USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 10
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
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.
26
J (If death occurred in a hospital or institution, St. | give its NAME instead of street and number) No. Winthrop Community Hospital
2 FULL NAME Donald Gerard Poirier
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a U. S. War Veteran, ( if so specify WAR) No
(a) Residence. No. (Usual place of abode)
119 Lexington St. East Boston St (If nonresident, give city or town and State)
Length of stay: In place of death. ..... years. .. months .. 1. days. In place of residence . .years .. 4 .. .. months 1.8.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month) (Day)
9.5
1449
(Year)
8 SEX
Male
9 COLOR OR RACE
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY, That I attended deceased from 19 19 c)el: 24 49 to .. Det ?- 2.5°
.
I last saw has
.. alive on
7) el: 25
19 49, death is said to
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Laborprocuração
INTERVAL BE- TWEEN ONSET AND DEATH 5 k.
11 IF STILLBORN, enter that fact here.
12
AGE
Years
4
Months
.19Days
If under 24 hours
Hours
. Minutes
13 Usual
Occupation :
None
(Kind of work done during most of working life)
14 Industry
or Business:
None
15 Social Security No ..
None
16 BIRTHPLACE (City)
(State or country)
Mass.
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
.Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?.... . /
If so, specify// ...
(Signed)
6-Date 1:1 15 1996
M. D.
6 Holy Cross Cemetery .. Malden Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
February 26.
19.
4
7 NAME OF
DIRECT Richard C. Kirby
ADDRESS.
17 Bennington St., E. Boston Walter f. Praksis.
Received and filed FEB-2-8-1949 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Elizabeth Thibodeau
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21 Hubert Poirier (Father)
Informant (Address) 119 Lexington St., E. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
2/26/49
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
iving OF DEATH t enter han one For each b) and (c)
does not mean f dying, such ure, asthenia, . as the disease, ations which h.
I conditions, tg rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
100M-(D)-10-48-24688
ANTE
Due To Savena Plectic
CEDENT (b)
CAUSES
Due To (c)
Winthrop
17 NAME OF
FATHER
Hubert Poirier
have occurred on the date stated above, at 9:15 am
PHYSICIAN - IMPORTANT
Registered No.
Boston stible
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 required 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, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 section 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 nineteen 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 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 inter- ment, 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 physician 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 required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such 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 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 registra- tion. The person to whom the permit is so given and the physician certifying 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 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 body lies and take charge of the same; . . General Laws, Chap. 38, Sec.6. .
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received 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 follow- ing 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 deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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, however, 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
1
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston
(City or town making return)
13597
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
George H Ostman
(If deceased is a married, widowed or divorced woman. give also maiden name.)
100 Marshall St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years.
months.
S.days. In place of residence.
50 years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb. 10/49
(Month) (Day)
(Year)
9 SEX
M
10 COLOR OR RACE
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
4 I 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.) Leukemia following prolonged occupational exposure to benzene
11a If married, widowed, or divorced
HUSBAND of
Bridie Feeney
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE.5Q ... Years.
Months.
.Days
If under 24 hours
Hours ...
.. Minutes
14 Usual
Occupation1.
Pressman
15 Industry
or Business:
Printing
16 Social Security No.
012-09-3080
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Manner of
(Specify type of place}
Under investigation
Injury
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed?
Yes
6 Was disease or injury in any way related to occupation of deceased?
If so, specify
Under investigation
(Signed)
A R Moritz
M. D.
(Address)
25 Shattuck St
Date ..
2-11
... 19 .... 245
Holy Cross-Malden Mass.
7 Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL.
Feb. 14/49
19
8 NAME OF
FUNERAL DIRECTOR
J F VIMaley
ADDRESS. Winthrop Mass
Received and filed. MAR 25 1949 19
(Registrar of City or Town where deceased resided)
PARENTS
18 NAME OF FATHER John T Ostman
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass.
