USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 81
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by section ten of chapter forty-six, tuat 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 neces- sary information which can he 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 hy 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 hody 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 hoard, from the clerk of the town where the body is to be huried 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 hedside 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 hy recognized disease unrelated to any forum of injury, have died without recent medical attendance or whose phy- 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 deaths caused directly or indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, 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 morhid 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 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 he 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 hy the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
301 A
PLACE OF DEATH
(County)
1 Winthrop (City or Town)
No.
Winthrop Comunity Hospital
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. 226
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence.
No.
4] Upland Road
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
10 min.
months
days.
In this community
20
yrs.
mos.
days.
PERSONAL ANO STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIEO
WIOOWED
OF DIVORCED Id owed
5a If married, widowed or divorced
HUSBANO of. Theresa Meagher
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
62
Years
Months
Oays
If less than 1 day
. Hours
Minutes
Usual
9 Occupation:
Tailor
Industry
10 or Business:
Mfg.
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or Country)
Italy
13 NAME OF
FATHER Charles A. Dondero
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
Italy
15 MAIDEN NAME
OF MOTHER
Mary Dondero
(okay)
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
Italy
17 Informant Anthony Dondero
(Address! 41 Upland Rd. Winthrop I HEREBY CERTIFY That a satisfactory standard certificate of death was filed with me BEFORE the burial og transit permit was issued: Wollte H. Maker Signature of Agent of Board of Health Going Health Office 11/29/46 (Official Designation) (Date of Issue of Permit)
19 I HEREBY CERTIFY,
www. 28 , 19
That I attended deceased from
Y6.
to
, 19
[ last saw h
alive on
11.
SP
m.
Immediate cause of death at ;
Duration
IMPORTANT
Due to
Que to
Other conditions
(Include pregnancy within 3 months of death) .
Major findings: Of operations ..
Oate of
Of autopsy
What test confirmed diagnosis?
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed) ..
(Address)
Nachpontos 11/24
, M. O.
19
21
Holy Cross
MaldenCity or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL Dec. 2, 1946
19
22 NAME OF
FUNERAL DIRECTOR Vienael
ADDRESS L.O. No. Bennett St., Boston
Received and Filed NOV 2 9 1946
(Registrar)
00m-9-44-14955
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
pur hoep.
2 FULL NAME
Henry ADondero
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
(Month)
28 (Day)
1946 (Ycar)
mr. 28
19
death is said to
have occurred on the date stated above. at
18 OATE OF
DEATH
St. ? (If death occurred in a hospital or institution, give its NAME instead of street and numher)
Hoop
+ Suffolk
Relation, if any ) Brother
19
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 he death of a person whom he has attended during his last illness, at the equest of an undertaker or other authorized person or of any member of he 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 leceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last llness, when last seen alive by the physician or officer and the date of is 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 four- een, shall, if the deceased, to the best of his knowledge and belief, served n the army, navy or marine corps of the United States in any war in which t has been engaged, insert in the certificate a recital to that effect, speci- ying 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 he 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- ion and of sections forty-five, forty-six and forty seven of said chapter ne 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- een hundred and seventeen. G. L. Chap. 46, See. 10.
No undertaker or other person shall hury 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 receiving omb 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, satisfactory written statement containing the facts 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 physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal 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 hereunder. If the death certificate contains a recital, as required
by section ten or chapter ionty -six, tuat 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 neces- sary information which can he 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, he shall forthwith go to the place where the hody 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, hut 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 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 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
R-305
+
Middlesex (County)
The Commontuealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Framingham
(City or town making return)
1
Framingham
(City or Town)
General Motors Assembly Plant
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Frank Lanza
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
45 Enfield Rd.
St.
Winthrop,
l'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
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED Married
or DIVORCED
5a If married, widowed, or divoroed HUSBAND of
Concetta Perella
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve 6.9
7 IF STILLBORN, enter that faot here.
8
AGE
71
Years
Months.
