USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 59
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5.0.years.
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
1
1959
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan
55
to
Nov
1959
I last saw heLalive on
Octoberny, 1959, death is said to
have occurred on the date stated above, at
1:30 p. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
uremia
UREMIA
Due To
Senility
(b)
SENILITY
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify H. B. Greenfield
(Signed)
H. B. Buenhele
M. D.
447 Shirley SF
(Address)
Winthrop Mass Date
NOV1
1959
6 Evergreen Cemetery Eastham, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL
November 4,1959
9
7 NAME OF
FUNERAL DIRECTOR
ADDRESS174 Winthrop St. Winthrop, Mass.
Received and filed
NOV 3 1959
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female White
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of Winfield Scott Doane
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 89 Years.
9Months
4Days
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
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
David Willard Tribou
18 BIRTHPLACE OF
FATHER (City)
Bridgewater
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Elizabeth Shute
20 BIRTHPLACE OF
MOTHER (City)
Bridgewater
(State or country)
Massachusetts
21 Miss. Ellen M. Doane
Informant
(Address)
51 Fremont St. Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Marple S. Aircanning 1
(Signature of Agent of Board of Health or other)
de altti ficar
11/3/59
(Official Designation)
06
(Date of Issue of Permit)
X
301A 1
IONS
TIFICATE ng
DEATH nter one each and (c)
not mean f dying, t failure, It means r compli- caused
if any, rise to (a). under- last.
contrib. but not terminal on given
pter 137, requires print or ause · or eath on ates.
50M-1-58-921876
No. Mayflower Rest- Home
Registered No.
[(If death occurred in a hospital or institution,
St. Įgive its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO.
INTERVAL
BETWEEN
ONSET AND
DEATH
3 mos.
East Bridgewater
PARENTS
Wished to March
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, eightcen 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 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 intetment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULESOF PRI
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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
SUFFOLK
(County) WINTHROP (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
1.99
16 Paine Street, Winthrop
St. [ give its NAME instead of street and number) No.
2 FULL NAME
DOMINIC
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Paine Street,
St
Winthrop
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
.18years.
.. months ..
............ days. In place of residence.
18
.. years ..
.......
.months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
3 DATE OF
DEATH
November
3,
1959
(Month)
(Day)
(Year)
9 SEX
M
10 COLOR
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
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.
lla If married, widowed diversa Danielle
HUSBAND of w.det
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
84 Years ..
8
Months.
2.9 .... Days
If under 24 hours
Hours
.Minutes
14 Usual
Occupation :
Retired Restarant
Man
(Kind of work done during most of working life)
15 Industry
or Business :
Resturrant
16 Social Security No.
August
17 BIRTHPLACE (City)
(State or country)
Italy
18 NAME OF FATHER Sabstian Paci
19 BIRTHPLACE OF
August
FATHER (City)
(State or country)
Italy
20 MAIDEN NAME
OF MOTHER
Veerna Bombara
21 BIRTHPLACE OF
August
MOTHER (City)
(State or country)
Italy
22 Domenica Baci
Informant
(Address)
16 Paine St Winthrop, Mass
I HEREBY CERTIFY that a satisfactory, standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mau C terraun st.
(Signature of Agent of Board of Health or other)
11/5/5/
(Official Designation)
(Date of Issue of Permit)
V.BV
×
R-303 A 1
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
§§ 44-48.
25M-3-59-924934
7
Winthrop Cemetery
Winthrop
Place of Burial, or Cremation.
(City or Town)
Nov 6 L
19
59
DATE OF BURIAL
8 NAME OF
FUNERAL DIRECTOR
Ernest P Caggiano
ADDRESS 747 Winthrop NOV & Sagenthrop
Received and filed 19
(Registrar)
PARENTS
6 Was disease or injury in any wayrelated to occupation of deceased?
If so,
(Sighed
1 Mango
M. D.
Michael A. Luongo, M. D.
(Print or Type Signature)
Boston
11/3
19 .. 5.9
Date.
(Address)
Was autopsy performed ? N.o
While at work ?
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
IF ACCIDENTAL, was injury causally related to the death? Where did Injury occur ? (City or town and State)
au
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
S(Ii death occurred in a hospital or institution,
PACI
[ PHYSICIAN - IMPORTANT
j(Was deceased a
U. S. War Veteran,
none
(if so specify WAR)
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 :5 1950 :1 (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 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 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 ad- ministered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Frac- ture 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.)"
