USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 57
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12/6/60
(Official Designation)
(Date of Issue of Permit)
6-59-925686
X Suffolk (County)
Winthrop (Cityfor Town) PLACE OF DEATH 19-10->
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
262
No. 142 Pleasant St. - Winthrop Conr. (If death occurred in a hospital or institution. Home , instead its :
PHYSICIAN - IMPORTANT
[(Was deceased a {U. S. War Veteran, (if so specify WAR)
NO
(If deceased is a married, widowed or divorced woman, give also maiden name.) 57 Walford way charlestown, Mass. (L'sual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .. .O .years ... / month: 13
days In place of residence.
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December 4.
(Month)
(Day)
1960
(Year)
4 I HEREBY CERTIFY,
Oct. 22
19.60. 1
to ...
That I attended deceased from
Nov.
29,
19.
60
I last saw h.@ Lalive on
NOV.
29.
19 60.
death is said to
have occurred on the date stated above, at
6:30 A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Generalized Arterio -
Sclerosis
Due To (b)
INTERVAL BETWEEN ONSET AND DEATH 20YRS
PARENTS
M. D.
19
(PRINT OR, TYPE SIGNATURE)
East Boston, Mass Date 12-4-
60
MOTHER (City)
(State or country)
Italy
21 Informant (Address) 57 Walkord way charlestown
To be filed for burial permit with Board of Health or its Agent.
Santa Bellamacina
2 FULL NAME
(a) Residence. No.
X
itions contrib- death but not the terminal ondition given
Chapter 137 , 1954. requires ng.to print or e causes or of death 'on rtificates, and 48, Acts of quires Physi- print or type der signature.
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.
RECEIVED
TOWA
OF
FFICE
11.12
GLER
NIV!
8
5
6
THROP
DEC = 61960 AM
M R-301A 1 Suffolk (County) Winthrop (City or Town) Cliff House
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
263
CERTIFICATE OF DEATH
Registered No.
§(If death occurred in a hospital or institution,
170 Cliff Ave
PHYSICIAN - IMPORTANT
St. ? give its NAME instead of street and number) No. [(Was deceased a ABRAHAM HIRSCHBERG
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
170 Cliff Ave
St.
(Usual place of abode)
Length of stay: In place of death .............. years.
8 months. .days. In place of residence .............. years.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Dec.
4
1960
(Month)
(Day)
(Year)
CERTIFY,
That I attended deceased from
60
I last saw himalive on
Dec
4
1960, death is said to
have occurred on the date stated above, at
7:15A,m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arterio Selerotic Heart
(a)
Disease
INTERVAL
BETWEEN
ONSET AND
DEATH
lyx.
10a If married, widowed, or divorced EThel Shapiro
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 AGECO Years. Months ... ...... Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
TAXI DRIVER
(Kind of work done during most of working life)
14 Industry
or Business :
TRANSPORTATION
15 Social Security No.
029-16-8837
16 BIRTHPLACE (City)
(State or country)
Besten Mass
17 NAME OF
FATHER
Louis
HIRSCHBERG
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signed) Charles Liberman .. M. D. Charles LIBERMAN
(Address)
(PRINT OR TYRE SIGNATURE) Winthrop, Mass Date ... 12/4/1960
Chesed ShiEl EmElk DANVERS
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
TORF Funeral Service Inc
ADDRESS
Washington Ave
Chelsea
Received and filed DEC 5 1960 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
CBL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Informant
Mrs Natalie Brevenick
(Address)
29 Brookdale Rd Natick
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 Crecer 12/5/60
(Official Designation)
(Date of Issue of'Permit)
X
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ), (b) and (c)
does not mean ode of dying, s heart failure, 1, etc. It means ease, or compli- which caused
itions, if any, h gave rise to cause (a), ig the under- cause last.
nditions contrib- o death but not to the terminal condition given
- Chapter 137, 1954. requires ans to print or he cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
1-11-59-926662
PLACE OF DEATH
(b)
1 day
Due To
(c)
OTHER
SIGNIFICANT
Gout
CONDITIONS
20 yrs.
Was autopsy performed?
NO
What test confirmed diagnosis ? .
Clinical
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
4 I HEREBY
Feb
47
to ...
Dec
4.
19
(If nonresident, give city or town and State) 8 months. .days.
