USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 94
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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 domestie 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
SUFFOLK BOSTON!
(City or Town)
No. 6 Farley Vale
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) 10316 261
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
100 Quincy 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
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED Married
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Nov.24
April ... 18
19.
51
to
I last saw h.
.im .. alive on.
Nov. 24, 19 57 €
h is said to
have occurred on the date stated above, at
3:30P
m.
10a If married, widowed, or divorced C Clark
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)
Cerebral hemorrhage
INTERVAL BE- TWEEN ONSET AND DEATH. 13 Hfs
11 IF STILLBORN. enter that fact here.
12
AGE
62Years
4
Months.
23
Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation :.
Ships Captain
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
217-14-3473
16 BIRTHPLACE (City)
(State or country)
Waldoboro Maine
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
(Signed)
If so, specify ...
Ruth M Crossfield
M. D.
(Address)
Date ....................
19 .......-
6
Sweetland.Cem South Waldoboro Mel.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Nov .27/51
19
21
Informant
(Address)
Mrs F Hoffses
7 NAME OF
FUNERAL DIRECTOR
C H Stone
ADDRESS Quincy Mass.
Received and filed
NOV 30 1951
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
David W Hoffses
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Waldoboro Maine
19 MAIDEN NAME
OF MOTHER
Elva Kaler
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Waldoboro Maine
A TRIBEOR arles H. Lachie
ATTEST!
(Registrar of City or Town where death occurred) Nov.26/51
DATE FILED
.19
25M (E).6-50.902253
ANTE CEDENT (b)
CAUSES
Due To
Generalized arterio
sclerosis
4 Yrs
Due To (c)
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, Ser 12. G. L.)
-302 1
Registered No.
Glenside Hospital
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Frederick L Hoffses
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass.
W W #1
(a) Residence. No. (Usual place of abode)
3 DATE OF
DEATH
Nov. 24/51
19
51
RECEIVED
OF
TOW
3013
11 12
CUM
3
W
ASS
HROP M
NOV301951 AM
Entered Service 3-12-18 Discharged 9-30-21 Lt. Jg. Transport Duty C-3-116044
R-301 1
TIONS R RTIFICATE ing DEATH enter an one each and (c)
s not mean lying, such e, asthenia, the disease. ons which
conditions, rise to the a) stating ng cause
s contrib- ath but not disease or ing death.
PLACE OF DEATH
CanThof) (County) Lufock. (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
1.57
(City or town making return)
265
Registered No ..
J (If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death. .
.years.
months.
29
.. days. In place of residence
61
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Mal:
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Widowed
(write the word)
4 I HEREBY CERTIFY.
That I attended deceased from
October 28,5%
to ...
noventa 25 /05/
I last saw
h.MA alive on
November 25,05% death is said to
have occurred on the date stated above, at. 11PIZ INTERVAL BE-
TWEEN ONSET
AKO DEATH
11 IF STILLBORN, enter that fact here.
12
Years.
Months
13
.Days
If under 24 hours
Hours.
Minutes
eds
ANTE
Subarachnoid
Subarachnoid and
CEDENT
(b)
DEtracianial hannohage
(c) Crecental
aucunsun arguziaum
OTHER SIGNIFICANT /Sarmal Brancho - CONDITIONS pneumonia
2 days
Major findings: Of operations. none
Date of operation
Was autopsy performed Seo
clinical & pathological
What test confirmed diagnosis!
no
(Signed) Faço
(Addresster Sely St Date 11/27/516
M. D.
winthrop
6 Place of Burial or Cremation DATE OF BURIAL
(City or Town)
1Ov . . 28.
19 57
7 NAME OF
R Howard SIunold
ADDRESS
Received and filed 19
DEC 3
1951 (Registrar)
A TRUL COPY ATTEST
PARENTS
18 BIRTHPLACE OF
FATHER (City).
