USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 79
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I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burlel of transit parmit was/Issued : Importebuldrer
(Signature of Agent pt Board of Health or other)
ate Dec-1/44
..... (Officiel /Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
November
28
......... 1944
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
May 15
19.30
, to
That I attended deosased from
Nov 27,.
1944
I last saw her
.allve on
Nov27
19:44, death is said to
have oocurred on the date stated above, a
7.30P
.m.
Immediate oouse of death.
Diabetic Coma
Duration 2days ··· IMPORTANT
....
15 years
Due to
Other conditions.
( Include pregnancy within 3 months of death)
Major findings :
Of operations
20000
Dete of-
Underline the cause to which death should be
Of autopsy
What test confirmed diegnosis?
Clinical Signs
charged sta. tistically.
200
......
, M. D. Date Nov 25 1944
21 .Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL.
.Dec .1. 1944
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
147 .Winthrop ... St ... ,Winthrop
19
( Registrar) X
100M-6 - 2-42-8855
extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a "U. S. War Veteran, G. L. Chap. 46. Section 10, requires physicians to insert a recital to that effeot. PARENTS
PLACE OF DEATH
1
Due to Chronic Diabetes
IMPORTANT Physician
20 Was disease or injury in/eny way related to oooupation of deosesed?
If so, spsoify
(Signed)
(Address)
...
Received and Aled.
DE0 4
1944
St.
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 attemled during his last illuesa, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnisb for registration a standard certificate of death, ststing to the best of his knowledge and belief the umine of the deceased, his supposed age, the disease of which he died. defined as re- quired by section one. wlivre same was contracied. the duration of his last illness, when laat seen alive by the physician or omcer and the date of bis death ... Geu. 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 bundred and four- teen, sligli, if the deceased, to the best of his knowledge and helief, served in the ariny, usvy or marine corps of the I'nited States in any war in which It has been engaged. insert in the certificate s 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, auch physician or officer shall forfeit ten dollars. For the purposes of thia aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bundred and fourteen, the word "war" shall inchule 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 Jtexi- can border service of nineteen hundred aud sixtcen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other 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 issue 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 ahali exhume a human body and remove it froin a town, from one cemetery to another, or from one grave or tomb other than the receiving tonib 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 sucb board, agent or clerk, as the case inay 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 physi- cian who is a member of the board of health, or employed by It or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death Is caused by violence, the medi- cal examluer ahali make such certificate. If such a permit for the removal of a human body, not previously interred, froin one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of desth made as above provided and in the possession ot the undertaker desiring to make such renioval 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 obtahued hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-øix, that the deceased served in the army, bavy or marine corps of the United States In any war In which It has been engaged. sucb recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statenient and certificate, shall forthwith countersign it and transniit It to the clerk of the town for registration. The person to whom the permit ia so given and the physician certifying the cause of death shall thereafter furnish for registration any other nece+ aary information which can be obtained as to the deceased, or as to the manner of canse of the death, which the clerk or registrar may require .- Cbap. 114. Sec. 45. G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a hunian hody or the ashes thereof which have been brought luto the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue much permita, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the inerment is made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
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 liis county the body of such a person, he shall forthwith go to the place where the Indly fies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :
(1) Attending physicians will certify to such deatha oniy aa those of persons to whom they have given bedside care during a fast illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though disshled by recogulzed disease unrelated to any form of injury. have died without recent medical attendance or whove pbyef- cian ia ahsent from home when the certificate of death is needed.
(8) Medloal Examiners will Investigate and certify to all deaths aup- posably due to Injury. These Include not only deaths caused directly or In- directly hy traumatiam (including reauiting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from diseass resulting from Injury or infeotlon 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 deathi meana the disease, or complication which causea death. not the mode of dying, e. g., heart fallure, asphyxia, asthenia, etc. Aa principal cause name the disease caualug 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 Oooupstion .- Precise statement of occupation ia very im- portant, so that the relative bealthfulness 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 dixcase 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 he returned aa at school or at hoine. For a woman wbose only occupatiou was that of honie bousework, write housework. 'For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
.
RM R-305
No.
2 FULL NAME
3 SEX
M
W
(or) WIFE of
8
AGE
56
Industry
10 or Business :
14 BIRTHPLACE OF
FATHER (City)
(State or country)
PARENTS
(State or country)
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 return of deaths recorded during the previous month which occurred in your city or town in case the deceased
11 Social Security No ..... y.O.S.
25m (h)-1-41-4667
=
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.)
Syncope while under the influence
of ether given as a surgical
anesthetic for bilateral
herniotomy; coronary sclerosis
20 Acoldent, suicide, or homicide (specify)
Accidental
Date of occurrence.
Nov. 4, 1944
Where did
Boston
injury occur ?
(City or town and State)
Did Injury occur In or about the home, on farm, In Industrial place, or In
pubilo place ?
Hospital
(Specify type of place)
Manner of
Injury
As .... above
Nature of Injury
While at work?
