Town of Winthrop : Record of Deaths 1961, Part 16

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 16


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


14 Industry or Business :


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Q1+1.1


17 NAME OF


FATHER


James McGuirk


18 BIRTHPLACE OF FATHER (City) (State or country)


Revere, Mass.


19 MAIDEN NAME OF MOTHER Eleanor Lane! ; t ~


20 BIRTHPLACE O MOTHER (City) (State or country)


Winthrop,., Mass.


21 James McGuirk


Informant (Address) 8 Constitution Ave. Revere


I HEREBY CERTIFY that a satisfactory standard certificate of deat was filed with me BEFORE the burial on transit permit was issued: Ralph 5


Ctf Agent of Board of Health or other)


HO


4/ 28/6/


(Official Designation)


(Date of Issue of Permit)


V


RM R-301A 1


INSTRUCTIONS FOR ICAL CERTIFICATE


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


is does not meon mode of dying, os heart foilure, nia, etc. It means isease, or compli- s which caused


ditions, if ony, ich gave rise to I've couse (0), ling the under- g couse last.


Conditions contrib- n to death but not at to the terminol eb condition given


::- Chapter 137, e f 1954. requires y cians to print or e the cause or s of death on scertificates, and aer 48, Acts of 9 requires Physi- no print or type n inder signature.


14-11-59-926662


PARENTS


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


Winthrop Community Hospital No.


S(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)


PERSONAL AND STATISTICAL PARTICULARS


INTERVAL BETWEEN ONSET AND DEATH


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


TO !!


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-li 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


-


, Li


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


STANDARD


CERTIFICATE OF DEATH


Registered No.


S(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


73 Green Street


St.


Charlestown


(If nonresident, give city or town and State)


Length of stay: In place of death .............. years. months .. 2 ..... days. In place of residence22 .... years ........... months ... .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


or DIVORCEWIDOW


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


JAMES JOSEPH MAHONEY


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE65 Years.


Months.


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


HOUSE-WORK With


(Kind of work done during most of working life)


14 Industry


or Business :


AT HOME


15 Social Security No.


NONE


16 BIRTHPLACE (City)


(State or country)


NEWFOUNDLAND.


CANADA


17 NAME OF


FATHER


PETER CLEARY


18 BIRTHPLACE OF


FATHER (City)


NEWFOUNDLAND


(State or country)


CANADA


19 MAIDEN NAME


OF MOTHER


MARY O'BRIEN


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


NEWFOUNDLAND


CANADA


6 .ST ..... JOSEPH'S


ROXBURY


(City or Town)


Place of Burial or Cremation


DATE OF BURIAL


.MAY ....


1


19.6.1


19


7 NAME OF FUNERAL DIRECTOR Frank CARR


ADDRESS


CHARLESTOWN


Received and filed APR 27 1961 19


(Registrar)


PARENTS


Cheaples


(Signed)


Fiberman


2., M. D).


(Address)


Charles Liberman (PRINT OR TYPE SIGNATURE) Winthrop, Mass Date.


4/27 1961


21 MRS. CHRISTINE ..... CORBETT


Informant (Address) 56 GREEN ST CHARLESTOWN


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with: me BEFORE the burial of transit- permit was issued: Kalkh &. Serianme


(Signaty e) of Agent of Board of Health or other)


Ho att


april 27-1961


(Official Designation)


(Date of Issue of Permit)


(write the word)


3 DATE OF


DEATH


April


(Month)


(Day)


27


1961


(Year)


4 I HEREBY CERTIFY,


April 25


19 61


to ..


April. 27,


19194


That I attended deceased from


I last saw he Valive on


April 26, 19146, death is said to


have occurred on the date stated above, at 2:00 A.m.


INTERVAL


BETWEEN


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Cerebral Hemorrhage


(a)


ONSET AND


DEATH


2 days.


Due


Cerebral Arteriosclerosis.


(b)


1gr.


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? No. If so, specify


7


(County)


WINTHROP


(City or Town)


No.


Winthrop Community Hospital


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


75


2 FULL NAME


CHRISTINE (Cleary) MAHONEY


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


NSTRUCTIONS FOR CAL CERTIFICATE


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


s does not mean mode of dying, as heart failure, ja, etc. It means sease, or compli- which cuused


litions, ij uny, h gave rise to e cause (a), ing the under- cause last.


onditions contrib- to death but not to the terminal condition given


:- Chapter 137, 1954. requires sians to print or the cause or e of death on Certificates, and pr 48, Acts of , equires Physi- so print or type ender signature.


