USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 85
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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.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or 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.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any forum of injury, have died without recent medical attendance or whose phy- sician is absent from home wben the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly 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 from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- 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 morbid conditions, if any, related to the principal canse and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation by the appropriate terms, as housekeeper -- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
RM R-302
PLACE OF DEATH
(County)
(City or Town)
No.
Infants Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
254
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
97 Summit ave
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: in hospital or institution.
(Before death)
....
years
months
9 days.
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
D.e.c .... 6./.45.
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
11/27/45
19.
to ... 12/6/4.5
19
That I attended deceased from
I last saw h ...... j.m ... alive on.
12.1.6. 45
19
.... , death is sald to
have ocourred on the date stated above, at
4 .;. 15.p.m.
Duration
immediate cause of death Atelectasis
15 dys
GastroEnteritis
15 dys
Due to.
Prematurity
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- tlstically.
Of autopsy ...... a.8.above
What test confirmed diagnosis ?
20 Was disease or Injury in any way related to oooupation of deceased ?.
If so, speolfy
s-W-Wright
(Signed)
Boston Mass
(Address)
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery )
(City or Town)
DATE OF BURIAL
Dec .... 8/45
19
22 NAME OF
FUNERAL DIRECTOR
Reynolds Funeral Home
ADDRESS
.Winthrop ....... Mass.
Received and filled JAN 22 1946 19
(Registrar of City or Town where deceased resided)
Date
12/6/459
M. D.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Quincy Mass.
Stewart .E .Jackson ( Relation, If any
A TRUE COPY. ATTEST :
(Registrar of city or town where death occurred)
19
DATE FILED 0 Dec 10/45
5 SINGLE
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 allve years
7 IF STILLBORN, enter that faot here.
8
AGE
Years.
Months .. 16 ... Days
If less than 1 day .Hours. .. Minutes
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass.
13 NAME OF
FATHER
Stewart E Jackson
14 BIRTHPLACE OF
FATHER (City)
(State or country)
York Penn
15 MAIDEN NAME
OF MOTHER
Marion E Glines
50m-(b)-6-44-14607
3 SEX Male (or) WIFE of Usual 9 Ocoupation : PARENTS 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-808 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WHITE PLAINST, WITH CITADINO BLACK TEA THIS IS A PERMANENT RECORD industry 10 or Business :
1
St.
Ronald E Jackson
(if U. S.
War Veteran,
speolfy WAR)
(a) Residenoo. No.
(Usual place of abode)
4 COLOR OR RACE
White
(Specify whether)
Y
+ SUFFOLK
(County)
OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
255
Registered No.
10580
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
Michael J. Milano
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
xx Winthrop
Mass.
(a) Residence. No.
229 Main St.
(Usual place of abode)
Hosp.
years
months
Ways.
In this community
yrs.
mos.
days.
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
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
Married
5a If married, widowed, or divorced
HUSBAND of
Helen .... J ....... Driscoll
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If alive 2.9 years
7 IF STILLBORN, enter that fact here.
8
AGE.
35 Years.
.9.
Months
28Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Longshoreman
Industry
10 or Business :
Waterfront
11 Social Security No.
021-09-9654
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
Louis Milano
14 BIRTHPLACE OF
FATHER (City)
Italy
(State or country)
15 MAIDEN NAME
OF MOTHER
Antonette DiNunno
16 BIRTHPLACE OF
MOTHER (City)
Italy
(State or country)
17 Helen J. Milano
Informant
(Address)
A TRUE COPY.
ATTEST:
Dec. 13, 1945
(Registrar of city or town where death occurred)
DATE FILED 19
0
18 DATE OF
DEATH
Dec. 9,
1945.
(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.) Shock and cardiac decompensation following fall from ladder to deck of vessel Dec. 6
O
no ..... anatomital .... evidence .... of. rauma
20 Acoldent, sulolde, or homlolde (specify)
Date of ocourrence
19
Where did Injury ooour ? (City or town and State)
Did Injury oocur In or about the home, on farm, In Industrial place, or In publlo place ?
(Specify type of place)
Manner of
Injury
Nature of Injury
While at work ?
Yes
Was there an autopsy ?.. Yes
21 Was disease or Injury In any way related to occupation of deceased ?
If so, speolfy
(Signed)
Timothy ..... Leary
(Address)
22 Holy Cross Cem.
Malden
Place of Burial, Cremation or Removal.
