Town of Winthrop : Record of Deaths 1947, Part 10

Author: Winthrop (Mass.)
Publication date: 1947
Publisher:
Number of Pages: 544


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 10


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it has been engaged, such recitsl shall sppear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer tifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the decessed, or as tu the manner or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercenteoary Edition).


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue 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 per- son appointed to have the care of the cemetery or burisl ground in which the intermeut is made. . . . Chap. 114, Sec. 46, G. L., (Terceutenary Edi- tion ).


Medical examiners shall mske exsmination 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 hia county the body of such a person, he shsit forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 3S, Sec. 6.


... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his uante and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.


... The medical examiner certifles the cause and manner of death to the best of his knowledge and belief.


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illnesa from disease unrelated to sny forın of injury.


(2) Board of Hesith physiclans will certify to such deaths only as those of persona wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent inedical attendance or wbose pbysi- ciatt is absent fromn hoine 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 in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, aud deatha following abortion, but also desths 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


Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify : (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing septicenria (gss bacillus) caused by a steam railway sccident." "Pistol shot wound of the cbest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, suicids !. " "Syncope while under the influence of ether sdininlstered as a surgical ansesthetic." "Fracture of the skull with associated internal injury aus- tained under circumstances unknown."


If disease or injury wss related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumahle nsiure; snd (2) under manner, indicate tbe circum- stances leading to medico-legst inquiry. For example : "Hemorrhage spon- taneous of the brsin (hasal ganglia) (found desd in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death. )"


DESCRIPTION (for unknown person)


NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute there


shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.


THIS CERTIFICATE CONSTITUTES SUCH PERMIT


ORM R-302


PLACE OF DEATH -


Suffolk (County)


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


Boston


(City or town making return)


1


Boston


(City or Town)


Magnolia Rest Home


Magnolia St


St.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


2 FULL NAME


Ida Minson


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


41 Ocean Ave.


St.


Winthrop .. Ma.ss ..


(a) Residence. No.


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In hospital or institution.


(Before death)


(Specify whether)


years


3


months


days.


in this community


yrs.3


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE|


5 SINGLE


(write the word)


MARRIED


WIDOWED,


or DIVORCED d OW


52 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Joseph .. Minson ..


(Husband's name in full)


have ooourred on the date stated above, at


7: 40AM


m.


Duration


6 Ags of husband or wife If allve years


7 IF STILLBORN, enter that faot here.


8


AGE ..


90 Years


Months.


Days


If less than 1 day Hours Minutes


Usual


9 Ocoupation :


Housework


Industry


10 or Business :


At Home


11 Social Security No ...


Nono


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


Morris Bassman


14 BIRTHPLACE OF


Russia


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Bessie


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


50m-(b)-6-44.14607


17 Informant (Addre 2Jichael


N.Sandler. (


Relation, if any Grandson DATE OF BURIAL


(Cemetery)


Jan.2.9 47


19


(City or Town)


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


B Birnbach


Dorchester Mass


A TRUE COPY.


ATTEST :


(Registrar of city or town where death occurred) Jan.30


19


47


DATE FILED


Copies of returns of deatha 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-308 to the clerk


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


PARENTS


Of autopsy


What tsst confirmed diagnosis?


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


If so, speolfy.


A Mills


(Signsd)


M. D.


(Address)


Boston Mass


Date 1-28


19


47


21 PLACE OF BURIAL,


CREMATION OR REMOVE . Lebanon Polonnoe West Rox.


Underline the cause to which death


Date of


should be


charged sta- tistically.


Other conditions.


(Include pregnancy within 3 months of death)


Physician


Major findings:


Of operations


20 Yrs ....


Due to.


Senility


Due to.


Gen.Arterio Sclerosis


.... 20 Yrs


18 DATE OF


DEATH


(Month)


Jan. 28/47


(Day)


(Year)


19 | HEREBY CERTIFY,


19


to


That I attendsd deceased from


19.


i last saw h.


allve on.


19.


death is sald to


Immedlate cause of death


Post Mortem Diagnosis


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


Received and filed FEB-15 1947 19


(Registrar of City or Town where deceased resided)


T


Registered No.


92529


No.


(If U. S.


War Veteran,


spoolfy WAR)


-----


FORM 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)


Registered No.


