USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 63
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To be filed for burial permit with Board of Health or its Agent.
214
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,
{if so specify WAR) ........ O ...
(a) Residence. No.
89 Bowdoin Street
(Usual place of abode)
St
(If nonresident, give city or town and State)
Length of stay : In place of death
years 3 months 14 days. In place of residence
.2.4.years .. 6
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November 261959
(Day)
(Year)
(Month)
4 I HEREBY CERTIFY,
That I attended deceased from
SEPT.
....
1958
NOVEMBER 26, 1959
.. , to ..
I last saw HE Calive on
Nov.
26
1959
death is said to
have occurred on the date stated above, at
9 40A
.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
CARDIAC. DECOMPENSATION
(a)
Due To HYPERTENSION THEART DISEASE (b)
2 YEARS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
CEREBRALHEMORRHAGE
2 YEARS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) G. M. Caplan A.M. CAPLAN MD
(PRINT OR TYPE SIGNATURE)
(Address) 19MERMAID WINTHROP MASS
6 Winthrop Cemetery Winthrop Mass, Place of Burial or Cremation (City or Town)
DATE OF BURIAL November 28 1959 ... 19 ..
lefed 3 March
Received and filed
NOV-3-0-1959
19
(Registrar)
PARENTS
17 NAME OF
FATHER
Stephen Slater Smith
18 BIRTHPLACE OF
FATHER (City)
Slatersville
(State or country)
Rhode Island
19 MAIDEN NAME
M. D.
OF MOTHER
Fannie augusta Curtis
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
L'aine
21 Informant iss ....... Hazel ............ Smith (Address) 89 Bowdoin St Winthrop Lass. 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)
The atthe ceviche.
11/27 /54
(Official Designation)
(Date of Issue of Permit)
...
8 SEX
9 COLOR
white
MARRIED
WIDOWEDWidowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Allister Mansfield Smith ....
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE82 ...... Years .. 6 ........ Months.1.4 .... 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 Homo
15 Social Security No. ... 029-10-2792-B.
16 BIRTHPLACE (City)
Somerville
(State or country) Massachusetts
ddison
7 NAME OF
FUNERAL DIRECTOR ...
ADDRESS
774 Fintprov St. Finttrop Lass
....
11-27
1959
PERSONAL AND STATISTICAL PARTICULARS
10 SINGLE
(write the word)
Female
INTERVAL
BETWEEN
ONSET AND
DEATH
INFEK
2 FULL NAME
Carrie Augusta Smith ( Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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.
TO!
.....
..
...
6
THROP
NOV 3 01959 AM
X PLACE OF DEATH
Suffolk County )
Winthrop
(City or Town)
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.
Registered No.
215
[(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Albanus S Maddocks
(If deceased is a married, widowed or divorced woman, give also maiden name.)
130 Pauline Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years ... ......... months 5
days. In place of residence
.years.
months.
......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Nov. 28,
1959
(Year)
8 SEX
Male
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED!
Married
4 I HEREBY NOV . 19
CERTIF
59
Nov. 28,
59
19
HUSBAND of
(Give maiden name of wife in full)
I last saw hmhMalive on
Nov. 26
15.5.9., death is said to
have occurred on the date stated above, at
4:05 Pm.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bronchopneumonia, terminal
(a)
Due To Carcinoma of sigmoid
(b)
with metastases to liver
1 yr
Due To
Ascites
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
no
What test confirmed diagnosis ?
X-Ray
5 Was disease or injury in any way related to occupation of deceased ? If so, specify,
I. D.
(Signed) Joseph Gregorier
washington 1 94PRINT OR TYPE SIGNATURE NOV. 30. 59 Date.
(Address) ......
Monroe Maine
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds Winthrop Mass
ADDRESS
Received and filed DEC 2 1959 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Bangor
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Ruby York
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
21 Mattie E Maddocks
Informant
(Address)
130 Pauline St. Winthrop
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)
ilealix
+
12/7/59
(Official Designation)
(Date of Issue of Permit).
VAV
1
11 IF STILLBORN, enter that fact here.
77
3
23
Months.
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
Contractor
(Kind of work done during most of working life)
14 Industry
or Business :
Builder
15 Social Security No.
013-28-7264
Swansville
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
John Maddocks
ins contrib- uth but not he terminal o'ition given
napter 137, 14. requires 1 to print or e cause or c death on ricates, and 3, Acts of çıres Physi- int or type c- signature.
59-925686
1-301A 1
TIONS
IRTIFICATE
j'ing DEATH Center tin one r each and (c)
not mean of dying, furt failure, e. It means or compli- och caused
, if any, De rise to tese (a), e under- use last.
102Kg
6 Monroe
Place of Burial or Cremation
Dec. 3 59
INTERVAL BETWEEN ONSET AND DEATH 2 daj
PERSONAL AND STATISTICAL PARTICULARS
10 SINGLE
(write the word)
(Month)
(Day)
19.
to ...
That Lattended deceased from
[(Was deceased a { U. S. War Veteran, {if so specify WAR)
(a) Residence. No. (Usual place of abode)
40
No.
Winthrop Community Hospital
Frankfort
AGE
Years.
10a If married, widowed, or, divorced
Mattie .... E .... Brown
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.