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Engineer
Industry 10 or Business :
11 Social Security No.
023-18-2283
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
Gaetano Lanza
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17
Informant
Albert ... Lanza
Relation, if any (.son
(Address)
Winthron. Masse
A TRUE COPY.
1. Walsh
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
November 20,
.19 46
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
ITovember 15, 1946
(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.) Coronary Occlusion
years Sudden death
20 Aocident, suicide, or homiolde (specify)
Date of ocourrenoe
19
Where did
Injury ooour ?
(City or town and State)
Dld injury occur in or about the home, on farm, in Industrial place, or In publio place? (Specify type of place)
Manner of
injury
Nature of
injury
While at work?
Was there an autopsy?
view
21 Was disease or Injury In any way related to ocoupation of deceased? no
If so, specify
(Signed)
Michael F. Burke
M. D.
(Address)
Natick, Mass.
Date
11/15 19 46
22
Winthrop Cemetery, Winthrop, Mass.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
November
18
19
46
23 NAME OF
FUNERAL DIRECTOR
Jos. A. Langone, Jr.
ADDRESS
41 Haverhill St .Roston
19
Received and filled.
DEC 5 1943
(Registrar of City or Town where deceased resided)
occurred. (See Chap. 46, Sec. 12, G. L.) of the city of town in Which the deceased resided as soon as possible alter wie close of the month In which the desus PARENTS
25m (h)-1-41-4667
PLACE OF DEATH
No.
-
Registered No.
227
(If U. S.
War Veteran,
specify WAR)
(write the word)
DEC-61345 AM
1:1-
9.
GLERA
NM
NIW
5
OFFIC
LIL !
MO.
RECEIVED
-302
Suffolk
(County)
Chelsea
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
228
(If death occurred in a hospital or institution,
St. give its NAME instead of street and number)
Samuel C. Dobson
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 2 Edgar Terr.
(a) Residence. No.
(Usual place of abode)
Hosp.
years
months
5
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4 COLOR OR RACE|
white
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divoroed HUSBAND of
(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
53
AGE
Years
4
Months.
27 Days
If less than 1 day .. Hours. .Minutos
Usual
9 Ocoupation :
Switch attendant
Industry
10 or Business :
unknown
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
Samuel A. Dobson
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
15 MAIDEN NAME
OF MOTHER
Etta E. Smith
16 BIRTHPLACE OF
MOTHER (City)
Nova Scotia
(State or country)
17 Hosp.records
Relation, if any
Informant
(Address)
(
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
Nov. 19.
19 46
DATE FILED
18 DATE OF
DEATH
Nov. 19, 1946
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFYNOVThat 1 attended deceased
Nov. 14
16:6
to.
19
! last saw h.
im
Nov. 19
19.46
.. alive on
death Is sald to
have ooourred on the date stated above, at
9.55 .... A ... m.
Duration
Immedlate cause of death.
Cardiac Failure
?
Due to
Arteriosclerotic Heart Dis. ?
Due to
Other conditions.
auricular fibrillati
Physician
(Include pregnancy within 3 months of death)
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 ?.
If so, speolfy.
(Signed)
James ....... Collins
M. D.
(Address)
Date .. 12 /199 ....... 46
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemeterbv. 22,
inthrop Cem,
DATE OF BURIAL
19
(City of Town OP
46
22 NAME OF
John F.O Maley
FUNERAL
DIRECTOAtlantic st. , Winthrop, Mas
ADDRESS
Received and filed DES 101946 .19
50m-(b) -6-44-14607
PLACE OF DEATH
1
(City or Town) Soldiers' Home Hospital
No.
(If U. S.
War Veteran,
speolfy WAR)
WW I
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ...
(Before death)
(Specify whether)
5 SINGLE
(write the word)
(Give maiden name of wife in full)
Railroad
PARENTS
Underline the cause to which death
Enlisted
4/29/18 Dischgd.
6/13/19 Rank
Sgt.Major,Hq.443rd Reserve Labor Bn.
Service No. ASN -2,719,778
1
-302
PLACE OF DEATH -
Middle sex (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Arlington
(City or town making return)
Registered No.
