USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 56
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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 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 suchi 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
4
M R-303-A
PLACE OF DEATH
Suffolk (County) Winthrop (City or Towp) No. 254 Main St
The Commontoralth 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.
162
St. { { If death occurred in a hospital or institution, { give its NAME instead of street and number)
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
(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
yTs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
single
(write the word)
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.
8
AGE
Years
4
Months
Days
If less than 1 day
Hours ........
.Minutes
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Hyman Bargar
14 BIRTHPLACE OF
Chelsea
(State or country)
Mass,
15 MAIDEN NAME
OF MOTHER
Dorothy Weinstein
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
( \ditreKn)
254 Main St-Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was flied with me BEFORE the bydal of Vansit permit was issued ; Haller L' Bakery
(Signature of Agent of Board of wealth or other) Healther Officer 8/25/47
(Official Dealgnation) (Date of Issue of Permit) :
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
august-24-1947
( 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.)
20 Accident, sulolde, or homlolde (specify).
Prosemath Suicidal
Date of occurrence.
aug -24-
.......
1947
Where did
Winthrop
Injury ooour?
(City or town and State)
Did Injury occur in or about home, on farm, In Industrial place, or in publio
place?
Injury
· Found dead in a gas eller
(Specify type of place)
Manner of
.
Nature of
Room at her turne
Injury
While at work?
Was there an autopsy?
200
21 Was disease or Injury in any way related to occupation of deceased ?
If so, speolfy
(Signed)
M. D.
(Address)
Bustin
22 Ahavas Achim Anshe Sfaard, Lynn.
Place of Burial, Cremation or Removal.
(City or Town)
August 25, 19 47
DATE OF BURIAL
23 NAME OF
Beni 7. Solomon.
FUNERAL DIRECTOR
ADDRESS
4.20
Harvard St-Brookline.
Received and filed.
AUG 26- 194 .........
19
(Registrar)
A
50m . (f) .6.43-12056
Cynthia
Barges
(If deceased is a married, widowed or divorced woman, give also maiden name.)
254 Main St. Withrob
Ist.
1
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
3 SEX
4 COLOR OR RACE
female
white
Sa If married, widowed, or divorced
(or) WIFE of
18
8
Industry
B.U.
10 or Business :
11 Soolal Security No ..
FATHER (City)
PARENTS
17
Informant.Lyman Bargar
If deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to Insert a reoltal to that effeot
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,
Usual
9 Occupation :
Student
Boston,
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 whoin he has attended during his last illness, at the request of an umlertaker 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 bis knowledge and belief the name of the deceward, his supposed age, the disease of which he died, defined as required by section one, where sume was contracted. the duration of his last illness, when last seen alive by the physician or officer aud 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 humlred 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 "wer" shall inclinie the China relief ex- pedition and the l'hilippine insurrection, which shall, for said purposea, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight 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 iu 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 ita 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 be 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 aball have lieen 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 nieinber 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 atterling physician. If death is caused by violence, the medical examiner shall make such certificate. If auch a permit for the removal of a human body, not previously interred, from one town to an- other within the coninionwealth cannot be obtained early enough for the purpose, the certificate of death made ss above provided and in the pos- session of the undertaker desiring to inake 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- moval, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased aerved in the ariny, navy or marine corps of the United States in any war in which
it has been engaged, such reeital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certifcate, shall forthwith countersign it amt 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 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 ur other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until lie 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 burial ground in which the intermeut is niade. ... Chap. 114, Sec. 46, G. L., (Terceutenary Edi- tion).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to liave 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 body liea 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 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 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 illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deatha only aa those of persons wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent inedical attendance or wbose physi- cian is absent from horne when the certificate of death ia 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 trauinatism (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 Infeotion 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 wlien these are known. For example: "Com- pound fracture of tbe femur with ensuing septicemia (gas bacillus) caused by a steam railway accident." "Pistol shot wound of the chest with asso- ciated 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 unkuuwn."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify : (1) Under cause its known or presumahle nature; and (2) umler manner, indicate the circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal ganglia) (found dead in bed)." "Heart 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
M R-302
cvpiva vi returns of deathe recorded during the previous month which gecuffed if your city of town In case the accesstu 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.)
