USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 26
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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.)"
M R-301A 1
F OF
Winthrop
(City or Town)
Winthrop Community Hospital No.
S (If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Gillis, Baby Girl
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[if so specify WAR)
(a) Residence. No.
(L'sual place of abode)
129 Cottage Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .......... ... years ...
..... . months
days In place of residence.
.years.
months ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
single
or DIVORCED
4 I HEREBY CERTIFY
That I attended deceased from
19
I last saw h ........ alive on
, death is said to
have occurred on the date stated above, at
.. m.
V
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 ? 925 If so, specify
(Signed)
Louis ESdurffa
M. D.
6
Place of Burial or Cremation
May
16, (City or Town)
60
19.
7 NAME OF
FUNERAL DIRECTOR
Anthony P. Rapino.
ADDRESS 9 Chelsea St. , East Bos ton ,Mass,
Received and filed
MAY 16 1960
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
Winthrop
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME OF MOTHER Rose Valletta
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Zast Boston
Walter J. Gillis (father)
129 Cottage St., East Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: o teren
(Signature of Agent of Board of Health or other}
(Official Designation)
(Date of Issue of Permit)
I RUCTIONS FOR : CERTIFICATE
giving OF DEATH
tiot enter › than one t for each (b) and (c)
Des not mean le of dying, heart failure, tetc. It means e, or compli- chich caused
ms, if any, ave rise to ause ( a ) , the under- ause last.
tions contrib- leath but not the terminal ndition given
Chapter 137, 154. requires s to print or cause or death on ificates, and 48, Acts of ires Physi- rint or type r signature.
59-925686
PLACE OF DEATH
Suffolk (County)
19911
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.
116
Registered No.
3 DATE OF
DEATH
May
(Month)
(Day)
12
1460
(Year)
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
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.
none
winthrop
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
Walter James Gillis
(Address)
LOUISE SchraffAMD
(PRINT OR TYPE SIGNATURE)
19 Benning Ton St Date May 12 1960
DATE OF BURIAL
Woodlawn Cemetery Everett
21
Informant
(Address)
f(Was deceased a
{ U. S. War Veteran,
no
East Boston
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
12
AGE
Years
Months
Days
none
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
"TO. i 1
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
2
10
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observAnte pf 01960 AM 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.
ORM R-302
HM .... AU TUU ULALA LIFEWKIIEK RIBBON -
THIS IS A PERMANENT RECORD
No ..
2 FULL NAME.
(a) Residence. No ..
( Usual place of abode)
5
Length of stay:
In place of death.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Hay
13,
DEATH
(Month)
(Day)
Jan. 11
BY CERLIFY,
55
im
Ma'y
May
19
لبر
Due To Pneumoconiossis &
(b)
Emphysema
(c)
OTHER
SIGNIFICANT
CONDITIONS
HO
What test confirmed diagnosis ?
All A.Gurcay
(Signed)
Rutland state san.
( Address)
Calvary
6
Place of Burial or Cremation
DATE OF BURIAL
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
Due To
Pulmonary tuberculosis
1960
( Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED Jarried
or DIVORCED
10a If married, widow@zabeth T.Winslow 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
59
2
14
AGE
Years.
Months.
.....
.. Days
If under 24 hours
Hours ........ Minutes
7 yrs
13 Usual
Occupation :
Salesman
( Kind of work done during most of working life) .
14 Industry
or Business :
Leather Goods
7 yr6
003-07-0945
16 BIRTHPLACE (City) (State or country) Mass.
17 NAME OF
FATHER
Cornelius Keleher
18 BIRTHPLACE OF
Woburn,
FATHER (City)
(State or country )
Nass.
19 MAIDEN NAME
OF MOTHER
Elizabeth McGovern
20 BIRTHPLACE OF
Toburn,
MOTHER (City) ( State or country)
Mass.
( Address )
Shirley St., Winthrop, Last
" NAME OF
A.P.Graham FUNERAL DIRECTOburn, Mass. ADDRESS
Received and filed
19
( Registrar of City or Town where deceased resided )
PARENTS
M.
May 13, 60
19
.Date
Woburn, Mass.