20 MAIDEN NAME
OF MOTHER
Margaret Cannon
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
B Ostman
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred) Feb. 15/49
DATE FILED
.. 19
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
5 Accident, suicide, or homicide (specify). Date and hour of injury 19
Where did
Injury occur?
(City or town and State)
25m-(h)-10-48-24658
M R-305 1
No.
Mass.General Hospital
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
Winthrop Mass.
(Kind of work done during most of working life)
17 BIRTHPLACE (City).Winthrop Mass. (State or country)
22
Informant
(Address)
M R-302 1
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
1551 28
Registered No.
Mass.General Hospital
J (If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME.
Harry W Graff
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
75 Beal
St.
Winthrop Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
years ..
14
months.
.days. In place of residence
20
.years.
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb. 17/49
(Month)
(Day)
8 SEX
M
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
4 I HEREBY CERTIFY,
Feb. 3 ..
19 49.
to
feb. 17
That I attended deceased
from
49
19
10a If married, widowed, or divorced
HUSBAND of.
Josephine Wallace
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEAP NEmonary embolism
TO DEATH (a).
massive
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
Terminal
AGE
76
Years
Months.
Days
If under 24 hours
Hours.
Minutes
ANTE
Due To
Phlebothrombosis of leg
CEDENT (b)
"and veins
Due To Coronary sclerosis
(c)
and nephrosclerosis
OTHER
SIGNIFICANT
CONDITIONS
1
Major findings:
Of operations.
None
Date of operation
.Was autopsy performed ?.
.. Yes
What test confirmed diagnosis ?. Autopsy.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
CL Clay
(Signed)
Mass. General Hospit. 2-18 . 49
(City or Town)
DATE OF BURIAL.
C H Treanor
7 NAME OF
FUNERAL DIRECTOR.
East Boston Mass.
ADDRESS
Received and filed. MAR 25 1949 19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (CityUnknown
(State or country)
19 MAIDEN NAMEnknown
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Unknown
(Address)
New Calvary
6 Place of Burial or Cremation Feb. 21/49 19
21
Informant
M Donnelly
(Address)
·
A TRUE COPY ...
ATTEST:
(Registrar of, City or Town where death occurred)
Feb. 23/49
DATE FILED .19
(Kind of work done during most of working life)
14 Industry
or Business:
Waterfront
? Yrs
15 Social Security No. 023-03-7342
16 BIRTHPLACE (cGermany (State or country)
17 NAME OF
FATHER
Unknown
? Yrs
13 Usual
Occupation :
Stevedore
Unknown
(Give maiden name of wife in full)
have occurred on the date stated above, at.
6;35P
.m.
(Year)
I last saw h ... im .... alive on.
Feb. 17, 19
49
death is said to
INTERVAL BE-
. Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES 50m-(e)-10-48-24658
WNICTWAINLI, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
M R-302 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
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.
29
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
William Gage Reed
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 58 Pleasant St. Winthrop, Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .. ......... years.
3
months ............ days. In place of residence. L ..... years ............ months. .... days.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb ..
(Month)
1.9 1949 (Day) (Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCED Widowed
4 I HEREBY CERTIFY,
That I attended deceased
from
July 1
48
to
Feb. 19
1949
49.
I last saw
h.1m .... alive on
Feb. 18
19
death is said to
have occurred on the date stated above,
10:45 P
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Hypostatic
Pneumonia
ho day
13 Usual
Occupation :.
Bootmaker
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No.
None
16 BIRTHPLACE (City)
Burlington
(State or country)
Mass.
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
No
(Signed)
4 Washington Avevate 2/21
194.9
(Address)
mehrop, Burlington
6 Burlington Cemete
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
F.e.b .....
.22
19.49
21
Informant
L Harriett Brush
(Address) 58 Pleasant St. Winthrop, Mass.
A TRUE COPY
ATTEST:
(Registrar of City of Town where death occurred)
Received and filed. 19
MAR 16 1949
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE ... 93 Years
.O ... Months
11Days
If under 24 hours
Hours.
