Town of Winthrop : Record of Deaths 1943, Part 42

Author: Winthrop (Mass.)
Publication date: 1943
Publisher:
Number of Pages: 594


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > 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).


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(State or country)


Ireland


Relation, If any (.wife


17 informant (Address)


A TRUE COPY.


.


ATTEST :


(Registrar of city or town where death occurred)


DATE FILED May .... 12 . 19 43


18 DATE OF


DEATH


May


8


1943


(Month)


(Day) pronounced dead


19 | HEREBY CERTIFY,


on


May 8


19


43


to


19


I last saw h


alive on


19


death is said to


have occurred on the date stated above, at


8.10


a .


m.


Duration


Immediate cause of death.


Coronary occlusion


Due to.


Arteriosclerotic


? yrs.


heart disease


Due to.


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-


tistically.


What test confirmed diagnosis ?


Hist. & Clin. signs


no


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


(Signed)


(Address)


Carney Hospital


Date


5-8


1943


21 PLACE OF BURIAL,


Winthrop Cem.


Winthrop, Mass.


CREMATION OR REMOVAL ..


(Cemetery )


(Clty or Town)


DATE OF BURIAL


Mey ... 11


1943


22 NAME OF


FUNERAL DIRECTOR


J.F. Q'Maley


ADDRESS


Winthrop


Received and filed


JUN ........... ... 4043.


...... 19


(Registrar of City or Town where deceased resided)


50m (e)-1-41-4667


resjued in another city or town at the time of death should be made forthwith and transmitted on Form 12.802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


PLACE OF DEATH


Suffolk (County)


Carney Hospital


No.


(If nonresident, give city or town and State)


Length of stay: In hospital or institution.


(Before death)


(Specify whether)


(If U. S.


War Veteran,


( spoolfy WAR)


That I attended deceased from


Of autopsy


If so, speolfy


A. P. Sullivan


M. D.


--


×


R-302


PLACE OF DEATH -


S.SUFFOLK (County) ) BOSTON


(City or Town)


No.


Beth Israel Hospital


St.


give its NAME instead of street and number)


2 FULL NAME


Monte Cohen


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


(a) Residenoe. No.


(Usual place of abode)


79 Cliff Avenue


St.


Winthrop,


Mass.


(If nonresident, give city or town and State)


Length of stay : In hospital or Institution.


(Before death)


(Specify whether)


years


months 7


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE!


WW


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Single


Sa 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


7 IF STILLBORN, enter that fact here.


8


AGE. 28 Years Months. Days


If less than 1 day Hours ..... Minutes


Usual


9 Oocupation :


Clerk


Industry 10 or Business :


11 Social Security No .....


032-03-3238


Boston


12 BIRTHPLACE (City)


(State or country)


Mass.


13 NAME OF


FATHER


Jacob Cohen


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Jennie Abrams


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


17 Informant. (Address)


Relation, if any (Father ..


A TRUE COPY.


ATTEST :


francis


(Registrar of city or town where death occurred)


DATE FILED May 28 19 43


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


May


24


1943


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY,


May ..... 18


19


43.


to


That I attended deceased from


May .... 24 .....


19 .. 4.3 ...


I last saw h ...


im .... alive on


May 24


19.43 death Is sald to


have ocourred on the date stated above, at


9.1Q p .m.


Duration


Immediate cause of death.


Leukemia


2 yrs.


Due to


Due to.


Other conditions.


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations


Underline the cause to which death should be


Leukemic bone marrow; Gas bacilluschargedsta-


anfection


tistically. What test confirmed diagnosis Gros.s ... exam ... of .... liver 20 Was disease or Injury In any way related to oooupation of deocased ?


If so, speolfy


(Signed)


T ... Sack


M. D.


(Address)


330 Biline Ave.


Date ... 5 -25 1943


1


21 PLACE OF BURIAL,


Ansha Polin


Woburn Mass.


DATE OF BURIAL


May .... 26 ... 19.43 ...


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


Reoelved and filed


19


(Registrar of City or Town where deceased resided)


50m (e)-1-41-4667


acu in aute y 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.)


1


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.


5239


( If death occurred in a hospital or institution,


Date of.


Of autopsy


no


CREMATION OR REMOVAL


(Cemetery)


(City or Town)


I ..... H ..... Levine


Boston


(If U. S.


