USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 49
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(Signed)
MYRON N. KING M.D
(PRINT OR TYPE SIGNATURE)
(Address) 122 PLEASANT 52
WINTHROP 810 Date 10/16
196à
6
Winthrop Cemetery
Winthrop
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
October 19 ... 1960 ........... 19.
7 NAME OF FUNERAL DIRECTOR Richard C. Kirby Inc.
ADDRESS 917 Bennington St. E.B.
Received and filed OCT17 1060 .19
(Registrar)
PARENTS
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Marrie
4 I HEREBY
JAN
10a If married, widowed, or divorced
HUSBAND of
Alice G. Forshner
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
57 Years ....
9
Months ....
3 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Sheet Metal Worker
(Kind of work done during most of working life)
14 Industry
or Business :
Self Employed
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
New Jersey- TRENTO W
17 NAME OF
FATHER
Philip J. Boudrow
18 BIRTHPLACE OF
FATHER (City)
Nova Scotia
........
(State or country)
19 MAIDEN NAME
M. D.
OF MOTHER
Jane Boudrow
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21 Mrs. Alica Bondrow
Informant (Address) 24 Franklin Stat Vinthron
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 Vinte
10/07/60
(Date of Issue of Permit)
(Official Designation)
M R-301A 1
TRUCTIONS FOR IL CERTIFICATE
n giving C OF DEATH not enter e than one se for each , (b) and (c)
does not mean de of dying, heart failure, etc. It means ase, or compli- which caused
ions, if any, gave rise to cause (a), the under- .cause last.
ditions contrib- death but not do the terminal condition given
. Chapter 137, ( 1954. requires i ins to print or le cause or t of death on rtificates, and t 48, Acts of quires Physi- print or type der signature. ,,S .
0) 6-59-92 5686
No.
Winthrop Community Hospital
To be filed for burial permit with Board of Health or its Agent.
no PHYSICIAN - IMPORTANT [(Was deceased a ¿U. S. War Veteran, (if so specify WAR)
(write the word)
CERTIFY,
1950
to ....
OCT 16
I last saw h.{.h.alive on
Oct 16
19 66
.......
St.
VI
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
OF 10:
DATE OF DISCHARGE
98.12 5 RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
7 .... 6.2
ROB
OCT 1'71960 AM
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.
1.
IT!
LERK
.3.
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
1 giving OF DEATH
not enter : than one e for each (b) and (c)
does not mean de of dying, heart failure, i, etc. It means ise, or compli- which caused
Gions, if any, gave rise to cause (a), the under- cause last.
olitions contrib- t death but not the terminal ondition given Hi S .
e Chapter 137, o1954. requires ons to print or e cause or sof death on rtificates, and ‹ 48, Acts of quires Physi- print or type i'der signature.
16-59-925686
PLACE OF DEATH
Suffolk (County) Winthrop
ANSE PITTO
(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.
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)
(a) Residence. No.
114 Winthrop Street
St.
(Usual place of abode)
Length of stay: In place of death .............. years.
months
4
days. In place of resident
25
.years.
......
... months.
.........
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
CERTIFY
That I attended deceased from
19.60
I last saw Halive on
Oct. 17
1960
death is said to
have occurred on the date stated above, at
11:32 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
a) Cerebrovascular Occlusion
Due
Cerebralarteriosclerosis
(b)
Due To (c)
OTHER
SIGNIFICANT
None 1
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)
Charles Liberan
CHARLES LIBERMAN
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop Lass Date 10/17/1960
6
Winthrop
winthrop
(City or Town)
,60
Place of Burial or Cremation
DATE OF BURIAL
Oct 20
7 NAME OF
Ernest P Caggiano
FUNERAL DIRECTOR
ADDRESS 147 Winthrop St, Winthrop
Received and filed OCT 1-9-1960 19
(Registrar)
PARENTS
M. D.
OF MOTHER
Elizabeth Tierney
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Mrs Elizabeth Gildea
Informant (Address) 114 Winthrop 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 of other) Lebley Cieche 10/19/60
(Official Designation)
(Date of Issue of Permit)
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business :
028-03-1745
15 Social Security No.
Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF.
FATHER James Gildoa
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
U. S.MAIL Retired
3yrs.
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
10a If married,
widowedza Bygrey Wolffsohn
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
79
AGE
Yearsm.m.
