USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 70
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
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 heen 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 hy 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 hy 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 registration. 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 he 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).
TO: RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 traymatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those persons found dead M
OCT13
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
R-302 1
PLACE OF DEATH
Suffolk (County)
Revero. (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or town making return)
225
Revere Memorial Hospital
[(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME ..
(Baby Girl)
Campo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
573 Pleasant St.
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
3 DATE OF
DEATH
October 14, 1953
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
4 I HEREBY CERTIFY.
Oct. 14
53
19
to
Oct. 14
19.
death is said to
have occurred on the date stated above, at. 7:45 P.
m. INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Prematurity - 7 mos.
ANTE Due To Atelectasis
CEDENT (b) CAUSES
Due To (c)
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? If so, specify. .A. J. ... Luongo
PARENTS
18 BIRTHPLACE OF
Somerville,
FATHER (City) (State or country) Mass.
19 MAIDEN NAME
OF MOTHER
Josephine Celata
20 BIRTHPLACE OF MOTHER (City) East Boston (State or country) Mass.
Anthony Campo
DATE OF BURIAL.
19
Informant
(Address)
573 Pleasant St. ,Winthrop
A TRUE COPY
ATTEST:
(Registrar of City of Town where death occurred)
Received and filed NOV 6 500 19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE.
Years.
Months.
Days
under 24 109s
Hours ....
Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No. Revere
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF FATHER Anthony Campo
(Signed)
17 Vinal
(Address). Revere
Date 10/14 M53
6
St. Michael Cemetery Forest Hills Place of Burial or Cremation (City or Town) October 16,
5B 21
ADDRESS
Lillian Cataldo
7 NAME OF FUNERAL DIRECTOR 374 Broadway, Som., Mass.
DATE FILED
October 16,
.19 ...
53
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.)
25M (E).6.50.902253
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
I last saw h ......... alive on
Oct.
11
19.53
53
That I attended deceased
from
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop,
Mass.
(a) Residence. No. (Usual place of abode)
Registered No.
No.
6
HROB
NOV-G.
X
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bos ta
(City or town making return) 22 8064
Registered No.
Veteran's Adm.Hospt Boston Mass.
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.) 85 Johnson Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years
1
months.
24
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
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY.
August 21 19 53
to
Oct. 15
19
10a If married, widowed, or divoggi e Eburne
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 60
AGE
Years
9
Months
15
If under 24 hours
Days
Hours.
Minutes
13 Usual
Occupation:
Salesman
14 Industry
or Business:
Dental Sup lies
021-09-1653
15 Social Security No.
Haverhill Mass.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
J Sheldon Cartwright
18 BIRTHPLACE OF
Atkinson N.H.
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Ella M Wood .
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick Canada
Winthrop Cem-Winthrop Ress.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Oct.19/53
19
7 NAME OF
H S Reynolds
FUNERAL DIRECTOR
Winthrop Miss.
ADDRESS
Received and filed
OCT 26 1955
19
M. D.
(Address)
VA.Hospt
Date ..
10-15
19. 53
25m-(b)-11-49-900,475
3 DATE OF DEATH 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 (c)
DISEASE OR CONDITION
DIRECTLY LEADINGarcinoma left lung
TO DEATH
(a)
with erosion of pulmonary
vessel
Immed
ANTE
Due To
CEDENT (b) .... Metastases to hilar nodes
CAUSES
both kidneys left parietal
Due To
pleural and mesentery
OTHER
Left lung non functioning
SIGNIFICANT
CONDITIONS
necrotic purulent
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
Yes
What test confirmed diagnosis?autopsy.
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .......... ""Marks
(Signed).
PARENTS
21
Informant
(Address)
Hos pt Records Boston
A TRUE COPY
harkes A. Machine
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Oct/19/53
.. 19 ..
MS.
PLACE OF DEATH
R-302 1
No.
Edmund S Cartwright
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass.
W W
#1
(a) Residence. No. (Usual place of abode)
Oct. 15/53
(Month)
(Day)
(Year)
That I
attended deceased
from
53
I last saw h .............. alive on
19
death is said to
have occurred on the date stated above, at
11:40A
m.
INTERVAL BE- TWEEN ONSET AND DEATH
(Registrar of City or Town where deceased resided)
(Kind of work done during most of working life)
! ECCIVL
TOM
1
1
6
OCT26 AM
Entered Service 9-26-1918 Discharged Jan. 10,1919 Private U S Army Service No. 4776611
R-301A 1
PLACE OF DEATH
X Suffolke County (Čity or Town) 104 Highland Que No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
227
MOUNT'S CONCERTIFICATE OF DEATH
Registered No.
