USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 40
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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
X
PLACE OF DEATH
Suffolk (County)
ISN'T
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.
201
Winthrop Community Hospital
f(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME Annetto
( DeLuca)
Stasio
(Last Name)
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
149 Somerset Avo.
.St.
Winthrop Mass ..
(If nonresident, give city or town and State)
Length of stay: In place of death. .years. months. 1 .days. In place of residence. 12
years
months ..
.....
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
(write the word)
DEATH
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY, That I attended deceased from
APRIL 10
19
5€
to.
CCT 13
196
I last saw h ERalive on
DC+ 13
1961
.,
death is said to
have occurred on the date stated above, at
8°- P
m.
INTERVAL BETWEEN ONSET AND DEATH
INFARCTION.
Due To
CEREBRAL HEMORRHAGE
(b)
ARTERIO SCLERITIC + HYPERTENSIVE
Due To
(c)
HEART DISEASE È AURICULAR
FIBRILLATION
2 mo.
OTHER
"LEFT HEMIPLEGIA FROM
SIGNIFICANT
CONDITIONS
PREVIOUS CEREBRAL
2 mg
Was autopsy performed?
N'a
What test confirmed diagnosis?
IKS. + CLINICAL
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
M. D
MYRON IN. KING M.D.
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST
WINTHROP.
Date.
10/13
061
6
Winthrop.Cemetery ...... Winthrop
(City or Town)
Place of Burial or Cremation
Oct. 16,
61
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St. Winthrop
Received and filed
OCT 16 1961
19.
(Registrar)
PARENTS
17 NAME OF
FATHER
Joseph DeLuca
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Philomena Sarni
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
Arthur Stasio
(Address) 149 Somerset Ave, Winthrop
I HEREBY CERTIFY that 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 or other) Materi Ningen
10/16/61
(Official Designation)
(Date of Issue of Permit)
7 :B.
UCTIONS 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- sich caused
s, if any, ve rise to zuse (a), he under- use last.
ons contrib- ath but not the terminal dition given
FRICAL EXAMINER
Chapter 137, 954. requires is to print or cause
or death on tificates, and 48, Acts of uires Physi- print or type er signature.
R-301A 1
JURISDICTION
NOTIFIED & DECLINED
3 DATE OF
OCT
13
1961
WIDOWEDmarried or DIVORCED
10a If married, widowed, or divorced HUSBAND of
Arthur
(Give maiden name of wife in full)
Stasio
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
60
If under 24 hours
12
AGE.
Years.
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.
16 BIRTHPLACE (City) (State or country) Italy
No.
[ (Was deceased a
U. S. War Veteran,
(First Name)
( Middle Name)
(Usual place of abode)
(or) WIFE of
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ANTERO-LATERAL MYOCARDIAL
(a)
28145
.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
0
TROP
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
OCT .. J.G.1961.AH
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 ( punty,
Winthrop (City or Town)
No. 8.76 Shirley ..... St.
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.
202
f(If death occurred in a hospital or institution, St Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[ (Was deceased a
{ U. S. War Veteran,
no
lif so specify WAR)
(a) Residence No. 876 Shirley St. (I sual place of abode )
St
( It 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
18
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
19 ... , to
I last saw h ........ alive on
19
death is said to
have occurred on the date stated above, at
5:10 Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a)
Death was due to
Due
natural causes
(b)
presumably coronary
Due (c)
Toocclusion acute que
OTHER O Coronary ARTERY SIGNIFICANT CONDITIONS Heart Disease,
Was autopsy performed Charles Liberwan My What we confirmed dipep throp Board of Health
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Sigpad); Clearles LebenMaria, M. D. CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE)
(Address) Winthrop Man Date. 10/19/1961
6
Winthron
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
Oct 21 (City or Town) 61
19
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath
ADDRESS East Foston
Received and filed OCT.19 1961 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWEmarried
or DIVORCED
10a If married, widowed, or divorce
E.
Cahill
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
61
If under 24 hours
AGE
Years ...
„Months.
.Days
supervisor
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
N. E. Tel & Tel. Co.
15 Social Security No.
011-05-0207
16 BIRTHPLACE (City)
(State or country)
East roston, Nass.
17 NAME OF
FATHER
Henry Hill
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ma.s.s.
19 MAIDEN NAME
' Catherine Hanrahan
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
East Foston
Mass.