.Was there an autopsy?
yes
21 Was disease or injury in any way related to ocoupation of deceased?
If so, specify
(Signed)
W. J. Brickley
M. D.
(Address)
Boston
Date
11/5/644
22
Pride of Boston, Montvale
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Nov ...... 6, .... 1944
19
23 NAME OF
FUNERAL DIRECTOR
Brookline
B. F. Solomon
A TRUE COPY. Francis
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
NOV., ..... 8, ...... 1944
.19
WWWIUN
(City or town making return)
234
Peter Bent Brigham Hospi taOf death occurred in a hospital or institution. give its NAME instead of street and number) r
Louis Marden
(If deceased is a married, widowed or divorced woman, give also maiden name.)
246 River Rd.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
Hosp
years
months
3 days.
In this community
yrs.
mos.
Bays.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Nov. 4, 1944
DEATH
(Month)
(Day)
(Year)
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 51
years
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Contractor
Building
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Abraham Marden
15 MAIDEN NAME
OF MOTHER
Fannie Liberman
16 BIRTHPLACE OF
MOTHER (City)
Russia
Harry Kaufman Bro-theligyif any
17
Informant.
(Address)
PLACE OF DEATH
1
(County)
SUFFOLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Registered No.
9576
(If U. S.
War Veteran,
specify WAR)
no
(a) Residence. No.
(Usual place of abode)
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEparried
Rose Ruskin
7 IF STILLBORN, enter that faot here.
Years
Months
Days
Russia
ADDRESS
Received and filed
DEC 1 2 1944
19
(Registrar of City or Town where deceased resided)
19
(Specify whether)
1
1
1
RM R-302
PLACE OF DEATH
SUFFOLTZ PO(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Registered No.
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
27 ..... Taft ... Avenue.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
Hosp
years
months
21
days.
In this community
yrs.
mos.
21 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
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
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
AGE.
.7.4. Years.
.. 4 .... Months
8
.Days
If less than 1 day Hours .. Minutes
Usual
9 Occupation :
Carpenter.
Industry
10 or Business :
Construction
11 Social Security No .....
017-18-3351
12 BIRTHPLACE (City)
(State or country)
Yarmouth County, N. S.
13 NAME OF
FATHER
Foreman Porter
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Yarmouth County, N. S.
(State or country)
15 MAIDEN NAME
OF MOTHER
Anna LaBlano
16 BIRTHPLACE OF
MOTHER (City)
Yarmouth County, N .. ... S.
(State or country )
Relation, if any
17 Informant (Address) Ronald Porter
Son
A TRUE COPY.
J. Tan
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Nov ....... 10., .... 19.4.4 ....... 19.
18 DATE OF
DEATH
Nov. 7, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
Oct 18/44
19
to. Nov.7/44
19
I last saw h
imlive on.
NOV 7/44
19
death Is said to
have occurred on the date stated above, at
5.30 p
m.
Duration
Immediate cause of death Carcinoma gastric
3-6 mos
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
Underline the cause to
which death
Date of
should be
charged sta-
tistically.
What test confirmed diagnosis?
20 Was disease or injury in any way related to oooupatlon of deceased ?.
If so, speolfy.
(Signed)
P. Burka
M. D.
(Address)
Lahey Clinic, BostonDate 11/7/44
21 PLACE OF BURIAL, Oak Grove Cem. Medford CREMATION OR REMOVAL .. (Cemetery)
(City or Town)
DATE OF BURIAL
......
Nov. 10, 1944
19
22 NAME OF
FUNERAL DIRECTOR
F. M. Wilson Inc.
Somerville
ADDRESS
Received and filed
.D.EG -1-8-1944.
.. 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.)
50m (e)-1-41-4667
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
DOSTA
(City or town making return)
9656
235
1
(City or Town)
No.
N.E. Baptist Hospital
Stephen Porter
(If U. S.
War Veteran,
specify WAR)
no
(Specify whether)
W
Hattie M Jefferson
Of autopsy
€
ORM R-302
SUFFOLK BOSTON (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
9727236
...
( If death occurred in a hospital or institution, St. give its NAME instead of street and number)
Mary c. Casey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
29.2 .... Winthrop
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
Hosp
....
years
months
1
days.
In this community
yrs.
mos.
1 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE;
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Arthur ... Casoy
(Husband's name in full)
6 Age of husband or wife if alive 49
years
7 IF STILLBORN, enter that fact here.
8 AGE. 43 Years Months
Days
If less than 1 day
. Hours ..
Minutes
Usual
9 Occupation :
At ... homo
n
none
12 BIRTHPLACE (City)
(State or country)
Boston, Mass.
Augustus W. Norris
FATHER (City)
Halifax, N. S.
15 MAIDEN NAME
OF MOTHER
Ellen G. Lane
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston, Mass.
Relation, if any (Husband .......
A TRUE COPY.
Pr. Francis
ATTEST:
( Registrar of city or town where death ooburred)
DATE FILED
Nov 13, 1944
19
18 DATE OF
DEATH
Noy. 8 , ... 1944
(Month)
(Day)
(Year)
19
INOF.R 99/44
ERTIFY,
Not. attended deceased from
I last saw h.
er
Nov 8/44
19
to
19
....
have occurred on the date stated above, at
8,35 p.
m
Immediate cause of death.
