Town of Winthrop : Record of Deaths 1947, Part 32

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 32


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 or 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 be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, hc 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 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


I


M R-302


SUFFOLK


BOSTON


(City or Town)


No.


NE Baptist Hospital


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.


4206 92


(If death occurred in a hospital or institution,


St.


give its NAME instead of street and number)


Ina B Mason


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


583


Shirley


Winthrop Mass.


St.


(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)


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


May 4/47


(Day)


(Year)


19 | HEREBY CERTIFY,


March .... 12 .. , 19.


4.7.


to


That I attended deceased from


May 4


19


47


I last saw h ........ ex .. allve on


May 4


19.47 death is said to


have ooourred on the date stated above, at.


5 PM


.. m.


Duration


Immedlate oause of death


Metastatic carcinomatosis


7 IF STILLBORN, enter that faot here.


8 AGE 54 Years 5 Months. Days


16


If less than 1 day


Hours.


Minutos


Registered Nurse


Private


None


12 BIRTHPLACE (City)


(State or country)


Fabnico N.S.


Locke A Larkin


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Nova Scotia


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Nova Scotia


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


Husband


Michael Planning


(Registrar of city or town where death occurred)


DATE FILED May ..... 7. .19 47


21 PLACE OF BURIAL,


Jaurel Hill Com-Pubnico N.S.


CREMATION OR REMOV


(Cemot


May 18/47


(City or Town)


19


DATE OF BURIAL


22 NAME OF


FUNERAL DIRECTOR


W C Goodrich


ADDRESS


Lynn Mass.


Reoelved and filed MAY 1-2-1947


19


(Reglatrar of City or Town where deceased resided)


7 Mos. ...


Due to


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations.


Inoperable .... carcinoma


of ..... stomach


Date of


3-14-47


Of autopsy


What test confirmed diagnosis?


20 Was disease or Injury In any way related to occupation of deocased ?


If so, spoolfy


N W Swinton


(Signed)


M. P


(Address)


Lahey Clinic Boston, 5-4


19.


Relation, if any


1


2 FULL NAME 3 SEX F Usual 9 Occupation : Industry 10 or Business: 13 NAME OF FATHER 15 MAIDEN NAME OF MOTHER PARENTS 17 Informant (Address) of the city or town in which the deceased resided. (See Chap. 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-308 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city of town in case the deceased 11 Soolal Security No.


4 COLOR OR RACE|


W


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


5a If married, widowed, or divoroed HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Allen.Mason ..


(Husband'a name in full)


6 Age of husband or wife If allve 67


years


(If U. S.


War Veteran,


specify WAR)


months


2


days.


4


In this community


yrs.


mos.


2


4


days.


years


PLACE OF DEATH


Alicia E Brand


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


Dua to


Carcinoma of stomach


301


Suffolk


(County) . Winthrop


(City or Town) 81 Sunnyside Ave.


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


(City or town making return)


St.


Emma L (Wilson) Tewksbury


a FULL NAME


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


81 Sunnyside Ave.


St.


(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


48 11.


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 Married


(Month)


(Day)


(Year)


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


(Husband's name in full)


years


7 IF STILLBORN, enter that fact here.


AGE


8


56


Years


5


Montha.


9 Days


If less than 1 day


Hours


Minutes


Usual


9 Occupation :


Housewife


Industry


At Home


10 or Business:


11 Social Security No.


None


12 BIRTHPLACE (City)


East Boston


(State or country)


Mass.


13 NAME OF


FATHER


Charles Wilson


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Norway


15 MAIDEN NAME


OF MOTHER


Emma Anderson


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Sweeden


17 Myron W Tewksbury


Informant


(Addrea)


81 Sunnyside Ave. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was fied with me BEFORE the burial of traneit permit was lasued:


(Signature of Ageof of Board of Health or other) Health Effects 5/6,47


(Jaclal Designation)- (Date of Isine of Permit)/


Major findings:


Of operations


Date 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)


For Short Drie


Date.


