USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 82
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Received and filed.
59
Father
Winthrop, Mass
PARENTS
X
M R-302 1
Winthrop
Mass
RECEIVED
6
DEC28
+ +
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.)
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1059247
J (If death occurred in a hospital or institution, No. St. [ give its NAME instead of street and number) En route to Beth Israel Hospital
MAE LEIBOVITZ
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 18 Cross. S.t.
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.9
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November 21, 1955
(Month)
(Day)
(Year)
9 SEX
F
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widower
11a If married, widowed, or divorced
HUSBAND of ..
(Giye maiden name of wife in full)
Barnet Leibovitz
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
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:
none
16 Social Security No ...
Chelsea
17 BIRTHPLACE (City).
(State or country)
Mass
18 NAME OF
FATHER
David Solomon
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
20 MAIDEN NAMEElizabeth Rosenthal OF MOTHER
21 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
Son
Russia
7 Ohel Jacob woburn, Mass.
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL. November 22 1955 .19
8 NAME OF
FUNERAL DIRECTOR
Aaron Golov
ADDRESS
1668 Beacon St., Brookline
Received and filed.
JAN 3 1550
19
...
- d. DEc. CH. "
(Registrar of City or Town where deceased resided)
PARENTS
22 Informant (Address)
A TRUE COPY Land, 21 Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
November 25, 1955
19
25M-5.52-907046
(Specify type of place)
Manner of
Collapsed at home; died en
Injury
Nature of
(How did injury occur?)
Injury
to hospital
While at work?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
wim J Brickley
M. D.
(Address)
Boston
11/21
19.55
Date
55
Housework
Date and hour of injury .19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
5 Accident, suicide, or homicide (specify)
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.)
Hypertensive heart disease
Congestive heart disease
× SUPPOR BOST
(City or Town)
1 R-305 1
...
(Was deceased a
U. S. War Veteran,
{ if so specify WAR)
No
(write the word)
at home
RECEIVED
TO ::
6
THROP
JAN-S
P
X
PLACE OF DEATH
(County) BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1068248
No.
Veterans Administration Hospitalst.
[(If death occurred in a hospital or institution. { give its NAME instead of street and number)
2 FULL NAME.
SIDNEY F ASTON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
186 Winthrop
St.
Winthrop, Mass.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WW 1
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.....
.. years.
months.
6
days. In place of residence.
3
.years.
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
November 22, 1955
DEATH
(Month)
(Day)
(Year)
9 SEX
M
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCEDSingle
11a If married, widowed, or divorced
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:
Hospital patient
(Kind of work done during most of working life)
15 Industry
Soldiers' Home, Chelsea
or Business:
16 Social Security No ..
17 BIRTHPLACE (City)
(State or country)
Nova Scotia
18 NAME OF
FATHER
George Aston
19 BIRTHPLACE OF
FATHER (City).
(State or country)
England
20 MAIDEN NAME
OF MOTHER
Julia Walsh
21 BIRTHPLACE OF
MOTHER (City)
England
(State or country)
sister
22
Informant
(Address)
A TRUE COPY,
ATTEST:
harkes 2.
actie
ADDRESS Winthrop, Mass.
Received and filed.
JAN 6 1-56
19
(Registrar of City or Town where deceased resided)
....
(Specify type of place)
Manner of
Injury
Fall from window - manner
(How did injury occur?)
Nature of
Injury
undetermined
While at work?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Richard Ford
M. D.
(Address) Boston
Date. 11/23 19 55
7 Winthrop
Winthrop
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL November 26 1955 .19
8 NAME OF
FUNERAL DIRECTOR
Arthur J. O.Maley
(Registrar of City or Town where death occurred)
DATE FILED
November 29, 1955
19
....
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.) Septicemia cerebral laceration
fracture of leg
5 Accident, suicide, or homicide (specify).
Date and hour of injury.
Nov 16 55
19
Where did
Injury occur ?.
Chelsea
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
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.)
A R-305 1
PARENTS
(write the word)
TO!
7
1
6
HROP
JAN-C
Apr 26 1918 Mar 20 1919 Pvt Bat C 77th FA 4th Div 1 691 799
M R-302 1
PLACE OF DEATH
Suffolk (County)
tevoro
(City or Town)
No. rover anor
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVEN
(City or town making return)
Registered No.
249
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 81 Somerset
St.
intirop
(If nonresident, give city or 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
3 DATE OF
DEATH
love her
22,
1955
(Month)
(Day)
(Year)
8 SEX
To male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
arried
4I HEREBY CERTIFY,
That I attended deceased from
... o.v.
13., 1955 .....
to ........ C.V .....
22, 1955
I last saw h .. e.r ..... alive on .......... No.v ........ 22.,. 19.5 ... death is said to
have occurred on the date stated above, at 5:101.
.m.
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
arry I.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
ccio cerebral
INTERVAL BE- TWEEN ONSET AND DEATH 7
11 IF STILLBORN, enter that fact here.
12
AGESIL
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:
At home
15 Social Security No ....... none
16 BIRTHPLACE (City) ............ G.t.a ...... cotia. (State or country)
17 NAME OF
FATHER
18 BIRTHPLACE OF
FATHER (City)
Nova Scotia
(State or country)
19 MAIDEN NAME
OF MOTHER
Ann Smith
20 BIRTHPLACE OF
MOTHER (City)
Tova Cotia
intiro. (State or country)
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL ...
Hove iter
25,
155
7 NAME OF
FUNERAL DIRECTOR
Maurice M. Tinby
ADDRESS.
