USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 76
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extracts from the laws relative to the return of certificates of death.
so that it may be properly classified under the International Classification of Causes of Death. See reverse side for
50m (g)-1-41-4667
PARENTS
Relation, if any
(City or Town) No. en rarite to Winthisop. Community Hoop S.
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 registersd hospital medloal offioer 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. 16, Sec. 9.
A physician or offieer furnishing a certificate of death as required by the preceding seetion or by section forty-tive 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, specl- 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 offieer shall 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 ex- pedition and the Philippine Insurrection, which shall, for said purposes, be deemed to have taken place between 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 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 la no such board, from the clerk of the town where the person dled; 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 receiving tomb to another in the same cemetery, until he has recelved a permit from the board of health or its agent aforesald or froin the clerk of the town where the body Is buried. No such perinit shall be Issued until there sball have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the faets required by law to he returned and recorded, which shall be accompanied, In case of an original interment, by a satisfactory certificate of the attending physiclan, 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 hoard of health, or employed by it or by the selectinen for the purpose, shall upon application make the certificate re- quired of the attemling physician. If death is caused by violence, the medieal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as ahove provided and in the pos- session 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 re- moval, 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 section ten of chapter forty-six, that the deceased served in the army, nave 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 regis- tration. The person to whom the permit is so given and the physician cer- tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the decraand, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- 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 sueh permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral ia to be held, or front a per- son appointed to have the care of the cemetery or burial ground in which the internient is made. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and mauner of death .- General Laws, Chap. 38, Sec. 7.
. The medical examiner certifies the cause and manner of death to the . . best of bis knowledge and belief.
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 discase unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any forın of Injury, have died without recent inedical attendance or whose pliyal- cian is absent from home when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably dus to Injury. These include not only deaths caused directly or In- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths fron dissase resulting from Injury or Infactlon related to occupation, the sudden deaths of persons not disabled by rscognizsd disease, and those of persons found dsad.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause, the nature of an Injury and of Its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal Injury sus- tained under circumstances unknown."
If discase or injury was related to occupation, specify. If Investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circuin- stances leading to medico-legal inquiry. For example: "Hemorrhage spun- taneous of the brain (basal ganglia ) (found dead in bed)." "lleart disease, presumably coronary sclerosis. (Sudden death. )"
DESCRIPTION (for unknown person)
NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.
THIS CERTIFICATE CONSTITUTES SUCH PERMIT
1
M R-302
SUFFOLK
(County)
1
(C'ity or Town)
Beth Israel hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
OUSiUN (City or town making return)
Registered No.
870
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
Harry Flaughaum
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Winthrop Arms Hotel St.
(a) Residence. No.
(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
34 days.
In this community
yrs.
mos.
34
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct 10/45
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
9.7 45
19
That I attended deceased from
to
Oct .... 10/45
19
I last saw h.i.m ........ alive on .. Oct .... 10/45
19 ........ , death Is sald to
have occurred on the date stated above, at.
6:55a
Duration
Immedlate cause of death Heaptic Insufficiency
Due to
Carcinomatosis
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Carcinomatosis
9/11/45
Date of
Physician 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, speolfy
no
(Signed)
L ... Persky.
M. D.
(Address)
Boston
Date
10/10/45.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Shara Tfilo
Mt Leb
DATE OF BURIAL
(Cemetery)
Oct 11/4sty or Town)
19
22 NAME OF
FUNERAL DIRECTOR
Benjamin F Solomon
ADDRESS
Brookline ... Mas ..
Reoelved and filed
.....
19
( Registrar of City or Town where deceased resided)
25 M-(f)-11-12 10746
2 FULL NAME
3 SEX
Male
(or) WIFE of
Usual
9 Oooupation :
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
PARENTS
16 BIRTHPLACE OF
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 TCLOTHS OF GENIUS SCEICCO QUITE, HIE FIctives Hvata waits octalice in your City of Low III Case LIG accessed
(State or country)
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or dlvoroed
HUSBAND of
(Give maiden name of wife in full)
(Hueband's name in full)
6 Age of husband or wife if alive 56 years
7 IF STILLBORN, enter that faot here.
8 57 Years Months
If less than 1 day
Hours
.Minutes
Salesman
Industry
10 or Business :
... REal Estate
Russia
13 NAME OF
FATHER
Morris Flangbaum
FATHER (City)
Russia
15 MAIDEN NAME
OF MOTHER
Rachel Resnick
Russia
Son
(
Relation, if any
A TRUE COPY
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Oct 15/45
19
PLACE OF DEATH
No.
(If U. S.
War Veteran,
specify WAR)
Winthrop
White
Alice Elpert
Days
=
M R-302
SUFFOLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
SUSION
(City or town making return)
Registered No.
8756226
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Sarah C Riley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
100 Summit Ave
St.
Winthrop ... Mas.s.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
monthes
days.
