USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 37
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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 unrelated to any form of injury.
(2) Board of Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
inthro: Convalescent Home
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.
167
f(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)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
77 Read 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. 58 .years. months .. .davs.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
JULY
17
1910
(Month) /
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED "i dowed
or DIVORCED-
4 I
HEREBY CERTIFY,
NYE 4
19.60, to JULY 17
That I attended deceased from
1960
I last saw h. {Aalive on
JULY 17
19. 600, death is said to
have occurred on the date stated above, at
11.05 Am
INTERVAL BETWEEN ONSET AND DEATH
5DAY
Years
12
AGE 4
4
Months
13
.Days
If under 24 hours Hours .... .. Minutes
13 Usual
Occupation :
Carpenter
(Kind of work done during most of working life)
14 Industry
or Business :
Retired
15 Social Security No. None
16 BIRTHPLACE (City)
(State or country)
Prince Edward Island
17 NAME OF
FATHER
Benjaminė Baker
18 BIRTHPLACE OF
FATHER (City) (State or country) Prince Edward Island
19 MAIDEN NAME
Charlott
ROSE.
20 BIRTHPLACE OF MOTHER (City) (State or country) Prince Edward Island
21 Caroline Baker Informant/ ...... (Address) /( Read t. Inthron, Vass.
7 NAME OF
FUNERAL DIRECTOR
Howard 3 Reynolds
"Inthron Lass
Received and filed
.. 19
JUL 18 1960
(Registrar)
i MO.
(c)
Du ARTERIO SCHLEROTIC HEARTDO. 5YRS
OTHER
SIGNIFICANT/ POSTATIS TUPERTROPHY
CONDITIONS
ÉBENCEN .
Was autopsy performed?
NO
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? (2 If so, specify
(Signed)
Parles Haceun
CHARLEY SALEM: (PRINT OR TYPE SIGNATURE) (Address) 342 HANOVER ST Jos Rage 7/17/ 1960
6 winthrop
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
July 20
(City or Town) 19.60
PARENTS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Mattocks
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
BRONCHO PNEUMONIA
(b) CARDIAC FAILURE
P'RUCTIONS FOR C. CERTIFICATE
giving S OF DEATH
donot enter ac than one ale for each (a (b) and (c)
is'oes not mean nie of dying, ( heart failure, mi etc. It means di: se, or compli- s which caused
ndons, if any, icigave rise to we cause (a), tir. the under- ng cause last.
Coitions contrib- tdeath but not the terminal ed se ondition given ).
te Chapter 137, o1954. requires ic is to print or : cause or Is f death on 1 ctificates, and te 48, Acts of ruires Physi- toprint or type : u er signature.
DM-59-925686
I HEREBY /CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued: Habple Jereanugy. (Signature of Agent of Board of Health of other)
7/18/60
(Official Designation) (Date of Issue of Permit)
M R-301A 1
Registered No.
(a) Residence. No.
(Usual place of abode)
Alban C Baker
ADDRESS
10 /25
M. D. OF MOTHER
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.
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. 168
Winthrop Convalescent Home No.
[(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
Douglas Cetkinson
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran,
[if so specify WAR)
(If deceased), is a married, widowed or divorced woman, give also maiden name.)
Winthrop Convalescent Home
.
(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)
divorced
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY
CERTIFY , That I attended deceased from
1950
to ...
Valy 24
60
I last saw h.l/halive on
July 23, 1960, death is said to
have occurred on the date stated above, at 8.04 A
.. m.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Broncho pneumonia
(Terminal)
Due To
(b)
.....
Marcardial Heart
1 Disease
gos
(c)
arteriosclerosis gen.
OTHER
SIGNIFICANT
CONDITIONS
Parkinson's Disease
Was autopsy performed ?
