USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 72
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(If U. S.
War Veteran,
speolfy WAR)
(a) Residenoe. No.
28 Chester Ave .
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years
months
26days.
In this community
yre.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
male white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
5a if married, widowed, or divoroed
HUSBAND of
(or) WIFE of
(Hueband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
8
AGE
.2.Years
Months ...
Days
If less than 1 day Hours. ...... .Minutes
Usual
9 Oooupation :
......... poof ...... reador.
Industry 10 or Business :
11 Social Security No ............... no.ne.
12 BIRTHPLACE (City) .... Boston
(State or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Jemima Swim
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
17 M.K.MCPhillips
Relation, if any
Informant
(Addrese)
DSH
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
10/24/44
19
18 DATE OF
DEATH
Oct. 14, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, That I attended deceased from Sep ........ 1.8 ... , 19 ... 44., to ... O.c.t .............. ].4 ... ... 19 .. 4.4 .. I last saw h ..... j.m .... allve on .0.0.6 .... 1.4, 19 ...... 4 death Is said to
have occurred on the date stated above, at. 7.500 m.
Duration
Immedlate cause of death
Bronchopneumonia"prima mon 2 days
Due tarteriosclerosis .... heart ... disesso.
2 yrs
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
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 oocupation of deceased ?.
If so, specify
Abraham Gardner
(Signed)
M. D.
10/20,44
Date ..
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
(Cemeter
10/17
(City or Town)
19
44
22 NAME OF
Howard S. Reynolds
FUNERAL DIRECTOR
ADDRESS
Winthrop
Received and filed 19
(Registrar of City or Town where deceased resided)
VI VILY or Jown where. Hansard -- !!
..
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.)
PARENTS
Amaziah N. Hill
Major findings :
Of operations
Date of
(Address)
DSH
25M-(f)-11-42 10746
(County)
Registered No.
213 ...
(Usual place of abode)
(Give maiden name of wife in full)
ORM R-302
1
PLACE OF DEATH
SUFFOLK ) BOSTON
The Commontucalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or
or town making
Registered No.
9070
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
Edward E. Adams
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Bellevue Ave.
St.
Winthrop
(If nonresident, give city or town and State)
mos.
1 7days.
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct 19. 1944
(Month)
(Day)
(Year)
19 HEREBY CERTIFY,
That I attended deceased from
10/2/44
19
to
10/19/44
19
I last saw h
im
10/19/44
alive on
19.
..... , death is said to
have occurred on the date stated above, at.
8:30 ... a.
..... m.
Duration
Immediate cause of death.
Bronchopneumonia
Dey s
Due to.
Post operative
Bilateral inguinal hernia
weeks
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
Bilateral strangulated
which death
hernia
Date of.10./3/44
should be
charged sta-
tistically.
Of autopsy
What test confirmed diagnosis?
20 Was disease or Injury in any way related to ocoupation of deceased ?
If so, speolfy
(Signed)
R. W. Magwood
M. D.
(Address) .Carney .... Hosp.
Da 10/19/419
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.Winthrop Winthrop
(Cemetery)
(City or Town)
DATE OF BURIAL
October 21; 1944
19
22 NAME OF
FUNERAL DIRECTOR
R ..
C. Kirby
ADDRESS
Boston
Received and filed NOV 1 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
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
50m (e)-1-41-4667
2 FULL NAME
(a) Residenoe. No.
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
3 SEX
M
4 COLOR OR RACE|
W
(or) WIFE of
6 Age of husband or wife if alive
60
7 IF STILLBORN, enter that fact here.
8
AGE ... 63
Years.
Months.
.Days
Industry
10 or Business :
Railroad
Il Social Security No .. 023-07-1623
12 BIRTHPLACE (City)
(State or country)
Hopedale, Mass.
14 BIRTHPLACE OF
(State or country)
PARENTS
(State or country)
17
Informant.
