USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 80
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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
11 Social Security No ... 030-01-6823
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
ORM R-302
2 FULL NAME
(Usual place of abode)
3 SEX
Female
4 COLOR OR RACE|
White
5a If married, widowed, or divorced
HUSBAND of
7 IF STILLBORN, enter that fact here.
AGE.86
Years
Months
Days
Usual
9 Occupation :
Housewife
At home
11 Social Security No ..
None
12 BIRTHPLACE (City)
(State or country)
England
14 BIRTHPLACE OF
FATHER (City)
PARENTS
of the city or town in which the deceased resided. (Sce 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)
England
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
6 Age of husband or wife if alive years
If less than 1 day Hours. Minutes
13 NAME OF
FATHER
George Maris
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
17 Inform Marie H. Terrille
Relation, if any
(Friend-
(Address) 44 Quincy Ave Winthrop
A/TRUE COPY.
Preta M. Dishop
ATTEST .
(Registrar of city or town where death occurred)
December 8,
19
44
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
November
30 1944
(Month)
(Day)
(Year)
19 | HEREBY
CERTIFY,
That I attended deceased from
April 15
19
44
to
Nov. 30
19.
44
I last saw h.e.r.
alive on
Nov ...
28
19 ... 44 death Is sald to
have occurred on the date stated above, at
3:30 P.
m.
Duration
Immediate cause of death
Myocarditis
8 .... mos.
arterio sclerosis
8.mos
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
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify.
M. D.
(Signed)
C. F .Mahoney
(Address AWashingtonwtMehrdp
12/1 19 44
21 PLACE OF BURIAL,
CREMATION OR REMOVALOak Grove
Medford
DATE OF BURIAL
December 2,
(City or Town)
19.
44
22 NAME OF
FUNERAL DIRECTOR
Chas ...... R ...... Bennison
ADDRESS
Winthrop, .... Ma.s.s.
Received and filed
DEC-1-8-1944
19
(Registrar of City or Town where deceased resided)
1
PLACE OF DEATH
Suffolk (County)
Revere (City or Town)
No. Wheaton Home, 214 Endicott Avenue
The Commontucalthy of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Revere
(City or town making return)
Registered No.
239
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
Sophia Lewis (Maris)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
54 Quincy Avenue
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution onv. home
yeare
6
months
days.
In this community
yTS.
mos.
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
(or) WIFE of
Frank Inomas Lewis
(Husband's name in full)
idemname of wife in
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 Industry 10 or Business :
50m (e)-1-41-4667
DATE FILED
(If U. S.
War Veteran,
specify WAR)
R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recitai to that effeot. extracts from the laws on back of certificate. ville; W test tettey ve property siesslied. aast statement et decorAtion is very important. See instructions and PARENTS
100M-6 -2-42-8855
i HEREBY CERTIFY that a satisfactory standard certificate of death was flied with me BEFORE the burial or transit permit was Issued : Www.D. Children (Signature of Agent of Board of Health or other)
Heatil Officer 1/2/5/44 (Oficial Designation) (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
3 SEX
7 male
4 COLOR OR RACE
While
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
manuel
5a If married, widowed, or divorced
HUSBAND of
...
(or) WIFE of
Te (Give maiden name of wife in full)
( Husband's name in fuli)
6 Age of husband or wife if alive
> IF STILLBORN, enter that fact here.
8
AGE
75
ears
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
10 or Business :
Industry
at Home
11 Social Security No.
12 BIRTHPLACE (City)
(Siate or country)
manos
13 NAME OF
FATHER
storing
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Steeland
15 MAIDEN NAME
OF MOTHER
may.
20 Was disease or injury in any way related to occupation of deceased ? to
if so, specify .....
Jern. H .Schwartz
('Signed)
8 Aquellos St 213 Date 12/20
(Address)
M. D.
19
21
Piace of Buriai, Crewation or Removai.
DATE OF BURIAL
19.
(City or Town)
22 NAME OF
FUNERAL DIRECTOR ....
ADDRESS
Received and Aled.
DE0-7 --- - 1944
19
( Registrar)
1
...
(City or, Town) Winthrop Comments No.
The Commontoralil 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. 240 ....
