USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 49
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93
No undertaker or other person shall bury or otberwise 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 wbere 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 tbc 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 sball 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 furnisb 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 .- Cbap. 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 asbes thereof which have been brought into the commonwealth until be 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 following rules of practice :
(1) Attending physicians will certify to sucb 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and tbose 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 tbe 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
9/23/17
DATE OF DISCHARGE 3/1/19
RANK, RATING Miloval
ORGANIZATION AND OUTFIT.
U.S. army
SERVICE NUMBER
1657468
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
146
J(If death occurred in a hospital or institution. St. { give its NAME instead of street and number)
2 FULL NAME
John F. O'Maley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
79 Atlantic Street
(a) Residence. No. (Usual place of abode)
St. (If nonresident, give city or town and State)
Length of stay: In place of death years. months .. ........ .days. In place of residence 50
.years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
DEATH
3 DATE OF
June 29 . 1954
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED idowed
4 I HEREBY CERTIFY.
That I attended deceased from
May 29,
,54
to
June 29
1954
I last saw hm
alive on.
June 29
19 ..... 5,4eath is said to
have occurred on the date stated above, at.
11.00P.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Symptoms appeared
Carcinomatosig
5 Mos.
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANTSecondary Anemia
CONDITIONS
Major findings:
Of operations.
None
NÖ
Date of operation
Was autopsy performed ?.
Rays April 1954
What test confirmed diagnosis?
X
5 Was disease or injury in any way related to occupation of deceased ?.
If so, spe
John 7 Geling
M. D.
(Signed).
(Address)
Revere, Mass
Date June 29,54
6
Winthrop
Place of Burial or Cremation
July
3
19
7 NAME OF
FOR Frederick . Magnate
ADDRESS
EAST Boston (
Received and filed. 2 1954 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
South .... B.o.s.ton
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Mary Doherty
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
Mass
21 Arthur J. O'Maley
Informant
(Address)
79 Atlantic St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Haber x-
(Signature of Agent of Board of Health or other)
7 2/54
(Official Designation)
(Date of Issue of Permit) / PV
10a
If m
ETl'éhor tvorkelly
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
AGE
80 Years
Months
.Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
Funeral Director
(Kind of work done during most of working life)
14 Industry
or Business:
Funeral
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
New Hampshire
17 NAME OF
FATHER
Michael O'Maley
No
Winthrop
DATE OF BURIAL.
(City or Town) 54
100M-10-53-910621
M R-301A 1
RUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one · for each (b) and (c)
does not mean of dying, such silure, asthenia, ans the disease, ications which ath.
id conditions, ving rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
5.
No.
79 Atlantic St
Registered No.
PHYSICIAN - IMPORTANT -
(Was deceased a U. S. War Veteran, if so specify WAR) None
-
Portsmouth
TWEEN ONSET AND DEATH
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registercd 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 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 betil 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 issuc such permits, or if there is no such board, from the derk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
· Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent ' from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
X
PLACE OF DEATH
Middlesex
(County)
Cambridge
(City or Town) Cambridge City Hospital No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Cambridge
(City or town making return)
Registered No.
(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.)
50 Moore St.
St.
(If nonresident, give city or town and State)
(Usual place of abode) Dead on arrival 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
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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.)
11a If married, widowed, or divorceSara Barbee HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
63
13
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:
350-12-1301
.....
16 Social Security No ... Madison
17 BIRTHPLACE (City).
(State or country)
Hiram W. Ball
18 NAME OF
FATHER
19 BIRTHPLACE OF
Barnsville,
FATHER (City)
(State or country)
Ghio
20 MAIDEN NAMEsabelle V. Rex OF MOTHER
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sara J. Gervais
Parkersburg,
W. Virginia
Woodlawn Cem.
Everett
7
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL .. June 2, 1954 19
8 NAME OF
FUNERAL DIRECTOR
John F. OtMaley
ADDRESS Winthrop Mass.
Received and filed.
JUL 1 4 1954
19
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed)
Leo T. Myles
M. D.
(Address)
Cambridge
Date 5/29/549
25M-5-52-907046
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-305 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, Sec. 12, G. L.)
