Town of Winthrop : Record of Deaths 1961, Part 38

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 38


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).


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...


(write the word)


3 DATE OF


DEATH


August


7


1961


(County)


No. MASSACHUSET.T.S.GENERAL HOSPITAL.


١٢


TO !.


١٠٠٠


٠٠٠


OCT 2 51961 AM


RM R-302


THIS IS A PERMANENT RECORD


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c) resided as soon as possible. after the close of the month in which the death occurred. (See Chap. 46. Sec. 12. G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


September 21, 1961


( Month )


(Day)


( Year)


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


4 I HEREBY CERTIFY,


Sept. 12


61


19


to


September 21.


1961


I last saw him.


..... alive on


September 21 1961


death is said to


have occurred on the date stated above, at


INTERVAL BETWEEN ONSET AND DEATH weeks


11 IF STILLBORN. enter that fact here.


12


68


AGE.


Years.


8


Months


28


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


President


(Kind of work done during most of working life )


14 Industry


or Business :


National Lobster Co.


15 Social Security No.


East Boston


16 BIRTHPLACE (City)


(State or country )


Mass:


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?


What test confirmed diagnosis ?


NO


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


If so, specify


Ko


PARENTS


18 BIRTHPLACE OF


Unable to obtain


FATHER (City)


(State or country )


Ireland


(Signed )


John S. Graf


M. D.


( Address )


Melrose, Mass.


Date


Sept.22, 61


19


Winthrop 6


Winthrop, Maes.


City or Town) Place of Burial or Cremation September 23, 61


DATE OF BURIAL 19


21


Informant


( Address)


73 Orchard bane, Melrose, Mass.


7 NAME OF


FUNERAL DIRECTOR


John H. Cately


ADDRESS Helrose, Mass.


A TRUE COPY


Raymond H. Greenlaw.


ATTEST :


(Registrar of City or Town where death occurred)


DATE FILED


September 25 1961


.19


X


50M-9-59-926111


PLACE OF DEATH


Middlesex ( County )


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


Melrose


(City or Town making this return)


1 Melrose


(City or Town)


Melrose-Wakefield Hospital No ..


St.


[ {If death occurred in a hospital or institution,


1


give its NAME instead of street and number)


2 FULL NAME


Peter Aloysius Flannery


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


73 Orchard Lane


St


( Was deceased a


U. S. War Veteran.


(if so specify WAR,


Melrose Mass.


WWI


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


( If nonresident. give city or town and State)


Length of stay:


In place of death .......... years .....


months.


7


days. In place of residence.


8


.years ....


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


10a If married, widowed, or divorced


HUSBAND of


Esther G, O'Neil


( Give maiden name of wife in full)


(or) WIFE of.


( Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Congestive Heart Failure


Due To


Hypertensive Cardiovascular


(b)


Heart Disease


years


17 NAME OF


FATHER


Peter Flannery


19 MAIDEN NAME


OF MOTHER


Bridget Kennedy


Unable to obtain


20 BIRTHPLACE OF


MOTHER (City)


Ireland


( State or country )


Mrs, Peter A. Flannery


Received and filed


OCT 10 1961


.19


( Registrar of City or Town where deceased resided )


102


Registered No.


That I


attended deceased from


9:05 A


.m.


TOW.


1/ 12


LERK


WINT


6


THROR. MASC.


1.0


OCT : 91961 AM


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


Oct. 5 - 1917


DATE OF DISCHARGE


Nov. 8 - 1917


RANK, RATING


Private


ORGANIZATION AND OUTFIT U. S. Army


Machine Gun Co. 301st Inf.


SERVICE NUMBER


RM R-304


1


Suffolk (County ) Winthrop (City or Town) PLACE OF DELIVERY No. Winthrop Community Hospital


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)


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


Registered No.


193


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


3 DATE OF


DELIVERY


Oct 4.1961


( Month )


(Day)


(Year)


4 SEX


Male


. Female .. . Undetermined


5 COLOR (if


determined)


W


6 THIS BIRTH (Check one)


SingleTwin


Triplet


7 IF MULTIPLE BIRTH, BORN :


1st .... . 2nd


. . 3rd


FATHER


8 FULL NAME Robert Cutler


14 MAIDEN NAME


MOTHER Esther Jaffe


PRESENT NAME


Esther Cutler


9


RESIDENCE, NO.


