USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 37
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RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of tbe following rules of practice:
(1) Attending physicians will certify to such deatbs 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 pby- 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, 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 bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION. AND OUTFIT
SERVICE NUMBER
R-302
1
PLACE OF DEATH
Suffolk (County)
Revere
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.
1.08
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Alice E. Bernier (Belcher)
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
15 Ingleside Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
yeare
In this community
yrs.
mos
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
DEATH
May
23,
1947
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Waldove gaidengensff reein full)
(Husband's name in full)
have occurred on the date steted above, at.
7:00P
m.
Duration
Immedlate cause of death
Uremic Coma
2 .... Days
8
AGE ... 32.
.Yoors
6
Months.
10 Days
if less than 1 day
.. Hours ............ Minutes
Usual
9 Ocoupation :
Housewife
industry
10 or Business:
At Home
11 Social Seourity No.
023-09-3748
12 BIRTHPLACE (City)
(State or country)
Winthrop
Mass.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations
No
Date of
should be charged sta- tistically.
What test confirmed diagnosis Clinical ..... Signs. 20 Was disease or Injury In any way related to occupation of deceased ?
NO
If so, spoolfy
(Signed)
James .... F ...... Burns
M. D.
(Address)
Everett
Date 5/23 19 47
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery>
(City or Town) 19.4 7 ....
informant.
(Address)
15 Ingleside Ave. Winthrop
A TRUE COPY. ATTEST :
DATE FILED
(Registrar of city or town where death occurred)
May
27,
19
47
18 DATE OF
19 | HEREBY CERTIFY,
.March ... 1.5 ..... ,
1947
to ..
May
2.3
Thet i attended deceased from
19.
47
I last saw h ..
er
.. allve on.
May
23
.. , 19 ...
4.7death is said to
6 Age of husband or wife If ailve
36
years
Due to
Nephritis
Monthg
Due to
Diabetes
Years
Physician Underline the cause to which death
13 NAME OF
FATHER
Harold P. Belcher
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Winthrop
(State or country)
Mass
15 MAIDEN NAME
OF MOTHER
Margery Joy
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Mass.
17 Margery Belcher
DATE OF BURIAL
May
2.6.,
22 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop, Masg.
JUN 5 1947
Received end filed
(Registrar of City of Town where deceased resided)
30m . (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 of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
No.
(City or Town) Grover Manor Hospital
(if U. S.
War Veteran,
specify WAR)
Winthrop
(Usual place of abode)
Hogp.
2
months
days.
32
MARRIEMarried
WIDOWED
or DIVORCED
7 IF STILLBORN, enter that fect here.
Of autopsy
No
-301 A
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, Q. L. Chap. 46, Seotion 10, requires physicians to insert a recital to that effeot.
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 26 Faun Bar 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 Registared No. 109. ....
{ (If death occurred in a hospital or institution, St ( give its NAME instead of street and numher)
2 FULL NAME
Mae osgood Barker
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Rasidenca. No.
26 Faun Bar Ave.,
(Usual place of abode)
(If nonresident, give city or town and State)
Langth of stay : In nnsottat nr Institution
( Before death)
years
months days.
In this community
yra.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACEI
5 SINGLE
( write the word)
Female White
MARRIED
WIDOWED
or DIVORCED Widow
5a If married, widowad, or divorced
HUSBAND of
(Give maiden name of wife in full )
(or) WIFE of
Richard A. Barker
( Husband's name in full)
6 Age of husband or wife if aliva yaars
7 IF STILLBORN, enter that fact here.
8 AGE 26 Years 6 Monthe 20 Days
If lese than 1 day
Hours
Minutas
Usuel
9 Occuoetion:
Housewife
Industry
10 or Business :
At .... Home
11 Social Security No.
12 BIRTHPLACE (City)
( Siste or country)
Maine
13 NAME OF
FATHER
Forest Osgood
14 BIRTHPLACE OF
FATHER (Chy)
Prentiss
( State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Robena Boyington
16 BIRTHPLACE OF
Prentiss
MOTHER (Clty)
(State or country)
Maine
17 Informant ( Addrese)
Barker. Payne Winthrop
Relation, If any Daughter ...
