USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 70
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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- te"n, 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 Heaith 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
OCT+8
NINTHRI
2
E :
ORGANIZATION AND OUTFIT
SERVICE NUMBER
...........
X SUFFOLK (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
195
ERNEST R. MARTIN 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) HOI PLEASANT STREET
. St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years .... .months. 13 days. In place of residence 25 years. .. months ........ .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF OCTOBER
11
1956
DEATH
(Year)
(Month) (Day)
4 I HEREBY CERTIFY
That I attended deceased from
SEPT 1
55
to ...
OCT. 11.
1956
I last saw h.//nalive on
OCT /1, 1956 death is said to
have occurred on the date stated ahove, at
10.30Pm
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
BRONCHO PNEUMONIA
INTERVAL BETWEEN ONSET AND DEATH 5 dias
2yrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
(Address).
Date 10/12
1956
WOODLAWN CREMATORY EVERETT Place of Burial or Cremation (City or Town)
DATE OF BURIAL OCTOBER 15 1956
7 NAME OF
HOWARDS. REYNOLDS
FUNERAL DIRECTOR.
ADDRESS.
WINTHROP MASS
Received and filed.
OCT 22 1956
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED MARRIED
10a If married, widowed, or divorced HUSBAND of FLORENCE
L. FOSTER
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 78 Years.
0 Months 10 Days
If under 24 hours
.. Hours ........ Minutes
13 Usual
TEAMSTER
RETIRED
(Kind of work done during most of working life)
14 Industry
or
Business s
EXPRESS
Co
15 Social Security No ....
NONE
16 BIRTHPLACE (City)
(State or country)
NEW HAMPSHIRE
17 NAME OF
FATHER
FRANK P. MARTIN
PARENTS
18 BIRTHPLACE OF
FATHER (City)
WILTON
(State or country)
NEW HAMPSHIRE
19 MAIDEN NAME
OF MOTHER
MARY E. HOPKINS
20 BIRTHPLACE OF
MOTHER (City)
HAMPDEN
(State or country)
MAINE
21 FLORENCE L. MARTIN
Informant ..
(Address) 401 PLEASANTST. WINTHROP
HEREBY CERTIFY that a satisfactory standard certificate of death was fied with me BEFORE the burial or transit permit was issued:
11. Varlatade
(Signature of Agent of Board of Health or other)
Que Board of Health
10/15/56
(Official Designation )
(Date of Issue of Permit)
...
Ve
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
loes not mean , of dying, heart failure, etc. It means > e, or compli- which caused
ns, if any, ave rise to cause (a), the under- ause last.
ions contrib-> leath but not the terminal ndition given
Chapter 137, 954, requires is to print or cause or f death on tificates.
100M-11-55-916145
PLACE OF DEATH
R-301A 1 WINTHROP (City or Winthrop ng
No. ..
142 PLEASANT STREET
CERTIFICATE OF DEATH
Registered No.
$(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)
--
(a) Residence. No.
(Usual place of abode)
M. D.
MILFORD
CEREBAL SCLEROSÉS
(b)
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- te n, 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 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.
(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 ..... .......
×
COPY OF CERTIFICATE OF DEATH
CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE
TOWN OR CITY CLERK'S NO
53,96
1. NAME OF
DECEASED
(Type or Print)
a. (First)
b. (Middle)
c. (Last)
2. DATE
OF
DEATH
(Month)
(Day)
(Year)
3. PLACE OF DEATH
a. COUNTY
Carroll
4. USUAL RESIDENCE (Where deceased lived. If institution: reald-
8. STATE
b. COUNTY
ence before admission).
Suffolk:
b. CITY
OR
TOWN
Commy
c. LENGTH OF
STAY (in this place)
Summor
18
c. CITY (Give actual town of residence, NOT mailing address).
OR
-TOWN
Winthrop
d. FULL NAME OF (If not in hospital or institution, give street address or location)
HOSPITAL OR
INSTITUTION
Contor Cormayy
6. COLOR OR RACE |7. MARRIED. NEVER MARRIED. 8. DATE OF BIRTH
WIDOWED, DIVORCED (Specify)
9. AGE (In years
last birthday)
IF UNDER 1 YEAR Months
Days
IF UNDER 24 HRS
Hours
10a. USUAL OCCUPATION (Kind of work done during most of working life, even if retired) Stock & Bond Jalo
10b. KIND OF BUSINESS OR IN-
DUSTRY
11. BIRTHPLACE (State or foreign country)
odloni, Taco.
12. CITIZEN OF WHAT
COUNTRY?
13. FATHER'S NAME Frederick Jaciccon
14. MOTHER'S MAIDEN NAME
Einarva Murphy
15. WAS DECEASED EVER IN U. S. ARMED FORCES?
(Yes, no, or unknown) | (If yes, give war or dates of service)
16. SOCIAL SECURITY 17. INFORMANT NO.
1St. Doris
INTERVAL BETWEEN
ONSET AND DEATH
Duddon Death
18. I. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death. (b)
(a) ..