War Veteran,


speolfy WAR)


R-302


Suffolk


(County)


TON


(City or Town)


Carney Hospital


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


BOSTON


(City or town making return)


119 5277


No. (If death occurred in a hospital or institution, St. give its NAME instead of street and number) r


2 FULL NAME


Albert F. Welch


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


90 Circuit Road


St. ... Winthrop ...... Mas.s.


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution ...


Hosp.


(Before death)


(Specify whether)


yeara


months


9


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEDMarried


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


May 17


19


43


to.


That I attended deceased from


May 26


19.43


I last saw h


im


.. alive on


May 26


19.43


death is sald to


have occurred on the date stated above, at


1.25


p ... m.


Duration


Immediate cause of death


Arterio Sclerotio heart in


2 mos


7 IF STILLBORN, enter that fact here.


8


AGE ... 54 ..... Years.


Months


Days


-


If less than 1 day


Hours.


Minutes


Usual


Salesman


9 Occupation :


Industry


10 or Business :


Neckwear


11 Soola! Seourity No ...


028-01-6787


12 BIRTHPLACE (City)


(State or country)


Mass.


East .... Bo.s.ton


13 NAME OF


FATHER


Thomas H. Welch


14 BIRTHPLACE OF


FATHER (City)


East Boston


(State or country)


Mass.


15 MAIDEN NAME


OF MOTHER


Elizabeth L. Griffin


16 BIRTHPLACE OF


MOTHER (City)


East Boston


(State or country)


Mass.


17


Informant.


(Address)


Relation, if any wife .....


A TRUE COPY.


PY. Francis


ATTEST :


(Registrar of city or towh where death occurred)


DATE FILED June .. 1 1943


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


May


26


1943


-


5a If married, widowed, or divorced


HUSBAND of


Rose .M.Altomare


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if allve 30


years


decompensation


Due to. Uremia


9 das


Due to.


Cardio Renal disease


3 yrs


Other conditions.


(Include pregnancy within 3 months of death)


Physiclan


Major findings :


Of operations


Underline the cause to which death should be charged sta-


tlstically.


What test confirmed diagnosis?


Clin & Lab work


20 Was disease or injury In any way related to oooupation of deceased ?


no


If so, specify


(Signed)


A. ..


Sullivan


M. D.


(Address) .Carney ..... Hospital


Date


5-2619 43


21 "PLACE OF BURIAL,


CREMATION OR REMOVAL


Winthrop Cem


Winthrop,


DATE OF BURIAL


(Cemetery )


May 29


(Gfty or Towg)


1943


22 NAME OF


FUNERAL DIRECTOR


J. F. O'Maley


ADDRESS


Winthrop, Mass.


Reoelved and filed JUN 2 1 1943 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.) PARENTS


PLACE OF DEATH


1


Registered No.


(If U. S.


War Veteran,


speolfy WAR)


(a) Residence. No.


(Usual place of abode)


W


(Give maiden name of wife in full)


1 Fan


Date of.


Of autopsy


none


X


R-302


Middlesex


(County) Cambridge


(City or Town)


No. Holy Ghost Hospital


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


Cambridge


(City or town making return)


873


Registered No.


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


Elizabeth Kenneally


2 FULL NAME


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


(a) Residence. No.


(Usual place of abode)


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


F.


4 COLOR OR RACE


W.


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Single


(Month)


(Day)


(Year)


19


I HEREBY CERTIFY.


May 1


1943


May 27


That


attended deceased from


143


I last saw h


eralive on


have occurred on the date stated above, at


m.


Duration


6 Age of husband or wife if alive years


7 IF STILLBORN, enter that fact here.


8


76


Years


Months.


.Days


If less than 1 day Hours Minutes


Usual


9 Occupation :


maid


Industry


10 or Business :


none


11 Social Security No.


Boston


12 BIRTHPLACE (City)


(State or country)


David Konnoally


13 NAME OF


FATHER


Boston


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Mass.


(State or country)


Katherine Murphy


15 MAIDEN NAME


OF MOTHER


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


Ireland


17 Mr. H Dudley Murphy Cousin


Relation Vany


Informant.


12 .... Summit .... Rd ........ Lexington ... Mass


(Address)


DATE OF BURIAL


Joany A Show


19


A TRUE COPY.


ATTEST :


May 29, 1943


ADDRESS


Received and filed JUN 1 4 1943


.19


DATE FILED


19


18 DATE OF


DEATH


May 27, 1943


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


Immediachroni cathArthritis &


Hypertension


Due to.


Arterio SC160818


5-arg


Due to.