(Address)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
13 NAME OF
FATHER
Edward S. Adams
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Mary .... E ..... Nelson
(Husband's name in full)
years
If less than 1 day .Hours. .Minutes
Usual
9 Oocupation :
Ticket agent Ret. 5 yrs.
FATHER
(City)
Block Island, R. I.
15 MAIDEN NAME
OF MOTHER
Sarah J. Eldredge
16 BIRTHPLACE OF
MOTHER (City)
Block Island, . R ..... I.
Relation, if any Wife
A TRUE COPY.
ATTEST :
(Registrar of city or town where(death occurred)
DATE FILED
Oct -23 .... 1844.
.19
Hosp ....
years
months
17
days.
In this community
yrs.
PERSONAL AND STATISTICAL PARTICULARS
(City or Town)
Carney Hospital
No.
(If U. S.
War Veteran,
speolfy WAR)
no
Underline the cause to
Due to.
RM R-302
j SUFFOLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSI'ON
(City or town making return)
216
Registered No.
9245
(If death occurred in a hospital or institution, St.
( give its NAME instead of street and number)
Albert G. Wyman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
speolfy WAR)
no
(a) Residence. No.
(Usual place of abode)
156 Washington Ave.
St.
Winthrop,Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or institution.
(Before death)
years
months
6 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
5a If married, widowed, or divorced HUSBAND of
Catherine C. Dyer
(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
84
Years
8
Months.
28 Days
If less than 1 day
Hours ......
.Minutes
Usual
9 Occupation :
Master .... Mariner.
Industry
10 or Business :
Merchant Marine
Il Social Security No ......
none
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Jerome Wyman
14 BIRTHPLACE OF
FATHER (City)
E. Boston, Mass.
15 MAIDEN NAME
OF MOTHER
Eliza March
(State or country)
Newburyport, Mass.
Hosp Records ( Relation, if any
A TRUE COPY.
ATTEST :
1. Man
(Registrar of city or towy where death occurred)
DATE FILED
Oct 30-1944
19
18 DATE OF
DEATH
Oct .... 26. .... 19.44
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Oct 21/44
19
toOct 26/44
19.
That I attended deceased from
... i.m ..... alive on Oct 26 /44
19
death Is said to
have occurred on the date stated above, at.
1.20 a
.m.
Duration
Immediate cause of death. Pyelonephritis bilateral chronic acute flareux
y ...
Due to .. Generalized ... arteriosclerosis
.yr.s
Hypertrophy .... benign .... prostate
.. yr.s.
Due to .. Cystitis ... chronio.
y.r.s.
Bronchitis
y.r.s.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
Date of
should be
charged sta-
tistically.
What test confirmed diagnosis?
Clinical
20 Was disease or injury in any way related to oooupation of deceased ?.... O
If so, specify
A. J. Lund
(Signed)
(Address)
U.S. Marine Hosp
Data 0/26/44
M. D.
21 PLACE OF BURIAL,
Winthrop Cem. Winthrop
CREMATION OR REMOVAL
DATE OF BURIAL
Oct(Cezgery 1944
19
(City or Town)
22 NAME OF
Horace A. Wile
FUNERAL DIRECTOR
ADDRESS
Lowe 11
Received and filed NOV TO 19:14
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
2 FULL NAME
3 SEX
M
(or) WIFE of
AGE
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
17
Informant
(Address)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
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
(State or country)
-
No.
PLACE OF DEATH 1
(City or Town)
U. S. Marine Hosp
(Specify whether)
1
Underline the cause to
which death
Of autopsy
ORM R-302
3 SEX
(or) WIFE of
10 or Business :
11 Social Security No.
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.)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
(State or country)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
4 COLOR OR RACE| 5 SINGLE
Female
White
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced
HUSBAND 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
53
3
AGE.
