USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 7
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70
with left hemiplegia
5mos.
ANTE
Due To
Arteriosclerotic
CEDENT
(b)
Due To
(c)
Arteriosclerosis
OTHER
SIGNIFICANT
None
CONDITIONS
Major findings:
Of operations
None
Date of operation
Was autopsy performed?
No
5 Was disease or injury in any way related to occupation of deceased?
NO
If so, specify.
(Signed)
562 Shirley St. Date 1/10
Maurice Traunstein
(Address). .
Winthrop
Winthrop
Winthrop
6
Place of Burial or Cremation
(City or Town)
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
Heart disease
layrs.
50m-(e)-10-48-24658
7 NAME OF
FUNERAL DIRECTOR
John F. O'Maley
ADDRESS
Winthrop, Mass.
Received and filed
FEB 16 1949
19
(Registrar of City or Town where deceased resided)
PARENTS
DATE OF BURIAL
January 13,
19 49
Iżyrs .
Brewer
What test confirmed diagnosis? Clinical & Laboratory
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Alfred Tewksbury
(Husband's name in full)
M R-302 1
Registered No.
+
PLACE OF DEATH
Suffolk (County) Boston
(City or Town)
Mass. General Hospital
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)
Registered No.
J(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 Highland Ave.
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
.....
.years
1
months
2
.days.
In place of residence
40
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
(Month)
(Day)
(Year)
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.)
Fracture of hip
11a If married, widowed, or divorced
HUSBAND of.
Mary F Dunne
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
Years
81
Months.
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation 1
Lithographer Retired
(Kind of work done during most of working life)
15 Industry
or Business:
Lithographic
16 Social Security No.
011-16-9187
17 BIRTHPLACE (City)
(State or country)
Boston Mass.
18 NAME OF
FATHER
Cannot be learned
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
20 MAIDEN NAME
OF MOTHER
Cannot be learned
Germany
St Joseph's Boston Mass
Place of Burial, or Cremation.
(City or Town)
Jan. 18/49
.19
8 NAME OF
FUNERAL DIRECTOR
J. F. O. Maley
ADDRESS.
Winthrop Mass
Received and filed 19
FEB 21 1949
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
No.
2 FULL NAME
(a) Residence.
No.
(Usual place of abode)
3 DATE OF
DEATH
Jan/15/49
Phlebothrombosis
Pulmonary embolism
Date and hour of injury.
Dec. 10
Where did
Winthrop
Home
Manner of
(Specify type of place)
Injury
Fell
(How did injury occur?)
Nature of
See above
Injury
(Signed)
A R Moritz
25 Shattuck St
(Address)
7
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-305 to the clerk of the city or town in which the deceased resided as soon as possible
Injury occur?
(City or town and State)
5 Accident, suicide, or homicide (specify)
Accident
19
48
Did injury occur in or about home, on farm, in industrial place, or in public
place?
While at work?
Was autopsy performed?
No
No
6 Was disease or injury in any way related to occupation of deceased? If so, specify.
M. D.
PARENTS
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
C Holthaus
22
Informant.
(Address)
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurfed) Jan. 18/49
DATE FILED
19
M R-305 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25m-(h)-10-48-24658
Date1 .-. 16.
19 49
Charles Holthaus
(Was deceased a
U. S. War Veteran.
if so specify WAR)
PLACE OF DEATH
X Suffolk County)
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.
18
Winthrop Community Hospital No. Dr. Samuel a. miller
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 79" Share Drive, Winthrop, Dass.
(If nonresident, give city or town and State)
Length of stay: In place of death. years.
months 4 days. In place of residence 2.3 years . .. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male white
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
muriel
4 I HEREBY CERTIFY,
That I attended deceased from
February 1. 19. 49. to .. February 4. 1949
I last saw heis alive on February 4, 1949, death is said to
have occurred on the date stated above, at
9:00 P.m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) acute Coronary thrombosis
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Bronchopneumonia
3 days.
Major findings:
Of operations.
none
Date of operation
What test confirmed diagnosis? Clinical + Laboratory
5 Was disease or injury in any way related to occupation of deceased? If so, specify. (Signed) Maurice Traunstein M. D. (Address) 5625 henley Stante Date Feb4 19.49
Daved VICOR CHOULIM CEM. ( LEBANON) W ROX) Place of Burial or Cremation (City or Town)
DATE OF BURIAL ..
