USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 84
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it has heen engaged, such recital shall sppear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign in and transmit it to the clerk of the town for regis- trution. The person to whom the permit is so given and the physician cer tifying 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 rv quire .- Clap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bory a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived 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 boily is to be buried or the funeral is to be hield, or froni a per- son appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion).
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 bis county the body of such a person, he shall forthwith go to the place where the body lles and take charge of the same; ... - General Laws, Chap. 3S, Sec. 6.
... Be shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, witb tbe cause and manner of death .- General Lawa, Chap. 38, Sec. 7.
... The medical examiner certifies the cause and manner of death to the best of bis knowledge and belief.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla for the observance of the following rulea of practice :
(1) Attending physicians wili certify to such deaths only as those of person to whom they have given bedside care during a last llinesa from disease unrelated to any forin of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons wbo, though disabled by recognized disease uurelated to any form of injury, have died withtout recent inedical attendance or whose phyof- ciau is absent frmin hoine when the certificate of death Is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to Injury. . These include not ouly deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from Injury or Infection related to occupation, tha sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
Medical Examilners in certifying to a death will state the cause and manner thereof, and will specify : (1) Uniler cause, the nature of an Injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example : "Com- pound fracture of tbe femor with ensuing septicemia (gas bacillua) caused by a steam rallway accident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, sulcidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated Internai injury sus- tained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause Its known or presumable nature; and (2) under manner, indicate tbe circum- stances leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (basal gangiia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RM R-301A 1
PLACE OF DEATH
Suffolk County) Winthink (City or Town) Bay View Rist Home mc Govern (If deceased is a married, widowed or divorced woman, give also maiden name.) 65 St andrew Road
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. 252
Registered No.
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)
none
St. East Boston
(If nonresident, give city or town and State)
Length of stay: In place of death
1 .. years . .. months.
days.
In place of residence
69 years
.months .. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December 30 (Day)
1950 (Year)
8 SEX
Female Muito
10 SINGLE
MARRIED
WIDOWED
(write the word)
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 AGE 69 Years
Months
Days
If under 24 hours
Hours .. . Minutes
13 Usual
Occupation:
Celente
(Kind of work done during most of working life)
14 Industry
or Business:
Naldo Bros
15 Social Security No. ..
011-03-2950
16 BIRTHPLACE (City) ..
(State or country)
East Boston mass
17 NAME OF
FATHER
Charles mc Govern
18 BIRTHPLACE OF FATHER (City) (State or country)
cheland
19 MAIDEN NAME OF MOTHER Mary mc Govern (O.K.)
20 BIRTHPLACE OF MOTHER (City) (State or country)
chiland
mary Qui
65 JA andrew Road Er
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter Maher H. O.
(Signature of Agent of Board of Health or other) Der 31-50 (Date of Issue of Permit)
(Official Designation)
100M-(D)-10-48-24658
6
Holy Cexpo Place of Barial or Cremation DATE OF BURIAL.
Jan 2 1958
7 NAME OF FUNERAL DIRECTOR Frederik mannach
ADDRESS East Botão
19
Received and filed JAN 3 1951
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
(Address) 6 2clDe
M. D.
Date 12-30 19 50
malden (City or Town)
Major findings:
Of operations
Date of operation
What test confirmed diagnosis?
INTERVAL BE- TWEEN ONSET AND DEATH 1948
ANTE CEDENT (b) CAUSES
Due To arterosclerosi
?
Due To Hipertensión
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? Urmalik - Stillescon
19
50 death is said to
have occurred on the date stated above, at m.
DISEASE OR CONDITION DIRECTLY LEA Chronia Leplantes
TO DEATH (a)
19. 50
to ..
That I attended deceased from Vec 30
50
I last saw h.l ........ .alive on Lamb 30
6 P.
9 COLOR OR RACE
(Month)
4 I HEREBY CERTIFY,
In giving SE OF DEATH o not enter ore than one use for each ), (b) and (c)
his does not mean de of dying, such t failure, asthenia, means the disease, plications which death.
orbid conditions, giving rise to the cause (a) stating nderlying cause
ditions contrib- the death but not to the disease or on causing death.
