USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 60
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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 huried 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 hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths 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, 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 heen 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 he 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 nonc.
SPACE FOR ADDITIONAL INFORMATION
.
R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physicians to Insert a recital to that effect. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exder Statement of USCOTATION IS very Important. See instructions and PARENTS
100m (d)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was Issued : Um. A Celulares
(Signature of ;4geht of Board of Health or other)
Ho, atte Sept. 24/41
(Official Designation) (Date of Issue of Permit
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept.
23
1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
Que 28-
1941,
to ...
Sept 23
1941
I last saw her
.allve on
Sept. 19
19/4/, death Is sald to
have ocourred on the date stated above, at
6.15 a.
.
Duration
immediate oause of death
Cancer dutenis, and Bladder Jan. 1941
U
AGE
Years
¥7
Months
25
Days
If less than 1 day
.Hours
Minutes
Usual
9 Occupation :
At home
industry
10 or Business :
11 Social Security No.
Boston
12 BIRTHPLACE (City)
(State or country)
Massachusetts
13 NAME OF
FATHER
Joseph M. Adams
14 BIRTHPLACE OF
FATHER (City)
New London
(State or country)
New Hampshire
15 MAIDEN NAME
OF MOTHER
Abagail A. Weed
16 BIRTHPLACE OF
MOTHER (City)
East Unity
(State or country) New Hampshire
17 InformanrS. Laura A. Mirick Relation, if any (Address) 20 Elmwood Ave. Winthrop Hass
DATE OF BURIAL.
19
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
Received and filed
19
(Registrar)
1
PLACE OF DEATH
Suffolk (County)
Winthrop
No.
(City or Town)
20 Elmwood Avenue
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or Its Agent.
179
§ ( If death occurred In a hospital or Institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Clara Louise (Adams ) Wiswell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
20 Elmwood Avenue
St.
......
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
( Before death)
(Specify whether)
years
months
days.
In this community
17 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACEJ
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Lowe li maiden wes prywife in full)
(Husband's name in full)
6 Age of husband or wife if alive
years
Due to
Due to
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings :
Of operations.
none
Date of.
Of autopsy.
nome
What test confirmed diagnosis?
Clinical
Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury in any way related to occupation of deceased ?........
If so, specify ...........
(Signed).
Herdie N. Dickinson
M. D.
(Address) Wartburg, Mass Date Sept 23 1941
.....
21
Woodlawn Cemetery
Everett
Place of Pattini, Cremation
Sept. 25, 1941
(City_or Town)
Registered No.
(Usual place of abode)
-
7 IF STILLBORN. enter that fact here.
8 84
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortliwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorizeil 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. defined as re- quired by section one, where same was contracted. the duration of his last illnesa, when last seen alive by the physician or officer and the date of bis death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa required by the preceiling section or hy section forty-five of chapter one hundred and four- teen, shall, if the deceased. to the best of his knowledge and belief, served in the aring. navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary ail the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred aml fourteen, the word "war" shall incluule the China relief ex- pedition all the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety eight and July fourth. nineteen hundred and two, and the Mexi- · can horder service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body itt 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 tomb other than the receiving 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 boily is buried. No such permit shall be issued until there shall have been ilelivered to such board, agent or clerk, as the case inay be, & satisfactory written statement containing the facts required by law to be returneil and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, aa required by law, or in lieu thereof a certificate as lrereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quireil of the attending physician. If death is caused by violence, the medi- cal 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 ileath 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 removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by aection ten of chapter forty-aix, 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 perntit is so given and the physiciun certifying the cause of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceaseil, or as to the manier or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).
No umlertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a perinit so to do from the hoard 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 he 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).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have ilied hy violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persons to whom they have given beilside care during a last illness from disease unrelated to any form of injury.
