USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 5
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(or) WIFE of
Ellis Nelson
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bilateral bronchopneumonia
(a)
Parkinson's disease
10 yrs
10 yrs
*16 BIRTHPLACE (City)
(State or country)
Nova Scotia
Was autopsy performed?
no
What test confirmed diagnosis ?.
Clinical & Laboratory
5 Was disease or injury in any way related to occupation of deceased?No If so, specify
(Signed)
M Traunstein
,M. D.
(Address)
73 Bartlett Pd.
Date
Jan. 31, 19 59
6
Winthroanthrop 52, Mass.
Winthrop (City or Town)
Place of Burial or Cremation
DATE OF BURIAL
Feb. 3
19.59
50M-11-56-918978
MR-301A 1
TRUCTIONS FOR L CERTIFICATE
1 giving OF DEATH
not enter : than one e for each (b) and (c)
daes nat mean de of dying, heart failure, etc. It means ase, or compli- which caused
ians, if any, gave rise to cause (a), the under- cause last.
itions contrib -- death but nat to the terminal condition given
- Chapter 137, 1954, requires . ans to print or he cause or of death on certificates.
5
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: talle C.treanni, 8 (Signature of Agent of Board of Health or other) Lealle thieee 2/2/59
(Official Designation)
(Date of Issue of Permit)
V.B.
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME
Amy L (Nickerson) Nelson
(a) Residence. No. (Usual place of abode)
39
PARENTS
15 Social Security No .......
None
Doctors Cove
Due To (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- 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 1frf Odinlaw 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 townwhere 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., (Tetcentenary Edition)
RULES OF PRACTICE CLA
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. 6
(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 ot 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 depths caused diregtle or indirectly by traumatism (including resulting septice i )and by u 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
M R-302 1
PLACE OF DEATH
Suffolk
(County) Cheleca
(City or Town)
U.S.Naval Hospital
No.
Baby Girl Feal
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
86 Sagamore Ave.,
sinthrop,
Lass
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years ...
months ...... Jadays. In place of residence.
.years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Jan . 9,1959
DEATH
(Month) (Day)
(Year)
8 SEX
Female
9 COLOR
White
MARRIED
WIDOWED ..
or DIVORCEDngle
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 -
7 hrs
·AGE.
.a
Months.
Days
JI 4
under30
hours
Hours.
.Minutes
13 Usual
Occupation :.
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City) Chelsea , Mass (State or country)
17 NAME OF
FATHER
John S.
18 BIRTHPLACE OF
FATHER (City) ...
Hot Springs ,Ark.
(State or country)
19 MAIDEN NAME
OF MOTHER
Lola I.Fernandez
20 BIRTHPLACE OF Bogota, Columbia MOTHER (City) (State or country) dom . Jeal-father
Informant86 Sa amore Ave. , Winthrop (Address)
DATE OF BURIAL
7 NAME OF
R.C.Kirby
FUNERAL PIREE Boston, Mass
ADDRESS
Received and filed .. 19
(Registrar of City or Town where deceased resided)
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Prematurity
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
L. Marinelli, Lt.MC USN
M. D.
USNH, Chelsca, "ass ... 1/9/59
19
(Address) .... Woodlawn, verett, Lass.
6 Place of Burial or Cremation Jan . 12, (f959own) 19
PARENTS
21
A TRUE COPY
Joseph a. Tyrrell.
ATTEST:
Registrar of City or Town where death occurred)
DATE FILED
Jan. 12,1959
19
50M.11-55-916145
Due To (b) Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
16 13
Registered No.
§(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan.9
59
Jan.9
19
to ..
19.
59
I last saw
he Mive on
Jan. 9
19.5.9., death is said to
have occurred on the date stated ahove, at
1005 2%.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
PERSONAL AND STATISTICAL PARTICULARS
10 SINGLE
(write the word)
RECEIVED
12
-
,
3
3
FEB 1 31959 AM
1
RM R-305 1
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-305 to the clerk of the city or town in which the deceased resided as soon as possible
X
Middlesex
(County) Cambridge
(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
Cambridge
(City or town making return)
Registered No.
142 4-1
907 Massachusetts Av. No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Henry J. Lappen
(If deceased is a married, widowed or divorced woman. give also maiden name.) 87 Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
....... years .......
months. days. In place of residence
35 years.
.... months.
..... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
January 30, 1959
DEATH
(Month)
(Day)
(Year)
4I 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.) Coronary Heart Disease
Sudden Death
12 IF STILLBORN, enter that fact here.
13
70
AGE
Years
Months.
Days
If under 24 hours
Hours ........
.. Minutes
14 Usual
Occupation:
(Kind of work done during most of working life)
Retired
15 Industry
or Business:
013-28-7253
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Boston, .... Mass.
18 NAME OF
FATHER
Henry A. Lappen
19 BIRTHPLACE OF
Ireland
FATHER (City).
(State or country)
20 MAIDEN NAME
OF MOTHER
Catherine Kennedy
21 BIRTHPLACE OF
Boston, Mass.
MOTHER (City)
(State or country)
22 Susan A. Lappen
(Address)
07 inthrop St. Winthrop
DATE OF BURIAL
19
8 NAME OF
FUNERAL DIRECTOR
Maurice Kinby
Winthrop Mass.
ADDRESS FEB TUT
Received and filed 19 ...
....
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
11a If married, widowedog ani
mor divorced A. Greenfield
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
5 Accident, suicide, or homicide (specify)
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?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
.Was autopsy performed?
N
6 Was disease or injury in any way related to occupation of deceased?
If so. specify,
David C. Dow
(Signed)
Cambridge, Mass.
