Town of Winthrop : Record of Deaths 1946, Part 46

Author: Winthrop (Mass.)
Publication date: 1946
Publisher:
Number of Pages: 526


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 46


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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17 BATI AND HOUR OF/ DEATH


April 8


19 COLOR GA HÀCA


20 Approximate Ape


7 IF STILLBOR


WIFE HUSBAND


of


Barnard


(Month)


(Day)


(Year)


MACHENT


If LESS than 1 day,


Usual 9 Occupation!


67,


days


hrs. of


pła.


Harlv, Mother


A Trade, profession, or particular kind of work dont, as aplus Mayer, bookkeeper, ett.


Housewife


11 Social Secu


Cause 1


12 BIRTHPLAC. (State or cou


094


() City, Towa or Village


() County


OF WHAT COUNTRY WAS DACIDENT A CITIZEN AT TIME OF DEATH?


I further certify that death + WA.S.N.q.Z. due to communi- cable disease requiring special preparation for shipment by common carrier.


· Creer out worda that do not apply.


t See frol instruction on reverse of certifcuts.


Type Auk


TI MATHPLACE OP FATHER


Russia


(State or country)


IT MAIDEN NAME


OF MOTHER


IDA Unknown


OF DECEDENT


TT BIRTHPLACE


Address


622 WEST 168th ST. C.Y.C.


19


y or Town) 12


23 FUNERAL


Park Nost Memorial Ch., Ino.


ADDRESS


115 West 79th St.,


PERMIT


NUMBER


2430


BUREAU OF RECORDS AND STATISTICS


DEPARTMENT OF HEALTH


CITY OF NEW YORK


nd state) days.


'ear)


eased from 19 ......


path is said


Duration


........


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


. M. D.


OF MOTHER (State or country))


Russtá


IT AUNATURE OF INFORMANT


LILATIONSHIP TO DECEASED


Yry South At. Brookline


17


Informant (Address)


Com


Å TRUE COPY ATTEST:


DATE FILED


19


Received and filed ..


JUL 1 9 1946


(Registrar of City or Town where deceased resided)


after the close of the mouth in which the death occurred. (Sec Chap. 46, Scc. 12, G. L.) 50m-10-'39. No. 8427-f


PARENTS


Operalisa


10 WAS DICLASED WAR VETERANT I SO, NAME WAR


no


O


TT NAME OF FATHER OF


JUDA BALTIMORE


DICEDENT


15 MAIDEN OF MOT


Witness my hand this E day of APAR


1946


Signature Silberttrung& M. D.


16 BIRTHPL MOTHER (State or


PARENTS OF DECEASED |


Furlustry or business in which work was done, at sik mill, sawmill, book, own business, one, Con Home


BIRTHPLACE OP DICEDENT: (a) State.


fussia


16 PLACE OF DEATHI


(a) NEW YORK CITY: (b) Borough MANHATTAN


(c) Name of Hospital PRESBYTERIAN HOSPITAL or Institution .... Uf not in hospital or institution, give street and number.)


(Year) | (Hour) A


3 HHALL, MARRIO, WIDOWIR, OR DIVORCED (trực the woord)


married


6 Age of husb


FEMALE WHITE


68


21 I HEREBY CERTIFY that (F-Monded-the-docensed)" (a staff physician of this institution attended the deceased)' APR. IST 10 46 to A pc. 8th 19 46 and last saw h. ER alive ar 9:30M on Apr. 8th 19 46


from


Industry 10 or Business


16


I further certify that death + WAS NOT caused, directly or indirectly by accident, homicide, suicide, acute or chronic poisoning, or in any suspicious or unusual manner, and that it was due to NATURAL CAUSES more fully described in the confi- dential medical report filed with the Department of Health.


13 NAME C FATHER


Natlv. Det. 16 Citta. Det.


S AGE Y


MEDICAL CERTIFICATE OF DEATH (To be Klied in by the Physician)


3 SEX


191 Bero Beeld.


8


MEN GH C


(a) Re (U Length of sta


Doro-Death


Certificate No. 8444


NT


WASSERMAN


Souli Security Number


ANNIE First Name


St.


No.


OR CREMATION


M PLACE OF JUMIAL Jewish Cemetery, Boston, Yessd


son-in-law


DATI OF BURIAL OR CREMATION April 10, 1946


14 BIRTHPL FATHER (State or


(Month) (Day)


19.4.6 19:30


17 Ocean Avenue


19


R-302


Middlesex


(County) Tewksbury, Mass.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Tewksbury State Hospital and Infirmary


(City or town making return) 123


Registered No.


16.7


(If death occurred in a hospital or institution, St.


give its NAME instead of street and number)


2 FULL NAME.


William Davis


(If deceased is a married, widowed or divorced woman, give also maiden name.)


