Town of Winthrop : Record of Deaths 1954, Part 65

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 65


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


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE RANK, RATING.


ORGANIZATION AND OUTFIT SERVICE NUMBER


sdiction given to Chairman of Boa The Commonwealth of Massachusetts


× Suffolk (County)


Winthrop


No.


269 Revere St.


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


2 FULL NAME Marion Tanchat divorced woman, give also maiden


269 Revere St


(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 5


.... years.


months ...


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR OR RACE


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEDrried


4 I HEREBY CERTIFY,


That I attended deceased from


19


to


19.


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Roland Gammabeth full)


11 IF STILLBORN, enter that fact here.


12


AGE5.3.


.. Years


Months.


Days


If under 24 hours


.. Hours ...


Minutes


13 Usual


Occupation:


housewife.


(Kind of work done during most of working life)


14 Industry


or Business:


at ..... home


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Albert B. Marden


17 NAME OF


FATHER


Francis L. Marden


18 BIRTHPLACE OF}


Marblehead


FATHER (City)


(State or country)


mais


19 MAIDEN NAME


OF MOTHER


Catherine Toomey catherine Wong


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


ruland


21 Informant Roland ..... Campbell


(Address)


260 levere St.


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


(Signature of Agent of Board of Health or other)


Health Officer 9/20/54


(Official Designation)


(Date of Issue of Permit)


.


R-301A 1


CTIONS OR ERTIFICATE


iving F DEATH : enter an one or each ) and (c)


es not mean dying, such re, asthenia, s the disease. tions which ·


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


ons contrib- eath but not · disease or using death.


50M-10-52-908091


5 Was disease or injury in any way related to occupation of deceased? no


If so, s


(Signed) ..


(Address) Mantrop Board of Health


M. D.


.Date. 18 Sept 1954. ~


6 Place of Buria Portcien Diga


DATE OF BURIAL.


Sept. 20 1956


19


7 NAME OF


FUNERAL DIRECTOR.


J.Vincent .Murray


ADDRESS Revere .. lass.


Received and filed SEP 2 0 1954 19


(Registrar)


3 yrs


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


Date of operation


.. Was autopsy performed ?.


no


What test confirmed diagnosis?


INTERVAL BE- TWEEN ONSET AND DEATH hours


DISEASE OR CONDITION


Natural Causes


DIRECTLY LEADING


status


TO DEATH (a)


Asthmaticus


ANTE


To Bronchial Asthma


CEDENT (b) CAUSES


(c) Due ToChronic Bronchitis


3 yrs


EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Examiner


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


191


Registered No.


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


no


if so specify WAR)


3 DATE OF


DEATH


September


(Month)


17, 1954


(Day)


(Year)


I last saw h ..........


.. alive on.


19


, death is said to


have occurred on the date stated above, at. 9:48pm.


** alden ... Ma.s.s ..


PARENTS


ME


PLACE OF 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 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 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 1 engaged. insert in the certificate a recital to that effect, specifying the Car, and shall also certify in such certificate both the primary and the secondary of immie- 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 1.TE 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 such permits, or if there is no such board, from the clerk of the town wherebe 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 C Edlsyblediby 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.


TOO dertaker 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 ofthe funeral is to be held, or from a person appointed to have the care of the cemetery of burial ground in which the interment is made.


Chap. - 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


[Thefulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


Attending physicians will certify to such deaths only as those of persons tp Whopi they have given bedside care during a last illness from disease unrelated holdhy form of injury.


(2) Board of Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of nggry, have died without recent medical attendance or whose physician is absent Groth 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


A R-301A 1


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


Registered No.


195


WINTHROP COMM. HOSPITAL No.


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


Annie Mo Laughlin Nee Call


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


104 Highland Ave


St


(If nonresident, give city or town and State)


Length of stay: In place of death .. years .... ..... .months.L.4 days. In place of residence. 30 .. years. .months .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


SEPTEMBER 17


(Month)


(Day) /


1954 (Year)


8 SEX


Female


9 COLOR OR RACE


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED Widow


4 I HEREBY CERTIFY,


That I attended deceased from


MAX 10


1951


to


SEPT. 17


54


I last saw her


.alive on


SEPT. 17, 1954 death is said to


have occurred on the date stated above, at


9:00p.m.


INTERVAL BE- TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


12


AGE


84Years


8.


Days


If under 24 hours


Hours


Minutes


Housewife


13 Usual


Occupation:


(Kind of work done during most of working life)


14 Industry


or Business:


15 Social Security No.


Bangor


16 BIRTHPLACE (City)


(State or country)


Maine


17 NAME OF


FATHER


John Call


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Maine


Bangor


19 MAIDEN NAME OF MOTHER Elizabeth Sheehan


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Maine


Bangor


6 Winthrop Cemetery


Winthrop (City or Town)


Place of Burial or Cremation DATE OF BURIAL Sept 21 1954


19


7 NAME OF


FUNERAL DIRECTOR.