May (Loor Town) 60
19
50M-9-59-926111
PLACE OF DEATH
Worcester
(County)
TUTLAND
(City or Town)
Rutland State Sanatorium
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
( City of Town making this return)
117
§ (If death occurred in a hospital or institution.
St.
give its NAME instead of street and number)
John Francis Keleher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1,61 Shirley
Winthrop, Mass.
St
( If nonresident. give city or town and State)
4
2
10
years
...... months ...
.days. In place of residence .......... years .....
... months .......... days.
PERSONAL AND STATISTICAL PARTICULARS
(write the word )
That I attended deceased
13
from 60
I last saw h ...... alive on 19 ........ , death is said to
1:15 a
have occurred on the date stated above, at .m.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Myocardial infarction- "Coronary Heart Disease
60
19.
....
21
Elizabeth T.Keleher
Informant
46I
A TRUE COPY Linda as Hanff
ATTEST :
( Registrar of City or Town where death occurred
DATE FILED May 13,
0 19.60
15 Social Security No.
Woburn
Was autopsy performed?
X-ray &1ab
5 Was disease or injury in any way related to occupation of deceased ? If so. specify
1
Registered No.
( Was deceased a
U. S. War Veteran.
(if so specify WAR,
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
1 R-301A 1
RUCTIONS FOR CERTIFICATE
1 giving JOF DEATH
o ot enter than one for each (b) and (c)
bes not mean az of dying, sheart failure, tetc. It means ke, or compli- hich caused
hans, if any, have rise to erause (a), n he under- , ause last.
m'ions contrib- death but not the terminal adition given
Chapter 137, £ 54. requires to print or cause or death on ceificates, and 8, Acts of retires Physi- rint or type r signature.
d-59-925686
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.
118
Registered No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN ---- IMPORTANT
2 FULL NAME. Charles Henry Whitney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 90 Cottage Avenue St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
57
.years.
months .............. days. In place of residence
57
years
.months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
13
1960
(Year)
8 SEX
male
white
MARRIED
WIDOWED Widowed
or DIVORCED
-
4 I HEREBY CERTIFY,
That I attended deceased from
May 13,
19.60
June 18,
, 19.5.2,
to.
I last saw him.alive on
May 12, 19.60 ,death is said to
have occurred on the date stated above, at
9:10 a.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic heart disease
INTERVAL
BETWEEN
ONSET AND
DEATH
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
93
12 yrs
. AGE.
Years.
5
Months
12 Day's
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
retired salesman
(Kind of work done during most of working life)
· 14 Industry
or Business :
wholesale cotton sales
15 Social Security No.
none
Roxbury.
16 BIRTHPLACE (City)
(State or country)
lass.
17 NAME OF
FATHER
Charles Joseph Whitney
18 BIRTHPLACE OF
FATHER (City)
Roxbury
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Mary Elizabeth Dunbar
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Roxbury
Informant Mrs. Fred W. Lee (Address) 111 River St. Matapan, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with. me BEFORE the burial or transit permit was issued: Mass.
(Signature of Agent of Board of Health or other) 1/16
50
(Registrar)
PARENTS
(Signed)
In. Traunstein M. Traunstein, Jr., M.D7
., M. D.
(PRINT OR TYPE SIGNATURE)
73 Bartlett Rg.
May 14,60
(Address) Winthrop 52
Date
6 Winthrop Cemetery Winthrop Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL May 16 ,1960
Gefreut B. Manale
7 NAME OF FUNERAL DIRECTOR 174 Winthrop St. Winthrop,
ADDRESS
Received and filed
15 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
herniae
Bilateral inguinal
Was autopsy performed ?
no
What test confirmed diagnosis ?
Clinical and laboratory
5 Was disease or injury in any way related to occupation of deceased ? no If so, specify
8 yrs.
9 COLOR
10 SINGLE
(write the word)
(Month)
(Day)
[(Was deceased a
U. S. War Veteran,
[if so specify WAR)
NO.
10a If married, widowed, or divorced
HUSBAND of
Harriet .A. Booth
(Give maiden name of wife in full)
Due ToGeneralized arteriosclerosis (b)
(a)
No. 90 Cottage Avenue
(Official Designation)
(Date of Issue of Permit)
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.
