Town of Winthrop : Record of Deaths 1951, Part 58

Author: Winthrop (Mass.)
Publication date: 1951
Publisher:
Number of Pages: 614


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 58


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93 | Part 94 | Part 95 | Part 96 | Part 97 | Part 98 | Part 99 | Part 100 | Part 101 | Part 102 | Part 103 | Part 104


(write the word>


3 DATE OF


DEATH


July


16


1951


(Year)


8 SEX


Male


9 COLOR OR RACE


Photo


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY,


That I attended deceased from


19


to


19


10a If married, widened,


HUSBAND 6f .......


myves Leavitt


(Give maiden name of wife in full)


I last saw h


alive on.


19


....... , death is said to


(or) WIFE of


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY


TO DEATH (a)


Dy natural causes


ANTE


Due To


· Presumably coronary


CEDENT (b)


CAUSES


occlusion


Due To (c)


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? no


arthur C. Murray M. D.


(Signed) Idress Wanethrob Board ofhealth 1951


6 Winthrop


Place of Burial or Cremanon July 19


(City or Town)


DATE OF BURIAL 1957


7 NAME OF FUNERAL DIRECTOR ADDRESS 147 11 withrif St Hrefthey


Received and filed 19


JUL 19 1951


(Registrar)


INTERVAL BE- TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


12 AGE


49


Months,


Days


If under 24 hours


.Hours ...


Minutes*


13 Usual


Occupation:


(Kind of work done during most of working life)


14 Industry


or Business:


Tour of Winther


15 Social Security No ... 029-01-9438.


16 BIRTHPLACE (City) .. (State or country) Rever, Mais.


17 NAME OF FATHER Author :" Winter


18 BIRTHPLACE OF FATHER (City) (State or country)


Peabody, Must


19 MAIDEN NAME OF MOTHER


Mary Miller


20 BIRTHPLACE OF MOTHER (City) (State or country)


Wieland


21 Informant : (Address) 113 Canbe Do . Gunther


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter S. Haller (Signature of Agent of Board of Health or other)/


Healthe office 7,18/51


(Official Designation) (Date of Issue of Permit) 1


-


iving F DEATH t enter han one or each ) and (c)


Does not mean dying, such ure, asthenia, s the disease. utions which 1.


conditions. g rise to the (a) stating ying cause


ons contrib- death but not e disease or using death.


100M-(D)-10-40-24650


No.


Winthrop Community Hospital


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


( if so specify WAR)


St.


(If nonresident, give city or town and State)


MEDICAL CERTIFICATE OF DEATH


(Month)


(Day)


have occurred on the date stated above, at.


1:22 PM


.. m.


Labour


PARENTS


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 nas 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 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 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.


s


SPACE FOR ADDITIONAL INFORMATION


I


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


I E RANK, RATING


( ORGANIZATION AND OUTFIT


SERVICE NUMBER


c C t 1 ( C C T t a C S


F 0 T d SI C ir h S p 0 re 0 sł a m la P e1 0 a


C: P P tl TE


R-301A 1


PLACE OF DEATH


(County> Winthrop (City or Town)


Revere 8/8/51


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.


157


Winthrop Community Hos No.


· J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


William S- Leonard 2 FULL NAME.


(If deceased is a married, widewed or divorced woman, give also maiden name.)


41 Library ft


St


Revere


(Was deceased a U. S. War Veteran, if so specify WAR)


no


(a) Residence. No. (Usual place of abode)


Length of stay: In place of death years.


months. 4 days. In place of residence


15 years


.. months .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July (Month)


17 (Day)


1951


(Year)


4 IHEREBY CERTIFY, July 12 19


That I attended deceased from July 17 195/


death is said to


have occurred on the date stated above, at


INTERVAL BE-


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12 AGE6 7 .Years


Months


Days


If under 24 hours Hours ... Minutes


13 Usual Occupation :. Betired Burger


(Kind of work done during most of working life)


14 Industry


or Business:


Fish Pier


15 Social Security No. .


013-03-6773


16 BIRTHPLACE (City). (State or country) ") Boston Mass


17 NAME OF FATHER Joseph F. Leonard


Major findings:


Of operations.


Partrata aprender


July 12


Was autopsy performed ?. 10


5 Was disease or injury in any way related to occupation of deceased? tui


If so, Gronk. It. Silwork M. D.


(Signed)


(Address) 19 Aquilo de E. Bitte


7/18 1951 Boston (City or Town)


6 . new Calvary Place of Burial or Cremation


DATE OF BURIAL


July 19 1951


7 NAME OF FUNERAL DIRECTOR - Charles H. Tregner ADDRESS Carl Boston


Received and filed JUL 19 1951 19


(Registrar)


8 SEX


male


9 COLOR OR RACE White


10 SINGLE


MARRIED


WIDOWED


or DIVORCiounale


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


I last saw h


alive on


File


17 1951. 1 m.