147 Winthrop St. Winthrop


ADDRE


Received and filed


SEP 2 1954


19


(Registrar)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


Michael Mo Laughlin


(Husband's hamch minh)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a) ARTERIOSCLEROTiC


AND HYPERTENSIVEHEART


5 yrs. DISEASE


(b)


Due TO - ENERALERED


ANTE


CEDENT


CAUSES


ARTERIOSCLEROSIS


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


OSTEOPOROSIS


2yRs.


Major findings:


Of operations.


Date of operation ..


Kone


.. Was autopsy performed?


NO.


What test confirmed diagnosis? CLINICAL +LABORATORY


NO


5 Was disease or injury in any way related to occupation of deceased?


If so, specify .......


(Signed) Mannes Traunsere 1


(Address) 562SHIRLEY St Walter


M. D.I


V Septi) 1954


PARENTS


21 Mrs. James Mount


Informant-


(Address)


104 Highland Ave Winthrop


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


(Signature of Agent of Board of Health or other) Health Office 9/20/54


(Official Designation) (Date of Issue of Permit),


RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)


does not mean of dying, such ilure, asthenia, ans the disease, cations which ith.


id conditions, ing rise to the se (a) stating rlying cause


tions contrib- e death but not the disease or causing death.


50M-5-52-907046


15.


2 FULL NAME.


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


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


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


Ernest P Caggiano


(write the word)


Months.


At Home


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 (3) remove it from a town, from one cemetery to another, or from one grave or tomber injury.


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.


A SC Ed wakerpr 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 of 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.


11. (bap, 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- mg rules of practice! (1) Attending physicians will certify to such deaths only as those of persons Whom they Have given bedside care during a last illness from disease unrelated tolanyformof fmjury.


to


Board of, Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, Have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


Medical Examiners will investigate and certify to all deaths supposably These include not only deaths caused directly or indirectly by ftarmatism (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


× Suffolk (County)


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


STANDARD CERTIFICATE OF DEATH


(City or town making return)


Registered No.


196


Vincetuch Com Hash No. ..


Overlan M. Barry Bourke


2 FULL NAME.


(If deceased is a married, widowed or divorced woman, give also maiden name.) 95 hain Sh


St.


(If nonresident, give city or town and State)


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


SEPT.


(Month)


(Day)


18


1954


(Year)


8 SEX


9 COLOR OR RACE


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Marred


4 I HEREBY CERTIFY,


Oct. 9.


1951


to ..


SEPT. 18


19


54


1954, death is said to


have occurred on the date stated above, at.


2:20 P. m.


INTERVAL BE-


DISEASE OR CONDITION


DIRECTLY LEADING,


TO DEATH


(a) CHRONIC GLOMERUlo-


NEPHRITIS


TWEEN OHSET AND DEATH 5 YRS.


11 IF STILLBORN, enter that fact here.


12


AGE 41 Years


Months.


.. Days


If under 24 hours


Hours .....


Minutes


13 Usual


Occupation :


Home


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No. Maldin


16 BIRTHPLACE (City)


(State or country)


marc


17 NAME OF


FATHER


John. Bourke


18 BIRTHPLACE OF


FATHER (City).


Chelsea


(State or country)


mass


19 MAIDEN NAME


OF MOTHER


Elizabeth Gunin


20 BIRTHPLACE OF MOTHER (City) (State or country)


21 Informant Parece Ubaci (Address)


95 Manik & Wineud


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter . Bakerg (Signature of Agent of Board of Health or other) Healthe Office 9/20/54


/ (Official Designation)


(Date of Issue of Permit)


A TRUE COPY ATTEST:


(Registrar)


PARENTS


Maurice Traunstein M. D.


be DEN-181954


6 Taly close Place of burial of Cremation


Malder (City or Town)


DATE OF BURIAL. Sept 21. 0.19 54


7 NAME OF


FUNERAL DIRECTOR.


Maurice W Anky


ADDRESS Аликор


COP 21.1951 19


Received and filed.


PLACE OF DEATH


I R-301 -


ICTIONS OR CERTIFICATE iving F DEATH t enter han one for each ) and (c)


oes not mean dying, such ure, asthenia,- s the disease, tions which .


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


ions contrib-> death but not e disease or using death.


50M.(A)-11-51-905807


OTHER


SIGNIFICANT


CONDITIONS


PERICARDITIS


· BRONCHOPNEUMONIA


IWK.


Major findings:


Of operations


NONE


Date of operation


Was autopsy performed?


VES.


What test confirmed diagnosis ?.


Autopsy-CLINICAL + LAB.


5 Was disease or injury in any way related to occupation of deceased' NO.


If so, specify ..


(Signed)


(Address) 562 SHIRLEYST WithPODE


ANTE


Due To


CEDENT (b)


CAUSES


Due To (c)


10a If married, widowed, or divorced


HUSBAND of.


(Give maiden name of wife in full)


(or) WIFE of Janus Barry




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.