USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 32
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No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held. or from a person appointed to have the care of the cemetery or burial ground in which the interment is made,
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation. the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death,
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework, For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
M R-302 1
Copies of returns of deaths which occurred in your city or town in case the deccased 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)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers
(City or town making return)
81
(City or Town) Danvers State Hospital, Hathorne, No.
f(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME NOYES , Byron W.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 Washington
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.2 .... years ...
1
months.
1
.days.
In place of residence.
.......... years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
10,
1951
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Marrie
4 I HEREBY CERTIFY ,
April 10 .... 50
to ..
April .... 10
That I attended deceased from
19
51
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Tears
12
AGE
43,
2
Months
28
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Salesman
(Kind of work done during most of working life)
14 Industry or Business :.
15 Social Security No.
Unknown
16 BIRTHPLACE (City)
(State or country)
Mass.
Everett
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
No
What test confirmed diagnosis?
Clinical
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Middleton
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Helen Brider
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Andrew Nichols ..... 3nd.
M. D.
(Signed)
(Address) Danvers , ... Mass.
Data / 13/51 19
Oakdale Cemetery
Middleton
DATE OF BURIAL
April 13,
19 5]
21
Informant
(Address)
Mary E. Sheehan
Hathorne, Mass,
7 NAME OF
FUNERAL DIRECTOR
Gardner H. Shattuck
ADDRESS
Evetett, Mass.
Received and filed
1951
19
A TRUE COPY
Arthur W Say
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
Annabelle Wheeler
I last saw
h
im
alive on
April
10 19 5 death is said to
6:20 pm.
have occurred on the date stated above, at INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING,monary Tuberculosis
TO DEATH (a)
months
ANTE
CEDENT
CAUSES
Due To
(b)
Due To (c)
50m-(e)-10-48-24658
Danvers
CERTIFICATE OF DEATH
Registered No.
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop
(a) Residence. No. (Usual place of abode)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
17 NAME OF
FATHER
Byron W. Noyes, Sr.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Missouri
St. Louis
6
Place of Burial or Cremation
(City or Town)
April 16,
.19
51
M 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
Worcester (County)
RUTLAND (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
Registered No. 82.
Rutland State Sanatorium No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Donald Ray Futchinson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 Revere
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
1
years
6
months
10
days.
In place of residence
... years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
14.
1951
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
divorced
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
October 41.49
to
April
14.
I last saw
h.
im
.. alive on
pril14,. 19.51 death is said to
have occurred on the date stated above, at.
3:25 pm.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Pulmonary
tuberculosis
TWEEN ONSET AND DEATH 2 yrs
11 IF STILLBORN, enter that fact here.
12
AGE
40 Years
2
Months
Days
If under 24 hours
Hours.
Minutes
ANTE Due To Diabetes mellitus
CEDENT (b)
CAUSES
5 ≥ yrs
13 Usual
Occupation :
Cab driver
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
032-03-3868
16 BIRTHPLACE (City)
(State or country)
N.H.
17 NAME OF
FATHER
Fred Hutchinson
18 BIRTHPLACE OF
FATHER (City)
Lynn
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Alice Astelle
20 BIRTHPLACE OF
MOTHER (City)
Waterbury,
(State or country)
Vermont
21 Merrill Hutchinson
Informant.
(Address)
303 Main St., winthrop, cass
7 NAME OF
FUNERAL DIRECTOR
John F. 0'Maley
ADDRESS ./inthrop , Mass.
Received and filed.
19
1951
(Registrar of City or Town where deceased resided)
A TRUE COPY
PY Livida a. Hanff
ATTEST:
(Registrar of City or Town where death occurred)
DASTHEBoard of Health
April 15,1951
25m-(b)-11-49-900,475
6
Winthrop Cemetery, Winthrop, Iges Place of Burial or Cremation (City or Town) April 17, 19 51
DATE OF BURIAL
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
George Altenhaus
(Signed) ...
(Address)
1.VIAnd 2935.
Date
April 14.
.1951
·
10a If married, widowed of divers ley
19 51 HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?.
Yes
What test confirmed diagnosis?X-ray,laboratory test
Concord,
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No.
(Usual place of abode)
1
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
Boston
(City or town making return)
Registered No.
3732 83
CERTIFICATE OF DEATH
f(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME
Evelyn Atwood
(If deceased is a married, widowed or divorced woman, give also maiden name.)
33 Bellevue Ave.
St.
(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
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
Married
of DIVORCED
4 I HEREBY CERTIFY,
April 10
19
51.
to
That I
attended deceased from
April 1519
51
I last saw h
Chalive on
April 15
51
19. "death is said to
have occurred on the date stated above, at.