249 Pleasant


St.


Winthrop


(If nonresident, give city or town and State)


Length of stay : In hospital or Institution ..


(Before death)


(Specify whether)


...


years 2


months


3


days .


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Single


Male White


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, anter that fact here.


8


AGE ..


.6.8Years.2.


Months.


24 ... Days


If less than 1 day Hours. Minutes


Usual


9 Ocoupatlon :


Laborer


Industry 10 or Business :


11 Sooial Security No. Not learned


12 BIRTHPLACE (City)


(State or country)


Wales


13 NAME OF


FATHER


George T. Davis


14 BIRTHPLACE OF


FATHER (City)


Not learned


(State or country)


Wales


15 MAIDEN NAME


OF MOTHER


Sarah Anthony


16 BIRTHPLACE OF


MOTHER (City)


Not learned


(State or country)


Wales


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Winthrop,


Winthrop


DATE OF BURIAL


(Cemetery)


June"


'10,


46


(City or Town 19


A TRUE COPY.


ATTEST:


C.Wentvon Wrighton m. ]Supr.


(Registrar of city or town where death occurred)


DATE FILED


June 6,


19.46


22 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS


Winthrop, Mass.


Recelved and filed


JUL .3 1 1946


19


(Registrar of City or Town where deceased resided)


50m. (b) ·6-44-14607


resided in another city or town at the time of death słodte ot inade fortiwith and gemsmitted du Forts trova w tue ciers of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


1


-


No.


(City or Town) Tewksbury State Hospital and Infirmary


give


(If U. S.


War Veteran,


spoolfy WAR)


(a) Residence. No.


(Usual place of abode)


18 DATE OF


DEATH


June


6


1946


(Month)


(Year)


19 | HEREBY CERTIFY,


Apr.i.l .... 3 ...


19.46


.June ... 6


:


19.46


I last saw h. .1m .... alive on. June .6 .......... , 19 .... 4.6death Is sald to have occurred on the date stated above, at ... 1.1 ..:. 0.5.A ... ...... m.


Duration


Immedlate oause of death


Bronchogenic Carcinoma


of ..... Right ..... Lung.


1 ..... year


Due to


Due to ...


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations


Date of


should be charged sta- tistically.


Of autopsy


X-ray


What test confirmed diagnosl


Clinical


20 Was disease or injury in any way related to oooupation of dscsased ?.


If so, speolfy


(Signed)


T.S.H. &h. TSkihergson


M. D.


(Address)


Date.


6/6 9 46


17 Hospital Records


Relation, if any


Informant.


(Address)


Cardiff ..


Underline the cause to which death


PARENTS


PLACE OF DEATH


(Day)


That i attended deceased from


R-302


Suffolk


(County)


Boston


(City or Town)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Boston


(City or town making return)


6021


Registered No.


121


2 FULL NAME


Sarah London


(If deceased ia a married, widowed or divorced woman, give also maiden name.)


(a) Residenoo. No.


47 Tewksbury


Winthrop


ass.


(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


7 days


In this community


yrs.


mos.


7


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE|


(write the word)


Widowed


1


5a If married, widowed, or divorced


HUSBAND of


(Giye maiden name of wife in full)


(or) WIFE of


.Harry ... London


(Husband's name in full)


6 Age of husband or wife If allve


years


7 IF STILLBORN, enter that fact here.


8 AGE. ... 7.5 Years. Months. Days


If less than 1 day Hours .Minutes


Usual 9 Occupation :


Housework


Industry


10 or Business :


At Home


11 Soolal Security No.


None


12 BIRTHPLACE (City)


(State or country )


Russia.


13 NAME OF


FATHER


Israel Penan


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Bessie -


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


17 Informant. (Address)


I ... London


A TRUE COPY.


ATTEST :


(Registrar of city or we where


July


5/4 6 cœurred) 19


DATE FILED


18 DATE OF


DEATH


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


June .... 26 ..


.....


19


46


to ..


That i, attended deceased


July


19


I last saw h .....


er allve on


July 3/46


19.


death Is said to


have ooourred on the date stated above, at


5;20₽


m.


Immedlate cause of death Pulmonary .... Embolus


3 Hrs


Due to


Due to


Other conditions.


Diabetes mell.


Physician


(Include pregnancy within 3 months of, death) Arterio sclerotic heart di's.peritonitis


Major findings: Diverticulitis, melanosis


Of operations.


coli


Date of


should be


Of autopsy


Pulm.embolus peritonitis


charged sta- tistically.


What test confirmed diagnosis ?


autopsy


No


20 Was disease or injury in any way related to oooupation of deopased?


If so, speolfy ..


D"B"Hackel


(Signed)


(Address)


Beth Israel HosptDat.


7-3


..


