USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 29
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
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
25m-(b)-11-49-900,475
PLACE OF DEATH
Essex (County)
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
71
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Mass.
2 FULL NAME. LUBELI ...... Never
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. inthron, Mass St.
........ ............
(If nonresident, give city or town and State)
Length of stay: In place of death ...... .. years. 1.months .... ] .. ] .. days. In place of residence. .... years.
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 2.
1951
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
4 I HEREBY CERTIFY,
Jan. 30
19 51
to .. March 2
19
51
I last saw
h.
im
alive on
March 2,, 19.
19 5 ] death is said to
have occurred on the date stated above, at. 10:00 pm.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Bronchopneumonia
TWEEN ONSET AND DEATH 2 da
11 IF STILLBORN, enter that fact here.
AGE 94
Years
Months.
.Days
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)
Russia
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
No
What test confirmed diagnosis?
Clinical
19 MAIDEN NAME
OF MOTHER
Unknown
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
cev mitchols 3rd
M. D.
(Signed) ....
(Address) Danvers, Dass. Date
19
. Temple Israel Cemetery
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
liarch
195.1
21
Informant
(Address)
Hathorne, Mass.
7 NAME OF
FUNERAL DIRECTOR
Levine Funeral ServiceTRUE COPY
ADDRESS
Boston ....... Ma.s.s.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Larch 9
1957
......
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Unknown
18 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
Unknown
Unknown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unknown
Takefield
Georgie T. Brimigion
Received and filed.
APR 1 1 1951
19
10a If married, widowed, or divorceunknown 2. Unknown
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
Unknown
R-302 1
Registered No.
No. Danvers State Hospital, Hathorne
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
That I attended deceased from
RECLIVE.
APR121951 1Y
R-302 1
PLACE OF DEATH
Essex (County)
Danvers (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers.
(City or town making return)
Registered No.
72
No. Danvers .... State .... Hospital. .... Hathorne.
St. \ give its NAME instead of street and number)
2 FULL NAME. GARDINER ....... Edwin .... P.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. 11 .... Prospect.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ...... .years.
.months 1 .. days. In place of residence. ........ .years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
5
19.5.1
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED Widowed
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
.March 4" 19 .. 51 to March 5 ...
19
50
10a If married, widowed, or divorced HUSBAND of.
Unknown
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
month&GE .... 76 Years.
Months.
Days
If under 24 hours
.. Hours.
Minutes
13 Usual
Occupation:
Retired .... railroad .... man
(Kind of work done during most of working life)
years
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City) ..
(State or country)
Chelsea
OTHER SIGNIFICANT CONDITIONS
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). Andrew .Nichols .... 3rd. M. D.
(Address)
Danvers, Mass.
Date 3/8/51 19.
6 Place of Buri der Cremation
Auburn Cemetery Cambridge. (City or Town)
DATE OF BURIAL March 9, 19. 51
Informant (Address)
Georgie .... T ........ Brimigion Hathorne Mass
A TRUEOCOPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
........
7 arch
.19
57
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City) (State or country)
Unknown
Mass
19 MAIDEN NAME
OF MOTHER
Adelaide Hyde
20 BIRTHPLACE OF MOTHER (City) (State or country) Lass .Lynn
21
7 NAME OF FUNERAL DIRECTOR J ..... S .Vaterman & Son
ADDRESS Boston ...... Ma.ss ..
Received and filed.
APR 1.1 1951
19
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
25m-(b)-11-49-900,475
ANTE
Due To Malignant .... Hypertension
CEDENT (b) CAUSES
Due To (c)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Hypertensive ... heart disease
TWEEN ONSET AND DEATH
I last saw him alive on March 5, 19 .... 5Jdeath is said to have occurred on the date stated above, at 10:40pm. INTERVAL BE-
Winthrop
(Usual place of abode)
J(If death occurred in a hospital or institution,
1
17 NAME OF FATHER Charles L. Gardiner
0
APR111951
+
PLACE OF DEATH
Essex. (county)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers (City or town making return)
Registered No.