ISTRUCTIONS FOR CAL CERTIFICATE
Margaret a Fita No.
(a) Residence. No. (Usual place of abode)
21 Informant (Address)
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 hall 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 elief expedition and the Philippine insurrection, which Shall, for said purposes, be leemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border ervice 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 n a town, or remove therefrom a human body which has not been buried, until he as received a permit from the board of health, or its agent appointed to issue uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shallexhume a human body and emove it from a town, from one cemetery to another, or from one grave or tomb ther than the receiving tomb to another in the same cemetery, until he has eceived a permit from the board of health or its agent aforesaid or from the clerk f the town where the body is buried. No such permit shall be issued until there hall have been delivered to such board, agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, 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 nough 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 aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town o 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 he undertaker desiring to make such removal shall constitute a permit for such emoval; provided, that such body shall be returned to the town from which it was emoved within thirty-six hours after such removal. unless a permit in the usual orm 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 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 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
+
PLACE OF DEATH
Middlesex (County)
Framingham (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Framingham
(City or town making return)
Registered No. 253
Framingham Community Hospital No.
§(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Rose E. Rubin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
379 Shirley St.
Winthrop, Mass.
St.
(If nonresident, give city or town and State)
(Usual place of abode)
Length of stay: In place of death
.. years.
months.
2
.days. In place of residence
30 years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December 30, 1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Dec. 29 19 50
to ..
Dec. 30
19
50
I last saw h ...
er.alive on
Dec. 30
....... 19.5.0 death is said to
5:45 PM
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
Cerebral hemorrhage
TO DEATH (a)
18 hrs
ANTE
CEDENT (b)
CAUSES
Due To
Hypertension
?
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Glycosemia
?
Major findings: Of operations.
Date of operation ..
none
Was autopsy performed?
What test confirmed diagnosis ?.
Symptoms
5 Was disease or injury in any way related to occupation of deceased? IO If so, specify Herbert Frankel, M. D. (Signed). Framingham, Mass, Date
12/30/50 D. (Address). Tifereth Israel of Winthrop-Everett 6
Place of Burial or Cremation
(City of Town)
DATE OF BURIAL
January 1, 1951
19
7 NAME OF
FUNERAL DIRECTOR
Louis Levine
ADDRESS
470 Harvard St., Brookline
Received and filed.
JAN 9 1951
.......... 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
MARRIED
WIDOWED
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
55
Years
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Housekeeper
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Private residence
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Edward Rubin
18 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
SArah Silver
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Lena Disler
Informant
(Address)
379 Shirley St. Winthrop
A TRUE COPY
ATTEST:
W= A Walch
(Registrar of City or Town where death occurred)
DATE FILED
January 3, 1951
19
MARGIN RESERVED FOR BINDING
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25m-(b)-11-49-900,475
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
ORM R-302 1
PARENTS
Russia
no
(Was deceased a
U. S. War Veteran,
if so specify WAR)
10 SINGLE
(write the word)
F
ORM R-302 1
2 FULL NAME ..
ANTE
CEDENT (b)
Major findings:
Of operations.
Date of operation.
(Address)
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
Due To
(c)
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50m-(e)-10-48-24658
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
PLACE OF DEATH
Essex (County) Ipswich (City or Town) Benjamin Stickney Cable memorial Sagitalis No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Rawich (City or town making return) 89254
Registered No.
occurred in a hospital or institution, give uts NAME instead of street and number)
Jasper Lampasona
(If deceased is married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
Winthrop
(If nonresident, give city or town and State)
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Dec
31
1950
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
aug . 24,
19 ..
50
to Dec- 31
19.50
I last saw him alive on.
Dec. 31
1950, death is said to
have occurred on the date stated above, at
3:15 a. m.
