USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 35
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
1/27/13
DATE OF DISCHARGE 8/2.9/20
RANK, RATING Muster Sey.
ORGANIZATION AND OUTFIT
SERVICE NUMBER 598,303
+
Middlesex
(County)
Natick
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Natick
(City or town making return)
Registered No.
105
3 Dartmouth f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Emma S. Betts (Pommet)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
259 Bowdion
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ......
.. months.
13
.. days. In place of residence.
5.
.years .......
.. months ........
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
June 13, 1950
DEATH
(Month)
(Day)
(Year)
9 SEX
F.
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
Widowed
or DIVORCED
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.)
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
George L. Betts
(Husband's name in full)
Coronary Occlusion
Sudden Death
12 IF STILLBORN, enter that fact here.
13
AGE
68 Years ..
5
Months.
3
Days
If under 24 hours
Hours .....
Minutes
5 Accident, suicide, or homicide (specify).
Date and hour of injury.
19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed?
viewed
6 Was disease or injury in any way related to occupation of deceased? .. no
If so, specify
(Signed)
M. F. Burke
M. D.
(Address) Natick
Date.
6-13
19 50
Winthrop
Winthrop
7
Place of Burial, or Cremation.
(City or Town)
June 16,
19 50
DATE OF BURIAL.
8 NAME OF
FUNERAL DIRECTOR
A. H. Doherty
Natick
ADDRESS.
Received and filed. 19
JUL 13 1950
(Registrar of City or Town where deceased resided)
PARENTS
19 BIRTHPLACE OF
FATHER (City).
(State or country)
France
20 MAIDEN NAME
OF MOTHER
Mary S. DeGange
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
France
22
Informant
(Address)
George L. Morgan
Natick
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
June 14,
.19.50
MARGIN RESERVED FOR BINDING
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.)
25m-(h)-10-48-24658
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
PLACE OF DEATH
ORM R-305 1
-
15 Industry or Business:
16 Social Security No ...
none
14 Usual
Occupation 1.
Hswf.
(Kind of work done during most of working life)
18 NAME OF
FATHER
Joseph Pommet
17 BIRTHPLACE (City).
(State or country)
France
Paris
(write the word)
(a) Residence.
No.
(Usual place of abode)
Winthrop, Mass.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No.
ORM 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
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE (City or town making return)
Registered No.
106
f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) ·
2 FULL NAME. Annie T. Brooks
(If deceased is a married, widowed or divorced woman, give also maiden name.)
69 Almont
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
years.9 ..
months.
.days. In place of residence.
30
.. years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY,
Jan. 1
50
19
I last saw h.e.r ...
.alive on
June 20, 19.50
h is said to
11:45 Pm.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
Days
82
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Housekeeper
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Ireland
17 NAME OF
FATHER
John Brooks
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Catherine Morgan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Mrs .M. F . Brooks
Informant
(Address)
31 Cross St., Winthrop
7 NAME OF
FUNERAL DIRECTOR
John F O' Maley
ADDRESS
Winthrop
Received and filed.
JUL 20 1950
19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?....... NO
If so, specify ..
Charles F Mahoney
(Signed)
4 Washington AveDate.
6/22
19 58
winthrop, Mass . Boston
6
Calvary
Place of Burial or Cremation
(City or Town)
June 23 1950
DATE OF BURIAL
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED July 5, 19 50
X
3 DATE OF
DEATH
June
21
1950
(Month)
(Day)
(Year)
That I attended deceased from
19.
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)
Cerebral embolism
ANTE
CEDENT (b)
CAUSES
Due To Arteriosclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis ?.
25m-(b)-11-49-900,475
No. Resthayne
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
to
June 21
50
have occurred on the date stated above. at.
9 COLOR OR RACE
(Address).
MANOIN NEOENYED TOR BINDING
ORM 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
NORFOLK (County)
BROOKLINE (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BROOKLINE (City or town making return)
Registered No.
439
107
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME Baby Girl - Patricia Martin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
328 Pleasant
St.
Winthrop, Massachusetts
(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.
......
... years ....
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
22
1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
19
to
19
I last saw h ....
.alive on
19
death is said to
have occurred on the date stated above, at
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) .Premature ... separation ... of
Placenta
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
STILLBORN
12
AGE
Years.
.Months.
Days
If under 24 hours
Hours
Minutes
ANTE
CEDENT (b)
CAUSES
Due To
Pre-eclamptic Toxemia
of pregnancy in nother
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Jackson Martin
18 BIRTHPLACE OF
FATHER (City)
Somerville
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Ina Strain
20 BIRTHPLACE OF
St. Thomas
6 Woodlawn Cemetery, Everett, Massachusetts Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
June ... 24
19.50
7 NAME OF
FUNERAL DIRECTOR
Edmund J Carafa
ADDRESS 38.9.Washington ... Av. Chelsea, Mass.
Received and filed. 19
JUL. 1-2-1950
(Registrar of City or Town where deceased resided)
21 Ina Martin
Informant
(Address)
328 Pleasant St Winthrop Mass
A TRUE COPY
ATTEST:
ath Shim
(Registrar of City of Town where death occurred)
DATE FILED
June 30, 1950
Town Clerk
19
X
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
50m-(e)-10-48-24658
(Address)
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .... Daniel C Goldfarb
(Signed)
483 Beacon St. Poston June 22.
PARENTS
Brookline
OTHER
SIGNIFICANT
CONDITIONS,
Major findings:
Of operations
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis ?.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No. Booth Memorial Hospital
.