73
St. [ give its NAME instead of street and number) J(If death occurred in a hospital or institution. No. Danvers State Hospital, Hathorne.
2 FULL NAME. (If deceased is a married, widowEd Fa Gud Com) , give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. $2.Fremont St ...
.......
St.
WintherQin city or town and State)
Length of stay: In place of death. 1.8years .. 2months. &days. In place of residence. ........ years. .months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
(Month)
(Day)
1951
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY,
That I attended deceased from
April 10 ...
19 ... 50.
to ..
March 8.
19
51
I last saw h ..... p.alive on ..... March ............... 19.5.7, 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 ....... Years.
Months.
Days
If under 24 hours
.Hours ......
.Minutes
13 Usual
Occupation :
most& borking life)
14 Industry or Business:
15 Social Security No .. None
16 BIRTHPLACE (City).
(State or country)
Somerville
Lass.
17 NAME OF
FATHER
John H. Williams
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Lass
Boston
19 MAIDEN NAME OF MOTHER Sarah Bragdon
20 BIRTHPLACE OF MOTHER (City) Boston
(State or country)
Mass.
21 Informant (Address) Mary E. Sheehan
A TRUE COPY
Hathorne, 1995.
ATTEST:
(Registrar of City of Town where death occurred)
DATE FILED
March 12
19 51
(Registrar of City or Town where deceased resided)
weeks
ANTE Due To
CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed ?. Yes
What test confirmed diagnosis ?.........
Autopgy
5 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed). Andrew Nichols 3rd. M. D.
(Address). Danvers Hass
19.
6
Milton Cemetery ........ Milton, Mass
Place of Burial or Cremation
DATE OF BURIAL March 10
7 NAME OF FUNERAL DIRECTOR Mortimer .N .... ..... Peck
ADDRESS Braintree Lass.
Received and filed APR 1-11951 ..... ...... 19
PARENTS
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 of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
R-302 1
have occurred on the date stated above, at 12.05 am. INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Bilateral Lung
Abscess
(write the word)
(Usual place of abode)
APR _ _ 1051 /1
F
PLACE OF DEATH
Suffolk
(County)
(City or town making return)
Registered No.
3312.4
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Anna Gilman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran.
if so specify WAR)
St.
Winthrop
Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
2
.years
1
months.
days. In place of residence
2 years
1
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widow
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
March 1.
19 ..
49
That I
attended deceased
April 3
19
51"
I last saw
h
alive on
19
death is said to
have occurred on the date stated above, at
12:20A
m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING cute myocardial infarction
TO DEATH (a)
3 Day
12
72
AGE
Years
Months.
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Housework
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Russia
5-6 Yrs
17 NAME OF
FATHER
Rubin Bian
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
Examination
NO
5 Was disease or injury in any way related to occupation of deceased ?..
If so, specify ....
HA Derow
M. D.
(Address)
Boston Mass.
Date. 4-3 19
6
Place of Burial or Cremation DATE OF BURIAL.
April 4/51
19
7 NAME OF
FUNERAL DIRECTOR
A Golov
Dorchester Mass.
ADDRESS
Received and filed. APR 16 1951
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Sarah -
Russia
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Informant (Address)
HebrewHome for Aged
A TRUE COPY
ATTE
Martes H. Inackie
(Registrar of City or Town where death occurred)
DATE FILED
April 6/51
19
R-302 1
Boston
(City or Town)
No.
21 Queen St
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
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 of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)
25m-(b)-11-49-900,475
ANTE Due To Coronary arterio sclerosis
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Senile psychosis
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Morris Gilman
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
3 DATE OF
DEATH
April 3/51
(write the word)
(a) Residence. No.
36 Cutter
(Usual place of abode)
to
April 3
51
er
Major findings:
Of operations.
