation, 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, aspbyxia, astbenia, etc. As principal cause name the disease causing deatb. As related causes, name earlier morbid conditions, if any, related to the principai cause and any important complication of tbe 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 deatb, report the usual occupation prior to illness. If the deceased had retired from business, 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, etc. For a person wbo had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Surflok
(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.
9
Registered No
§ (If death occurred in a hospital or institution,
St.
{ give its NAME instead of street and number)
2 FULL NAME
Lucy Hope (Howes) Chace
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
40 Thorton Park
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community 5 0yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Fredrick B Chace
(Husband's name in full)
6 Age of husband or wife if alive. 7.1 ... years
7 IF STILLBORN, enter that fact here.
8
AGE .? O.
Years
4 Months
5 Days
If less than 1 day
Hours
Minutes
9 Occupation:
Housewife
Chatham
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Daniel Howes
FATHER (City) .
Chatham
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Hope Atkins
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
Mass.
Chatham
Relation, if an
(Address) 40 Thornton Park Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Burial or transit permit was issued : Www. D. Culorenz
,(Signature of Agent of Board of Health or other) Healthe Officer 1/8/4/
"(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from november 19, 1940, to December 26, 1940 I last saw her alive on december 26, 1940, death is said to have occurred on the date stated above, at. 3:15 P.
Immediate cause of death .. Cerebral Hemorrhage
Due to. Itpertension
meno
Due to. Generalized arteriosclerosis
Mean
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
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? 120
If so, specify -.....
(Signed)
(Address) Mintha Mul Date 1/7
M. D.
19.5%./ ...
Place of Burial, Cremation or Removal.
(City or Town)
4I
DATE OF BURIAL ....
Jan.
9
19
22 NAME OF
Howard S Reynolds
FUNERAL DIRECTOR
ADDRESS
Winthrop
Mass.
Received and filed
19
(Registrar)
Duration IMPORTANT
Major findings: Of operations ..
Date of
Of autopsy.
What test confirmed diagnosis ?.
21 Methodist Union Chatham
17 Fredrick B Chace (
Winthrop 1 (City or Town) (Usual place of abode) 3 SEX Female Usual 11 Social Security No ... 14 BIRTHPLACE OF PARENTS Informant. is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-2-'40-D-729-a N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry 10 or Business: Own .... Home
No 40 Thornton Park
(If U. S.
War Veteran,
specify WAR)
6
1941
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 registration 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, definded 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, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefroin a human body which has not been buried, until he has received a permit froin the board of health, or its agent appointed to issue such perinits, 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 froin one grave or tomb other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory 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 in- sufficient, a physician who is a meinher of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit t to the clerk of the town for registration. The person to whom the permit s so given and the physician certifying the cause of death shall thereafter Furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (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 buried 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, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance 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 illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated 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 indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized dlsease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or coniplication 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 conditions, if any, related to the principal cause and any important complication 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 business, 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, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A
Suffolk
(County) Winthrop
(City or Town)
No. 411
Shirley
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. 10
Registered No.
§ (If death occurred in a hospital or institution. { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
H11 Shirley
St
Winthrop
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community 2Cyrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
/3 SEX
4 COLOR OR RACE
Male While
5 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCED
A divorced Referwet
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. 40 years
7 IF STILLBORN, enter that fact here.
8 11
AGE Years .. Months. ........... .. Days!
Usual
9 Occupation :..
Talar
Industry
10 or Business:
For Himself.
11 Social Security No ....
12 BIRTHPLACE (City).
(State or country)
Aussi
13 NAME OF
FATHER
Sund Cohen
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME OF MOTHER Cannot be learned.
16 BIRTHPLACE OF MOTHER (City) (State or country)
Cussin
Cohen
Relation, if any Som
.17 Claron Informant .... 411 Shirley + winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Man. D. Childrens (Signature of Agent of Board of Health of other)
1/4/4/
(Date of Issue of Permit)/
18 DATE OF
DEATH.
Jan.
6
(Month)
(Day)
(Year)
18 August
I HEREBY CERTIFY. 19.2.7% to
., 19 .. 2. /, death is said to have occurred on the date stated above, at 7:50 p.m. Immediate cause of death. Heart Block Duration IMPORTANT
anterior Salenti /1 at
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations
Date of
Of autopsy ....
2000
What test confirmed diagnosis? EKg
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.