No
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? 20 If so, specify
(Signed)
Joseph GREGORIE
(PRINT OR TYPE SIGNATURE)
(Address) 194 Washingtado Date 7-24/1960
6 Woodlawn Cemetery 4, Everett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 27 ,1960
19
7 NAME OF
Ernest P. Caggiano
FUNERAL DIRECTOR
ADDRESS
147 Winthrop St., Winthrop
Received and filed JUL-26-1960 19
(Registrar)
PARENTS
M. D.
OF MOTHER
Laura Chapman
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sackville . N.B
Canada
21 Leonard C. Atkinson
Informant
(Address)
Springfield, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
1
(Signature of Agent of Board of Health or other)
1/25/6.
(Official Designation)
(Date of Issue of Permit)
Hours.
........... Minutes
13 Usual
Occupation :
RETIRED
(Kind of work done during most of working life)
14 Industry
or Business :
at home
15 Social Security No.
0.30-01-3561a
16 BIRTHPLACE (City)
(State or country)
Canada
17 NAME OF
FATHER
Talbert Atkinson
18 BIRTHPLACE OF
Sackville N.B.
FATHER (City)
(State or country)
Canada
19 MAIDEN NAME
New Brunswick
ptions contrib- fileath but not the terminal ndition given
Chapter 137, f )54. requires ci s to print or t cause or if death on cificates, and e148, Acts of ruires Physi- torint or type mer signature.
M 59-925686
IM R-301A 1
N RUCTIONS FOR C CERTIFICATE
giving S OF DEATH not enter o than one It for each a (b) and (c)
s oes not mean me of dying, a heart failure, ti, etc. It means iste, or compli- $ chich caused
d.ms, if any, Fl'ave rise to le cause (a), n the under- & cause last.
ce/2
grs
INTERVAL
BETWEEN
ONSET ANO
12
DEATH
24hs
73
Years.
1
If under 24 hours
22
Months.
Days
10a If married, widowed, or divorced
HUSBAND of
Julia ............ Miller
(Give maiden name of wife in full)
11 IF STILLBORN, enter that fact here.
3 DATE OF
DEATH
July
24
1960
(Monthy
(Day)
(Year)
2 FULL NAME
(a) Residence. No. (L'sual place of abode)
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.
IM R-301A 1
-
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No.
100 Almont St.
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.
169
S(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)
No
(a) Residence. No.
17 Cutler St.
St.
Winthrop
(Usual place of abode)
Length of stay : In place of death .............. years ..
2
months.
.........
.days. In place of residence.
.. years ...
.. months ...
......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
27
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Oct
54
to>
That I attended deceased from
1960
I last saw h ... valive on
July
76 19 60, death is said to
have occurred on the date stated above, alt
9:35 pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Coronary Artery Heart
Disease
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Due To (c)
OTHER
SIGNIFICANT Subacute Bacterial
2 mos
CONDITIONS
Endocarditis
Was autopsy performed?
What test confirmed diagnosis ?
Clinical.
5 Was disease or injury in any way related to occupation of deceased? NVC If so, specify
(Signed)
Charles Libera
. D.
OF MOTHER
Charles Liberman 2.38 (PBHope TYPE SIGNATURE) (Address) ........ in.thr.o.p Date ... 7/27 1960
American Friendship
6
West Roxbury (City or Town)
Place of Burial or Cremation
DATE OF BURIAL
July
.29.
1960
7 NAME OF
Paul R. Levine
FUNERAL DIRECTOR
ADDRESS 170 Harvard St, Brookline
Received and filed JUL 28 1860 19
(Registrar)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divorced
Ida S. Blotnick
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.
77 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 :
Building contractor
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
(name
17 NAME OF
FATHER
Schmeier Gold
changed
by law)
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
Rachael (unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
21 Louis Aronson
Informant
(Address)
100 Almont 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 ofher y 1/28/60
(Official Designation)
(Date of Issue of Permit)
I TRUCTIONS FOR IIL CERTIFICATE
n giving JE OF DEATH
i not enter r. e than one case for each (, (b) and (c)
hs does not mean de of dying, heart failure, er. etc. It means dase, or compli- which caused k.
mions, if any, gave rise to cause (a), ti. the under- in cause last.
hi
102
C ditions contrib- g death but not cao the terminal use ondition given a)
Chapter 137, o1954. requires liens to print or e cause or esof death on tificates, and te 48, Acts of quires Physi- {print or type Euler signature.