Minutes
ANTE
Due To
Myocarditis
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
17 NAME OF
FATHER
Artimus Reed
18 BIRTHPLACE OF
FATHER (City).
Unable to obtain
(State or country)
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
Charles F. Mahoney
M. D.
PARENTS
19 MAIDEN NAME
OF MOTHER
Elizabeth Winn
20 BIRTHPLACE OF
MOTHER (City) Unable to obtain
(State or country)
DATE FILED March 2, 19 49
..
50m-(e)-10-48-24658
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop, .... Ma.s.s ..
10a If married, widowed, or divorced
HUSBAND of
Minnie Wilson
19
(Give maiden name of wife in full)
(or) WIFE of.
TWEEN ONSET AND DEATH
MEDICAL CERTIFICATE OF DEATH
.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
No. Resthaven
(Was deceased a
U. S. War Veteran,
if so specify WAR)
M R-302 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
SUFFOLK
...
(County)
BOS TON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
1584 30
2 FULL NAME
FRANCES ELIZABETH ALLISON
(If deceased is a married, widowed or divorced woman, give also maiden hame.)
532 SHIRLEY ST
St.
WINTHROP
MASS
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.years
months ....
days.
In place of residence
12
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
MARRIED
4 I HEREBY CERTIFY,
That I attended deceased from
FEB 14
19
49
FEB 20
to
19.49
I last saw h.
ER alive on
FEB 20
19 ... 4.9 death is said to
m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
HYPERTENSIVE CARDI
VASCULAR DISEASE
TERM
ANTE
Due To
HYPERTENSIVE ENCEPHALOPATHY
CEDENT (b)
CAUSES
-
YR
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation.
.Was autopsy performed?
What test confirmed diagnosis?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? If so, specify NA WILHELM
(Signed).
M. D.
(Address)
PETER & BRIGHAM
DatFEB 20
19 ... 49
6
WINTHROP CEM WINTHROP MASS
Place of Burial or Cremation
(City or Town)
.
DATE OF BURIAL
FEB 23
18 9
7 NAME OF
FUNERAL DIRECTOR
HOWARD S REYNOLDS
WINTHROP MASS
ADDRESS
Rec(*
FEB 24 1949
MAR 25 1949
: Registrar of City or Town where decor.
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
BOSTON MASS
19 MAIDEN NAME
OF MOTHER
ADIE EMMETT
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
WILLIAM G ALLISON .. HUSBAND
21
Informant
(Address)
532
#INTHROP MASS
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
....................... 19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
WILLIAM G ALLISON
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
.. Years.
AGE47
3
Months.
6
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :...
.H.OVEWIE
(Kind of work done during most of working life)
14 Industry
or Business:
.. A.T ... HOME.
15 Social Security No ..
16 BIRTHPLACE (City) ........ BOSTON MASS (State or country)
.
Registered No.
(City or Town)
No.
PETER BENT BRIGHAM HOSP
j(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
3 DATE OF
DEATH
FEB 20,
1949
(Month)
(Day)
(Year)
have occurred on the date stated above, at
12:35A
50m-(e)-10-48-24658
17 NAME OF
FATHER
WILLIAM HAVEY
BO.S.T.O.N .... M.A.S.S ..
(Was deceased a
U. S. War Veteran,
if so specify WAR)
+
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)
31
J(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Bessie Rubinstone (Cohen)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
159 Locust
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death .years ... .months. ...... days. In place of residence .years. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
February 24, 1949
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
That I attended
deceased
from
40
19
10a If married. widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
I last saw
her
alive on
Feb.
24
... 19-19, death is said to
3:30A.
m.
(or) WIFE of.
Louis Rubinstone
(Husband's name in full)
have occurred on the date stated above, at
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a)
Carcinomatosis
TWEEN ONSET AND DEATH L year
11 IF STILLBORN, enter that fact here.
78
12
AGE
Years
Months.
Days
If under 24 hours
Hours .
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