25 Alden Ave


Revere


CITY OR TOWN


STATE


15


RESIDENCE, NO.


CITY OR TOWN


25 Alden Ave Revere Mass


STREET


10 COLOR OR


RACE .... . White


11 AGE AT TIME OF THIS DELIVERY 35 (Years)


16 COLOR OR


RACE


White


17 AGE AT TIME OF


THIS DELIVERY


32


(Years)


12 PLACE OF


BIRTH


Chelsea


(City or Town


Mass


(State or country


18 PLACE OF


BIRTH


Chelsea Mass


(City or Town)


(State or country)


13 OCCUPATION Self Employed


19 INFORMANT Robert Cutler.


20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus)


4


(a) How many children are


now living?


4


(b) How many children were born alive but are now dead? 0


(c) How many previous fetal deaths of ANY gestation age ?


21 LENGTH OF


PREGNANCY


37 .completed


weeks


22 WEIGHT OF FETUS 6 Lb. & Oz.


(or


Grams )


23 WHEN DID FETUS DIE? Before Labor


X During Labor or Delivery Unknown


24 AUTOPSY


Yes


No


25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE AsphyXIA Inutero. (a)


Due To (b)


Due To (c)


OTHER SIGNIFICANT


CONDITIONS


26 Workmans Circle Place of Burial or Cremation


MELROSE


(City or Town)


DATE OF BURIAL Oct 6 196%.


27 NAME OF FUNERAL DIRECTOR TORF Funeral Service due ADDRESS 151 Washington Ave Chelsea


Received and filed OCT 6 1961 19


(Registrar


A TRUE COPY ATTEST :


I HEREBY CERTIFY that this delivery occurred on the date stated above at 4:59 Pm, and product of conception was not a live birth.


Signature of Attending Physician or Medical Examiner : Morris I. Sacks


M.D.


MORRIS


I


1


SACKS


M.D


(PRINT OR TYPE SIGNATURE)


Address


45 Shirley Ave Rever Bate Cet 6. 1961


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


Ralph En Sirianni (Signature of Agent of Board of Health or other)


1.00


(Official Designation )


Oct. 6-1961


(Date of Issue of Permit) X


In giving AUSE OF CAL DEATH o not enter re than one use for each f (a), (b) and (c)


or maternal tion causing death (do use such as stillbirth ematurity. ) and/or ma- conditions, , which gave to above (a), stating inderlying last.


tions of fetus other which ave contrib- to fetal , but, in so s is known, not related use given ).


5M-6-60-928241


2 NAME OF FETUS (if given )


Baby Boy Cutler


St.


STREET


Mass


STATE


TO !!


ERK


FETAL DEATH 1


6


HROR MACY.


EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.


OCT -61961 PM


Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, ... shall not be permitted except ... ".


Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.


Section 12. " ... No birth record of· a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."


Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.


X


[ R-303


1


(County) WINTHROP


(City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE 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.


194


90 Highland Avenue, Winthrop


f(If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


No.


THOMAS


A. Mac CRINDLE SR.


PHYSICIAN - IMPORTANT


2 FULL NAME


(First Name) (Middle Name) (Last Name) (If deceased is a married, widowed or divorced woman, give also maiden name.) 228 Bowdoin Street, Winthrop


.. St.


(a) Residence. No. (U'sual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death .. years. months. days. In place of residence 2.5 .. .. years months .. .. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


October


9,


1961


DEATH


(Month) (Day)


(Year)


Male


White


YES NO


12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN


C


12a If married, width E Phillips HUSBAND of


(or) WIFE of


(Husband's name in full)


13 DATE OF BIRTH Ded


28 1892


14 69


AGE ..... Years.


Months ........ .... Days


Date and hour of injury 19


IF ACCIDENTAL, was injury causally related to the death? Where did Injury occur ?


(City or town and State) Did injury occur in or about home, on farm, in industrial place, of in public place ?