Diabetes
Due to
Due to.
Other conditions.
(Include pregnancy within 3 months of death).
Physician
Major findings :
Of operations
.
Underline the cause to which death
Date of.
should be
charged sta-
tistically.
What test confirmed diagnosis ?
20 Was disease cr injury in any way related to occupation of deceased ?
If so, speolfy
Harry L. Fulchino
M. D.
(Signed)
(Address)
Carney .... Hosp
Date
11/8/44
21 PLACE OF BURIAL,
St. Joseph,
Boston
CREMATION OR REMOVAL
(Cemetery)
(City or Town)
DATE OF BURIAL
NOV. 11, 1944
19
22 NAME OF
FUNERAL DIRECTOR
Edwin ... S ..... Lane
ADDRESS
·Dor chester.
Reoelved and filed.
D.E.C .... 1.2 .... 1944
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
2 FULL NAME 3 SEX F Industry 10 or Business : 11 Social Security No. 13 NAME OF FATHER 14 BIRTHPLACE OF PARENTS 17 Informant (Address) Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD 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)
PLACE OF DEATH
(City or Town)
-
No.
Carmey Hospital
1
1
(a) Residence. No.
(Usual place of abode)
(If U. S.
War Veteran,
speolfy WAR)
alive on
19
death Is sald to
Duration
Of autopsy
ORM R-302
1
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
No. 158 Prospect Avenue
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Revere
(City or town making return)
Registered No.
232
.....
- (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Carrie E. Kalbfleisch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
185 Circuit Road
St.
Winthrop
(If nonresident, give city or town and State)
Length
stay: In h
ospital or Institutio
(Before death)
(Specify whether)
Conv. home
1
years
months
1 Qays.
In this community
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
November
10,
1944
(Month)
(Day)
(Year)
19 1 HEREBY CER
Oct. 8
19
to
43
Nov. 10
19
44
[ last saw h
er
alive on
Nov.
8
19 ..... 4, Heath is sald to
have occurred on the date stated above, at
6A .m.
Duration
Immediate cause of death. Myocarditis
Due to
arterio sclerosis
1 yr
Due to ...
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed).
C .F. Mahoney
M. D.
(Address) 4 Washington Ave Date 11/10944
winthrop
Everett
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ... Woodlawn ..... Cemetery.
....
DATE OF BURIAL
November 13,
(City or Town)
19
44
22 NAME OF
Chas. R. Bennison
ADDRESS
Received and filed
DEC18.1944
.19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
17
John J. Mccarthy
Relation, if any
Attorney ..... )
16 Bowdoin St. winthrop, Mass
A TRUE COPY.
feta 1
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
November 21,
19
44
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACE
White
Female
(or) WIFE of
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE
.78Years.
8
Months.
22.
Days
Industry
10 or Business :
Il Social Security No ...
12 BIRTHPLACE (City )
Chelsea
(State or country)
Mass,
14 BIRTHPLACE OF
FATHER (City)
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Germany
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-302 to the clerk
(State or country)
Germany
5 SINGLE
(write the word)
Single
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
At home
13 NAME OF
FATHER
John Kalbfleisch
15 MAIDEN NAME
OF MOTHER
Hannah Deusch
Physician
Underline the cause to which death
FUNERAL
174 Winthrop St., Winthrop
(If U. S.
War Veteran,
specify WAR)
FY ,
That I attended deoeased from
RM R-305
SUFFOLK BOSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
10133238
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
William J. Greathead
(If deceased is a married, widowed or divorced woman, give also maiden name.)
52 .Washington Ave
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
In this community 32 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
Married
Ellen J. Conklin
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If allve 63
years
If less than 1 day
Hours
Minutes
12 BIRTHPLACE (City)
(State or country)
St. John, N. B.
13 NAME OF
FATHER
James Greathead
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Mary Collins
England
17
Informant
(Address)
Relation, if any
Wife
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Nov 28 1944
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Nov. 22, 1944
(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.) Arteriosclerotic heart disease
20 Acoldent, suicide, or homicide (specify)
Date of ocourrence
19
Where did
Injury occur ?
(City or town and State)
Did injury occur In or about the home, on farm, in industrial piace, or In
publlo place?
(Specify type of place)
Manner of 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 ? no
If so, specify
(Signed)
A. R. Moritz
M. D.
(Address)
Boston
Date. 11/23,144
22
Winthrop, Winthrop, Mass.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Nov. 25, 1944
19
23 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop
Received and filed
DEC 1 & 1944
19
(Registrar of City or Town where deceased resided)
-
25m (h)-1-41-4667
PLACE OF DEATH r
(County)
1
(City or Town)
818 Harrison Ave.
(If U. S.
War Veteran,
specify WAR)
no
St.
Winthrop
(If nonresident, give city or town and State)
No.
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACE|
M
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
7 IF STILLBORN, enter that faot here.
8
AGE
73 Years
Usual
9 Occupation :
Salesman
11
12
Days
Industry
10 or Business :
Clothes
14 BIRTHPLACE OF
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
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
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