Coronary Ceclusion
DUE TO
ANTECEDENT CAUSES
Morbid con-
ditions, if any, giving rise to the above cause
(a) stating the underlying cause last.
(c)
DUE TO
II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing it.
19a. DATE OF OPERA- 19b. MAJÖR FINDINGS OF OPERATION TION
21a. ACCIDENT
SUICIDE
HOMICIDE
(Specify)
21b. PLACE OF INJURY (e.g., in or about
home, farm, factory, street, office bldg., etc.)
21c. (CITY OR TOWN)
(COUNTY)
(STATE)
21d. TIME
(Month) (Day) (Year) [Hour)
OF
INJURY
m.
21e. INJURY OCCURRED WHILE AT WORK NOT WHILE AT WORK
21f. HOW DID INJURY OCCUR?
22. I hereby certify that I attended the deceased from 31 Ch
alive on ~. Jan 19 .... Land that death occurred at
( Degree or title)
23c. DATE SIGNED
24a. BURIAL. CREMATION.
ENTOMBMENT, REMOVAL
( Specify )
24b. DATE
Oct. 17, 1956
24c. NAME OF CEMETERY OR CREMATORY
Foodl:
24d. LOCATION (City, town, or county ) (State) b.
IF ENTOMBED
24e. PLACE OF BURIAL
( Name of Cemetery)
LOCATION (City, Town, County)
(State)
DATE
25. FUNERAL DIRECTOR
A
ADDRESS
COUNTERSIGNED - AGENT (City Bd. of Health)
DATE
DATE REC'D BY TOWN OR CITY CLERK
Oct. 22, 1256
CLERK'S OWN SIGNATURE
Loom A. 3.2007
CLERK OF
A true copy, Attest: Leon of Shirley
Clerk of ...... Gra
Dated .... 10-22 .. ... 19 .56
V. S. 17
[OCT 24 1956
1-53-50M I.B/
€
Min.
5. SEX
2℃lo
White
d. STREET
ADDRESS
41 Buckthorn Torruco
(If rural, give location)
Oct, 11, 1594
62
MEDICAL CERTIFICATION
20. AUTOPSY?
YES
NO
19. , to.
19. .._
., that I last saw the deceased
7:30 m., from the causes and on the date stated above.
23a. SIGNATURE
charles 5. DIE!
23b. ADDRESS Comme,
1.0.
Orrin
7000
100M.11-55-916145
7 NAME OF
FUNERAL DIRECTOR
Benjamin Birnbach
ADDRESS10 Washington St .. Dorchester
Received and filed. IOCT 15 1956 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
10a If married, widowed, or divorced, Bertha Elfman
HUSBAND of ......
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
70
12
AGE
Years.
Months.
Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation :
M. T. A. Motorman
(Kind of work done during most of working life)
14 Industry
or Business :
Retired
15 Social Security No ....
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Aaron Wolk
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Jeanette-Cannot be learn
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Alexander Wolk
Informant (Address) 43 Norman St.
Milton
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued : Halu K. Vaughan& Agent of Board of death or other) Chairman Board Healthe 10/15/56 (Official Designation ) (Date of Issue of Permit)
×
CTIONS OR CERTIFICATE
giving OF DEATH t enter han one for each b) and (c)
es not mean of dying, eart failure, c. It means , or compli- which caused
A
- (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Ne.
Was autopsy performed?
What test confirmed diagnosis ?..
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify ...
No
(Signed)
Charles Fiberway
M. D.
(Address) Winthrop Mass Date 10/14/1956
Everett
6 Montifiore
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
October
15,
19.56
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
1.97
St. { give its NAME instead of street and number) No ..
Charles Walk. Charles Work. 2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
208 Harvard
St.
Dorchester, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
.days. In place of residence.
.. years.
months
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
14.
1956
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct.
1
1956,
to ....
Oct.14
1956
I last saw himalive on
Oct.14, 1956 death is said to
have occurred on the date stated above, at 11:40A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Coronary Occlusion
(Anterior).
Du I Coronary Sclerosis.
INTERVAL BETWEEN ONSET AND DEATH 1994
yours.
...... L Suffolk (County)
Boston 11-6-56
Winthrop Community Hospital
$ (If death occurred in a hospital or institution.,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
(a) Residence. No ..
(Usual place of abode)
months
4
To be filed for burial permit with Board of Health or its Agent.
R-301A 1 Winthrop (City or Town)
PLACE OF DEATH
is, if any, ve rise to huse (a), he under- use last.
ons contrib- ath but not the terminal dition given
Chapter 137, 954, requires s to print or cause or E death on tificates.
PARENTS
Married
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.
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