5/3


M. D.


1947


21 winthrop


winthrop


Place of Burial, Cremation or Removal.


DATE OF BURIAL


May


6 (Clty or Town) 47


22 NAME OF


Haward SOhunolds


FUNERAL DIRECTOR ADDRESS


Received and filed MAY 1 7 1947


19


(Registrar)


A TRUE COPY ATTEST:


+ years


Other conditions.


Diabetes mellitus


(Include pregnancy within 3 months of death)


Duration IMPORTANT 6 moins


Due to.


generalized arterio -


3 years


Due to.


I last saw bin


alive on Mang Ya, 1947, death is said to


have occurred on the date stated above, at


12 11-12 M.


Immediate cause of death. Verprosdevous and Wiener


19 I HEREBY CERTIFY, That I attended deceased from


to


19×7


6 Age of husband or wife if alive.


59


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


from the laws on back of certificate.


100m- (1)-1.45.15510


PLACE OF DEATH.


No.


[ give its NAME instead of street and number)


PHYSICIAN-IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No.


(Usual place of abode)


18 DATE OF


DEATH


may 4th


19:7


§ (If death occurred in a hospital or institution,


Registrar's No.


93


(Address)


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 otber authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest of his knowledge and helief 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 bis last illness, wben 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 bundred 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 iu the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth 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, sucb 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 bundred and ninety-eigbt and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until be has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such hoard, from tbe clerk of the town where the person died; and 110 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, bis certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- cian wbo is a member of the board of health, or employed by it or by the selectmen for the purpose, sball 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 sball 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 ien 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 ageut, 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 registar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners sball 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 witbin bis 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 pby- sician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deatbs following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, aspbyxia, 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 heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wbose only occupation was that of home housework, write bousework. 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


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


M R-302


1. ORCESTER


(County)


RUTLAND


(City or Town)


No. Jewish Buberculosis Sanatorium


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


2 FULL NAME ..


Frank C.Fish


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


25 Perkins St.


St.


Winthrop .lass.


(a) Residence. No.


(Usual place of abode)


Sanatorium


Length of stay: In hospital or Institution ..


(Before death)


(Specify whether)


years O


months


19 days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


5


1947


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


April 17


19.4.7 ..... to.


That I attended deocased from


1947


I last saw h.


im


alive on


192 .. 7 ... , death is sald to


have occurred on the date stated above, at


11 : 10 P .Im


Duration


Immediate cause of death Chronic pulmonary tuberculosis


5 years


Due to.


Emphysema . pulmonary


Due to ..


Arteriosclerosis


Congestive heart failure


Other conditions.


(Include pregnancy within 3 months of death)


Physician


Underline the cause to


which death


Date of


should be


charged sta-


tistically.


What test confirmed diagnosis ?.


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


If so, specify


otto stern


M. D.


(Address)


21 PLACE OF BURIAL,


Hillside, Lastport, Me.


CREMATION OR REMOVAL


Jay Cemetery ?) 47


(City or Town) 19


22 NAME OF


FUNERAL DIRECTOR.


Frank N.files Co.


ADDRESS


efferson , fass.


Reoelved and flied


JUN 4 1947


... 19


(Registrar of City or Town where deceased resided)


50m. (b) .6.44-14607


A TRUE COPY.


ATTEST :


Frances . Hanff.


(Registrar of,city of Losyn where death occhired)


DATE FILED


way 7,


19


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Single


HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


6 Age of husband or wife If alive years


If less than 1 day .Hours Minutos


11 Soolai Security No ..


104 30 5577


12 BIRTHPLACE (City)


(State or country)


England


13 NAME OF


FATHER


John Fish


15 MAIDEN NAME


OF MOTHER


Rebecca Tinker


16 BIRTHPLACE OF


MOTHER (City)


campobello


(State or country)


New Brunswick


17


Hospital Records


(


Relation, if any


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


RULAND


(City or town making return)


CERTIFICATE OF DEATH


Registered No.


