USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 12
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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).
1.7. 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 fornr 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 horhe 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, .Dthe sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE. RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
-
-
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
38
Hon J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME. George E Kinnear (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)
(a) Residence. No. 104 Highland Ave. (Usual place of abode)
St.
(If nonresident, give city or town and State) 6
Length of stay: In place of death
2 years ... 6
: months. days. In place of residence 2
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Fel
.26
19.53
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
19 50
to
Feb
25
1953
I last saw h IM alive on
Fel- 25
19. 53 death is said to
have occurred on the date stated above, at
1.50 P.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
77
Years
8
Months
24
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Truckman
(Kind of work done during most of working life)
14 Industry
or Business:
Lumber
15 Social Security No ...
None
16 BIRTHPLACE (City) New Brunswick (State or country)
17 NAME OF
FATHER
William Kinnear
18 BIRTHPLACE OF
FATHER (City)
(State or country) New Brunswick
19 MAIDEN NAME
OF MOTHER
Lavina
Tait
20 BIRTHPLACE OF
MOTHER (City)
(State or country) New Brunswick
21 Informant. (Address) 55 Edgehill Rd. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial on transit vermit was issued: Walter & Bakets. Signature of Agent of Board of Health or other)
· Thealth Officer
(Official Designation)
(Date of Issue of Permit)
10a If married, widoweds
Essig parker
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)
cerebrovascular
accident
5 days
ANTE
Due To
content sclerosis
CEDENT (b)
CAUSES
and c. v.a.
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
If so, specify,
(Signed)
+47Aharley
(Address) Winthrop was
Date Feb 27
19:53
6
Woodlawn
Everett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March
2
1953
Haward S Rymulls
ADDRESS
Received and filed
MAR 3. 1953
19
(Registrar)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDVidowed
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH not enter re than one ise for each ), (b) and (c)
is does not mean de of dying, such failure, asthenia, means the disease, plications which death.
orbid conditions, giving rise to the ause (a) stating derlying cause
nditions contrib- the death but not to the disease or n causing death.
50M (B)-1-51 903586
No.
104 Highland Ave. (Mount' Convalescent
To be filed for burial permit with Board of Health or its Agent.
RM R-301A 1 Winthrop (City or Town)
7 NAME OF
FUNERAL DIRECTOR ....
Winthing melis
M. D.
PARENTS
Pauline Baker
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 deccased, 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 clisease 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 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 elerk, 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 nianner 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 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 whorn 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
MARS
THROP.
1
1
11 12
RM R-302 1
PLACE OF DEATH
Middlesex (County)
Tewksbury, Mass. (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE· OF DEATH
TEWKSBURY STATE HOSPITAL AND INFIRMARY
(City or town making return)
Registered No.
39 ...
39
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
Dennis Flynn
(If deceased is a married, widowed or divorced woman, give also maiden name.)
86 Summit Street Av.
......
St.
Winthrop ..... Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
11
.years.
7
months
28days.
-In place of residence. .years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
10
(Month)
(Day)
1953
(Year)
8 SEX
Mole
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Sep.
4 I HEREBY CERTIFY,
June ..... 12 ..
19
41
to.
Feb. 10
19
53
HUSBAND of
(Give maiden name of wife in full)
have occurred on the date stated above, at.g ..... P ...
.m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADINGTerminal
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
abt.
12
AGE.7.2 .... Years
2. Months .. 2.5 .. Days
If under 24 hours
Hours ...
Minutes
13 Usual
News Paper Man
Occupation:
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
Boston
16 BIRTHPLACE (City).
(State or country)
Massachusetts
17 NAME OF
FATHER
Thomas F. Flynn
18 BIRTHPLACE OF
Boston.
FATHER (City)
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Ellen Condon
20 BIRTHPLACE OF
MOTHER (City)
not learned
(State or country)
not learned
Hospital Records
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
113,
Chapter
General
Laws
Received and filed.
APR ........
1953
19
(Registrar of City or Town where deceased resided)
21
Informant
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
February 10.
53
25m-(b)-11-49-900,475
C
X
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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
ANTE
Due To
Arteriosclerotic
CEDENT (b)
CAUSES
Heart Disease
Due To (c)
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)
Nils E. Sylbergson
M. D.
(Address)
T. S. H. and I., Tewksbury
... Date ... 2-1.0 19 53
6 Place of Burial or Cremation
(City or Town)
19
PARENTS
(write the word)
I last saw
h
im
Feb. 10
alive on
19
death is said to
53
10a If married, widowed, or divorced
Saran E. Seaman
(or) WIFE of
TO DEATH (a)
Bronchopneumonia
That I
attended deceased from
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
No.