500.1-59-926662
2 FULL NAME
Hyman Doodlesack
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Registered No.
(If nonresident, give city or town and State)
5
PERSONAL AND STATISTICAL PARTICULARS
Russia
PARENTS
July
27
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JUL :. 07"
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.
I R-301A 1
FUCTIONS FOR & CERTIFICATE
I giving IOF DEATH
o ot enter than one u for each )(b) and (c)
es not mean M! of dying, as heart failure, aetc. It means see, or compli- which caused
fins, if any, have rise to e ause (a), ngthe under- " ause last.
m ions contrib- to eath but not & the terminal udition given
: Chapter 137, of 54. requires dos to print or tl
cause
or death on ceificates, and er -8, Acts of retires Physi- forint or type un r signature.
M-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.
Registered No. 120
[(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
PHYSICIAN ---- IMPORTANT
2 FULL NAME.
HARRY KRENTZMAN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
39 SAGAMORE AVE.
St. WINTROP
(If nonresident, give city or town and State)
5
.months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
JULY
28
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
MARCH
19.57, to
July 25
60
19.40
., death is said to
have occurred on the date stated above, at
..... m.
A
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) ARTERIOSCLERCTIC HEART Disease
DEATH
15YEARS
12
AGE.
82 Years ...
.......... Months ...
........... Days
If under 24 hours
Hours.
.. Minutes
13 Usual
Occupation :
DEALER
(Kind of work done during most of working life)
14 Industry
or Business :
COAL
15 Social Security No.
NONE
16 BIRTHPLACE (City)
(State or country)
RUSSIA
17 NAME OF
FATHER
HERSHEL KREUTZMAN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
OF MOTHER
LENA (CBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21 Informant
MRS BAIZEN
(Address)
39 SAGAMORE AVE WINTROP
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) Jealete Pricer
7,28/60
(Date of Issue of Permit)
(Official Designation)
PARENTS
(Signed)
J. albert Karp
M. D.
1. ALBERT
KARP
(PRINT OR TYPE SIGNATURE)
(Address
8 CRESCENT AVE. CHELSEA Date July 28
19. 0
6 CHELSEA CHEVRA KADISHA . EVERETT
Place of Burial or Cremation
(City devant) wRin
DATE OF BURIAL
July 29
1960
7 NAME OF
FUNERAL DIRECTOR
TORF FUNERAL SERVICE
CHELSEA
ADDRESS
Received and filed JUL 28 1860 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
-
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED WIDOWED
OF DIVORCED
10a If married, widowed, or divorced A GREENGLASS
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Due To (b)
Due To (c)
OTHER
SIGNIFICANT CHRONIC BRONCHITIS
CONDITIONS
20 years
Was autopsy performed?
140
What test confirmed diagnosis? EXAMINATION
5 Was disease or injury in any way related to occupation of deceased ? If so, specify NO
That I attended deceased from
I last saw him.alive on
July
25
(Usual place of abode)
Length of stay: In place of death. .. years. 5 .months .. days. In place of residence. .. years
[(Was deceased a U. S. War Veteran, (if so specify WAR)
NO
(write the word)
X
No.
39 SAGAMORE AVE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE JUL 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.
I R-301A 1
S UCTIONS FOR A CERTIFICATE
[: giving EOF DEATH ot enter rthan one s for each ) b) and (c)
es not mean 0 of dying, s Heart failure, a, tc. It means e', or compli- hich caused
it ss, if any, h .ve rise to Mouse (a), ig he under- luse last.
ncions contrib- orath but not Lithe terminal c dition given
- hapter 137, 54. requires to print or th cause or death on ¡erficates, and r 8, Acts of 'erires Physi- o int or type no: signature. S.
Thiliel
× PLACE OF DEATH
Suffolk {County)
Winthrop (City or Town) 117 Shore Drive
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.
§(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,
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