USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 38
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(City or town making return) 111
Registered No. § (If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NA
NEW JERSEY DEPARTMENT OF HEALTH-BUREAU OF VITAL STATISTICS
Registrar'. No .. x86
AR)
y or town and state) yrs.
mos. days.
TH
('Year)
Itended deceased from
19. .......
19 ... death is said
... m.
Duration
Duration
Immodisto cause of death ...
(Month, day and year)
AGE
Years
Months
Day
If less
Hra
68
11
9
Min.
BIRTHPLACE (City or town) anossenos: adocente Md Stvve etgodt 1 to
CAUOU
(State or country)
USUAL OCCUPATION IRON WORKER
.........
Hemiplegia
PHYSICIAN
Other conditions ofscoringstetsorangersesas (Include pregnancy within 3 months of death)
Major findings:
Of operations
- Underline the cause to which death should bs charged sta- tistically.
If desth were due to external causes, All to the following: Accident, suicide, or homlelde (specify)
Date af occurrence ......
Where did Injury occur !
(City or towa)
(County) (State)
Did injury occur in or about home, on farm, In industrial place, in publie place I.mwontsetstutto
(Specify type of place)
While at work [ ......... ...... Means of Injury ...... A. She Blgastaro ....... PHÍTetA
(M. D. or other)
Address .. w
I'LL M. D.
North Augen
(AdGre88
.Date. 19 ...
Relation, if any
I HEREBY CERTIFY that a satisfactory standard certificate of death was Eled with me BEFORE tho burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation) (Date of Issue of Permit)
FORMER OR USUAL RESIDENCE
State MASSACHUSETTS County MiddleSEX
(a) Resio (Usual Length of stay: I
764
PLACE
Length of Stay
in this Community.
mos. 5 days hrs
foreign country ? .... country ....
Kindly Type or Print
FULL NAME EDWIN FRANCIS (Surname last, Arst name bere)
ANDERSON
MEDIOAL CERTIFICATION
IF VETERAN, NAME WAR GAM VSE SECURITY
DATE OF DEATH
4-16 20 44
5a If married, w HUSBAND of
RLOIDENCO
OOLOR OR RACE
Single, Married, Widowed or Divorced {write the word) 1 HEREBY CERTIFY, That I attended the deceased from
Male
white
widowed.
4-131974
4 - 16 - 1964
If married, widowed or divorced HUSBAND OF
Age, if that I lest saw hislive on ..... n.C., 199.4. - sad that death occurred on the date stated above, at ......... L.npouring.
(Olive full maiden name) PocheEl MARINE
6 Age of husban
95
Industry or business RETIELd.
NAME William. B. ANDERSON
CONT.
BIRTHPLACE (City ar town) (State or country)
SWEDEN
12 BIRTHPLACE (State or coun
MAIDEN NAME LAVIA LUNDEEN
BIRTHPLACE (City or town) . ....... .... ro ogoni os do ctrimvi sor se desFrupln) (State or country)
SwedEN
14 BIRTHPLA FATHER (
PLACE OF ACCIDENT
(Address) 9/1 . 82 st. North Bergen, N. J. PLACE OF BURIAL Cremation or Removal WyRmIRE CEMETERY DATEAPRIL 19, 10.4 .... MELRose. Mass.
15 MAIDEN I OF MOTH
FUNERAL Henry Leber N. J. License No.
DIRECTOR (Address) 2000 Miken Blvd. Unienfin, N.J.
RECEIVED. 4/16
Loool Registrar.
00 NOT WRITE IN SPACES ICLOW
PLACE OF DEATH
Conn Hudson COUNTY Township NORTH BERGEN
City or Borough Name of Hospital or Inetitation ........ 911-92 St.
City or Borough ....... (If outside city or borough limite, name township)
Street No ...... 95 COURT?