INTERVAL BE-
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 60 Years - Months
.. ... .. Days
If under 24 hours
Hours
Minutes
Occupation:
13 Usual
Fruit Peddler
(Kind of work done during most of working life)
14 Industry
or Business.
Fruit Stare
15 Social Security No. none
16 BIRTHPLACE (City)
(State or country)
Sicily, Italy
17 NAME OF
FATHER
Jaseph
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Sicily
Italy
19 MAIDEN NAME
OF MOTHER
anna Direta
(State or country)
Italy
21 Carmen hampaso
(Address)
23 Belchevalte Zintherap
A TRUE COPY
ATTEST:
Lucy & Dalan active
(Registrar of/City or Town where death occurred)
DATE FILED
January 2,
19 ..
51
0
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
(write the word) Single
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 LEADING
TO DEATH
(a).
Carcinomatoria
of large bowl
with metaxases
to lungo
G mos
OTHER
SIGNIFICANT Der Phe Terminal
CONDITIONS Cardiac Decompensation 1 uk.
Was autopsy performed?
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify .....
(Signed)
J.H. Fonte
M. D.
20 BIRTHPLACE OF
MOTHER (City)
Sicily
Winthrop Cemetery
6
Place of Burial og Cremation
DATE OF BURIAL. Jan. 3
195/
Winthrop (City or Town)
7 NAME OF
FUNERAL DIRECTOR.
Ernest Loggiana
ADDRESS
Winthrop, mais
Received and filed. 19
1
MAKGIN KEDEKYED FOR BINDING
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
PARENTS
Date Dec. 31 1950.
(a) Residence. No. (Usual place of abode)
80 Locust
Length of stay: In place of death. years. 4 months 7 days. In place of reside 35 years.
RM R-303-A
1
PLACE OF DEATH
County) Winthrop
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Heaith or Its Agent.
Registered No.
255
St. { { If death occurred in a hospital or institution, 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.)
233 Winthrop St.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months
days.
In this community 30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Wil fiye maiden name of Tits &vfH
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that faot here.
8
80
4
AGE
Years
Months.
5 Days
If less than 1 day
Hours.
.Minutes
Usual
9 Oocupation :
Housewife
Industry
10 or Business :
Own ... home
11 Soolal Security No ..
None
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
Frank Brendle
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Ann Kellitt
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17
ida Leigh
Informant.
( Address) 2048 Broad St. Edgewood R.I ..
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with Die BEFORE the burial or transit permit was issued : Walter Makelze
(Signature of Agent of Board of Health or other)/ Health officer 1/2/5/
(Official Designation) (Date of Issue of Permit)
20 Accident, sulolde, or homloide (specify).
Presumably
Date of ooourreno .... 350
Where did
Injury ooour ?
With
man
(City (or town and State)
Did Injury ooour In or about home, on farm, In Industrial place, or In publio
place ?
(Specify type of place)
Manner of Inhalation fellament
Injury
Nature of
Injury
aplique
While at work ?
Was there an autopsy ?.............
21 Was disease or Injury in any way related to ocoupation of deceased ?.
if 30, 5
(Signed
a .... , M. D.
(Address) 25 thatthis X Date /2/ 31 19.50
22
Winthrop
Winthrop
Place of Burial, Cremation or Removel.
(City or Town)
Jan. 3
151
23 NAME OF
Howard 5 Uhrynolds
FUNERAL DIRECTOR ...
ADDRESS
Winthrop mad.
Received and flied
JAN 2 1950
19
(Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physiolans to Insert a recital to that offoot extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms,
No.
(City or Towne) 233 Winthrop St
Lightbrown
(Was deceased a U. S. War Veteran, if so speolfy WAR)
(If nonresident, give fty or town and State)
har 31 1950
(Month)
(Day)
(Year)
Female
White
18 DATE OF
DEATH
MEDICAL CERTIFICATE OF DEATH
19 | 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.) despania Que te in
50m- (i)-1-45-15510
Daughter
DATE OF BURIAL
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
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