21
Informant
(Address)
876 Shirley St. Winthrop
I HEREBY CERTIFY that 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 or other) Health Afiex
10/19/11
(Official Designation)
(Date of Issue of Permit)
1.1. V.B.
R-301A 1
UCTIONS OR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
s not mean of dying, eart failure, tc. It means or compli- hich caused
s, if any, ve rise to use (a), he under- use last.
Fons contrib- ath but not the terminal dition given
hapter 137, 54. requires to print or cause or death on ificates, and B, Acts of ires Physi- int or type · signature.
0 9-925686
PARENTS
Mary E. Hill
East Foston
.. Hours ..... .. Minutes
2 FULL NAME
Frederick J. Hill
( If deceased is a married, widowed or divorced woman, give also maiden name.)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
TOM 11
LI
. fi.
ERST
6.
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 rece.it 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 pur uits 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.
OCT 1 91961 PM
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.
Winthrop Convalescent Home. No.
[(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Elvira Frattaroli
(If deceased is a married, widowed or divorced woman, give also maiden name.)
lif so specify WAR)
(a) Residence. No.
521 Bennington St.
St.
EastFoston
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In place of death .
. ...
years 2 months 24 days. In place of residence
5
years.
months ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
Oct. 19 -1961
DEATH
(Month)
(Day)
(Year)
1961
4 I HEREBY CERTIFY
,That I attended deceased from
July 28
1961
Oct. 19
to ...
I last saw he Yalive on
Oct 18
1961
death is said to
have occurred on the date stated above, at
30
m.
INTERVAL
BETWEEN
ONSET AND
DEATH
7 months AGE
(or) WIFE of
Joseph Frattaroli
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) .... Carcinoma of uterine cervix
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ? Laboratory Biopsy
5 Was disease or injury in any way related to occupation of deceased? Ne. If so, specify
(Signed)
Chaney Milano
M. D.
CHARLES MELONI (PRINT OR TYPE SIGNATURE)
(Address) 305 Harre tt 219 rtm Date. Oct 19-186 /
6 Holy Cross
Nalden
Place of Burial or Cremation
Oct.
21
(City or Town) 61 19
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath
East Foston
ADDRESS
Received and filed 19
(Registrar)
PARENTS
17 NAME OF
FATHER
Antonio Diracco
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Palma Granali
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Olga Tango
21
Informant
(Address)
Neptune Rd. E. oston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 60 Percauur 1
(Signature of Agent of Board of Health or other)
10/20161
(Official Designation)
(Date of Issue of Permit)
X
UCTIONS OR CERTIFICATE
giving OF DEATH t enter .han one for each b) and (c)
ès nat mean of dying, eart failure, tc. It means , or campli- hich caused
is, if any, ve rise ta use (a), he under- luse last.
ians cantrib- ath but nat the terminal ditian given
hapter 137, 54. requires to print or cause or death on ficates, and 8, Acts of tires Physi- int or type ir signature.
59-925686
1
203
Registered No.
10 SINGLE
(write the word)
MARRIED).
WIDOWED dowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
11 IF STILI.BORN, enter that fact here.
12
62Years.
......... Months ............ Days
If under 24 hours
Hours.
Minutes
13 L'sual
Occupation :
housework
(Kind of work done during most of working life)
14 Industry
or Business :
own home
15 Social Security No.
C. N. B. L.
16 BIRTHPLACE (City)
(State or country)
Italy
8 SEX
female
9 COLOR
white
f(Was deceased a
{U. S. War Veteran,
no
R-301M -26-
in
-
DATE OF BURIAL
POSTEre 17-6-11
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF TOTVA
7% . .......
10
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ 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 if ho2 01961 AM persons who, though disabled by recognized disease unrelated to my forin 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.
OFRICE
CLERK
6 5
MASS.
WINTER
R-305
1
Middlesex (County) Medford
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Medford (City or town making return)
Registered No.
204
2 FULL NAME Martha E. Malone
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[if so specify WAR)
no
(a) Residence. No. 7.77 Shirley
St.
winthrop
(If nonresident, give cfty or town and State)
Length of stay: In place of death. ...... .... years ..... months. 1 days. In place of residence. 10 years .. months. ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October 23 1961
(Month) (Day) (Year)
9 SEX
female
10 COLOR
white
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widowed
4I 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.)
lla If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
James H. Malone
(or) WIFE of
(Husband's name in full)
Cerebral Hemorrhage
5 Accident, suicide, or homicide (specify)
Date and hour of injury 19
If accidental, was injury causally related to the death ?