U. S. War Veteran,
(if so specify WAR)
NC
MEDICAL CERTIFICATE OF DEATH
Due
·Coronary Occlusion acute
6
Place of Burial or Cremation
DATE OF BURIAL
Dec
5
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
1280
.V. P
5
6
HROP MARS
DEC -51960 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.
X SUFFOLK (County) WINTHROP , MEISS (City ør Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN 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.
264
[(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
Mass.
1
Boston
MOSS )
Length of stay: In place of death
years.
2
2
months
days. In place of residence
(If nonresident, give city or town and State)
Wydardo months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Dec
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
July 5
, 1960
Dec. 5
19.60
I last saw h , Malive on
Dei
5.
, 1960, death is said to
have occurred on the date stated above, at
9.30 A.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
2 yrs
2yrs.
Due To (c)
OTHER
SIGNIFICANT Bronchopneumonia
CONDITIONS
2 days
Was autopsy performed?
What test confirmed diagnosi Pleincal- Burgical Patte.
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify.
(Signed)
Charles Liberman, M. D.
(Ad Winthrop, Mass Date Dec 5, 1960
6 FAIRVIEW CENT. FOREST HILL
- CREMATORY BOSTON
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL DECEMBER 12
1940
7 NAME OF
FUNERAL DIRECTOR
JOHN
SHEA
ADDRESS DORCHESTER
MASS
Received and filed Végember 5 19 60
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX M
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
lu sive maiden name
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
87
Years
Months
Days
If under 24 hours
Hours ..
._. Minutes
13 Usual
Occupation :
PAINTER
(Kind of work done during most of working life)
14 Industry
or Business :
employed
15 Social Security No. 122-09-9475
16 BIRTHPLACE (City)
(State or country)
Toledo, Ohio
17 NAME OF
FATHER
unknown
18 BIRTHPLACE OF
-
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
-
21 Elisabeth Cavourin, LPN
Informant.
(Address) 39 Growers Ave Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued: Packa ,cercanas & (Signature of Agent of Board of Health or othery Haite Cricke 12/5/60
(Official Designation)
(Date of Issue of Permit)
X
RUCTIONS FOR . CERTIFICATE giving OF DEATH not enter than one : for each (b) and (c)
does not mean le of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause
(a), the under- cause
last. 1.5. tions contrib- death but not the terminal ondition given
Chapter 137, 1954, requires ns to print or e cause or of death on ertificates.
erman y
50M-5-57-920345
PLACE OF DEATH
2 FULL NAME
No .. FITHIAN, NELL
Phillip
(If deceased is a married, widowed or divoreed woman, give also maiden name.)
39 GROVERS Are
Winthrop
(a) Residence. No.
(Usual place of abode)
5
1960
(Year)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Busal Carcinoma of Nose
Due To
To Carcinomatosis
(b)
Na
PARENTS
Registered No.
MAYFLOWER NURSING HOME, WINTHROPS
MR-301A 1
COMN
RETURN
A physician or 1 death of a person
of an undertaker of the deceased, furnis best of his knowled disease of which he contracted, the dur or officer and the di
A physician or ( preceding section ( teen, shall, if the de army, navy or mari engaged, insert in t shall also certify in : diate cause of deatl with any provision o For the purposes of of said chapter one 1 relief expedition and deemed to have tak ninety-eight and Jul service of nineteen G. L. Chap. 46, Sec
Not to be Cremated
No undertaker or in a town, or remove has received a perm such permits, or if t person died; and no remove it from a tov other than the rece received a permit frc of the town where th shall have been de a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
Fethian.
Tel Phillip
5. Waterwant
Fair View
y-Six, tates rmit.
cate.
istra- fying ssary er or c. 45,
odies
on of
Bases
a not
neral
ereof
:rmit
:s, or
Iried
f the
llow-
sons
ated
se of n of
isent
ably
y by
nical
. but
tion,
se of
ptisulis lVully ucau.
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
X
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
PLACE OF DEATH
Suffolk
(County )
1 Revere
(City or Town )
Grover Manor Hospital No.
George A. Blanchard
2 FULL NAME
( Was deceased a
U. S. War Veteran,
No
(If deceased is a married, widowed or divorced woman, give also maiden name.) Winthrop Convalescent Home
(a) Residence. No. ( Usual place of abode)
16
10
Length of stay: In place of death .......... years .... .months. days. In place of residence .... .. years ... .... months .......... days.
