USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 13
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Benjamin Birnbach
ADDRESS 10 Washington St. Dorchester
Received and filed
APR 3-1961
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
MARRIED
(write the word)
.
WIDOWER
or DIVORCE!)
10a If married, widowed Tivace- Cannot be Earned HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
ViFENN
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 74,64
Years ..
Months ......
Days
If under 24 hours
Hours .............. Minutes
13 Usual
Occupation .
DENTIST
(Kind of work done during most of working life)
14 Industry
or Business :
Self-Employed
15 Social Security No.
16 BIRTHPLACE (City9
(State or country)
BROOKLYN, N.Y.
17 NAME OF
FATHER
SAMUEL KAYE
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
M. D.
OF MOTHER
BETTY ETTINGER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21
ESTHER D. KAYA
Informant
4808 Granthan St. Chevy Chase, Md.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E Serianni (Signature of Agent of Board of Health or other)
40
att april 3-1961
(Official Designation) (Date of Issue of Permit) X
.0-926662
PLACE OF DEATH
SUFFOLK 265
INST PPT
(County) WINTHROP (City or Town) WINTHROP COMMUNITY HOSP. No.
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.
59
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)
WASH., D.C.
no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5415 Connecticut AVE N.W.,
(a) Residence. No. (Usual place of abode)
7
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
APRIL 3
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
MAR. 31,
19.61
to ..
That I attended deceased from
1961
I last saw him live on
APRIL 3
19.61, death is said to
have occurred on the date stated above, at ..
6:51A
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CARDIAC DECOMPENSATION
(a)
Due
(b)
ARTERIOSCLEROTIC HEART
DISEASE
INTERVAL
BETWEEN
ONSET AND
DEATH
SMO.
PARENTS
(PRINT OR TYPE SIGNATURE)
ASS BROOKLYN, N.Y.
R-301A 1 -
vis contrib- ih but not Je terminal Tion given
pter 137, 5 requires print or ause or eath on ates, and Acts of s Physi- : or type gnature.
2 FULL NAME
DR. JACK M. KAYE
CERTIFICATE OF DEATH
(If nonresident, give city or town and State)
APRIL 3
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 infory."
(2) Board of Health physiclans 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 Oclude mot only deaths caused directly or indirectly by traumatism (including)resukiby septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa . tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
R-303 A
P.s. icu uuer ne international Classification of Causes information should be carefully sunnlist ... ' .. of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
§§ 44-48.
50M-6-60-928145
I.C.
PLACE OF DEATH
SUFFOLK (County)
WINTHROP
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
60
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No.
2 FULL NAME
EDITH
D. (PL .; ) WARNOCK
PHYSICIAN - IMPORTANT
{ (Was deceased a
(First Name)
(MiddleName)
(Last Name)
U. S. War Veteran,
(if so specify WAR)
No
(If deceased is a married, widowed or divorced woman, give also maiden name.)
12 Seewall Ave.,
St.
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
.years.
.months.
.days. In place of residence 7
years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
4.
1961
(Month)
(Day)
(Year)
4 I 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.) Asphyxia due to drowning.
lla If married, widowed, or divorced HUSBAND of
(or) WIFE of
John
(Give maiden name of wifeAn full)
Warnock
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE .:
57Y
3
Months
27 Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
Waitress
(Kind of work done during most of working life)
15 Industry or Business :
16 Social Security No. ...........
17 BIRTHPLACE (City)
(State or country)
Vermont
18 NAME OF FATHER
James Phillips
19 BIRTHPLACE OF FATHER (City) (State or country) Scotland
20 MAIDEN NAME OF MOTHER Joan Simpson
21 BIRTHPLACE OF MOTHER (City) (State or country) Scotland
22 Mrs annabelle Webber
Informant (Address)
Place of Burial, or Cremation. DATE OF BURIAL april7 1961
8 NAME OF
FUNERAL DIRECTOR Cartwright Funeral Home
ADDRES
419 M. My aimft Grund
Received and filed APREY
19
9 SEX
Female
10 COLOR
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5 Accident, suicide, or homicide (specify)
Suicide.
Date and hour of injury
19
IF ACCIDENTAL, was injury causally related to the death ?
Injury occur ?
Where did
Winthrop Mass.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
Waters off Winthrop Mass.
(Specify type of place)
Manner of
Drowning.
Injury
(How did injury occur ?)