51-11-59-926662


RM R-301A 1


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


FEMALE


WHITE


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


TON


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE 4P. 'YISul fu


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.


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


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


76


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


PHYSICIAN - IMPORTANT


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


No


2 FULL NAME


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


23 Tewksbury Street


(a) Residence. No.


(Usual place of abode)


45


Length of stay: In place of death


years.


.months.


.days. In place of residence.


45


years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


29


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


10.05 pm.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Natural Causes


(a)


Due To


(b)


To Presumably Coronary Occlusion


(c)


Arteriosclerotic Heart Disease


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? no If so, spegify


Arthur C. Murray


(PRINT OR AYPE SIGNATURE)


Winthrop Board of Health at. 1 May 61


6


Woodlam Crematory


Everett


Place of Burial or Cremation


DATE OF BURIAL


May


3


(City or Town)


19 61


7 NAME OF


FUNERAL DIRECTOR


winthrop Mass


Howard S Reynolds


ADDRESS


Received and filed


MAY 2 1961


19.


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED Married


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


88


AGE


.Years


.. Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Waiter


14 Industry


or Business :


Hotel


15 Social Security No.


Berlin


030-03-6634


16 BIRTHPLACE (City)


(State or country)


Germany


17 NAME OF


FATHE


Unable to obtain LA10.7


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Unable to obtain


19 MAIDEN NAME


OF MOTHER


Unable to obtain


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Unable to obtain


21


Elise Krauthausen


Informant


(Address)23 Tewksbury 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.


(Signature of Agent of Board of Health or other) ceft


4.(


C


May 2-1961


(Official Designation)


(Date of Issue of Permit)


STRUCTIONS FOR AL CERTIFICATE


In giving E OF DEATH not enter re than one se for each ), (b) and (c)


does not mean ode of dying, s heart failure, a, etc. It means ease, or compli- which caused


itions, if any, h gave rise to e cause (a), ng the under- cause last.


nditions contrib- o death but not to the terminal condition given


:- Chapter 137, : 1954. requires ians to print or the cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.


1


-11-59-926662


RM R-301A 1


Registered No.


No.


23 Tewksbury Street


Emil Krauthausen


St.


(If nonresident, give city or town and State)


INTERVAL


BETWEEN


OKSET AND


DEATH


(Kind of work done during most of working life)


PARENTS


TOW


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


MAY =21961 AM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


IT:


A'


7. 6 3


HROP


PLACE OF DEATH


Suffolk (County)


CINSI


Winthrop (City or Town)


No. .1.2 ...... Charles ..... S.t.


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.


Registered No.


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


2 FULL NAME Frank G. Corbitt (First Name) (Middle Name) (Last Name)


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


12 .... Charles ... St


St.


( If nonresident, give city or town and State)


Length of stay: In place of death.


.years ..


.. months


days.


In place of residence.3.5.


years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


May1 1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


May ..... 29


19 .. 50 .. , to .. May ..... 1,


1961


I last saw himalive on .. May ..... ]


19 .... 61, death is said to


have occurred on the date stated above, at


9:35 ..... p.m.


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ...


.85


........ Months ..


.Days


If under 24 hours


Hours ......


Minutes


13 Usual


Occupation :


Retired


14 Industry


or Business :


Music ..... Business.


15 Social Security No.


021-07-2682


Jeffersonville


Was autopsy performed?


no


What test confirmed diagnosis? Clinical & Laboratory


5 Was disease or injury in any way related to occupation of deceased? NO. If so, specify


(Signed)


M. Tranny


5


M. D


M.Traunstein, Jr . , M.D.


(PRINT OR TYPE SIGNATURE)


(Address)


.73 ... Bartlett ... Rd.


.Dat


5,2


1961


Cremation


6


... Woodlawn .Cemetery ..


Everett ...


(City or Town)


DATE OF BURIAL


May 4, 1961 19


7 NAME OF


FUNERAL


DIRECTOR


Arthur J. O'Maley


ADDRESS


Winthrop .... Mass


Received and filed


MAY 4 1961


.19


( Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City) .Cannotbelearned ..


