Town of Winthrop : Record of Deaths 1961, Part 14

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 14


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


6.2/1


R-302


Suffolk .......


...


(County )


Revere


(City or Town )


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Revere


(City or Town making this return)


64.


§ (If death occurred in a hospital or institution. .St. ¿ give its NAME instead of street and number)


Thomas Fazio


(If deceased is a married, widowed or divorced woman, give also maiden name.)


194 Main


winthrop


St


(a) Residence. No ( Usual place of abode )


15


Length of stay: In place of death


......... years .......... months.


......... days. In place of residence.


.years.


.months.


......


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


April


11,


1961


(Month)


(Day)


(Year)


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


4 I HEREBY


CERTIFY,


That


I


attended deceased


from


61


April 11


19


61 April 11


19


im


April 19 61


death is said to


have occurred on the date stated above, at m.


INTERVAL BETWEEN ONSET AND DEATH


2


hours


12


AGE ..


Years.


If under 24 hours


......


Hours .......


Minutes


13 Usual


Occupation:


Instructor


(Kind of work done during most of working life)


14 Industry


Auto School


or Business :


15 Social Security No.


033-160-6722


16 BIRTHPLACE (City)


(State or country)


Italy.


17 NAME OF


FATHER


Thomas Fazio


18 BIRTHPLACE OF


FATHER (City)


(State or country )


Italy


19 MAIDEN NAME OF MOTHER Pietrina Galena


20 BIRTHPLACE OF MOTHER (City) Italy


( State or country)


Mrs.


Thomas Fazio


21


Informant


194 Main St., Winthrop


( Address )


A TRUE COPY


ATTEST :


» (Registrar of City or Town where death occurred )


April


14,


61


.19


( Registrar of City or Town where deceased resided )


PARENTS


D. D. Potito


(Signed)


M. D. 17A Bennington St.


( Address ) L ..... Boston


Date ...


1;/11 6


19


Winthrop


winthrop


Place of Burial or Cremation DATE OF BURIAL


April


(City ar Town) 15,


61


19


7 NAME OF


FUNERAL DIRECTOR


Ernest P. Caggiano


ADDRESS 147 Winthrop St., Winthrop


Received and filed


19


10a If married. widowedsor pivoregde Blanca HUSBAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Acute coronary thrombosis


( a) Due To (b) 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46. Sec. 12. G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased VI ILLUINS UI ucallis willen occurred in your city or town in case the deceased resided in another city or town Due To (c)


50M-9-59-926111


1


PLACE OF DEATH


340 Reservoir Ave.


No ..


2 FULL NAME


( Was deceased a


U. S. War Veteran,


if so specify WAR,


(If nonresident, give city or town and State)


I last saw h ...


.alive on


12:15P


to


CONDITIONS


No


Was autopsy performed ?


What test confirmed diagnosis ?



5 Was disease or injury in #


If so. specify


Proway related to occupation of deceased ?


5yrs. ago


OTHER Coronary Thromb.


SIGNIFICANT


61


3


Months ..


.Days



DATE FILED


Registered No.


3


1


5


6


HROB


MAY =51961 FM


SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


<


PLACE OF DEATH


SUFFOLK (County) Winthrop (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered


65


[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) No. Winthrop Community Hospital


2 FULL NAME John Haugh


(If deceased is a married, widowed or divorced woman, give also maiden name.)


86 Pellevue Avenue


St.


Winthrop


(If nonresident, give city or town and State)


Length of stay: In place of death.


............. years.


months.


.11 .. days. In place of residence,


35


.. years.


.months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


11


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY,


That I attended deceased from


APRIL


11


19


1-et-10


,61


to ..


APRIL 10 19 61


death is said to


have occurred on the date stated above, at


2 º1 Am.


INTERVAL


BETWEEN


ONSET AND


DEATH


7mc.


11 IF STILLBORN, enter that fact here.


12


AGE


7.5 Years.


Months .....


Days


If under 24 hours


Hours ...


