Town of Winthrop : Record of Deaths 1961, Part 22

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 22


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


(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.


HERE'SSC


5 TOF


6


ien ?.


JUN -51961 PM


x


PLACE OF DEATH


Suffolk (County)


INS


Winthrop Mass .


(City or Town)


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


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


49 Hermon Street


(a) Residence. No.


(Usual place of abode)


2


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


June


7


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That Iattended deceased from


6/4/


1961


to ...


6/7/


61


I last saw He .. Y .. alive on


6/7/


19.61


death is said to


have occurred on the date stated above, at


7:30 Ppm.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Cerebral Hemorrhage


Due To


(b)


Hypertension


Due To


(c)


OTHER


SIGNIFICAN Arteriose levotic Heart Disease


CONDITIONS


Atrial Fibrillation


lomos.


Was autopsy performed?


NO


What test confirmed diagnosis?


Clinical


5 Was disease or injury in any way related to occupation of deceased?


If so, specify .


No


(Signed)


Charles Liberman


M. D


Charles


Liber mani


(PRINT QR TYPE SIGNATURE)


(Address)


Winthrop, Mass


Date ..


6/7/


1961


6


Winthrop Cemetery


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


June 10, 19 67


7 NAME OF


FUNERAL


DIRECTOR


Arthur .... J ........ 0."Maley.


Winthrop, Mass.


ADDRESS


Received and filed JUN 12-1961 .. 19.


( Registrar )


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Finland


19 MAIDEN NAME


OF MOTHER


Margaret Mckeon


20 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


Mass


21 Eileen Wilson


Informant


(Address)


49 Hermon St., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: DolphE. Sercanni (Signature of Agent of Board of Health or other)


2.0.


June 8/1961


(Official Designation)


(Date of Issue of Vermit)


MARRIED


WIDOWER.


or DIVORCEIdOwed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Albert J. Mulrey


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


72


Years ...........


Months ...


.Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Housekeeper


(Kind of work done during most of working life)


14 Industry


or Business:


.Home


15 Social Security No.


Charlestown


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


Joseph Wilson


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


TRUCTIONS FOR L CERTIFICATE


giving OF DEATH not enter : than one e for each (b) and (c)


does not mean de of dying, heart failure, etc. It means ise, or compli- which caused


ions, if any, gave rise to cause (a), the under- cause last.


ditions contrib- death but not o the terminal condition given


50-928145


M R-301A 1


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


Winthrop Community Hospital


No. Julia (Wilson) Mulrey


2 FULL NAME


(First Name)


(Middle Name)


(Last Name)


St.


(If nonresident, give city or town and State)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


INTERVAL


BETWEEN


ONSET AND


DEATH


3days


2 yrs,


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE FT


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


1.


-.


JUN 1 2 1961 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.


×


:00


M R-303 A


1


(City or Town) PLACE OF DEATH Suffolk County)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


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


Registered No.


112


No


10 Surfside Live


St.


§ (If death occurred in a hospital or institution,


( give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


[(Was deceased a


(Last Name)


U. S. War Veteran,


[if so specify WAR)


No


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


10


Surfside ave Winthrop.


Man


( If nonrendent, give city or town and State)


Length of stay: In place of death. .. years. .. months. days. In place of residence. 38years


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


F


10 COLOR


White


11 SINGLE


(write the word)


MARRIED


WIDOWED Single


or DIVORCED


lla If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


5 Accident, suicide, or homicide (specify)


Date and hour of injury


.19


IF ACCIDENTAL, was injury causally related to the death?


Where did


Injury occur ?


12 IF STILLBORN, enter that fact here.


13


69


AGE.


Years ..


Months ..........


Days


If under 24 hours


Hours


.Minutes


14 Usual


Occupation :


Clerk


(Kind of work done during most of working life)


15 Industry


or Business :


Brine's Sporting Goods Co.


16 Social Security No.


032-03-3937


17 BIRTHPLACE (City)


(State or country)


Mass.