J (If death occurred in a hospital or institution.
..... St. | give its NAME instead of street and number)
William austin knowlton 2 FULL NAME ..
(If deceased is a married, wijlowed or divorced woman, give also maiden name.) 34 Banks
St.
(If nonresident, give city or town and State)
.days. In place of residence .years months .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF Get
DEATH
15
1953
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
19
55
That , I
1
attended deceased from
1953
to
Get 1
5:3
I last saw him
alive on
19
death is said to
7.00
P.m.
have occurred on the date stated above, at
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
cerebral Mirenbasis
ANTE
CEDENT (b)
CAUSES
Due To
artani scheren
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
pinsicil aucunation
5 Was disease or injury in any way related to occupation of deceased? "0 If so, specify ....... (Signed) .... 4.3. quewie ... , M. D.
(Address) 47 Only Winston Date Eret 15 1955
celery Writtenp (City of Town)
1929
Nowards. Reynolds
Received and filed ACT 16.1053 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS -
8 SEX
9 COLOR OR RACE
Male White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED
(write the word)
married
10a If married, widowed, or divorced
HUSBAND of ..
Eva
a.
milla
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
INTERVAL BE- TWEEN ONSET AND DEATH 11 IF STILLBORN. enter that fact here.
12
? I Monis AGE
23 Years
7
Months
17 Days
If under 24 hours
Hours . Minutes
13 Usual
Occupation :
Engineer
(Kind of work done during most of working life)
14 Industry
or Business :.
marine
15 Social Security No.
021-05-0676
16 BIRTHPLACE (City) .
(State or country)
marie
17 NAME OF
FATHER
deer chile
18 BIRTHPLACE OF
FATHER (City)
(State or country)
mama
19 MAIDEN NAME
OF MOTHER
Fannie Barbour
deer Cole
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
maine
21 Informant (Address)
34 Backs ST. Writings
N (K ) HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter . Bakerz.
(Signature of Left of Board of Health or other)
Health Office 10. 16.53
(Official Designation) (Date of Issue of Permit)
50m-(b)-11-49-900,560
0
Place of Burial or Cremation Get 17
DATE OF BURIAL ..
7 NAME OF FUNERAL DIRECTOR 180 WinthropSto ADDRESS.
Deer .(
isle
Clarence E Knowlton
PARENTS
Mo, Eva a. Knowlton
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR)
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death .... years 1 months. 21
15
UCTIONS FOR CERTIFICATE
iving OF DEATH t enter han one for each b) and (c)
oes not mean f dying. such ure, asthenia, ns the disease, ations which h.
I conditions. ng rise to the : (a) stating ying cause
ions contrib- death but not e disease or using death.
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 tof persons tas are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from discases 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.
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 meif there is ansich board. from the clerk of the town where the body is to be buried
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 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
& Noj undertaker or other persons shall bury a human body or the ashes thereof which has been brought into the commonwealth until he has received a permit 1 ste to do from the board of health or its agent appointed to issue such permits, or For The funeral is to be held, or from a person appointed to have the care of the :cemetery for burial ground in which the internient is made.
. Chap ¿. 114, Sec. 46, G. L .. (Tercentenary Edition).
8
RULES OF PRACTICE
6
The foullment of the purpose of these laws calls for the observance of the follow- Hg rules of practice:
(+)-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
K2 Board of Health physicians will certify to such deaths only as those of Ulpersons 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 occup ::- 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
R-302 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 CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
9076228
J (If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
158 Circuit Road
St.
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death.
.years ..
.. months.
5
.days.
In place of residence
50
years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Oct.15/53
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCED arried
4 I HEREBY CERTIFY,
That I attended deceased from
Oct.15
Oct .... 10,
19 ....
53
to
I last saw h ...
im .. alive on
Oct. 15 19 53
death is said to
have occurred on the date stated above, at.
2:03PM
.. m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cormary thrombosis
1 Week
12
AGE7.8
.Years
Months.
Days
If under 24 hours
Hours.
Minutes
ANTE
Due To
Arterio sclerctic
CEDENT (b)
disease
CAUSES
Due To (c)
Cystitis
Few Days
16 BIRTHPLACE (City)
(State or country)
Charlestown lass ..
OTHER
SIGNIFICANT
CONDITIONS
Benign prostatic hyper trophy NAME OF
Yr9
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?
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.