(Specify type of place)


Manner of


(How did injury occur?)


Nature of


While at work ?


Was a


or deceased ?.


(Signe1)


M. D.


Michael A Luongo M.D


Boston


10/9 61


(Address)


Date


Winthrop


(City or Town)


61


DATE OF BURIAL 19


8 NAME OF


FUNERAL DIRECTORErnest P Caggiano


ADDRESS 197 Winthrop St, Winthrop


Received and filed OCT 11 1961 19


(Signature of Agent of Board of Health or other> Healle Officer


(Official Designation)


(Date of Issue of Permit)


10/11/61/ T V.B.


A TRUE COPY ATTEST :. (Registrar)


LEDA


18 NRTHPLACE (City) (State or country) 0


19 NAME OF FATHER Thomas Mac Crindle


20 BIRTHPLACE OF FATHER (City) (State or country) Scotland


21 MAIDEN NAME OF MOTHER Ma ry White


22 BIRTHPLACE OF MOTHER (City) (State or country) Scotland


: Thomas Mac Crindle


7 Winthrop Place of Burial, or Cremation.


50M-3-61-930213


Injury 6 Was If s 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 miton snou De carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF Injury §§ 44-48. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.


5 Accident, suicide, or homicide (specify)


If under 24 hours Hours .Minutes


15 Usual Occupatio


Painter


(Kindai work done during most of working life)


stry Bu. ness.


Painting Business


014-18-2940


1) Social Security No.


Fast Boston


PARENTS


250


(Print or Type V'ame)


9 SEX


10 COLOR


11 CITIZEN


OF U.S.


(Give maiden name of wife in full)


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.) C CORONARY OCCLUSION


( Was deceased a


{ U. S. War Veteran.


[if so specify WAR)


PLACE OF DEATH


SUFFOLK


Oct 13


23 Informant (Address) 228 Bowdoin St Winthrop


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


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


TO!


1


ERK :


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 lor 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.)".


PLACE OF DEATH


Suffolk (County)


LINSE PETER


STANDARD


CERTIFICATE OF DEATH


Registered No.


195


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


2 FULL NAME


James William Bolger


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


(a) Residence. No.


(Usual place of abode)


434 Revere Street St.


(If nonresident, give city or town and State)


Length of stay: In place of death .............. years. months. 3 .days. In place of residence. 3.Gears


.months.


............ days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


October


10


1961


(Year)


(Month)


(Day)


That I attended deceased from


4 L HEREBY CERTIF


October


,51


0


to.


X


Oct.


10


61


1961


death is said to


have occurred on the date stated above, at


11:55 P.m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Cerebral Embolus.


Due To


Rheumatic Heart Disease


(b)


Due To


Mitral Stenosis


(c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


yes


What test confirmed diagnosis Ethical and Post Mortem


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


(Signed)


M. D.


Charles Liberman


MIDI


(Ad


6 Woodlawn Cemetery Everett, Mass (City or Town)


Place of Burial or Cremation


DATE OF BURIAL


October 16, 1961


19


7 NAME OF


FUNERAL DIRECTOR


Cached B. March


ADDRESS


174 Winthrop St. Winthrop, Dass.


Received and filed OCT 11-1961 . 19 ..


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


9 COLOR


8 SEX


male


white


10 SINGLE


(write the word)


MARRIED marriec


WIDOWED


or DIVORCED


10a If married, widewed, or divorced


gdrotHerraldenhauer


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


AGE


64Years.


O


Months ..


11.Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


power plant engineer


(Kind of work done during most of working life)


14 Industry


or Business :


Metropolitan District Com.


15 Social Security No.


none


St. John's


16 BIRTHPLACE (City)


(State or country)


New foundland,


17 NAME OF


FATHER


Edward Bolger


18 BIRTHPLACE OF


FATHER (City)


St. Johns


(State or country)


New Foundland.