TWEEN ONSET AND DEATH


DISEASE OR CONDITION DIRECTLY LEADING TO DEATH Fivival Pastoriles


3 Day


ANTE CEDENT (b) CAUSES


Due To Ruptive appendientes


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Diabetes.


1


PARENTS


18 BIRTHPLACE OF FATHER (City) (State or country)


Ireland


19 MAIDEN NAME OF MOTHER


Margaret E. Fuery


20 BIRTHPLACE OF MOTHER (City) (State or country)


Meland


21 nicholas F. Leonard


Informant (Address) 103 Homes Ih Est Boston


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buriahor transit permit was issued: alter & Bakker (Signature of Agent of Doardot Health or other) Health Of Liche (Official Designation)


(Date of Issue of Permit) 7.19/51


Y


UCTIONS FOR CERTIFICATE


giving OF DEATH t enter than one for each b) and (c)


does not mean of dying, such lure, asthenia. > ns the disease, ations which .h.


d conditions. ng rise to the e (a) stating lying cause


ions contrib- death but not he disease or ausing death.


SOM (D).6-50.902253


Registered No.


PHYSICIAN - IMPORTANT


(If nonresident, give city or town and State)


(write the word)


(or) WIFE of


6 Days


Date of operation ...


What test confirmed diagnosis?


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 samne 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.


1 1


] ( I C 1


S ( 1


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 dcemed to have taken place between February fourteenth, cighteen nundred 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 whichit 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 ertifying 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 disease, or when any person is found dead. . - General Laws, Chap. 38, Sec. 6 .. as amended by Chap. 632, Sec. 4. Acts of 1945.


No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the fureral 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, See. 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, wrice 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. Fo- a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


] DATE OF ENTERING MILITARY SERVICE


] DATE OF DISCHARGE


I RANK, RATING


( ORGANIZATION AND OUTFIT


§ SERVICE NUMBER


S


I C r C s


T r 1.


e c a C F


F t r T f.


1


1


1 1


1


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 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. Ser 12, G. L.)


25M (E )·6.50-902253


PLACE OF DEATH


ISBEFOLK BOSTON


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No.


6476158


f(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.)


115 Putnam


St.


Winthrop Mass


(If nonresident, give city or town and State)


Length of stay: In place of death


......


.years.


.months


7


days. In place of residence.


.months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July 18/51


8 SEX


F


9 COLOR OR RACE


W


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widowed


4 I HEREBY CERTIFY,


That


I


attended deceased from


July 11


19 ...


51


to


July 18


19.51


I last saw h .............. alive on


July 18/51


Reath is said to


10a If married, widowed, or divorced


HUSBAND of.


(Give maiden name of wife in full)


John Lampasona


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


72


12


AGE


Years


3


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.


16 BIRTHPLACE (City)


(State or country)


Italy


OTHER


SIGNIFICANT


CONDITIONS


Major findings: Of operations


Date of operation.


None


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.


L Lezer


(Signed)


Mass. General HospDate


7-18"


5


19.


Jem-Winthrop Mass. (City or Town)


6 Place of Burial or Cremation


DATE OF BURIAL


July 21/51


19


7 NAME OF


FUNERAL DIRECTOR


E P Caggiano


Winthrop Mass.


ADDRESS


Received and filed


AUG 2


19


1951


(Registrar of City or Town where deceased resided)


PARENTS


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


21 A Circidelacona


Informant.


(Address)


A TRUE COPY


ATTEST:


......


(Registrar of City or Town where death occurred)


July 20/51


DATE FILED


19


......


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Carcinoma of biliary


tree,probably pancreas


INTERVAL BE- TWEEN ONSET AND DEATH


1 Yr


Plus


ANTE


Due To


CEDENT (b)


CAUSES


Due To (c)


17 NAME OF


FATHER


Salvatore Ganci


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Unknown


(Address)


Winthrop


M. P.


No.


Mass.Gener al Hospital


Mary Lampasona


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No.


(Usual place of abode)


35.years.


(Month)


(Day)


(Year)


have occurred on the date stated above. at.


3;45A


m.


R-302 1


Housewife


de of th di: co or pr te aT en sh di wi F of de nil se1 G. in ha su pe rer ot rec of sh: a ret m lav ph en of ap ca pe to pu th re re fo S I I R


C


S


:


I R-301 1


PLACE OF DEATH


(County)


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


(City or town making return)


Registered No. 159


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. (Usual place of abode)


.. months. - Length of stay: In place of death. fears. 3 hrs 3 min.


...... days. In place of residence




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.