.210
Winthrop St., "inthe 0
Received and filed DEC ... 1955 .... 19
(Registrar of City or Town where deceased resided)
21
Informant .......... [ ..........
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
November 28,
19.55
LEVY
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,
25M .(B)-11-51-905807
Was autopsy performed ?...
...... no
What test confirmed diagnosis ?.
Clinicalsigns
2
roars
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
nore
Date of operation
5 Was disease or injury in any way related to occupation of deceased ?.......
If so, specify.
(Signed) Ja 09
(Address) 37 Quay Everett Date QV 22 195
M. D.
6 inthrin Comotomar
PARENTS
og ital
2 FULL NAME.
Cara' Durditt
(cIsaac)
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(Usual place of abode)
Due To
arteriosclerovic
ANTE
CEDENT (b)
CAUSES
heart disease
(write the word)
L
RECEIVED
TO !!!
.....
.
5
6
THROP
DEC13
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.)
No.
(Usual place of abode)
DEATH
June 28
1955
I last saw
h
er
TO DEATH
CEDENT (b)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
What test confirmed diagnosis ?.
(Address)
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,
CAUSES
accident
25M-5-55-915025
3 DATE OF
November 30, 1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
to ..
Nov. .. 30
19
55
have occurred on the date stated above, at.
2:115a.
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
Bilateral Broncho-
pneumonia
ANTE
Due Toold Cerebro Vascular
Due To Arteriosclerotic
(c)
Hypertension
Date of operation
Was autopsy performed ?. nQ
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ..
(Signed).
nte
" Smith
Foly Chost Cap. Datel 1/20%
no
M. D. 1955
Holy Cross Cem
Talden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL ..
December 3.
155
7 NAME OF
FUNERAL DIRECTOR ...
John C. Kelly
ADDR
286 NeriMan t. T.Boston
Received and filed.
SAN & No
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCEDSingle
10a If married, widowed, or divorced
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
AGE79
Years
Months. 1 .. .. Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
Housework
14 Industry
or Business: em .... home
15 Social Security Naone
16 BIRTHPLACE (City) Tast Boston (State or country)
17 NAME OF
FATHER
John Lesson
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Treland
...
19 MAIDEN NAME
OF MOTHER
Elizabeth Hassan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Trclara
21
Informant Ohn F. E=0
(Address R5 Porrer St. Dorchester
ATTEST:
A TRUE COPY
Inderició N. Burio
(Registrar of City or Town where death occurred)
DATE FILED
Dec ....... 2,
........
........
.19 .. 5.5.
V.B .-
1 R-302 1
PLACE OF DEATH
Middlesex (County)
Cambridge
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Cambridge
(City or town making return)
Registered No.
1306 251
Holy Ghost Hospital
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME Elizabeth Hasson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 2h Fairview St. Winthrop
(If nonresident, give city or town and State)
58
(Was deceased a
U. S. War Veteran,
if so specify WAR) ... no
Length of stay: In place of death
1
5
.months&
days.
In place of residence
years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
alive on
Nov. 30
55
death is said to
(Kind of work done during most of working life)
PARENTS
.S.
OF TO !!
.1
5
6
THI
JAN-5 AM
X
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No.
586 Shirley street
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial pormit with Board of Health or its Agent.
Registered No. ............
252
2 FULL NAME Frank C Jackson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 586 Shirley Street (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
5
years
months.
days. In place of residence
.years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
19000-
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
4I HEREBY CERTIFY,
That I attended deceased from
19
190 €/ to
to
Rec.1St
19-5-
10a If married, widowed, or divorced Ethel B Colby
HUSBAND of
(Give maiden name of wife in full)
have occurred on the date stated above, at
9:15Am.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
75 Years.
Months.
.Days
If under 24 hours
Hours ... . Minutes
ANTE
Due To
arteriosclerosis
CEDENT (b)
CAUSES
general, zed
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
nephro sclerose
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? 20
If so, specify.
(Signed)
(Address)
9+ deslangtids Date 12-2
195-
6
Woodlawn Crematory
Place of Burial or Cremation
Everett (City or Town)
DATE OF BURIAL.
Dec. 3
19.55
7 NAME OF
FUNERAL DIRECTOR
Howard Sternolis
ADDRESS
Received and filed DEC 2 1955 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Unable to obtain
(State or country)
19 MAIDEN NAME
OF MOTHER
Charlott Hamilton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
21 Ethel B Jackson
Informant.
(Address)
586 Shirley St.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Watter I Ha ex. (Signature of Agent of Board of Health of other)
Thealche Sauce
(Official Designation)
Vi
12/2/50
(Date of Issue of Permit)/
X
CTIONS R RTIFICATE
ving DEATH enter an one r each and (c)
s not mean dying, such e, asthenia, the disease, ions which
conditions, rise to the (a) stating ing cause
ns contrib- ath but not disease or sing death.
TOOM-10-53-910621
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH , (a)
Myocardial
iheart Disease
grs
13 Usual
Occupation :
Interior Decorator
(Kind of work done during most of working life)
14 Industry
or Business:
Self
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Maine
Morrill
(or) WIFE of
(Husband's name in full)
I last saw h / M alive on
no. 30
1950, death is said to
25
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)
R-301A 1
repli Megane
M. D.
17 NAME OF
FATHER
Horace
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 hy 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 physician's 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 idisabled 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
R-301A 1 Winthrop (City or Town)
No. .. " inthrop & m.
Hosp
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.
253
Registered No.
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME Baby Boy) Jodoin (If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. VS Chelsea St., E. Boston, Massof (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
8 SEX
M
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
3 DATE OF
DEATH
12
1
55
(Month)
(Day)
(Year)
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