USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 45
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18. (a) Signature of funeral director.
Stillman Sural
(b) Address Clinton Cran.
19. (a)
6/6/42 (6)
Charles Poltri
(Date received local registrar) (Registrar's signature)
20 Date of death: Month Arne day
Į hereby certify that I attended the deceased from 1942
30
June 5
1.19 42
6. (b) Name of husband or wife
6. (c) Age of husband or wife ff
alive
15
1875-
Immediate cause of death
Interstitial Vechile
If less than one day
Due to 8 stembrian
4
(City, town, or county)
MOTHER FATHER
- 12. Name Willidefa Walter
SOity. town, or countyhe
(State of foreign country)
Of autopsy
17. (a)
Crematim(b) Date thereof
6/8/42
(If outside city or town limite, write RURAL)
(If outside cityfor town limite, write RURAL)
(If not in hospital or institution write street number or location)
If foreign born, how long in U. S. A .? years.
3. (a) FULL NAME
A R-302
Ouffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return).
56634 ......
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Lillian Ruskin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
246 River Rd
St.
Winthrop
(If nonresident, give city er town and state)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 2 1942
(Month)
(Day)
(Year)
19 L HEREBY CERTIFY.
6/30/42
19
to.
7/2/42
19 ...
(or) WIFE of
(Husband's name in full)
.years
7 IF STILLBORN, enter that fact here.
8 AGE 42 Years Months. .Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation:
public steno-
grapher
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
Frank Ruskin
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Fannie Rosenberg
18 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant.
(Address)
father (
Relation, if any
A TRUE COPY.
ATTEST
(Registrar of city of town where death occurred)
DATE FILED 7/6/42 19
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related to occupation ef deceased ?
If so, specify
(Signed)
R.E .Barkin
M. D.
(Address)
Boston
7/2/19 -- 42
21 PLACE OF BURIAL.
CREMATION OR REMOVAL ...
Pride ... of .... Boston
DATE OF BURIAL
July 37
22 NAME OF
FUNERAL DIRECTOR
B F Solomon
ADDRESS.
Brookline
Received and fled ..
AUG 1 1 1942
19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
(County)
1
RfCity of Town)
No.
Beth Israel Hospital
St.
Registered No.
(If U. S.
War Veteran.
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
In this community yrs.
mos.
days.
3 SEX
fem
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
(write the word)
white
or DIVORCED
single
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
I last saw h .. e.r ..... alive on. 7.12142 19. .... , death is said to have occurred on the date stated above, at 12/304 Duration Immediate cause of death. fall in b.p. and cessation of. .respiration
Due to
subarachnoid hemorrhage
Due to
12 ... dys
Industry
18 or Business:
.....
PARENTS
Underline the cause to which death should be charged sta- tistically.
Date of.
(City of Town)
Montvale
copies of returas of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
That I attended deceased from
6 Age of husband or wife if alive.
A R-305
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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-10-'39. No. 8427-g
PLACE OF DEATH
"SUTF(County) BOSTONJI
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON (City or town making return) 135
Registered No. 5789
(If death occurred in a hospital or institution,
give its NAME instead of street and number) St. 1
2 FULL NAME
Harry E
Burditt .... Ir
(If deceased is a married, widowed or divorced woman, give also maiden name.) 304 Main
..... .....
St.
months
days.
(If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE 5 SINGLE
white
MARRIED
WIDOWED
or DIVORCED
(write the word)
divorced
Sa If married, widowed, or divorced
HUSBAND of .
Mary E Fahey
(Give maiden name of wife in full)
(ot) WIFE of
(Husband's name in full)
40
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact hero.
8
41
AGE
Years
Months.
Days
If less than 1 day
.Hours.
Minutes
Usual
9 Occupation:
painter
Industry
10 or Business:
11 Social Security No ....
002-16-5099
12 BIRTHPLACE (City)
(State or country)
Providence RI
13 NAME OF
FATHER
Harry E Burditt
14 BIRTHPLACE OF
FATHER (City)
Brooklyn NY.
(State or country)
15 MAIDEN NAME
OF MOTHER
Sarah McIsaac
16 BIRTHPLACE OF
MOTHER (City)
Nova .... Scotia
(State or country)
17
Informant.
(Address)
father
Relation, if any
A TRUE COPY.
ATTEST:
.
(Registrar of city or town where death occurred)
DATE FILED
7/10/42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
July 6 1942
(Month)
(Day)
(Year)
19 | 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.) Asphyxiation by meat in pharynx
alcoholism
20 Accident, suicide, or homicide (specify)
accident
Date of occurrence ..
19
Where did Injury occur? (City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place?
Manner of
Found dead in alley
Injury
Nature of Injury
While at work ?
.. Was there an autopsy ?....
.y.os.
21 Was disease or Injury la any way related to occupation of deceased ?.
If so, specify
(Signed)
Timothy Leary
(Address).
Boston
Dat
7/7/
. M.
42
22.
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July ..... 9.1942
23 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS
Boston
Received and filed ..
AUG 1 1 1942
19
(Registrar of City or Town where deceased resided)
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
1
-
No .. g18 ... Harrison ... Ave
(If U. S.
