USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 4
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death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner nr cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L .. (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. . - General Laws, Chap. 38, Sec. 6 . as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the derk of the town where the body is to be buried or the funeral is to. be held, or from a person appointed to have the care of the cemetery or burial ground in. which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
TORULES OF PRACTICE
The fulfillment of the purpose of, these laws calls for the observance of the follow- ing rules of practice bill 1
(1) Attending-physicians wint certify to such deaths only as those of persons to whom they have given bedside came during a last illness from disease unrelated to any form offinjury. 2120!
(2) Board of Health physicians will certify to such deaths only as those of persons whol 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 weumitute & death is needed.
(3) Medical Exam herDy vestigate and certify to all deaths supposably due to injury A th not only deaths caused directly or indirectly by traumatism Onel RO kung septicemia), and by the action of chemical (drugs or poisons) thefin orelectrical 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 foundAN 2'41961 AM
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 import- ant, 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. Children 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
HO XNI HOVIII ONILVANI HIJIMA
MIAL XOVI UXAG.
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
X
PLACE OF DEATH
Essex (County)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS TH COPY OF CERTIFICATE OF DEATH
Danvers
(City or Town making this return)
1
Danvers
( City or Town )
No.Danvers ..... State .... Hospital, .... Hathorne .... St.
§ (If death occurred in a hospital or institution.
give its NAME instead of street and number)
2 FULL NAME
Elizabeth .... Colbert
(.Smith.).
( If deceased is a married, widowed or divo ced woman, give also maiden name.)
7 .... Willis
Avenue
$1
Winthrop, Mass
( If nonresident, give city or town and State)
Length of stay: In place of death. .. years .. 4 8 .months 10 .days. In place of residence .......... years ...... .. months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January. 21 ( Month ) (Day)
1961 ..
( Year)
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED Widowed
4 I HEREBY CERTIFY.
That I attended deceased
from
19 56
to January ..... 21.
19
61
I last saw h .. enlive on
January ...... 21., 19 .... OLdeath is said to
have occurred on the date stated above, at
7:00a .m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Arteriosclerotic ..... Heart .... Disease
years
(b) Due TGeneralized .... Arteriosclerosis
years
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
.. yes
What test confirmed diagnosis ? aut.o.p.sy.
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
PARENTS
(Address)
Hathorne, ... Mass ... Date ... 1/21/
19. 61
Woodlawn .... Cemetery, ..
Everett ..... Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January 24,
19
61
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
Winthrop Mass.
Received and filed
JAN-3-0 1961-
... 19.
(Registrar of City or Town where deceased resided )
10a If married, widowed, or divorced Benjamin ... Arnold
(Give maiden name of wife in full)
(or) WIFE
of 2 ..
William Colbert
( Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE7.9 ... Years ....
...?... Months .. 5 ..
Davs
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
Waitress & Cook-Retired
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
024-01-0342A
Lawrence,
16 BIRTHPLACE (City)
(State or country )
Mass:
17 NAME OF
FATHER
George Smith
18 BIRTHPLACE OF
Lawrence,
FATHER (City)
(State or country )
Mass.
19 MAIDEN NAME
OF MOTHER
Mary Hopping
20 BIRTHPLACE OF
Lawrence,
Mass.
MOTHER (City )
(State or country)
Mary E. Sheehan
21
Informant
(Address)
Hathorne, Mass.
A TRUE COP
Daniel J. Toomey
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED January 25, 19 61
<
May 6 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
(Signed )
Andrew .... Nichols ... III
M. D.
50M-9-59-926111
Registered No.
( Was deceased a
U. S. War Veteran.
(if so specify WAR,.
NO
(a) Residence. No ... ( Usual place of abode)
R
6 3
ROE
JAN 3 01961 AM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
-
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No.
38 Forrest St
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. 16
S(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Estelle Bornstein
(First Name)
( Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
38. Forrest St ..
St.
Winthrop
( Usual place of abode)
38
Length of stay: In place of death
.years.
months.
.days. In place of residence
.years
38
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
23
1961
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
cet. 19.470 to
ANI
23
1961
I last saw h& .. L.alive on
Jan .23
19 61, death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Theodore Bornstein
(Husband's name in full)
If under 24 hours
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.
Canada
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Jacob Trattenberg
18 BIRTHPLACE OF
FATHER (City)
Lithuania.
