USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 35
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-
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
364 Winthrop Street
St
Winthrop
Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years.
... months
days. In place of residence .
.... months ....
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FLMILLE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That Lattended deceased from
April 26, 1960, to May 4
1960
Welast saw hC.lalive on
May 4
60 death is said to
have occurred on the date stated above, at &:10a.m.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
HAROLD 13 LEWIS
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
ACUTE MYOCARDIAL
INFARCTION
INTERVAL
BETWEEN
ONSET AND
DEATH
5 days
11 IF STILLBORN, enter that fact here.
12
AGE 79 Years 3 Months 4 Days
If under 24 hours
„Hours ....... Minutes
13 Usual
Occupation :
HOUSE WIFE
(Kind of work done during most of working life)
14 Industry
or Business :
NONE
15 Social Security No .....
NONE
BOSLANDOLE
OTHER
CARCINOMA OF GALL
SIGNIFICANT
CONDITIONS
BLADDER
unknown
Was autopsy performed?
What test confirmed diagnosis ?.
....... autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so. specify __....
(Signed
Callay
M. D. (Address) Aus'+ Dir, Moss. Com
FOREST HILLS
6
BOSTON.
Place of Burial-or Cremation (City or Town) DATE OF BURIAL. MAY 1600
Received and filed .....
MAY ~ ~ 1960
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City). (State or country)
ENGLAND
19 MAIDEN NAME
OF MOTHER
SURH JOHNSTON
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
21 Informant. MRS. LINCOLN BATES MASS (Address) PUDDINGHILL LANE MARSHFIELD
7 NAME OF FUNERAL DIRECTOR ALBERT & SULLIVAN I HEREBY CERTIFY that a satisfactory standard certificate of death ADDRESS 45 EAST WATER ST BUCKLAND. was filed with me BEFORE the burial or transit permit was issued :
Lacqualera
Signature of Agent of Board of Health or other)
2989
5-4-60
(Official Designation) (Date of Issue of Permit)
V
APPROVED ink or black ariter ribbon.
: RUCTIONS FOR C CERTIFICATE
1 giving IOF DEATH
o ot enter 1 than one u for each )(b) and (c)
isloes not mean " of dying, u heart failure, arte. It means sie, or compli- pkich
caused 120.1 lites, if any, A ave rise to e krause (a). ng the under- last.
Melons contrib- toleath but not the terminal ndition given 1. 1 ,
e :. Chapter 137, of ?54, requires ci s to print or t cause of . 1 ! death on ctifcates. CHP. 46, 55 9 & CHP. 114 $$ 45, : CAP. 38 $ 6.)
er Director: as use only
Lik Ink. 14. 60
OM. 1-88-923886
- (b)
Due To
CORONARY THROMBOSIS
5 days
Due To
(c)
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
GEORGE TYLER.
.
Massachusetts General Hospital BAKER MEMORIAL
No.
St. [give its NAME instead of street and number)
Registered No.
f(If death occurred in a hospital or institution,
(Usual place of abode)
3 DATE OF
DEATH
Ma.v.
1
1960
WIDOWED
Charles L. Clay. M. Piera
Date May 4
......
160
A TRUE COPY ATTEST: Charles i Mackie City Regatear
JUL 1. LEIA
X
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
Massachusetts General Haspitai
The Commonwealth of Massachusetts OUT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS To be filed for burial permit with Board of Health or Its Agent. STANDARD Registered No. 04962 CERTIFICATE OF DEATH PHILLIPS HOUSE
2 FULL NAME Mrs. Elizabeth Bridgeman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deccased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
916 Shirley Street
St
Winthrop,
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years.
months
5
days. In place of residence
........ months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
7
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That"P attended deceased from
May 2
er
19
60 to May 7,
19.60
Wf last saw h ._..... alive
May 7,
19 60, death is said to
have occurred on the date stated above, at
11:40 am.
10a If married, widowed, or divorced
HUSBAND of _
(Give maiden name of wife in full)
(or) WIFE of
William V. Bridgeman
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 56
Years
1
Months.
