USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 44
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Italy
19 MAIDEN NAME
OF MOTHER
Adelina Defilippo
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Giovannina Marasca (wife)
Informant
302 Maverick St., East Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued: Taltele El ercause (Signature of Agent of Board of Health of other)
11/6/61
(Date of Issue of Permit)
(Official Designation)
C-
1
Registered No.
Alfred
Marasca
2 FULL NAME
(a) Residence. No. ( Usual place of abode )
Boston 42-7-61
PARENTS
3YRS
(Kind of work done during most of working life)
2 DAYS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
NOV -01961 111 ...
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 bad 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)
CONSE PITIT
Winthrop (City or Town)
No.
58 Harbor View Ave.
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)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
58 Harbor View Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
40
.. years.
months.
......
.days. In place of residence .O.
years
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November 4
(Day)
(Year)
1961
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCER idow
4 I
HEREBY CERTIFY, That I attended deceased from
19 ..**
to.
19 .....
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Clement Wood
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Years
12
AGE.70
6
Months.
11 Days
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.
16 BIRTHPLACE (cipston
(State or country)
Mass.
17 NAME OF
FATHER
William J Anderson
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Louise
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 Dorothy Herdt Informant (Address) 3 Cottage Ave. Winthrop, Mass.
I HEREBY CERTIFY that a, satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Maliye de fireannex
(Signature of Agent of Board of Health/or other)
11/6/61
(Official Designation)
(Date of Issue of Permit)
M-4-59-926662
R-301A 1
S UCTIONS FOR A CERTIFICATE Agiving EOF DEATH
d bt enter e than one u for each b) and (c)
es not mean of dying, Ificart failure, aetc. It means s&:, or compli- hich caused
lins, if any, Five rise to e ause (a), nethe under- Cause last.
onions contrib- to eath but not the terminal dition given IC
: hapter 137, f i t 54. requires to print or cause or death on conficates, and er 8, Acts of retires Physi- o int or type de signature.
6
Winthrop'
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
8
19
Nov.
61
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop Mass
Received and filed
November 6.
. 19 67
(Registrar)
PARENTS
sudden
Due
Arterio-sclerotic Heart Disease
(c) .....
10 yrs
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
no
What test confirmed diagnosis? post-mortem judgement
5 Was disease or injury in any way related to occupation of deceased? no If so, specify
M. D).
(Signed)
arthur C. Murray
Arthur C. Murray
(PRINT OR TYPE SIGNATURE)
(A) Winthrop Board of Healthe 5 Nov
19 61
INTERVAL BETWEEN ONSET AND DEATH
Presumably
(b)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Natural Causes
(a)
(Month)
Frances J (Anderson) Wood
Registered No.
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, (if so specify WAR)
(a) Residence. No. (Usual place of abode)
I last saw h ........ alive on
19 ............ , death is said to
have occurred on the date stated above, at
/٥ p.m.
Coronary Occlusion
010-10-8529
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
TOU
DATE OF DISCHARGE
RANK, RATING
Ci
00
ORGANIZATION AND OUTFIT
6
SERVICE NUMBER
NOV -61961 PM
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
TI CTIONS IR L ERTIFICATE
living F DEATH n: enter elan one eor each . ) and (c)
di: not mean &of dying, art failure, c. It means 1 or compli- sich caused
IN, if any, De rise to use (a), ke under- lise last.
dions contrib- tith but not to he terminal co ition given
- lapter 137, 144. requires anto print or he cause or death on O epicates, and · . Acts of gres Physi- Int or type nd signature.
-6)-92 5686
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. Winthrop Community Hospital
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
226
§(If death occurred in a hospital or institution, St. } give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
{if so specify WAR)
2 FULL NAME Mrs. Elizabeth VanBuskirk (Tower)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
50 Hutchinson St.
(Usual place of abode)
St.
20
(If nonresident, give city or town and State)
Length of stay: In place of death .. . .. years.
months
3
.days. In place of residence.
