USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 17
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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 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 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 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
May- 3-49 Mro Philip 2 lu PLACE OF DEATH No.
Suffolk
(County)
(City of 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.
54
Registered No.
[(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
Phillip Zamiany Miller (If deceased is a married, widowed or hvorced woman, give alse maiden name.) 235 Bowdoin RY
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ... years months
In place of residence
13 years
.months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
aren't
(Month)
28 (Day)
1949 (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Mark 22 1949
to
april 2
19
I last saw h.
.... alive on
3 ×2%
m.
.. , death is said to
have occurred on the date stated above. at
INTERVAL BE- TWEEN ONSET AND DEATH
ANTE
CEDENT (b)
CAUSES
2 pi 11
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
were Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify. (Signed) (Address) Si Dentin. Date
M. D.
6 Place of Burial or Cremation
(Chy of Town)
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTOR
ADDRESS 220. Живой. Циловая.
19
Received and filed MAY 3 1949
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Mule
9 COLOR ØR RACE WJute
10 SINGLE
MARRIED
WIDOWED
or DIVORCE
(write the word)
C
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full) Julia Pontes
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
.....
Months
Days
If under 24 hours
.Hours . .. Minutes
13 Usual
Occupation :.
Cheack
(Kind of work done during most of working life)
14 Industry
or Business:
Grocery store
15 Social Security No ..
16 BIRTHPLACE (City) (State or country)
17 NAME OF FATHER Therace Miller
18 BIRTHPLACE OF FATHER (City) (State or country)
Unikniona
.
19 MAIDEN NAME OF MOTHER
Samatha Pierce
20 BIRTHPLACE OF
+ 19 4.5 MOTHER (City) 6 ovn.
(State or country) Mere Julia Million
21 Informant. (Address) 2357/breodor L&
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter &. Daleles (Signature of Agent of Board of Health or other) Healthe office 3-/8/49
Official Designation) (Date of Issue of Permit)
TIONS RTIFICATE
ing DEATH enter in one · each and (c)
s not mean ying, such e. asthenia. the disease, ons which
onditions, rise to the a) staling cause
s contrib- Ith but not disease or ing death.
100M-(D)-10-48-24858
₹-301A
2 FULL NAME.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
May 2 1949
PARENTS
65,
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Coronary acclación
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 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 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
-
.
:
.
1
:
.
-
1
PLACE OF DEATH
Essex (County)
Danvers (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers (City or town making return)
Registered No. 55
Danvers State Hospital, Hathorne, Mass(If death occurred in a hospital or institution. No.
2 FULL NAME.
Fred .... W .Messer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 79 Summit Ave., Winthrop, Mass
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ..... .. years. 9 months 25 days. In place of residence. ...... .. years. .. months ... .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
3
1949
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, June 9 48 19. to .. April 3
19
49
I last saw
him
.alive on
April 3, 1949, death is said to
10a If married, widowed, or divorced
HUSBAND of.
Cannot ve handel andin full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Arteriosclerotic
heart disease
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Watch repairer (retired)
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
New Hampshire
17 NAME OF
FATHER
Cannot be learned
Major findings:
Of operations
Date of operation
Was autopsy performed?
no
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify ..
(Signed) ...
Francis X. Sullivan
M. D.
(Address).
Hathorne ........ vass. Date .....
4/8
49
Greenlawn ..... Cemetery , ..... Keene ....... N .H. Place of Burial or Cremation (City or Town) April 8
19.449
Info
(Address)
Hathorne, Mass
7 NAME OF
FUNERAL DIRECTOR
William D. Grannan
Arlington, Mass.
ADDRESS
Received and filed 19
MAY 1 0 1949
(Registrar of City or Town where deceased resided)
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
April 9
19.
49
·
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Cannot be learned
19 MAIDEN NAME
OF MOTHER
Sylvia Booth
20 BIRTHPLACE OF
MOTHER (City)
(State or country) New Hampshire
21 Mary E. Sheehan
DATE OF BURIAL.
5 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
1 yr-
ANTE . Due To
CEDENT .(b)
CAUSES
sclerosis
Generalized ... Arterio ...
50m-(e)-10-48-24658
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 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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
R-302 1
St. [ give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
That I attended deceased
from
Divorcec
have occurred on the date stated above. at!
11:10 am.
INTERVAL BE.
80
no
6
R-302 1
PLACE OF DEATH
No.
Mass. Gen. Hosp.
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. 2996 56
J (If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
2 FULL NAME
Florence ... Penney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
18.6.Highland.Avo ..
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
.....
.years
2
months ..
14 ... days. In place of residence.
3.9 .. years.
