Town of Winthrop : Record of Deaths 1947, Part 17

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 17


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).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87


(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, hut 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 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 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-302


Suffolk (County)


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


Revere


(City or town making return)


Registered No.


48


(If death occurred in a hospital or Institution,


give its NAME instead of atreet and number)


2 FULL NAME.


Mary C. Boris


(Callahan)


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


50 Pleasant



Winthrop


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution


(Before death)


Conv. Home


years


months


days.


In this community


yrs.


mos.


days.


(Specify whether)


8 Weeks


8 Weeks


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Femal


4 COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widow


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


Aug.


16


19 ..


to


46


That I attended


Feb.


24


deceased


19


I last saw h .... @T ...... allve on ..


Feb.


2.3 19.4.7, death Is sald to


have occurred on the date stated above,


8:00A


.m.


Duration


Immediate cause of death.


Chronic ... Rheumatic


Heart Disease


Due to ..


Due to.


Industry


Retired Housewife


10 or Business:


11 Soois! Security No .....


None


12 BIRTHPLACE (City)


(State or country)


Mass.


13 NAME OF


FATHER


Daniel Callahan


PARENTS


15 MAIDEN NAME


OF MOTHER


Catherine (Unknown)


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


17 D. Callahan


Informant


( Address)


B484HAY


50 Pleasant St. Winthrop


A TRUE Copy Left Shill


ATTEST :


(Registrar of city or town where death occurred)


Feb.


27


147


22 NAME OF


FUNERAL DIRECTOR


Kirby ... Bros


Winthrop


ADDRESS


Winthrop St.


MAR 7


19.47


19


(Registrar of City or Town where deceased reskled)


50m-(b).6.44-14607


of the city or town in which the deceased resided. (See Obap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased


1


Revere


(City or Town)


214 Endicott Ave.


St.


(If U. S.


War Veteran,


No


specify WAR)


(a) Residence. No.


(Usual place of abode)


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


Raphe live Bude name of wife in full)


(Husband's name in full)


6 Age of husband or wife If allve years


7 IF STILLBORN, enter that fact here.


AGE


8


: 86


Years


.Months.


Days


If less than 1 day Hours Minutes


Usual


9 Ocoupation :


At Home


Other conditions ... Senility


(Include pregnancy within 3 months of death)


Physiclan Underline the cause to


Mejor findings:


Of operations


which death


Date of


should be charged sta- tistically.


Of autopsy What test confirmed diagnosis? Clinical Signs 20 Was disease or Injury In any way related to occupation of deceased ?.


NO


If so, spoolfy


Daniel J. O'Brien


(Signed)


(Address)


Winthrop


Date


2/2519


....


M. D.


47


21 PLACE OF BURIAL,


CREMATION OR REMOVAL .


Winthrop Cem. Winthrop


(Cemetery)


(City or Town)


. DATE OF BURIAL


February


2.6


19


47


Received and filed.


DATE FILED


18 DATE OF


DEATH


February


24, 1947


40 Yrs.


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


Boston


PLACE OF DEATH


No.


RM R-302


1


PLACE OF DEATH


Suffolk (County) Boston


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.


18431 0


No.


(City or Town)


Peter Bent Brigham Hospital


St.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


Phillip Kaufman


2 FULL NAME.


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


(a) Residence. No.


54 Shore Drive


St.


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


years


monthal2


days .


In this community


yrs.


mos. 12 days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE|


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Married


5a If married, widowed, or divorced HUSBAND of


(or) WIFE of


(Husband's name in full)


70


6 Age of husband or wife If allve years


7 IF STILLBORN, enter that faot here.


8 AGE 73 Years Months. Days


If less than 1 day Hours .Minutes


Usual


9 Oooupation :


Merchant


Industry 10 or Business :


Groceries-Wholesale


11 Soolal Seourity No. None


Russia


12 BIRTHPLACE (City)


(State or country)


13 NAME OF FATHER Alfred Kaufman


14 BIRTHPLACE OF


Russia


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Elizabeth


Russia


17 Informant (Address)


A KaufmannRelationSonny


DATE OF BURIAL


Feb.25/47


Everett ... Mass. (City or Town) 19


22 NAME OF


FUNERAL DIRECTOR


Henry Levine


ADDRESS


Brookline Mass.


