Town of Winthrop : Record of Deaths 1954, Part 50

Author: Winthrop (Mass.)
Publication date: 1954
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 50


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


Wellfleet Mass.


Date of operation.


June ... 22Was autopsy performed?


Yes


What test confirmed diagnosis ?.


electrocardiogram


5 Was disease or injury in any way related to occupation of deceased .o If so, specify.


(Signed)


(Address)


Boston Mass


Date 7-2


19


Winthrop Cem-Winthrop Mass.


6 Place of Burial or Cremation July 6/54 19


DATE OF BURIAL.


7 NAME OF


FUNERAL DIRECTOR


J F O'Maley


ADDRESS Winthrop Mass.


Received and filed.


JUL ---- 19 .... 1954.


19


...


(Registrar of City or Town where deceased resided)


PARENTS


19 MAIDEN NAME


OF MOTHER


--- Coffey


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Bos ton Mass.


E A Murray


A TRUE COPY Les A. Mackie


ATTEST:


(Registrar of City or Town where death occurred)


July 7/54


19


DATE FILED


25M-3-53-909098


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,


No.


New England Center Hospt.


John B Murray


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Winthrop Mass.


(a) Residence. No. (Usual place of abode)


have occurred on the date stated above, at


8:05PM


.m.


INTERVAL BE-


TWEEN ONSET AND DEATH


DISEASE OR CONDITION


DIRECTLY LEADING


Myocardial infarction


TO DEATH (a)


4 Days


ANTE


CEDENT (b)


CAUSES


Due To


Arteriosclerosis.


Yrs


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Dysphasia due to cerebral thrombosis


9 Mos.


Major findings:


Of operations.


Feeding ..... je junos to my


JH Fisher


(City or Town)


21


Informant.


(Address)


RM R-302 1


(Month)


(Day)


(Year)


10a If married, widowed, or divo nelizabeth A Rinn


HUSBAND of


(Give maiden name of wife in full)


'THROP.


JUL 19


X


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town) MayFLOWER


NURSING


No. 39 Grovers Ave


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


150


2 FULL NAME ..


Paralee.G. Sanders


(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.


20 Crescent St.,


(Usual place of abode)


St.


(If nonresident, give city or town and State)


Length of stay: In place of death. ..... years.


months. 2 .days. In place of residence 40 years


months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July 2 1954


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


That I attended deceased from


Sept.


50


19


to


July 1


13/54


I last saw her ..... alive on


July1.


19 ... 5.4death is said to


have occurred on the date stated above, at L.O ... 40A .... m.


INTERVAL BE-


TWEEN ONSET


AND DEATH


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Senility


ANTE


Due To


Cerebralvascular.


CEDENT (b)


CAUSES


accident (old)


Due To


(c)


Arteriosclerosis


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? NO


If so, specify ...........


(Signed) ..


(Address) :47 Shirley st Wuistros Date July 2


M. D.


6


Mt ...... Hope Cemetery,Boston


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 6


195.4


7 NAME OF


FUNERAL DIRECTOR


Mario Splans


ADDRESS


89 Walnut Ave Roxbury


Received and filed.


....... 1954.


19


(Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Columbia


(State or country)


South Carolina


19 MAIDEN NAME


OF MOTHER


?


20 BIRTHPLACE OF


MOTHER (City)


Columbia


(State or country)


South Carolina


John Sanders


Son


21


Informant ...


(Address)


20 Crescent St. , Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


Matter


A. Haberg


(Signature of Agent of Board of Health or other)


Frealthe Office


7/4/54


(Official Designation)


(Date of Issue of Perr. . ),


>


9 COLOR OR RACE


10 SINGLE


(write the word)


8 SEX


Female


Colored


MARRIED


WIDOWED


or DIVORCED


Widow


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


John A. Sanders


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE 79 Years


Months.


Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation:


At Home


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No. none


Charleston Columbia


16 BIRTHPLACE (City)


(State or country)


South Carolina


17 NAME OF


FATHER


?


Logan


IOOM-10-53-910621


R-301A 1


UCTIONS FOR CERTIFICATE


giving OF DEATH t enter han one for each b) and (c)


oes not mean f dying, such ure, asthenia, is the disease. ations which


conditions, g rise to the (a) stating ying cause


ons contrib- Heath but not e disease or using death.