R-301A
THIS IS A ENT RECORD. only EAPPROVED k or black ter ribbon.
AJCTIONS TOR CERTIFICATE Diving F DEATH t enter chan one for each d) and (c)
es not mean of dying, Part failure, . It means or compli- hich caused
if any, ve rise to buse (a), The under- last. use
wns contrib -- ath but not to the terminal edition given
hapter 137, 4, requires to print or cause or death 1 ficates.
10. 46, 55 9 & A. 114 $$ 45, HP. 38$ 6.)
58-923886
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 filled for burial permit with Board of Health or its Agent.
Registered No. 200
[(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,
if so specify WAR)
(a) Residence.
No ..
(Usual place of abode)
707 Winthrop Ave. Revere ,Mass
(If nonresident, give city or town and State)
Length of stay: In place of death 0 years. 0 months. Q. days. In place of residence ....... years .... O.
months.
0 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Nov.
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
19
to
19
That I attended deceased from
I last saw h
........ alive on
19
, death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Stillborn - ancephalic
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
- (b)
Due To (c)
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
Dr. Joseph Gregorie
(Signed)_
, M. D.
(Address) 19 UW De Want It
WOODLAWN 6
Place of Burial or Cremation
EVERETT. (City or Town)
DATE OF BURIAL
Nov. 7
1959
7 NAME OF
FUNERA
MAURICE W.ITIRBY
ADDRESS
WL KOV6/1959
Received and filed 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX F
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
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.
STILLBORN
12
AGE
Years.
Months
Days
If under 24 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)
(State or country)
Massachusetts
17 NAME OF
FATHER
Joseph DiGiovanni
18 BIRTHPLACE OF"
FATHER (City)
(State or country)
Mass
Boston
19 MAIDEN NAME
OF MOTHER Carol Wood
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Mass
Revere
21 Father of baby
Informant
(Address)
as above
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph
(Signature of Agent of Board of Health or other)
40.
noi. 6/59
(Official Designation) (Date of Issue of Permit)
×
1
1.57.5%
No. Winthrop C mmunity Hospital DiGiovanni, Baby Girl
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1959
(write the word)
Winthrop
PARENTS
x-1
Date / -2 19 3- >
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 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.
RECEIVED
TO !.
1
5
13
6
HROB
NOV - 61959 FM
X
2
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. 201
Registered No.
[(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
2 FULL NAME
Feeley, Baby Foy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Neptune Road, East FosterSt. Lass
(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
3 DATE OF November
DEATH
4,
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
11-4
19
59
That I attended deceased from
19
59
I last saw h ___ alive on
19
death is said to
have occurred on the date stated above, at
3:58am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Fremature Pirth
( 5 Months foetus)
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
(Stillborn)
- (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? IN.O.
If so, specif
Pasquale Contener A. S
(Signed)
Pasquale Costanza, M.D.,
M. D.
(Address)
238 Maverick St . Date 11-4
1959
6 East Foston, Mass.
Place of Burial or Cremation CAR-GROVE (City or Tow VEDE: )))
DATE OF BURIAL
Rev. 5
1954
7 NAME OF
FUNERAL DIRECTOR
Sparge. L.Daherte
ADDRESS
855 Broadway namenelle
Received and filed
NOV 4 / 195
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
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.
Stillborn
12
AGE
Years.
Months.
... Days
If under 24 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)
(State or country)
Winthrop, lass.
17 NAME OF
FATHER
Patrick Feeley
18 BIRTHPLACE OF
Medford, Mass.
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary L. Scopa
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
John Feely - Father
21
Informant
(Address)
34 Neptune Rd E Bealone
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial' or transit permit was issued: Tackle ( Terrasse,
(Signature of Agent of Board of Health or other) The day Raceu
11/4/59
(Official Designation)
(Date of Issue of Permit)
X
-301A
HIS IS A T RECORD. only PROVED or black r ribbon.
TIONS 1 RTIFICATE
ring
DEATH enter in one r each and (c)
not mean of dying. rt failure, It means or compli- ch caused
if any, rise to ise
(a), under- se last.
s contrib- - th but not e terminal tion given
apter 137, , requires to print or cause or death on cates.
. 46, 55 9 & 114 $$ 45, P. 38$6.)
58-923886
1 1
No .. Winthrop Community Hospital
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
to
11-4
PARENTS
Boston, Ma?s.
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:
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