STATE OF
Department of Health of the City of
BUREAU OF RECORDS
Registered No.: 17288
1. Place of Death: Borough of
No.: Pier 5, Robbins Dry Dock
Character of Premises:
2. Full name: Harold Mulvaney
Personal and Statistical Particulars
3. Sex: Male
4. Color or Race: White
5. (Marital Status): Single
6. Date of birth: [blank]
7. Age of decedent: 28 yrs
8. Occupation
a. trade: Machinist’s
b. industry: Rigger
c. No. years so occupied: [blank]
9. Birthplace:
9A. How long in US (if of foreign birth): [blank]
9B. How long resident in City of
Parents of Deceased
10. Name of father of decedent: Patrick
11. Birthplace of father:
12. Maiden name of mother of decedent: Julia Toner
13. Birthplace of mother:
14. Usual residence:
Medical Certificate of Death
15. Date of death: August 28, 1933
16. I hereby certify that the foregoing particulars (Nos. 1 to 15 inclusive) are correct as near as the same can be ascertained, and I further certify that I have this 26 day of August, 1933, taken charge of the body of the deceased found at Morgue, and that I have investigated the essential facts concerning the circumstances of the death.
17. I further certify that I have viewed said body and from autopsy and evidence, that he died on the 26 day of August, 1933, at 12:30AM., and that the chief and determining cause of his death was Drowning. ACCIDENT. And that the contributing causes were [none].
Signature: G. [Mouiluiel]
Assistant Medical Examiner
Approved: Charles Morris, [--]
Chief Medical Examiner
18. Place of Burial:
Date of Burial: Aug. 29, 1933
22. Undertaker: Joseph Redmond, Undertaker
John J. Redmond, 2190
Address:
The Department of Health may, from time to time, make rules and regulations fixing the time of rendering and defining the form of returns and reports to be made to said department by the office of the chief medical examiner of the City of New York, in all cases of death which shall be investigated by it; and the office of the chief medical examiner is hereby required to conform to such rules and regulations.—Sec. 1203, Chap. 466, Laws of 1901, as amended by Chap. 284, Laws of 1915.
It shall be the duty of the next of kin of any person deceased, and of each person being with such deceased person at his or her death, to file a report in writing with the department of health within five days after such death, stating the age, color, nativity, last occupation and cause of death of such deceased person, and the borough and street, the place of such person’s death and last residence. Physicians who have attended deceased persons in their last illness shall, in the certificate of the decease of such persons, specify, as near as the same can be ascertained, the name and surname, age occupation, term of residence in said city, place of nativity, condition of life; whether single or married, widow or widower, color, last place of residence and the cause of death of such deceased persons, and the medical examiners of the city shall, in their certificates conform to the requirements of this section.—(Sec. 1238, Chap. 466, Laws of 1901, as amended by Chap. 284, Laws of 1915. In effect January 1, 1918.)
Accident, suicide, or homicide? Accident
Date of injury: August 26, 1933
Where did injury occur? Pier 5, Robbins Drydock
Manner of injury? Accidental fall overboard
Nature of injury? Drowning
TO UNDERTAKERS
1. No burial permit can be obtained without a proper certificate.
2. Certificates must be written through in black ink.
3. No certificate will be accepted which is mutilated, illegible, inaccurate, or any portion of which has been erased, interlined, corrected or altered, as all such changes impair its value as a public record.
I hereby certify that I have been employed without any solicitation on my part or that of any other person as undertaker by Julia Mulvaney the mother of deceased. This statement is made to obtain a permit for the burial or cremation of the remains of deceased Harold Mulvaney.
Signature: Joseph Redmond, undertaker
John J. Redmond, 2190
No comments:
Post a Comment