War Veteran,
specify WAR)
Winthrop
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
sign8
PARENTS
(Specify type of place)
19
L
R-305
AGE PARENTS 25m-10-'39. No. 8427-g after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-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 Industry 10 or Business:
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
white
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
65
Years
9
Months.9
Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation:
chef
Winthrop Arms
Il Social Security No .....
030-05-7023
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
John Kelley
14 BIRTHPLACE OF
FATHER (City) Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Naughton
16 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
17
Informant.
(Address)
James ... Kelley .... ( ...
Relation, if any bro.
A TRUE COPY
ATTEST:
(Registrar of city"or town where death occurred)
DATE FILED
7/10/42
9
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 7 1942
(Month)
(Day)
(Year)
19 |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.) general peritonitis contusion .of .... intestines intestinal obstruction
20 Accident, suicide, or homicide (specify)
accidental
Date of occurrence ..
June .... 30
19
42
Where did
Injury occur?
Boston
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
public place?
common
Manner of
(Specify type of place)
Injury
Nature of
Injury
Common June 30 1942
While at work ?
.Was there an autopsy ?...... y.e.s
21 Was disease or Injury In any way related to cccupation ol deceased ?
If so, specify
(Signed)
W. J. Brickley
Boston
Dat
7/7/ 19.
42
22
Mt Benedict
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July 10 1942
19
23 NAME OF
FUNERAL DIRECTOR
A J Breslin & Son
ADDRESS
Malden
Received and bled AUG 1 1 1942 19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
SMEFOLK (County) ]
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
POSTON (City or town making return) 136
Registered No ...
5.79.3
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Michael ... H Kelley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
WinthropArms ... Hotel
.St.
Winthrop
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
years
months
days.
(If nonresident, give city or town and state)
In this community
yrs.
mos. days.
(Specify whether)
.....
No.
Mass ..... General ... Hospital
(If U. S. War Veteran, specify WAR)
, M.
D
(Address).
Boston
R-302
2 FULL NAME
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
3 SEX
fem
5a If married, widowed, or divorced
HUSBAND of
6 Age of husband or wife if alive.
7 IF STILLBORN, enler thal fact here.
AGE
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
..
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
17
husband
Informant.
(Address)
50m-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon 23 possible
Websug Watch Votessty la your city of town in case the deceased resided in another city or town at the time
8
69
Years
1
Months.
Days
4 COLOR OR RACE! 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
married
(Give maiden name of wife in full)
(or) WIFE of
Barney Cohen
(Husband's name in fu
6& years
If less than 1 day
Hours.
Minutes
at-home
Russia
David B Levy
(State or country)
Russia
Julia Udlofsky
Russia
Relation, if any
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED 7/29/42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
July 27 1942
(Month)
(Day)
(Ycar)
19
IHEREBY CERTIFY.
6/23/42
19.
., to ..
a/24/4deceased from
19.
I last saw h ... e.r ... alive on
7/24/42, 19
.....
death is said
to have occurred on the date stated above, at.
2 P
.m.
Immediale cause of death .... peri.toni.ti.s.,
otroulatory ..... collapse
Duration
3 dys
Due to .s.e.c.infection to ca of colon with extension ... to .... uterus .... and .... bladder
Due lo
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Of aulopsy
What lest confirmed diagnosis ?.
20 Was disease or fojury in any way related to occupation of deceased ? If so, specify.
(Signed)
S M Levenson
M. D.
(Address)
Boston
Date
7/27/42
1
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Maple H111
Peabody
DATE OF BURIAL
(Cemetery)
July 28 1942
19
22 NAME OF
FUNERAL DIRECTOR
P Hymanson
ADDRESS
Lynn
Received and filed.
AUG 1 1 1942
19
1
PLACE OF DEATH
SUPPORT (County)Vi. j
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON 137
(City or town making return)
Registered No ..
6326
(If death occurred in a hospital or institution,
No .... ................ St. 1 give its NAME instead of street and number) -
Jane
Cohen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Carol Ave
St.
Winthrop
(If nonresident, give city or town and state)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
Beth ... Israel .... Hospital
(If U. S. War Veteran, specify WAR)
Underline the cause to which death should be charged sta- tistically.
(Registrar of City or Town where deceased resided)
R-301 A
Susfalch.
(City or Towns 39 Wilshire
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.
138
( If death occurred In a hospital or institution, give its NAME instead of street and number)
Amélia Dello Russo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
39 Wilshore
(Usual place of abode) 56 years
SŁ
(If nonresident, give city or town and State)
Length of stay : In hosoltal or Institution
(Before death)
( Sperify whether)
years
months days.
In this community / 6
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Franche White
Widow
5a If married, widowed, or divorced HUSBAND of 26
(or) WIFE of
Generoso Delo Russo ( Husband's name in full)
6 Age of husband or wife if alive
years
> IF STILLBORN. enter that fact here.
8 AGE 4 Years Months Days
If less than 1 dey
Hours
Minutes
Usual
9 Occuoatlon :
House Wife
11 Social Security No. Italy
13 NAME OF
FATHER
Generoso Potito
14 BIRTHPLACE OF
FATHER (City)
....