479229
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Mabelle G. Balkan
(Simpson)
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
217 Pleasant Street
St.
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)
3
years
5
months
24 days.
In this community
3
yrs.
5 mos.
24 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
whi te
5 SINGLE
(write the word)
DEATH
MARRIED
WIDOWED
or DIVORCED
Wido wed
5ª If married, widowed, or divorced HUSBAND of
(or) WIFE of
Vincent nym Bat&H)
(Husband's name in full)
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that faot here.
8
69
0
20
AGE
Years
Months.
Days
If less than 1 day
Hours
.Minutes
Usual
9 Ocoupatlon :
Housewife
sclerosis
3 yrs.
Due to
Senile Psychosis- Depressed
Other conditions
30 Trs.
(Include pregnancy within 3 months of death)
and Agitated type
Major findings :
Of operations
Date of.
Underline the cause to which death should be charged sta- tistically.
14 BIRTHPLACE OF
FATHER (City)
Campobello
(State or country)
N.B., Canada
15 MAIDEN NAME
OF MOTHER
Gertrude Appelby
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
17 Ring Sanatorium & Hospit&elation, if any
Informant.
(Address) 163 Hillside Avg., Arlington
A TRUE COPY.
ATTEST :
Real ARyder
(Registrar of city or town where death occurred),
December
DATE FILED
7
2046
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
December
3
1946
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
June
9, 19 43.
to
De c
3
That I attended deceased
from
46
I last saw h
er
allve on.
Dec
3
19.115death Is said to
have occurred on the date stated above, at.
3:45
P.
Duration
Immedlate cause of death
Arteriosclerotic heart
Disease
About
Due to.
Generalized Arterio-
About
Industry
10 or Business:
11 Soolal Security No ..
12 BIRTHPLACE (City)
(State or country)
Maine
13 NAME OF
FATHER
James Simpson
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?
No
If so, speolfy.
Martha Brunner
(Signed)
d
(Address) Ring Sanatorium & Dat 12-3-20 46
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ..
Mt. Auburn -Cambridge
(Cemetery)
DATE OF BURIAL
December
6
(City or Town)
1946
FUNERAL
22 NAME OF
DIRECTORA. Allen Kimbal 1
ADDRESS
39 Church St., Winchester
Received and filed
JANO 1017
.19
(Registrar of City or Town where deceased resided)
50m-(b)-6-44-14607
1
Arlington
No.
(City or Town) Ring Sanatorium and Hospital 163 Hillside Avenue
St.
(If U. S.
War Veteran,
specify WAR)
19.
3 yrs.
Eastport
PARENTS
٤
٢
301 A
1
PLACE OF DEATH
Suffolk (County)
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.
Registared No.
230
No. Winthrop Community Hosp. f (If death occurred in a hospital or institution,
Harry C Temple
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
78 Center St
(Usual place of abode)
Hosp.
years
months
19 days.
in this community
25 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACEİ
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED Married
5e If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
Lottie M.Cooley
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if elive years
7 IF STILLBORN, enter that fect here.
8
AGE 76 Years
4
Montha
25Days
if less then 1 dey Hours Minutes
Usual
9 Occupation :
Pullman Conductor (Retired
Industry
Bonton Albany
Railroad
10 or Business :
100
11 Social Security No.
* 709-10-5459
Bowdoinham
12 BIRTHPLACE (City)
( Siste or country)
Maine
13 NAME OF FATHER Bonn
Temmlc
14 BIRTHPLACE OF
Bowdoinham
FATHER (City)
(State or country)
igine
15 MAIDEN NAME
OF MOTHER
Louise Cuker
16 BIRTHPLACE OF
Bowdoinham
MOTHER (City)
(State or country)
Maine
17 Everlyn Mitchel
Informent
Narutogi If any (Address) 56 Gardner St Alliston Mass
I HEREBY CERTIFY that g satisfactory standard certifioata of death was fled with me BEFORE the burial or transit pormit was Issued : Taller & Kapit
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