(Registrar of city or town where-death-cocufred)


DATE FILED


(


Feb. 27/47/


19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


Feb. 24/47


(Day)


(Year)


19 | HEREBY CERTIFY,


Feb/11/47


19.


to ..


That66 24947 eased from


19.


I last saw h ..... 1m .... allve on


Feb.24/47


19


death Is said to


4,25AM


m.


Duration


Immedlate oause of death. Arterio sclerotic heart disease


Yrs .....


o1d.


Cardiac infarct


otd.


Due toMural thrombus


Phlebothrombosis rt.leg


Dupulmonary embolism, bilateral


Other conditions.


(Include pregnancy within 3 months of death)


Physician Underline the cause to


Major findIngs :


Of operations


Date of


should be


charged sta- tistically.


Of autopsy What test confirmed diagnosis ?... autopsy ... 20 Was disease or Injury In any way related to oooupation of deceased ? NO.


If so, spoolfy


(Signed).


R.A ... Wilhelm


(Address) Peter B. Brigham Hosph. 2-24


19


M. 87


21 PLACE OF BURIAL fareth Israel of Winthrop,


CREMATION OR REMO


(Cemetery)


50m- (b) .6.44-14607


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk


Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased


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


PARENTS


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


A TRUE COPY.


ATTEST: Nicklas


Reoelved and filed


MAR 10 1947


19


(Registrar of City or Town where deceased resided)


(If U. S.


War Veteran,


speolfy WAR)


Winthrop Mass.


(Usual place of abode)


Lena Greenberg


(Give maiden name of wife in full)


have ooourred on the date stated above, at


F


which death


RM R-303-A


+ Julio. /(County)


1


Mutteroh


(City or Town)


No.


2 FULL NAME


(Usual place of abode)


Sinead upon assen


3 SEX


Female White


5a If marrled, widowed, or divoroed


HUSBAND of


(or) WIFE of


6 Age of husband or wife If allve


7 IF STILLBORN, enter that fact here.


8


AGE 62 Years


4


Months.


13 Days


Usual


9 Occupation :


10 or Business :


11 Soolal Security No.


12 BIRTHPLACE (City)


(State or country)


PARENTS


If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect


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


so that it may be properly classified under the International Classification of Causes of Death. See reverse side for


should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,


50m. (f)-6-43-12056


N. B .- WRITE PLAINLT, WITH ONFADING DLAGR INK-IMIS IS A PERMANENT RECORD. Every Tem er menteTion


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


4 COLOR OR RACE| 5 SINGLE


MARRIED


WIDOWED


or DIVORCED


Widowed


(Give maiden name of wife in full)


Condon


(Husband's name in full)


years


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


Howchuper


Industry


Private family


13 NAME OF


FATHER


Michael J. Riley


15 MAIDEN NAME


OF MOTHER


mary Cusack


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


17 Informant Russian Chiudere(raccolta" (1dilimen ) Lander ave Rara


I HEREBY CERTIFY that a satisfactorystandard certificate of death was filed with me BEFORE the burial or transit permit was Issued:


Healthe Officer 2/26/47


(Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY that I have Investigated the death


of the person above-named and that the CAUSE AND MANNER thereof


are as follows: (If an injury was involved, state fully.)


acute Cardiac Facture


Ceramic Myocarditis


20 Accident.


sulolde, or homioldo (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


Collapsed while walking.


Injury


Injury


Nature of


un street + died qui dle


While at work ?


Was there an autopsy ?.


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


If so, speolfy


The J. Trickley


M. D.


(Signed) ...


(Address)


Bonten


Joly 25€


19 47


22


Cedargrove


Peabody


Place of Burial, Gremation or Removal.