42


3.0


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


2 FULL NAME


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


59 Summit Avenue


.... St.


Winthrop, Mass.


(If nonresident, give city or town and State)


Length of stay : In hospital or Institution ..


(Before death)


1 bears 1 months


3 days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX Male


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Married


5a If married, widowed, or divoroeds


HUSBAND of


Elizabeth .... Thompson


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wifs if allve ..


Not Learned


years


7 IF STILLBORN, enter that fact here.


AGE.5.3 ...... Years ..


2


Months.


3


Days


If less than 1 day


.. Hours ..


.......... Minutos


Usual


9 Ocoupation :


Cabinet Maker


Industry 10 or Business:


11 Soolsl Security No. None


12 BIRTHPLACE (City)


Quincy.


(State or country)


Mass.


13 NAME OF


FATHER


Noah Curtis


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country ) Mass.


Quincy


15 MAIDEN NAME


OF MOTHER


Abigail Chamberlain


16 BIRTHPLACE OF


MOTHER (City)


(State or country) Mas8.


Quincy


17 Hospital Records


Relation, if any


Informant


(Address)


A TRUE COPY.


ATTEST :


C. Winthrop Houghton


SUPS:


(Registrar of city or town where death occurred)


DATE FILED


Jan .29


19.47


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Jan.


29


1947


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY, That 1 attendsd deceased from


Dec.


.26., ......


...


U


......


to Jan. 29


19 ... 4.7 ...


I last saw


........ allve on


Jan. 28,


. 19.4.7, death Is sald to


have ooourred on the date stated above, at4:15A


m.


Duration


Immediate oause of death


Acute Coronary Thrombosis


Sudden


Due to.


Arteriosclerosis


Yrs.


Post-Encephalalitis


Due to ....


Parkinsonian


Yrs.


Other conditions


(Include pregnancy within 3 months of desth)


Physician


Major findings :


Of operations


Date of


should be


charged sta- tistically.


What test confirmed diagnosis ?


20 Was disesse or injury in any way related to oooupstion of deceased ?


If so, speolfy


No


(Signsd)


Frank_I


Heifetz


M. D.


(Address)


Date


1/29 19 47


21 PLACE OF BURIAL,


CREMATION OR REMOVAL t. Wollaston, Quincy


Cemetery )


( City or Townh


19


Jan. 31,


DATE OF BURIAL


22 NAME OF


FUNERAL DIRECTOR


John Hall Funeral Home


ADDRESS


Quincy ...... MIa.s.s ...


MAR 6 1947


19


Received and filed


(Regietrar 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.) Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk .


PLACE OF DEATH


1


Tewksbury State Hospital and Infirmary


No.


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No.


(Usual place of abode)


(Specify whether)


MARGIN RESERVED FUK DIRVING


Underline the cause to which death


Of sutopsy


T. S. H. & I., Tewksbury


terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and


1


PLACE OF DEATH


Suffolk (County) C


chatham


notified 3/11/47.


Winthrop (City or Town) Kirkpatrick 46 Washington Ave


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. 31


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


2 FULL NAME


Etta May (Nickerson) Chase.


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


(a) Residence. No.


Couth Chatham Mass


St.


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In napitel nr Institutio


( Before death)


(Specify whether )


nursing home ... 5


months


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


( write the word)


MARRIED


WIOOWED


or DIVORCEQTidowed


50 If married, widowed, or divoroed HUSBAND of


(or) WIFE of Zebina


Give mand


maiden name of wife in full)


( Husband's name in full)


6 Age of husband or wife if eliva yaers


7 IF STILLBORN, enter that fact here.


8


AGE 84 Years


8


Months


1.3 Days


If less than 1 day


Hours


Minutes


Usuel


9 Occupetion :


retired


Industry


housewife


10 or Business:


11 Social Security No.


none


Chatham


12 BIRTHPLACE (City)


( State or country)


Mas's.


13 NAME OF


FATHER


Darius Nickerson


14 BIRTHPLACE OF


FATHER (City)


Harwich


( State or country)


Mass.


15 MAIOEN NAME


OF MOTHER


Esther Ireland


16 BIRTHPLACE OF


Harwich


MOTHER (City)


(State or country)


Mass.