Winthrop
(State or country) Mass
19 MAIDEN NAME
OF MOTHER
Henrietta Fenerette Fuller
20 BIRTHPLACE OF
MOTHER (City)
Chelsea
(State or country)
Mass
21 Doris Cochrane ~ Elliott Ra. Lynfield
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Valter & thaler ( Signature of Agent of Board of Health or other )
Health (Official Designation)
11/28 /51
(Date of Issue of Permit) 1
12/4/51
DISEASE OR CONDITION A tracyaren.
DIRECTLY LEADING
TO DEATH
Intracranial hemontage
Right Temporo- parental lobe
surce
13 Usual Occupation: Hardware Executive (Kind of work done during most of working life)
act . 28/5A
Industry
or Business:
Hardware
15 Social Security No.
012-05-9748
16 BIRTHPLACE (City)
(State or country)
Winthrop
17 NAME OF
FATHER
George F Paine
per tel com. mas Hups
SOM (A). 12.49.900722
No.
2 FULL NAME.
Winthrop Community Los. Lion / althomas Paine
(If deceased is a married, widowed or divorced woman, give also maiden name.)
23 Cliff ave.
10a If married, widowed, or divorced.
HUSBAND of
Mary
Be11
Sampson
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
november 25, 1951
(Month)
(Day)
(Year)
29 daysDE
61
4
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
ob & achams n.
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 leath 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 ofhcer 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- chate 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, 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 clerk of the town where the person died; and no undertaker or other person shall exhume a human hody 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 hody 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 horne 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
Essex (County)
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MT COPY OF CERTIFICATE OF DEATH
Da: vers
(City or town making return)
Registered No. 266
J(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME .. Hannah Elizabeth Conway
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 Wadsworth
St.
inthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
8
months.
19
days. In place of residence. ...... .years. .months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November
(Month)
8,
1951
(Day)
(Year)
4 I HEREBY CERTIFY,
Feb.
57
19
to
19
10a If married, widowed, or divorced HUSBAND of.
(or) WIFE of
Arthur Conway
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Coronary heart
TO DEATH (a)
disease
gears
12
84
AGE
Years
.Months.
.Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation:
House ife
(Kind of work done during most of working life)
years
14 Industry or Business :.
15 Social Security No. None
16 BIRTHPLACE (City) ..... Irland- (State or country)
17 NAME OF
FATHER
Jeremiah Riordan
18 BIRTHPLACE OF
Un !... own
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Catherine McCarthy
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed)
Banters,
Nichols 3rd.
Date.
11/8/5M. D.
(Address)
Calvary Cer. etery 6 Place of Burial or Cremation
Brockton
DATE OF BURIAL. Nov. 10
19
21
Informant
(Address)
HatKonie sheehan
7 NAME OF
FUNERAL DIRECTOR
John J. Hickey
ADDRESS
Brockton, Macs
Received and filed.
DEC 1.3 105
19
(Registrar of City or Town where deceased resided)
8 SEX
Female
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
I last saw h er alive on November 8 1 51
-death is said to
have occurred on the date stated above, at 2:30 a. m.
INTERVAL BE-
TWEEN ONSET AND DEATH
ANTE CEDENT (b) CAUSES Arteriosclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
.Was autopsy performed ?. YES
What test confirmed diagnosis ?.
Autopsy
PARENTS
Unknown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
A TRUE COPY ATTEST: Fitline W Say
(Registrar of City or Town where death occurred)
DATE FILED Nover er 13, 51
25M (E )-6-50.902253
(City or Town) 5
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.) 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
R-302 1
No. Danvers State Hospital,
Hathorne (Riordan)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
-
(a) Residence. No. (Usual place of abode)
That I attended
NOV .
deceased. from
51
, (Give maiden name of wife in full)
11 IF STILLBORN, enter that fact here.
Due To
Generalized
شديد
OF TO"
71 12
1
S
8
1
65
TROP
DEC131951 AN
7
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City of tdwh(mktg return)
267
¡(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME .. Hurene Danorm
(If deceased is a mat
Widowed or divorced woman, give also maiden name.)
St.
Uf hondesidont give city or town and State)
Length of stay: In place of death. ....... years .. .. months.
days. In place of residence ... years months. .days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDCarried
10a If married, widowed, or divorced
HUSBAND of
LOUdi ve Chaidet ninde ofOble in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
3 dayAGE ......
