USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 17
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(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.
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
Registered No.
73
2 FULL NAME
Joseph J. Carlz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 35 Cottage Park Road
St.
(Usual place of abode)
(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
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WidoWed
4 I
HEREBY
CERTIFY,
Thật
3/27
3/25
1900
to
I last saw h.IMalive on
3/27
12,60
.. ,
death is said to
have occurred on the date stated above, at
... m.
1450
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
ACUTE BRINCHOQUEMONIA
(a)
Due
(b)
GENERAL ARTERIOSCLEROSIS
Due To (c)
OTHER
SIGNIFICANT
BLINDNESS
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
(Signed)
M. D.
MYRON UN. KING M.D.
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST WINNMORTE
3/25
1960
6 Winthrop Cemetery Winthrop
Place of Burial or Cremation DATE OF BURIAL March
(City or Town)
19
60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop Mass
Received and filed
MAR 29 1960
19.
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Azores
19 MAIDEN NAME
OF MOTHER
Louisa
20 BIRTHPLACE OF MOTHER (City) (State or country) Azores
21
Informant
(Address)
Lydia M. Carlz
35 Cottage Park Road
I HEREBY CERTIFY that a satisfactory standard certificate of death vas filed with me BEFORE the burial or transit permit was issued: Ralfla C. Percanfix- (Signature of Agent of Board of Health or other) (Thealth officer 3/29/60
Oficial Designation) (Date of Issue of Permit)
L
R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH
ot enter than one for each b) and (c)
es not mean of dying, heart failure, etc. It means , or compli- hich caused
ns, if any, ave rise to cause (a), the under- ause last.
tions contrib- eath but not the terminal ndition given
Chapter 137, 54. requires s to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.
2.5.
No.
35 Cottage Park Road
[(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a ¿U. S. War Veteran, lif so specify WAR)
50
Emilydiced Melanson
10a If marri
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
AGE
94
Years.
Months ..
Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
Retired Sup't
(Kind of work done during most of working life)
14 Industry
or Business :
Elevators
15 Social Security No.
Gloucester
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Joseph Carlz
2 YRS
3 DATE OF
DEATH
March 27 1960
(Month)
(Day)
(Year)
attended deceased from
60
INTERVAL
BETWEEN
ONSET ANO
DEATH
2 DAYS
To be filed for burial permit with Board of Health or its Agent.
-59-925686
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the !! following les 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.
R-301A 1
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
Registered No.
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
Charles P. Anzalone
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
57 Cottage Park Road
. St.
Winthrop
(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
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
widowed
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
19
to.
19.
10a If married, widowed, or divorced
HUSBAND of
Mary Portera
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
75
Years.
Months.
.Days
If under 24 hours
Hours .....
.. Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business :
******
15 Social Security No. unknown
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Frank Anzalone
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Carmella (unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country) Italy
21 Mary Anzalone (wife)
Informant (Address) 57 Cottage Park Rd. winthrop
I, HEREBY CERTIFY that )a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Talle C Siranne 8. (Signature of Agent of Board of Health or other)
seattle Offices 3/30/60
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
es not mean of dying, heart failure, etc. It means e, or compli- which caused
ms, if any, ave rise to cause (a), the under- cause last.
Due To
Disease
(c)
-
OTHER
None
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no,
What test confirmed diagnosis ? post mortem judgement
5 Was disease or injury in any way related to occupation of deceased? no If so, specify arthur @.Murray M. D. (Signen) Arthur C. Murray, M.D (PRINT OR TYPE SVNATURE) Winthrop Board of Healthe 28 Munch 60
6 Holy Cross Cemetery
Malden
Place of Burial or Cremation DATE OF BURIAL
(City or Town)
March 30,
60
19.
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS 9 Chelsea St East Boston Mass 19
Received and filed
(Registrar)
PARENTS
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
no
[if so specify WAR)
(a) Residence. No.
