Town of Winthrop : Record of Deaths 1942, Part 42

Author: Winthrop (Mass.)
Publication date: 1942
Publisher:
Number of Pages: 524


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 42


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


SPACE FOR ADDITIONAL INFORMATION


RM R-302


NORFOLK (County)


1 .BROOKLINE (City or Town) 23 SUMNER ROAD


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


BROOKLINE (City or town making return)


Registered No.


368125


5 (If death occurred in a hospital or institution, 1 give its NAME instead of street and number)


2 FULL NAME.


ANNE E. THIDEMANN (Ossawy)


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


(a) Residence. No.


81 SOMERSET AVENUE


(Usual place of abode)


Conv Home


years


months


5


days.


In this community


yrs.


48


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female


4 COLOR OR RACE|


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widowed


5a If married, widowed, or divorced HUSBAND of


(or) WIFE of


Harold"


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 fact here.


8


77


21


AGE


Years


Months.


Days


If less than 1 day


Hours


Minutes


Usual


9 Occupation :


Housewife


Industry


10 or Business :


At home


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


Norway


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Norway


15 MAIDEN NAME


OF MOTHER


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Norway


17 Informant.William Thidemann


Relation, if any


(Address)


106 Hamilton St. Cambridge


A TRUE COPY.


anthony


Shimmer


ATTEST :


(Registrar of city pr town where death occurred)


DATE FILED


July 13,


19


42


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


July


12


1942


(Month)


(Day)


(Year)


19 1 HEREBY CERTIFY,


July 6


19


42


.. ,


That I attended deceased from


to


July 11


19


42


I last saw h .... @r ...... alive on.


July .... 11


19.42, death Is sald to


have occurred on the date stated above, at.


7:40


A.m


Duracion


Immediate oause of death Apoplexy


6 dys.


Due to.


Arteriosclerosis


Due to


Other conditions.


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations.


Date of


should be


Of autopsy.


What test confirmed diagnosis ?.


Clinical


20 Was disease or Injury in any way related to oocupation of deceased ?..... no


If so, specify


(Signed).


C ...... A ..... Nelson


M. D.


(Address) 27 Clinton St.


Camb . Dat


7/12 19 42


21 PLACE OF BURIAL,


CREMATION OR REMOVAL.


Cambridge,


Cambridge


DATE OF BURIAL


(Cemetery)


July 14,


19.


(City or Town


22 NAME OF


FUNERAL DIRECTOR


Christian J. Berglund


ADDRESS


Arlington


Received and filed 19


(Registrar of City or Town where deceased resided)


Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased


of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


50m (e).1-41-4667


PLACE OF DEATH


No.


St.


(If U. S.


War Veteran,


specify WAR)


St.


WINTHROP,


MASS .


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk


13 NAME OF


FATHER


( Ossawy)


Underline the cause to which death


charged sta- tistically.



RM R-301


Winthrop Bylin 7 (City of Town) No. Community Hospital


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


(City or town making return)


Registered No


186


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


2 FULL NAME.


SARDARA


Campbell) C. BEIchER


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


(a) Residence.


No


301 Winthrop


(Usual place of abode)


Length of stay : In hospital or institution


(Specify whether)


Ifoglital


years


months 20


days.


In this community 59 yrs. mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


HUSBAND of Frank NBelcher


"full)


(or) WIFE of


(Husband's name in full)


77


6 Age of husband or wife if alive. .years


AGE 71 Years 6 Months ... I.l. Days


lf less than 1 day


Hours


Minutes


Il Social Security No. None


Cape Britton


Breton


13 NAME OF


FATHER


?


Campbell


(State or country) Cape Britton Breton


15 MAIDEN NAME


OF MOTHER


Unable to Cbtain


16 BIRTHPLACE OF MOTHER (City) (State or country) Cape Britton Breton


17 Frank N Belcher


Informant.