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Manner of
(Specify type of place)
Injury
(How did injury occur?)
Nature of
Injury
5 Accident, suicide, or homicide (specify).
Date and hour of injury.
19
Where did Injury occur?
Coronary thrombosis
3
M R-305 1
WRITE PLAINLY, WIIM UNFAVING BLACK INK - THIS IS A PERMANENT RECORD
OM
POCky
1 .
Marshall E. Ball
(Was deceased a
U. S. War Veteran, no
if so specify WAR)
Winthrop
(a) Residence. No.
3 DATE OF
May 28, 1954
Widowed
Salesman
Lingerie
Milisconsin
22 Informan10 Water St Lake Geneva, Wisc. (Address)
A TRUE COPY. Frederick N. Burke
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
June 2, 1954
.19
.........
772
While at work?
Was autopsy performed?
no
THROP.
JUL12 AM
NORFOLK
(County) PROOKLINE
(City or Town)
No. 69 Park Street
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BROOKLINE (City or town making return)
Registered No.
423
1.48
[ (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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR) ... no
(a) Residence. No.
555 Shirley Street
(Usual place of abode)
St.
Winthrop,
Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death.
.....
.. years.
1}
.. months.
days. In place of residence
6
.. years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
1
1954
8 SEX
female
white
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED
married
4 I HEREBY CERTIFY,
That I attended deceased from
19.
44
to.
June ... l.
19.
54
I last saw
h .... er ..... alive on
June 1, 19 54 death is said to
have occurred on the date stated above, at.
5:50 p.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Broncho Pneumonia
4 days
12
AGE.
7.2 Years.
Months.
.Days
If under 24 hours
Hours ...
Minutes
ANTE
Due To Generalized Carcinoma-
CEDENT (b)
CAUSES
tosis
6 mos
Due To
(c)
Carcinoma ... Liver
6 mos
15 Social Security No.
none
16 BIRTHPLACE (City).
(State or country)
Russia®
17 NAME OF
FATHER
Abraham Barru
18 BIRTHPLACE OF
FATHER (City)
(State or country) Russia
19 MAIDEN NAME
OF MOTHER
Sarah (cannot be learned)
20 BIRTHPLACE OF
MOTHER (City)
(State or country) Russia
Hyman Yaffe
7 NAME OF
FUNERAL DIRECTOR
Erwin L Levine
ADDRESS.
470 Harvard St., Brookline, Mass
Received and filed ..
JUL 14 1951
.19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?.... no.
If so, specify.
A J Wekstein
M. D.
(Signed).
13.31 Blue Fill Ave
(Address)
Mattapan Mass
Date .... June 1.
19.5/1
6 Tifereth Israel ... of .... Everett, .... Everett ..... Place of Burial or Cremation (City or Town)
Mass
DATE OF BURIAL
June ... 2.
19 .. 54
21
Informant
(Address)
69 Park St., Brookline, Mass.
A TRUE COPY
ATTEST:
L.(Registrar of City of Warif whore deathroocungd)
DATE FILED
June 4
.19 54
25M (E)-6-50-902253
PLACE OF DEATH
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
m.S.
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
General Arteriosclerosis's 15yrs
Major findings:
Of operations.
Biopsy Liver - Ca.
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
Biopsy & Clinical
13 Usual
Occupation :.
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
at home
OTHER
SIGNIFICANT
CONDITIONS
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Harry
Tobin
11 IF STILLBORN, enter that fact here.
9 COLOR OR RACE
Ida Tobin
!
6
JUL15 FTI
X
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. 5834
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.) 99 Marshall St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
......
.. years
months. 174 days.
In place of residence. ... years.
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 1/54
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
Jan ..... 8.
1திப
to
July 1
That
I attended deceased from
19.
54
I last saw h ..... im ... alive on
July .... 1.
1954 death is said to
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE72
Years
Months
Days
If under 24 hours
Hours ... ... Minutes
Supt.
Elk's Club
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
025-05-7570
15 Social Security No.
Bostar Mass.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
John Murray
18 BIRTHPLACE OF
FATHER (City)
(State or country)
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.