Registered No. S ( If death occurred in a hospital or institution, St. [ give its NAME Instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased is a married,) widowed or divorced" woman, give also maiden_ _ name.)
(a) Residence. No.
2
Swan Cf
(Usumi piace of abode)
(It nonresident, give city or town and State)
Length of stay: In hospital or Institution 2/2
(Before death)
(Specify whether)
......
yeare
1
months
21
days.
in this community yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
har. 7
1944
Dec.20
19.
That I attended deceased from
xx
i last saw
Er
alive on.
Die- 2, 19%, death Is said to
have occurred on the date stated abova, at
1 9, m.
years
Immedlate oause of death
Denli Tulum Edenca
Due to
Chimie tivalites
6 .....
...
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
Of autopsy
What test confirmed diagnosis?
Duration
............
IMPORTANT
-
Physician Underiino the cause to which death shouldi bo charged st&- tistically,
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Shock & Kelle Relation, if any
Informant ( Address )
PLACE OF DEATH
(County) Winthrop man
staples
Studia Stelly
(Was deceased a
U. S. War Veteran,
if so spoolfy WAR)
1944
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 an undertaker or other authorizeil person or of ans meniber of the family of the deceased, furnish for registration a standard certidcate of desth, stating to the best of his knowlexige and belief the name of the deceased, l,is 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 seen slive by the physician or officer and the date of his death ... Ceu. Laws, Chiap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceiling 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 I'nited States in aus war in which it has been engaged. insert in the certificate a recital to that effect, speci- fying the war, and shail also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the ssine. For neglect to comply with any provision of this section, auch physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty five, forty-six and forty-zeven of said chapter one humired and fourteen, the word "war" shall inchide the Chius relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetwcen 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 hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undortaker 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 froin a town. from one cenietery to another, og from one grave or tomb other than the receiving tomb to another in the same cemetery, ustil e has received a permit from the board of health or its agent aforesald or from the clerk of the town. where the boily is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay be, a satisfactory written statement containing the facts required by law to be returtied and recorded, which shall be accompanied, in case of an original internient, by a satisfactory certificate of the attending physician, if any, as required by law, o1 in lieu thereof a certificate as liereinafter provided. If there ia 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 selectinen for the purpose, shall upon application niake the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner shall make such certificate. If such a permit for the remoral of a liumsu boily, not previously interred, from one town to another will the conunouwealth cannot be obtained early enough for the purpose, the certificate of desih made as above provided aud in the possession ot the undertaker desiring to make such removal alisll 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 hody has been 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 ['nited States In sny 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 urce+ sary information which can be obtained as to the deceased. or us to the manner or cause 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 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 hoard of heaith or its sgent appointed to issue such perinits, or if there is no such hoard, from the clerk of the town where the boily 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 grouml in which the internieut is made. ... Cbap. 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 hody of such a person, he shall forthwith go to the place where the luxly liea 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 rules of practice :
(1) Attending physicians will certify to such deatha only aa 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 physiolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attemlance or whose phyel- cian is absent from home when the certificate of death is needed.
(3) MediosI Examiners will Investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (Including resulting septicemia), and hy the action of clientical (drugs or poisons), therinal, or electrical agents, ainl deaths following abortion, but also deaths from disessa resulting from injury or Infeotion reiated 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 meana the disease, or complication which causes death, not the mode of dying, e. g., hrart failure, asphyxia, asthenia, etc. Aa principal cause name the disease causing death. Au related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Oooupatlon .- Precise statement of occupation la very 1m- portant, so that the relative healthfulness of various pursuits call 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 ou account of the discase 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 hoine. For a woman whose only occupation waa that of honie housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, aa housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-302
1
PLACE OF DEATH
Berkshire
(County)
North Adams
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
North Adams
(City or town making return)
Registered No.
241
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
(Infant Son) Drury Breed Sayre
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
105 Triton Ave.
.......
Winthrop, Mass
(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
yT8.
mos.
days.
-
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
X
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
19
to
19
I last saw h ..
.allve on
19.
have occurred on the date stated above, at.
11.00 P
.. m.
Duration
Immedlate cause of death
still born
Due to.
Miscarriage produced by
attending Physician because
Due to ....
of Pernicious vomiting
and Insane Period of Mother
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
Of autopsy
What test confirmed dlagnosis ?