Somerville


18 NAME OF


FATHER


Charles Edward Stevens


19 BIRTHPLACE OF


St. Johns


FATHER (City)


(State or country)


N.B., Canada


20 MAIDEN NAME


OF MOTHER


Mary Emma Armstrong


21 BIRTHPLACE OF


MOTHER (City)


Lunenburg


(State or country)


Nova Scotia


22 Mrs. Mary E.Taylor


Informant


(Address)


10 Surfside Ave. Winthrop


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


(Signature of Agent of Board of Health or other)


96.0.


June 12, 1961


(Official Designation) (Date of Issue of Permit)


(Registrar)


PARENTS


............... , M. D.


.... M ...............


11


1961


Malden


(City or Town)


1961


8 NAME OF


FUNERAL DIRECTOR


FRANK H. CARR


ADDRESS


79 Elm St. Charlestown


Received and filed


JUN 12-1961


19.


2 FULL NAME (a) Residence. No. (Usual place of abode) MEDICAL CERTIFICATE OF DEATH 3 DATE OF DEATH (City or town and State) Manner of (Specify type of place) Injury (How did injury occur ?) Nature of Injury (Signed) Michael A ...... Luongo ......... (Painfor Type Signature) Boston (Address) Date 6 Holy Cross 7 Place of Burial, or Cremation. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF §§ 44-48. DATE OF BURIAL June 13. ٢١ 50M-6-60-928145 E N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of While at work? Was autopsy performed ?


(June (Month) (Day) (Year)


10 1961


4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof ; are as follows: (If an injury was involved, state fully.)


ARTERIOSCLEROTIC HEART DISEASE ACUTE CONGESTIVE HEART FAILURE


Did injury occur in or about home, on farm, in industrial place, or in public place ?


6 Was disease or injury in any way related to occupation of deceased ?


If so, specify/ ...


(First Name) (Middle Name)


Stevens


months


.. days.


VIL


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


OF TOWN


RANK, RATING


NIW


3


ORGANIZATION AND OUTFIT


ERK


7


5


6


TROP MAS


JUN 1 21961 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 unrelated to any form of injury.


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


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


STATEMENT OF CAUSE OF DEATH


Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."


If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"


SERVICE NUMBER


PLACE OF DEATH


Suffolk (County)


PENSI


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.


113


[(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)


5. Hillside Avenue


St.


(If nonresident, give city or town and State)


Length of stay : In place of death. .years .. months. 4 days. In place of residence. 43


years.


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED Married


WIDOWED


or DIVORCED


10a If married, widowed, or divorced Agnes Brown


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


81


2


15


AGE


Years


Months


Days


If under 24 hours


Hours.


.Minutes


8 yrs 13 Usual


Occupation :


Engineer


14 Industry


or Business :


architectural


15 Social Security No.


011-01-0396


Lowe II


16 BIRTHPLACE (City) (State or country) Mass


17 NAME OF FATHER Frederick Munn


18 BIRTHPLACE OF


FATHER (City)


Sandy Hill


(State or country)


New York


19 MAIDEN NAME


OF MOTHER


Emeline Caufield


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass.


Lowell


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


June 16


19 ... 61


7 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


Winthrop, Mass


ADDRESS


Received and filed JUN 2-0 1961 .19


( Registrar)


PARENTS


Agnes Munn


21


Informant


(Address)


5 Hillside Ave.


Winthrop


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


Lisanne


(Signature of Agent of Board of Health or other)


4,0 6/16/6/


l (Official Designation)


(Date of Issue of Permit)


UCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each (b) and (c)


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


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


tions contrib- leath but not the terminal ndition given


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


-928145


2 FULL NAME Ernest Gibson Munn ( First Name) (Middle Name) (Last Name) (1f deceased is a married, widowed or divorced woman, give also maiden name.)


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


June


14


196I


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


8 Sept 19 58


to


That I attended deceased


14


June


19


1 last saw h ........ alive on


death is said to


have occurred on the date stated above, at


1:10 Pm.