(City or Town)
Relating any
DATE OF BURIAL
Dec. 13,
1945
.19
23 NAME OF
Richard C. Kirby
FUNERAL DIRECTOR
ADDRESS
17 ..... Bennington .... E.Boston
Received and filed
JAN 22 1946
19
(Registrar of City or Town where deceased resIded)
25m (h)-1-41-4667
of the city or town in which the deceased resided as soon as possible after the close of the month in which the death
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-805 to the clerk
PLACE OF DEATH
1
(City or Town)
No. Carney .... Hosp.
occurred. (See Chap. 46, Sec. 12, G. L.)
PARENTS
M. D.
Dato 12/101945
(If U. S.
War Veteran,
speolfy WAR)
(If nonresident, give city or town and State)
M R-302
1
PLACE OF DEATH
(County)
1
(City or Town)
Beth Israel Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
10800256
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
Josse ₩ Sargeant
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Moore St
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ...
(Before death)
(Specify whether)
years
months 2 days.
In this community
yra.
moe.
2 daye.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Dec 16, 1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
12. 14.45
... ,
19
to.
12/16/45
19
., 19 ..
.. , death 1s sald to
have occurred on the date stated above, at
8,50p ... m.
Duration
6 Age of husband or wife If allve years
7 IF STILLBORN. anter that fact here.
8
AGE. 49
Years
2
Months.
7 Days
If less than 1 day .Hours Minutos
Usual
9 Ocoupatlon :
Stone mason
Industry
General Elec.
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Auburndale Mass.
13 NAME OF
FATHER
Cyrus Sargeant
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cadia N H
15 MAIDEN NAME
OF MOTHER
Alice Seavey
16 BIRTHPLACE OF
MOTHER (City)
Chicago I11.
(State or country)
Cousin .... Paul E (Sargent.
A TRUE COPY.
ATTEST :
......
(Registrar of city of tony zbgre death occurred)/
DATE FILED
.19
Relation, if any
(Cemetery)
(City or Town)
DATE OF BURIAL
Dec 19 45 ...... 19
22 NAME OF
FUNERAL DIRECTOR
Eastman Funeral Serv.
ADDRESS
Boston Mass.
Received and filed
JAN 2 : 1346
19
(Registrar of City or Town where deceased resided)
5
Due to
Malignant hypertension
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
which death should be charged sta- tlstically.
Of autopsy
12/18/45
What test confirmed diagnosis ?.
Post ... Mortem
20 Wae disease or Injury In any way related to oooupation of deceased?
If so, speolty
CE Rubin
(Signed)
(Addrese)
Boston
Dat 1 2/17/45
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Hill Cem
Candia N. H.
50m. (b).6-44-14607
3 SEX Male (or) WIFE of PARENTS 17 Informant (Addrese) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-308 to the clerk 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 10 or Business :
4 COLOR OR RACE|
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband'e name in full)
SUFFOLK
No.
2 FULL NAME
(If U. S.
War Veteran,
spoolfy WAR)
(a) Residenoo. No.
(Usual place of abode)
Winthrop
Mass.
i last saw h ..
im ..... allve on
12/16/45
That I attended deceased from
Immediate cause of death
Pulmonary edema
Physician Underline the cause to
M R-305 +
SUFFOLK BOSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making
257
Registered No.
10858
(If death occurred in a hospital or inetitution, St. { give its NAME instead of street and number)
2 FULL NAME
Ubaldo Guidi Buttrini
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or Institution
(Before death)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
"hite
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)
Esterina Guidi
(Husband's name in full)
6 Age of husband or wife If alive years
7 IF STILLBORN, enter that faot here.
If less than 1 day .Hours. Minutes
Usual
9 Occupation :
Radio
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
Guiseppe Buttrini
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Elvira Carassale
16 BIRTHPLACE OF
MOTHER (City)
Italy
(State or country )
17 Informant (Address)
Son.
Joseph G Butting any
A TRUE COPY
ATTEST :
(Reglatrar of city on town where death peenrred)
DATE FILED
Dec 21/45 19
18 DATE OF
DEATH
Dec 17/45
(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.) Acute cardiac failure Hypertensive heart disease General arteriosclerosis
20 Acoldent, sulolde, or homlolde (specify)
Date of ocourrenoe
19
Where did Injury occur ?