Veb 6
1949
7 NAME OF
FUNERAL DIRECTOR.
Beni. 7, Solomon.
ADDRESS 420 Harvard SV Brookline
Received and filed.
FEB-9-1943
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Ita Capelan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Louis miller
21
Informant.
(Address) 45 Rogers Park Que Brighton
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter I. Bakery (Signature of Agent of Board of Health or other) Health Mier 2/5/49
(Official Designation)
(Date of Issue of Permit)
1
TRUCTIONS FOR L CERTIFICATE
giving : OF DEATH not enter e than one e for each (b) and (c)
s does not mean e of dying, such failure, asthenia, eans the disease, lications which :ath.
bid conditions. iving rise to the use (a) stating erlying cause
ditions contrib- he death but not the disease or causing death.
100M-(D)-10-48-24688
11 IF STILLBORN, enter that fact here.
INTERVAL BE-
TWEEN ONSET
ANO DEATH
4 days
12
AGE 55
Years
Months
Days
If under 24 hours
Hours ...... Minutes
13 Usual
merchant
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
retail shoes
15 Social Security No.
16 BIRTHPLACE (City) Haverhill
(State or country)
mass
17 NAME OF
FATHER
mak miller
Was autopsy performed? ko
10a If married, widowed, or divorced
HUSBAND of .
Benina Rothstein
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
February (Month)
4. 1949
(Day)
1
(Year)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WWI
(a) Residence. No. (Usual place of abode)
Registered No.
M R-301A 1 Hinchoop Mas (Citwor Toyn)
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 artny, 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
1
ORGANIZATION AND OUTFIT
SERVICE NUMBER
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)
Danvers
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers (City or town making return)
Registered No. 19
Danvers State Hospital, Hathorne, Masof death occurred in a hospital or institution, No.
St. [ give its NAME instead of street and number)
2 FULL NAME
Bridget Theresa leagher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
949 Shirley St., Winthrop, Mass.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years 5 3 months. 1 days. In place of residence. ... years. .. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
5
1949
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
Nov. 4
43
19
to
That I attended
Feb. 5
deceased
from
49
19
1949
death is said to
have occurred on the date stated above, at
1:05 pm.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
AGE
Years
7
Months.
8
Days
If under 24 hours
.Hours ....
Minutes
ANTE
CEDENT (b)
CAUSES
Due To Bronchopneumonia 1
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.
(Signed) .Pasquale .... Buoniconto.
M. DI
(Address) ..... Hathorne ....... Mas.s .... Date ... 2./11
19 49
6 Oakdale Cemetery, Middleton
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
February 9
19
49
21 Mary h. mcPhillips
Informant
(Address)
Hathorne, Thass,
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed.
MAR 9
1949
19
(Registrar of City or Town where deceased resided)
-2 days
13 Usual
Occupation:
Unable to work
(Kind of work done during most of working life)
14 Industry or Business :.
15 Social Security No.
Halifax
16 BIRTHPLACE (City).
(State or country)
Nova Scotia, Canada
17 NAME OF
FATHER
John Meagher
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Ellen Condon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
7 NAME OF
D. W. Trannan & Son
FUNERAL DIRECTOR
ADDRESS
Arlington Mass.
DATE FILED
February 12
19
49
(write the word)
8 SEX
Female
White
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
I last saw h
er
.. alive on
Feb. 5
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)
Chronic Myocarditis
6 yrs
T2
72
PARENTS
50m-(e)-10-48-24658
CERTIFICATE OF DEATH
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
+
PLACE OF DEATH
Middlesex Waltham
(County)
(City of Town) Murphy General Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Waltham
(City or town making return) 63
20
Registered No.
(Was deceased a U. S. War Veteran.
Winthrop if sagecify WAR)
St.
1
(Ifnonresident ggive 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
February 1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof Smokdolldk nhadatdernyolved, state fully.)
Edema of lungs and glottis
Terminal Bronchopneumonia . Accident ...