(If rural give location)
(If not in hospital or institution write strect number or location)
Citizen of
If so, name
PE
29
SOCIAL
CAST
BOSTON
Due to
Of antopsy
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
21 Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed. JUN 27 1918; 19
A TRUE COPY ATTEST:
(Registrar)
600 - 80 €
Date signed
APRIL 26, 1875
Then One Day
Due to AHó
MOTHER | FATHER
SIGNATURE OF Charles H Anderson INFORMANT
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS
GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered bospital medical officer sball forthwitb, after the death of a person whom he bas attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deccased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased. bis supposed agc, the disease of which be died, defined as required by section one, where same was contracted, the duration of his last illness, wben last seen alive by the physician or officer and the date of bis death ... Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a buman body in a town, or remove therefrom a human body which bas not been buried, until be has received a permit from the board of health or its agent appointed to issue such permits, or if there is no such hoard, from the clerk of the town where the person died ; and no undertaker or other person shall exhume a buman 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 be has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been de- livered to such 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 select.men for the pur- pose, shall upon application make the certificate required of the at- tending physician. If deatb is caused by violence, the medical cxam- 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 he obtained early enough for the purpose, the certificate of death made as ahove provided and in the possession of the undertaker desiring to make such a removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtaincd 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 bealth, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can he
ohtaincd as to tbe deccascd, 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 buman body or tbe ashes thereof which bave 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 buricd or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edition.)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized diseasc 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 deatbs caused directly or indirectly by traumatism (including resulting septice- inia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infcelion 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., beart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing deatb, report the usual occupation prior to illness. If the deceased bad retired from busi- ness, report the usual occupation prior to retirement. Children not gainfully employed may he 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, designatc 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
R-302
PLACE OF DEATH
Lidolesex (County)
1 Cambridge, Mass. (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Camebridge .... (City or town making return)
6412
No. Holy Ghost For it 1, 1575 G mbriege Stl (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Timothy Croulev
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 George Street Winthrop, Lasst.
inthrop
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution LOSnite ]
years
months 27
days.
(If nonresident, give city or town and state)
In this community
yrs. 5
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE 5 SINGLE
MARRIED
nite
WIDOWED
or DIVORCED Single
(write the word)
18 DATE OF
DEATH
6
1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
That I attended deceased from
I last saw h ............ alive on.
6
19.
44
death is said
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8 AGE 74 Years Months .Days
If less than 1 day
Hours.
Minutos
Usual
9 Occupation:
retirer
Blapieni.th
Industry
10 or Business:
BAAR.R.
11 Social Security No.
774- 09 - 2662
Boston
12 BIRTHPLACE (City)
(State or country)
"Haso.
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis?
20 Was disease or Injory In any way related to occupation of deceased ?
no
If so, specify.
Daniel mccall_ op
(Signed)
Cambridge
19
44
17 Mrs . Margaret R . Crowle Relation, if any
Informant ....
(Address) 59 St . Andrew Ra . E. 3.
A TRUE COPY.
ATTEST:
John D. Crowley - Clerk
(Registrar of city or town where death occurred)
DATE FILED
play.
8
19
44
Frederick H. Banks
21 PLACE OF BURIAL.
CREMATION OR REMOVAL.
Holy Cross
Malden
DATE OF BURIAL
(Cemetery)
9
(City or Town).
19
44
22 NAME OF
FUNERAL DIRECTOR
Jchn C. Kelly
ADDRESS.
11
ericin It J.B.
Received and filed
JON 4-2-1944
19
44
(Registrar of City or Town where deceased resided)
Y
6
19
44
(or) WIFE of
(Husband's name in full)
to have occurred on the date stated above, at.
9.10P
m.
Duration
Immediate cause of death ..
Carcinoma of Stomach
Due to
Due to
13 NAME OF
FATHER
Patrick. Cro ley
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
PARENTS
15 MAIDEN NAME
OF MOTHER
Kary Connor
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Major findings :
Of operations
Of autopsy
Date of.
Date.
5-7
M. D.
....
(Address)
50m-10-'39. No. 8427-f
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Registered No.
(If U. S.
War Veteran,
specify WAR)
ro
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
7
19.4.4.,
6 mos
RM R-302
1 SUFFOLK BOSTON (County)
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return) 113
Registered No.
4500
(If death occurred in a hospital or institution, -
Rita Frederick
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
269 Bowdoin St.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
6
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
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Vito Frederiok
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE
8 76 Years ? Months. ? Days
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Housework
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
?