Nature of
Injury
While at work?
Was autopsy performed ?
Yes
6 Was disease or injury in any way related ver occupation of deceased ?
If so, specify 1 ....
(Signe) Cheha Michael A. Luongo, M.D.
M. D.
Boston( Print or Type Signature) 4/5
19.
61
(Address) Date
Central Permeten Gandalf City or Town)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued: Kalkh E. Serianni
(Signature of Agout of Board of Health or other)
H.O.
4/ 6/6/
(Official Designation)
(Date of Issue of Permit)
<
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
XI 1 -
Waters of Broad Sound
(If nonresident, give city or town and State)
Jemmister
PARENTS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE:
,
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
APR -61961 FH
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 unrelated 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 poison) 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
PLACE OF DEATH
X SUFFOLK (County) WINTHROP (City or Town) 28 CHESTER
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.
61
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
(First Name)
(Middle Name)
(Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
28
Chester Ave
WINTHROP
(Usual place of abode)
Length of stay: In place of death.
15 years.
.. months.
days.
In place of residence
15 years
.. years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
7
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19 ...........
.. , to
19
I last saw h ........ alive on
19 ....
., death is said to
have occurred on the date stated above, at ...
6:02 pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL
BETWEEN
ONSET ANO
DEATH
Due To
(b)
Presumably Coronary Occlusion
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
Post Mortem Judgement
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
no
(SignedX
arthur C. Murray, M. D
Arthur C. Murray, M.D
( PRINTDOR TYPE SIGNATURE
(Address
Winthrop Board
Date 8 April 1961
of Health
6
MOUNT LEBANON WEST ROXBURY Place of Burial or Cremation (City or Town)
DATE OF BURIAL
APRIL 9
1961
7 NAME OF
FUNERAL DIRECTOR
ARNOLD GOLOV
ADDRESS
1668 BEACON ST BROOKLINE
Received and filed
APR-11-1961
.19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED MARRIED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Il IF STILLBORN, enter that fact here.
12
68
AGE.
Years ..
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
CHEMICAL MFG. CO
(Kind of work done during most of working life)
14 Industry
or Business :
SELF EMPLOYED
15 Social Security No. 090-14-3983
16 BIRTHPLACE (City)
(State or country)
GERMANY
17 NAME OF
FATHER
JULIUS LAMM
18 BIRTHPLACE OF
FATHER (City)
(State or country)
GERMANY
19 MAIDEN NAME
OF MOTHER
SARAH (C.BL.)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
GERMANY
21 GEORGE LAMM
(Address)
28 CHESTER DUE, WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Ralphie Semana (Signature of Agent of Board of Health or other) 4/9/87
96.0
(Official Designation) (Date of Issue of Permit)
V.B.
2845
-301A 1
IONS
TIFICATE
ng DEATH ater one each nd (c)
ot mean dying, failure, It means compli- caused
f any, rise to (a), under- last.
contrib- but not terminal in given
pter 137, requires ) print or ause or leath on dates, and Acts of is Physi- tor type :gnature.
No. Carl
Lamm
[ (Was deceased a
U. S. War Veteran,
{if so specify WAR)
NO
St.
(1f nonresident, give city or town and State)
STRAUSS
PARENTS
Registered No.
AVENUE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
APP 1 11961 A1
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.
5M-6-60-928241
R-304 X
PLACE OF DELIVERY
Suffolk (County )
1 Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
62
(If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVE
APRIL Month :
7 1961 (Year)
(Tray )
4 SEX
Male ..
Female
Undetermined.
5 COLOR (if
determined )
w.
6 THIS BIRTH (Check one)
Single
Twin
Triplet
7 IF MULTIPLE BIRTH, BORN:
1st.
.2nd
.3rd.
FATHER
MOTHER
8 FULL NAME DOMENIC MASIELLO
14
MAIDEN NAMEELIZABETH PADA
PRESENT NAMEELIZABETH MASIELLO
RESIDENCE, NO80 BAYS WATER STREET CITY OR TOWNEAST BOSTONSTATEMASS
RESIDENCE, N 80 BAYSWATER STREET CITY OR TOWN PAST BOSTON STATENASS
10 COLOR OR RACE. WHITE
11 AGE AT TIME OF THIS DELIVERY 36 (Years)
16 COLOR
RACE
WHITE
17 AGE AT TIME OF
THIS DELIVERY
31
(Years)
12 PLACE OF EAST BOSTON
BIRTH
MASS
18 PLACE OF
BIRTH
MASS
( State or country )
13 OCCUPATION REFRIGERATION MECHANIC
20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus) four
(a) How many children are now living ? 3
(b) How many children were
born alive but are now
dead?
one
(c) How many previous fetal deaths of ANY gestation age ?