R-301A 1
S UCTIONS FOR A CERTIFICATE
giving EDF DEATH ot enter r than one s for each ) b) and (c)
es not mean 0 of dying, s teart failure, 1, tc. It means et, or compli- hich caused
it:ss, if any, kove rise to e huse (a), ng he under- suse last.
mcions contrib- oath but not tithe terminal c dition given
- hapter 137, 54. requires ia. to print or th cause or death on sei ficates, and 8, Acts of 'ecires Physi- o int or type un r signature.
1- 9-925686
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. . 19.Summit Avenue
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. 119
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Elizabeth ... A ...... Lapham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
19.Summit Ave.
(Usual place of abode)
Length of stay: In place of death. 5Qyears.
months ..
... days. In place of residence
5.0.
.years.
months ..
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May 16, 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
12 0 May, 1960,
to ..
16 0may
19.60
I last saw he.Y .. aliye on .
12
may
19.601, death is said to
have occurred on the date stated above, at/ 3 A
.. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Carcinoma of Stomach
Due To (b)
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Generalized Arteriosclerosis
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. (Signed)
Arthur C. Murray (PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date
17 May : 60
6 Winthrop Cemetery Winthrop Mass
Place of Burial or Cremation DATE OF BURIAL
May 18
City or Town) 1$60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS
Received and filed
18 1960
(Registrar)
8 SEX
Female
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.
12
AGE 80
Years ....
Months.
Days
If under 24 hours Hours ............ .Minutes
13 Usual
Occupation :
Retired Clerk
(Kind of work done during most of working life)
14 Industry
or Business :
Food
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Patrick J. Lapham
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
19 MAIDEN NAME
OF MOTHER Ann Rafferty
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
21
Informant
(Address)
Thersa Kichle 19 Summit Ave 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 of d
Health Officer 5/18/60
(Official Designation)
(Date of Issue of Permit)
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, {if so specify WAR)
St.
(If nonresident, give city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
INTERVAL BETWEEN ONSET AND DEATH
1 yr
That I attended deceased from
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 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 bad been given up or cbanged, 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.
MAY 1 81960
PLACE OF DEATH X
(i)
Suffolk (County)
CA
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. 120
[(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)
(a) Residence.
No.
(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
3 DATE OF
DEATH
1/24
(Month)
(Day)
19, 1960
(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
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Still Born
Stillborn
Due To
ProCoquel Card.
(b)
Prolapsed Cord
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 .........
(Signed)
LouiseSchaffa
M. D.
19 Deminsta /Su EB (PRINT OR TYPE SIGNATURE)
(Address) Louis E. Schraffat May 19 1960
6 Holy Cross
Melden
Place of Burial or Cremation (City or Town) Nay 23, 19.60 DATE OF BURIAL
7 NAME OF FUNERAL DIRECTOR Frederick J. Jagrath
ADDRESS 45 Waldemar Ave E. Boston
Received and filed MAY 2-3 1960 ... 19 .....
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
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)
17 NAME OF
FATHER
JOSEPH GENTILE
18 BIRTHPLACE OF
BOSTON
FATHER (City)
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
ROSE FRENO
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS
21 Informant Joseph Gentile
(Address)
Le Paris St. E. Doston
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued: Halble Jereantes (Signature of Agent) , Board of Health or other)
Health Officer 5/23/60
(Official Designation)
(Date of Issue of Permit)
X
I R-301A 1
RRUCTIONS FOR I CERTIFICATE
I giving IOF DEATH o ot enter DI than one u' for each )(b) and (c)
ves not mean Mi. of dying, as heart failure, atc. It means see, or compli- which caused
liins, if any, have rise to e ause (a), sithe under- ause last.
mions contrib- foleath but not i the terminal sdition given
Chapter 137, f 54, requires ils to print or tl cause or death on seificates, and r 18, Acts of retires Physi- print or type In r signature.
1 59-925686
40 Lincoln St., Baby Girl Gentile 12 Paris St.,
fedor divorced woman, give also maiden name.)
E. Boston, Mass
St.
2 FULL NAME.
Winthrop Community Hospital No.
To be filed for burial permit with Board of Health or its Agent.
PARENTS
Winthrop, Mass:
SOMERVILLE
INTERVAL
BETWEEN
ONSET AND
DEATH
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.
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