1
St. ( If death occurred in a hospital or Institution, give ite NAME instead of street and number)
2 FULL NAME
Augustus D. Arnaud
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
52 Brookfield 2d. Winthrop st.
(Usual place of abode)
Length of stay: In hospital or Institution Hospital
3
months
19 daye.
years
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
W
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divoroed
HUSBAND of
Mary ..........
LeBlanc
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
8 AGE .... 8.4 .. Years. Months ..... Days
If less than 1 day
.Hours.
.....
Minutes
Usual
9 Ocoupation :
Paper ..... Han.ge.r.
Industry
10 or Business :
Paper
11 Soolal Seourity No ..
12 BIRTHPLACE (City)
(State or country)
Bordeaux, France
Major findings:
Of operations
Date of
Underline the cauee to which death should be charged sta- tletically.
Of autopsy
Abox e
What test confirmed diagnosis?
20 Was disease or Injury In any way related to oooupation of deceased ?........ O
(Signed)
If so, speolfy
F. I. Landrigan
M. D.
(Address)
Holy Ghost Hosp.
0 8/27/1997
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Winthrop
winthrop
(Cemetery)
(City or Town)
194.7
A TRUE COPY.
Frederick H. Burke
ATTEST :
(Registrar
Aus ogty or town where death occurred)
19
18 DATE OF
DEATH
August 27 1947
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFY,
That I attended deceased from
May ..... B ...
19.4.7 ....
to ................ 2.7 ..
19.4 .. 7 ....
I last saw h Im alive on aug. 27,
, 19±.7 .. , death Is sald to
have ooourred on the date stated above, at .. 1.3.0 .... P.
.. m.
Duration
Immedlate cause of death.
Broncho Pneumonia
& days
Due to ..
Portal Cirrhosis of Liver
8 yrs
Due to.
Other conditions Carcinoma of Prostate Physch (Include pregnancy within 3 months of death) Generalized Arterio Sclerosis
13 NAME OF
FATHER
Cannot be learned
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
France
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
France
17 MaryZ. Shaw Informant
(Address)
52 Brookfield 2d.,
Relation,,If
iny
DATE OF BURIAL
....
Jugus.t ..... 30 ...
22 NAME OF
FUNERAL DIRECTOR
John F. O'Maley
ADDRESS
Winthrop
Reoelved and filed
SEP 2 -1947
19
(Registrar of City or Town where deceased reskdled)
50m- (b) .6.44-14607
1
PLACE OF DEATH
Middlesex
(County)
Cambridge (City or Town)
No. Holy Ghost Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bal
V
Cambridge (City or town making return) 168
Registered No. 1.2.5.8:
(If U. S.
War Veteran,
speolfy WAR)
(If nonreeldent, give city or town and State)
In this community 40 yrs.
mos.
days.
DATE FILED
5 SINGLE
(write the word)
Wid.
(Give maiden name of wife in full)
RECEIVE
-
0
ji 17. 1
1.
1
200
6
THROP
SEP2 1047 AM
-
-
1
RM R-302
3 SEX Male (or) WIFE of AGE 66 PARENTS Informant .... (Addrees) .... IS PLAINLY, WITH ONFADING BLACK INK - THIS IS A PERMANENT RECORD Industry 10 or Business:
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-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
PLACE OF DEATH
Essex (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers
(City or town making return)
1 CERTIFICATE OF DEATH Danvers (City or Town) Danvers State Hospital , Hathorne, MasSS (If death occurred in a hospital or institution, No.
give ite NAME instead of street and number)
Samuel Levy
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
53 Trident Ave. , Winthrop, Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ...
(Before death)
(Specify whether)
......
years 8 monthe 24 days.
In this community
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
.2.3
1947
(Year)
5a If married, widowed, or dlvoroed Freda Scwarm
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If allve .
.....
63.
...
years
7 IF STILLBORN, enter that faot here.
Years Months. .Days
If less than 1 day .Hours. Minutes
Usual
9 Ocoupation :
Tailor (Retired)
11 Soolal Security No .....
Cannot be learned
12 BIRTHPLACE (City)
(State or country)
Poland
13 NAME OF
FATHER
Samuel Levy
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
15 MAIDEN NAME
OF MOTHER
Bertha (Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Poland
17 Mary K. McPhillips Relation, If any
Hathorne Mass.