Minutes


Retired


13 Usual


Occupation :


Stationary Fireman


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


022- 03 - 3788A


16 BIRTHPLACE (City Westport, Cty. Mayo


(State or country)


Ireland


17 NAME OF


FATHER


Francis Haugh


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Burke, Mary


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21


Informant


Mary Haugh


(Addres 86 Bellevue Avenue, Winthrop


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


ADDRESS


Winthrop, Massachusetts


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


WIDOWED


or DIVORCED


10a If marri


HUSBAND of


catherine Tarmey


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


GENERAL CARCINOMATOSIS


(a)


Due To CARCINOMA OF LARYNX


(b)


5YRS


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


NONE


Was autopsy performed?


No


What test confirmed diagnosis ?


CLINICAL


5 Was disease or injury in any way related to occupation of deceased 10 If so, specify


(Signed)


M. I).


MYRON JU. KING MITD


(PRINT OR TYPE SIGNATURE)


(Address) 2-2 2 PLEASANT W INTEPE CP /2.1755 Date.


4/11


1961


Winthrop Cemetery


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 14,


61


19


I HEREBY CERTIFY that a satisfactory standard certificate of death


was filed with me BEFORE the burial or transit permit was issued:


Ralph E. Saranno


(Signature of Agent of board of Health or other)


1.0


april 11 - 1961


(Official Designation) (Date of Issue of Permit)


-926662


-301A 1


TONS


TIFICATE


ing DEATH nter n one each and (c)


nat mean dying, failure, It means r campli- caused


if any, rise ta (a), under- last.


contrib- but nat terminal an given


ter 137, equires print or use or ath on tes, and Acts of Physi- or type nature.


PARENTS


To be filed for burial permit with Board of Health or its Agent.


PHYSICIAN - IMPORTANT


(Was deceased a U. S. War Veteran, [if so specify WAR)


(a) Residence. No. (Usual place of abode)


(Give maiden name of wife in full)


I last saw h/ .. / ... ]live on


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 PT. 1 1 1961 AM 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


FORM R-302


WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD


6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46. Sec. 12. G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)


PLACE OF DEATH


Essex


(County)


1


Danvers


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Danvers


(City or Town making this return)


66


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


184 Somerset Avenue


11. St


Winthropº 5


if so specify WAR


(a) Residence. No .. ( Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death.


8


.years.


8


.. months


.6


.days. In place of residence .......... years .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


April


12,


1961


(Month )


(Day)


(Year)


8 SEX


male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


single


4 I HEREBY CERTIFY.


That I


attended deceased


from


August 6,


52


,61


April


12


19


im


I last saw h ...... alive on


19


., death is said to


have occurred on the date stated above, at


INTERVAL BETWEEN DNSET AND DEATH


11 IF STILLBORN, enter that fact here.


12 .76 10 18


Retired Government


Inspecto


( Kind of work done during most of working life)


14 Industry or Business :


Unknown


15 Social Security No.


South Boston


16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF FATHER John Manning


18 BIRTHPLACE OF


Boston


FATHER (City)


( State or country)


Mass.


19 MAIDEN NAME OF MOTHER Mary Feenan


20 BIRTHPLACE OF


Boston


MOTHER (City)


(State or country)


Mary E. Sheehan


Mass.


Place of Burial or Cremation


April (City & Town) 61


19


21 Informant ( Address )


Hathome ,Mass.


7 NAME OF


FUNERAL DIRECTOR


Bernard S McNamara


Boston, Mass.


ADDRESS


Received and filed


19


(Registrar of City or Town where deceased resided)


A TRUE COPY


.


ATTEST :


(Registrar of City or Town where death occurred)


r


April


17,


19


61


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of ..


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Cerebro-Vascular Accident


(a)


Due To generalized Arteriosclerosis (b)


years


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? NO Clinical & Laboratory


What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ? If so. specify


( Signed)


Andrew Nichols III


(Address )


Hathome, Mass.


4/12/


Date


19


PARENTS


M. D. 61


Calvary Cemetery, Roslindale, Mass.


50M-9-59-926111


24 hours


AGE


Years ..


.Months.


Days


If unde


Ho


3.