(City or town and State)
Did Injury occur In or about the home, on farm, In Industrial place, or In publlo place? (Specify type of place)
Manner of
Injury
Collapsed and died quickly
Nature of
Injury
While at work?
?
Was there an autopsy ?.
no
21 Was dlsease or Injury In any way related to occupation of deceased ?
If so, specify
(Signed)
W J Brickley.
M. D.
(Address)
Boston
Date.12 /1.7.1945
22 St .... Michael ... Boston
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Deo 20/45
19
23 NAME OF
FUNERAL DIRECTOR
J .... Cincotti ... and .... Son
ADDRESS
Boston Mass".
Received and filed
JAN 22 1346
19
(Registrar of Clty or Town where deceased resIded)
25m (h)-1-41-4667
(or) WIFE of 8 AGE .... 6.7 .... Years. Industry 10 or Business : PARENTS occurred. (See Chap. 46, Sec. 12, G. L.) of the city or town in which the deceased resided as soon as possible after the close of the month in which the death resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased 11 Soolal Seourlty No.
PLACE OF DEATH
(County)
1
(City or Town)
No. 3.17 .... Hanover .... St
34 Gilderstone Rd
St.
Winthrop Mass.
(If nonresident, give city or town and State)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
Months
Days
M R-302 +
Middlesex
(County)
Arlington
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Ar lington
(City or town making return)
258
No. 99 Claremont Avenue
St.
(McFee )
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1/1 Loring Road
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: in hospital or Institution ..
(Before death)
(Specify whether)
years 11
months
day s.
In this community
yra.
11 mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
18 DATE OF
DEATH
December
30
1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased, from
February- 19
45 to Dec.
30
19.45
30
19_1_5, death is said to
I jast saw h .....??...... allve on ...
Dec
have occurred on the date stated above, at 3:30 P
.m.
6 Age of husband or wife If allve year
7 IF STILLBORN, enter that faot here.
AGE ..
7.9 Years.
9 Months.
16 Days
If less than 1 day
Hours.
Minutes
Usual
9 Ocoupatlon :
Housework
industry
10 or Business:
Own home
11 Social Security No ..... one
New Canaan
12 BIRTHPLACE (City)
(State or country)
New Brunswick
13 NAME OF
FATHER
Adam McFee
14 BIRTHPLACE OF
Campabello
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Lucinda Campbell
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Boston
17 Ethel L. Mackenzie
Informant (Address) 82 Marked Tree Rd ..
Reiation,, if any Daughter) Needham
A TRUE COPY.
ATTEST :
Mail KRyder
DATE FILED
(Regiatrar of city or town where death occurred), January 5
19
46
Received and filed
DEC 10 1946
19
(Registrar of City or Town where deceased resided)
50m . (b).6.44-14607
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-808 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
PARENTS
Of autopsy
What test confirmed diagnosis?Clin & Lab
20 Was disease or Injury In any way related to oooupation of deceased ?.
No
If so, spoolfy R. E. Chapin, D. O.
(Signed)
(Address) 41 Jason St., Arl Data 2-30-1945
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Januar
2
(City or Town) 16
19
DATE OF BURIAL
22 NAME OF
Alger E.Eaton & Sons
FUNERAL DIRECTOR
ADDRESS
Need ham , .... Ma.s.s ...
15 yrs.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings:
Of operations
No Op.
Date of
Duration
Immedlate cause of death. Hypertensive Heart Dis
12 yrs.
Due to
Arteriosclerosis
15 yrs.
(or) WIFE of
WilliamWallace ..... Mackenzie
(Husband'a name in full)
(Give maiden name of wife in full)
MARRIED
WIDOWED
or DIVORCED
Widowed
1
5a If married, widowed, or divorced HUSBAND of
(if U. S.
War Veteran,
spooify WAR)
Mass.
No
(a) Residence. No.
(Usual place of abode)
Nursing Home
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Cora Elona Mackenzie
1
PLACE OF DEATH
Registered No.
480
Mount Hope - Boston
Underline the cause to which death should be charged sta- tistically.
Due to
Diabetes Mellitus
RM R-301 t.
ATH
The Gammanmralth af Massarhnartis OFFICE OF THE SECRETARY
New York State Department of Health DIVISION OF VITAL STATISTICS CERTIFICATE OF DEATH
(City or town making return) 59777 129 .....
Registered No.
[ If an institution, give place of residence prior to admission.