(Usual place of abode)
3 DATE OF
March 28, 1960
DEATH
(Month)
(Day)
(Year)
I last saw h ........ alive on
19 ............ , death is said to
have occurred on the date stated above, at
3:30 A. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
Arteriosclerotic Heart
(b)
years
BONSEPETIT
To be filed for burial permit with Board of Health or its Agent.
57 Cottage Park Road
No.
-59-925686
Chapter 137, 954. requires s to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type ler signature.
tions contrib- death but not the terminal ndition given
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
RULES OF PRACTICE
1
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- 1960 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.
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) - 19- Lincoln-Terrace
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 75
WINTHROP COMMUNITY [HodeathTodurred in a hospital or institution,
St. ? give its NAME instead of street and number) No.
2 FULL NAME Izora Ross/ Silvey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (U'sual place of abode)
19 Lincoln Terrace
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
3 DATE OF
DEATH
March
28
1960
(Month)
(Day)
(Year)
8 SEX
Penale
9 COLOR
'hite
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY
3/19
19
CERTIF
3/28
60
19
19
death is said to
have occurred on the date stated above, at
8:15Am
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
70
3
20
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :
Tonifc
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
William Ross
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Helena Nickerson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
Donald Silvey
(Address) & Allow Court Saugus
I HEREBY CERTIFY that a satisfactory standard certificate of death BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health of other),
Health Officer
3/29/60
(Official Designation)
(Date of Issue of Pormit)/
UCTIONS OR CERTIFICATE
giving OF DEATH t enter than one for each b) and (c)
es not mean af dying, heart failure, tc. It means , or compli- hich caused
ns, if any, ave rise ta cause
(a), the under- ause last.
Due To (c)
OTHER
Virus Pneumonitis
CONDITIONS
7 Days
Was autopsy performed?
No
What test confirmed diagnosis ?
EKG & Clinical
NO
(Signed)
myran n-17uma
M. D.
MYREN N KING MID
(PRINT OR TYPE SIGNATURE) 3/28
(Address)
222 PLEASANT SWING LA Date.
6
winthrop
winthrop
Place of Burial or Cremation
DATE OF BURIAL
March
(City_or Town)
30
60
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
winthrop
.Mass.
Received and filed
MAR-2-9-1960
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Harry TilV."
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Acute myocardial Infarct-
(a)
Anterior
Due To Arterio-Sclerotic Heart (b)
Dis.
1 Yr.
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
PARENTS
21 Informant
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, [if so specify WAR)
30
That I attended deceased from
I last saw he .... alive on
3/28
60
7 day SAGE ...
Years.
Months.
.Days
(Kind of work done during most of working life)
tians contrib- eath but nat the terminal ndition given
Chapter 137, 54, requires s to print or cause or f death on tificates, and 48. Acts of uires Physi- rint or type er signature.
-59-925686
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.
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-305 to the clerk of the city or town in which the deceased resided as soon as possible 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-5-52.907046
DATE OF BURIAL ..
19
8 NAME OF
Benj. F. Solomon
FUNERAL DIRECTOR Harvard St. Brookline
ADDRESS. APR. IT 1960
Received and filed. 19
(Registrar of City or Town where deceased resided)
11a If married!
@dikatz
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12JE STILLBORN, enter that fact here.
13
AGE
Years
PNAber
Days (ret.)
14 Usual
Occupation:
Plum showofddorduring most of working life)
15 Industry or Business:
16 Social Security No.
Russia
17 BIRTHPLACE (City).
(State or count fm
18 NAME OF
FATHER
19 BIRTHPLACE Russia .. FATHER (City) (State or country)
20 MAIDEN NAME
OF MOTHER
c/n/b/1
(HymanntOscar
5 Grover Ave. Winthrop
22 Informant (Address)
A TRUE COPY.
ATTEST:
- (Registrat of City or Town where death occurred)
DATE FILED
3/23/60
16
Lynn
(City or town making return)
76
Registered No.
f(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.)