.. Minutes


13 Usual


Occupation:


19


April


12",


61


9:45 a


to ..


Danvers State Hospital, Hathorne


No


George L. Manning


( Was deceased a


U. S. War Veteran,


Nc


Registered No.


S (If death occurred in a hospital or institution, .. St. ¿ give its NAME instead of street and number)


DATE FILED


DATE OF BURIAL


F TOM


MAY -51961 PM


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


×


PLACE OF DEATH -


Suffolk (County)


Winthrop


STANDARD CERTIFICATE OF DEATH NoME


Registered No.


S(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


f(Was deceased a U. S. War Veteran, [if so specify WAR)


67


(a) Residence. No. 46 Washington Ave. St.


(Usual place of abode)


Length of stay: In place of death.


............. years.


4


months ... ........... days. In place of residence 3


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


APRIL


12


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY,


That I attended deceased from


Fib, 24


1961, to HPBin


12


19. Ei


10a If married, widowed, or divorced


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


69


8


2


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


None


(Kind of work done during most of working life)


14 Industry


or Business :


at home


15 Social Security No.


Boston


16 BIRTHPLACE (City)


(State or country)


Lass.


17 NAME OF


FATHER


George Marsters


18 BIRTHPLACE OF st. John


FATHER (City)


(State or country) New Brunswick


19 MAIDEN NAME


OF MOTHER


Mary Schlchuber


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass.


Boston


21 Records O.A.A.


Informant


(Address)


Town of Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Jack/2 E.


(Signature of Agent of Board of Health or other)


H.G


4/14/6/


Received and filed


APR 14 1961


19


(Registrar)


PARENTS


M. D.


MITRAUNSTEINi UR:


(PRINT OR TYPE SIGNATURE)


(Address) 13 BARTLETT


Date APRIL 7061 Winthrop


6


Hinthrop


Place of Burial or Cremation


DATE OF BURIAL


19


April 14


(City or Town) 61


7 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


ADDRESS


Winthrop Mass


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


(City of TownAintROP Convalescent 142 Pleasant St.


No.


2 FULL NAME


Viola Marsters


(If deceased is a married, widowed or divorced woman, give also maiden name.)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word


MARRIED


WIDOWED


or DIVORCEISingle


I last saw h .... lalive on


APRIL 11


19. 61, death is said to


have occurred on the date stated above, at


7:25 Pm.


INTERVAL BETWEEN ONSET AND DEATH


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


BRONCHOPNEUMONIA


(a)


Due To


MYOCARDIAL INFARCTION


(b)


3Mg


Due To


ARTERIOSCLEROTIC iFART


DISEASE


2 YRS


OTHER


SIGNIFICANT


AMPUTATED LETTREG


CONDITIONS


3: LATERAL BREAST CHE ON092


Was autopsy performed?


What test confirmed diagnosis ?(


CLINICAL, LAB.


5 Was disease or injury in any way related to occupation of deceased? (0) If so, specify


(Signed)


RM R-301A 1


NSTRUCTIONS FOR CAL CERTIFICATE


In giving SE OF DEATH do not enter ore than one ause for each a), (b) and (c)


s does not mean mode of dying, os heart failure, io, etc. It meons iseose, or compli- IS which coused


ditions, if ony, ch gove rise to ve cause (o), ing the under- cause last.


conditions contrib- to death but not to the terminol condition given


:- Chapter 137, f 1954. requires ians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.


:4-11-59-926662


(Official Designation) (Date of Issue of Permit)


X


MEDICAL CERTIFICATE OF DEATH


(If nonresident, give city or town and State)


.years .............. months .............. days.


AGE


Years.


Months.


Days


030-14-2534


(c)


To be filed for burial permit with Board of Health or its Agent.


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 Deatb .- 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 JUFFOLYT (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. 68


[(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.) 93 LOCUST ST St.


Length of stay : In place of death .......... ... years .. 6. months days In place of residence.