( ") Board of Health physicians will certify to such deaths only aa those of persons who, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly by trauinatism (including resulting aepticemla), and by the action of chemical ( drugs or poisons), thermal. or electrical agents, and deaths following ahortion, but also deaths 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 thic 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 conditions, if any, relateil to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portaut, 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 discase causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retireinent. Children not gainfully employed may be returned as at school or at horne. 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 fantily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-302
PLACE OF DEATH
VORCESTER
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
1
RUTLAND
(City or Town)
Rutland State Sanatorium
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Harry Lubin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
140 Shirley
St.
Winthrop, Mags
(Usual place of abode)
(If nonresident, give city or town and Statc)
Length of stay: In hospital or Institution .. Sanatorium years
8
months
5
days.
In this community
yTs.
8
mo8.
5
days.
(Before death)
(Specify whether)
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
1.8 DATE OF
September
29.
1941
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
Betty Belak
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
58
years
7 IF STILLBORN, enter that fact here.
8
AGE.5.8.
Years
7
Months.
1
Days
If less than 1 day
.Hours
Minutes
Usual
9 Occupation :
Painter
Industry
10 or Business :
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
Russia
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of ..
Underline
the cause to
which death
should be
charged sta-
Of autopsy
Microscopical
tistically.
What test confirmed diagnosis?
20 Was disease or injury in any way related to oooupation of deceased ? Unknown
If so, specify.
(Signed) ...
Heinz J. Lorge
M. D.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Workmen's Circle , Melr(
(Cemetery)
DATE OF BURIAL
22 NAME OF
FUNERAL
DIRECTOR
Manuel Stenetsky
ADDRESS
10 Washington St. orchester
Received and filed
OCT 6 ....
1941
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
A TRUE COPY. Frances P. Hanff
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
September 29.1941
19
19 1 HEREBY CERTIFY
That I attended deceased from
January 24
19.
41 September 29 19 41
I last saw h
im
alive on.
Sept. 29
19 .. 4.1, death Is sald to
have occurred on the date stated above, at
5:50 A.M
Duration
Immediate cause of death
Pulmonary tuberculosis
about
43 vri
Due to
Due to.
13 NAME OF
FATHER
Henry Lubin
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Ida Savel
Rutland State San Date9/29
19
41
19
(Address)
Rutland Mass
Relation, if any
September 30. 192th or Towe) se
17 State San. Records
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
No.
Registered No.
IN 1801
(If U. S.
War Veteran,
specify WAR)
(Give maiden name of wife in full)
R-305
Budoux
PLACE OF DEATH
(County) Borton
(City or Town)
The Commoninealily of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making repu@1
7601
Registered No
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 5 Irwin Ave
years
months
days.
In this community
yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept 1
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) drowning
presumably suloldal
20 Accident, suicide, or homicide (specify)
Date of occurreachout .... Sept 1
19
Where did
? Boston Harbor
(City or town and State)
Injury occur ?.
Did injury occur in or about the home, on farm, in industrial place, or in
public place ? )
harbor
Manner of
Injury
Nature of
as above
Injury
While at work?
.no
.Was there an autopsy ?......
no
21 Was disease cr injury in any way related to occupation et deceased ?
I! so, specify.
(Signed)
W J Brickley
(Address)
Boston
Date
9/2/9 41
22 St. Joseph's
Relation, if any Place of Burial, Cremato Removal. Bos. ston of Town)
DATE OF BURIAL
Sept 4 1941
19
23 NAME OF
FUNERAL DIRECTOR
F.T. Prescott
ADDRESS
Boston
Received and filed 19
1041
(Registrar of City or Town where deceased resided)
2 FULL NAME
Thomas M
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
male
white
or DIVORCED
Sa If married. widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
AGE
54 Years
10 Months
5 Days
If less than I day
Hours
Usual
9 Occupation:
Industry
contact man
oston Edison Light Co
IO or Business:
II Social Security No.
026-01-1267
12 BIRTHPLACE (City)
13 NAME OF
FATHER
John Doherty
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary McMahon
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Ireland
I7
John P Doherty
Informant.