Town ....
Babylon
Village.
A ty Herbor
NO. ....
Albert Road
(If a hospital or institution give its NAME instead of street and number)
In hospital or institution .....
In town, village or city ... •.... rs. 4_mos. mos ...
.mos,
days
2a Citizen of foreign country (alien) ?. NO
(Yes or no)
days If yes, name country.
3 Full Name EDIARD ... G. TTARIAN
MEDICAL CERTIFICATION
22 DATE OF DEATH (Month, Day and Year) October 15, 1945
^I HEREBY CERTIFY, That I attended deceased from
1av 1943 to OCK Oct 14
1945
5:30 P fast saw h allve on .. To the best of my knowledge, death occurred on the date stated above, at .. m.
DURATION OF CONDITION Yrs. Mos. Dys.
Coronary
Chronic myconuly Due to Curientar Fibrillation
Due to .....
Intermitent Claudicitu
6
Other condid (Include pregnancy within 3 months of death)
Major andings: Of operations ..
PHYSICIAN Underthe the
Of autopsy ...
What laboratory test was made?
24 If death was due to external cause, fill In the following?
(a) Accident, suicide, or homicide (specify)
(b) Date of occurrence
(c) Where did Injury occur ?..
(City or town) (County) (State) (d) Did Injury occur In or about home, on farm, In industrial place, In · public place? While at work ?.
(Sparlfy type of place)
(a) Means of Injury Charle LC Murphy
Address .
Date. 10/16/45 19
Burial or Transit Permit issued by
Samo & yorker
Date of issue
Ust 17 1945
100m (h)-1
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
JAN 13.1946
19
(Registrar)
or institution, and number) ORTANT
...
State)
days.
Year)
eceased from 9
th is said to
Duration Important
Important ..........
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
M. D.
18
21 Date received Oct 12
.1,45
Signature of Registrar er Subregistrar
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD ... Every itam.of infor-
N.B .- WRITE LEGIBLY WITH DURABLE BLACK INK -THIS IS A PERMANENT RECORD. Every item THIS CERTIFICATE MUST BE FILED WITH THE LOCAL REGISTRAR WITHIN 72 HOURS AFTER DEATH MOTHER
County folk City Length of stay: 4 (a) Social Security No ... 010-07 .... 8042 5 Sex white 10 AGE Years 14 NAME FATHER OCCUPATION are very important. See instructions on back of certificate. CAUSE OF DEATHI in plain terms so that It may be properly classified. Exact statements of RESIDENCE and of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 52 5
4 (b) If Veteran, Name War
6 COLOR OR RACE
7 Single, Married, Widowed, or Divorced (Write the word). rried
8 IF MARRIED, WIDOWED OR DIVORCED, Name of Aga if, alive 53
Husband (or) Wife. day we 1on lyckof:
ny year
9 DATE OF BIRTH (month, day, year) Apr 1 19, 1893
Months
Days
IF LESS than 1 day ... or
1 .min.
11 Usual occupation Elegi. En-iree
12 Industry or business Qil -- 8 cuny
13 BIRTHPLACE (City or Town) (State or Country)
New York City Legerdich Attarian
15 BIRTHPLACE (City or Towp) (State or Country) urkey
16 MAIDEN NAME Mary L. Sutton 17 BIRTHPLACE (City or Town) (State or Country) NwYr ity
18 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Informant's own Marin Of Italian signature .....
Address_ _ Emily ville a .h.4
19 PLACE OF BURIAL, CREMATION DATE OF BURIAL
Cemetery ork Q-t ber 18,19 45
20 UNDERTAKER OR PERSON IN CHARGE (Signature) ......
ADDRESS 230 Broadway, Amityville,
UNDERTAKER'S License No.
5:14
Form VS No. H
1 PLACE OF DEATH: STATE OF NEW YORK
2 USUAL RESIDENCE OF DECEASED: State. ... assachusetts County Suffolk Town ... Winthrop
Village or City. Winthrop
Ward St. No. 1.53 Circuit Road
St. Is residence within limits of city or Incorporated village ?....
19.45
... hra. Immediate cause of death.O.
doeth should be charged.
Received and filed
259
Dist. No. 5150 To be inserted by registrar
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 famlly 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, hls supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of hls last illness, when last seen allve by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and fourteen, shall, if the deceased, to the best of his knowledge and helief, 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, specifying 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 pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
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