USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 49
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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 on account of the disease causing death, report the usual occupation prior to illness. If the deceased had 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 whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, 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
01 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. 60 Floyd Street
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent
£45
2 FULL NAME
Edwin Alfred Holmes
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 60 Floyd Street St.
(Usual place of abode)
(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
18773.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorcededith Douglas
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. 43
years
7 IF STILLBORN, enter that fact here.
8
AGE 53 Years.
1
Months ...
0
Days
If less than 1 day
Hours ....
Minutes
Usual
9 Occupation :
Agent
Industry
10 or Business:
Insurance
11 Social Security No.
024-01-1012
12 BIRTHPLACE (City)
(State or country)
Mass.
Brockton
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT Physician
Major findings:
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
Underline the cause to which death should bc charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? 40
If so, specify.
(Signe
city Louis 7. Salerno
M. D.
(Address) 75 Pleasant St
21
Evergreen Cemetery
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
August 2.
19
44
22 NAME OF
FUNERAL DIRECTOR
SMynolds
ADDRESS
Wenthis Mus
Received and filed
AUG 2 1944-
19
(Registrar)
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect.
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Elisabeth Gay
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass"
Stoughton
17 Edith Holmes
RelWanffeany
Informant
(Address)
60 Floyd St. Winthrop
was filed with me BEFORE the burial or transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of death We-D' Cularexxx (Signature of Agent of Board of Health or kher) Health officer 7(Official Designation) (Date of Issue of Hermits / 14
18 DATE OF
DEATH
July
30
1944
(Year)
(Month)
(Day)
That I attended deceased from
19 I HEREBY CERTIFY,
July 26, 1944
to.
July 30
1944
Mast saw him_alive on
July 30, 1944, death is said to
have occurred on the date Stated above, at.
10 AM.
Immediate cause of death.
Coronary Thrombosis
Duration IMPORTANT 4 days
Due to.
Due to.
13 NAME OF
FATHER
Alfred Holmes
from the laws on back of certificate.
50m.(e)-3-43-11574
1
Registrar's No.
St.
§ (If death occurred in a hospital or institution,
{ give its NAME instead of street and number)
PHYSICIAN-IMPORTANT
(Was deceased aworld
U. S. War Veteran,
if so specify WAR)
War 1
Date Jeely 31 1944
Stoughton
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 the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last scen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, 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 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 immediate 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 sball 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 expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not been huried, 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 exhunc a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforcsaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have heen 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 interinent, 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 hy 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 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 carly 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 thic 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 scction 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 heen 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 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 neces- 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 .- 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 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 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 hurial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within his county the body of such a person, he shall fortliwith go to the place where the body lies and take charge of the samnc; . . . - 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 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 physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any forin of injury, have died without recent medical attendance or whose phy- sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly hy 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 infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Canse of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, astbenia, etc. As principal cause namnc 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 on account of the disease causing death, report the usual occupation prior to illness. If the deceased had 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 whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, 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
R.302
Essex
PLACE OF DEATH
(County)
Saugus
Gino Lincoln Ave.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
.... A Pr (City or town making return)
Registered No
87
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2 FULL NAME
Walter Alward Sharkey, Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 Cliff Ave.
St.
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
July 12, 1944
(Month)
(Day)
(Year)
19 HHEB5BY CERTIFY.
TJet f attended deceased froh
......... , to.
19.3 .......
I last saw
............. alive on ..
to have occurred on the date stated above, ............. Immediate cause of death ..... carcinomatosis
.m.
Duration .6 mos.
Due to
Primary annular carcinoma of
transverse colon with metastasis
Due to
Other conditions
Annular carcinoma of
(Include pregnancy within 3 months of death)
Major findings : Of operations
..
Of autopsy
What test confirmed diagnosis ?. clinico1
20 Was disease or Injury in any way related to occupation ol deceased ? If so, specify. Leroy C. Furbush M. D.
(Signed)
(Address)
Saugus ........ ass ....
.Dato ..
7/13/0 4/4
21 PLACECOR RURAL,Cemetery, Lelrose, Dass
CREMATION OR REMOVAL
Julyceny) 1944
(City or Town)
DATE OF BURIAL
19
22 NAME OF
„George E. Meany, Jr.
FUNERAL DIRECTOR
ADDRESS
410 Lincoln Ave.,
Saurus.