To be filed for burial pormit with Board of Health or its Agent.


HOME


J(If death occurred in a hospital or institution,


St. [ give its NAME instead of street and number)


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 board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be. a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the


death certificate contains a recital. as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of 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 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


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.


151


Winthrop Community Hospital No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME Albert E Cole.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, 1 if so specify WAR)


(a) Residence. No. 61 Washington Ave. Winthrop St.


(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 12 years


.. months


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Jolly


(Month)


(Dag)


3


1954


(Year)


8 SEX


Male


9 COLOR OR RACE


White


10 SINGLE


MARRIED


WIDOWEDMarried


or DIVORCED


4 I HEREBY CERTIFY,


19


...


I Just saw him alive on


to.


July 3


19 54 death is said to


INTERVAL BE-


have occurred on the date stated above, at 11:50 A.m.


10a If married, widowed, or divorced


HUSBAND of


Etta ... Merriam


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


66


Years


0 Months 4


Days


If under 24 hours


Hours


Minutes


13 Usual


Occupation :


Electrical Contractor


(Kind of work done during most of working life)


14 Industry


or Business:


Cole Electric Co.


15 Social Security NQ13-07- 1679


16 BIRTHPLACE (City) Philadelphia (State or country) Penna.


17 NAME OF FATHER ClarenceCole


18 BIRTHPLACE OF


FATHER (City) (State or country)


Portland , Maine


Date of operation


Was autopsy performed?


What test confirmed diagnosis ?.


Clinical


No.


(Signed)


(Address) WinthropMe Date July 3 1954


6


Winthrop Cemetery Winthrop Mass Place of Burial or Cremation (City or Town)


DATE OF BURIAL July 6, 1954 19


7 NAME OF


FUNERAL DIRECTOR


Leslie W, Pike


ADDRESS 305 Besch St. Revere


Received and filed


8 .1954 19


(Registrar)


PARENTS


19 MAIDEN NAME


OF MOTHER


Carrie Edwards


(State or country)


Mass


21 Informant. Etta Cole


(Address) 61 Washington Ave Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter f. Walker (Signature of Agent of Board of Health or other)


I Dealte Oficer 76/54


(Official Designation)


(Date of Issue of Permity


5.


M R-301A 1


TRUCTIONS FOR L CERTIFICATE


giving : OF DEATH


not enter e than one e for each . (b) and (c)


s does not mean : of dying, such ailure, asthenia, eans the disease. lications which ·ath.


bid conditions. iving rise to the «se (a) stating erlying cause


itions contrib- he death but not the disease or causing death.


50M-5-52-907046


ANTE CEDENT (b) CAUSES


Due To Hypertension


2 yrs.


Due To (c)


OTHER SIGNIFICANT CONDITIONS


None


Major findings: Of operations


TO DEATH


(a).


Coronary Thrombosis


TWEEN ONSET AND DEATH 2days


DISEASE OR CONDITION


DIRECTLY LEADING


That I attended deceased from July 3. 1954


(write the word)


Registered No.


5 Was disease or injury in any way related to occupation of deceased? If so, specify ........ " harles Liberman M. D. 20 BIRTHPLACE OF MOTHER (City) Cambridge


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 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 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 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 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 supposahly 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


July ..... 25, .191.7.


DATE OF DISCHARGE


May 24, 1919


RANK, RATING


Sgt.


ORGANIZATION AND OUTFIT


Army


SERVICE NUMBER


583575


×


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.


5883 152


[(If death occurred in a hospital or institution,


..... X.x.SE give its NAME instead of street and number) No. Baker Memorial Hospital


2 FULL NAME. JOHN F MC MAHON (If deceased is a married, widowed or divorced woman, give also maiden name.)


(Was deceased a


U. S. War Veteran,


if so, specify WAR)


6 Adams


'inthrop,


Mass


St.


(If nonresident, give city or town and State)


Length of stay: In place of death.


.....


.years.


months.


1.3lays. In place of residence


.......... years.


.. months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July


5


195.4


(Year)


8 SEX


M


9 COLOR OR RACE


10 SINGLE




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.