19 Days
If under 24 hours
.. Hours ...... Minutes
13 Usual
Occupation :
house wife -
(Kind of work done during most of working life)
14 Industry
or Business:
at home
15 Social Security No.
Metrose
16 BIRTHPLACE (City)
(State or country)
Mass .
17 NAME OF
FATHER
Charles Parker
18 BIRTHPLACE Ofalden
FATHER (City)
(State or country)
Mass .
19 MAIDEN NAME
OF MOTHER
Charlott Goodwin
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
cannot be Learned
21 William V., Bridgeman
Informant
(Address)
916 Shirley St, Winthrop
I HEREBY CERTIFY that A satisfactory standard certificate of death was filed with nfe BEFORE the burial or transit permit was issued : 1X-y Oferta
(Signature of Agent of Board of Health or other) 8024
(Official Designation) (Date of Issue of Permit)
V
F
FAR-301A
1-THIS IS A NENT RECORD. le only 1 APPROVED Slak or black griter ribbon.
RUCTIONS FOR CI| CERTIFICATE
] giving IOF DEATH · ot enter. oi than one u for each )(b) and (c)
istoes not mean mi' of dying. a heart failure, arte. It means ise. or compli- which 70
diins." if any, have rise to e cause (a). ng the under- cause
mions contrib- teleath but not 1
the terminal ndition given 1.
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
@@@lay
-
(Signed)
Chorlo. L. CTay, M.D.
(Address) Ass't Dir., Mass, Gor'l Hosp. /
M. D.
Date May 7
140.
6 Forest Dale Cemetery
Place of Burial or
Cremation
Malden Mass. DATE OF BURIAL May 11,1960
(City or Town) 19
7 NAME OF
FUNERAL DIRECTOR
Charles & D. Mangeson Ju
ADDRESS 039 Main St Malden, Mass.
Received and filed MAY 11 1960 19
Charles H. Znackis
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Gastro-intestinal hemorrhage
Due To
Blodenal Ulcer
(h)
Due To
Meticorten
(c)
Carcinoma of Breast
OTHER
SIGNIFICANT
Tingrated sigmoid
CONDITIONS
diverticulum
sd
Was autopsy performed?
What test confirmed diagnosis?
Autopsy
Yes
INTERVAL
BETWEEN
ONSET AND
DEATH
5 days
und
buks
Gerson
PARENTS
Charges S. L. Mangeunh
158
1
caused
last. 15.
e: Chapter 137, of }54, requires ci s to print or t cause or s / death on c tificates. CHP. 46, §§ 9 & CHP. 114 $$ 45, CAP. 38 $ 6.) ro Director: isuse only .AK ink. 1.14.1000 MAX2.58.92366
No.
f(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
9,
A TRUE COPY ATTEST: Charles it Mackie City Registrar
JUL 1. 1.0 0
3 DATE OF DEATH Where did Injury occur? public place ? Manner of Injury Nature of Injury of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH In plain terms, so that it may be properly classified under the International Classification of Causes If deceased was a U. S. War Veteran, G.L. Chapi#, Section 10, requires physicians to insert a recital to that effect. information should be carefully. supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF 25M-8-57-920750 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of While at work?
5. €14,62
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN 159
To be filed for burial permit with Board of Health or its Agent.
Registered No.
05312
..................
BETH ISRAEL HOSPITAL
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. SARAH ZELLICKMAN
PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4
49 Shirley Street,
St
Winthrop,
(Was deceased a
U. S. War Veteran,
if, so specify WAR)
Massachusetts
NO
(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 ...
22
wyears ............ months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Femald
White
11 SINGLE
(write the word)
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.) Cerebral thrombosis; Hypertensive and arteriosclerotic heart disease.
11a If married, widowed, or divorced
HUSBAND of ...
(Give maiden name of wife in full)
(or) WIFE of
Barnet Zelickman
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 83
Years .....
.. Months .............. Days
If under 24 hours
.....
.. Hours .......... Minutes
14 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
15 Industry
or Business :
At Home
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
Samuel Ginsburg
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
20 MAIDEN NAME
OF MOTHER
Unknown
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
22
Anna Zelickmen
Informant
(Address) \te Shirley Street
I HEREBY CERTIFY that a satisfactory standard certificate of death was Gled with me BEFORE the burial or transit permit was issued:
ADDRESS
1668 Beacon St, Brookline
Received and
MAY 23 1960
19
Charles H. IM a BAD
PARENTS
Miterath Israel, Everett 7
Place of Burial, or Cremation.
