Town of Winthrop : Record of Deaths 1946, Part 81

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 81


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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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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