7;3.04
.m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Obstruction of gall
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE 73 Years
5
16
Months
.Days
If under 24 hours
Hours ........ Minutes
duct
CEDENT (b)
CAUSES
Gallstones ..
(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)
Milford N.H.
17 NAME OF
FATHER
Elmon Gutterson
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Manchester N.H.
Date of operation
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
autopsy
19 MAIDEN NAME
OF MOTHER
--
Anthoney
20 BIRTHPLACE OF
MOTHER (City)
Hancock N.H.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April/18/51
19
21
Informant
(Address)
Husband
A B Marsh
ADDRESS
Received and filed. APR 30 1951 19
(Registrar of City or Town where deceased resided)
IPARENTS
25m-(b)-11-49-900,475
3 DATE OF DEATH 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 CONDITIONS
OTHER
SIGNIFICANT
WRITE PLAINLY, WITTT UNFADING DLAGR INS - THIS IS A PERMANENT RECORD
ANTE
Due To
April 15/51
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Charles E Atwood
(or) WIFE of
TO DEATH (a)
bladder and common
2 Weeks
Years
13 Usual
Occupation:
Housewife
Due To
Coronary arterio
(c)
sclerosis
Years
Cerebral ... edema
Nephrosclerosis
Major findings:
Of operations
None
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
N A Wilhelm
(Signed)
Peter Bent Brigh Date Hospt
4-4:5251
(Address)
Winthrop Cem-
Winthrop Mass (State or country)
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass.
A TRUE COPY
Prles H. Zacks
ATTEST;
(Registrar of City or Town where death occurred)
DATE FILED
April 18/51
19
M R-302 1
No.
Peter Bent Brigham Hospital
(Was deceased a
U. S. War Veteran,
if so,specify WAR)
(a) Residence.
No.
(Usual place of abode)
Winthrop Mass.
(write the word)
+
PLACE OF DEATH
Suffolk (County)
The Commonmralth 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.
84
Registered No.
J(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 60 Court Rd.
(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. .years .. .months. .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
APRIL
(Month)
(Day)
15.1951 (Year)
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
S
(write the word)
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-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
STILL BORN
12
AGE
Years
Months.
Days
If under 24 hours
Hours .. Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No. Winthrop
16 BIRTHPLACE (City). (State or country) Mass
17 NAME OF FATHER Paul Magee
18 BIRTHPLACE OF
Chelsea
Was autopsy performed?
L
FATHER (City)
(State or country)
Mass
What test confirmed diagnosis?
Clinical Livraga
5 Was disease or injury in any way related to occupation of deceased ?! If so, specify .... (Signed) (Address) 3116 Por Ode Brat Da
4-15 995%
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April 17 5.
19
7 NAME OF
FUNERAL DIRECTOR.
Laway Fermola
ADDRESS
Winthrop Mass
Received and filed.
APR 2 5 1951
19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Marie Fabiano
M. D. 20 BIRTHPLACE OF Revere MOTHER (City) (State or country) Nass
21 Informant Paul Magee
(Address) 60 Court Rd. Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter S. pbakker. (Snmature of Agent of Board of Health or other)
Jealito Oficer 4/16/51
KOfficial Designationy
(Date of Issue of Permit)
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)
neck
2 tures
Card tightober
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
6 ..
Winthrop
50M·2-19-25666
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure. asthenia, ans the disease, cations which 1th.
id conditions. ring rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
R-301A 1 Winthrop (City or Town) Winthrop Community Hospital No.
Baby Girl Magee
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, ( if so specify WAR)
PERSONAL AND STATISTICAL PARTICULARS
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 arrny, 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 shallexhume 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 inake 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 discasc, 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 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
A R-301A 1
PLACE OF DEATH
+ Sofack. (County) Monthup (City or Town)
Revere 5/7/5/
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.
85
Registered No.
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
Baby bayJuices angenica (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)
St. Revere, mass (If nonresident, give city or town and State)
... days. ,In place of residence .years .months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR OR RACE Máte
10 SINGLE MARRIED WIDOWED or DIVORCED
(write the word)
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 22Minutes
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)
17 NAME OF FATHER
Cangenica
18 BIRTHPLACE OF FATHER (City) (State or country)
Portland, maine
OF MOTHER.
20 BIRTHPLACE OF MOTHER (City) (State or country)
6. Posten, maso
21 Informant (Address)
Então angenica
I HEREBY CERTIFY that a satisfactory standard certificate of death was filedwith me BEFORE the byfria or transit permit was issued: Walter & Makers ( Signature of Agent of Board of Health or other
Health Office (Official Designation)
(Date of Issue of Permit)
4/25/57
(Registrar)
1451 (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
1951
to
apr 21
19
I last saw h I Walive on 2 ., 19 .2 ...... death is said to
8kg .. m. INTERVAL BE-
have occurred on the date stated above, at
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