TO
OF
11 1/
3
KLERK
6
17
R
DEC - 21959 AM
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. 216
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME . Karl H. Schaalman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
29 Wilshire St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years 1 months. .days. In place of residence
25
years
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November 28, 1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
JANUARY
19
59
to NOVEMBER LE 1959
I last saw 1
IM
alive on
NOVENIREE 27 1959, death is said to
have occurred on the date stated above, at
8:46 7.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
CARCINOMA STOMACH
TWEEN ONSET AND DEATH 6 MOIS
11 IF STILLBORN. enter that fact here.
75
12
AGE
Years
Months
Days
Machinist Retired
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
American Stay Co.
15 Social Security No.
022-07-3871
Bridgeport
16 BIRTHPLACE (City)
(State or country)
Connecticut
17 NAME OF
FATHER
Joseph Schaalman
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME OF MOTHER Christine Mack
20 BIRTHPLACE OF
MOTHER (City) .
Stamford
(State or country)
Connecticut
21 Warren Schaalman
Informant (Address) 192 W. Wyoming St Melrose
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)
Health
12/1/59
(Official Designation)
(Date of Issue of Permit)
100
CTIONS )R ERTIFICATE
iving F DEATH : enter han one or each ) and (c)
Mes not mean dying, such ure. asthenia. es the disease. utions which
b conditions, tig rise to the (a) stating tying cause
dons contrib- A death but not e disease or using death.
Chapter 137. 1 954, requires Is to print or cause or causes in on death
SOM-3-54-911887
6
... Woodlawn Crematory.
Place of Burial or Cremation
Everett
(City or Town)
19
7 NAME OF
FUNERAL DIRECTOR
305 Beach St. Revere
ADDRESS
Received and filed.
DEC 1 1959
19
(Registrar)
8 SEX Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced.
Mabel E.
Langton
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
ANTE Due To CEDENT (b) CAUSES CARCINOMATUSIS
Z MOS
Due To (c)
OTHER
PROSTATIC HYPERTROPHY.
SIGNIFICANT
CONDITIONS
GENERIZILED ARTERIOSCLER
Major findings:
Of operations
Date of operation
What test confirmed diagnosis ?.
Was autopsy performed?
X-RAY- CLINICAL ORSEX
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
(Address) 620 Brachte Avec Date Not 79 19:54
M. D.
DATE OF BURIAL. December 1, 1959
Leslie W. Pike
PHYSICIAN - IMPORTANT
-
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
No.
Winthrop Community Hospital
R-301A 1
PERSONAL AND STATISTICAL PARTICULARS
If under 24 hours
Hours .
. Minutes
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 ched, 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 heen 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 horder 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 hoard 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 hody, 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 he 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 he 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 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 supposahly 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 of a't 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 hone.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
DEC -11959 FM
...
1
PLACE OF DEATH
SUFFOLK (County) WINTHROP (City or Town)
84 CLIFF
AVE
(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.)
84 CLIFF
AVE
St
(If nonresident, give city or town and State)
Length of stay: In place of death
years
6
2
months
days. In place of residence//. years ...
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November 30
(Month)
(Day)
1959
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19.
... , to
19
I last saw h ___ alive on
19
, death is said to
have occurred on the date stated above, at
6:30 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Natural Causes
INTERVAL
BETWEEN
ONSET AND
DEATH
-
Due To
Presumably Coronary
(b)
Occlusion
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
-
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
Arthur C. Murray, M.D.
6 TIFFRETH ISRAEL OF WINTHROP
Place of Burial or Cremation
DATE OF BURIAL DEC 2 1059
7 NAME OF
FUNERAL DIREC
JORF FUNERALSERVICE INV
CHELSEA
ADDRESS
Received and filed
LEC 1 1959
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
SINGLE
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.
Years.
12
AGE 59.
-
Months
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation :
SALESMAN
(Kind of work done during most of working life)
14 Industry
or Business:
MENS FURNISHINGS
15 Social Security No.
028-01-7367
16 BIRTHPLACE (City) CHELSEA MASS (State or country)
17 NAME OF
FATHER
JACOB LEVENSON
18 BIRTHPLACE OF
RUSSIA
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
LENA M. TAYMOR
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
AUSSIA
-
21
JAMES ALTER
(Address) 84CUFF AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Farra & fireauf (Signature of Agent of Board of Health or other) Hearit Maicie 12/1/09
(Official Designation)
(Date of Issue of Permit)
-
-
.
.
.
PARENTS
No. - Joseph Levenson
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
1
To be filed for burial permit with Board of Health or its Agent.
Registered No.
217
· HIS IS A ET RECORD. only A PROVED n or black ir ribbon.
TIONS
IRTIFICATE ving : DEATH enter an one r each and (c)
not mean of dying, rt failure, It means or compli- ch caused
1 if any, rise to use (a), e under- use last.
is contrib- th but not he terminal ition given
apter 137, 4, requires to print or cause or death on icates. . 46, 85 9 & . 114 $$ 45, P. 38 $6.)
58-923886
:
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No. (Usual place of abode)
, M. D. 30 Nov.1959 (Address) Winthrop Mass Date fötter EVERETT (City or Town)
Sudden
[ -301A
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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