In this community
yrs.
mos.
1
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married,
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Den ffivs mideR page of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive 53 years
7 IF STILLBORN, enter that faot here.
8
56
AGE
Years.
Months.
Days
If less than 1 day Hours ..... Minutes
Usual
9 Occupation :
Housework
Industry
10 or Business :
At ... home
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
Patrick Collins
PARENTS
14 BIRTHPLACE OF
FATHER (City)
...
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Catherine Kelley
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Reiation, if any
17
Informant
(Address)
Husband ( .
A TRUE COPY.
ATTEST :
( Registrat of city ortowa where death occurred)
Oct 15/45
19
I HEREBY CERTIFY,
Oct.9/45,
19
to Oct 10/45
19
That I attended deceased from
I last saw h .... @r ...... alive ofc.t .... 10. 45.
19
desth is sald to
have occurred on the date stated above, at
4, 30
P
.m.
Duration
Immediate cause of death Cerebral hemorrhage
1 dy
Due to Cerebral arteriosclerosis
25yrs
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?
Lumbar .... puncture
20 Was disease or injury in any way related to oooupstion of deceased ?.
If so, specify.
no
(Signed)
L ... Weinstein
M. D.
(Address)
Boston
010/10/459
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross
Madlen
( Cemetery)
(City or Town)
DATE OF BURIAL
Oct 13/45
19
22 NAME OF
FUNERAL DIRECTOR
JF Ward
ADDRESS
Everett.Mass.
Received and filed 19
(Registrar of City of Town where deceased resided )
25M-10)-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.)
PLACE OF DEATH
(County)
1
(C'ity or Town)
No.
Mass. Memorial Hospital
DATE FILED
18 DATE OF
DEATH
Oct 10/45
(Month)
(Day)
(Year)
Female White
(If U. S.
War Veteran,
speolfy WAR)
I R-302
SUFFOLK
The Commontocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
881223
( If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
Brn jamin Ziegler
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
speolfy WAR)
(a) Residence. No.
(Usual place of abode)
26 .... CoralSt
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay : In hospital or institution.
(Before death)
(Specify whether)
years 2 - months days.
In this community
yrs.
2
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
Widower
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Oct 10/45
19
That I attended deceased from
Oct 14/45
19
I last saw h
imalive on
Q.c.t ... 14. 4519
death is said to
(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 ... 89 .... Years. Months. Days
If less than 1 day Hours .Minutes
Usual
9 Occupation :
Retired Salesman
Industry
10 or Business :
Poultry
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Abraham MZiegler
14 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
15 MAIDEN NAME
OF MOTHER
Bala
If so, speolfy
(Signed)
B ... A ... Udelson
M. D.
(Address)
Boston.
Date.10/14 /5
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Chevra Torah
Everett
¿ or Town) DATE OF BURIAL
(Cemetery )
Oct 15/45
19
17
Informant
(Address)
Alice ... Phillips ...... daughter.
Relation, if any
26 Carol Ave. Winthrop
A TRUE COPY.
ATTEST :
.........
(Registrar of city or town where death occurred)
DATE FILED
Oot 17/45
19
22 NAME OF
FUNERAL DIRECTOR
H J Torf
ADDRESS
Chelsea ... Mass.
Received and filed
19
(Registrar of City or Town where deceased resided)
25M.(f)-11-12 10746
PLACE OF DEATH
(County)
1
(C'ity or Town)
-
No.
Hebrew Aged Home
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
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
Underline the cause to which death should he charged sta- tistically.
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?.
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Russia
18 DATE OF
DEATH
Oct 14/45
5a If married, widowed, or divorced HUSBAND of
Nellie .... Palais
(Give maiden name of wife in full)
have occurred on the date stated above, at
6.p
m.
Duration
Immedlate oause of death
Bronchopneumonia.
10/14/45
Due to.
Cerebralhemorrhage
10/10/45
? ?
Due to.
Arteriosclerosis
to
R-302
of the city or town in which the deceased resided. (See Chap. 16, Sec. 12, G. L.)
15M-(f)-11-42 10746
PLACE OF DEATH r
-(County)
(City or Town)
No. 534 Mass. Ave.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
8953 68
(If death occurred in a hospital or inetitution, St . {it death give its NAME instead of street and number)
2 FULL NAME
Daniel A. Hazen
(If deceased ie a married, widowed or divorced woman, give aleo maiden name.)
(a) Residence. No.
46 Bates Ave
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospltai or Institution ..... Home
(Before death)
(Specify whether)
years
monthe
1Olaye.
In this community
yrs.
mos.
10 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widower
a If married, widowed, o
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 faot here.
8
AGE ..
78 Years.
3 Months
2 3ayı
If less than 1 day Hours Minutes
Usual
9 Oooupation :
Retired
Industry
10 or Business :
Hazen Mills
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
... Boston Mass ...
13 NAME OF
FATHER
Daniel A.
