USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 33
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AGE
Usuai
9 Occupation :
PARENTS
(Address)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
Copies vi tellins vi des revues during the previous man with occurred in your city of town in case the deceased
WRITE PLAINLIAWITH ONFADING BLACK INK - THIS IS APERMANENT RECORD
Industry
10 or Business :
50m (e)-1-41-4667
DATE FILED 5/11/42
No. Peter Bent Brigham Hospital
(If U. S.
War Veteran,
speolfy WAR)
(a) Residence. No.
(Usual place of abode)
M R-302
PLACE OF DEATH
SUFFOLKI CountyY BOSTON
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON'
(City or town making return)
Registered No.
4256 93
S (If death occurred in a hospital or institution, St. give its NAME instead of street and number) No. -
2 FULL NAME
Simon
Malinsky
(If U. S.
War Veteran,
specify WAR)
(a) Residenoe. No.
(Usual place of ahode)
16 Nevada
St.
Winthron
(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
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
5a if married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
68
6 Age of husband or wife If alive years
7 IF STILLBORN, enter that fact here.
8
AGE
80 Years
Months. Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Industry
Roxbury Ladies Fuel
10 or Business :
Society
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Morris Malinsky
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russin
15 MAIDEN NAME
OF MOTHER
unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Rugals
17
Informant
(Address)
Sarah Jacobs
(
Relation, if any
A TRUE COPY.
ATTEST :
(Registrar of city or town (where death occurred) (19
DATE FILED 5/15/42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 13
1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
to
5/13/42
19.
I last saw h ....... m ..... alive on
5/13/42
.. , 19
death is sald to
have occurred on the date stated above, at.
3 A
m.
Duration
Immediate oause of death cerebral hemorrhage
May ..... 7
?
Due to arteriosclerosis
Due to.
myocarditis
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis ?
20 Was disease or injury In any way related to ocoupation of deceased ?
If so, specify
(Signed)
J Ginsburg
M. D.
(Address)
Boston ..
Date 5/73/19 42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Adath Jechurn il Roy
(Cemetery)
(City or Town)
DATE OF BURIAL
11941 777042
19
22 NAME OF
FUNERAL DIRECTOR
J ............ La.v.i.n ....
ADDRESS
UN 10 1.42
19
Reoelved and filed
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
THIS IS APERMANENT RECORD of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk Copies of returns of ueains recorueu auring the previous month wnien occurred in your city or town in case the deceased WRITE PLAINLY WITH UNFADING BLACK INK
1
(City or Town)
27 Howland
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Rebecca Evans
>
Innil
19 42,
...
(Give maiden name of wife in full)
collector
Major findings :
Of operations
Date of.
PARENTS
IM R-302
1
PLACE OF DEATH
"SUFFOLK BOSTON
(City or Town)
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City "or town making return)
Registered No.
43094
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME.
Anna
Swartz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
20 Sea
Foam
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
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
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
Morris ..... Swartz
(Husband's name in full)
55
7 IF STILLBORN, enter that fact here.
AGE
g
47
Years
Months ..
.......
Days
If less than 1 day
Hours.
.Minutes
Due to.
Usual
9 Dccupation :
At home
Industry 10 or Business :
11 Sooial Security No.
12 BIRTHPLACE (City)
( State or country)
Boston Mass
13 NAME OF
FATHER
Jacob Levine
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Russia"
(State or country)
15 MAIDEN NAME
OF MOTHER
Jennie Levine
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Relation, if any
17
Hvman Levine
Informant
(Address)
bro
A TRUE COPY
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
5/16/42
9
19
18 DATE OF
DEATH
May 14 1942
(Month) (Day)
(Year)
19 | HEREBY CERTIFY,
5/24/42
19
to
5/14/42
19
That I attended deceased from
I last saw h ..
er alive on
5/14/42
19
death is sald to
have ocourred on the date stated above, at 10/25A .m.
Duration
Immediato oause of death .. cerebral hemorrhage
Hyperter
essential hypertension
gion for many yrs
Due to ..
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to ocoupation of deceased?
If so, speolfy
(Signed)
Albert Roos
M. D.
(Address)
Boston
Date 5/14/19 42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
(Cemetery)
(City or Town)
DATE OF BURIAL
NOV 15 1942
19
22 NAME OF
FUNERAL DIRECTOR
M Stanetsky
ADDRESS
Boaton
Reoelved and filed.
0 1942
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk copies or returus or ueains recurveu uuring the previous mouth which occurred in your city or town in case the deceased WRITE PLAINLY. WITH UNFADING BLACK INKAS
No.
330 Brookline Ave
(If U. S.
War Veteran,
speolfy WAR)
Winthron
6 Age of husband or wife If allve years
...
Physician
Underline the cause to which death should be charged sta- tistically.
Winthrop
Everett
M R-302
PLACE OF DEATH
SUFFOLK 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.
