USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 31
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
(City or Town)
DATE OF BURIAL
August ..... 2.9.
1.61
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.
155
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not meon e of dying, heart failure, etc. It means se, or compli- which coused
ons, if ony, gove rise to cause (0), the under- couse lost.
itions contrib- deoth but not the terminal ndition given
1
Chapter 137, 954. requires is to print or :
cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.
6-59-925686
I HEREBY , CERTIFY that a satisfactory standard certificate of death sax filed with me BEFORE the burial or transit permit was issued: Galpli & teriaque g (Signature of Agent of Board of Health or other) Health Officer 8/25/61
(Official Designation)
(Date of Issue of Permit)
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
(a)
Arteriosclerotic
Heart Disease
Due (b)
Cardiac Decompensation
4 uks
Due To (c)
OTHER SIGNIFICANT Fracture Rt. Hip CONDITIONS
2mos.
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
1961
That I attended deceased from
(a) Residence. No. ( L'sual place of abode)
Length of stay : In place of death ....... .. ... years.
months
11
days. In place of residence
11 IF STILLBORN, enter that fact here.
I R-301A 1
Medical Examiner Notified
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE A RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
6
RULES OF PRACTICEAUG 2 91961 AM
The fulfillment of the purpose of these laws calls for the observance of the following · les 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) )
No.
Winthrop Rest Home
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
156
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
SARAH, GREENE . GREEN,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 Trident Avenue
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In place of death .......... ... years ....
. months !. ..... days. In place of residence
12
.years.
... months ...... " ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
August
27
1961
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY
19.56
to. August 27
I last saw helalive on
August 26, 1961, death is said to
have occurred on the date stated above, at
1:30 A. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebrovascular Conclusion
Lift Hemiplejia
Due To
(b) Arterios clerosis, cerebral
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes Mellitus
Byrs.
Was autopsy performed?
٨٥٠
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased? A0 If so, specify
(Signed)
Tau berman, M. D. Charles Liberman 1. (PRINT OR TYPE SIGNATURE)
(Address) diethirep lass Date.
8/27/1961
6
Anshe Poland Cong. Cem. Woburn
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL August 28, 1961 19
7 NAME OF
B.SCHLOSSBERG & SONS
FUNERAL DIRECTOR
ADDRESS
1257 Blue Hill Ave. , Mattapan
Received and filed AUG 29 1961 .... 19.
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
19 MAIDEN NAMRachael OF MOTHER
c.n.b.l.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)- -
-
Poland
21 Nathan Green
Informant (Address)
40 Trident Ave. Winthrop
I HEREBY CERTIFY tbat 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& "atther) .....
Health Office
8/28/6
(Date of Issue of Permit)
(Official Designation)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED)
WIDOWED Widowed or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Myer Greene
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
If under 24 hours
12
AGE
65
ears. Months. Days
Hours ............ Minutes
13 Usual
Occupation :
Housewife
(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)
P land
17 NAME OAbraham Segal FATHER"
itions contrib- deoth but not the terminal ondition given
Chapter 137, 954. requires ns to print or e
cause or of death on tificates, and 48, Acts of quires Physi- print or type ler signature.
5-59-925686
I R-301A -
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not meon le of dying, heart failure, etc. It means se, or compli- which caused
ons, if ony, gave rise to cause (o), the under- cause last.
PHYSICIAN - IMPORTANT
[(Was deceased a
{ U. S. War Veteran,
[ if so specify WAR)
N.o
(a) Residence. No.
( U'sual place of abode)
That I attended deceased from 1961
INTERVAL
BETWEEN
ONSET AND
DEATH
Zuks.
EURS,
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME
SPACE FOR ADDITIONAL INFORMATION
!
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
AUG 2 91961 AN
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
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
152
2 FULL NAME
Daniel, Canney
(If deceased is a married, widowed or divorced wonfan, give also maiden name.)
186 Winthrop St
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years ...
1
.months.
............ days. In place of residence.
47 years.
............. months .......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF Ja
DEATH
29
1961
(Month)
(Day)
(Year)
4 f HEREBY CERTIFY
July 28 1961, to.
aug 29
That I attended deceased from
19.
I last saw h./ malive on
aug
28, 1961
death is said to
have occurred on the date stated above, at .
6:47Am.
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
(b) arteriosclerosis - generalized
yo
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
emphysema
Was autopsy performed ?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed) a) Josep theple treforce M. D. OF MOTHER Margaret
Joseph GREGORIE (PRINT OR TYPE SIGNATURE) (Address) 194 Washington av Date 8/29 1961
6 Winthrop winther Winthrop
Place of Burial or Cremation DATE OF BURIAL August 31 67 (City or Town)
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Arthur J. O'Maley Winthrop, Mass
Received and filed AUG 30 1961 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVMarried
10a If married,
HUSBAND of
Elizabeth Turnbull
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE89
Years.
Months
.Days
If under 24 hours
Hours ....