19 MAIDEN NAME


OF MOTHER


Ellen Rutledge


20 BIRTHPLACE OF


St. Johns


MOTHER (City)


(State or country)


New Foundland


21 Informant


Irs James W. Bolger


(Address) 434 Revere St. Winthrop,


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


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


Thealte Ovice 10/11/01/ (Official Designation) (Date of Issue of Permit)


1 V.B.


1 R-301A 1


RUCTIONS FOR CERTIFICATE


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


oes not mean le 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 s to print or cause or f death on ificates, and 48, Acts of uires Physi- print or type Fer signature.


1-1-59-926662


Winthrop (City or Town)


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


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


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


[if so specify WAR)


NO.


I last saw himalive on


COM.


10


19


INTERVAL


BETWEEN


ONSET AND


DEATH


3 days


10yrs


10 yrs


PARENTS


(PRINT OR TYPE SIGNATURE) Winthrop, Mass Date 10/11/1961


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE.


RANK, RATING


F


ORGANIZATION AND OUTFIT


SERVICE NUMBER


2 70 RA


RVBEŞIR PIRE PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physiciane wilt ceftify to such deaths only as those of persons Opring) 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


R-301A


1


PLACE OF DEATH


Suffolk (County)


CANSE PETIT


TYCH


STANDARD


CERTIFICATE OF DEATH


Registered No.


196


No.


Winthrop Convalescent Home 142 Pleasant St. Bertha .M ...... Dennison (Kempton ) (First Name) ( Middle Name) (If deceased is a married, widowed or divorced woman, give also maiden name.) (Last Name)


[(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)


10


164 Vane Street


Revere


(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


3 DATE OF


DEATH


Oct.


10.


1961.


(Month) (Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIEDY]


WIDOWED, Idowed


or DIVORCED


4 I HEREBY CERTIFY


Aug. 30


19.61


Oct 10,


That I attended deceased from


19. 61


I last saw


Leralive on


Coc+10


19 61, death is said to


have occurred on the date stated above, at


1:30 P. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE (a) CORONARY Thrombosis


Due To


(b)


Rheumatic Heart DZ


Due To


Gener Alized Arteriosclerosis


(c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? What test confirmed diagnosis?


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


(Signed) Minis & Sacks


MORRIS I SACKS


MID


(Address)


(PRINT QR TYPE SIGNATUREY 45 Shirley Ave Rev Date Octio


, 19 601


Locuet Grove 6


Rockport


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL Oct. 13,1861


19


7 NAME OF


FUNERAL


DIRECTOR


Leslie W. Pike


ADDRESS


305 Beach St. Revere


Received and filed


OCT 1 3 1961


19


(Registrar)


PARENTS


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


21 Herbert Dennison


Informant (Address) 164 Vane St. Revere


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit permit was issued: Trable 6. 9 manuel Signature of Agent of Board of Health or other) Offices 10/13/61


(Official Designation)


(Date of Issue of Permit)


JCTIONS OR CERTIFICATE


iving OF DEATH t enter han one for each b) and (c)


s not mean of dying, eart failure, c. It means or compli- rich caused


s, if any, ve rise to use (a), he under- use last.


ons contrib- ath but not the terminal dition given


Chapter 137, 954. requires s to print or cause or f death on ificates, and 48, Acts of uires Physi- rint or type er signature.


-


-


(Kind of work done during most of working life)


one


15 Social Security No. None


Bear ..... River.


BIRTHPLACE (City (State or country) ova Scotia


17 NAME OF


FATHER


Isaac Vempton


18 BIRTHPLACE OF


FATHER (City)


Unable to Learn


M. D (State or country) Nova Scotia


19 MAIDEN NAME OF MOTHER Vary Parker


If under 24 hours


86 11


Months


2


Days


Hours.


Minutes


13 Usual


Occupation :


At Home


14 Industry


or Business :


20 yrs. 30 yrs,


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Frank E. Dennison


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


INTERVAL BETWEEN ONSET AND DEATH 1 hour 12 AGE Years.


St.


(Usual place of abode)


1


65


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


Winthrop (City or Town)


TEVERE 19-4-11


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


2 FULL NAME


(a) Residence. No.


PERSONAL AND STATISTICAL PARTICULARS


28145


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


CLERK


"SS


M


TC


( Mi )


11


6


':10


OCT 1 31961 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.




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