INTERVAL BETWEEN ONSET AND DEATH 1 yr


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Carcinomatosis


(a)


Due To


Carcinoma of Larynx


(b)


Due To


(c)


OTHER SIGNIFICANT CONDITIONS


None


Was autopsy performed?


No.


What test confirmed diagnosis?


Biopsy MGH 1959


5 Was disease or injury in any way related to occupation of deceased? IO. If so, specify. Ene: Arthur CO. Murray, M. D Arthur C. Murray, M. D. (PRINT OR TYPE SIGNATURE)


(Address) Winthr ..... as.S. Date .. 15 June 61


6


Edson


Lowell


Registered No.


No. ...


Winthrop Community Hospital


R-301A 1


3 DATE OF


DEATH


June6I


(Kind of work done during most of working life)


RECE VED


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OFFI.


2 ERK


...


TH


JUN- 2.01961 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)


CANSi


Winthrop, Mass. (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.


Registered No. 114


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


2 FULL NAME Louise (Ingalls) I. Griffin


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


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


[if so specify WAR)


(a) Residence. No. 15.VillaAve,Winthrop , .... Mass .... St. (Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death .............. years .............. months.


3 ... days. In place of residence ...... Oyears ...


.months .............. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED TAI


or DIVORCEWidow


10a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


(Give maiden name of wife in full)


Arthur Eugene Griffin


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


8.5Years


8


Months.


.5 ..... Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


None


15 Social Security No.


None


16 BIRTHPLACE (City)


Boston , ...... Mass ..


(State or country)


17 NAME OF


FATHER


Frederic C. Ingalls


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Boston, Mass.


19 MAIDEN NAME


OF MOTHER


Mary Munro ( Ingalls)-


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Paspbiac Canada


21 Dora M. Ingalls (sister)


Informant


(Address)


15 Villa Ave. Winthrop


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


ADDRESS 174 Winthrop St. Winthrop


Received and filed


JUN 2 0 1961


19


(Registrar)


PARENTS


myron . Kung


(Signed)


M. D.


MYRON UN. KING MOD


(PRINT OR TYPE SIGNATURE)


6/17 /06/


(Address) 222 PLEASANT WINTHROP MYASS Date.


6


Winthrop Cemetery,


Winthrod


Place of Burial or Cremation


(City or Towass .


DATE OF BURIAL June 20 ,1961 19


2 YRS


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


PARTIAL UREMIA.


3 DAYS.


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


INTERVAL


BETWEEN


ONSET AND


DEATH


3 DAYS


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


CEREBRAL VASCULAR


ACCIDENT


(b)


ions, if any, gave rise to cause (a), the under- cause last.


ditions contrib- death but not o the terminal condition given


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


C


11-59-926662


6


17


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY


That I attended deceased from


61


4/26


19.61


to


6/17


I last saw h.ERalive on


6/12


1961


death is said to


have occurred on the date stated above, at


.. m.


9A


ARTERIO-SCLEROTIC HEART


DISEASE + KIDNEY DIS.


M R-301A 1


TRUCTIONS FOR CERTIFICATE


1 giving OF DEATH


not enter than one e for each (b) and (c)


does not mean de of dying, heart failure, etc. It means se, or compli- which caused


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or . transit permit was issued: Ralph E Sirianni af (Signature of Agent of Board of Health or other) H.C. 6/20/61


(Official Designation)


(Date of Issue of Permit)


V.IL


.Houserife


3 DATE OF


DEATH


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


ERK


.C


HROBY


JUN 2 01951 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.


X PLACE OF DEATH


Suffolk (County) 1


Winthrop (City or Town)


Winthrop Community Hospital No.


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


2 FULL NAME


Mary Malloy


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


(if so specify WAR)


(a) Residence. No.


98 Bradstreet Avenue


St.


Revere Mass


(Usual place of abode)


(If nonresident, give city or town and State)


............. months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


June 21 1961


DEATH


(Month)


(Day)


(Year)


That I attended deceased from


19


6


10a If married, widowed, or divorced HUSBAND of




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