Town of Winthrop : Record of Deaths 1954, Part 54

Author: Winthrop (Mass.)
Publication date: 1954
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 54


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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 retumed as at(school of it 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.


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-302 to the clerk of the city or town in which the deceased resided as soon as possible,


PLACE OF DEATH


...


SUFFOLK E (County) IN


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No.


6412161


2 FULL NAME.


JUS SOLIMBERG


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. (Usual place of abode)


25 .... Sturgis


.....


.........


St.


(If nonresident, give city of 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


(Month)


July


.23


1954


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended , deceased from


was


D


19 ..


5


I last saw h


alive on


19


death is said to


have occurred on the date stated above, at.


10:20p.


.m.


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a) cerebral hemorrhage


6wks


ANTE


Due To


CEDENT (b)


CAUSES


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? If so, specify


(Signed).


H Migro


M. D.


(Address)


BOŘ


Date.


7/23 54


6 Place of Burial of Cremation th Target of Winthrop Everett


DATE OF BURIAL .................... 2.5 19 .. 5.4


7 NAME OF


FUNERAL DIRECTOR ..... Torf.


ADDRESS


Chelsea, Mass


Received and filed. 19


A TRUE COPY


Parkes H. Mackie


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Jul 27


54


......


.19


(Registrar of City or Town where deceased resided)


11 IF STILLBORN, enter that fact here.


12


AGA5


.. Years.


Months.


Days


If under 24 hours


Hours .....


Minutes


13 Usual


Occupation:


Dealer


(Kind of work done during most of working life)


14 Industry


or Business:


Waste Materials


15 Social Security No.


16 BIRTHPLACE (City).


(State or country)


Chelsea, Mass


17 NAME OF


FATHER


Isaac Steinberg


PARENTS


18 BIRTHPLACE OF


FATHER (City).


(State or country)


19 MAIDEN NAME


OF MOTHER


Russia


20 BIRTHPLACE


dida Payman


MOTHER (City)


(State or country)


Russia


21


Informant


(Address)


B Steinberg


25M-3-53-909098


No.


Boston City Hospital


[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


XXX


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(write the word)


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


Married


7/23


19 ..


to


...


10a If married, widowed, or divorced


HUSBAND of.


Bobby .....


Give maiden name of wife " fuii)


(or) WIFE of


(Husband's name in full)


INTERVAL BE-


TWEEN ONSET


AND DEATH


8 SEX


9 COLOR OR RACE


M R-302 1


WIIn UNPAVING BLACK INK - THIS IS A PERMANENT RECORD


AUG-2


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.


162


No. Winthrop community Hospital ercy FRANK P. Churchill


(If deceased is a married, widowed or divorced woman, give also maiden name.)


369 Winthrop St.


WINtheop, MASS.


St.


(If nonresident, give city or town and State)


Length of stay: In place of death. years .. . .months. 4 days. In place of residence 1 .years . 3


.months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


7


(Month)


24 (Day)


54 (Year)


8 SEX


Male


white


10 SINGLE


write the word)


MARRIED Widowed


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY,


That I attended deceased from


July 21 -


5%


July at


19


54


I last saw h. Im alive on


July 24


19 9, death is said to


have occurred on the date stated above, at


7


p.m.


INTERVAL BE- TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


12


AGE 87


.Years


6 . Months


Days


If under 24 hours


Hours .. Minutes


13 Usual


Occupation:


retired salesman


(Kind of work done during most of working life)


14 Industry


or Business:


Safe and vault Mfg.co.


15 Social Security No. UNABLE TO OBTAIN


16 BIRTHPLACE (City)


(State or country)


Freedom


N.H


17 NAME OF


FATHER


John C. Churchill


18 BIRTHPLACE OF


FATHER (City)


North Parsonsfield


(State or country)


Maino


5 Was disease or injury in any way related to occupation of deceased ?.


NO


-


. M. D.


cremation Woodlawn cem. Everett, Mass Place of Buriaf or Cremation


DATE OF BURIAL. July 27 195411/ E ... 19


7 NAME OF


FUNERAL DIRECTOR


Afull Mariah


ADDRESS


174 Winthrop St, Winthrop,


Received and filed SUL 2/ 1954 19


(Registrar)


PARENTS


19 MAIDEN NAME


OF MOTHER


Annie Burk


20 BIRTHPLACE OF MOTHER (City) (State or country) Penna.


21 Informant (Address) Preston B. churchill


369 Winthrop St.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or trapsit permit was Issued:


Mass Walter& Hakers (Signature ofrAgent of Board of Health or othery Healthe Office 7 21 54


(Official Designation) (Date of Issue of Permit)/


RUCTIONS 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, cations which th.


d conditions, ing rise to the e (a) stating lying cause


tions contrib- death but not he disease or ausing death.