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED September 16 19 47
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
( Month)
(Day)
That I attended deceased from
19.| HEREBY CERTIFY, Nov. 30
19 46
to
Aug ........ 2.3
19 47
1 last saw h ... ].m ..... allve on
Aug
23, 19 47death is said to
have occurred on the date stated above, at
10: 05.
.am.
Duration
Immedlate cause of death Bronchopneumonia
2 .... days
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be charged sta- tistically. nọ
What test confirmed diagnosis ?.
Clinical
20 Was disease or Injury in any way related to oooupation of deopased ?.
If so, speolfy.
Francis X. Sullivan
M. D.
(Signed)
(Address)
Hathorne, Mass. Date 9/12 1947
21 PLACE OF BURIAL,Abiamson Cem. W. Roxbury CREMATION OR REMOVAL (Cemetery ) (City or Town)
DATE OF BURIAL
August ..... 24.
19 .... 47
22 NAME OF
FUNERAL DIRECTOR
Solomon Funeral Service
ADDRESS
Brookline., ..... Mass.
Received and filed
OCT 9 1947
19
(Registrar of City or Town where deecased resIded)
Underline the cauee to which death
Of autopsy
50m- (b) .6-44-14607
4 COLOR OR RACE|
White
(If U. S. War Veteran, specify WAR) -
Registered No.
169
1,
RM R-302
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-302 to the clerk Copies of returna of deaths recorded during the previous month which occurred in your city or town in case the deceased ----- - -
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)
Registered No. 76750
(If death occurred in a hospital or Institution, St. give its NAME instead of street and number)
2 FULL NAME
Morris Goldman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
85 Shore Drive
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
2 days.
In this community
yrs.
mos.
2
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE| 5 SINGLE
MARRIED
W
WIDOWED
or DIVORCED
(write the word)
Married
5& If married, widowed, or divorcedLillian Wool
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
{Husband's name in full)
6 Age of husband or wife if allve 46
yourd
7 IF STILLBORN, enter that fact here.
8
AGE 49
Years
Months
Days
If less than 1 day
Hours
Minutos
Usual
9 Occupation :
Manufacturer
Industry
10 or Business:
Garment Mfr.
11 Social Security No.
011-10-6366
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Eli Goldman
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Anna Tobe Koor
If so, speolfy ...
CL Clay
(Signed)
M. D.
(Address) ..
Mass.General .... Hos.pt Date ...... 9 .... ] .... 19
47
21 PLACE OF BURIAL,
Cong.Beth Israel Com.
CREMATION OR REMOVAL
(Cemetery )
DATE OF BURIAL
Sept.2./4.7.
19
22 NAME OF
FUNERAL DIRECTOR
H J Torf
ADDRESS
Brookline Mags
SEP & 2 2 1947
19
DATE FILED
Sept/4/47
.,19
18 DATE OF
DEATH
(Month)
Aug. 31/47
.
(Day)
(Year)
19 | HEREBY CERTIFY,
Aug .. 30
....
That I attended deceased from
I last aaw h ...... 1m ... allve on.
Aug.
31
1947
death is said to
have occurred on the date stated above, at
8:30₽
m.
Duration
Immediate cause of death. Coronary Thrombosis
2 Days
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings:
Of operations
None
Date of.
should be charged sta- tistically.
Of autopsy.A.s ... a.bo.v
What test confirmed diagnosis ?. autopsy.
20 Was disease or Injury In any way related to oooupation of deceased ?.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant (Address)
Wife
( Relation, if any
A TRUE COPY.
ATTEST :
(Registrar of city or town where death. occurred)
Received and filed
(Registrar of City or Town where deceased resided)
50m. (b).6.44-14607
1
Boston
(City or Town)
No.
Mass.General Hospt
(If U. S.
War Veteran,
spoolfy WAR)
(Usual place of abode)
19 ..
to.
.4.7
Ang. 31
1947
Underline the cause to which death
C
M R-301 A Suffolk
Revere 10/7/47
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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