Date. 1-30 1, 59
(Address)
7 inthrop Cemetery Winthrop
Place of Burial, or Cremation. (City or Town)
M. D.
PARENTS
A TRUE COPY.
Frederick H. Burks
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED Feb. 3, 19 59
25M.5-52.907046
PLACE OF DEATH
2 FULL NAME ..
(a) Residence. No. (Usual place of abode)
winthrop,
Mass .
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(write the word)
Storekeeper
No
February 2,
59
M.S.
RECEIVED
-
1
FEB 1 01959 /11
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
To be filed for burial permit with Board of Health or its Agent.
Registered No. 15
NO.89 Somerset Avenue Cronin.
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 89 Somerset Avenue
(Usual place of abode)
Length of stay: In place of death. 1_years. 2 . months .. ..
days. In place of residence.years 2 _months. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
male white
10a If married, widowed, or divorced
HUSBAND of
Louise Myron
(Give maiden Name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE _. 7 8Years.
11Months
1.7Days
If under 24 hours
.. Hours ....... Minutes
13 Usual
Occupation :
Retired Police Officer
(Kind of work done during most of working life)
14 Industry
City Of Boston
or Business:
15 Social Security No.012-05-1495
16 BIRTHPLACE (City)
(State or country)
Mass .
17 NAME OF
FATHER
Mortimer Cronin
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Ireland
19 MAIDEN NAME OF MOTHER Anna Noonan
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
21
Informant Mrs. Gyrdie W. Dickinson
(Address) 89 Somerset Ave inthron
I HEREBY CERTIFY That a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
+ lass. Malker C. Percaune
(Signature of Agent of Board of Health or other)
Health Offer 2/4/59
(Official Designation)
(Date of Issue of Permit)
X
4 ₺
HEREBY CERTIFY
1958
to.
February
That I attended deceased from 1959
I last saw himalive on
Jan
3/-
1659
death is said to
have occurred on the date stated above, at
3:40PM
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
ADENOCARCINOMA OF CECUM
È CARCINOMATOSIS
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
Surgery
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed).
M. D.
(Address). Capleton 15 Mally Date 2/3/59
19
Calvary Cemetery Toburn Mass. 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL February 5 1959 19
7 NAME OF
FUNERAL DIRECTOR
alfred BB. March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed 2-5-54 19
(Registrar)
J (If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
Daniel Lea
PHYSICIAN - IMPORTANT (Was deceased a
U. S. War Veteran,
NO.
Winthrop (if so specify WAR)
St. -Boston Massachusetts
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February 2.
(Month)
(Day)
1959 (Year)
INTERVAL BETWEEN ONSET AND DEATH 18 mos.
MR-301A
3 .- THIS IS A ANENT RECORD. Use only 'E APPROVED ‹ ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE
n giving OF DEATH
not enter e than one se for each , (b) and (c)
does not mean ode of dying. heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib -- o death but not to the terminal condition given
- Chapter 137, 1954, requires ans to print or he cause or of death on .ertificates. HAP. 46, šš 9 & HAP. 114 $$ 45, CHAP. 38$ 6.)
MIS.
1-10-58-923886
PARENTS
South Boston
MARRIED
WIDOWED Widowed
or DIVORCED
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
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.
RECEIVED
1
OF
11 12 1
OLE
3
6
FEB -51959 AM
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.
Af death occurred in a hospital or institution, NBay View Nursing Home 41 Washington (Aves NAME instead of street and number)
2 FULL NAME
Joseph S. Cann
(If deceased is a married, widowed or divorced woman, give also maiden name.)
3 Willis Avenue, Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .1.years .. 3 months days. In place of residence 4 years. months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February
(Month)
4 1959
(Year)
8 SEX Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED'Y
(write the word)
Widowed
4 I HEREBY CERTIFY
August
19
57
Feb.
4
1959
I last saw himalive on
Feb
4
, 1951, death is said to
have occurred on the date stated above, at
7:30 P.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
2yrs.
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Varicose Ulcers
lyr.
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify.
(Signed).
Cheaples Liberman
M. D.
(Address). Wirthras, Maso Date.
2/5/
1959
Woodlawn Cemetery, Everett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 7th
19.
59
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS17 Bennington St. . E.Boston
Received and filed FEB 5 1959
19
(Registrar)
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
CBL
(State or country)
Nova Scotia
21
Informant
Jesse C. Cann-Son
(Address) 2 Willia Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial .or transit permit was issued : Galkle C. Pereaust. (Signature of Agent of Board of Health or other)
health office
2/5/19
(Official Designation) (Date of Issue of Permit)
X
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
loes not mean e of dying, heart failure, etc. It means e, or compli- which caused
ns, if any, ave rise to cause (a), the under- last.
cause
ions contrib- death but not the terminal indition given
Chapter 137, 954, requires as to print or e cause of death on Irtificates.
SOM-5-56-917573
PERSONAL AND STATISTICAL PARTICULARS
10a If married, widowed, or divorced
HUSBAND of
Sarepta Cox
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 75 Years 7 Months 26 Days
If under 24 hours
Hours _...
Minutes
13 Usual
Occupation :
Proprietor
Retired
(Kind of work done during most of working life)
14 Industry
or Business
Restaurant
15 Social Security No ...
012-18-1057
16 BIRTHPLACE (City)
Yarmouth
(State or country)
Nova Scotia
17 NAME OF
FATHER
Jesse Cann
18 BIRTHPLACE OF
FATHER (City).
CBL
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Mary Crosby
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence.
No.
(Usual place of abode)
(Day)
That I attended deceased from
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Hypertensive Coronary Artery
Heart Disease.
IR-301A 1
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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