M. D. 1950. MOTHER (City) (State or country) Canada
Due To (c)
ORM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25m-(b)-11-49-900,475
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No. 5550
108
[(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.)
88 Putnam
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. 2 Hrs
days.
In place of residence.
......
.years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June 25/50
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
June 25
19.
50
That I
attended deceased
from
June 25
50
19
19
50death is said to
have occurred on the date stated above. at
6;15A
m.
INTERVAL BE- TWEEN ONSET AND DEATH 3 Hrs
11 IF STILLBORN. enter that fact here.
70g
12
AGE
Years
Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Barber
14 Industry
or Business:
Retired
15 Social Security No ...
None
16 BIRTHPLACE (City) Italy (State or country)
17 NAME OF
FATHER
Paul Petralia
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Josephine
-
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Winthrop Cem-Winthrop Mass.
(City or Town)
Place of Burial or Cremation DATE OF BURIAL
June 28/50
19
21 Informant (Address)
Mrs P Petralia
A TRUE COPY
Charles 4. Inachin
(Registrar of City or Town where death occurred)
Received and filed
JUL -1.0.1950
19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ....
CL Clay
(Signed).
Date.
6-25
19
(Address).
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical
6 Mos Plus
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
None
Date of operation.
to
im
I last saw h
alive on
June 25
10a If married, widowed, or divorced
HUSBAND of.
Petrina Muscara
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY L
Coronary occlusion
TO DEATH (a)
ANTE
Due To
Arterio sclerotic
CEDENT (b)
heart disease
M.
7 NAME OF
FUNERAL DIRECTOR
M Kirby
ADDRESS
Winthrop
Mass.
DATE FILED
June 29/50
....................... 19
6 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
·
No.
Mass.General Hospital
Louis Petralia
(Was deceased a
U. S. War Veteran.
{ if so specify WAR).
(Kind of work done during most of working life)
ORM R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
109
Harry Williams Farquhar 2 FULL NAME (If deceased is a married, widowed or divorced woman, give also maiden name.)
59 Park Avenue
St. .
(If nonresident, give city or town and State)
Length of stay: In place of death · years months .days. In place of residence
42years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
(write the word)
Male
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEMarried
4 I HEREBY CERTIFY.
nov. 23. 1948
to
That I
July 3
1950
I last saw him alive on
July3
1950, death is said to
have occurred on the date stated above. at 9:30 Pm.
INTERVAL BE- TWEEN ONSET AND DEATH 72 hrs
11 IF STILLBORN, enter that fact here.
12
AGE 72
Years
1
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Contractor
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Roof
15 Social Security No. .
None
16 BIRTHPLACE (City)
(State or country)
Magg
17 NAME OF
FATHER
Joseph Farquhar
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Annie Williams
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
R.I.
Providence
21 Alice S Farquhar (Ado Informant,- 59 Park Avenue Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
Valter A garros- (Signature of Agent of Board of Health or other) Halter Neck 7/6 /50
(Official Designation)
(Date of Issue of Permit)
+50M (B)-12-49-900722
Walnut Hill
0
Brookline
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL .. ...
July . 6
150
7 NAME OF FUNERAL DIRECTOR Douala Saturnaldo ADDRESS Unthey mails.
Received and filed JUL 1 0 1950
19
(Registrar)
years
CEDENT
CAUSES
disease
() Treneralizea arteno -
Sclerosis
.-
OTHER SIGNIFICANT CONDITIONS
sonic Franchiecases
7 years
Major findings:
Of operations zone
Date of operation.
-
Was autopsy performed?
no
What test confirmed diagnosis ?.
cúnicas
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify 7
٥
murray
(Signed)
.
(Address) Pentirof Mass Date Sucré
M. D.
50
years
10a If married, widowed, or divorced
HUSBAND of
Alice Shaw
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
(Month)!
(Day)
1950 (Year)
J (If death occurred in a hospital or institution,
St. [ 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)
42
No. . 59 Park Avenue
INSTRUCTIONS FOR ICAL CERTIFICATE In giving JSE OF DEATH do not enter more than one ause for each (a), (b) and (c)
This does not mean node of dying. such art failure. asthenia, It means the disease, omplications which d death.
Morbid conditions. y. giving rise to the cause (a) stating underlying cause
Conditions contrib- to the death but not d to the disease or tion causing death.
Boston
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Occlusion
ANTE
Un Isteno-schematic heart
attended deceased
from
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 discase 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, cighteen 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 cen:etery, 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 of 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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. -- General Laws, Chap. 38, Sec. 6., as amended by Chap. 632. Sec. 4. Acts of 1945.
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 ' he 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 dore 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.
+
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 19 Moore Street
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 110
Mary Ann (McAskill) Howard 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Moore Street
St. .
(If nonresident, give city or town and State)
Length of stay: In place of death years months days, In place of residence
35 ars
months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF DEATH
July (Month)
3 (Day)
1950 (Year)
July
HEREBY CERTIFY,
12
19 47
to
July
3
19
I last saw h & alive on July 2, 1950 death is said to
have occurred on the date stated above, at
3:15 A. m.
INTERVAL BE- TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
8 months 12
85 10
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