4635
95
S (If death occurred in a hospital or institution, St. give its NAME instead of street and number) C
Henrietta
Wolfe
(If U. S.
War Veteran,
speolfy WAR)
(a) Residence. No.
(Usual place of abode)
21 Nevada
St.
Winthrop
(If nonresident, give city or town and State)
Langth of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
married
MARRIED
WIDOWED
or DIVORCED
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 78
years
7 IF STILLBORN, enter that fact here.
8 AGE74 Years Months. Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Industry
10 or Business:
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Austria
13 NAME OF
FATHER
Jacob Coma
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Austria
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Austria
17
Informant
(Address)
husband
Relation, if any
A TRUE COPY
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
5/28/42
( 1.19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 25 1942
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
5/12/42
19
to
5/25/42
.. ,
19.
I last saw h.e.n.
allve on
5/25/45
19.
death Is sald to
have ocourred on the data stated above, at.
9.45P
m.
Duration
Immediate oausa of death
Hypertensive cardio vascular
dirense
Dua to
Dua to
Other conditions."
SEn arteriosclerosis
vre Physician
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed dlagnosis ?. autons.v.
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify
(Slgnad)
H Beniamin
M. D.
Det26/42 19
(Address)
21 PLACE OF BURIAL,
Har Moria W Box
CREMATION OR REMOVAL ..
(Cemetery)
(City or Town)
DATE OF BURIAL
Nav 26 1042
..... 19
22 NAME OF
FUNERAL DIRECTOR
....
BF Solomon
ADDRESS
Brookline
Raoelved and filed 19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
1
No. Poter Bent Brigham Hospital
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk Copies or returus or ueains recorueu auring we previous mouth wien occurred in your city or town in case the deceased WRITE PLAINLYWITH-UNFADING BLACK INK THIS IS A PERMANENT RECORD
...
IM R-302
PLACE OF DEATH
SUFFOLKI County BOSTON
(City or Town)
Mass General
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.
467296
Hnonital (If death occurred in a hospital or institution, St. give its NAME instead of street and number) No. -
Frank J
Belcher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
15 Ingleside Ave
St.
Winthron
(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
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
5a If married, widowed, or divoroed HUSBAND of
Mary Farnum
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that faot here.
4
Months 20 Days
If less than 1 day
Hours.
.Minutes
11 Social Security No.
010-05-7562
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
Harold P Belcher
14 BIRTHPLACE OF
FATHER (City)
Winthrop Mass
15 MAIDEN NAME
OF MOTHER
Marrerv Jov
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston Mass
father
(
A TRUE COPY
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
5/29/42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 26 1042
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
5/25/42
19
to ... ,
5/2,142
19
im
I last saw h
.. allve on.
5/26/42
19
death Is sald to
have occurred on the date stated above, at.
7.30
m.
Immedlate cause of death.
chronic glomerular nenhriti
unk
17 yrs
r
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations ......... n.o.n.e.
Date of.
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed dlagnosis ?.
20 Was disease or injury In any way related to ocoupation of deceased?
If so, specify
G F Houser
(Signed)
M. D.
(Address)
Boston
Date 5/20/19 42
21 PLACE OF BURIAL,
Wintheon Mass
CREMATION OR REMOVAL ..
(Cemetery)
(City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
I S Reynolds
ADDRESS
Hanthnon ...
0 1942
19
Reoelved and filed.
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
2 FULL NAME 3 SEX male (or) WIFE of 8 AGE. 30 Years Usual 9 Occupation : Industry 10 or Business : PARENTS 17 Informant (Address) of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk (State or country)
1
{ giv
(If U. S.
War Veteran,
speolfy WAR)
That I attended deceased from
Due to. diabetes mellitus
Duration
2.1.
Relation, if any
DATE OF BURIAL
May 23 7042
R-301
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that offoot. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and snouId De Carcluny SUPHIICU. MUL JIIVUIU
100M-€ -2-42-8855
PLACE OF DEATH -
Suffolk (County)
The Commontoralth 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.
S ( If death occurred in a hospital or institution, St. { give its NAME instead of street aud nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME.
Baby Girl DE Napoli
( If deceased is a married, widowed or divoived woman, give also maiden name.)
(a) Residence. No.
6 Central
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Refnre death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3-SEX
4 COLOR OR RACE|
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
may
287
(Month)
(Bay)
(Year)
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
> IF STILLBORN. enter that fact hera.
Stillborn
8
AGE
Years
Months
Days
-
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No.
'2 BIRTHPLACE (City)
(State or country)
Winthrop.
Mass.
PARENTS
15 MAIDEN NAME
e
OF MOTHER
Madaline Scandone
16 BIRTHPLACE OF
MDTHER (City)
Winthrop,
(State or country)
Mass.
17 George DE Napoli Reption enx Informant. 6 Central St., Winthrop
l'lace of Burial, Creniation or Removal.