6 July JA, 79440
Received V Ha G. Wilson 19
(Registrar of City or Town where deceased resided)
PHYSICIAN
14 BIRTHPLACE OF
FATHER (City)
St.Martin
(State or country)
Now Brunswick
15 MAIDEN NAME
OF MOTHER
Elisabeth ( NoDermott)
16 BIRTHPLACE OF
MOTHER (City)
Boston,
(State or country)
Mass:
Relation, if any
Informant. (Address) winthrop, Lass.
L.Sharkey ...
.. ( ... wife
·)
A TRUE Lopred M. Furlong
ATTESTI (Registrar of city of town where death occurred) Bd. of Health JJuly 14, 1944
DATE FILED 19
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
widowed or divenneds (Hurley) Sharkey HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife il alive .. Years
7 IF STILLBORN, enter that fact here.
6
Months
Days
li less than 1 day .. Hours Minutes
Usual
9 Occupation:
Plumer.
Industry 18 or Business: 032-05-1992
11 Social Security No.
032-05-4992
13 NAME OF
FATHER
Halter Alward Sharkey
Date of
3/17/41
Underline the cause to which death should be charged sta- tistically.
- 3 SEX Male (or) WIFE of AGE Years 12 BIRTHPLACE (City) (State or country) PARENTS 17 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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 Wwwwirsu wu yves city of fowa in case the deceased resided in another city or town at the time 8 55 0
1
No
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and state)
July
11
19.
death is said
50
4 COLOR OR RACE' 5 SINGLE
white
U
AUG1 41344 AM
M R-302
2 FULL NAME
3 SEX
M
(or) WIFE of
8
59
Usual
9 Occupation :
14 BIRTHPLACE OF
FATHER (City)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
17
Informant
(Address)
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
(State or country)
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Josephine McDonald
(Husband's name in full)
6 Age of husband or wife if alive 56
years
7 IF STILLBORN, enter that fact here.
AGE .Yesrs Months. .. Days
If less than 1 day Hours Minutes
Gateman
Industry
10 or Business:
City of Boston
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
East Boston, Mass.
13 NAME OF
FATHER
Hugh MoMullen
New Brunswick, N. S.
Mary Good
unknown
Relation, if any ,"Wife
A TRUE COPY.
r. Francis
ATTEST :
..... (Registrar of city or town where death odeurred)
DATE FILED
July .... 18, ... 1944.
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 14, 1944
(Month)
(Day)
(Year)
19 I HEREBY July 12744
CERTIFY,
That I attended deceased from
19
to
19
I last saw h
himallve on
July 14 44
19
.. , death Is sald to
have occurred on the date stated above, at. 5.0.25 ...
Immediate cause of death.
Chronic myocarditis with pulmonary odema
2 days
Due to.
Bilateral polypoid
Ethmoid and antra with asthma
5 yrs
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings : Polypoid bilateral ethmoid
Of operations.
and antra
Date of
Underline the cause to which death should be charged sta- tistically.
Of sutopsy What test confirmed diagnosis ?...... X-Rays
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) G.H.Poirier M. D.
(Address) 60 .... Bay .... State Rd.
Date.
7/14 /44
21 PLACE OF BURIAL,
Winthrop Cem. Winthrop
CREMATION OR REMOVAL ..
(Cemetery )
(City or Town)
DATE OF BURIAL
July 17,
1944
19
22 NAME OF
VERAL
J. T. White
ADDRESS
E. Boston, Mass.
Received and filed AUG-1 1 1944 19
(Registrar of City or Town where deceased resided )
1
PLACE OF DEATH
(County)
(City or Town)
Mass. Eye & Ear Infirmary
St .
( If death occurred in a hospital or institution, 3 give its NAME instead of street and number)
William Mouullen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
102 Loring Rd
Winthrop
(a) Resldenoo. 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)
Hosp
years
months
days.
In this community
yrs.
mos.
2
days.
PERSONAL AND STATISTICAL PARTICULARS
50m (e)-1-41-4667
SUFFOLK BOSTON
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
ORTON
(City or town making retura)
Registered No.
6291
No.
(If U. S.
War Veteran,
specify WAR)
no
2
Duration
no
X
RM R-305
SUFFOLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON-
(City or town making returng)
Registered No.
6366
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Lorena Johnson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
22 ... Washington .. Ave.
St.
Winthrop
(If nonresident, give city or town and State)
months
days.
In this community
yrs.
mos.
1
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 171944
(Month)
(Day)
(Year)
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.)
Multiple .... injuries .... including ... crushed
chest and fractured siull
Zygoma and lower jaw
XX
20 Accident, suloide, or homicide (specify)
Date of occurrence
.19
Injury occur ?
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
publio place ?