Years
Months
Days
11
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Waitress
Industry
Restaurant
12 BIRTHPLACE (City)
(State or country)
new work
13 NAME OF
FATHER
John Adolphos
ocnoonta
N.Y.
Anna Gibson
Kartright
N.Y.
Lome a COTafelation, if any
A TRUE COPY.
Emil 8. Bergeron
ATTEST :
(Registrar of city or town where (death occurred)
DATE FILED
11/8/44
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October 51, 1914
(Month)
(Day)
(Year)
195 HEREBY CERTIPY,
attended deceased
from
I last saw h
Callve on.
Nct. 01.
.14
9
death Is sald to
have occurred on the date stated above, at
5:20
m
Duration
Immediate cause of death Carcinomatosis
frimary of ovaries
2 yrs
Due to
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findIngs:
Of operations
Carcer
Date of
3/3/12
Of autopsy
What test confirmed diagnosis?
20 Was disease or Injury in any way related to oooupation of deceased ?...
If so, specify
(Signed).
Joooch G. Hormon
M. D.
(Address)
21 PLACE OF/BURIAL
New York
CREMATION OR REMOVAL
DATE OF BURIAL
„(Cemetery), lov.
(City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
000
prin; st., Fall river
D.D. Sullivan &
ons
ADDRESS
Received and filed.
NUV
19
1
PLACE OF DEATH
Bristol (County) Fall River
The Commontucalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Fall river
(City or town making return)
Registered No.
212
No. Rose Hawthorne Latimon Home
2 FULL NAME
Mildred M. Branndow
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
10 Revore
St.
Winthrop
ass
(Usual place of abode)
Home
years
1
months
18
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
50m (e)-1-41-4667
WOMANEITI RECORD
(City or Town)
¿ (If death occurred in a hospital or institution,
St.
{ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
(If nonresident, give city or town and State)
That
19
.- to
19
Underline the cause to which death should be charged sta- tistically.
tcroscopic
1
registrar of City or Town where, den
1 3 SEX m (or) WIFE of. 8 Usual 9 Occupation : PARENTS information should be carefully supplied. AGE should be stated LAAciLl. FRIDICIAND should state Industry 10 or Business: 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
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mu-X. Childelff
(Signature of Agent of Board of Health or other) Health Which
11/4/44
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
nov
2
(Month)
(Day)
1944 (Year)
19
I HEREBY CERTIFY.
That I attended deceased from
19.2 ... %, to ..
2002
19«Y
I last saw h ............ alive on nen 2, 1944, death is said to have occurred on the date stated above, at .... 4:03 P m.
Immediate cause of death.
Duration IMPORTANT
aprilia nestaloum
Due to.
Cerebral : Quonia
Due to.
Pelapary atractiva
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT PHYSICIAN
Major findings: Of operations.
Underline the cause to which death
Of autopsy.
Congenital Precisa
should be charged sta- What test confirmed diagnosis ?.
tlstically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
(Signed)
Donald Porto
...
J Central 59,31 Date 11/3 194/11 (Address) ..
21 ..........
It- Mutuals
Place of Burial, Cremation or Removal. (City or Town) DATE OF BURIAL A pocaber 6
22 NAME OF Fancy Dillettro
FUNERAL DIRECTOR ......... ADDRESS 2016Marie tte Sa
Received and filed NOV / 1944
.19
(Registrar)
L
ALTIFIED
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
218.
2 FULL NAME.
Baby Boy Polimeno
(If deceased is a married widowed or divorced woman, give also maiden name.)
(a) Residence. No. 1 75 Chenton (Usual place of abode) Length of stay: In hospital or institution.
years
months
/
days.
4%
Av.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
(write,the word)
MARRIED
Single
or DIVORCED
5a If married, widowed, or divorced HUSBAND 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.