25m-10-'39. No. 8427-g
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
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
(State or country)
White River Jot Vt
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
(write the word)
single
6 Age of husband or wife if alive. years
Minutes
(Address)
Arlington
"bro
A TRUE COPY.
ATTEST:
A(Registrar of city or town where death occurred)
DATE FILED 9/5/11 19
-
No. Boston ... Harbor .... near .... City ..... Point St.
Doherty
(If U. S. War Veteran, specify WAR) Winthrop
.St.
(If nonresident, give city or town and state)
about
(Specify type of place)
, M. D.
R-302
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsoa
(City or town making return)
673
182
Registered No.
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2 FULL NAME
William E.Ricker
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
891 .... Shirley.
St.
Winthrop. Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
In this community
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
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
19 |
HARLEBI CERTIFY4]
19
to
19
I last saw h.
alive on
have occurred on the date stated above, at. 4:50 m.
Duration
Immediate cause of death.
Carcinoma
of the colon
? mos.
U
Due to.
Due to.
Chronic colitis
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta-
Of autopsy
clinical & sidy
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
Isadoro.Kaplan
M. D.
(Address)
Soldiergl Home
Date
9/20
4:
CREMATION OR REMOVAL
21 PLACE OF BURIAL,
Winthrop Com. Linthr
(Cemetery)
(City or Town)
19
DATE OF BURIAL
Supt
5
4.
22 NAME OF
FUNERAL DIRECTOR
180 Winthrop St. , Winthrop
ADDRESS
Received and filed
1
104.1
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
41
18 DATE OF
DEATH
Sept. 2,
1941
5a If married, widowed, or divorcedthel Pinkham
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Hushand's name in full)
67
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
67
27
28
Days
AGE
.Years
Months
If less than 1 day
Hours
.Minutes
Usual
9 Oocupatlon :
Engineer
Industry
Fire Department
10 or Business :
nono
11 Social Security No ..
Cambridge , mas.
12 BIRTHPLACE (City)
(State or country)
John E.Ricker
13 NAME OF
FATHER
Manchester
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Helen A.Hall
N.H.
15 MAIDEN NAME
OF MOTHER
Groton,
16 BIRTHPLACE OF
MOTHER (City)
(State or counthopstal records
N.H.
17 Informant ( Address)
(
Relation, if any
resided in another city or town at the time of death should be made forthwith and transmitted on Form Rt-302 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
1
Chelsea (City or Town)
No. Soldiers1 .... Home ... in Mass ..
(If U. S.
War Veteran,
Spanish
speolfy WAR)
(Usual place of ahode)
Hospital
1
That Beterted deceased from 4]
Sept. 199
.death Is said to
-
Howard v.Reynolds
DATE FILED
Sept. 2,
19
8
R-302
PLACE OF DEATH -
(County)
(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) 53
Registered No.
7647
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
No.
Boston .... City ..... Hospital
St. 1
Kelley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
304 River
St.
Winthrop
(a) Residence. No ..
(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
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCEMarried
(write the word)
.years
Minutes
retired-beef salesman
Industry
10 or Business:
wholesale .... mea.t.
13 NAME OF
FATHER
Michael Kelley
Catherine Riley
Relation, if any
A TRUE COPY .-
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED CZ
9/8/41
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept 3 1941
(Month)
(Day)
(Year)
IS I HEREBY CERTIFY,
8/17/41
19
.... , to.
That I attended deceased from
9/3/41
19.
I last saw hi.m ...... alive on.
9/3/41, 19
death is said
to have occurred on the date stated above, at 6/50Am. Immediate cause of death. myocardial infarction
Duration
30yrs
Due to
.....
nephrolithiasis
y.r.s.
Due to
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)
J Lacey
M. D.
..
(Address)
Boston
Dat
9/3/49
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Mass
DATE OF BURIAL.
(Cemetery)
Sept 6 1941
19
{Gity or Town)
22 NAME OF
FUNERAL DIRECTOR
M A Curtis
ADDRESS
Boston
Received and filed.
19
(Registrar of City or Town where deceased resided)
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