PARENTS
14 BIRTHPLACE OF
Boston Mass.
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Flora Morrison
If so, specify,
(Signed)
Dominic Prika
M. D.
(Address) ... Boston
Date 10/17 19 45
17
Informant
( Address)
Hubert .... F ...... Hazen
Relation, if any
DATE OF BURIAL
Oct .. .. 20.,
1945
A TRUE COPY.
ATTEST :
Oct. 22, 1945
(Registrar of city or town 'where death occurred)
DATE FILED
19
22 NAME OF
FUNERAL DIRECTOR
J.S ...... Waterman .... &Sons
ADDRESS
Boston .... Ma.s.s.
Received and filed
JAN 7 1945
.19
(Registrar of City or Town where deceased resided)
sald to
have occurred on the date stated above, at
8:30₽
Duration
Immedlate cause of death.
Carcinoma
1 yr
Due to.
Metastatic .... Epidermoid
Due to.
Carcinoma of Neck
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
which death
Date of
should be
charged sta- tietically.
Of autopsy.
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to oocupation of deceased ?.
16 BIRTHPLACE OF
MOTHER (City)
Scotland
(State or country)
18 DATE OF
DEATH
Oct. 17,
1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
traian M. MacPhay
Oct
19.
45, to.
Oct.
.. 17
1945
I last saw h ....
Im alive on
Oct ...
1.7 ..
, 19 45
(If U. S.
War Veteran,
WW I
spoolfy WAR)
(Usual place of abode)
TBOSTON
1
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Forest Hills Ce, Boston
(Cemetery )
(City of Town)
Underline the cause to
R-302
SUFFOLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
1
PLACE OF DEATH -
County)
(City or Town)
No.
Mass. General Hospital
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
John Knight
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Cottage Park Yacht Club
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
40
years
months
day B.
In this community 40 yr8.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Jale
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Wid owed
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
8
AGE 58
Years
Months
Days
If less than 1 day
Hours.
.Minutos
Usual
9 Occupation :
Teacher
Industry
10 or Business :
Charlestown ... High ... School
11 Sooiai Seourity No ...
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
William S Knight
PARENTS
14 BIRTHPLACE OF
FATHER (City)
PE .... I.
(State or country)
15 MAIDEN NAME
OF MOTHER
Laura Owen
16 BIRTHPLACE OF
MOTHER (City)
PEI
(State or country)
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ...
Woodlawn
Everett
(Cemetery)
(City or Town)
DATE OF BURIAL
Oot .... 25/45
19
22 NAME OF
FUNERAL DIRECTOR
M Kirby
ADDRESS
Winthrop Mass
Reoelved and fied.
.19
(Registrar of City or Town where deceased resided)
50m. (b) .6.44-14607
A TRUE COPY! Thomas F. Micready
ATTEST :
(Registrar of city or town wbere death occurred)
DATE FILED
Oot 25/45.
19
18 DATE OF
DEATH
Oct 22/45
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
10/20/45.,
10/22/45
19
That i attended deceased from
i last saw h ...... i.m .... allve on.
10/22.45.
19
death Is sald to
have ocourred on the date stated above, at ..
8,22 .... 8
.. m.
Duration
Immediate oause of death
Coronary .... o.cc.lusi.on
5 mins
Due to.
Coronary ... arteriosclerosis
4 mos
Due to
Other conditions
(Include pregnancy within 3 months of death)
General ... arteriosclerosis
Physician
y ERderline the cause to
Major findings :
Of operations
Date of.
which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis?
autopsy
20 Was disease or injury In any way related to oooupation of deceased ?
If so, specify
(Signed)
C .Clay
M. D.
(Address)
Boston
D10/ 22/46
17
Informant
(Address)
Son
(
Relation, if any
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
Registered No.
9066
(If U. S.
War Veteran,
spoolfy WAR)
229.
X
Florence Duane
25m (h)-1-41-4667
A TRUE COPY.
ATTEST :
(Registrar of childis towhy they demeurant
DATE FILED Thomas T! !!
Oct 26/45
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct .... 22/45
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that 1 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.) Bronchopneumonia Cerebral thrombosis Recent fracture right femur
20 Accident, sulolde, or homlolde (specify)
Accidental
Date of ocourrence
Sept.1/45
19
Where did
Wonthrop
Injury ooour ?
(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
Fell accidentally at her home
Injury
Nature of
On Sept 1/45
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)
W J. Brickley
(Address)
Boston ... Mass
Date .. 10/22/95
22 Winthrop Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Oct 25/45
19
23 NAME OF
FUNERAL DIRECTOR
M S Caggiano
ADDRESS
Boston ... Mass.
Received and filed
19
(Registrar of City or Town where deceased resided)
X
I R-305 +
SUFFOLK
PLACE OF DEATH
(County) ... BOSTON
(City or Town)
No. Mass. General Hospital
St.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
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