No
(Signed)
Winthrop Cem-Everett Mass.
(City or Town)
<
RM R-301 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
Winthrop (City or town making return)
25
42 Harbor View Avenue No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Helen Marie Williams (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. . 42 Harbor view Avenue (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. .. years. ..... months. .days. In place of residence.20 ... years. ... months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
white
10 SINGLE
MARRIED
WIDOWED Widowed
or DIVORCED
4 I HEREBY CERTIFY,
19.
to
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
WilliamA ... Williams
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGB60
Years
3 Months 21 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :.
Graphotype Operator
(Kind of work done during most of working life)
14 Industry
or Business: Christian ..... Science ..... Pub .... Co.
15 Social Security No ... 0.1.5-20-08.61
0
16 BIRTHPLACE (City)
Malden
0
(State or country)
Mass.
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed ?.
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
(Signed) .
(Address) Wanting Board Date 4 abril 951
inthrop
of reality womb
.inthrop
(City or Town)
Place of Burial or Cremation
DATE OF KURAL entombment 4/6/51 19
7 NAME OF
FUNERAL DIRECTOR.
alfred B. Marek
ADDRESS
174 Winthrop St, Winthrop
Received and filed
19
APR 9 .
.1951
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
charlestown
(State or country)
Mass.
ยท
willlow
19 MAIDEN NAME
OF MOTHER
Llano Elwa Williams
20 BIRTHPLACE OF
Charlestown
M. D. MOTHER (City) (State or country) Mass.
21
Informant
Harold F. Robie
(Addr Prospect St, Marshfield,Mass I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Watter of Bakker (Signature of Agent of Board of Health of other)
Health Oficer (Official Designation) (Date of Issue of Permit)
4/5/51
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, iring rise to the use (a) stating erlying cause
ditions contrib- he death but not the disease or causing death.
to get there due to road 1.16. When it is fusible.
conditions approximately avril 28, V951
Due To
Presumably
ANTE
CEDENT (b)
CAUSES
Coromant
Due To
Occlusion
(c)
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Natural causes
I last saw h ...........
alive on 19 death is said to
have occurred on the date stated above, at
about 8 p.m.
3 DATE OF
DEATH
abril
4.
1951
(Year)
9 COLOR OR RACE
(write the word)
(Month)
(Day)
That I attended deceased from
(Was deceased a U. S. War Veteran, if so specify WAR)
NO.
Registered No.
A IRLL COPY ATTEST
17 NAME OF
FATHER
Eugine Field Robie
.
Helen
Cemetery Effingham
-
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 behef 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 imine- diate cause of death as nearly as he ean 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, br (leemed 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 elerk 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 elerk 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 elerk 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 elerk or registrar may require .- Chap. 114, See. 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 medieal 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 elerk 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., (Tereentenary 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 oeeupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instruetions 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 oceupa- tion had been given up or changed, or it 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 domestie service for wages, however, designate the oeeupation by the appropriate terms, as housekeeper-private family, cook-hotel, ete. 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
1
PLACE OF DEATH
Winthrop (County) Suffolk (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.
76
J(If death occurred in a hospital or institution. St. { give its NAME instead of street and number) No. Winthrop Community Hospital Annie Elizabeth Riley (If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
80 Buchanan Street
St. .
(If nonresident, give city or town and State)
Length of stay: In place of death .. years ...
months 2.3 days. In place of residence 32 years
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
abril Month)
6
(Day)
1951 (Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
4I HEREBY CERTIFY,
March 1,
er
1951.
to
.alive on
april 6
I last saw h.
That
I
Atended deceased from
abril 6
1257
1957, death is said to
have occurred on the date stated above, at
9:30 A.m.
INTERVAL BE-
TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
2 weeks
12
78
AGE
Years
Months
Days
If under 24 hours
.. Hours .. .. Minutes
13 Usual
Housewife
4 weeks
Occupation :..
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