TEWKSBURY STATE HOSPITAL and INFIRMARY
11.12 -
in
9
3
.
5
6
APR-8
RM R-302 1
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 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25m-(b)-11-49-900,475
C
PLACE OF DEATH
Middlesex (County)
Everett
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
EVERETT
(City or town making return) - 40
Registered No.
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
Annie Fisher ( Dreben)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
100 Grovers Ave.
St.
(If nonresident, give city or town and State)
.months ...
Length of stay: In place of death
.years.
3
days.
In place of residence
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
14 1953
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
1-4
.53
19
to
I
attender
2-14
1953
I last saw h
emlive on
2-13
,53
19
death is said to
have occurred on the date stated above, at
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
59
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:
Own home
15 Social Security No ..
Cambridge
Mass.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Michael Dreben
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
RachaelCT JE ASCERTAINE
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
6
Place of Burial or Cremation
(Ci
2-15
DATE OF BURIAL.
1953
7 NAME OF
FUNERAL DIRECTOR
Hyman J. Torf
ADDRESS
Received and filed.
MAR 23 1553
195.3
(Registrar of City or Town where deceased resided)
PARENTS
21 Informant (Address)
Harry Drehen Chelsea
A TRUE COPY
John Mc Jarras.
ATTEST·
(Registrar of City or Town where death occurred)
DATE FILED
2-17- 1353
10a If married, widowed, or divorced
HUSBAND of
John Fisher
len game of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINGHypertensive Ht.Dis. 2
TO DEATH (a)
yrs
ANTE CEDENT (b) CAUSES
Due To
Due To (c)
-
OTHER
SIGNIFICANT
CONDITIONS
Diabetes Mellitus
2 yrs
Major findings:
Of operations
no
Date of operation
Was autopsy performed? clinical
What test confirmed diagnosis ?.
no
5 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed). Benjamin Barton Everett .Date.
2-14 M. D.
19.5.3
(Address)
Agudas ..... Sholom
Everett
Chelsea
8 SEX
f
9 COLOR OR RACE
Wht
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
-fo specify WAR)
(a) Residence. No. (Usual place of abode)
3
(Was deceased a
U. S. War Veteran,
Winthrop
That
deceased from
At home
5 .a.
m.
No. Whidden Hospital
$1.1%
i
6
MAR 23/83 /14
X
PLACE OF DEATH
Essex
(County) Danvers
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if to specify WAR).
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years
18
1
months
29
40
days.
In place of residence
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF February
15,
1953
DEATH
(Month)
(Day)
(Year)
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.)
1 Arteriosclerotic heart disease.
2. Bronchopneumonia 3. Fracture 1. hip.
5 Accident, suicide, or homicide (specify) ..
Acciden
Date and hour of injury
Dec.
12,
19.
52
Where did
Danvers State
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
(Specify type of place)
Manner ofpushed by another patient
(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
(Signed) Ralph P. Mccarthy
M. D.
Date
12/15/53
Holy Cross Cemetery
Malden
DATE OF BURIAL
February
17,
8 NAME OF
Charles H. Treanor
FUNERAL DIRECTOR
East Boston, Mass.
ADDRESS
Received and filed
MAR 1 0.53
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Female
Whi
℮
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
11a If married, widowed, or divorced
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
AGB8
Years
Months.
Days
-
If under 24 hours
Hours .
Minutes
14 Usual
Occupation 1.
Housework
(Kind of work done during most of working life)
15 Industry or Business:
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Ireland
18 NAME OF
FATHER
John Downing
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
20 MAIDEN NAME
OF MOTHER
Elizabeth Shinnick
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
22 Mrs. Daniel Murphy
Informant (Address)
15 Prescott St inthron
A TRUE COPY.
ATTEST:
three/W Say
(Registrar of City or Town where death occurred)
DATE FILED
Ferus
19 53
X
2
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
ORM R-305 1
(City or Town) Denvers State Hospital No.
Mary Downing
(a) Residence. No. 15 Prescott
2 FULL NAME (Usual place of abode) Injury occur? place? Hospital Injury Nature of (Address) Leabody Mass. 25m-(h)-10-48-24658 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-305 to the clerk of the city or town in which the deceased resided as soon as possible Injury Fract. 1. Hip
7 Place of Burial, or Cremation. (City or Town) 53
PARENTS
(write the word)
!
2
MAR11
ORM 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
Suffolk
(County)
Chelsea
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
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