17 Preston .... L ....... Chase ..


Reistion, if any


Informant ( Address) 270 Winthrop St Winthrop


I HEREBY CERTIFY that a satisfactory standard oartifioata of death was filed with me BEFORE the burla or tragalt permit was Issued : Walter P- paket


(Signature of Agent af Board of Healthght other) 1 Health officer 2/3/47


(Oficial Dealgnation)


(Date of True of Permit) :,


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


February ..


20


.1.9.4.7


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


Dec


29, 1946, to.


Feb. 2


That I attended deosased from


19.


47


I last saw h.


....


allve on ...


7 cb


1


1947


death Is sald to


heve oocurred on the dete stated above, at


/ A


m.


Immediate oouse of death.


Chronic Myeconditii ......


Que to


Que to.


Other conditiona


Senility


( Inelude pregnancy within 3 months of death)


IMPORTANT


Physician


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


20 Was disease or injury in any way related to occupation of deceased ? 200


...


=


Louis 7 Salerno


(Signed)


1125 Pleasant St Date Feb 3 1947


. M. D.


21 Evergreen Cemetery E. Harwich Piace of Burial, Cremation or Removal. (City or Town) mass.


Don.


DATE OF BURIAL.


Feb .... 4,1947


19 ..


22 NAME OF


FUNERAL DIRECTOR


174


Winthrop St, Winthrop


alfred & March


ADORESS


Received and Alled


F.E.B.7. 1947


19


( Registrar)


If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physiolans to insert a reoltal to that effect.


100m(i).1.44.13634


IM R-301 A


should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain


extracts from the laws on back of certificate.


PARENTS


Major findings :


Of operations


Date of


Of autopsy


Whet test confirmed diagnosis ?.


Duration


IMPORTANT 1 45.


3 qu


female


white


South Chatham Lass


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO


Registared No.


No.


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 family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 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- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, 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 he 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 hury or otherwise dispose of a human hody 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 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 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, 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, 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 hody has been sooner obtained hereunder. If the death certificate contains a recital, as required


by section ten of chapter forty-six, that the deceased served in the army, 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 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 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 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 form 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 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 hy 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


RM R-303-A


PLACE OF DEATH Suffolk (County) Winthrop mass 3/11/


Silen notified


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Registered No.


32.


a hospit l or institution,


give ics NAME instead of street and number)


O' Connell


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


St.


...


(If nonresident, give city or town and State)


months


days.


In this community


yTs.


mos.


daye.


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


( Month)


4


1947


(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.)


20 Accident, sulolde, or homloide (specify)


Date of ooourrenoe.


19


Where did Injury ooour?


(City or town and State)


Did Injury ooour In or about 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?


21 Was disease or Injury In any way related to occupation of deceased ?


If so, speolfy


anmm


M. D.


(Signed)


(Address)


25 pharma 200


Date 2/5147


Salem


22


St. Mary's


Place of Burial, Cremation or Removal.


(City or Town)


Relation, if any


DATE OF BURIAL


Yet ?


1947


Informant ....


1/1 Blacauf & Wife


I HEREBY CEATIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or trausit permit was Issued : Affalter A paul Signature of Agent of Board of Health or other)


2/5/47


/dmcial Designation) (Date of Issue of Permity


(write the word)


married


6 Age of husband or wife If allve


60


years


If less than 1 day


Hours.


Minutes


1


No.


2 FULL NAME


(a) Residence. No.


12 Brann AT


(Usual place of abode)


Length of stay: In hospital or Institution.


( Before death)


( Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


male


4 COLOR OR RACEİ


white


Sa It married, widowed, or divorced clic Leary


HUSBAND of


(or) WIFE of


(Give maiden name of wife in fullof


(Husband's name in full)


7 IF STILLBORN, enter that fact here.


8


70


Years


Months


Days


Usual


Danvers Stata Hospital


9 Occupation :


Industry


10 or Business :


Retired 1-1946


11 Soolal Security No ..


12 BIRTHPLACE (City)


(State or country)


Peabody mass


14 BIRTHPLACE OF


Ireland


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Mary & Sullivan


16 BIRTHPLACE OF


PARENTS


MOTHER (City)


Ireland


(State or country)


17


mis O' Connell


extracts from the laws relative to the return of certificates of death.


If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotlon 10, requires physicians to Insert a recital to that effeot




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