Town of Winthrop : Record of Deaths 1944, Part 39

Author: Winthrop (Mass.)
Publication date: 1944
Publisher:
Number of Pages: 526


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 39


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time


of death should be transmitted on Forma 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.)


50m-10-'39. No. 8427-f


DATE FILED


None


PARENTS


17


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution.


(Specify whether)


War Veteran,


specily WAR)


19441


RUCCIDE


U


.


JUN-01544 24


R-301


Suffolk


(County)


1


Winthrop


(City or Town)


No.


101 SummitAve ....


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


To be filed for burial permit with Board of Health or its Agent


Registered No.


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


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


(a) Residence. No.


101 Summit Ave


(Usual place of abode)


Length of stay: In hospital or Institution.


( Before desth)


years


months days.


In this community


20grs.


mos.


dayı.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


( write the word)


MARRIED


WIDOWED


or DIVORCED


Married


Sa If married, widowed, or divorced HUSBAND of


(or) WIFE of


Les ... Hale


Char fi'e maiden name of wife In full)


( Husband's name in fu !! )


6 Age of husband or wife if alive 74


years


> IF STILLBORN. enter that fact here.


AGE


Years 11Months .. .19 Days


If less than 1 day Hours Minutes


Usual


9 Occupation :


Housewife.


Industry


10 or Business :


At Home


11 Social Security No.


Providence


12 BIRTHPLACE (City)


( State or country)


R. I.


13 NAME OF


FATHER


Nehemiah Sherman


14 BIRTHPLACE OF


FATHER (City)


not .... known


(State or country)


15 MAIDEN NAME


OF MOTHER


not known


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


not known


17 Relation, if any husband


Informant. ( Address)


CharlSatteAre., Winthrop


I HEREBY CERTIFY that a satisfactory: standard certificata of death was filed with me BEFORE the burlal of transtt permit was Issued :


(Signature of Agent of Board of Health or othery seattle Jeklick ( (Official Designation) (Date of Issue of Permit) 6/2/44


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


June


2


1944


( Month)


(Day)


(Year)


19, 1 HEREBY CERTIFY,


44


Ło ...


TRat I attended deceased from


4/48


i last saw her


allvo on och/ 100


1944 death Is sald to


have occurred on the date stated above, at 10-30A


Duration


m.


Immediate cause of death.


.IMPORTANT


Due to


Hemoshay L.


2 days


Due to ..


Carmona of Ploro


21 his


Other conditions.


( Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of


Of autopsy


What test confirmed diagnosis?


Underline the cause to which death should ba charged sta- tistically.


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


If so, specify. Ergroup ('Signed)


, M. D.


(Address)


20 Curenych.


Date 6/2


19.84


21 Warren Place of Burial, Cremation or Removal. DATE OF BURIAL June,


6,


1944


19.


22 NAME OF FUNERAL Richard Towhite


ADDRESS


Winthrop mix


Received and Alled. 19


IUN 5


( Registrar)


100M-6 - 2-42-8855


terms, so that it may be properly classified. Exact statement ot OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that effect. PARENTS extracts from the laws on back of certificate.


St.


PHYSICIAN - IMPORTANT


(Was deosased a


U. S. War Veteran,


if so specify WAR)


St.


(If nonresident, give city or town and State)


(Specify whether)


Female White


19


IMPORTANT Physician


(City or Town)


8 75


PLACE OF DEATH


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medioal officer shall forthwith. after the death of a person whoin he has attended during his last illness, at the request of sn undertaker or other authorized person or of snr member of tbe family of the deceased, furniab for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased. his supposed sge, the disease of which he died. defined as re- quired by section one. where same was contracieil. the duration of his last illness, when last seen alive by the pbyaician or omdcer and the date of his death ... Gen. Lawa, Chap. 46, Sec. 9.


A' physician or officer furnishing a certificate of death aa required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served in the army. navy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war. and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the saine. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bunifred and fourteen, the word "war" shall inclmle the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen bundred and seventeen. G. L. Cliep. 46, Sec. 10.


