USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 55
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If disease or injury was related to occupation, specify. If investigation shows the death to have heen due to disease, specify: (1) Under cause its known or presumahle nature; and (2) under manner, indicate the cir- cumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous, of the hrain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
-302
Essex
(County) Danvers
(City or Town) Danvers State Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
72 Bowdoin
(a) Residence. No.
(Usual place of abode)
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
3
months 21 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED,
or DIVORONa dowed
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE ofAlonda G Perdue
(Husband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8
AGE
Years
Months.
.. Days
If less than 1 day
.Hours.
Minutes
Usual
9 Occupation :
at- home
Industry
10 or Business :
Il Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
Georgia
13 NAME OF
John L. Layton
FATHER
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Georgia
15 MAIDEN NAME
OF MOTHER
Cook
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Georgia
Relation, If any
17
Informar
(Address)
Mary DsuMcPhillips (
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
7/27/43
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July8 1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Mar. 17
19.433
to July
That I attended deoeased from
19.43 ...
I last saw h.
er
alive on
July
8
.19 ..
Hp death Is sald to
have oocurred on the date stated above, at.
6.25p
m.
Duration
Immediate cause of death.
Myocardial failure
3.
mos.
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Major findIngs :
Of operations.
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis?
clinical
20 Was disease or Injury In any way related to oooupatlon of deceased ? If so, speolfy
(Signed)
Flora M. ..... Remillard
M. D.
(Address)
DSH
Date
7/23013
21 PLACE OF BURIAL,
CREMATION OR REMOVALIthron
Winthrop
DATE OF BURIAL
49948/43
(City or Town)
19
22 NAME OF
FUNERAL DIRECOWard S. Reynolds
ADDRESS
Winthrop
Reoelved and filed.
AUG 9 1613
19
(Registrar of City or Town where deceased resided)
60m (e)-1-41-4667
1
PLACE OF DEATH
Belle Evans Perdue
(If U. S.
war Veteran,
specify WAR)
Registered No.
Physician
70
302
1
PLACE OF DEATH
SUFFOLK BOsty T'ON
(City or Town)
Jewish Memorial Hospital
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
HOSTON
(City or town making return)
Registered No.
L 6640
give its NAME instead of street and number)
2 FULL NAME
Morris Gilman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
36 Cutler St.
St.
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: in hospitai or institution
(Before death)
(Specify whether)
years
months
14days.
in this community
yrs.
mos.
14 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
June .... 28.
19.4.3.
...
That I attended deosased from
July 11
19
43
I iast saw h
im
.. alive on
July 11
143
death is said to
(or) WIFE of
(Husband's name in full)
67
years
7 IF STILLBORN, enter that fact here.
8
AGE
67
Years
Months.
Days
-
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Tailor
industry
10 or Business :
For Himself
11 Social Ssourity No.
.none
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
which death
should be
charged sta· tistically.
Of autopsy
clinical
What test confirmed dlagnosis ?.
20 Was disease or injury In any way related to occupation of deceased ?
If so, speolfy.
(Signed)
M. Gerstein
Boston
19.43
(Address)
21"PLACE OF BURIAL, Winthrop Cem.
CREMATION OR REMOVAL
(Cemetery)
Everett, Mass.
DATE OF BURIAL
July fgity or Town)
19
43
A TRUE Color francis
ATTEST :
( Registrar of city or fown where death occurred)
DATE FILED
July .... 14 .19
43
22 NAME OF
FUNERAL DIRECTOR
M. Stanetsky
ADDRESS
Dorchester
Received and filed
AUG .1.61043
19
(Registrar of City or Town where deceased resided)
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Sarah
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Relation, if any
... w.i.f.o .........
18 DATE OF
DEATH
July
11
1943
have occurred on the date stated above, at
6.25 p. m.
Duration
Immediate cause of death. Cerebral hemorrhage
(recurrent )
2 wks
Due to.
Generalized arteriosclerosis
many yrs
Due to.
Diabetes mellitus
3 yrs
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Abraham E. Gilman
Major findings :
Of operations
Date of
Date
7/IT, M. D.
17
Informant
(Address)
50m (e)-1-41-4667
No.
{if death
(If death occurred in a hospital or institution,
St.