I HEREBY CERTIFY that a setisfactory standard oartifioata of daath wss fled with me BEFORE the burjal or branelt permit was Issued :
(Slenature of agent ." Board of Hefith nr other ) ) tealle offices 5/26
( Date of Imme of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
27
1947
( Month)
( Day)
(Year)
19 IHEREBY CERTIFY,
That 1 attendad deosesad from
1915
may 27
Ło
19
47
I last saw h.
.. alive on
May 27
19:47
daath Is said to
hava occurred on tha date statad above, at
8.30
Immediata causa of death.
8:3= inte
IMPORTANT
- yrs
Due to
Dua to
Other conditiona
( Include pregnancy within 3 months of death)
Major findings :
Of operations
Data of
Of autopsy
What test confirmed diagnosle?
20 Was disease or injury in any way related to oooupation of deocased ? 120
If so, spoolfy.
( Signed)
305 Heures Sposta.
Date
=
M. D.
( Address)
21
Corinna
Corinna
Maine
(City or Town )
Place of Burial, Cremation or Removal.
DATE OF BURIAL
May 31, 1947
19
22 NAME OF
FUNERAL DIRECTOR
Richard H. White
ADDRESS
147 Winthrop. St., Winthrop ...
Received and flad
JUN 6 1947
19
( Registrar)
100m(1) 1.44 13634
(Oficial Designation)
IMPORTANT
Physician Underline the cause to which death should be charged s.t. tistically.
PARENTS
1
No.
( Specify whether)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
5
Duration
Prentiss
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 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 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 hody and remove it from a town, from one cemetery to another, or from one grave or tomh 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 he 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 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, 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 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
A R-302
2 FULL NAME
Baby Maskell
(a) Residenoo. No.
29 Cora
(Usual place of abode)
3 SEX
Male
4 COLOR OR RACE!
White
.
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve
8
AGE ......
Years
Uwal
9 Occupation :
Industry
10 or Business :
11 Social Security No ....
Melrose
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Arthur M. Maskell
14 BIRTHPLACE OF
FATHER (City)
Winthrop
15 MAIDEN NAME
OF MOTHER
Marion Thompson
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Mass.
17
Arthur Maskell
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-802 to the clerk
(State or country)
Mass.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May 27 1947
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19
to
19.
I last saw h
.alive on
19
death Is said to
have occurred on the date stated above, at
m.
Duration
Immediate cause of death
Stillborn
Toxemia of mother
24-48
hrs
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
should be charged sta- istically.
What test confirmed dlagnosis ?
Clinical
20 Was disease or Injury In any way related to oooupation of deceased?
If so, spoolfy
R. W. Layton
(Signed)
M. D.
(Address)
Melrose Mass.
Date
51.27 19 47
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
May 28, 1947
(City or Town)
19
A TRUE COPY.
Raymond If. Previous
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
May 27, 1947
.19
mary
(City or town making return)
1
PLACE OF DEATH
Middlesex
(County)
Melrose
(City or Town)
Melrose Hospital
No.
St.
(If death occurred in a hospital or institution,
...... give its NAME instead of street and number)
Jar u. s.
war Veteran,
speolfy WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
Winthrop
(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
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Single
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
years
7 IF STILLBORN, enter that fact here.
STILLBORN
.. Months - ... Days - If less than 1 day .Hours. Minutes Due to.
Informant
(Address)
29 Cora St., Winthrop
Relation, if any
father
22 NAME OF
Alfred B. March
FUNERAL DIRECTOR
ADDRESS
Winthrop. Mass ..
Received and filed JUN 4 1947 19
(Registrar of City or Town where deceased resided)
50m. (b).6.44.14607
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Melrose
Registered No.
110
Of autopsy
Physician Underline the cause to which death
Due to.