No undertaker or othar person shall bury or otherwise dispose of a buman body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or ita agent appointed to lasue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or otber person ahall 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 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 facta required by law to be returned and recorded, which shall be accompanied. in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, 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 pbyal- cian who ie 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 medi- cal examiner chall 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, tbe certificate of deeth made as above provided and in the possession ot tbe undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from wbich 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, ae required


by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States In any war in which it has been engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith countersign it and trananilt it to the clerk of the town for registration. The person to whom the permit le so given and the physician certifying the cause of death shall thereafter furnish for registration any other uece+ sary 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 require .- Cbap. 114. Sec. 46, G. L., ( Tercentenary Edition ).


No undertaker or other person shall bury a human body or the ashea thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do 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 body is to be buried or the funeral is to he held, or from s pierwun appointed to heve the care of the cemetery or burial ground in which the interment is made ... . Cbap. 114. Sec. 46. G. L., (Tercentenary Edition).


Medical examiners shell make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within ilis county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.


RULES OF PRACTICE


The fulfillment of the purpose of these lawe calle for the observance 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 illness from disease unrelated to any form of injury.


(2) Board of Health physlolans will certify to such deaths only aa those of persons who, though disahled 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 ie needed.


(3) Medloal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directiy by traumatiam (Including resuiting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diseasa resulting from Injury or Infeotion related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statemant of Cause of Death .- Cause of death meana the disease, or complication which causes death, not the moile of dying, e. g., heart fallure, asphyxia, asthenia, etc. Aa principal cause name tbe disease causing death, As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of tbe principai cause.


Statement of Oooupatlon .- Precise statement of occupation la 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 on account of the disease causing death, report the usual occupation prior to Illness. If the deceased bad retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at bome. For a woman wbose 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, aa housekeeper-private family, cook-hotel, etc. For a person wbo had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


M R-302


SUFFOLK BOSTON


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


CERTIFICATE OF DEATH


St.


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


John Frances Larkin


2 FULL NAME


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


249 Pleasant


(If U. S.


War Veteran,


speolfy WAR)


Winthrop, Mass.


no


(a) Residenoe. No.


(Usual place of abode)


St.


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution


(Before death)


Hosp


....


years


months


1


days.


In this community


yrs.


mos.


1


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE;


W


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.


8


30


AGE.


.Years


11


Months


14


.Days


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


Usual


9 Occupation :


Clerk


Industry


10 or Business : Sub. Gas & Electric Co.


11 Soolal Security No ...


023-09-4285


12 BIRTHPLACE (City)


(State or country)


Lynn, Mass.


13 NAME OF


FATHER


John F. Larkin


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Lynn, Mass.


15 MAIDEN NAME


OF MOTHER


Ruth Andersen


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Sweden®


17 E. Taylor


Informant


(Address)


Relation, if any LAunt


A TRUE COPY.


ATTEST :


(Registrar of city or town where death occurred)


DATE FILED June8 19449


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


June 4 1944


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY,


June 4/44


19.


to.


That I attended deceased from


June 5/44


19.


I last saw h ..


im


... alive on.


June


5/44


19


death Is sald to


have ocourred on the date stated above, at


June 5/44


m.


Duration


Immediate cause of death


Addisons disease


Ter.


Due to.


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


Above


What test confirmed diagnosis ? Autopsy


20 Was disease or injury in any way related to oooupation of deceased ?.... no


If so, specify.


W. R. Duden


M. D.


(Address)


Peter.B. BrighamHoapte 6/5/44


21 PLACE OF BURIAL,


Winthrop, Winthrop, Kass.


CREMATION OR REMOVAL


(Cemetery)


June


1944


19


(City or Town)


DATE OF BURIAL


22 NAME OF


R. White


FUNERAL DIRECTOR


ADDRESS


Winthrop, Mass.


Received and filed


JUN- 12-1944


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. I .. ) 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


PLACE OF DEATH


(County)


1


(City or Town)


Peter Bent Brigham Hospital


(City or town making return)


Registered No.