(City or Town)
DATE OF BURIAL.June.10,
19.42
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Man. D. Childress (Signature of Agent of Board of Health 65 other)
Healthe Officer 6/9/42
7(Dfficial Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to oooupation of decaasad ?.
If so, specify ..
.....
('Signad ).
(Addrass)
02. 6-2 1942
M. D.
21 St. Michael
Boston
22 NAME DF
FUNERAL DIRECTOR
Michael Forcella
ADDRESS
10No Bennet St.
Boston
Received and Aled.
JUN 1 1 1942
19
( Registrar) X
IMPORTANT Physician Underline the cause to which death should be charged sta- tistically.
Major findings:
Df operations
Date of
Of autopsy.
What test confirmed diagnosis ?
Pathological
Duration IMPORTANT 1
Immadiate oause of death.
Dua to.,4.
( maceratal
fretus
5
Due to
Other conditions
( Include pregnancy within 3 months of death)
13 NAME OF
FATHER
George Di Napoli
e
14 BIRTHPLACE OF
FATHER (City)
Revere., ..
(State or country)
Mass ..
19 | HEREBY CERTIFY,
That i attended deosased from
19
40
to
...
1940
I last saw h. S ....
alive on ....
19
death is said to
have occurred on the date stated abova, at ............ "
.m.
I
Winthrop
(City or Town)
No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1940
( write the word)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physioien or registered hospital medioel officer shall forthwith, after the death of a person whoin he has attemled during his last illness, at the request of an undertaker or other authorizeil person or of aus meniber of the family of the deceased, furnish for registration a standard certificate of death. stating to the best of his knowledge and behef the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. wlirre same was contracieil. the duration of his last illnese, when last seen alive by the physician or ottcer and the date of bia death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, aerved In the army, 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 and the secondary or iinmeiliate 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 thla aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one huitred and fourteen, the word "war" shall inchule the China relief ex- pedition and the Philippine insurrection, which shall, for sail purposes, be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chiap. 46. Sec. 10.
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 ahall exhume a human body and remove it froin a town. from one cemetery to another, or from one grave or tomb other thsu 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 body Is buried. No such permit shall be issued until there aball have been delivered to such board, agent or clerk, as the case inay be, a satisfactory written etatenient containing the facts required by law to be returned and cecorded, which shall be accompanied. in case of an original Interment, by a satisfactory certificate of the attending physician, if any, as required by law, o1 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 physi- cian who is a member of the board of health, or employed by it or by the selectmien for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner chall make such certificate. If auch a permit for the removal of a human boily, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of desth made as above provided and in the possession ot 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. unlesa a permit in the usual form for the removal of such body has been sooner obtalued hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased aerved In the army, navy or marine corps of the United States In any war In which It has been engaged. sucb recital shall appear upon the permit. The board of health. or its agent, upon receipt of such stalenient 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 furnish for registration any other niece+ eary information which can be obtained as to the deceased, or as to the manner or canse 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 ashea thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to Issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he hell, or from a person appointed to have the care of the cemetery or burial ground in which the internient 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 died hy violence. If a medical examiner has notice that there is within lis county the hody of such a person, he shall forthwith go to the place where the huily llea and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawe calle 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 bedside care during a last illness from disease uurelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only se those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attemlance or whose phyaf- cian is ahsent from home when the certificate of death Is needed.
(3) Medloal Examiners will investigate and certify to all ilcatha sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (Including resulting septicemla), and by the actlon of chemical @Jrugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deaths from diseass resulting from injury or Infection related to ocoupation, the sudden deaths of persons not disablad by recognized disease, and those of persons found deed.
Statement of Cause of Death .- Cause of death meana the disease, or complication which "causes death, not the moile of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualug death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complicetion of the principal cause.
Statement of Occupetlon .- Precise statement of occupation la very Im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 yeara 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 retlreinent. Children not gainfully employed may be returned aa at school or at horne. For a woman whose only occupation wsa that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, as housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
suffolk
(County) Winthrop
.... (City or Town)
No 404 Revere
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 .... 98
[ (If death occurred In a hospital or Institution, St. [ give its NAME instead of street and number) - (If U. S. War Veteran, specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
404 Revere
St
(If nonresident, give city or town and state)
yrs.
mos.
-
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)|
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
William H. Cunningham
(Husband's name in full)
6 Age of husband or wife if alive
.years
7 IF STILLBORN, enter that fact here.
AGE Years
Months.
13 Days
If less than 1 day
Hours
.. Minutes
At Home
12 BIRTHPLACE (City)
(State or country)
None
11 Social Security No.
Cambridge
13 NAME OF
FATHER
John Mc Coart
14 BIRTHPLACE OF
FATHER (City) .....
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Margaret Brennan
16 BIRTHPLACE OF MOTHER (City) ... (State or country) Ireland
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