(Specify type of place)
Manner of Struck by train in Subway station
Injury
Nature of Injury
While at work?
Was there an autopsy ?......... no
21 Was disease or Injury In any way related to occupation of deceased? If so, specify
(Signed)
T. Leary
M. D.
(Address)
Date.
7/18/48
22
Winthrop Cem. Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
July 20, 1944
19
23 NAME OF
C. R. Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop, Mass
Received and filed.
AUG 11 1944
19
(Registrar of City or Town where deceased resided)
No.
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
W
MARRIED
WIDOWER& COW
or DIVORCE
F
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
wirfiam Ca
(Give maiden name of wife in full)
Johnson
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
75
7
AGE
Years
Months
Days
13
Usual
9 Occupation :
11 Social Security No .......
017-05-0679
12 BIRTHPLACE (City)
(State or country)
"Westchester; Penn"
13 NAME OF
FATHER
James S. Elliott
14 BIRTHPLACE OF
FATHER (City)
Ireland
......
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Jones
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Willistown, .... Ponn.
(State or country)
17
Mrs. H.E. Meyer
occurred. (See Chap. 46, Sec. 12, G. L.)
of the city or town in which the deceased resided as soon as possible after the close of the ' month in which the death
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
industry
10 or Business :
.. Treas .... of above companies.
5 SINGLE
(write the word)
6 Age of husband or wife if ailve years
If less than 1 day Hours ... .Minutes
Treas. Melrose News Co. and
Hilld Co. Melrose Mass
25m (h)-1-41-4667
Informant
(Address)
Winthrop
Sister
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
July 20, 1944
19
3 L (County ON
1
PLACE OF DEATH
(City or Town)
Boston City Hospital
St.
(if U. S.
specify WAR)
years
Relation, if any DATE OF BURIAL
Where did
Under investigation
2.
1
a
1 2 FULL NAME BEX (or) WIFE of 8 54 AGE Years Usual 9 Occupation: 10 or Business: 11 Social Security No. 12 BIRTHPLACE ( (State or country) FATHER (City) 16 BIRTHPLACE OF PARENTS MOTHER (City) (State of country) 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. information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-10-'39. No. 8427-e N. B .- WRITE PLAINLY, WITTY UNTADING DLAGR INA-THIS IS A PERMANENT RECORD. Every item of (State or country)
PLACE OF DEATH
Ot or Towny
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, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(a) Residence. No .. (Usual place of abode)
Length of stay : In hospital or institution.
years*
months
7 days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Female White
5 SINGLE
(write the word)
Named
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of
Jovanna
(Husband's name in full)
53
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
If less than 1 day
Months
Days
Hours Minutes
Strusewife
Industry
At Home
Caso Contr
Mass.
13 NAME OF
FATHER
Charles . Sloan
14 BIRTHPLACE OF
Philadelphia
Bmw.
15 MAIDEN NAME
OF MOTHER
Manon Anderson
Denmark
17 Frank Poranna
Relation, y any
Informant (Address) 152 Juin to Endolyan
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bugal er transit permit was issued:
(Signature of Agent of Board of Healthor other) health office 8/8/44
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH Cinq 65, 1944 (Month)
(Day) (Year)
19 I HEREBY CERTIFY 20
198 .....
„ to Que
That I attended deceased from 5 19.
Vlast saw en alive 19 ...... , death is said to have occurred on the date stated above, at ? 32 p.m.
Duration IMPORTANT
30
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings :
Of operatio
Jorge 2 bilical hernia
Date of ..
Underline the cause to which death
Of autopsy
should be charged sta- What test confirmed diagnosis ?.
tistically.
20 Was disease or Injury In any way related to occupation of deceased? 20
If so, specify. SausSchiffer . M. D.
(Signed) ..
(Address)ZS
By Date" & Halden, Miss
51964
21 Holy Cross
Place of Bufal, Cremation or Removal. DATE OF BURIAL 19
9 (City or Town)
OF Metal.be
22 NAME OF FUNERAL DIRECTOR ADDRESS 98. Saratoga 88 2003200
Received and filed
AUG 8 1944
19
(Registrar)
1
M R-301 AI Suffolk Ninthroh (County) ·BOSTON NOTIFIED 9/9/4of
Winthrop Community Hospital No.
Mary 6. (Nee Iban) lovanna
St. 1
(If deceased is a married, widowed or divorced woman, give also maiden name.) 152 Leyden St.
........
(If nonresident, give city or town and state)
years Immediate cause of death
PHYSICIAN
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 deccased, 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 hy the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
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