Years.
Months
Days
If under 24 hours
Hours
Minutes
13 Usual'
Occupation:
Sw Rindo work done during most of working life)
14 Industry or Business:
15 Social Security No. HOWit
16 BIRTHPLACE (City).
(State or country)
Lawrence
Hass.
17 NAME OF
FATHER
PARENTS
18 BIRTHPLACE oJeremiah Donovan FATHER (City) (State or country) ireland
19 MAIDEN NAME
OF MOTHER
Mary heCarthy
20 BIRTHPLACE OF
Lowell
MOTHER (City) (State or country) Mass.
21 Informant (Address) Mary C. Shuchan
A TRUE COPYITIS
rthai No Gay
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
November
13, 19 51
3 DATE OF
DEATH
ANTE
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations ..
(Address)
25M (E)·6.50.902253
after the close of the month in which the death occurred. (See Chap. 46, Ser 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
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
Date of operation.
51 have occurred on the date stated above, at AA .m. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Bronchopneumonia
Due To CEDENT (b) CAUSES
Due To (c)
Hypertensive Heart" Disease years
Was autopsy performed ?.... NO
What test confirmed diagnosis ?..
Clinical & LD
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Andrew Nichols Dary1 10/
M. D.
19, -.
6 "Place Of Bbik Pod cremacon tery" "intily "(pn)
DATE OF BURIAL November 10 1953
7 NAME OF FUNERAL DIRECTOR.E. ............... Cangiano ADDRESS Winthrop, Kass.
Received and filed DEC 1 3 1951 19
(Registrar of City or Town where deceased resided)
Day) 1951Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
November. 11951 to November 8.
19.5.3 .-
I last saw h ............ alive on.Nov .... 8.
19.
death is said to
INTERVAL BE- TWEEN ONSET AND DEATH
MEDICAL CERTIFICATE OF DEATH
R-302 1
No. Danvers State Hospital, Hathorne
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. .. (Usual place of abbde) 11 Shore Drive
OF TO! 11.12
0 901
6 5
Nº TH
IRO
DEC131951 AM
-305 1
PLACE OF DEATH
Suffolk (County)
Cholsez
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Chelsea
(City or town making return)
633
268
Registered No.
en route to Chelsea Memorial Hospital No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Goorge A.Livingstone
(If deceased is a married, widowed or divorced woman, give also maiden name.)
419a Revero
St.
Winthrop,
if sprspecify WAR)
(a) Residence. No. (Usual place of abode)
(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
Nov.14,1951
(Month) (Day)
(Year)
9 SEX Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED Married
or DIVORCED
4 I 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.) Acute cardiac failure :
Hypertensive heart disease : Probably coronary sclerosis
5 Accident, suicide, or homicide (specify)
Date and hour of injury 19
Where did Injury occur? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
Manner collapsed suddenly & died
(How did injury occur?)
While at work? Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased?
If so, specify ..... Wm. J. Brickloy
(Signed)
Boston, Mass.
Nov.15 Date
M.59 19
Woodlawn, Everett ,Mass.
(City or Town)
DATE OF BURIAL Ilov.17, 1951 .19
8 NAME OF
FUNERAL DIRECTOR
Carafa Funeral Home
ADDRESS 389 Wash Ave Cholsca
Received and filed
DEC 1 1 1951
.......... .19
(Registrar of City or Town where deceased resided)
11a If married, widqwe@fidiyorgeoono HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13 54 9 15
AGE Years.
Months.
.Days
If under 24 hours Hours .. Minutes
14 Usual
Occupation :.:
(Kind of work done during most of working life)
15 Industry or Business:
16 Social Security No .. Iroland
17 BIRTHPLACE (City).
(State or country)
NAME OF George A. FATHER
PARENTS
19 BIRTHPLACE OF
Ire land
FATHER (City) (State or country)
20 MAIDEN NAME ro Marshall OF MOTHER
21 BIRTHPLACE OF MOTHER (City) (State or country)
Iroland
22 Elsie Livingstono (wife )
Informant (Address)
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