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