USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 6
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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, Scc. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thercot 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 bekl, or from a person appointed to have the care of the cemetery or burial ground in which the interment is madc.
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 occup :- 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
ORM R-301A 1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
2/6/50
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Writtrop (community Htebetal) (If death occurred in a hospital or institution. No.
&. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1806 North Shore Rd
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years.
months.
6 days. In place of residence. ... years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
JANUARY
30
1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE,
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY, JANUARY 20 1950
JANUARY 30 1050
I last saw him
alive on JANUARY 30 150
death is said to
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
CEREBRAL HEMORRHAGE 100YS.
11 IF STILLBORN, enter that fact here.
12
AGE
20
.Years
Months
.Days
If under 24 hours
Hours . Minutes*
13 Usual
Occupation :
Stewart.
(Kind of work done during most of working life)
14 Industry
or Business:
South Station
15 Social Security No.
012-05-1774
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
William Johnston
18 BIRTHPLACE OF FATHER (City) (State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Barbara Eduardo
20 BIRTHPLACE OF MOTHER (City) (State or country)
Scotland
21 Nuo Mande B. Sagar
Informant (Address)
1506 Vs. Slune Red Parce
7 NAME OF
Caixa M. merci
FUNERAL DIRECTOR
ADDRESS 305 Beach St. Perea Mass
Received and filed 19
FEB .2 ......... 1950
(Registrar)
5 YRS
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings: Of operations
Date of operation
Was autopsy performed? NO
What test confirmed diagnosis?
CLINICAL OBSERVATION
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify (Signed)
(Address)
620 Beach Rabatte 1-31 1950
6
Cedar grove lementary multon Waves Place of Burial or Cremation
DATE OF BURIAL ..
February 2
1950
(City or Town)
50M-2-49-25666
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Bakes (Signature of Agent of Board of Health or other)
Health
officer
NA
(Official Designation)
(Date of Issue of Permit)
NSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH lo not enter ore than one use for each a), (b) and (c)
This does not mean ode of dying, such ri failure, asthenia, - ' means the disease, mplications which l death.
forbid conditions." giving rise to the cause (a) staling underlying cause
onditions contrib- 'o the death but not to the disease or aion causing death.
PARENTS
If married, widow HUSBAND of ..
· divor Mande B. Sagar. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
mass.
(a) Residence. No. (Usual place of abode)
44
(Was deceased a U. S. War Veteran, if so specify WAR)
(write the word)
That I attended deceased from
6.50 A. m.
ANTE CEDENT (b) CAUSES
GEN. ARTERIOSCLEROSIS
Harold Musgrave M. D.
Registered No.
14
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 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 discase, or when any person is found dead. .. - General Laws, Chap. 38. Scc. 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 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 in jury, 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
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
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)
35
Danvers State Hospital, Hathorne, Ma.s/sIf death occurred in a hospital or institution. No.
St. [ give its NAME instead of street and number)
2 FULL NAME
Verna .... Burns
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
14 Charles St., Winthrop, Mass,
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ...... ... years months. 13 ... days. In place of residence ............ years. .months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
1
1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
Dec .19
19 ...
49
to
Jan. 1
50
19
I last saw h ..... ] ..... alive on
Jan ...... 1 ... 19 ... 5.death is said to
have occurred on the date stated above, at
12:45pm.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
47
5 day AGE
Years
Months .........
... Days
Housewife
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No ..
None
16 BIRTHPLACE (City)
(State or country)
LockportNova Scotia
Cannot be learned
17 NAME OF
FATHER
(Stevens )
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 wass Date.
1/4
19.
50
Cambridge Cemetery
Cambridge
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January 4
.. 19.5.0
7 NAME OF
FUNERAL DIRECTOR
David Fudge & Son
ADDRESS
Somerville ...... Mass.
Received and filed.
FEB LI 1950
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Emily Wilson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21
MaryE Sheehan
(Address)
Hathorne Mass
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Jan. 5
.19.50
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Fred Burns
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Bronchopneumonia
TO DEATH (a)
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
50m-(e)-10-48-24658
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
8 SEX
Female
White
9 COLOR OR RACE
If under 24 hours
.Hours .....
Minutes
. IVA HIRVING
f
PLACE OF DEATH
SUFFOLK BOSTON|
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
313
16
No. . The Childrens Hospital
f(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME Boyer, Lewis Charles
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 11 Wave Way, Winthrop, Mass. St.
