USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 35
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 (link on the Part 1 page).
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 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89
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 mace 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 discases resulting frøur injurylor anfection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Soc/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; br from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 414, Sec.46, G.L .. . (Tercentenary Edition).
INT
6 RULES OF PRACTICE
The fulfillmed 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 pher vare giyen bedside care during a last illness from disease unrelated
(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
A R-302 1
PLACE OF DEATH
Worcester (County)
Westborough
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Westborough (City or town making return)
Registered No.
121115
Westborough State Hospital
J(If death occurred in a hospital or institution,
St. \ give its NAME instead of street and number)
2 FULL NAME
Abraham Katz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 Beach Rd ...
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
......... years.
months
6
In place of residence.
......... years.
months
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORC
Married
4 I HEREBY CERTIFY,
That I attended deceased from
19
53
I last saw
h ... ]m ... alive on May 18
19.53
death is said to
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
66
AGE
Years
Months.
.Days
If under 24 hours
.Hours
Minutes
13 Usual
Occupation :
Waiter
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Russia
17 NAME OF
FATHER
cannot be learned
18 BIRTHPLACE OF
FATHER (City)
cannot be learned
None
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
Russia
(State or country)
Informant
We.s.thorough .... State
(Address)
Hospital records
7 NAME OF
FUNERAL DIRECTOR
Erwin L. Levine
ADDRESS.
470 Harvard St., Brookline
Received and filed
June
10
1953
(Registrar of City or Town where deceased resided)
A TRUE COPY.
2.8%
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
June 8,
19.5.3
No.
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May 18, 1953
May 12,
53
to
May 18
have occurred on the date stated above, at.
1:30 p.
.m.
DISEASE OR CONDITION
DIRECTLY LEADING
Congestive
TO DEATH (a)
Heart Failure
ANTE
Due To
Generalized
CEDENT (b)
Due To
(c)
OTHER
Psychosis
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
None
.Was autopsy performed?
What test confirmed diagnosis?
(Address)
6Tifereth Israel of Winthrop,
Place of Burial or Cremation
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
50m-(e)-10-48-24658
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
CAUSES
Arteriosclerosi
INTERVAL BE- TWEEN ONSET AND DEATH
S
Clinical Findings
5 Was disease or injury in any way related to occupation of deceased ?.. If so, specify Donald P. Hickey
(Signed)
Westboro, Mass. Date 5/18
19.53
Everett, MasSi DATE OF BURIAL May 19,
(City or Town) 1953
PARENTS
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Month)
(Day)
(Year)
RECEIVED
OF
TOWA
3
11 12
3 .-
5
VI
6
MASS
JUN10 PM
X
DEATH
Suffolk
(County)
Bos ton
(City or Town)
818 Harrison Ave.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Bostan
(City or town making return)
Registered No.
47684 16
(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
32 Francs
8
St.
Winthrop Mass.
(a) Residence.
No.
(Usual place of abode)
LO
years.
Length of stay: In place of death.
.years.
.... months.
days. In place of residence.
months.
days.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
(Month) (Day) (Year)
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.)
Coronary
diabetes mellitus
while at work
12 IF STILLBORN, enter that fact here.
52
13
AGE
Years
.Months.
.....
Days
If under 24 hours
Hours ......
.. Minutes
Sta.Engineer
14 Usual
Occupation :.
(Kind of work done during most of working life)
15 Industry
or Business :.
Boston Safe Deposit
Tr.
16 Social Security No.
Somerville Mass
17 BIRTHPLACE (City) (State or country)
18 NAME OF FATHER
Thomas Benson
19 BIRTHPLACE OF
England
FATHER (City). (State or country)
20 MAIDEN NAME
OF MOTHER
Sarah Clark
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
22 Informant. (Address)
Wife
A TRUE COPY arles N. Macka
C
DATE OF BURIAL.
19
8 NAME OF
FUNERAL DIRECTOR
Winthrop Mass"
ADDRESS
Received and filed.
JUN 11953
19.
(Registrar of City or Town where deceased resided)
...
Date and hour of injury ..
19.
...
1
(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?
6 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Richard Ford
M. D.
(Address)
Date ....
5-20 . 19
Winthrop Cem-WinthropMass.
7 Place of Burial, or Cremati May :22/53 (City or Town)
25m-(c)-11-49-900.475
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
No.
John T Benson
(Was deceased a
U. S. War Veteran,
if so specify WAR)
3 DATE OF
DEATH
...
May 19/53
11a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
Beatrice Palliser
(or) WIFE of
(Husband's name in full)
5 Accident, suicide, or homicide (specify)
Where did Injury occur?
010-12-3037
PARENTS
Quincy Moss.
ATTEST:
(Registrar of City or Town where death occurred) May 25/53
DATE FILED
19
, JR.