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- tistically. no


What test confirmed diagnosis?


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


If so, speolfy.


Daniel Mackitrop


(Signed)


(Address)


Cambridge


Dato


5/27


M. D.


43


HARLy Cross Cem.


Malaen


21 "PLACE OF BURIAL,


CREMATION OR REMOVAL ..


(Cenielékyy 29, 1943


or Town)


50m (e)-1-41-4667


hannu in anutner city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L .. )


1


PLACE OF DEATH


(If U. S.


War Veteran,


specify WAR)


Winthrop


to.


May


26


death Is sald to


4-15


A


3yrs


AGE


retired


Of autopsy


22 NAME OF


FUNERAL DIRECTOR


323 Broadway ..... Camb ..


(Registrar of city or town where death occurred)


(Registrar of City or Town where deceased resided)


FTC


11 1 .


7


6


JUN 1 &1943 AM


X


R-302


1


(City or Town)


No.


The Boston Floating Hospital


(If death occurred in a hospital or institution,


St.


give its NAME instead of street and number)


2 FULL NAME


Jacqueline Magee


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


(If U. S.


War Veteran,


speolfy WAR)


(a) Residence. No.


(Usual place of abode)


340WinthropSt


St.


Winthrop,


Mass


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution.


(Before death)


years


months


1 days.


In this community


yrs.


mos.


1


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE|


W


5 SINGLE


(write the word)


MARRIED


WIDOWED


DIVORCED Single


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


May ..... 28 ........ , 19 ... 4.3 .. ,


Ma.y .... 29 .... ,


19 ... 43 ..


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


May .... 29


19 ... 4.3 death Is said to


have occurred on the date stated above, at


1.30 p.


Duration


Immediate oause of death


Congenital atelectasis


1 day


7 IF STILLBORN, enter that fact here.


8 AGE. .. Years.


Months.


1


Days


If less than 1 day


.. 26 ... Hours ............ Minutes


Usual


9 Ocoupatlon :


None


Industry


10 or Business :


None


11 Social Security No ... none


12 BIRTHPLACE (City)


(State or country)


Mass.


Winthrop


13 NAME OF


FATHER


John Magee


14 BIRTHPLACE OF


FATHER (City)


East Boston


(State or country)


Mass.


15 MAIDEN NAME


OF MOTHER


Eleanor Annis


16 BIRTHPLACE OF


MOTHER (City)


Madison


(State or country)


Wisconsin


21 PLACE OF BURIAL, St. Michael's


CREMATION OR REMOVAL


(Cemetery)


(City or Town)


June I


19


43


DATE OF BURIAL


A TRUE COPY.


ATTEST :


(Registrar of city or toym where death occurred)


DATE FILED


L


June 3


19


43


22 NAME OF


FUNERAL DIRECTOR


C. H. Treanor


ADDRESS


Boston


Reoelved and filed


19


1 ...... 1043


(Registrar of City or Town where deceased resided)


50m (e)-1-41-4667


PLACE OF DEATH -


I SUEFOLK (County) ) BOSTON


The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF


BOSTON (City or town making return)


21


CERTIFICATE OF DEATH


Registered No.


5418


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


PARENTS


17 Informant. (Address)


( ....


Relation, if any Father ....


Of autopsy


What test confirmed diagnosis?


no


20 Was disease or injury In any way related to occupation of deceased ?.


If so, speolfy.


C. H. Hollis


M. D.


(Signed)


Boston


Date


5-31 19 43


(Address)


Underline the cause to


which death


Date of


should be


charged sta- tistically.


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations.


1 day


Due to


Due to Prematurity


That I attended deceased from


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


(Specify whether)


18 DATE OF


DEATH


May


29


1943


1


M R-301 ||


Suffolk (County) 1 No. PLACE OF DEATH ....... 3 SEX 4 COLOR OR RACE Female White 5a If married, widowed, or divorced HUSBAND of 7 IF STILLBORN, enter that fact here. 8 AGE ... 6.9. Years ........ .. Months ............ Days Usual 9 Occupation: Housewife Industry Own Home 10 or Business: II Social Security No. 12 BIRTHPLACE (City) (State or country) Ireland 13 NAME OF FATHER John Devlin 14 BIRTHPLACE OF FATHER (City) (State or country) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or .country) 17 Informant .. J. Newton Esdaile (Address) 40 Coral Ave .. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state is very important. See instructions and extracts from the laws on back of certificate. 18.00 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Ireland 200m-10-'39. No. 8427-


Um. D Chiches


(Signature of Agent of Board of Health or other) June 3/43


(Official Designation)


(Date of Issue of Permit)


MEDICAL, CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


(Day)


1942 (Year)


19, I HEREBY CERTIFY. That I attended deceased from


1.