(State or country)
19 MAIDEN NAME
Pauline Geffen
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lithuania
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL January 24 .19.61
7 NAME OF
FUNERAL
DIRECTOR
Paul.R. Levine
ADDRESS
470 Harvard St., Brookline
Received and filed
JAN 24 1961
19
( Registrar)
PARENTS
Theodore Bornstein
21
Informant
(Address)
58 Forrest St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me
BEFORE the. burial or transit permit was issued:
Ralph E derianne
(Signature of Agent of Board of Health or other)
Jan, 23,1961
(Official Designation) {Date of Issue of Permit)
-{ 0-928145
IM R-301A 1
RUCTIONS FOR IEL CERTIFICATE
giving OF DEATH
S
not enter k than one ne for each (b) and (c)
sloes not mean de of dying, heart failure, etc. It means Bise, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
Editions contrib- death but not do the terminal ondition given
Cc ::- Chapter 137, tf 1954. requires ncians to print or the cause or is of death on &certificates, and ajer 48, Acts of D requires Physi- nto print or type nunder signature.
(Signed)
Cleartes Liberman
M. D.
Charles Liberman
238. SARDFOR THE SIGNATURE)
(Address)
winthrop.
Date.
1/23 1961
6
Artery Heart Disease
OTHER
SIGNIFICANT
Left Hemiparesis
CONDITIONS
NO
Was autopsy performed?
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
No
Due To
(b)
Hypertensive- Coronary
Due To
(c)
(a)
Coronary Occlusion Acute
10yrs
il yvs.
have occurred on the date stated above, at
4:15 A,m.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
ONSET AND
11 IF STILLBORN, enter that fact here.
DEATH
1 day.
12
62
AGE
Years
Months .....
......
.Days
[ ( Was deceased a { U. S. War Veteran,
{if so specify WAR) No
( If nonresident, give city or town and State)
Tifereth Israel of
Winthrop
Everett
10
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
10
(MIN)
GEERK
8
9:6
5 WINTERBBINSS.
RL PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice: - (1) Attending physicians AveDra96h deaths only as those of persons to whom they have given buside tare 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.
...
??...... 1
OFFICE
OF
E
X PLACE OF DEATH
Suffolk
(County)
FASE PETIT
Winthrop
(City or Town)
No. 42 Atlantic Street
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.
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
George J. Clarson
(First Name)
(Middle Name)
(Last Name)
[(Was deceased a U. S. War Veteran.
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
42 Atlantic St ...
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.. years.
months.
.days. In place of residence.22.
.. years.
months ..........
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
January 24, 1961
DEATH
(Month)
(Day)
(Year)
4 L HEREBY
CERTIFY,
That I attended deceased from
JEn. L.
-
6
Jon.
19
61
I last saw h ....... alive on
Jon
24
19 ........ 7,
death is said to
have occurred on the date stated above, at
7
n.m.
INTERVAL BETWEEN ONSET AND DEATH
[-21-
19/16
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business :
Electrical .... Contractor
15 Social Security No.
023-14-6873
Brooklyn
16 BIRTHPLACE (City)
(State or country)
New York
17 NAME OF
FATHER
Michael Clarson
18 BIRTHPLACE OF
Ireland
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary Ahern
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Harriet M. Clarson
Informant
(Address)
42 Atlantic St., Winthrop
I HEREBY CERTIFY that a satisfactorystandard certificate of death was filed with me BEFORE the burial or transit permit was issued: talthe Mirianm (Signature of Agent of Board of, Health or other) /26/6/
(Official Designation) (Date of Issue of Permit)
V. M.V
INTRUCTIONS FOR IEL CERTIFICATE
giving S OF DEATH d not enter 10: than one ale for each (b) and (c)
istoes not mean nie of dying, heart failure, ni etc. It means lisse, or compli- which caused
sions, if any, gave rise to cause (a), the under- cause last.
ulitions contrib- death but not d'o the terminal ondition given e
:- Chapter 137, f 1954. requires 's ians to print or the cause or of death on thcertificates, and Fr 48, Acts of 9, requires Physi- as o print or type minder signature.
PARENTS
Holy Cross Cemetery 6
Malden
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
January 28
.19.61
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass.
Received and filed
JAN-26 -1961
19
(Registrar)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWER
or FAVORGESa
10a If married, widow
detM. McDermott
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 75
Years.