AGE Years. Months
Days
If less than 1 day Hours. Minutes
11 Social Security No ..
12 BIRTHPLACE (City) there Miatt (State or country)
13 NAME OF
FATHER
Matteo Polimento
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Sena Amato
16 BIRTHPLACE OF MOTHER (City) ....... (State or country}
Laurence mass
į17 Matteo Polemicas
. Relation, if any
Date of ff,., ..........
....
..
M. D.
Informany. (Address) 175 Curent ....
R-301 A Suffolk 12/4/42 (County) Northrop (City of Town) inthing Community Hoffutol PLACE OF DEATH
St.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
.St.
(If nonresident, give city or town and state)
120 1
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 hest of his knowledge and helief the name of the deceased, his supposed age. the disease of which he died, definded as required hy 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.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which haa not heen huried, until he has received a permit from the hoard 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 human hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv- ing tomh 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 hody is huried. No such permit shall he issued until there shall have been delivered to such hoard, agent or clerk, as the case may he. a satisfactory written statement containing the facts required hy law to he returned and recorded, which shall he accompanied, in case of an original interment, hy 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 he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 removal shall constitute a permit for such removal; provided, that such hody shall he 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 re- moval of such hody has heen sooner obtained hereunder. If the death certificate contains a recital, as required hy 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 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 necessary information which can he ohtained 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 hury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the hoard 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 he huried 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. . . . 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 have given hedside 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 disahled hy recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid 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 he 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 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, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write nonc.
SPACE FOR ADDITIONAL INFORMATION
I A
1
1
Suffolk (County) Winthrop (City or Town) PLACE OF DEATH No. 122 Washington Ave. almira
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for barial permit with Board of Health or its Agent.
Registrar's No.
219
2 FULL NAME. Hattie Alma (Call) Morrison
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
122 Washington Ave.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community
40Is.
ICOS.
days.
PERSONAL AND STATISTICAL PARTICULARS
13 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in fuil)
(or) WIFE of
Walter W Morrison
(Husband's name in full)
6 Age of husband or wife if alive. 86
years
7 IF STILLBORN, enter that fact here.
8 86 9 15
AGE
Years.
Months.
Days
If less than 1 day
Hours ....
Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business:
At Home
11 Social Security No. None
12 BIRTHPLACE (City)
Augusta
(State or country)
Maine
13 NAME OF
FATHER
Otia Call
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
Dresden
15 MAIDEN NAME
OF MOTHER
Harriet Pichon
16 BIRTHPLACE OF
MOTHER (City)
Pishon
(State or country)
Maine
17 Walter W Morrison Relation, if any
Husband
Informant (Address) 122 Washington Ave, Winthrop
was filed with me BEFORE the burial of transit permit was issued: I HEREBY CERTIFY that a satisfactory standard certificate of death Nau-D' Couldreyes
(Signature of Agent of Board of Health or other) Health cer 11/6/48 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
nor
3
1944
(Year)
(Month)
(Day)
19 I HEREBY CERTIFY,
nori
19
That I attended deceased from
to
nor
3
19
44
I last saw her
Lalive on.
hor 3
19 44, death is said to
have occurred on the date stated above, at. 10.35 AM.
Immediate cause of death Broncho pneumonia (Terminal)
Duration IMPORTANT 4 days
gras
Due to.
Senility
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
-
Of autopsy.
What test confirmed diagnosis?
Clinical
IMPORTANT Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
M. D.
(Signed) Guichard Mihaly
(Address) 148 WintherSt
Date Che & 194/4
21 .
Woodlawn Crematory
Everett
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Nov. 6,
1944
22 NAME OF
FUNERAL DIRECTOR
Leward Streynolds
ADDRESS
Received and filed_
NOV
1344
19
(Registrar)
50ml-(e)-3-43-11574
If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physicians to insert a recital to that effect. Correcturo dy
Howard S Payroll 1/16/45
PARENTS
Perry
Due to myocarditis chimie
St.
S (If death occurred in a hospital or institution,
¿ give its NAME instead of street and number)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
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 beliei 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 secn alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
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