(Address)


301 Winthrop St Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mm. De Chile es


(Signature of Agent of Board of Health of other)


Health officer 1/20142 ( (Official Designation) (Date of Issue of Permit) (


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


July


(Month)


19, 1942


(Day)


(Year)


19


J HEREBY CERTIFY. That I attended deceased from


19.41, to


Sept 5


July 19


1942


I last saw hun alive on.


July 18, 1942, death is said


to have occurred on the date stated above, at.


5.40 Pm.


Duration


Immediate cause of death. Carcinoma of figura


Due to


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 lojury lo any way related to occupatioo of deceased ?


If so, specify.


city Louis 7. Salerno


M. D.


(Signed)


tion, if any (Address) 175 Pleasant St


Date, ..


July 191942


21 Winthrop


Winthrop


Place of Burial, Cremation gr Removal.


2 [City or Town)


1542


DATE OF BURIAL


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


Received and filed. JUL 2 1 1942


19


À TRUE COPY ATTEST:


(Registrar)


N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 200m-10-'39. No. 8427-d


1 PLACE OF DEATH - 3 SEX Female 8 Usual is very important. See instructions and extracts from the laws on back of certificate. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 10 or Business:


Suffolk


(County)


4 COLOR OR RACE


White


5a lf married, widowed, or divorced


7 IF STILLBORN, enter that fact here.


9 Occupation:


Housewife


12 BIRTHPLACE (City)


(State or country)


14 BIRTHPLACE OF


FATHER (City)


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION


Industry


Own Home


St.


(If U. S.


War Veteran.


specify WAR)


Winthrop, MASS


(If nonresident, give vity or town and state)


...


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


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the 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 underlaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not heen huried, 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 tomh 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 de- livered to such hoard, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to he returned and recorded, which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons. his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who Is a member of the board of health, or employed by it or by the selectmen for the pur- pose, shali upon application make the certificate required of the at- tending physician. If death is caused hy 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 made as above provided and in the possession of the undertaker desiring to make such a 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 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 hoard 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, Seo. 45, G. L., (Tercentenary Edition. )


No undertaker or other person shall bury a buman 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 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 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 un- related 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 lo injury. These include not only deaths causcd directly or indirectly by traumatism (including resulting septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infeclion relaled lo occupa- tion, the sudden deaths of persons not disabled by recognizod disease, and those of persons found dead.


Slatemeni of Canse 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 morhid con- ditions, if any, related to the principal cause and any important complication of the principal cause.


Stalement of Occupallon .- 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 iliness. If the deceased had retired from husi- 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 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


RM R-301


REVERE NOTIFIEDAUG 1 0 1342


Suffolk (County) Wenthoud (City or Town) Winthang Communityforge, St. No.


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


(City or town making return)


Registered No


...


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


aleck, Guverdinghy


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


208 Walnut ave


(write the word) Widowed


Goldie Cohen


6 Age of husband or wife if alive. .years


Minutes


13 NAME OF


FATHER


Harrie Soverdensby


200m-10-'39. No. 8427-d


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


agent July 21/42


(Official Thesignation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


July


21


1942


(Month)


(Day)


( Year)


19 | HEREBY CERTIFY. That I attended deceased from


fully


1


1942, to.


July 21


19 42


I last saw .......... alive on Jul 21, 942, death is said


to have occurred on the date stated above, at :20Pm. Immediate cause of death adenocarcinoma stranasene acon


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


adenvención of


transaction


.Date of


7/11/42


Of autopsy


What test confirmed diagnosis ?..


operation


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


20 Was disease or lojury in any way related to occupation of deceasad ?.


If so, specify.


M. D.


(Signed)


) 56 8link al Peres Man Date 7/2/1942


21


Chelseacent Montvale


Place of Burial, Cremation or Removal


DATE OF BURIAL


1942


22 NAME OF


FUNERAL DIRECTOR


Beyenin Ffoloman


ADDRESS


420 Howard It Brookline


Received and filed 19 ....


