USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 54
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7 NAME OF
FUNERAL DIRECTOR
c J Murphy
ADDRESS Everett Mass.
Received and filed.
DEC 7
1949
19
(Registrar of City or Town where deceased resided)
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
E Rackliffe
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED Oct. 24/49
19
1
6 Copies of returns of deaths which occurred in your city of 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
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
C L Clay
(Signed)
Mass. General Hospt 10-21 .49
(Address)
Was autopsy performed?
Yes
What test confirmed diagnosis?
Autopsy
Saleslady
Occupation:
Plus
(Kind of work done during most of working life)
Hypertension
Due To
(c)
to
Oct. 21
,49
death is said to
I last saw h
er ... alive on
6 A
have occurred on the date stated above, at
m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
Plus 15 Social Security No.
Major findings:
Of operations
Date of operation
No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1
RECEIVE4
1
1
6
DEC-GEMA
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 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.) 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
REVERE
(City or town making return)
CERTIFICATE OF DEATH
Registered No.
j(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME
Georgia Juan (Wentworth)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
-
91 Freemont
St.
Winthrop,
Mass.
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
.. years.
months
4
.. days. In place of residence.
2.0
.. years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
27
1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct. 24
1949
to
Oct. 27
19
49
49
19.
death is said to
have occurred on the date stated above. at
5:45 A ..
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Myocarditis
TWEEN ONSET AND DEATH + days
11 IF STILLBORN, enter that fact here.
12
AGE ...... ] .... Years.
9 Months 13 Days
If under 24 hours
.Hours .....
.. Minutes
13 Usual
Occupation:
Housewife.
14 Industry
or Business:
At ..... home
15 Social Security No ..
None
16 BIRTHPLACE (City).
(State or country)
Maine
Belfast
No
Major findings:
Of operations
No
Date of operation
Nc
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical Signs
NO
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
James F Burns
(Signed).
(Address)
Everett
Date.
10/27 049
6 Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Oct. 29
49
21
Informant.
Frederick Wentworth
(Address)
91 Freemont St.
Winthrop
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
Winthrop, Mass.
Received and filed
NOV 1 CM 19
......
(Registrar of City or Town where deceased resided)
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCED Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Walter W Juan
(Husband's name in full)
ANTE
CEDENT
(b)
Chronic Nephritis
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
2 Yrs
PARENTS
17 NAME OF
FATHER
George Wentworth
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Lydia Johnson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED October 311,49
50m-(e)-10-48-24658
ADDRESS.
No.
Grover Manor Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
I last saw h .. C.I ...... alive on.
Oct. 26
(Kind of work done during most of working life)
RECEIYLA
NOVAONDA
RM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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
Essex (County)
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.
176
Danvers State Hospital , Hathorne, Mas& death occurred in a hospital or institution No.
?give its NAME instead of street and number)
2 FULL NAME Clarissa L. Story
(If deceased is a married, widowed or divorced woman, give also maiden name.)
80 Shore Drive, Winthrop, Mass.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
20
years
4
months
7
days.
In place of residence ...
.......
.years ....
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
28
1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
Aug.
1
19 49.
to
Oct . . 28
19
49
I last saw h ...
.. er.alive on
Q.c.t ......
2.8
, 19.44.9, death is said to
5:45 am.
TWEEN ONSET
DISEASE OR CONDITION
DIRECTLY LEADING
Cerebral hemorrhage
TO DEATH (a)
AND DEATH
5 days
ANTE CEDENT CAUSES
Due To
(b)
Hypertensive Pneumonia
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
N.o.
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
6
Harmony Grove Cem., Salem, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
October 31
19 49
7 NAME OF
NERAL DIRECT
freo. W. Full & Sons
ADDRESS.
Salem, Mass.
Received and filed
NOV 21 1949
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
Essex
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Mary P. Prince
(State or country)
Mass.
21 Mary E. Sheehan
Informant.
(Address)
Hathorne, Mass.