... months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Apr ..... 3/49
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Wid.
4 I HEREBY CERTIFY,
1/26/49
19
That I attended deceased from
to
4/3/49
19
I last saw h.
alive on.
19
death is said to
have occurred on the date stated above, at
m.
INTERVAL BE-
(or) WIFE of
Frank .W ... Penney
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Pulm .... ombol.i ..
term
12
AGE.7.5.
.. Years.
Months.
Days
If under 24 hours
Hours .....
Minutes
1
Due To
CEDENT. (b)
CAUSES
thrombophlebitis,rt leg
3-5 days
Occupation:
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Maine
OTHER
SIGNIFICANT
Pulm.edema
CONDITIONS arteriosclerosis
term.
15, yr
Major findings:
Of operations.
bladder tumor
.....
Date of operation ..
2/3/49
.. Was autopsy performed ?... yes
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
BG St 11.III
M. D.
(Address)
Mass. ... Gen. Hosp ..... Date ..
4/3/49
.19
6 Pine Grove - Waterville, Me.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
4/6/49
19
21
Informant
Merla ... D. Pannoy
Winthrop
(Address)
7 NAME OF
FUNERAL DIRECTOR
H.S. Reynolds
ADDRESS
Winthrop
Received and filed.
MAY 19 1949
.19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mẹ,
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Me.
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
4/7/49
.19
50m-(e)-10-48-24658
1 SUFFOLK BOSTON (County)
(City or Town)
after the close of the month in which the death occurred. (Sce 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 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
ANTE
13 Usual
Housewife
Due To
(c)
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
17 NAME OF
FATHER
John Bradbury
ء
R-302 1
PLACE OF DEATH
( CHEFOLK : (County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
335453
No. Mass General Hosp
Baker Mem § (If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME
Bridget A Donoghue
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 69 Bellvue Ave
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death. ..... .. years. months. 4 .days. In place of residence. 55 ears. months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April 15/49
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
April 1219 49. toApril 15
19
49
I last saw h .... e.T .... alive on.
April .... 15.
19 .. 219death is said to
have occurred on the date stated above, at
2
AM
m.
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a)Intestinal infarction
Pulmonary embolism"
3 dys
? days
12
AGE
Years
72
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
At Home
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City) -.
(State or country)
Ireland
17 NAME OF
FATHER
Cornelius Sullivan
Major findings:
Of operations.
Thorancentesis
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
CL Clay
(Address)
Mass Gen Hosp Date 4-15
19.419
Holy Cross
Malden
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL April 18/49
19
7 NAME OF
FUNERAL DIRECTOR
F J Crosby
ADDRESS.
Boston Mass
Received and filed.
April 20
249
MAY 19 4949
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary Sullivan (Ok)
20 BIRTHPLACE OF
MOTHER (City)
(State or
'Ireland
21 Informant (Address)
A TRUE COPY.
ATTEST.
(Registrar of City or Town where death occurred)
DATE FILED
19
....... ...
50m-(e)-10-48-24658
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 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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Due TChronic cardiac valvular
ANTE
CEDENT (b)
CAUSES
disease, mitral and
Due Taortic stenosis and
(c) .... regurgitation of
rheumatic origin
20 yrs
OTHER SIGNIFICANT CONDITIONS
11 IF STILLBORN, enter that fact here.
TWEEN DNSET AND DEATH
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Charles C Donoghue
(Husband's name in full)
C W Donoghue
( Son )
u
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
M R-302 1
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.
58
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Howell Thomas Wood
(If deccased is a married, widowed or divorced woman, give also maiden name.) .
11 Neptune Ave.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.2
months ..
.days. In place of residence
30 years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
2 FULL NAME
(a) Residence.
No.
(Usual place of abode)
3 DATE OF
DEATH
April
21
(Day)
(Month)
4 I HEREBY CERTIFY.
July 13
19.
45
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary
artery disease
CEDENT
(b)
CAUSES
heart disease
? Carcinoma
Major findings:
Of operations.
None
(Signed)
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
Due To
(c)
Generalized
arteriosclerosis
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
CONDITIONS
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
(write the word)
WIDOWED Divorced
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Unable to obtain
(Give maiden name of wife in full)
have occurred on the date stated above.
6:25 P
.. m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ..
75Years
Months
Days
If under 24 hours
Hours . .. Minutes
13 Usual
Occupation:
Real estate
(Kind of work done during most of working life)
14 Industry
or Business:
Self
15 Social Security No ..
None
Boston
OTHER
SIGNIFICANT Prostatic hypertrophy
? yrs
2-3
mos
16 BIRTHPLACE (City).
(State or country)
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