USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 33
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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 of 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 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 personsewho, 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
e
1
PLACE OF DEATH
% (County) BOSTON
(City of 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)
97
Registered No.
3700
j(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
New England Deaconess Hosp John J Herbert
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
·86 Ingleside Ave:
St.
(If nonresident, give tity of town and State)
Length of stay: In place of death
......
.. years ..
... months.
4 ... days. In place of residence ... } ... years.
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
4 I HEREBY CERTIFY,
11/25/54
19.
That I attended deceased from
to ..
11/24/54
19
I last saw h
imive on.
4/24/54
19.
death is said to
m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ..
5 Years
Months.
Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation :
retired
(Kind of work done during most of working life)
14 Industry
or Business:
fish dealer
15 Social Security No.
cnb1
16 BIRTHPLACE (City)
(State or country)
Boston
OTHER
SIGNIFICANT
Diabetes
5 mox
Ankylosing.rheumatoid.
arthritis of spine
10/
Major findings:
Of operations.
Was autopsy performed?
no
What test confirmed diagnosis?
Lab study Phys exam
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
A P JosTin
M. D.
(Signed)
31 Bay State Ra Date 11/2/1/5/19
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
4/28/54
19
7 NAME OF
FUNERAL DIRECTOR
J O'Maley
ADDRESS
Winthrop
MAY 17 1954
Received and filed. 19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Boston
19 MAIDEN NAME
OF MOTHER
Catherine E Hickey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
21 M C Dellin
Informant
(Address)
A TRUE COPY
ATTEST Karles 2. Mackie
(Registrar of City or Town where death occurred)
DATE FILED
APR 2 % 100/
19
-
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.)
25M.10.53-910621
.S.
CEDENT (b)
(Address)
6
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible,
CONDITIONS
3 DATE OF
DEATH
(Month) Apr 24(0gb)
(Year)
Div
10a
If married, widowed, or divorced
HUSBAND of.
Margarina den hamed spett huck
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Myeloblastic leukemia
1f yrs
ANTE
Due To
Bronchopneumonia
CAUSES
with intestinal bleeding
4day-
Due To
(c)
Congestive heart failure
VIS 17 NAME OF
FATHER
John J Herbert
Date of operation
Holy Cross - Malden
M R-302 1
No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
.no
have occurred on the date stated above, at
1:04P
X
PLACE OF DEATH
SUFFOLK 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 .. 3776 › ..
98
j(If death occurred in a hospital or institution, xxxl give its NAME instead of street and number)
2 FULL NAME. A.BRAHAM MALOFF
(If deceased is a married, widowed or divorced woman, give also maiden name.)
85 Shore Drive,
(a) Residence. No. (Usual place of abode)
.₺ (If nonresident, give aty or town and State)
Length of stay: In place of death
years
months. 2. .days. In place of residence ............ years .... months ......... .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
28
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
4/26
19
to ..
That I
attended deceased from
4/28
19
54
I last saw
h
im
1/28
alive on
19 ... | death is said to
have occurred on the date stated above, at0 :28a
.. m.
INTERVAL BE-
TWEEN ONSET
ANO DEATH
11 IF STILLBORN. enter that fact here.
12
AGE 16
.. Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :... CivilEngineer.Attomey.
(Kind of work done during most of working life)
14 Industry
or Business
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston, Mass
17 NAME OF
FATHER
Samuel Aloff
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Aussia
19 MAIDEN NAME
OF MOTHER
Ida Plagoff
5 Was disease or injury in any way related to occupation of deceased ?... O.
If so, specify .....
M Stein
M. D.
(Signed).
(Address). BIH
Date 4/28
.19 .... 51
Mt.Lebanon-Sharo Tfilo- W Rox
a
(City or Town)
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
B Birnbach
ADDRESS
Dorchestor
Received and filed
0/ 17 1954
19
(Registrar of City or Town where deceased resided)
8 SEX
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDarried
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINChronic myelogenous
TO DEATH (a)
leukemia
-3y18
ANTE
CEDENT (b)
CAUSES
Due To
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?...
.no
What test confirmed diagnosis ?.
peripheral blood smo
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
(Address )
"S-Aloff
Parecerles 2. Lacket
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
May 3
19
54
25M-10.53-910621
MS.
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 of town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec 12, G. L.)
M R-302 1
No.
Beth Israel Hospital
.