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
November 12
49
DATE FILED
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
82
AGE
Years
Months.
Days
If under 24 hours
.Hours
Minutes
13 Usual
Occupation:
Retired school teacher
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Mass.
Essex
17 NAME OF
FATHER
Jonathan L. Story
50m-(e)-10-48-24658
Danvers
(City or Town)
(a) Residence. No. (Usual place of abode)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
have occurred on the date stated above, at.
INTERVAL BE-
8 SEX
Female
White
×
(Signed) .
Paul ..... B ...... Jossman
20 BIRTHPLACE OF
M. D.
(Address).Hathorne ....... Ma.s.s ........
Date 11/9.
: 19 49
MOTHER (City)
Essex
RECEIVED
6
NOV22CAR
PLACE OF DEATH
Suffolk (County)
12/8/44
The Commonwealth of Massachusetts OFFICE. OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
177
46 Washington Avenue
J (If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
No. Minette E. Hewitt (Hatch)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
Revere
(If nonresident, give city or town and State)
Length of stay: In place of death
.years ..
months. 10
25
In place of residence.
.years
months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
nov
1
1949
(Month)
(Day)
(Year)
4 I, HEREBY CERTIFY ,
That I attended deceased
from
19.
49
(Give maiden name of wife in full)
(or) WIFE of.
John Hewitt
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cerebral Thrombosis
TWEEN ONSET AND DEATH ( week
11 IF STILLBORN, enter that fact here.
12
AGE.
9.1Years ..
... ]. Months
1.6 Days
If under 24 hours
Hours .....
.Minutes
13 Usual
Occupation!Qusevife
(Kind of work done during most of working life)
14 Industry
or Business :.
.At ..... Home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF FATHER Hatch
PARENTS
18 BIRTHPLACE OF
Falmouth
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
unknown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
unknown
21 Informant. "iss Helen Hewitt
(Address)
14 Russell St. No. Quincy
7 NAME OF
FUNERAL DIRECTOR ..
Albert F. Douglass
ADDRESS
Lexington 73, Mass.
Received and filed. NOV 8 19.49 19
(Registrar)
1 year
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
norra
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
none
5 Was disease or injury in any way related to occupation of deceased? 200
If so, specify
(Signed)
(Address)
Chelsea
QueBenjamin
M. D.
Date 11/3
1949
Mayflower Hill
Place of Burial or Cremation
Taunton
(City or Town)
DATE OF BURIAL
November 4,
19.49
100M-(C)-10-48-24656
RUCTIONS FOR . CERTIFICATE
giving OF DEATH
not enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, ications which 3th.
id conditions. ring rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
€
3 -
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Bakery. (Signature of Agent of Board of Health of other)/
11/4/49
(Official Designation)
(Date of Issue of Permit)
MARRIED
WIDOWED Widowed
or DIVORCED
1
Jan 1
1949.
to
1
I last saw hem alive on
Out 30
19 ..
4% death is said to
10a If married, widowed, or divorced
HUSBAND of.
have occurred on the date stated above, at.
5.30g
.. m.
INTERVAL BE-
ANTE CEDENT (b) CAUSES
Due To Cerebral arterio - Sclerose
9 COLOR OR RACE
10 SINGLE
(write the word)
8 SEX
female
white
(Was deceased a U. S. War Veteran, if so specify WAR) no
(a) Residence. No. 4.73 Vane St. (Usual place of abode)
2 FULL NAME
(City or Town)
23-1151
M R-301) 1 Winthrop
(City or town making return)
Sandwich
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 shallexhume a human body and remove it from a town, from one cemetery to another, or from one grave c. 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
+
SUFFOLK BOSTON (County)
(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)
Registered No.
9248 1178
[(If death occurred in a hospital or institution,
St. \ give its NAME instead of street and number)
Sarah Currier (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 place of death.
......... years.
months
.. 6 .. .. days. In place of residence.