(if U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
5a If married, widowed, or divoroed
Anna Baun
HUSBAND of
(Give maiden name of wife in full)
to
6 Age of husband or wife if alive
"pl An
1
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
95 Court Road Winthrop
The Commontoralth of Massacinisetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
S ( If death occurred in a hospital or institution, St. [ give ita NAME instead of street aud nuniber)
2 FULL NAME
Matthew J. Barron
(If deceased is a married, widowed or divorced woman, give also maiden name.) 95 Court Road
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years - months days.
(If nonresident, give city or town and State)
in this community 15 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE|
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5€ If married
HUSBAND of
"Julia dipred Forti ss
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in fuli)
6 Age of husband or wife if alive
> IF STILLBORN. enter that fact here.
8 AGE 75 Years - Montha
Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Chauffeur
Industry
10 or Business :
Chaffeur
11 Social Security No.
'2 BIRTHPLACE (City)
(Siate or country )
Boston, Mass.
13 NAME OF
FATHER
Unknown
PARENTS
14 BIRTHPLACE OF
Unknown
FATHER (City)
(State or country)
Unknown
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF MOTHER (City) Unknown (State or country) Unknown
Reiation, if any
17 Informent ( Address)
Mr.s. Edna Maynes 95ªcourt .Minthaughter)
I HEREBY CERTIFY that a satisfactory standerd certificate of death wea filed with me BEFORE the Cusfal or transit permit was Issued: -Vms. Childress of
(Signature of Agent of Board of Health or other) Health officer 8/4/43
( Date of Love of Permit) /
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
aug
/
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
7 cb
That I attended deosased from
1939, to
aug 1
19 43
i last saw him
.. alive on .......
July 31
, 1943
death Is said to
have occurred on the date stated above, at.
7P
m.
years Immedlate cause of death
Duration IMPORTANT
.......... 2 yrs
Due to
Due to
Other conditions .... Diabetes (right les cumplatid) (Include pregnancy within 3 months of death) 14 mas ago)
2 yrs.
IMPORTANT
Physician
Major findIngs:
Of operations
Date of
Of eutopsy
What test confirmed diegnosis ?.
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?............
if so, specify .....
(Signed).
Loro 7. Salerno
M. D.
(Address) 175 Plasand St
Date Cung 3
194 ...
21
Holy Cross, Malden
Piace of Burial, Creniation or Removai.
(City or Town)
DATE OF BURIAL.August
1943
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
......
.Boston
Received and Aled.
AUG 4 1949 19 .....
(Omcial Designation)
( Registrar)
100M-6 - 2-42-8855
1 A
No.
PHYSICIAN - IMPORTANT
(Was deocased a
U. S. War Veteran,
if so specify WAR)
No
St.
Chronic Myacendity
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 whoin he has attended during his last illness, at the request of an undertsker or other authorizeil person or of sor meniber of the family of the deceased, furnish for registration a standard certificate of desth, stating to the best of his knowledge and belief the name of the deceased. his supposed age, the disesse of which he died. defined as re- quired by section one, where ssme wss contracted. the duration of his last illness, when Isst seen slive by the physician or officer and the date of hia death . . . Gen. Laws, Chiap. 16, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the decessed, to the best of his knowledge and belief, served in the army, navy or marine corps of the l'uited States in suy war in which it has been engaged, insert in the certificate s recitsl to that elect, speci- fying the war. sud shsil slso certify in such certificate both the primary and the secondary or iinmediste cause of desth ss nearly as he can state the ssine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion aod of sections forty-five, forty-six and forty-seven of said chapter one humired 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 hetwcen February fourteenth, eighteen hundred and ninety.eight sud July fourth, nineteen hundred and two, and the Slexi- can border service of nineteen hundred and sixtcen and nineteen hundred and seventeen. G. L. Chisp. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or ita 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 froin a town, from one cemetery to another, or from one grave or tomb other thau the receiving tomb to another In the same cemetery, until he has received a permit from the board of health or its agent sforexaid or from the clerk of the town where the boily is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay be, a satisfactory written statement containing the facts required by law to be returned sud 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. 01 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner 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 esrly enough for the purpose, the certificate of desth msde ss above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the desth certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, navy or marine corpa of the United States lo any war in which It has heen engaged. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificste, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other 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 hunisn body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the hoard of health or its agem appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chsp. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as sre supposed to have died hy violence. If a medical examiner hss notice that there is within hils county the hody of such a person, he shall forthwith go to the place where the body 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 following rules of practice :
(1) Attending physicians will certify to such deathe 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 phyalolans will certify to such deaths only as those of persons who, though disshled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all destha sup- posably due to Injury. These include ont ooly desths caused directly or in- directly by traumatism (including resulting septicemla), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aml deaths following abortion, but also deaths from diseass resulting from injury or Infeotlon related to occupation, the sudden desths 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 ilying, e. g., heart failure, asphyxia, asthenia, etc. Aa principai 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.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the discase causing death. report the ususl occupation prior to illness. If the deceased hsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman whose only occupatiou 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
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect PARENTS
50m (g)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : William D. Childrens (Signature of Agent of Board of Health or,other) agent Cinq 9/43
( Official Designation) (Date of Issue of Permit)