94


1


PLACE OF DEATH


3 SEX


lale


4 COLOR OR RACE|


White


5a If married, widowed, or divoroed


(or) WIFE of


7 IF STILLBORN, enter that fact here.


8


68


AGE


Years


7


Months


28


Days


Usuai


9 Oooupation :


Mechanic


Industry


10 or Business:


London


14 BIRTHPLACE OF


FATHER (City)


London


PARENTS


Informant


(Address)


of the city or town in which the deceased resided. (See Chap. 16, Sec. 12, G. L.)


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk


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


(State or country)


England


Major findings :


Of operations


Of autopsy


(Signed)


Rutland , fass.


Date


5/5


19 47


DATE OF BURIAL


(If U. S.


War Veteran,


speolfy WAR)


(If nonresident, give city or town and State)


Lay


5


ء


1


M R-302


2 FULL NAME


3 SEX


M


(or) WIFE of


AGE 65


Years


Usual


9 Occupation :


Industry


10 or Business:


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


14 BIRTHPLACE OF


FATHER (City)


15 MAIDEN NAME


OF MOTHER


PARENTS


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17


Informant


(Address)


of the city or town in which the deceased resided. (See Chap. 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-802 to the clerk


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


(State or country)


4 COLOR OR RACE


W


MARRIED


WIDOWED


or DIVORCED


Single


1


5% If married, widowed, or divoroed


HUSBAND of


(Give maiden 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.


Months. Days


If less than 1 day .. Hours.


Minutes


Retired


Musician


Finland.


-- Kol jonen


Finland


-


Finland


Relation, if any


Mr.s.W ... Be(r.r. Daughter


A TROT


(Registrar or chly or town where death occurred)


DATE FILED


May 7/47 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


(Month)


Mav 5/47


(Day)


(Year)


19 | HEREBY CERTIFY,


Ápril .... 25 ... , 19 ..


.4.7 to.


Mey 5


That I attended deceased from


19.4.7


I last saw h ... er ...... alive on.


May .... 5/47.


., 19.


death la sald to


have occurred on the date stated above, at 6,55AM


Duration


Immediate oause of death


Peritonitis, acute generalized


Il Das.


Perforation of ulcer


Il Das. ...


Due to.


Due to


Ulcer,gastric


25 Yrs


Other conditions


(Include pregnancy within 3 months of death)


Physician


Underline the cause to which death 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


JS Lichty


(Signed)


Mass. eneral Hospt


"Date


5-5 47


19


CREMATION OR REMCOAL Hill Hanson Mass.


21 PLACE OF BURIAL,


DATE OF BURIAL


J J Shepherd & Sons Ino.


ADDRESS


Whitman Mass.


Reoelved and filed. MAY 1 21947 19


(Reglatrar of City or Town where deceased resided)


1


PLACE OF DEATH


SUFFOLK


(County) BOSTON


(City or Town)


No.


Boston State Hospt


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


BOSTON


(City or town making return)


42095


Registered No.


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


John Melillo


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


120 Herman


St.


Winthrop


888.


(a) Residence. No.


(Usual place of abode)


Length of stay : In hospital or Institution.


(Before death)


39 years 8 months24


days.


In this community


yrs.


mos.


days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


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


22 NAME OF


FUNERAL DIRECTOR


(Cemetery)/ May 8/47


(City or Town)


19


(Address)


Perforated gastric ulcer


Date


4-30-47


Major findings :


Of operations


5 SINGLE


(write the word)


(If U. S.


War Veteran,


speolfy WAR)


(If nonresident, give city or town and State)


R-301 A X


1


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town) 20 Neptune 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,


96


Registered No. { { {If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


2 FULL NAME


Mary A. Donahue Mc Carthy


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


(a) Residence. No.


20NeptuneAve


St.


(Usual place of abode)


( If nonresident, give clty or town and State)


Length of stay: In hospital or Institution


( Before death)


(Specify whether)


years


months


days.


In this community


45


yrs.


mos.


days.




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