Months 5
Post Office Clerk
(write the word)
4 I HEREBY
August
1957
to ...
Det.
17
October
17
1960
(Year)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
2 FULL NAME
Thomas A. Gildea
No.
Winthrop Community Hospital
(If nonresident, give city or town and State)
INTERVAL
BETWEEN
ONSET AND
DEATH
10 days
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RECEIVED
RANK, RATING
ORGANIZATION AND OUTFIT
COR TO!
11 12 1
SERVICE NUMBER
8 ERK
RULES OF PRACTICE 7
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 bedsfie 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
Suffith
Winthrop
(City or Town) 36 take Strenne
No.
renatey
2 FULL NAME ..
{If deceased is a married, widowed or divorced woman, give also maiden name.)
30 Afake
(a) Reswięhoe. No.
( U'sual place of abode)
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
OCT
21
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
QUE- 15
19/02)
.. , to ....
OCT 21
That I attended deceased from
19.60
I last saw him lalive on
OCT 21, 19 6. C, death is said to
have occurred on the date stated above, at
10 26 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) CORONARY OCCLUSION
Due
GENERAL ARTERIOSCLEROSIS
(b)
5YRS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
ERYTHEMA MULTIFORME
2 De0.
Was autopsy performed?
No
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased ? / If so, specify
Hunmh. King
M. D.
(Signed) MYRUN N.KINGM.D. 22L (PRINT OR TYPE SIGNATURE) (Address) WITHRED SIMIES Date.
10/2160
6
Place of Burial or Cremation
DATE OF BURIAL
(Gity or Town) 1966
7 NAME OF FUNERAL DIRECTOR ADDRESS 265 MastingtousAS mutter
Received and filed Uetabler 21, 1960
(Registrar)
8.SEX Male
9 -COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED-
or DIVORCED ZelenEl
10a If married, widowed or divorced 7 & Jerry
HUSBAND of
Mary
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
3
Months.
Days
If under 24 hours
Hours.
.......
Minutes
13 Usual
Occupation :
PETTER FOREriver,
(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
Thomas Mulechey
18 BIRTHPLACE OF FATHER (City) (State or country)
Fretami
19 MAIDEN NAME
OF MOTHER
Ellen Granger
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Helen Din, Tablicating
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)
10/01/60
(Official Designation)
(Date of Issue of Permit)
STRUCTIONS FOR IL CERTIFICATE
n giving E OF DEATH not enter 'e than one se for each , (b) and (c)
does not mean de of dying, heart failure, etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not to the terminal Econdition given
1.5.
Chapter 137, 1954. requires ans to print or ne cause or of death on rtificates, and t 48, Acts of quires Physi- print or type der signature.
0.6-59-925686
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.
225
Registered No.
[(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, [if so specify WAR)
St
(If nonresident, give city or town and State)
4
INTERVAL BETWEEN ONSET AND DEATH
PERSONAL AND STATISTICAL PARTICULARS
PARENTS
Irland
Divali 21 Informant (Address) BL Afalesie
M R-301A -
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the 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)
LENSE PETIT
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.
226
2 FULL NAME. Grace (Carlton) Harden
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 142 Winthrop St
St.
Winthrop
(Usual place of abode)
Length of stay : In place of death .............. years .............. months ..
5
.days. In place of residence
.years.
.months.
......
days.
37
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
10
23
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
Feb
That I attended deceased from
19.60
I last saw h.Q.M.alive on
Oct. 23
1960
death is said to
have occurred on the date stated above, at
2: 45 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Cancer of Breast (Left)
DEATH
3yrs
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed?
NO
What test confirmed diagnosis Clinical + pathological
5 Was disease or injury in any way related to occupation of deceased ? .. If so, specify
Charles Like swan
M. D.
(Signed)
CHARLES
LIBERMAN
PRINT OR TYPE SIGNATURE)
(Address) Winthrop, Mass Date 10/23/1960
6
inth. op
winthrop
Place of Burial or Cremation
DATE OF BURIAL
Oct.
20
19 50
7 NAME OF
FUNERAL DIRECTOR
Howard 5 Reynolds
ADDRESS inthron Tass
Received and filed OCT.2.5 1960
19
(Registrar)
PARENTS
21
Informant
Marjori- Foulkes
(Address) e: bouy, ass.