(City or Town)


Relation, IfAny


DATE OF BURIAL


Feb 28, 1947


19


23 NAME OF


FUNERAL DIRECTOR


Johan @ Donovan


ADDRESS


Reoolved and filed


MAR : 47


19


(Signature of Agent of Board of Health or other)


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


To be filed for burlal permit with Board of Health or Its Agent.


Registered No.


50-


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


ann Jane Condon


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


PHYSICIAN-IMPORTANT


(Was deceased a


U. S. War Veteran,


If so specify WAR).


(a) Residenoe.


No.


503 Central Str Sangues Ision


(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


(write the word)


18 DATE OF


DEATH


Jean- 25-1947


(Registrar)


PLACE OF DEATH


Mutterale Community (tropitalie


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medloal offioer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an undertsker or other authorized person or of any mieniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the naine of the deceased. his supposed age, the disease of which he died, defined as required by section one, where same was contracted. the duration of his last illness, when last seen slive by the physician or officer and the date of his death ... Gen. Laws, Chap. 16, 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 humired 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 engageil, tusert 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 immediste cause of death as nearly as he can state the sante. F'or 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 sectinns forty-five, forty-six and forty seven of said chapter one hundred and fourteen, the word "war" shall include the ('hina relief ex- pedition sud the Philippine insurrection, which shall, for ssid purposes, be deemeil to have taken place between Feliruary fourteentli, eighteen hundred and ninety-eiglit and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Cbap. 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 perinit froin the board of health, or ite 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 exhunre a human body and remove it from a town, from one cemetery to anotlier, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until be has received a permit from the board of health or its agent aforessid or from the clerk of the town where the liody 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 Isw. or in lieu thereof a certificste as hereinafter provided. If there is 10 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, sliall upon application make the certificate re- quired of the attending physician. If desth is caused by violence. the medical exsininer shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to an- other within the coninouwesith cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to inske 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 re- movsi, unless a permit in the ususl form for the reinoval of such body 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 sppesr upon the permit. The board of lrealth, or its sgent, upon receipt of such statement and certificate, shalt forthwith countersign it aml transmit it to the clerk of the towir 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 deceased, or as to the manner or cause of the death, which the clerk or registrar may re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary 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 front 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 boily is to be huricd or the funeral is to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the intermeut is niade. ... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).


Medical examiners shsll mske 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 hia 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.


. . He shall in all cases certify to the town clerk or registrar in' the place where the deceased died his name 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 certifies 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 any forin of injury.


(2) Board of Health physiclans 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 medicsl attendance or wbose physi- cian is absent from horne wlieu 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 deatby caused directly or in- directly by trauinatism (including resulting septicemia), and by the action of chemical (drugs or poisons). thermal, or electrical agents, and deaths following abortion, but siso desths from disease resulting from Injury or Infeotion related to occupation, the sudden deaths of persons not disabled by recognized disease, and linse 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 septicemia (gas bacillus) caused by a steam railway sccident." "Pistol shot wound of the chest with asso- cisted hemorrhage, hoinicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unknown."


If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause ita known or presuinable nsture; snd (2) uneler manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain ( hasal ganglia) (found dead in bed)." "IHeart disease, presumably coronary sclerosis. (Sudden death. )"


DESCRIPTION (for unknown person)


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


1


PLACE OF DEATH


Essex (County)


Danvers


(City or Town)


No.


Danvers State Hospital


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


Danvers


(City or town making return)


Registered No.


51


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


2 FULL NAME


Mary G. Mccarthy


(McCormick)


give its NAME instead of street and number)


7


(If U. S.


War Vataran,


speolfy WAR)


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


(a) Residanoa. No.


9] Lowell Ra


St.


Winthrop


Mass


(If nonresident, give city or town and State)


Langth of stay: In hospital or Institution


(Before death)


4


years


10monthe


10days.


In this community


yre.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


Female


4 COLOR OR RACE|


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Widowed


5a If marrlad, widowed, or divoroed HUSBAND of


(or) WIFE of


Dan i (Giye maiden, neme of wife in full)


(Husbend's name in full)


6 Age of husband or wifa If allve years


7 IF STILLBORN, entar that faot here.


8


AGE 74


Yaars


Months.