Minutes
Occupation :
13 Usual
Retired R.R.Mail Clerk
(Kind of work done during most of working life)
14 Industry
or Business :
Railway ..... Mail
15 Social Security No.
015-20-4628
Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Michael Canney
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
21
Informant
Elizabeth .... Canney.
(Address) 186 Winthrop St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralkle ET erian (Signature of Agent of Board of Health of other) 1
Healthe Office
8/30/61
(Official Designation) (Date of Issue of/Permit)
To be filed for burial permit with Board of Health or its Agent.
No.
Winthrop Community Hospital
(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)
(a) Residence. No.
(Usual place of abode)
TRUCTIONS ' FOR L CERTIFICATE
n giving 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 ins to print or 1e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
11-59-926662
-2/1
M R-301A 1
PARENTS
Male
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Myocardial Heart
Piseuse
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
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.
R-301A 1
PLACE OF DEATH
Suffolk (County)
CANSTRETTO
Winthrop
(City or Town)
No. 95Marshall
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.
159
f(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
ANITA MARIA MULONE ( CAMMARATA)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
95 Marshall
St.
Winthrop
(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.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCE married
4 I HEREBY CERTIFY,
19
That I attended deceased from
19
I last saw h ........ alive on
19
death is said to
have occurred on the date stated above, at
12:30am
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ...
73
Years.
Months.
Days
If under 24 hours
Hours ..
.Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
a.t ..... home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Francesco Cammarata
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Marianna Palermo
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
(Address)
Anthony Mulone
95 Marshall St.
Winthrop
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS 147 Winthrop St.,
Winthrop
Received and filed SEP 1 1961 19
(Registrar)
PARENTS
(Signed) Charles
Fiberway, M. D). Charles Liberman m. D
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date ..... 8/29/1961
Winthrop Cemetery, Winthrop 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
19
Sept .1.
61
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: RalphE finan Signature of Agent of Board of Health or other)
96.0.
Plug 31, 1961
(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 €, or compli- which caused
ns, if any, ave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ndition given A.C
Chapter 137, 54. requires s to print or cause or death on ificates, and 18, Acts of ires Physi- rint or type r signature.
1-59-926662
3 DATE OF
August
29,
1961
DEATH
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Anthony Mulone
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Death ensued at 12:30 A.m.
D) August 24, 1961- Death presumably
due to hypertension and Due To! (c) Chronic nephritis. Duration
1 1/2 years.
OTHER SIGNIFICANT CONDITIONS Charles Libesudan mil
Was autopsy performed?
What test confirmed diagnosis ? ...
Far Whittherap
5 Was disease or injury in any wayrenewedmath Hellerch.
If so, specify
to.
45
[(Was deceased a
U. S. War Veteran,
[if so specify WAR)
no
(a) Residence.
No.
(Usual place of abode)
45
Registered No.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
SEP -- 11961 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.
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)
124 River Road
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS IPTCM STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 1.59
[(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,
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
124 River Road
....... St.
(If nonresident, give city or town and State)
60
.years ...
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August
31
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Sept 1960
19
to ...
August
19.
19
death is said to
have occurred on the date stated above, at ...
1:30A
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Congestive heart failure
Due To (b) ....
arteriosclerotic heart disease
6 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
senility
Was autopsy performed?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? NO If so, specify
PARENTS
6 Winthrop Place of Burial or Cremation DATE OF BURIAL
(City or Town)
Sept. 2
19
60
7 NAME OF
Howard S Reynolds
FUNERAL DIRECTOR
ADDRESS
Winthrop. Mass
Received and filed SEP 5 1961 19
(Registrar)
8 SEX
Female
White
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWER
or DIVORCEDO OW
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John L Jones
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
89
9
Months.
23
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
Own Home
15 Social Security No.
None
New York City
16 BIRTHPLACE (City)
(State or country)
New York
17 NAME OF
FATHER
John MacNiven
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
(Signed)
Harald B brutalt
M. D.
OF MOTHER
Sarah Morrison
Harold B. Greenfield (PRINT OR TYPE SIGNATURE)
(Address) #17 Shirley St winthe pate
Aug
19.31
Winthrop
Elsie Jones
21
Informant
(Address)
124 River Road Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
nsit permit
Signature of Agent of, Board of Health or other> Leatthe Office 9/1/69 (Official Designation) (Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137. 954. requires ns to print or e cause or of death on tificates, and 48, Acts of uires Physi- print or type ler signature. C
11-59-926662
R-301A 1
No.
Mary E (MacNiven) Jones
{if so specify WAR)
(a) Residence. No.
(Usual place of abode)
62
Length of stay: In place of death
... years ..
......... months.
.........
.. days. In place of residence
That I attended deceased from
I last saw he.x .. alive on
Aug 29
INTERVAL
BETWEEN
ONSET AND
DEATH
AGE
Years.
20 BIRTHPLACE OF MOTHER (City) (State or country) Nova Scotia
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 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.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.