Town of Winthrop : Record of Deaths 1961, Part 13

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 13


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51


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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