USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 1
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.
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
சிவன் -
....
٥ جيدا
-
鲁鲁卡
小書
中专
مصر
ஸரஸ்
பூர் ---------
معطوبى
カラーーーーーール
小書
ஆ.ஆ ... சூ. ஏ.
4
中中出すす
ميـ
1台中050中毒
中华一
-
トー+
THOMAS GROOM & CO.INC. STATIONERS AND ACCOUNT BOOK MANUFACTURERS 105 State Street. BOSTON.
To duplicate this Book send number 8-26163
Digitized by the Internet Archive in 2016 with funding from Boston Public Library
https://archive.org/details/townofwinthropre1962wint
X
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. 80 Upland Road
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
1
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Elmer .... Stuart Lipsett
(First Name)
(Middle Name)
(Last Name)
[ (Was deceased a { U. S. War Veteran, lif so specify WAR) W.W.1
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. !
80 Upland .Road
(Usual place of abode)
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
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED married
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
19
I last saw hj.malive on
19 ............ , death is said to
have occurred on the date stated above, at
11:20 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
sudden
Due To
(b) Presumably Coronary Occlusion
Due To
(c) Arteriosclerotic Heart Disease
OTHER
SIGNIFICANT
CONDITIONS
Hypertension
10 yrs 10 yrs
Was autopsy performed?
NO
What test confirmed diagnosis? post-mortem judgement
5 Was disease or injury in any way related to occupation of deceased? No If so, specify .......
0. Arthur C. Murray,
Arthur C. Murray
(PRINT OB TYPE SIGNATURE)
Winthrop Board of Health at
2 Jan 19 62
Winthrop Cemetery
Winthrop Mass MOTHER (City)
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
January 4,1962
19
7 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Mabel Phillips
20 BIRTHPLACE OF
(State or country) Maine
Mr.s ........ Elmer ..... S ........ Lipsett
21 Informant (Address) 80 Upland Road Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit, permit was issued:
Mass.
Kach E Surranni
(Signature of Agent of Board of Health or other)
Heath Office
1/3/62
(Official Designationy (Date of Issue of Permit)
INSTRUCTIONS FOR ¿DICAL CERTIFICATE
In giving USE OF DEATH do not enter more than one cause for each E (a), (b) and (c)
This does not mean mode of dying, h as heart failure, senia, etc. It means disease, or compli- ons which caused th.
Conditions, if any, which gave rise to bove cause (a), tating the under- ying cause last.
Conditions contrib- ig to death but not ted to the terminal ase condition given a).
Note :- Chapter 137, cts of 1954, requires nysicians to print or pe the cause or uses of death on ath certificates, and lapter 48, Acts of 59, requires Physi- ans to print or type ime under signature.
M-6-60-928145 T
11 IF STILLBORN, enter that fact here.
12
AGE .. 65
1.0Months2.6 .... Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Advertising agent
(Kind of work done during most of working life)
14 Industry
or Business :
paper ..... Mfg .Co ..
15 Social Security No.
028-03-2352
16 BIRTHPLACE (City)
(State or country)
Mass
Melrose
19
to.
10a If married, widowed, or divorced
HUSBAND of
.Hva .... Frances ...... Barrett
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
40
(If nonresident, give city or town and State)
16
3 DATE OF
DEATH
January
1
1962
(Month)
(Day)
(Year)
St.
Registered No.
ORM R-301A 1
17 NAME OF
FATHER
Andrew Lipsett
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE. n-7-1917
DATE OF DISCHARGE
7-1-19,9
RANK, RATING
SIE 1ST Class
ORGANIZATION AND OUTFIT
1. 407-8,7
bilization : Devar
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 un- related to any form of injury.
(2) Board of Health 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
X
PLACE OF DEATH
Suffolk (County)
SENSIE
Winthrop
(City or Town)
No. 17 Irvin Street
The Commomuralth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Dr King To be filed for burial permit with Board of Health or its Agent.
2
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, lif so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Irwin Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. .... .. . .years. 2 months days. In place of residence .years. months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
JAN
DEATH
(Month)
(Day)
1
1962
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widow
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Alfred E Whitehead
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
76
Years ....
4
Months.
0
Days
If under 24 hours
.. Hours .....
... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
Own home
None
15 Social Security No.
County Cork
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Butler
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary His Unable to obtain.