11 9 ~ 1047


A TRUE COPY ATTEST:


(Registrar)


(If U. S.


War Veteran.


specify WAR)


Revere mas.


St.


(If nonresident, give city or town and state)


Length of stay: In hospital or institution


Harpital


- years


-


months


11


days.


In this community - yrs. - mos. days"


1 PLACE OF DEATH (a) Residence. No .... (Usual place of abode) (Specify whether) PERSONAL AND STATISTICAL PARTICULARS 3 SEX Male 4 COLOR OR RACE White 5 SINGLE 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) 7 IF STILLBORN, enter that fact here. 8 AGE lf less than 1 day Hours ... 64 Years - Months .***** Days Usual Painter 9 Occupation :. 11 Social Security No. 12 BIRTHPLACE (City) (State or country) Russia 14 BIRTHPLACE OF FATHER (City) (State or country) Queria 15 MAIDEN NAME OF MOTHER unable to learn PARENTS 16 BIRTHPLACE OF MOTHER (City) Quesic (State or country) 17 Berg, L Barron ,Non-in. (Address) 2018 Walnut are Revere Informant William D. Childress information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state (Signature of Agent, of Board of Health or other) N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of 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 Industry 10 or Business: Own Business


Relation, if any


Duration


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed agc, the disease of which he died, defined as required hy 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 hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been huried, until he has received a permit 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 person died ; and no undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomh 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 huried. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy 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 made as ahove provided and in the possession of the undertaker desiring to make such a 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 hy section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be


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 hury a human body or the ashes thereof which have been brought into the coirmonwealth 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 ohserv- 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 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 un- related to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septice- mia), 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 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 morhid con- ditions, 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 husi- 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 nons.


SPACE FOR ADDITIONAL INFORMATION


!


A R-301 A


PLACE OF DEATH


Suffolk (County) Winthrop (City or Town) 83 Duyuruguide


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, St. ¿ give its NAME instead of street and number)


2 FULL NAME


Thomas a. Quelloney


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


83 Sunnyside Que


St


(If nonresident, give city or town and state)


at home


years


months


days.


In this community 35 yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Hale


4 COLOR OR RACE


White


5 SINGLE


(write the word)


Widowed


MARRIED


WIDOWED


or DIVORCED


5a If married, widowed,or diyorced


HUSBAND of


Margaret a schaefer


(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.


8


AGE ........ Years.


6


.Months.


6


Days


If less than 1 day


Hours


Minutes


9 Occupation :


Retired


10 or Business :


manager Plumbing


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


Boston, Thats.


13 NAME OF


FATHER


Frank H Mulloney


14 BIRTHPLACE OF


FATHER (City) .....


Porcompu


(State or country) Ireland


15 MAIDEN NAME


OF MOTHER


Many Doualine


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


17 Frederic a. Mullowey ford -


Relation, if any


Informant. (Address) 83 Sunnyside ave. fruttuo pe lucas


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


(Signature of Agent of Board of Health of other)


Healthe Officer (Official Designation) / (Date of Issue of Permit)


7/23/42


18 DATE OF


DEATH.


July 21


1942


(Month)


(Day)


(Year)


I HEREBY CERTIFY, That I attended deceased from


march 19, 194/0 July 21 , 19:42


I last saw how alive on July 21, 1942 death is said to have occurred on the date stated above, at. 10P. m.


Immediate cause of death. acute Coronary Trombosis


Due to.


anana Pectoris


buffles


Due to.


Arteriosclerosis


Other conditions more (Include pregnancy within 3 months of death)


Major findings: Of operations.


Date of.


Of autopsy


What test confirmed diagnosis? Chencalx


Lubnauery


20 Was disease or injury in any way related to occupation of deceased? 000


Jacob Straws


(Signed) .....


(Address) 062 erturley


.Date ...


M. D.


July 22942


21.


Place of Burial, Cremation or Removal.


DATE OF BURIAL Muy 24.




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