SOM (B)-1-51 903586


OTHER


SIGNIFICANT


CONDITIONS


Arteriosclerotic HEART


Disease with congestive.


HEART FAILURE.


Major findings:


Of operations


NONE


Date of operation.


.Was autopsy performed?


NO


What test confirmed diagnosis?


CLINICAL


If so, specify, (Signed) (Address) Winthrop, MASS Date 7.24 195+


10a If married, widowed, or divorced


HUSBAND of.


Florence Daniels


Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a) PRIMARY APLASTIC ANEMIA


ANTE


Due To


CEDENT (b)


CAUSES


Due To (c)


I R-301A 1


Registered No.


J(If death occurred in a hospital or institution,


St. [ give its NAME instead of street and number)


2 FULL NAME


(a) Residence.


No.


(Usual place of abode)


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO.


9 COLOR OR RACE


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 ninetcen 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; watil he, has received a permit from the board of health, or its agent appointed tof 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


0


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 inake 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 front 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


M R-302 1


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-302 to the clerk of the city or town in which the deceased resided as soon as possible,


25M·3-53-909098


PLACE OF DEATH


SUFFOLK


BO'SCounty). 2 . 0 8


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No.


6407163


(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number) XX


2 FULL NAME. ABRAHAM MARDEN


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. (Usual place of abode)


24 Coral Ave


.......


.»St.


-


(If nonresident. ive tity wn and State)


Length of stay: In place of death ... ].Q. years. ..... months days. In place of residence .. 35 .. years .. .months. .. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


24(Day)


1954/ear)


8 SEX


M


9 COLOR OR RACE


10 SINGLE


(write the word)


MARRIED WIDOWED or DIVORCEDWidowed


4 I HEREBY CERTIFY,


That I


attended deceased from


10a If married, widowed, or divorced


11/21 1948 to


7/24.


19


5 4HUSBAND of


Fannie


maiden hame of wife in full)


I last saw h ....... f.malive on 7/24 19 .. 5 4 death is said to


(or) WIFE of.


(Husband's name in full)


DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) ...... cerebral hemorrhage


TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.


7/19/544


AGE92


Years


Months.


.Days


If under 24 hours


Hours


Minutes


ANTE


Due To


CEDENT (b)


CAUSES


bronchopneumonia"


Due To (c) hypertensive ... heart. disease


11/21


OTHER SIGNIFICANT CONDITIONS


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)


B .... Udolson


M. D.


(Address). 460 Geneva Ave


.19 ...


6 Place of BunDaCid Pation (City of Turn


DATE OF BURIAL J.,1.25 19.54


7 NAME OF


FUNERAL DIRECTOR


B ... Birnbach


ADDRESS


Dorchester


Received and filed


(Registrar of City or Town where deceased resided)


PARENTS


18 BIRTHPLACE OF FATHER (City). (State or country)


Bussi &


19 MAIDEN NAME


OF MOTHER


Deborah - --


20 BIRTHPLACE OF MOTHER (City) (State or country) Russia


21 Informant. Hebrew ... H. me ..... for .... Agod.


(Address _


TRUE COPY orles " Mackie


ATTEST:


19


(Registrar of City or Town where death occurred)


DATE FILED


Jul 27


19 ....


54


(Kind of work done during most of working life)


14 Industry


or Business:


15 Social Security No ...


6 BIRTHPLACE (City). (State or country) Russ a


17 NAME OF


FATHER


William Marden


7/23/54


13 Usual


Occupation :


Real Estate - ret


have occurred on the date stated above,


5:55a.


.... m.


INTERVAL BE-


Date


7/84 54


WALLE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


No. Hebrew Aged Home


(Was deceased a


U. S. War Veteran,


if so specify WAR)


AUG -FI 79


X


PLACE OF DEATH


Suffolk


(County)


Bos ton


(City or Town)


Mass. General Hospt No.


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Boston


(City or town making return)


6438


Registered No.


164


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME Vincent Marotta


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No.


28 .... Beach Road


St


Winthrop Mass.


(If nonresident, give city or town and State)


Length of stay: In place of death ...


......


years.


months


.days. In place of residence.


Ili ....... years.


months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


(Month)


July 24/54


Day


(Year)


8 SEX


M


9 COLOR OR RACE


W


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


4 I HEREBY CERTIFY,


That I


attended deceased from


July 18


54.


to


I last saw h.4 mm


alive on


July 2l' 19.1 death is said to


have occurred on the date stated above. at


.m.