(State or country)


19 MAIDEN NAME


OF MOTHER


Anna Marie Gillespie


20 BIRTHPLACE OF


MOTHER (City)


Cannot be learned


(State or country)


Maetrue Corbitt


21


Informant


(Address)


12 Charles St. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: treff E- Verianais HO. (Signature of Agent of Board of Health or other) VaAC JHay 4/1961


(Official Designation)


(Date of Issue of Permit)


V.


RUCTIONS FOR CERTIFICATE


giving OF DEATH


ot enter than one for each (b) and (c)


Does not mean e of dying, heart failure, etc. It means e, or compli- which caused


os, if any, ave rise to cause (a), the under- cause last.


tions contrib- death but not the terminal ndition given


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


-928145


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


of DIVORERTried


HUSBAND of


Mare true Hennessey


(Give maiden name of wife in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Acute myocardial infarction


INTERVAL


BETWEEN


ONSET AND


DEATH


45 min


Due To


(b)


Arteriosclerotic heart disease


Due To


(c)


Generalized arteriosclerosis


4 yrs


OTHER


SIGNIFICANT


CONDITIONS


2 yrs


(Kind of work done during most of working life)


16 BIRTHPLACE (City)


(State or country)


Ohio


17 NAME OF


FATHER


Oliver K. Corbitt


Place of Burial or Cremation


[( Was deceased a U. S. War Veteran,


[if so specify WAR) No


(a) Residence. No.


(Usual place of abode)


I R-301A 1


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


TOWN


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


6


MAY - 41961 AM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


PLACE OF DEATH


Suffolk (County)


Winthrop


12


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


STANDARD CERTIFICATE OF DEATH


Registered No.


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


PHYSICIAN - IMPORTANT


2 FULL NAME


George W Coffin


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


(a) Residence. No.


30 James Ave


St.


(If nonresident, give city or town and State)


Length of stay: In place of death


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


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWEDM


or DIVORCEfarried


10a If married, widowed, or divorcedMinnie C Boyd


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


92


AGE


Years.


8


4


If under 24 hours


Hours


Minutes


13 Usual


Occupation :


Carpenter. Builder (retired)


(Kind of work done during most of working life)


14 Industry


or Business :


Self


15 Social Security No.


None


Nt Stewart


16 BIRTHPLACE (City


(State or country)


Prince Edward Island


17 NAME OF


FATHER


Duncan Coffin


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Prince Edward Island


19 MAIDEN NAME OF MOTHER Jessie Scott


20 BIRTHPLACE OF MOTHER (City) (State or country)


Prince Edward Island


6 Winthrop


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May 4


61


19


7 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


ADDRESS Winthrop Mass


Received and filed MAY 3 1961 19


(Registrar)


PARENTS


M. D).


Joseph Zambella


(Address)


(PRINT OR TYPE SIGNATURE) 35 Vilu Ave,Wirdlap Ja61


3400


(c)


Due To


Curoute Myocardials


3yrs


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis ?


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


(Signed)


May 2 1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


2-10-


1961, to.


That I attended deceased from


5-1-61


19


I last saw hq welive on


May


19.C. ( ... , death is said to


have occurred on the date stated above, at


9.469 m.


INTERVAL BETWEEN ONSET AND DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Hypertensive Heart


3410


Due To


Arteriosclerovic


(b)


Heart disease


litions, if any, h gave rise to e cause (a), ng the under- cause last.


nditions contrib- to death but not to the terminal condition given


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


C.


1-11-59-926662


21 Minnie C Coffin


Informant (Address 30 James Ave. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or trapeit permit was issued: Ralph E. Avranno (Signature of ageny @ Board of Health or other) 4.O. May 3/1961


(Official Designation) (Date of Issue of Permit) V.B. V


RM R-301A 1


STRUCTIONS FOR AL CERTIFICATE


(Usual place of abode) 63


91


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


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


(write the word)


Months


Days


In giving E OF DEATH o not enter re than one se for each ). (b) and (c)


does not mean sode of dying, s heart failure, a, etc. It means ease, or compli- which caused


(City or Town)


No. 30 James Ave.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


TOM


:


7 AF !


THROR:


RULES OF PRACTICE MAY = 31961 AM


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.




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