363 Shirley
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
7
.months days. In place of resident 50
.years.
months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
March 12, 1960
me|18 SEX
10 COLOR OR RACE
white
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
DEATH
(Month)
(Day)
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof Cerebro-The owlaringepisodey following fract. left humerus 3/1/60
accident
5 Accident, suicide, or tomitide Aspecify).
Date and hour of injury
3/1/60
Where did
Winthrop, Mass
Injury occur ?.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Public
Mann
slipped onffygidewalk
Injury
Nature ofFract. It Home
Injury
no
no
While at work?
.Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?
If so. spodmind A . ...... Jannino
(SignedLynn , Mass
3/12/60. D.
(Address) Date. 19
fifereth Israel
Everett
Place of Burial, or Cremation 3/13/60
(City or Town)
n1. 5.
Essex
(County)
M R-305 1 Lynn
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
PLACE OF DEATH PLACI
Lynn Hospital
Louis Smith
(Was deceased a
U. S. War Veteran.
if so specify WAR).
(a) Residence. No. (Usual place of abode)
19
If under 24 hours
Hours ...
Minutes
PARENTS
21 BIRTHPLACE OF
MOTHER (City)
Russi a
19
APR 111960 AN
X
PLACE OF DEATH
Suffolk (County)
SENSE MIT
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.
No.
Patrick B Kiernan
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
777 Shirley
St. winthrop
(a) Residence. No. (Usual place of abode)
Length of stay : In place of death ....... . .. years.
months. .. 1
.. days. In place of residence. years 3 . months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
april
2.
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Dec.20
19.
59
, to,.
april 2
That I attended deceased from
1967
I last saw himvalive on
apri
2.
19 60, death is said to
have occurred on the date stated above, at
12:35Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Carcinoma of Stomach
Due To (b)
Due To (c)
OTHER
SIGNIFI
CONDITIONS
inclastases la Lives
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? NO If so, specify
(Signed) G. Sand Della cobian M. D.
APaul DERHAGOPIAN
(PRINT OR TYPE SIGNATURE), (Address) 39 CARY AV. CHELSEA Date apri- 2- 1960
6 Holy ..... Cross.
Malden
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
April .... 5 .. ,
19 ... 6.0.
(Address)
7 NAME OF
FUNERAL DIRECTOR
I.F. McGlinchey
ADDRESS
583 Broadway Chelsea
Received and filed
APR-5-1960
19 ..
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
MARRIED
WIDOWED
or DIVORCEISingle
Male
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
AGE .. 6.3 ....
Months ...
Days
If under 24 hours
Hours .....
.. Minutes
13 Usual
Occupation :
Proprieter
(Kind of work done during most of working life)
14 Industry
or Business :
Apex Sign .Co.
15 Social Security No.
Chelsea
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHE
Patrick B Kiernan
18 BIRTHPLACE OF
FATHER (City)
(State or country)
B.o.s.ton
19 MAIDEN NAME
OF MOTHER
Catherine Kiernan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
21
Informant
.....
777 Shirley St
I HEREBY CERTIFY that aSatisfactory standard certificate of death was filed with me BEFORE the burial-or transit permit was issued: Malkle C. Perlants (Signature of Agent of Board of Health or other)
4/4/60
(Official Designation)
(Date of Issue of Permit) /
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
es not mean of dying, heart failure, etc. It means , or compli- which caused
ns, if any, ave rise to cause (a), the under- ause last.
tions contrib- leath but not the terminal ndition given
Chapter 137, 54. requires s to print or : cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.
-59-925686
1
Winthrop Community Hospital.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT f(Was deceased a { U. S. War Veteran,
{if so specify WAR)
(If nonresident, give city or town and State)
10 SINGLE
(write the word)
INTERVAL BETWEEN ONSET ANO DEATH
4 mos
PARENTS
Mrs. Martha MaloNe
Registered No.
R-301A 1
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.
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