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
21 Edna Joseph
Informant (Address) 135 Ocean Ct. Lynn Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit. was issued:
(Signature of Agent of Board of Health or other)
62
(Official Designation)
(Date of Issue of Permit)
-
1
INSTRUCTIONS FOR DICAL CERTIFICATE
In giving JSE OF DEATH do not enter more than one cause for each (a), (b) and (c)
his does not mean mode of dying, as heart failure, nia, etc. It means disease, or compli- which caused ns 4.
ditions, if any, hich gave rise to ove cause (a), Iting the under- ing cause last.
Conditions contrib- g to death but not ed to the terminal 'se condition given 1).
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) Ingran 2. 5mg M. D. MYRON N.KINGM.D (PRINT OR TYPE SIGNATURE)
(Address)24 FLETTJAN: 5 WINY Hun Date.
inthrop
Place of Burial or Cremation
DATE OF BURIAL
Jan.
14
19.
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop Mass.
Received and filed
19
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE _ (a) artère balenticHeart Disease with congestive facture
(b)
Due To GENERAL ARTERIOSCLEROSIS
375.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
CIRROSIS OF LIVER
7 YRS-
6 winthrop
(City, or Town) 62
PARENTS
1/2
PERSONAL AND STATISTICAL PARTICULARS
37
Mary K (Butler) Whitehead
2 FULL NAME
(a) Residence. No. (Usual place of abode)
4 I HEREBY
CERTIFY,
That I attended deceased from
1962
JUNE 28
1902
to
JAN
1
I last saw hat Ralive on
12/24
, 1961
death is said to
have occurred on the date stated above, at .
123- A
.m.
2 YRS. AGE
ORM R-301A 1
›te :- Chapter 137, : of 1954. requires sicians to print or the cause or .es of death on h certificates, and pter 48, Acts of , requires Physi- s to print or type e under signature.
)OM-6-59-925686 7
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 following 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 un- related to any form of injury.
(2) Board of Health 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
FORM R-303
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
§§ 44-48.
50M-3-61-930213
1
SUFFOLK (County)
WINTHROP
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
3
400 Revere Street, Winthrop
PHYSICIAN - IMPORTANT
[ ( Was deceased a
(First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
400 Revere Street, Winthrop
St.
(If nonresident, give city or town and State)
25. .. years .. months .. ...... ... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX Female
10 COLOR
white
11 CITIZEN
OF U.S.
YES
NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
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.)
Arteriosclerotic heart disease.
(or) WIFE of
George (Give sharpe
wife in full)
(Husband's name in full)
13 DATE OF BIRTH
May
19. 1891
14 ÅG 70 .Years. 7 Months ... Days
If under 24 hours .Hours .Minutes
...
Date and hour of injury 19
IF ACCIDENTAL, was injury causally related to the death ?
Where did Injury occur ?
(City or town and State) Did injury occur in or about home, on farm, in industrial place, of
(Specify type of place)
(How did injury occur ?)
While at work ? Was autopsy performed
6 Was disease or injury in any way related to occupationof deceased ?
If so, specify
(Signed) Michael A. Luongo
(Print or Type
Vame)
1/2
19 ,62
(Address) Winthrop
Date Winthrop
7 Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
January 5, 1962
8 NAME OF
FUNERAL DIRECTOR
Arthur J. OMaley
ADDRESS Winthrop, Mass
Received and filed
1 1.00 19
A TRUE COPY ATTEST:
(Registrar)
PARENTS
21 MAIDEN NAME
OF MOTHER
Margaret Maxwell
Cambridge
22 BIRTHPLACE OF MOTHER (City) (State or country) Mass
23 William Donovan ·
Informant (Address) 230 Pleasant St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death . with me BETA burial or transit permit was issued:
Mistimun of Agent of
1/4/ 62.
(Official Des.geldi
1
2 FULL NAME 3 DATE OF DEATH Manner of Injury Nature of Injury If deceased was a U. S. War Veteran, (I.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. public place ?
OR TYPE THE CAUSE OR CAUSES OF DEATH ON DEATH CERTIFICATES.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of -
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. MARGARET I. SHARPE
(a) Residence. No. (L'sual place of abode)
Length of stay : In place of death. .. years ... . ..... .months ..
January
2,
1962
(Month)
(Day)
(Year)
12a If married, widowed, or divorced HUSBAND of
15 Usual Occupation : ...
waitress
(Kindof work done during most of working life)
16 Industry Business.
Restaurant
curit
No.