20 Was diseass or injury in any way related to oocupation of deceased ?.
If so, specify ..
Wm A Nelson
(Signed)
Williamstown , Massat.
Dec . 29
44
M. D.
(Address)
21 PLACE OF BURIAL, C'estlawn Centy &mstown Mass
CREMATION OR REMOVAL
(Cemetery}
Dec. 6
(City or Town)
19 44
DATE OF BURIAL
22 NAME OF
Frank B.
McBride, for
FUNERAL DIRECTOR
Geo M. Hopkins Co.
ADDRESS
68 Spring St Williamstown, Mass.
Received and filed 19
-
(Registrar of City or Town where deceased resided)
1
Underline the cause to which death should be charged sta- istically.
14 BIRTHPLACE OF
Brooklyn
FATHER (City)
(State or country)
New York
15 MAIDEN NAME
OF MOTHER
Ruth Shaw Breed
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
17 Davis Austin Sayre
Relation, if any
Informant
(Address)
Winthrop Mass
A TRUE COPY.
ATTEST :
allt& Filler
(Registrar of city or town where death occurred)
DATE FILED
Dec. 8, ,1944
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec
3
1944
5a If married, widowed, or divorced
X
HUSBAND of
(Give maiden name of wife in full)
X
(or) WIFE of
(Husband's name in full)
6 Ags of husband or wife If alive X
years
7 IF STILLBORN, anter that faot høre.
Stillborn
8
AGE
Years
.Months.
.Days
If less than 1 day
Hours.
Minutes
Usual
9 Oooupation :
none
Industry
10 or Business :
none
11 Social Security No. none
12 BIRTHPLACE (City)
(State or country)
North Adams, Mass.
13 NAME OF
FATHER
David Austin Sayre
PARENTS
25M-(f)-11-42 10746
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.)
No.
(C'ity or Town)
North Adams Hospital
St.
(If U. S.
War Veteran,
speolfy WAR)
no
That I attended deceased from
......
death Is sald to
North Adams Hospital
Williamstown
.
R-301 A
1
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.
242
2 FULL NAME
Mary Anderson (Creases) Ellis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
117 Buchanan St Winthropst.
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution
-
(Specify whether)
years
months
days.
(If nonresident, give city or town and state)
In this community 30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
Lehite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of.
(Give maiden name of wife in full)
George Harvey Elles
(Husband's name in full)
6 Age of husband or wife if alive .. 58 -
years
7 IF STILLBORN, enter that fact here.
8
AGE ...
59 Years
6 Months.
11
Days
If less than 1 day Hours. Minutes
Usual
9 Occupation :
at home
Industry
10 or Business:
11 Social Security No ...
12 BIRTHPLACE (City).
(State or country)
Scotland
13 NAME OF
FATHER
John Creaser
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
PARENTS
15 MAIDEN NAME
OF MOTHER
Margaret Sinclair
16 BIRTHPLACE OF
MOTHER (City).
(State or country)
Scotland
.17 Hevige H. Ellis
Relation, if any (hwhard)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: W Mix Childress
Signature, of Ag.it >> Board of Health or other)
Healthe Officer 12/11/44
(Official Designation) (Date of Issue of Permit)
11
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
December 8
1944
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
19
to
19
I last saw h .............. alive on
have occurred on the date stated above, at ... Immediate cause of death
m.
Duration IMPORTANT
Due to.
......
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)
(Addres
tento Datel
21.
Nustros
Place of Burial, Cremation or Removal.
(City or Town) Cometiny
DATE OF BURIAL Dec 11
Winthrop, 1944
22 NAME OF
FUNERAL DIRECTOR
Char. R. Bennison
ADDRESS.
Winther of 7 Hass
Received and filed
19
1
(Registrar)
100m-2-'40-D-729-a
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 certificato.
Underline the cause to which death should be charged sta- tistically.
M. D.
Informant
(Address)
No ...
117 Buchanan 8 Finalement St.
§ (If death occurred in a hospital or institution,
{ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
19
death is said to
That I attended deceased from
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 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 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 facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is 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 the 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 within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has 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 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 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 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 have given bedside care during a last illness from disease unrelated to any form of injury.
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