(City or Town)
19.50
DATE OF BURIAL
May 19,
8 NAME OF
FUNERAL DIRECTOR
Arnold Golov
(Signature of Agent of Board of Health or, other)
8/99
4-14-60
(Official Designation) (Date of Issue of Permit)
X
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
(Specify type of place)
(How did injury occur ?)
Was autopsy performed? No
6 Was dis ase or injury in any way related to occupation of deceased?
(Signed,.
Michael H. Luongo, M . 5/18
.. Date ...
'68
(Address )
19.
.......
10 COLOR OR RACE
May
18,
1960
(Month)
(Day)
(Year)
M R-303
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
PLACE OF DEATH
Middlesex
(County)
Cambridge
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(Gombrådmaking this return) 160
Registered No.
1023
§(If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Marion.Monti
(If deceased is a married, widowed or divorced woman, give also maiden name.)
( Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No ....
(Usual place of abode)
80 Ingleside Avenue
St
Winthrop
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ....
months
16
Hays.
In place of residence.
50ars.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
1
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 15
19
60,
to ...
June ... 30
19
60
I last saw h ..... Calive on
June .... 30 ...... , 19.60, death is said to
have occurred on the date stated above, at
8:25 am
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Astrocytoma Gr. TV
INTERVAL
BETWEEN
ONSET AND
DEATH
4 mos
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?.....
No
If so, specify
(Signed).
Francis E. Smith
M. D.
(Address)
85 Otis St., Cambridge 7/1/
19 60
6
Winthrop Cemetery,
Winthrop, Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
July 5
19.
60
..........
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop,
Mass.
Received and filed
July 5
1960
..........
AUG. 2 1960
(Registrar of City of 'Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED idow
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
.Anthony.L ... Monti
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE25
Years.
Months.
.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 Home
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
William Mulloy
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Adelaide Crandall
20 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass.
21
Informant.
Josephine Dobson
(Address) 2 Edgar Terrace, Winthrop, Mass.
A TRUE COPY
Frederik it Darker
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
25M-8-56-918227
5.
VALA AM A MIALMA) WTAALL VREAUANU DLACK INK - THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BANDING
Due To (1) 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 (c)
MM R-302 1
PARENTS
Boston.
No. Guardian Hospital ,.85 Otis.St. ,Cambridge
0
A
LENK
7311
6
HROP
AUG 2 1960 /11
R-301A
PLACE OF DEATH Suffolk (County)
NosToro 27-95
DENSE PETIT
- Winthrop (City or Towh)
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. 161
[(If death occurred in a hospital or institution, Mayflanco humaine Xml No. St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
Hunger De Christifari
(If deceased is a married, widowed or divorced woman, give also maiden name.)
81 Brooks-
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death .............. years.
3
h:23
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)
3 DATE OF
DEATH
(Month]
(Day)
4 I HEREBY CERTIFY,
tune 1
1955, to the
That I attended deceased from
1960
I last saw himalive on
Full
1
19 64, death is said to
have occurred on the date stated above, at .
5G, m.
10a If married, widowed, or divorced Paglia
HUSBAND of Continent
(Give maiden name of wife in full)
(or) WIFE of
....
de auto
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 15 Years
.Months.
Days
If under 24 hours
Hours ........
.Minutes
13 Usual
Occupation :
Läraren
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security
611-18-0531
16 BIRTHPLACE (City)
(State or country)
tab
17 NAME OF
FATHER
Giovannible Christifor
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Fialy
19 MAIDEN NAME
OF MOTHER
Filomena (Unknown)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Informant
(Address)
John Lee Chrest Jord
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 officer
7/5/6.
(Official Designation)
(Date of Issue of Permit)
X
T CTIONS OR L ERTIFICATE niving
. F DEATH nt enter epan one e or each , ) and (c)
di not mean d of dying, art failure, . It means as or compli- Dich caused
tio, if any, Re rise to sse (a), The under- last.
diins contrib- d'th but not to the terminal contion given
- apter 137, 19. requires an o print or he cause or of death on ercates, and 4 Acts of eques Physi- > pht or type 1de ignature.