R-305
1
JF OrMaley
OF
TOWI
OFFICE
8
WIE
6
THROP.
JUN-1 AM
R-301A 1
... PLACE OF DEATH Suffolk (County) Winthrop (City or Town) Wirthropa
6/3/53
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.
Hospital
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 Davis St
St.
Evinité
(If nonresident, give city or town and State)
Length of stay: In place of death ... years months.
1 days. In place of residence .. years .. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
MAY
(Month)
19 1953 (Day) (Year)
8 SEX
male
9 COLOR OR RACE
intente
10 SINGLE
(write the word)
MARRIED
WIDOWED AL
or DIVORCEBEZZer.C
4 I HEREBY CERTIFY,
That I attended deceased from
19
1953
I last saw h-
.. alive on
MAY 19, 1953, death is said to
have occurred on the date stated above, at 1PM m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
.Months
Days
If under 24 hours
Hours
Minutes
13 Usual
retinal
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
LaCiones
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Italy
17 NAME OF
FATHER of extablestre al
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?
If so, specify
(Signed)
(Address) 305 Chiba 5
M. D.
Date. 19 MAY 1953 AMASS
6 Place of Burial or Cremation (City of Town)
DATE OF BURIAL ..... Mail 22/53 19
7 NAME OF FUNERAL DIRECTOR Salvatore Rocco, Sos
ADDRESS Centi
Received and filed.
2.1-1953
........ .19
(Registrar)
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Arily
19 MAIDEN NAME
OF MOTHER mit estableche.(
20 BIRTHPLACE OF MOTHER (City) (State or country)
21 Michael Dee Urin
Informant (Address) Illaves ST Ercect
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & thakketz. (Signature of Agent of Board of Health or other) Health Officer 5/21/53
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia, ns the disease. ations which h.
d conditions. ng rise to the e (a) stating lying cause
ions contrib- death but not he disease or ausing death.
SOM-5-52-907046
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Chomany Thanks
2 days
ANTE CEDENT (b) CAUSES
Due To Huputinin
380
Due To
(c) arturo schusio
5 gr.
OTHER SIGNIFICANT CONDITIONS
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
40
Registered No. 117
No. michael De Crio
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(a) Residence. No. (Usual place of abode)
19.5 ... to
Roberta
staly fin
EVERETT
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 deccased, 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 deccascd, 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).
RECEIY
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 .of 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 funeralis to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
What 114, Sec. 46. G. L., (Tercentenary Edition).
6
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
MAY Attending physicians will certify to such deaths only as those of persons hos 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 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
SOM-10-52-908091
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.
118
J(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
2 FULL NAME.
Abigail (Chamberlain) Curtis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 100 Quincy Ave.
......
St.
(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
3 DATE OF
DEATH
May
21
1953
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
195V
to.
may 21.
1953
I last saw her alive on
Zumy 20, 1953, death is said to
have occurred on the date stated above, at 1 0 : 00 A. m.
INTERVAL 8E.
TWEEN ONSET
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Noah Curtis
(Husband's name in full)
AND DEATH 11 IF STILLBORN, enter that fact here.
12
88
AGE
Years
7
Months
Days
22
If under 24 hours
Hours . . Minutes
13 Usual
Occupation:
housewife
(Kind of work done during most of working life)
14 Industry
or Business:
at home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
John ChamberTin
18 BIRTHPLACE OF
FATHER (City)
Quincy
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Abigail Baxter
20 BIRTHPLACE OF
·
A
MOTHER (City)
Quincy
(State or country)
Mass.
6
Mount Wollaston Cemetery, Quincy
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
May 23, 1953
19
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
19 Cottage Ave., Quincy
Received and filed. MAY 22 1553 19
(Registrar)
10days
ANTE
CEDENT (b)
CAUSES
15000
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
Clinical.
5 Was disease or injury in any way related to occupation of deceased? 220
(Signed) Charles Liberman
M. D.
(Address) 238 Steanne Drive Date
5/21/1983
PARENTS
Informant.
21
Miss Ethel Curtis
(Address) 100 Quincy Ave. , Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the byrial or transit permit was issued: Walter . Baker. (Signature of Agent of Board of Health or other)
Thealto of
5.22.53
(Official Designation)
(Date of Issue of Permit)
TIONS RTIFICATE ing DEATH enter n one reach and (c)
s not mean lying, such e, asthenia, > the disease. ons which
conditions. rise to the a) stating ng
s contrib- ath but not disease or ing death.
4
R-301A K- 1
No.
100 Quincy Ave.
PHYSICIAN - IMPORTANT
(Was deceased a
No
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
22
22
9 COLOR OR RACE
10 SINGLE
(write the word)
8 SEX
Female
White
MARRIED
WIDOWED
or DIVORCED Widowed
(Monthy
.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
a) Cerebral Hemorrhage
Quincy
cause
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.
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.