Accident
49
Where did
Fort Banks, Winthrop
Did injury odsut in Propres home, on farm, in industrial place, or in public place?
Nature of
no
(How did injury occur?)yes
While at work?
. Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased? If so, spelly ..... Morton Gallagher.
(Signed) .Newton ,Mass.
2-5.
...... M. P.
Mitlerest com., Kenoshate Wisconsin 7 Place of Burial, or Gregausuary 8 (City or Town) 49"
DATE OF BURIAL. 19.
8 NAME OF FUNERAL DIRECTOBelmont, Masa. ADDRESS
Received and filed.
MAR 1 0 100
19
(Registrar of City or Town where deceased resided)
SEX Ma Le
10 COLOR OR RACE
white
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fect here.
13 I
AGE
Years
Months.
.Days
If under 24 hours
Hours .....
Minutes
14 Usual
Occupation1.
(Kind of work done during most of working life)
15 Industry or Business:
16 Social Security No. Waltham
Mass ..
17 BIRTHPLACE (City)
(State or country)
18 NAME @Paniel Francis Spaulding FATHER
19 BIRTHPLACE OF
Fond du Lac
FATHER (City)
Wisconsin
(State or country)
20 MAIDEN NAMEleanor Laura Newmann OF MOTHER
21 BIRTHPLACE OF
Elkhorn
MOTHER (City)
..... Wisconsin
(State or country)
22
Daniel F. Spaulding
Informars./5 ...... Fort Banks .....
(Address)
Mass
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
February 8
19.49
25m-(h)-10-48-24658
No
Robert Spaulding
2 FULL NAME.
(a) Residence. No.
(Usual place of abode)
3 DATE OF
DEATH
5 Accident, suicide, or hophide yrerisyry .... 4
Manner of
Smoke Ixhat amiforre)
Injury
Injury
·no
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-305 to the clerk of the city or town in which the deceased resided as soon as possible
Injury occur?
(City or town and State)
f(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.) Fort Banks
1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
RM R-305 1
PARENTS
PERSONAL AND STATISTICAL PARTICULARS
5
28
Date and hour of injury.
.19
[ R-301 A
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. Junta In plan tennis, so that it may be properly classined. Exact statement of OCCUPATION is very important. PARENTS
PLACE OF DEATH
+ Suffolke Winthrop, Mas County) 1
City or Town)
CERTIFICATE OF DEATH
Community Hospital Winthropse!
(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 specify WAR)
(a) Residence.
No.
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4
COLOR OR RACE
W
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED
S
5a If married, widowed or divorced
HUSBAND of ..
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here. I plc enorm
8
AGE
Years
Months
Days
If less than 1 day Hours Minutes
Usual 9 Occupation:
Industry 10 or Business:
11 Social Security No.
Hinchrome
12 BIRTHPLACE (City)
(State or Country)
13 NAME OF
FATHER
Para ig natura
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or Country)
17 Gnolo Bnainto ( Relation, if any )
Informant (Address) 12 Battery St. Boston hans!
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter I' Galer (Signature of Agent of Board of Health or other) Wealth Officer (Official Designation) (Date of Issue of bermit) 2/10/19
19 I HEREBY CERTIFY, That i attended deceased from
I last saw h
E1
alive on
Ful ?
19
, death is said to
have occurred on the date stated above, at
835
m.
Immediate cause of death Stillborn
Due to
Cerebral accident
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased? If so, specify 2 horas Staffer
(Signed)
¿(Address)
21 Bread Lt
0
Date Fel ?
, M. D. 42
21 It. michaela acmetil , porest prile ^ ^ (City or Town) 1 Place of Burial, Cremation or Removal. DATE OF BURIAL for
1959
22 NAME OF
FUNERAL DIRECTOR
ADDRESS 04 (Frei
Received and Filed FEB 14 1949
19
(Registrar)
X
Duration IMPORTANT
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
100M-7-46-19068
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
Registered No. 21
2 FULL NAME
(Baby Girl Omainto (If deceased is a nrarried, widowed or divorced woman, give also maiden game.) 12 Battery It- Barlow
(If nonresident, give city or town and State)
18 DATE OF
DEATH
tel.
7
(Month)
(Day)
14×9 (Year)
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.