IT michau 6
Jansi Nici
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
July 7
19 66
7 NAME OF Janninialimenta ADDRESS 224 Have It Boston Man
Received and filed وج وباريلا 19 6
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(2) Cajanoma À Lauma
(b)
To métastases te Leser
Due To (c)
OTHER
Coronary themisen
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? \U If so, specify
(Signed)
Rose FirJANKINI
M. D.
(PRINT OR TYPE SIGNATURE) (Address) 450 PleasantST, WinThis Date July 4 19 ... 45.6 ....
PARENTS
[(Was deceased a U. S. War Veteran, [if so specify WAR)
East Boston, Massachus in
St.
(If nonresident, give city or town and State)
6
MARRIED
WIDOWED Wartimeit
of DIVORCED
July
4º
1961
(Year)
2 FULL NA
-6- 925686
SPACE FOR ADDITIONAL INFORMATION
1
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JUL - 61960 /1
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.
X 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.
162
Registered No.
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
NATHALIE ML (SURETTE) PORTER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. ( Usual place of abode)
33.
Length of stay: In place of death
.. years.
months. ..
... days In place of residence, 35 years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
7
5
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
7
1
5
53
19.
to ......
I last saw h.L.Alive on
7/4
death is said to
have occurred on the date stated above, at
12.344 m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ARTERIO-SCLEROTIC
(a)
HEART DISEASE
Due To
BRONCHI-PNEUMONIA
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
12
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
M. D. FRED OREGAN CIO
(PRINT OR TYPE SIGNATURE)
7/6
10 60
(Address) 13 /Reasonht
Date ..
6 WINTHROP.
WINTHROP
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
JULY 8
1960
7 NAME OF
FUNERAL DIRECTOR
MAURICE IN KIRBY
ADDRESS WINTHROP.
Received and filed 1- 8-62 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
CHIDULED
10a If married, widowed, or divorced
HUSBAND of
ROBERT
(Give maiden name of wife in full)
PORTER
(or) WIFE of
(Husband's name m full)
11 IF STILLBORN, enter that fact here.
12
AGE 90
Years.
Months.
Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
HOME
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
WEDGEDOPPI
16 BIRTHPLACE (City)
(State or country)
N. S,
17 NAME OF
FATHER
PETER SURETTE
18 BIRTHPLACE OF
WEDGE PORT
FATHER (City)
(State or country)
N/ J.
19 MAIDEN NAME
OF MOTHER
ROSALIE LABLANC
20 BIRTHPLACE OF
MOTHER (City)
WEDGEPORT
(State or country)
Nr.
21
Informant
MP) ROSE LA BLANC
WHYCOTTAGE 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: Match (Signature of Agent of Board of Health or other),
7/5/60
(Official Designation) (
(Date of Issue of Permit)
1-09-925686
PLACE OF DEATH
R-301A
TICTIONS
L'ERTIFICATE
living IF DEATH It enter chan one e or each .) and (c)
ds not mean dof dying, cart failure, c. It means a. or compli- ich caused
IS.
tis, if any, ve rise to use (a), ke under- use last.
d ons contrib- ath but not to he terminal codition given
hapter 137, 14. requires a to print or he cause or c death on ericates, and 1, Acts of eç res Physi- int or type no signature.
2 FULL NAME
49 COTTAGE PARK RD
PHYSICIAN - IMPORTANT
[(Was deceased a
{ U. S. War Veteran,
lif so specify WAR)
NL
69 COTTAGE PARK RD. St. (If nonresident, give city or town and State)
That/I attended deceased from
1966
7/466
PARENTS
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.
JUL - CISSO I.R
-
F
R-301A 1 Suffolk (County)
PLACE OF DEATH
Winthrop (City or Tewn) 509 Pleasant No.
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No.
To be filed for burial permit with Board of Health or its Agent.
163
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Hilda I.(Blonowis) Phelan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
509 Pleasant
(a) Residence. No.
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