Months.
.Days
If under 24 hours
Hours ..
.Minutes
Due To
(b)
Arteriosclerosis
Due To
(c)
Chronic lephritis
OTHER
SIGNIFICANT
Cerebral Hemorrhare
7
-15-
CONDITIONS
Colostomy
195
Was autopsy performed?
What test confirmed diagnosis?
NO
5 Was disease or injury in any way related to occupation of deceased? N.O ... If so, specify
G. n. Caplan
(Signed)
A. N. CAPLAN MD
(PRINT OR TYPE SIGNATURE)
M. D
(Address 186 PRINCETON ST. EAST BOSTON
Date 1-24-61
VC
IM R-301A 1
0-928145
Registered No.
(write the word)
(a) Residence. No.
(Usual place of abode)
19 ......
.... ,
to ....
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cromia
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.
-
X PLACE OF DEATH
Suffolk (County )
Winthrop (City or Town) No. 60. Johnson Avenue
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No.
To be filed for burial permit with Board of Health or its Agent.
[(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 VeteranCBL {if so specify WARY
2 FULL NAME
Clarence.A.Martin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
60 Johnson Avenue, Winthrop
St.
(If nonresident, give city or town and State)
( ['sual place of abode)
Length of stay: In place of death.
24years ..
. months
.. days In place of residenc 2.4
years.
months .. .
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
24.
1961
8 SEX
Male
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED Widowed
4 I HEREBY
CERTIFY,
That I attended deceased from
October 25, 19 60, to January 24,,
19.61
I last saw him alive on January 24,
19.6.1 .... , death is said to
have occurred on the date stated above, at
10 .: 20pm.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Acutemyocardialinfarction
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
3 mos
12
80
AGE
Years.
8
Months.
2.0 Days
If under 24 hours
Hours ......
Minutes
Due To
Arteriosclerotic and hyper-
(b)
tensive heart disease
10
years
Due To
(c) Generalized .... arteriosclerosis ...
12
years-
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Ambrose A. Martin
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Boston Marika
19 MAIDEN NAME
OF MOTHER
Annie Beadle
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Miss Georgia Morgan
60 Johnson Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Tabel 2. Serious
(Signature of Agent of Board of Health or other)
70.0 Jan 26 1961
(Date of Issue of Permit)
(Official Designation)
(Registrar)
PARENTS
6WinthropCemetery ,Winthrop
Place of Burial or Cremation
City of Town)
DATE OF BURIAL
7 NAME OF Richard C. Kirby, Inc. FUNERAL DIRECTOR ADDRES1Bennington St .E.Boston
Received and filed JAN 26 1961 19
5-59-925686
AI R-301A 1
NIRUCTIONS FOR CERTIFICATE
C
giving SOF DEATH miot enter 0 than one u for each a (b) and (c)
Does not mean me of dying, a heart failure, tu etc. It means isise, or compli- which caused
dions, if any, chgave rise to ve cause (a), in the under- ' cause last.
mitions contrib- t.death but not the terminal e ondition given
Chapter 137, of 954. requires cins to print or e cause or $ of death on ctificates, and Ce, 48, Acts of quires Physi- t print or type uler signature.
(Signed)
M. Tauxi Kein
M. D.
M. Traunstein, Jr., M/D.
(PRINT OR TYPE SIGNATURE)
(Address)
... 7.3 .... Bartlett .... Rd.WinDate ..... Jan .. 25, ... 19.61.
13 Usual
Occupa
Boston Harbor Pilot Retired
(Kind of work done during most of working life)
14 Industry
or Business :
Pilot Boats
15 Social Security No. .
CBL
East ... Boston
OTHER
SIGNIFICANT
CONDITIONS
none.
Was autopsy performed ?
no
What test confirmed diagnosis ? ... Clinical ... and. .. Lab.
5 Was disease or injury in any way related to occupation of deceased ? no ... If so, specify
January 27th
61
19
21 Informant (Address)
Boston celeru
V.D. V
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
10a If married, widowed,or divorced
HUSBAND of
Alice Dixon
(Give maiden name of wife in full)
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.
X PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 19
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Mary .... Jane Culkeen
(Sheerin)
[(Was deceased a
{U. S. War Veteran,
{if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 210 Main St.,
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