1.25PM


INTERVAL BE- TWEEN ONSET AND DEATH


11 IF STILLBORN, enter that fact here.


12


AGE


Years


2


Months


.Days


If under 24 hours


Hours


Minutes


13 Usual


Occupation:


Shoe Maker


(Kind of work done during most of working life)


14 Industry


or Business:


15 Social Security No.


Coronary thrombosis 1 Week BIRTHPLACE (City). Italy


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


Date of operation


Was autopsy performed ?. Yes


What test confirmed diagnosis?


suteDay


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


M. D.


(Address)


CL Clay


.. Date


19.


24-50


Mass. General Hospt


Place of Burial or Cremation throp Cem-Icintrom Mass DATE OF BURIAL


July 27/54


19


7 NAME OF


FUNERAL DIRECTOR


E P Caggiano


ADDRESS Winthrop Mass.


Received and filed 19


(Registrar of City or Town where deceased resided)


PARENTS


17 NAME OF


FATHER


Louis Marotta


18 BIRTHPLACE OF


FATHER (City).


Italy


(State or country)


19 MAIDEN NAME


OF MOTHER


Unknown


20 BIRTHPLACE OF


MOTHER (City)


Italy


(State or country)


21


Informant


(Address)


Louis Marotta


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


July 28/54


.19


DATE FILED


X


............. , WIIn UNFADING BLACK INA - THIS IS A PERMANENT RECORD


6 25M-3-53.909098 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-302 to the clerk of the city or town in which the deceased resided as soon as possible, CAUSES


ANTE


CEDENT (b)


Due To


Myocardial ... infarcti m


One


Due To (c)


Week


10a If married, widowed, or divorceanna Tasca


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Rupture of heart"


Mins. 84


(State or country)


M R-302 1


1.5.


(Usual place of abode)


19 ...


AUG-2


PLACE OF DEATH


Suffolk


County) Winthrop (City or Town) 435 Shirley St


The Commonwealth of Massachusetts EDWARD J. CRONIN 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.


Registered No.


165


(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME.


Elizabeth J. Netener


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


435 Shirley St.


(Usual place of abode)


Winthrop Man


(If nonresident, give city or town and State)


Length of stay: In place of death ........


.years.


.. months.


days. In place of residence ..


13


.. years


months.


.days.


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July


24


1954


(Year)


9 SEX


Female


10 COLOR OR RACE


White


11 SINGLE


MARRIED


WIDOWED Urried


or DIVORCED


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.)


ACUTE


CARDIAC


DILATATION


11a If married, widowed, or divorced


Lowell Of Neterer


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


13


AGE 50


Years


4


Months


3


Days


If under 24 hours


Hours


Minutes


14 Usual


Occupation :.


Housewife


(Kind of work done during most of working life)


15 Industry


or Business:


Own Home


16 Social Security No.


011-03-8568


East Boston


17 BIRTHPLACE (City)


(State or country)


Massachusetts


18 NAME OF


FATHER


Arsenius J. Kelly


19 BIRTHPLACE OF


FATHER (City).


East Boston


(State or country)


Massachusetts


20 MAIDEN NAME


OF MOTHER


Helen C. Healy


21 BIRTHPLACE OF


New Castle


MOTHER (City)


(State or country)


New Brunswick


22 Helen A. Millerick


Informant


(Address)


115 Summit Ave Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buriabor transit permit was issued: Walter I taller


(Signature of Agent of Board of Health or other)


Health Officer


7/17:54


(Official Designation) (Date of Issue of Permity


(Registrar)


PARENTS


M. D.


(Address 25 hattuck St Date 7/2/1950


Holy Cross Cemetery Malden


DATE OF BURIAL.


July 28


1954


ADDRESS. 11 Meridian St. East Boston


Received and filed JUL .2.7.1954


1 R-303 A y Book .. TIER ST No.


Every item of MEDICAL CERTIFICATE OF DEATH (Month) (Day) 5 Accident, suicide, or homicide (specify) Date and hour of injury 19 Where did Injury occur ?. (City or town and State) place? (Specify type of place) Manner of Injury (How did injury occur?) Nature of Injury 6 Was disease or injury in any way-related toloccupation of deceased ?. If so, specy. (Signedy 7 Place of Burial, or Cremation. (City or Town) 8 NAME OF FUNERAL DIRECTOR Alice M. Kelly If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. of Death. See reverse side for extracts from the laws relative to the return of certificates of death. 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 stato CAUSE AND MANNER OF 25M-1-52-906135 N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK -THIS IS A PERMANENT RECORD. While at work? Was autopsy performed?yes


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


No


if so specify WAR).


(write the word)


Did injury occur in or about home, on farm, in industrial place, or in public


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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