Lufizzi
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
?
Lugia
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17 Informant Long Island Hosp (Address)
Relation, if any
Boston , Mass
( .....
A TRUE COPY.
4
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
May 15 1944
19
18 DATE OF
DEATH
May 10, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
May 4/44
19
to .. May 10/44
19
That I attended deceased from
I last saw h
er
May 10/44
19
death is sald to
.. alive on
have ocourred on the date stated above, at. 5: Pm m.
Duration
Immediate cause of death
Arteriosclerotic heart disease
yrs
(Partial heart block)
Due to.Generalized ... arteriosclerosis
yrs
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.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to ocoupation of deceased?
(Signed)
If so, speolfy
J ..... V ...... Sacchetti
M. D.
(Address)
Long .... Island ... Hos.p.
Date
5./10/44
21 "PLACE OF BURIAL, Winthrop Cem. Winthrop, Mass. CREMATION OR REMOVAL
DATE OF BURIAL
May Igete944
(City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
M ..... Kirby
ADDRESS
Winthrop Mass
Received and filed
JUN- 1 2-1944
19
(Registrar of City or Town where deceased resided)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
resided in another 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.)
50m (e)-1-41-4667
PLACE OF DEATH
(L'ity or Town)
No.
Long Island Hospital
St. give its NAME instead of street and number)
(If U. S.
War Veteran,
Zweiły WAR;
(a) Residence. No.
(Usual place of abode)
1
0
M R-302
BOSTON
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
1
PLACE OF DEATH
(County)
(City or Town)
No.
Boston City Hospital
St.
S (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Edna Irene Leary
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
(Usual place of abode)
88 Main St.
St.
Winthrop
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
.....
years
months
1
days.
(If nonresident, give city or town and State)
In this community 17 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(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
17 Years.
Months.
Days
If less than 1 day .. Hours. .Minutes
Usual
9 Occupation :
Student
Industry
10 or Business :
11 Sooial Security No ..
12 BIRTHPLACE (City)
(State or country)
Cambridge, Mass.
13 NAME OF
FATHER
Francis J. Leary
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Saybrook, Conn.
15 MAIDEN NAME
OF MOTHER
Edna F. Mccarthy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Shanghai, China
17 Informant. (Address)
Relation, if any
( ...
Father
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED 19
May 15, 1944
18 DATE OF
DEATH
May .... 10/44
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
May .... 10/44.
19
tdMay .... 10/44
19.
I last saw h ...
......... alive on
--
19
death Is sald to
have occurred on the date stated above, at.
5:10 0.
m.
Duration
Immediate cause of death
Status epilepticus
8 days
Due to
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings :
Of operations
Date of.
which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis?
Clinical
20 Was disease or injury in any way related to ocoupation of deceased ?
(Signed)
Boston ... City ..... Hosp Date5/11/44
21 "PLACE OF BURIAL, Winthrop, Winthrop, Mass.
CREMATION OR REMOVAL.
(Cemetery)
(City or Town)
DATE OF BURIAL
May.13, 1 944
19
22 NAME OF
FUNERA
N. F. O'Maley
ADDRESS
Winthrop, .... Mass.
Received and filed
JUN 1-2-1944
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.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city of town in case the deceased
Registered No.
4467
(If U. S.
War Veteran,
specify WAR)
r
--
If so, specify
M. ". O' Connell
M. D.
(Address)
That I attended deceased from
(Give maiden name of wife in full)
M R-302
Suffolk
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
303
Registered No.
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
Bernard J.Flaherty
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
573 Pleasant
(a) Residenoe. No.
(Usual place of abode)
Homo &
Hospital
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
15
In this community
yT8.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE|
V
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
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
7 IF STILLBORN, enter that fact here.
g
AGE.
.5.3Years.
9 Months.
.9.Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Production Checker
Industry 10 or Business :
11 Social Security No ..
unknown
12 BIRTHPLACE (City)
(State or country )
Boston, Mass:
13 NAME OF
FATHER
John
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary McDonough
16 BIRTHPLACE OF
MOTHER (City)
Ireland
(State or country)
Hospital Records
17 Soldiers! Home Hosp nazista
Informant.