030-22-6753
18 NRTHPLACE (City)
(State or country)
Cambridge Mass
19 NAME OF
FATHER
John Mc Court
20 BIRTHPLACE OF
FATHER (City)
(State or country)
Cambridge
Mass
0
M. D.
Boston
PLACE OF DEATH
Registered No.
U. S. War Veteran,
[if so specify WAR)
No
days . In place of residence.
5 Accident, suicide, or homicide (specify)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF
TOK:
1.1.17
3
RULES OF PRACTICE
6
The fulfillment of the purpose of these laws calls for the observance of the following rules 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 deaths only as those JANersoAs98pofithough 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 poison) , 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal."""Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
X
PLACE OF DEATH
(County)
inthron
(City or Town)
No. .....
interce Comunitat
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
4
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME alert (First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
3" Frinonter it.
St. -......
03:on
(If nonresident, give city or town and-State)
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
4 I HEREBY CERTIFY,
Dec 2, 1961
19
That I attended deceased from
to January 2
1962
I last saw h alive on
January L, 1962, death is said to
have occurred on the date stated above, at
6 .: 45 P.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Pulmonary Embolism
(a)
INTERVAL BETWEEN ONSET AND DEATH
Due To
(b)
Carcinoma of bowel
Due To
(c)
Post-operative)
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 Nathaniel P. Danoff M. D
(Address)32 Prin neeton St. E.B Date Jan, 2 1962
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Jan. 6
19
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Larrath
ADDRESS 325 Chelsea St. E. - oston
Received and filed
in 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Olevia Smith
20 BIRTHPLACE OF MOTHER (City) (State or country)
Nova Scotia
21 Informant
Amaryllis Swimm
(Address)
37 Princeton St. E. Foston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit) permit was issued: Traviny & Pereanus (Signature of Agent of Board of Health or other) Health Receive 1/3/62
(Official Designation)
(Date of Issue of Permit)
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter more than one ause for each (a), (b) and (c)
is does not mean mode of dying, as heart failure, nia, etc. It means lisease, or compli- s which caused .
ditions, if any, ich gave rise to ve cause (a), 'ing the under- cause last.
Conditions contrib- to death but not d to the terminal e condition given ).
ote :- Chapter 137, s of 1954, requires 'sicians to print or : the cause or ses of death on th certificates, and pter 48, Acts of ), requires Physi- is to print or type le under signature.
6-60-928145
11 IF STILLBORN, enter that fact here.
12
AGE 70 Years
Months ...
.Days
If under 24 hours
Hours ...
.. Minutes
13 Usual
Occupation :
foreman
(Kind of work done during most of working life)
14 Industry
or Business :
retired
15 Social Security No.
011-01-3617
Clarks Harhon
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
Nathaniel Swimm
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
(PRINT OR TYPE SIGNATURE)
10a If married, widowed, or divorced
Amaryllis I Nickerson
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
....
(Month)
(Day)
1962
(Year)
((Was deceased a U. S. War Veteran,
{if so specify WAR) WWW 1
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death.
.years
months
31
.days.
In place of residence
years.
Registered No.
J
82-8im
RM R-301A 1
Clarks Harror
Nova Scotia
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE 7/30/18
DATE OF DISCHARGE
8/28/19
RANK, RATING
ORGANIZATION AND OUTFIT
Qtrmaster Corps
U.S. Army
SERVICE NUMBER 4306787
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 un- related to any form of injury.
(2) Board of Health 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 occu- pation, 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 impor - tant, 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. Chil- dren 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
TOWN
OFFICE OF
11 12. 1
V
MIN
is
CLERK
5
6
'11
THROF
JAN 3 1962 PM
FORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
X
PLACE OF DEATH
Essex
(County)
1
Danvers.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or Town making this retu.
5
Danvers State Hospital,
S (If death occurred in a hospital or institution. Hathorne .. St. ( give its NAME instead of street and number)
Mary u Black (Brooks )
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 137 Bowdoin Street ( Usual place of abode)
........
St
Winthrop.
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
2 ears. 4 months .. ZOdays. In place of residence .......... years ...... .. months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
(Month)
(Day)
That I
attended deceased from
August 20, 19
59.
to ..
January ........ 5
19
.62
1 last saw
h.o.klive on
Jan.
19 .. 62
death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH
years
12
AGE.
1.0Months ...
2.9Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
Domestic
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No.
Unknown
OTHER
SIGNIFICANT
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.