20 Aocident, suloide, or homicide (specify).
Date of ooourrenoe ..
19
Where did Injury occur ?
(City or town and State)
Did Injury poour In or about home, on farm, in Industrial place, or In publio
piaoe ?
(Specify type of place)
Injury
Collapsed solied quickly
Manner/of
Nature of
Injury
While at work ?.
Was there an autopsy?
200
21 Was disease or Injury in any way related to oooupation of deceased?
If so, specify
Hun Suckley
(Signed)
M. D.
(Address)
Brother
Cool 5-1943
22
Holy Cross
malden
Place of Bumal, Cremation or Removal.
(City or Town)
1943
23 NAME OF
FUNERAL DIRECTOR ...
Charles It Treanor
ADDRESS
Earl Baston.
19
Reoelved and filed
AUG 1 ~ 1943
(Registrar)
World 2
(a) Residence.
No.
26 Bellevue are Winthrop
(Usual place of abode)
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
male
4 COLOR OR RACEJ
White
5 SINGLE
MARRIED
WIDOWED
Married
18 DATE OF
DEATH
Current -5-1943
(Month)
(Day)
(Year)
5a If married, wideo
HUSBAND of
Marie-
martel
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8 43 Years Months Days
If less than 1 day Hours .Minutes
Usual
9 Occupation :
Truck Driver
Industry
10 or Business :
11 Social Security
024-06-7483
12 BIRTHPLACE (City)
(State or country)
Boston Masi
13 NAME OF
FATHER
James Deheskey
14 BIRTHPLACE OF
FATHER (City)
New Brunswick
(State or country)
15 MAIDEN NAME
OF MOTHER
annie Sheehan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
mass
17 informant.
Marie 1. De fishey wife Relation if any DATE OF BURIAL
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH Registered No. wat Is (If death occurred in a hospital or institution, LESKEN ( give its NAME instead of street and number) De Lasken
To be filed for burial permit with Board of Health or its Agent.
suite To Withich Comment Hospital
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran, If so specify WAR)
St.
(If nonresident, give city or town and State)
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.) acute cardiac Facture 1
Private Corman Scleroses
03-A Jul/kk (County) Winthrop (City or Town)
1 1 1 PLACE OF DEATH No . Stanley
(write the word)
AGE
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortliwith, 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 registration a standard certificate of deatlı, 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, See 9.
A physician or officer furmisning a certineate of death as required by the preceding section or by seetion forty-five of chapter one hundred and four- tcen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United 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 iminediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of ninctcen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, See. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove thercfrom a human body which has not been buried, until he has received a permit from the board of health, or its sgent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person dicd; 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 hoard 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 delivered to such board, agent or clerk, as the case may be, a satisfactory 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 physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such re- moval, unless a permit in the usual forni for the removal of such body hss been sooner obtained hereunder. If the death certificate contains a recital, ss required by section ten of chapter forty-six, that the deccased served in the army, navy or marine corps of the United States in any war in which
it ha. 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 regis- tration. The person to whom the perinit is so given and the physician cer- tifying the cause of death shall thereafter furnish 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 re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes Whereof which have been brought into the commonwealth until he bas re- coved a permit so to do from the board of health or its agent appointed to
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