(Kind of work done during most of working life)
15 Industry
or Business :
Retired
16 Social Security No.
Chelsea
17 BIRTHPLACE (City)
(State or country)
Mass.
18 NAME OF
FATHER
Patrick B. Kiernan
19 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass.
20 MAIDEN NAME
Catherine Kiernan
OF MOTHER
21 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass.
22
Bertha R. Kiernan
Informant
(Address)
777 Shirley St., Winthrop
ATTEST:
Flugh7 Lyons)
(Registraf b &o wher
Mere death occurred)
DATE FILED
Oat 25, 2661
19
Gify ... Glet
V.B.V
.
the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25M-4-59-925100
(Address)
Medford, Mass.
Date.
Oct 37, 67
7 Holy Cross
Malden
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL Oct 26, 1961 19
8 NAME OF FUNERAL DIRECTOR M.c.Glinchey Funeral
ADDRESS 383 Broadway Chelsea
Received and filed 19
(Registrar of City or Town where deceased resided)
12 IF STILLBORN, enter that fact here.
13
AGE.
71
Years.
Months ...
Days
Hours.
.Minutes
14 Usual
Occupation :
School Teacher
Where did Injury occur ? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place ?
Manner of
(Specify type of place)
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?n.O. If so, specify
(Signed)
Andrew D.
.Guthrie
M.
10
PLACE OF DEATH
No.
Lawrence Mem. Hospital
(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
[(Was deceased a { U. S. War Veteran,
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
If under 24 hours
PARENTS
HOYTRUE COPY.
RECEIVED
OF TOWN
11.12 1
MIN
WIN
6
ROP MASS
SPACE FOR ADDITIONAL INFORMATION
OCT 3.01961 AM:
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
C
PLACE OF DEATH
Suffolk (County)
"'inthron
(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.
205
Registered No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
(First Name)
(Middle Name)
(Last Name) (if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay :
In place of death.
years ..
.months
8
days. In place of residence. years .. months ......... ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
24,
1961
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY,
That I attended deceased from
61
I last saw Her.alive on
October .... 23,
19 .. 61 .. , death is said to
have occurred on the date stated above, at
1:50 a.
.. m.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Massive cerebral hemorrhage with
right hemiplegia
Due To
(b)
Generalized arteriosclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis? Clinical & laboratory
5 Was disease or injury in any way related to occupation of deceased? no If so, specify
(Signed)
M. Traunsteinf.
(PRINT OR TYPE SIGNATURE) (
(Address)
73. Bartlett Rd.
Winthrop 52, Mass.
Date Oct. 24, 19 61
6 Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Oct. 26 19.61
7 NAME OF
FUNERAL
DIRECTOR
Howard S Reynolds
Winthrop, Mass
ADDRESS
Received and filed
OUT 05 1961
19
( Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIEDidow
WIDOWEDLO
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Walter
(Give maiden name of wife in full)
Bliss
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
8 days
AGE
Years ..
.. Months.
15
If under 24 hours
12
70
11
Days
Hours.
.........
Minutes
13 Usual
Occupation :
Clerk
(Kind of work done during most of working life)
14 Industry
or Business:
Hospital record room
15 Social Security No.
034-20-9501
16 BIRTHPLACE (City) (State or country) MESS.
17 NAME OF
FATHER
Robert Brighty
18 BIRTHPLACE OF
FATHER (City)
M. D
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Eliza Porter
20 BIRTHPLACE OF MOTHER (City) (State or country) England
21
.Priscilla Colarusso
Informant
(Address)
5 Pearl Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 261 1
(Signature of Agent of Board of Health or other)
1 =1× 9 /6/
(Official Designation)
(Date of Issue of Permit)
V.B.
/
28145
R-301A 1
CTIONS OR ERTIFICATE
iving F DEATH enter an one or each ) and (c)
s not mean of dying, art failure, c. It means or compli- ich caused
s, if any, ve rise to use (a), he under- use last.
ons contrib- ath but not he terminal lition 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.
Bertha
(Brighty)
Fliss
[ (Was deceased a
U. S. War Veteran,
12 Girdlestone P.d.
St
35
(If nonresident, give city or town and State)
Feb. 17,
59
to ...
Oct. 24,
19
ONSET AND
DEATH
2 yrs.
Northbridge
PARENTS
Traunstein, Jr., M. D
Winthrop
PHYSICIAN - IMPORTANT
No. inthron Community 03.1001 4
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECEIVED
TOWA
OF
(MIN
BILERK
C
6
35
INTHROR
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.
OCT 2 51961 PM 1 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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