M. 4%


19


Montifiore Cem-Woburn


(City or Town)


DATE OF BURIAL


22 NAME OF


B Birnbach


FUNERAL DIRECTOR


ADDRESS


Dorchester Mass.


Received and filed JUL 24 1946


19


50m-(b)-6-44-14607


reaided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk -- of the city or town in which the deceased resided. (See Chap. 46, Sec. 12. G. L.)


1


PLACE OF DEATH


No.


Beth Israel Hospital


St.


(If death occurred in a hospital or institution give its NAME instead of street and number)


(If U. S.


War Veteran,


specify WAR)


St.


July 3/46


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


PARENTS


Relatiog jf any


21 PLACE OF BURIAL,


CREMATION OR REMOVAL ..


(Cemetery )


July 4/46


19


Underline the cause to which death


Duration


2-301 A


1


PLACE OF DEATH


Suffolk (County) Winthrop (City or Town) Winthrop Community Hospital No.


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.


125


2 FULL NAME


Baby que Boyle


(If deceased is a married. widowed or divorced woman, give also maiden name.)


(a) Residence. No.


143 Pleasant St


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In hospital or institution Hospital


(Before death)


{Specify whether


years


months


2


days.


In this community


yrs.


mos.


2


days.


PERSONAL ANO STATISTICAL PARTICULARS


3 SEX Female


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIEO


Single


WIOOWEO


or DIVORCEO


5a If married, widowed or divorced HUSBANO 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 1F STILLBORN, enter that fact here.


2


8


AGE


Years


Months


Oays


If less than 1 day


Hours


Minutes


Usual


9 Occupation:


Industry


10 or Business:


11 Social Security No ..


12 BIRTHPLACE (City)


Winthrop


(State or Country)


Massachusetts


13 NAME OF


FATHER


Joseph E. Boyle


14 BIRTHPLACE OF


FATHER (City).


Chicago


(State or Country)


Illinois


15 MAIOEN NAME


OF MOTHER


Catherine V. McAllister


16 BIRTHPLACE OF


MOTHER (City).


New York


(State or Country)


New York


17 Joseph E Boyle ( Từ thế py )


Informant (Address' 143 Pleasant St Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:


Walter


(Signature of Agent of Board of Health or other) Healthe Office 7/8/46


(Official Designation) (Date of Issue of Permit)


20 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


H. airlines


, M. O.


(Address) 192 Shuntely St


Date 7-7-1946


21


Winthrop


Winthrop


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


July 8, 1946


...


19


22 NAME OF


FUNERAL DIRECTOR


John F. qualey


AODRESS


Winthrop Massachusetts


Received and Filed JUL 0 1946


19


(Registrar)


1946 (Ycar)


19


1 HEREBY CERTIFY,


That 1 attended deceased from


July 5,


. 194C , to


July)


19 40


.


I last saw HER


alive on


July 70


, 1946,


death is said to


have occurred on the date stated above, at


5:30 A: m.


Immediate cause of death


Congenital Heart Disease


Que to


Cardine farline


Que to


atelectasia


atelectasia


Other conditions


(Include pregnancy within 3 months of death)


Major findings:


Of operations


Oate of


1 - 4 - 46


Of autopsy


Congenital Heart


What test confirmed diagnosis?


Duration IMPORTANT


IMPORTANT


Physician Underline the cause to which death should be charged sta- tistically.


0m-9-44-14955


See instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS


St.


-


(If death occurred in a hospital or institution, {


give its NAME instead of street and number) ,


PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) .


St.


MEDICAL CERTIFICATE OF DEATH


18 OATE OF


DEATH


July


(Month)


Zati


(Day)


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 tbe 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, bis 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 alive hy tbe physician or othcer and the date of his death ... Gen. Laws, Cbap. 46, Sec. 9.


A physician or officer furnishing a certificate of death as required by tbe preceding 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 United States in any war in which it bas heen engaged, insert in the certificate a 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 be can state the same. For neglect to comply with any provision of this section, such physician or officer 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 expedition 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 Mexican border service of nineteen hundred and sixteen and nine- teen 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, nr 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 receiving 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 wbere the body is buried. No such permit sball be issued until there shall bave 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, bis certificate cannot be obtained early enough for the purpose, or is insufficient, a pby si- 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 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 removal of such body has been sooner obtained bereunder. If the death certificate contains a recital, as required


by section ten ot chapter 1oily . six, qual the deceased served in the army, navy nr marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board nf 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 neces- sary 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).


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, be sball 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 sball bury a human body or the ashes tbereof which have been brought into the commonwealth until he bas 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 physfcfans will certify to such deaths only as those nf 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 sucb deaths only as those of persons wbo, though disabled by recognized disease unrelated to any forum of injury, have died without recent medical attendance or whose pby - sician is absent from home when 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 deathis 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, astbenia, etc. As principal cause name the disease causing 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 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 heen 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


R-302


SUFFOLK


BOSTON


(City or Town)


No.