RM R-302 +
1
1
No.
2 FULL NAME
Baby Girl Morrissey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
101 Almont St.
(Usual place of abode)
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.hospital
years
months
days.
In this community
yrs.
mos.
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
April
17,
1947
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw h.
alive on
19
death is sald to
have occurred on the date stated above, at
m.
Duration
Immediate cause of death.
Anencephalia
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Physician Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis?
20 Was disease or Injury In any way related to oooupatlon of deceased? If so, speolfy
(Signed)
Abraham Ceinsburg
(Address) 16 Iclean St. Bos Date
M. D.
4/199
47
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Wint rop
Mint-ro
DATE OF BURIAL
(Cemetery) 12×17
(City or Towv)
1947
22 NAME OF
FUNERAL DIRECTOR
Frederick .... J ......... jagrath
ADDRESS
Tat Boston
Reoelved and filed JUL 7 1947 19
(Registrar of Clty or Town where deceased resided)
50m (c)-1-41-4667
3 SEX (or) WIFE of Usual 9 Occupation : PARENTS 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 shonid 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 or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD Industry 10 or Business :
PLACE OF DEATH
Suffolk (County)
Chelsea (City or Town) Chelsea Memorial Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
2141
-
5
(If death occurred in a hospital or institution,
St.
¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
Female
White
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
Stillborn
8
AGE
Years
Months.
Days
If less than 1 day Hours Minutes
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
Chelsea
Mass
13 NAME OF
FATHER
James J. Morrissey
14 BIRTHPLACE OF
FATHER (City)
Roxbury
(State or country)
Mass,
15 MAIDEN NAME
OF MOTHER
Bernice F. Hill
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
East Boston
Mass
17 Informant. James J. Morrissey . ( Address) 101 Almant St, Winthrop
A TRUE COPY.
ATTEST:
Joseph 4. Tyrrell
(Registrar of city or town wlicre death occurred)
DATE FILED 19
Of autopsy
صددى
RM R-302
1
Boston
(City or Town)
Infant's 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.
48972
(If death occurred in a hospital or institution,
St.
give ite NAME instead of street and number)
2 FULL NAME
John M Harber
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
19 Buckthorn Terrace
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
years
months
1
days.
In this community
yre.
moe.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband'e name in full)
6 Age of husbend or wife If ailve
years
7 IF STILLBORN, enter that fact here.
8 AGE Years Months.
3
Days
If less than 1 day Hours .Minutos
Usual
9 Occupation :
Industry
10 or Business:
11 Soolai Security No ..
12 BIRTHPLACE (City)
(State or country )
Winthrop Mass
13 NAME OF
FATHER
Ralph F Harber
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass.
15 MAIDEN NAME
OF MOTHER
Kathleen F Shea
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cambridge Mass.
17 Informe ( Address)
Rather
Reiation, if any
A TRUE COPY ATTEST :
(Registrar of city or town where death occurred) May 29/47 19
DATE FILED
18 DATE OF
DEATH
May 26/47
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
M.a.y .... 2.5
19
.47to
That I attended deceased
May 269
I last saw h ....... jm .... allve on.
May.26
19 .... 47 death Is sald to
have ocourred on the date stated above, at
9:35AM
m.
Immediate cause of death
Congenital ht.disease
Duration 3 Days
Due to
Due to ..
Other conditions
(Inciude pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Physician Underiine the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury in any way related to oooupation of deceased?
If so, specify
No
(Signed)
F.Moll
M. D.
(Address) 3.00 .... Longwood ...
... Avenue Date.
5-26 -47
21 PLACE OF BURIAL,
CREMATION OR REMWinthrop Cem-Winthrop Mass.
(Cemetery
(City or Town)
DATE OF BURIAL
May 27/47
19
22 NAME OF
FUNERAL DIRECTOR
JF O'Maley
ADDRESS
Winthrop Mass.
Received and flied
19
( Registrar of City or Town where deceased resided)
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-308 to the clerk
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