47. years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Nov.2 1949
(Day)
(Year)
female
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCEBarriod
4 I HEREBY CERTIFY,
Oct 28
19
49.
to
That I
attended deceased from
Nov 2
19.49
Nov 2
.... 19 ...... " Heath is said to
have occurred on the date stated above, at
11:10 .P.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE ... 7.6 Years
2
Months
28
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Mass
Chelsea
17 NAME OF
FATHER
George
Gardner
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass
Nantucket
19 MAIDEN NAME
OF MOTHER
Mary Piggott
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Chelsea
Everett
Place of Burial or Cremation (City or Town)
Nov 5 1949 19
7 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS Winthrop
Received and filed.
NOV 16 1949
19
(Registrar of City or Town where deceased resided)
PARENTS
21 Hosprecords
Informant
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Now .... 7 .... 1949
........
.......... 19.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
2 FULL NAME .. (Month) I last saw h. OT .... alive on ANTE Due To CEDENT (b) CAUSES Due To (c) OTHER SIGNIFICANT CONDITIONS Major findings: Of operations. What test confirmed diagnosis? (Address) 6 ... Woodlawn DATE OF BURIAL 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 Date of 10/28/49 50m-(e)-10-48-24658
Carcinoma of breast, grade III
Was autopsy performed? yes
Path
autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
R. D.Margeson
Brookline
11/2
M49
Date
19
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Edward ... Currier.
(Husband's name in full)
(write the word)
8 SEX
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. 57 Loring Rd
(Usual place of abode)
Mass ... Women'sHosp No ..
PLACE OF DEATH
RM R-302 1
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)Cirrhosis of liver
Carcinoma of breast
RECEIVED
11 12
8
5
6
NOV 1GIO49 AM
RM 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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.)
50m-(e)-10-48-24658
PLACE OF DEATH
Middlesex (County) Medford
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Medford (City or town making return)
Registered No.
179
78 Magoun Ave.
.
[(If death occurred in a hospital or institution,
St. \ give its NAME instead of street and number)
2 FULL NAME Julia B. Hatch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 25 Faun Bar Ave.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
1
years.
months.
.days.
In place of residence
6
.years.
months
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November
3
1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
October
46
19
to
Novenber 3
19
49
I last saw h.eT alive on
Nov
3
149
death is said to
have occurred on the date stated above, at
3 A
.m.
INTERVAL BE-
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.8.2 .. Years
11Months .
.14Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Secre tary
( Retired)
(Kind of work done during most of working life)
14 Industry
or Business:
Private
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Mass.
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
none
Date of operation.
Was autopsy performed?
none
What test confirmed diagnosis ?.
clinical
19 MAIDEN NAME
5 Was disease or injury in any way related to occupation of deceased ?. ...... non OF MOTHER M. Ellen Hatch
If so, specify.
(Signed)
Paul P. Weinsait
(Address)
WH+4986 Dr.
.Date
11/3
M.
19.49.
Waterside
Marblehead
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Nov 5, 1949
19
21
Laurence Ethier
Informant
(Address)
25 Faun Bar Ave. Winthrop
A TRUE COPY
ATTEST:
2
(Registrar of City of Town where death occurred)
Clerk
DATE FILED
Nov 4,
1949
19
(Registrar of City or Town where deceased resided)
8 SEX
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
singl
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADINGCoronary Thrombosis 24hrs
TO DEATH (a)
ANTE
Due To
Generalized and
CEDENT (b) ..
CAUSECoronary arteriosclerosis
. 10yrs
Due To (c)
Marblehead
17 NAME OF
FATHER
George Hatch
18 BIRTHPLACE OF
FATHER (City)
Wells
(State or country)
Maine
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
Wells
(State or country)
Maine
6
7 NAME OF
FUNERAL DIRECTOR
Harvard S. Reynolds
ADDRESS
Winthrop, Mass ..
Received and filed
NOV 8
1949
19
1
(write the word)
female
(Was deceased a
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