USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 42
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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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