5248 1.9


No.


(Specify whether)


5 SINGLE


(write the word)


PARENTS


(Signed)


C


R-301 A


PLACE OF DEATH


Suffolk (County)


Winthrop


(City or Town)


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


To be filed for burial permit with Board of Health or its Agent


Registered No.


§ (If death occurred in a hospital or institution,


St.


¿ give its NAME instead of street and number)


2 FULL NAME


Manuilla (Colledge) Nicol


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


14 Fremont Street


St


(If nonresident, give city or town and state)


Length of stay: In hospital or institution.


(Specify whether)


years


months


days.


In this community


16 yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Female


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widow


Sa If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


James Nicol


(or) WIFE of


(Husband's name in full)


·


... years


7 IF STILLBORN, enter that fact here.


ÅGE


8


87 Years


3


.Months ..


6 Days


If less than 1 day Hours Minutes


Usual


Housewife


9 Occupation :


Industry


10 or Business :.


Own Home


11 Social Security No ... None


12 BIRTHPLACE (City)


Selkirk


(State or country) Scotland


PARENTS


15 MAIDEN NAME


OF MOTHER


Elizabeth Dudgeon


16 BIRTHPLACE OF


MOTHER (City).


(State or country)


Scotland


17 William Nicol


(


Son


Informant (Address)


14 Fremont Street Winthrop


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


....


(Signature of Agent of Board of Health or other) ...... He altle Of Rece 6/6/44


(Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


ni


1944


tạp.


19


have occurred on the date stated above, at ....... 5.30P .m.


Immediate cause of death ..


Duration


IMPORTANT


............


Due to. antonio Delunes


Due to


Other conditions. (Include pregnancy within 3 months of death)


IMPORTANT


PHYSICIAN


Major findings: Of operations.


Date of.


Of autopsy.


What test confirmed diagnosis ?.


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


If so, specify ..........


(Signed) ....


whenthe Date 6-5-19440


(Address).


21.


Woodlawn


Everett


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


June 6


44


19.


22 NAME OF


FUNERAL DIRECTOR .....


ADDRESS.


Received and filed JUN 7 1911


19


(Registrar)


CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.


100m-2-'40-D-729-a


(Official Designation)


18 DATE OF


DEATH.


fame


(Month)


4


1944


(Day)


(Year)


19 I HEREBY CERTIFY. That I attended deceased from


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


that, 1947, death is said to


6 Age of husband or wife if alive.


13 NAME OF


FATHER


Lames Colledge


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Scotland


Underline the cause to which death should be charged sta- tistically.


M. D.


Relation, if any


1


No. 14 Fremont Street


(If U. S.


War Veteran,


specify WAR).


(a) Residence. No ..


(Usual place of abode)


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 registration a standard certificate of death, stating to the best of his knowledge and belief tbe 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 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 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 receiv- ing 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 clerk of the town wbere the body is buried. No such permit sball be issued until tbere 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 tbe attending physician, if any, as required by law, or in lieu thereof a certificate as bereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of tbe 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 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 removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed witbin thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body bas been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of sucb 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 tbe physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to tbe 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 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 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 observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they bave given bedside care during a last illness 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 unrelated 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 deatbs supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), 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 infectlon related to occupation, 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 tbe 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 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 business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wbose only occupation was that of home bousework, write housework. For a person engaged in domestic service for wages, however, designate tbe 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


M R-302


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


17 Informant ( Addrese)


Relation, if any


Father ...


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


June 8, 1944


19


18 DATE OF


DEATH


June 5, 1944


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY, June 3/44


19


to.


June 5/44


19


I last saw h


allve on


have occurred on the date stated above, at


9:50


m.


Duration


6 Age of husband or wife If alive years


7 IF STILLBORN, enter that faot here.


8


AGE


Years


Months. .3 Days


If less than 1 day .. Hours. Minutes


Usual


9 Occupation :


Industry


10 or Business :


11 Social Security No ..




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