(Was deceased a
U. S. War Veteran, WW II
if so specify WAR)
(write the word)
Place of Burial or Cremation
Apr 29
54
DATE OF EN TERING MILITARY SERVICE - ,6/23/42 =
= DISCHARGE
3/26/46 Captain
RANK, RATING ORGANIZATION & OUTFIT U S Army Co B 1136 Eng.Construction Camp SERVICE NUMBER
31135934 & 01557404
MAYIY
PLACE OF DEATH
Suffolk
Boston 6/8/54
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
99
No. Boly Bey Naskian.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 145 Princeton
East ... Boston 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
9 COLOR OR RACE
21.
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Harrod
SIMPLE
4 I HEREBY CERTIFY ,
That I attended deceased from
19
I last saw h
alive on.
19
death is said to
have occurred on the date stated above, at
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Stillbom
TWEEN ONSET ANO DEATH
11 IF STILLBORN, enter that fact here. tilform
12
AGE
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF FATHER John Kashian
PARENTS
18 BIRTHPLACE OF
Chelsea
FATHER (City)
(State or country)
Mass
19 MAIDEN NAME OF MOTHER Christine Polizzi
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
East Boston
John Kashian
21
Informant
(Address)
145 Princeton St. , E. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter
(Signature of Agent of Board of Health of other) /
Theatthe Office 9 554
(Official Designation) (Date of Issue of Permit) , 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such lure, asthenia, ns the disease, cations which th.
id conditions. ing rise to the e (a) stating lying cause
tions contrib- death but not he disease or ausing death.
50M-5-52-907046
6
St. Michael
Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
May 5
54
7 NAME OF
FUNERAL DIRECTOR.
Vincent Rapino
ADDRESS 9 Chelsea St.East Boston, Mass.
Received and filed
VAY 5 1954 19
(Registrar)
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, (if so specify WAR)
3 DATE OF
mas
DEATH
(Month)
(Day)
1
1954
(Year)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed? Ves
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
D. Menan Ställas
M. D.
(Signed)
(Address).
26 Bread Let 5/y Date Shag / 195%
02/1/4
(County)
R-301A 1 "inthrop
(City or Town) ".inthrop Commun The
Hospital
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME ..
(Usual place of abode)
inthrop
19
to
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 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 hoard 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 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 huried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
--
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
×
PLACE OF DEATH
SUFFOLK 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.
3873
100
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
EDWARD ARONSON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
15 ... Tewksbury
St.
winthrop.
Mass
(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
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
2
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
4/7
19
to ..
That I
5/2
19
54
10a If married, widowed, or divorced
HUSBAND of.
Saúd emiliathe wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING tastatic carcinoma
TO DEATH (a).
of
the prostate
-3yrs
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
.Was autopsy performed?
What test confirmed diagnosis?
x-rays
5 Was disease or injury in any way related to occupation of deceased? no.
If so, specify ....... Maria's
(Signed).
(Address). BIH
Date.
5/2
MID. 1954.
Sharon Mem Park 6
Sharon
Place of Burial or Cremation
DATE OF BURIAL
May 4
21
Informant.
(Address)
Mrs S Aronson
7 NAME OF
FUNERAL DIRECTOR
A Golov
ADDRESS
Received and filed. 19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
57
12
AGE
Years
.Months.
.Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation:
kind of one during most of working life)
14 Industry
or Business:
H L Gerding Co-St. Louis
15 Social Security No ..
023-07-1704
MO
16 BIRTHPLACE (City).
(State or country)
Doston, mass
17 NAME OF
FATHER
Nathan Aronson
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Fannie Silverst: In
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
A TRUE COPY 21 Znacke
ATTEST:
(Registrar of City or Town where death occurred)
May 5
54
DATE FILED
19
...
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, Sec 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city of town in which the deceased resided as soon as possible,
M R-302 1
25M-10-53-910621
(City or Town) 54
8 SEX
M
9 COLOR OR RACE
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDarried
I last saw
h .. im
.alive on
5/2
19 ... 5/4 death is said to
have occurred on the date stated above, at2 .100.
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
attended deceased from
Brookline, Mass
Beth Israel Hospital No.
J (Was deceased a
U. S. War Veteran,
if so specify WAR)
XEGEI . ...
1
5
6
HROP.
MAY21
PLACE OF DEATH
SUFFOLK (County) WINTHROP (City or Town) 36 TAYLOR No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
101
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
John f. Y EACKERN 2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
36 TAYLOR
St. ...
WINTHROP
(If nonresident, give city or town and State)
Length of stay: In place of death
:" years.
·6 years m
.. months
days. In place of residence
66 years
.. months
...... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
2
1954
(Months
(Day)
(Year)
4 I HEREBY CERTIFY,
19
to
19
I last saw h .....
alive on.
19
, death is said to
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