19.4.13, to 5mg/


19.73


last saw halive on .. ....... 19 ×3 death is said


to have occurred on the date stated above, at 8 Pm.


Duration


Immediate cause of death ....


...


1 yr.


Due to


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 to any way related to occupation af deceased ?


If so, specity


(Signed)


(Address ) Washi


6m/1941


21 Winthrop winthrop


71/43


Place of Burial, Cremation or Remove DATE OF BURIAL


June4 I SEity or Town) 19


22 NAME OF


FUNERAL DIRECTOR


Form TOMhaley Winthrop


ADDRESS


Received and filed.


........ ... 19


1943


A TRUE COPY ATTEST:


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Widowed


(Give maiden name of wife in full)


(or) WIFE of


James N .Esdalle


(Husband's name in full)


6 Age of husband or wife if alive years


If less than 1 day


.Hours


.Minutes


15 MAIDEN NAME


OF MOTHER


Charity McCafferty


Ireland


reland


any


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


(City or town making return)


Registered No.


122


(If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


2 FULL NAME


Minnie Devlin Esdaile


(If U. S. War Veteran.


apecity WAR)


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


(a) Residence.


No.


(Usual place of abode)


ength of stay: In hospital or institution


(Specify whether)


40 oral Ave


St.


years


months


I4


(If nonresident, give sity or town and state)


days.


In this community


yrs.


mos.


days.


Underline the cause to which death


should be charged sta- tistically.


M.D.


Winthrop (City or Town) Winthrop Community Hospital


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


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 by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.


No undertaker or othor 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 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 elerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to sueh 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, 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, shall upon application make the certificate required of the at- tending physician. If death is caused by 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 inarine 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 elerk 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 deatb, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition. )


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observ- anee 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 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 by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diseaso 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 deatlı. As related causes. name earlier morbid con- ditions, If any, related to the principal eause and any important complication of the principal cause.


Statement of Occupation .- Precise statement of occupation is very important, so that the relative bealthfulness 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 busi- 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


X


R-302


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


50m (e)-1-41-4667


A TRUE COPY.


ATTEST :


(Registrar of city or town where death occurred)


DATE FILED


June 7


19


43


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


June


3


1943


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


April .... 13.


19.


.4.3


to


That I attended deceased f


June®


19


1 last saw h.


im


.alive on


June 2 .... 19 43 death Is sald to


have ooourred on the date stated above, at.


12.40 Pm.


Duration


Immediate cause of death


Bronchopneumonia (terminal)


5 days


7 IF STILLBORN, enter that fact here.


8 AGE 74 Years Months. Days


If less than 1 day


.. Hours ........


.. Minutes


Usual


9 Ocoupation :


Painter


Industry


10 or Business:


For himself


11 Social Security No ....


none


12 BIRTHPLACE (City)


(State or country)


Russia


Major findings:


Of operations


many yrs. Underline the cause to which death


Date of


should be


charged sta-


tistically.


20 Was disease or Injury In any way related to oooupation of deceased? IO If so, speolfy.


(Signed)


M. Gerstein


Boston


M,, D.


(Address)


Dato


19


3


21 "PLACE OF BURIAL,


Winthrop Cem.


Everett, Mass.


CREMATION OR REMOVAL


(Cemetery )


(City or Town)


DATE OF BURIAL


June 4


19


43


3


22 NAME OF


FUNERAL DIRECTOR


J. H. Levine


ADDRESS


Boston


Received and filed


10 32-1943


19


(Registrar of City or Town where deceased resided)


1


PLACE OF DEATH


SUFFOLK (County)


) BOSTON


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


CERTIFICATE OF DEATH


Registered No.


5528123


(If death occurred in a hospital or institution,


St.


give its NAME instead of street and number)


2 FULL NAME


Morris Annapolsky


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


105 Almont


St.


Winthrop,


Mass.


(a) Residenoe. No.


(Usual place of abode)


hospital


Length of stay: In hospital or Institution ..


(Before death)


(Specify whether)


years


1


months


20 days.


In this community


уга.


1 mos.


20days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE|


W


5 SINGLE


(write the word)




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