Town of Winthrop : Record of Deaths 1961, Part 31

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


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.




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