Beth - grael Hospital


(If death occurred in a hospital or institution, St. give its NAME instead of street and number)


2 FULL NAME


Charles I Floyd


(If deceased is a married, widowed or divorced woman, give also maiden name.)


249 Winthrop Shore Drive


St.


Winthrop


(Usual place of abode)


Hospital


years


months


in this community


yrs.


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


Widowed


5a If married, widowed Y diyored McConnell


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 Months.


Days


If less than 1 day .Hours .. ..... Minutes


Usual


9 Ocoupation :


Clerk


Industry


10 or Business :


Railroad


11 Soolal Security No.


12 BIRTHPLACE (City)


(State or country)


Haverhill Mass


13 NAME OF


FATHER


Charles Floyd


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Cannot be learned


15 MAIDEN NAME


OF MOTHER


Cannot be learned


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Cannot be learned


17 Robert S Floyd


Informant (Address)


Rel&ernif any 249 Winthrop Shore Drive


A TRUE COPY. ATTES Michael & Manning


(Registrar of city or town where death occurred) July 12


46


.19


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.


61.73


126


1


PLACE OF DEATH


of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


50m. (b)-6.44-14607


DATE FILED


Received and filed JUL 23 1946


( Registrer of Cite or Town where


resided )


19


I last saw h.


1.m ...... allve on


.. ,


19


to.


July 7


1946


death is sald to


have occurred on the date stated above, at .m.


Immediate cause of death


Myocardial infarct


Duration 10 days


Due to.


Hypertension &


Arteriosclerosis


? yrs


Due to.


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations


Date of


should be


charged sta- tistically.


Of autopsy


Clinical


What test confirmed diagnosis?


20 Was disease or injury in any way related to oooupation of deceased? No


if so, speolfy.


Erwin O Flinch


(Signed)


(Address)


BIH


Date 7/8


19


46


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Woodlawn


Everett


(Cemetery)


(City or ToIrb


DATE OF BURIAL


22 NAME OF


FUNERAL DIRECTOR


John F O' Maley


ADDRESS


Winthrop


19


deooased Lifegm


18 DATE OF


DEATH


July


7th


1946


(Month)


(Day)


(Year)


June 26 CERTAFY,


(if U. S.


War Veteran,


speolfy WAR)


No


(a) Residence. No.


Length of stay: In hospital or institution ..


(Before death)


(Specify whether)


10


days.


(If nonresident, give city or town and State)


July il


19


Underline the cause to which death


01 A


1


PLACE OF DEATH


...


Auffach. (County)


-or Toro Hunting Com


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.


127


Thank


S& & (If death occurred in a hospital or institution, give its NAME instead of street and number)


PHYSICIAN - IMPORTANT (W'as deceased a U. S. War Veteran, if so specify WAR)


(a) Rasidenca. No.


(Usual [ilace of abode)


Shop.


Length of stay: In hospital or Institution


( Before death)


( Specify whether)


Chro 3 8 min.


MEDICAL CERTIFICATE OF DEATH


3 SEX


Male


4 COLOR/OR RACE


While


5 SINGLE


MARRIED


WIDOWED


or DIVORCED Lance


( write the word)


fugle


5a If married, widowed, or divorced HUSBAND of


(Cive maiden name of wife in full)


(or)" WIFE of


( Husband's name In full)


6 Age of husband or wife if aliva


years


7 IF STILLBORN, enter that fact here.


8 AGE Years Months Days


If lass than 1 day


5 Hours 3 8 Minutes


Usual


9 Occuoatlon :


Industry 10 or Business :


11 Social Security No.


12 BIRTHPLACE (City)


( Siste or country)


13 NAME OF


FATHER


William Alivey


14 BIRTHPLACE OF


FATHER (City)


....


Baston U


( Stale or country)


15 MAIDEN NAME


OF MOTHER


Ctele & Kinky


16 BIRTHPLACE OF


MOTHER (City)


(State or country )


17 Informant ( Address Y 22 Real off Aux


I HEREBY CERTIFY that a satisfactory standard oartiftoate of daath was fled with me' BEFORE the burial or, transit permit was Issued :


(Signature of Agent of Board of Health or other) 1/10/40


18 DATE OF


DEATH


July


Months


(Daf)


7


1946 ( Year)


19 | HEREBY CERTIFY,


That


attandad deosased from


Ło


19


46


I last/ssw h ... +HAA allva on .. July 7 / 1946 death Is sald to have occurred on the dato stated above at 155b Duration .m. Immediate oause of death. Prematurity


IMPORTANT ....


Due to Placental Deharation




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