21 LENGTH OF PREGNANCY 20 .completed weeks (or
22 WEIGHT OF FETUS
Lb.
Oz
Grams )
23 WHEN DID FETUS DIE?
Before
Labor
During Labor
or Delivery
Unknown
25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Unkur
Due To (b) Due To (c)
OTHER SIGNIFICANT CONDITIONS none
26 HOLY CROSS Place of burial or Cremation DATE OF BURIAL APRIL 10
MALDEN (City or Town)
19 €/
27 NAME OF
FUNERAL DIRECTOR DIPIETRO XVAZZA ADDRESS IHENRY ST, EAST BOSTON
Received and filed
April 10,
19 b1
Registrar
I HEREBY CERTIFY that this delivery occurred on the date stated above at m., and product of conception was not a live birth.
Signature of Attending Physician or Medical Examiner: Charles meloni. M.D.
Address
CHARLES MELONI (PRINT OR TYPE SIGNATURE) 305 Have WE Both Dateepul7 1961
I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued :
Ralph E. Lerianne
Caffe nature of Agent of Board of Health or other)
H.O.
4/10/6/
( Official 1al Designation )
(Date of Issue of Permit)
-
riving SE OF DEATH t enter han one or each ). (b) (c)
maternal causing ath (do e such stillbirth turity. ) d/or ma- unditions, ich gave above , Stating ferlying! t.
·s of fetus r which contrib- fetal it, in so known, related given
No. Winthrop Community Hospital
2 NAME OF FETUS (if given )
Baby Girl Masiello
St.
A TRUE COPY ATTEST.
19 INFORMANT DOMENIC MASIELLO
(City or Town)
(State or country
BOSTON (City or Town
24 AUTOPSY
Yes
.No
FETAL DEATH
TOW
11 12 3
12
10.
9
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, .. . shall not be permitted except 4FŐ 1 01961 PM
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. " ... No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
301A 1
ONS
TIFICATE
1g DEATH iter one each nd (c)
ot mean dying, failure, t means compli- caused
any, ise to (a), under- last. contrib- but not terminal n given
pter 137, requires print or ause or eath on lates, and Acts of s Physi- et or type gnature.
2-45
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
Mount's Rest Home No.
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.
63
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
( First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
2.Bayou Street
.St.
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.years ...
1
months ..
.days. In place of residence.
5.0.years
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDowerried
or DIVORCED
(write the word)
3 DATE OF
DEATH
April10 ,1961
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
may
19.5 J
Gipril
10
........ , to ...
I last saw hl. malive on
1991
april
8
death is said to
have occurred on the date stated above, at
6:05Am.
10a If married, widowedupp dvouffd Tierney
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
85
If under 24 hours
AGE
Years
Months ............
.Days
Hours ....
......
... Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business:
....
U.S.Postal ..... employee
15 Social Security No. Boston
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Francis Boland
18 BIRTHPLACE OF
FATHER (City)
Fare M. D (State or country) Ireland
19 MAIDEN NAME
4901
OF MOTHER
Mary McVey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Helen ..... Boland.
Informant
(Address)
2 Bayou St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E Mireanne
Received and filed
APR 11 1961
19
(Registrar)
PARENTS
Winthrop Cemetery
Winthrop
6 Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April 13
19
61
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass.
ADDRESS
(PRINT OR TYPE SIGNATURE)
194 Washington are 4
(Address)
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
no
(Signed)
To Steph GREGORIO
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
INTERVAL BETWEEN ONSET AND DEATH up
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial Heart
(a)
Due To
(b)
arteriosclerosis gen
Due To
(c)
Senility
19.
Registered No.
141 Highland Ave. Richard Boland
[(Was deceased a U. S. War Veteran,
[if so specify WAR)
(Official Designation)
(Date of Issue of Permit)
atte Signature of Agent of Board of Health or other)
H.O.
april 11, 1961
8.
(Month)
RECEIVED
OF TOW 11 12. 3
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
APT 1 1 19GL CH
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.
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(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
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