Italy
(State or country)
15 MAIDEN NAME
OF MOTHER
Maria Rizzo
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy.
17 Michael Dello Russo( Bestof " any
( Address)
39 Wilshirest w: Th
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed withme BEFORE the buried or transit permit was issued :
(Signature of Agent of Board ot Health or othery
Wheatthe Repliche 8/3/42
(Officiel Designation) ( Date of Issue of Permit)
18 DATE OF
DEATH
august
1
().th)
(Day)
(Year)
19 | HEREBY CERTIFY.
June
19
40
July 21
Thet & attended deosased from
1942
I last saw he-
alive on .....
tule 31, 1942 death is said to
have occurred on the date stated above, at .. 5:50 € m.
Immediate oause of death ..... asthma
Cardiac Farbene
Que to
antesuselesstic Ht des
hypertension: Caravana of -tran, 14
transveraccolou c
0
2 years
metastasia
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was diseese or injury in any wey related to oooupation of deceased ?
If so, specify
Didneed Potuto
('Signed)
.....
M. D.
(Address)
Data 8/2 1942
21
Hoes Tross chinees Place of Burial, Cremation or Removal. (City or Towr) DATE OF BURIAL ug Hely 19/12
22 NAME OF
FUNERAL OLRECTOR .......
Tuning Sument
AODRESS 215 Jer outh 31- Boston.
Received and fled
19
(Registrar)
-
7
100M-6 -2-42-8855
if deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effect. extracts from the laws on back of certificate. Terms, so that it may be property classified. Exact statement of OCCUPATION is very important. See instructions and PARENTS
1
PLACE OF DEATH
No.
St.
2 FULL NAME
......
PHYSICIAN - IMPORTANT (Was deceased a U. S. Wer Veteren, it to specify WARY.
1942
Duration 2 certas
IMPORTANT
2we 0 year
...
Industry
10 or Business :
12 BIRTHPLACE (City)
(State or country)
Major findings :
Of operations
Carcucina y color
June 1,6940 Date Col.
Of eutopsy
What test confirmed diegnosis ?.
....
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medloai offioer shall forthwith, after the death of a person whoin 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 certifcate of death, stating to the best of his kuowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. wlivre same was contracted. the duration of his last Illness, when last seen alive by the physician or omcer and the date of bis deatb ... Ceu. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by tbe preceding section or by section forty-five of chapter one bundred and four- teen, xlrall, if the deceased, to the best of his knowledge and belief, served 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 immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, sucb physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-reven of said chapter one bunilred and fourteen. the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetween February fourteenth. eighteen hundred and ninety-eiglit and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen bundred and seventeen. C. L. Chiap. 46, Sec. 10.
No undartakar or other person shall bury or otherwise dispose of a buman 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 uo such board, from the clerk of the town where the person died; aud no undertaker or other person shall exhume a human body and remove it froin a town. from oue cemetery to another, or from one grave or tomb other than the receiving tonth 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 bave been delivered to mucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facta 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. of in lieu thereof a certificate as ilereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is iusufficient, a physi- cian who is a member of the board of health. or employed by it or hy tbe selectmen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If deatb is caused by violence. the medi- cal examiner sball make such certificate. If such a permit for the removal of a human body, not previously interred, froin one towi 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 ot the undertaker desiring to make such removal sliali 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 hody 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 transnift 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 nece» sary information which can be obtained as to the deceased, or as to the manter 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 ashea thereof which have been brought Into the contionwealth until he has re- ceived a perniit so to do front the board of health or its agent apjuifuted to issue such perinita, or if there is no such board, front the clerk of the town where the body is to be buried or the funeral Is to he held, or from a person apiminted to have tbe care of the cemetery or burial ground in which ibe intermeut is made. ... Cbap. 114. Sec. 16. 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 by violence. If a medical examiner has notice that there is within lils county the body of such a persou, he shall forthwith go to the place where the luxly lies aud take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the foliowing 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 unrelated to any form of injury.
(2) Board of Health physiolans 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 pbyaf- cian is ahsent from home when the certificate of death is needed.
( 3) Medioal Examiners will investigate and certify to all deatha sup- posably due to Injury. These Include not only deaths caused directly or in- directly hy traumatism (including resuiting septicemia), and hy the action of chenrical (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 disablad by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death. not the moile of lying. e. g., heart fallure, 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.
Statemant of Oooupation .- Precise statement of occupation is very im- portaut, so that the relative healthfulness of various pursuits can be known. Make some eutry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the disease causing death. report the usual occupation prior to illness. If the deceased bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at bome. For a woman wbose oniy occupatiou was that of honie housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
L
R-301 A
1
PLACE OF DEATH
Suffol (County)
Winthrop
(City or Town)
No. 59 .Lewis Ave ....... ......
The Commonturalth 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.
[ { If death occurred in a hospital or Institution, St. ( give its NAME instead of street and number)
2 FULL NAME
AgnesCox Thackray
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
59.Lewis ... Ave ....
(Usual place of abode)
St.
(Il nonresident, give city or town and State)
Length of stay : In hosoltal or Institution.
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