Days


If less than 1 day


.Hours


.Minutas


Usual


9 Occupation :


Housewife


Industry 10 or Business:


11 Soolal Security No .... o.n.e .::


Boston


12 BIRTHPLACE (City)


(State or country)


Mass


13 NAME OF


FATHER


Thomas McCormick


14 BIRTHPLACE OF


FATHER (City)


Halifax, N. D.


(State or country)


Canada


15 MAIDEN NAME


OF MOTHER


Jane Callahan


16 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


MASS


21 PLACE OF BURIAL,


CREMATION OR REMOVALOId Calvary


Boston


(Cemetery )


(City or Town)


DATE OF BURIAL February.


13


19.4.7 ..


22 NAME OF


FUNERAL DIRECTOR


Richard C. Kirby


ADDRESS


Boston, Mass


Reoelved and filed


MAR 1 2 1947


19


(Registrar of City or Town where deceased reelded)


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


Copies of returns of deaths recorded during the previous month which occurred in your city or town In case the deceased


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk


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


PARENTS


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


A TRUE COPY.


ATTEST :


(Registrar of city or town where death occurred)


DATE FILED


Feb.


1.9


19.4.7


18 DATE OF


DEATH


February


11


1.9.4.7


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


Feb


4


19 .... 46,


Teb ..


7.7


That I attanded daoaased from


... 194.7 ..


I last saw h ..


er .... allve on.


Feb.


.. 11.


.19 .. 4.7 daath Is sald to


have ooourred on the data stated above, at.


12.45 A. m.


Immedlate causa of death.


Arteriosclerotic heart disease


5y.r.s.


Due to.


Dua to.


Other conditions.


(Include pregnancy within 3 months of death)


Physician Underline the cause to which death


Major findinge:


Of operations


Date of


should be cherged sta- tietically.


What test confirmed diagnosis ?.


Clinical


20 Was disease or Injury In any way related to oooupation of daoeased ?


If so, speolfy


(Signed) ...... Francis .......... Sullivan


M. D.


(Address) Hathorne, Mass


Dato ..


/.21


19.47


17


Mary K.McPhillips ... (


Informant


(Address)


Hathorne Mass


Relation, if any


......


...........


(Usual place of abode)


(Specify whether)


Duration


Of autopsy


+


COPY OF CERTIFICATE OF DEATH


DEPARTMENT OF COMMERCE Bureau of the Census


STANDARD CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE


Town or City


Clerk's No.


52.


FULL NAME


1. PLACE OF DEATH:


(a) County


Cheshire


(b) City or town


Keene


(c) Name of hospital or institution:


Elliot Community Hospital


(If not in hospital or institution write street number or location)


(d) Length of stay:


Few Hours


In hospital or institution


(Specify whether years, months or days)


Few Days


In this community


(Specify whether years, months or days)


3. (a) If veteran, name war


(b) Social Security No.


4. Sex


Female


5. Color or race|


Whi te


6. (a) Single, widowed,


21. I HEREBY CERTIFY that I attended the deceased from


19.


married, divorced


Wid owed


19


to


.....;


6. (b) Name of husband or wife:


James Edward Thompson


(Full name-Maiden name. if wife)


6. (c) Age of husband or wife, if alive


years


7. Birth date of deceased


February


28


1875


(Month)


(Day)


(Year)


8. AGE: Years|Months


72


0


Days


0


If less than one day


hrs.


min.


9. Birthplace


Cambridge


Massachusetts


(City, Town. or County)


(State or Foreign Country)


10. Usual occupation


At Home


11. Industry or business


-


12. Name


Alfred George Austin


FATHER


13. Birthplace


Oxford


England


(City, Town, or County) (State or Foreign Country)


14. Maiden name Sarah Margetts


15. Birthplace Woodstock, Ungland


(City. Town, or County) (State or Foreign Country) 16. (a) Informant's own signature .Mr.s .... Lucille Smitho.




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