MEDICAL CERTIFICATE OF DEATH
December
8 ,
1960
( Month)
(Day)
(Year)
4 I HEREBY
Nov. 22,
CERTIFY, 60
That I attended
Dec .
deceased
68
19
,
19 death is said to
have occurred on the date stated above, at .. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Uremia
Due To Cerebral vascular (b)
accident
Due To Arteriosclerotic heart (c)
disease
Diabetes mellitus
3yrs.
Ng Clinical signs
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
James F. Burns
(Signed ) 537 Broadway
1278
( Address) Everett
Date. 19
Woodlawn Cemetery
Everett
Place of Burial or Cremation
Decemberity Ir(Town) 60
19.
7 NAME OF
Maurice W. Kirby 210Winthrop St., Winthrop
ADDRESS
Received and filed 1-6-61 19
( Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
New Hampshire
(State or country)
19 MAIDEN NAME
Malvina Bauther
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
( State or country)
Annette Donley
Canada
21
Informant
( Address)
30 ..... Reed Rd .... , ...... Peabody.
A TRUE COPY
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
December 9,
60
19
X
10a If married,
HUSBAND of
MargareteM. Powers
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
79
12
AGE
.Years ...
Months .......... Days
If under 24 hours
Hours ......
Minutes
Salesman
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
028-10-0259
15 Social Security No.
Turners Falls
16 BIRTHPLACE (City)
(State or country)
Mass ..
17 NAME OF FATHER Cyril Blanchard
Was autopsy performed ?
19 "Dec ...
I last saw h ...... alive on
5:30A
INTERVAL BETWEEN ONSET AND DEATH 48hrs
Imo.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
( write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
Winthropcify WAR
St
Revere
(City or Town making this return)
265
Registered No.
[ {If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number )
(If nonresident, give city or town and State)
3 DATE OF DEATH (a) OTHER 6 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) SIGNIFICANT CONDITIONS
50M-9-59-926111
DATE OF BURIAL
Salesman
5yrs.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RECEIVED
TOWi
OF
OFFICE C
11 12
CLERK
3
MIN
4
5
HROP
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
JAN! 5.1961 PM
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
Registered No.
266
No. Winthron Convalescent Home Pleasant Ir
[(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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
41 Shirley Street
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
. years.
8
months. .
.. days. In place of residence.
years.
months ...
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
8, 1960
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY , That I attended deceased from
May 6, 1956
19
to
December 8
19.60.
I last saw h.S.f.alive on
December 8 . 1960 ,death is said to
have occurred on the date stated above, at
.8:30 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Hypertensive and arteriosclerotic heart disease
Due ToGeneralized arteriosclerosis (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
none
Was autopsy performed ?
no
What test confirmed diagnosis ? . clincial ... & laboratory
5 Was disease or injury in any way related to occupation of deceased ? NO. If so, specify ....
(Signed)
12- Tracesp/Eci- M. Traunstein, Jr. ,M.D. (PRINT OR TYPE SIGNATURE) 73 Bartlett Road Date .. 12-8 1560
M. D.
6
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 10
19.60
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS 147 Winthrop St, Winthrop
Received and filed "EC. 9. 1960
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED)
WIDOWED
or DIVORCED Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William G. Marshall
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
Years ..
2
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: A ....... Home
15 Social Security No.
Harborville
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
Ronald Kelly
18 BIRTHPLACE OF
FATHER (City) (State or country) Nova Scotia
19 MAIDEN NAME
OF MOTHER
Agnes Sullivan
20 BIRTHPLACE OF MOTHER (City) (State or country) Nova Scotia
21 Informant (Address)
Thomas B. Marshall
47 Shirley 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 pf Agent of Board of Health or other)
HO Dec. 9/60
(Official Designation)
(Date of Issue of Permit)
X
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means se, or compli- which caused
1.2.
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not o the terminal condition given
Chapter 137, 1954. requires ans to print or he cause or of death on ertificates, and 48, Acts of quires Physi- print or type der signature.
-6-59-925686
To be filed for burial permit with Board of Health or its Agent.
142
2 FULL NAME
Laura K. Marshall (Kelly)
(a) Residence. No. (Usual place of abode)
50
INTERVAL
BETWEEN
ONSET AND
DEATH
4 yrs
AGE
81
6 yrs
Over.
PARENTS
(Address)
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.
ĐỨC = 91960 FM
NI
OFFI
OF
MIN
II I.2.
1
TOWA
. . 5-D
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
74 Beal Street
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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