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