(If nonresident, give city or town and State)
(Usual place of abode)
Length of stay: In place of death .. years. .. months. days. In place of residence. .years months. .. days.
6 hours and 20 minutes
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH Jan .. .... 12th ......
1950
(Month)
(Day)
(Year)
Male
white
MARRIED
WIDOWED
or DIVORCED single
4 I HEREBY CERTIFY.
That
I attended deceased from
1-12.50 19
to ..
1-12-50
19.
I last saw h ..... ].M.alive on
1-12-50
19
death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 2 Years ..
7 Months
1L[Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation :.
none
ANTE
CEDENT (b)
CAUSES
Due To
influenzal. , ..... acute.
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
None
Major findings:
Of operations
Tracheotomy
Date of operation]./12-50 Was autopsy performed ?..... v.e.s What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? no.
If so, specify
(Signed)
Joseph J. Maher
M. D.
(Address) 300 Longwood Ave
19
6
Mt. Lebannon-Sons of Abraham-W Rox Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
January 13, 1950
19
7 NAME OF
FUNERAL DIRECTOR.Benjamin .... Birnbach
ADDRESS
10 Washington St .Dorch ....
Received and filed
Jan. 16, 1950
19
FEB 17 1950
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF FATHER
Max Boyer
18 BIRTHPLACE OF
FATHER (City)
Boston, .... Lass ..
(State or country)
19 MAIDEN NAME
OF MOTHER
Betty Goldberg
20 BIRTHPLACE OF
MOTHER (City)
B.o.s.t.o.n., .... Ma.s.s ...
(State or country)
Max Boyer
21
Informant
(Address)
1] Wave Way Ave. Winthrop
ATTEST:
A TRUE COPY
Charles H. Mackie
(Registrar of City or Town where death occurred)
DATE FILED
..........
..................... ... 19 ..
X
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
Waived by Medical Examiner 1/12-50 (P.L.)
50m-(e)-10-48-24658
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
have occurred on the date stated above, at 1:20 pm.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Laryngotrachea
bronchitis
(Kind of work done during most of working life)
14 Industry
or Business :.
None
15 Social Security No ............ o.n
16 BIRTHPLACE (City) Winthrop Mass. (State or country)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
RECEIVE
11 12
ONTE
+ இருநிமி
FEB1'71950 AM
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
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. ......
J(If death occurred in a hospital or institution. Danvers State Hospital, Hathorne, Isabove its NAME instead of street and number) No.
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 57-A Beacon St. Winthrop, Mass (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ..... ... years. months.
8 .days. In place of residence. ........... years. .. months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
13
1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Jan. 5 19 50
to Jan ..... 13
19
50
I last saw h
.e.r.alive on
Jan. 13, 19 50 death is said to
have occurred on the date stated above, at.
7:05 pm.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
83 Years
4 Months
21Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Unable to work
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Stockholm
Sweden
17 NAME OF
FATHER
Forentine Lindquist
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Sweden
19 MAIDEN NAME
OF MOTHER
Sophie Lundgren
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify ..
No
(Signed) ...... Francis ........... Sullivan M. D.
(Address)
Hathorne, Mass Date
1/20 .... 1950
6
Winthrop Cemetery
Winthrop
Place of Burial or Cremation
(City or Town
January 16
10 50
.19
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTOR
Reynolds Funeral Home
ADDRESS
Winthrop, Mass.
Received and filed.
ICD -11950
19
(Registrar of City or Town where deceased resided)
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)
Arteriosclerotic
heart disease
2 yrs.
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Was autopsy performed ?.
No
Date of operation.
What test confirmed diagnosis ?.
Clinical
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
21 Mary E. Sheehan
Informant
(Address)
Hathorne Mass
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED January 2.5 .19 ...... 50
9 COLOR OR RACE
10 SINGLE
(write the word)
8 SEX
Female
White
MARRIED
WIDOWED
or DIVORCED
Single
... .......
50m-(e)-10-48-24658
Julia Lindquist
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1
PLACE OF DEATH
SUFFOLK County BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
328
13
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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
........
... years.
months
5
days. In place of residence
years.
months.
.days.
2 FULL NAME.
Max Slater
117
Shore Drive
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Jan 13 1950
(Day)
(Year)
(Month)
Jan 9
19
50
to
Jan 13
im
have occurred on the date stated above, at
8:15 Am
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)?Acute myocardial
infarction
ANTE
Due To
CEDENT
(b)
CAUSES
Due To
(c)
OTHER
Ruptured gall bladder
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