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 otherY, Malta Succe 10.2560
(Official Designation)
(Date of Issue of Permit)
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving : OF DEATH not enter e than one e for each , (b) and (c)
does not mean de of dying, heart failure, , etc. It means ase, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not o the terminal ondition given
Chapter 137, 1954. requires ans to print or cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
-6-59-925686
8 SEX
F
9 COLOR
W
10 SINGLE
(write the word)
MARRIED Widow
WIDOWED'
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Albert A Harden
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
83
AGE
Years.
2
Months
10
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. 029-10-5949
16 BIRTHPLACE (City)
(State or country)
Lowell Tass
17 NAME OF
FATHER
Orin Carlton
Pelham
18 BIRTHPLACE OF
FATHER (City)
(State or countryNew Hampshire
19 MAIDEN NAME OF MOTHER
Louise
20 BIRTHPLACE OF MOTHER (City) (State or country) Canada
To be filed for burial permit with Board of Health or its Agent.
No.
Winthrop Community Hospital
[(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)
(If nonresident, give city or town and State)
1959
Det.
23
-
(City or Town)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE.
RANK,
IN
C.
ORGANIZ ATION
3
SUMBER
CLERK:
OUTFIT
SERVICE
P.
RULES OF PRACTICE
OCT 2 51960 AM
"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 INSEP "County) Winthrop (City or Town) Winthrop
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.
222
[(If death occurred in a hospital or institution, y + tosSt, ( give its NAME instead of street and number) No.
marion SNour
(Foss)
PHYSICIAN - IMPORTANT
[(Was deceased a
¿U. S. War Veteran,
[if so specify WAR)
ono
(If deceased is a married, widowed or divorced woman, give also maiden name.) 95 Summit Kor
Winthrop, mass
St. (If nonresident, give city or town and State)
Length of stay: In place of death. ........... years. ... months. 1 .days. In place of residence ..... years .. months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
MARRIED
10 SINGLE
(write the word)
Widowed
or DIVORCED
4 I HEREBY CERTIFY, That I attended deceased from
our
1956, to Oct. 23
19 60
I last saw h.l.alive on
Oct.
23, 1960, death is said to
have occurred on the date stated above, at 1:28 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Myocardial Heart
Disease
(b) ....
Due To
(c) Senility
....... -
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
150
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Address)
Joseph GREGORIE (PRINT OR TYPE SIGNATURE) 194 Washington Date ... 10-20 1960
6 Franklin farmington, ME. Place of Burial or Cremation DATE OF BURIAL October
(gity or Town) 19.60
7 NAME OF
David Judar Sont
ADDRESS 100 Highland Ale, Som
Received and filed 001 25 1960 19
(Registrar)
PARENTS
19 MAIDEN NAME
(Signed) Deeple Gregore
M. D.
OF MOTHER
Edith CNBL
CNBC
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
maine
21 Informant
Charles on Tozier
30 Fenwick St. Som
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)
10,25/60
(Date of Issue of Permit)
(Official Designation)
VV
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Georgew, Snow
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
78 Years 10 Months 21 Days
If under 24 hours
Hours ....
.......
Minutes
13 Usual
Occupation :
Catoa
la
(Kind of work done during most of working life)
14 Industry
or Business :
home
15 Social Security No. Farmin atom
16 BIRTHPLACE (City)
(State or country)
romaine
17 NAME OF
FATHER
Fred m. Joss
18 BIRTHPLACE OF
FATHER (City)
CNBC
(State or country)
main
.......
-6-59-925686
PLACE OF DEATH
1 R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one : for each (b) and (c)
does not mean de of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
litions contrib- death but not o the terminal ondition given
Chapter 137, 1954. requires ns to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
m.c.
2 FULL NAME
(a) Residence. No. (Usual place of abode)
23
1960
3 DATE OF
DEATH
(Month)
(Day)
(Year)
(or) WIFE of
42
Registered No.
Due To
arteriosclerosis gla
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
AJA:3238.
ORGANIZATION AND OUTFIT
SERVICE NUMBER
TOWN
1
LERK
RULES OF PRACTICE +
The fulfillment of the purpose of these laws calls for the ob following rules of practice :
(1) Attending physicians will certify to such deaths only as those of 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 persons who, though disabled by recognized disease unrelated Udny201960 TH 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.
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