(Address)
A TRUE COPY.
ATTEST :
(Registrar of city, or town where death occurred)
5/23/447
.19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 23, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Oct .8
19
43
to
That I attended deceased from
May 23
19
44
I last saw h ...
im alive on
May ...... 2319 44death Is sald to
have oocurred on the date stated above, at.
12:35A
Duration
Immediate oause of death
.Hypertensiveheartdisease
?. yrs.
Essential .... hypertension
?yrs.
Due to.
Mitral regurgitation
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings:
Of operations.
Date of
tistically.
What test confirmed dlagnosis?
clinical
20 Was disease or injury in any way related to occupation of deceased ?
(Signed)
If so, specify.
Louis I. Rudiger
M. D.
(Address)
Soldiers' HomeDate.
5./2.319
.. 4.
21 PLACEOR BURIAL,OSS Malden, Mass.
CREMATION OR REMOVAL
Igmeter26, 1944 (City or Town)
19
DATE OF BURIAL
frank V.McArdle
22 NAME OF
FUNERAL
AFECTORelsea St . Charlestown
ADDRESS
JUN 1 3 1944
19
Regelved and filed
(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.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
1
PLACE OF DEATH
( County) Chelsea
(C'ity or Town)
No.
Soldiers' Home Hospital
WV!
1
(If U. S.
War Veteran,
speolfy WAR)
Winthrop, Mass.
St.
(If nonresident, give city or town and State)
DATE FILED
Underline the cause to which death should be charged sta-
Of autopsy.
RECEIVED
3
1
6
JUN131944 AN
R-302
1
Middlesex (County) Arlington (City or Town) ..... PLACE OF DEATH No. 12 Florence Avenue
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Arlington
(City or town making return).
Registered No.
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Alice ...
Sawyer (Coggeshall)
(II U. S.
None
(If deceased is a married, widowed or divorced woman, give also maiden name.)
258 Court Road
St.
Winthrop,
Mass.
(If nonresident, give city or town and state)
years
months
days.
In this community
yrs.
21 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
Or DIVORCED Widow ed
(write the word)
Female white
5a If married, widowed, or divorced
HUSBAND of
(Cive maiden name of wife in full)
(or) WIFE of
Charles A. Sawyer
(Husband's name in full)
.years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
ÅGE
a 83 Years ... 9 Months ............ Days
If less than I day
Hours.
Minutes
Usual
9 Occupation:
Housewife
Industry Il or Business:
1I Social Security No.
Nantucket
12 BIRTHPLACE (City)
(State or country)
Mass
13 NAME OF
FATHER
Charles Coggeshall
14 BIRTHPLACE OF
FATHER (City)
Nantucket
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Phoebe Mitchell Swain
16 BIRTHPLACE OF
MOTHER (City)
Nantucket
(State or country)
Mass.
Edi th
Sawyer Newton
Relation, if any
( Daughter ... )
Informant.
(Address)
A TRUE COPY.
ATTEST:
(Registrar of city or town/where death occurred)
June
2
19
44
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
May
31
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
March
5.
19
May
That I attended deceased from
31
19
I last saw h ......... alive on .. May.
31
19/1,
death is said
to have occurred on the date stated above, at ...
7
P
... m.
Duration
Immediate cause of death ........ Cerebral
Thrombosis
3 Mos
21dys
Due to
Broncho .... Pneumonia
6 dys
Due to
Senility
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-
Of autopsy
What test confirmed diagnosis ?.
Clinical
tistically.
20 Was disease or Injury In any way related to occupation of deceased ? NO
If so, specify.
(Signed) .ichard Metcalf
(Addre
18 winthrop St25-31- 1944
21 PLACE OF BURIAL,
CREMATION OR REMOVADak Hill-Sterling ,Mass
(Cemetery)
(City or Town) LL
19
DATE OF BURIAL.
June
2
22 NAME OF
FUNERAL DIRECTORW. E . King & Watson
ADDRESS
Main St., Clinton
Received and filed.
JUN 9 1944
19
(Registrar of City or Town where deceased resided)
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