40 years


.months .. .. ... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE


9 COLOR


WHITE


10 SINGLE


MARRIED


(write the word)


WIDOWED


Or DIVORCEDWIDOWED


4 I HEREBY CERTIFY,


Jan 17


1961


to April


15


That I attended deceased from


I last saw h& .. Y ... alive on


April


14


1961


death is said to


have occurred on the date stated above, at


6:30 A.m.


INTERVAL


BETWEEN


ONSET AND


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Pneumonia


Due To (b)


Due To (c)


OTHER SIGNIFICANT Arterio saleros is, generaliza 20yrs. 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


19 MAIDEN NAME


(Signed)


Charles Liberman


... , M. D.


OF MOTHER


ELIZABETH DIGMAN


CHARLES LIBERMAN


(PRINT OR TYPE SIGNATURE) (Address) Winthrop Mass Date


WINTHROP


6


WINTHROP


(City or Town)


Place of Burial or Cremation


18


DATE OF BURIAL


APRIL


1961


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS WINTHROP


Received and filed


19


(Registrar)


PARENTS


21 Informant


LOUISE MULLEN


(Address) 48 FOWLER ST REVERE


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)


16.0.


4/17/61


(Official Designation) (Date of Issue of Permit) Y


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


CAMPBELL


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE 86


DEATH


9 days


" Years


Months ..


Days


If under 24 hours


Hours .............. Minutes


13 Usual


Occupation :


HOUSE WIFE


(Kind of work done during most of working life)


14 Industry


or Business :


HOME


15 Social Security No.


NONE


16 BIRTHPLACE (City)


(State or country)


MASS


EAST BOSTON


17 NAME OF


FATHER"


THOMAS DALY


18 BIRTHPLACE OF


FATHER (City)


(State or country)


IRELAND


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


IRELAND


PLACE OF DEATH


M R-301A 1


TRUCTIONS FOR AL CERTIFICATE


n giving E OF DEATH not enter ·e than one se for each , (b) and (c)


does not mean ode 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 condition given


- Chapter 137, 1954. requires ans to print or he cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.


0.6-59-925686


April


(Month)


(Day)


15 1961 (Year)


To be filed for burial permit with Board of Health or its Agent.


No WINTHROP CONVALESCENT HOME 142 PLEASANT ST. CATHERINE & CAMPBELL (Daly)


2 FULL NAME


(a) Residence. No. ( Usual place of abode)


(If nonresident, give city or town and State)


3 DATE OF


DEATH


9.61


(or) WIFE of


WILLIAM


4/15/106/


SPACE FOR ADDITIONAL INFORMATION F


DATE OF ENTERING MILITARY SERVICE


DATE OF / DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER 6


11


4PT 21901 PM


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)


PENSE P


Winthrop (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Winthrop Convalescent Home


St. ¿ give its NAME instead of street and number) No.


2 FULL NAME


CharlesElmerAtwood


(If deceased is a married, widowed or divore 1 uman give also maiden name )


(a) Residence. No. (Usual place of abode)


33 Bellevue Avenue


1


Length of stay: In place of death. 2 .. years ... ...... ... months ... days. In place of residence.


(If nonresident, give city or town and State) 30 years months ... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIEDWidowed


WIDOWED


or DIVORCED


10a If married, widowed, or. divorced


KatieEvelynGutterson


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.9.1 ... Years.


4


Months.


2.8Days


If under 24 hours


.. Minutes


13 Usual


retired messenger


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Railway Express Agency


15 Social Security No. none


16 BIRTHPLACE (City)


(State or country)


Vermont


17 NAME OF


FATHER


Alvin Atwood


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Vermont


19 MAIDEN NAME OF MOTHER Brown


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Vermont


21 Loren Atwood


Informant


(Address)


Tarzena, California


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


Mass


(Signature of Agent of Board of Health or other) 4/18/01


(Official Designation) / (Date of Issue of Permit)


V.


3 DATE OF


DEATH


April


16


19.61


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


OCT 25


, 1952


APRIL 16


.... , to .....


APRIL 16, 1961


That I attended deceased from


69


19.


I last saw h./Malive on


death is said to


have occurred on the date stated above, at


5:00Pm.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE




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