.years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
NOVEMBER 5
1961
(Year)
8 SEX
Female
9 COLOR
T.h.ite
10 SINGLE
(write the word)
MARRIED
WIDOWED Widow
or DIVORCED
4 I HEREBY CERTIFY,
Nov
2
1961
.. , to.
Nov 5
That I attended deceased from
19.61
I last saw h .......
.. alive on
Nov 4
1961, death is said to
have occurred on the date stated above, at
6:10 Am
INTERVAL
BETWEEN
ONSET AND
DEATH
5 DAYS
5 DAYS
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Dorothy Chaney appleton
M. D.
DOROTHY Cheney VAPPLETON
(PRINT OR TYPE SIGNATURE)
Date. Nov 5 19.6%
6
.T'inthron.
Place of Burial or Cremation
DATE OF BURIAL
linthrop
(City or Town)
Nov. 8
6.1
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
... Winthrop.
Received and filed 19
(Registrar)
10a If married, widowed, or divorced HUSBAND of
Albert
(Give maiden name of wife in full)
VanDushirK
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
~2
4
AGE
Years.
Months.
Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
021-01-0743
16 BIRTHPLACE (City)
(State or country ) New Brunswick
17 NAME OF
FATHER
John Tower
18 BIRTHPLACE OF
FATHER (City)
(State or country) New Brunswick
19 MAIDEN NAME
OF MOTHER
Eliza Kelly
20 BIRTHPLACE OF MOTHER (City) (State or country) New Brunswick
21 Informant Aubert C VanBuskirk (Address) 20 Beacon St. Winthrop, Lass
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)
11/6/61
(Official Designation)
(Date of Issue of Permit)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
ACUTE BRONCHO PNEUMONIA
Due To
VIRUS INFECTION
(b)
l'ouselife
At home
15 Social Security No.
Loncton
PARENTS
(Address) 197 Woodside BUG WINTHROP, MASS
(Month)
(Day)
To be filed for burial permit with Board of Health or its Agent.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
-
DATE OF DISCHARGE
RANK, RATING
0
ORGANIZATION AND OUTFIT
SERVICE NUMBER
NOV - G.1961 FM
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 of Town)AT HOME 66 Winthrop Shore Drive
Thr 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.
[(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, lif so specify WAR)
2 FULL NAME
Marietta (White) Hoore
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(L'sual place of abode)
66 Winthrop Shore Drive
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
5
years.
months
days. In place of residence.
7.2 .. 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 DIVORCEAdDW
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Edwin L Moore
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
93
11
12
AGE
Years.
......
Months ...
2
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
None 1211:11.
(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)
hass
17 NAME OF
FATHER
Charles H White
18 BIRTHPLACE OF
Ashbørnham
FATHER (City)
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Florence H
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lass
Ashburnham
21 O.A.A. Recards
Informant
(Address)
Winthrop, Lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
latte,
(Signature of Agent of Board of Health or other) 11.20, 61
(Official Designation) (Date of Issue of Permit) ,
PARENTS
(Signed)
Mycon b. King
M. D.
MYRUN N.KING M.D.
(PRINT OR TYPE SIGNATURE)
(Address) 22 LI KENSANT ST WINitthe Date.
11/18 1061
6
inthrop
Winthrop
Place of Burial or Cremation
Nov.
(City or Town)
1351
7 NAME OF
FUNERAL, DIRECTOR
Howard S Reynolds
ADDRESS
winthrop Mass
Received and filed NOV 20-1961 19.
(Registrar)
INTERVAL
BETWEEN
ONSET AND
DEATH
7 Days.
Due
GENERAL ARTERIOSCLEROSIS AND
(b)
ARTERIOSCLERCTIO HEART DISEASE
6 YRS.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
Nov
18
1961
(Year)
(Month)
(Day)
161
4 I HEREBY CERTIFY, That I attended deceased from
OCT.
19:55
to ...
Nov
18
I last saw he Ralive on
11/16
1961
death is said to
have occurred on the date stated above, at
740 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
CEREBRAL VASCULAR ACCIDENT
(a)
YR-301A 1
TICTIONS İR L ERTIFICATE
ving
F DEATH enter elan one for each ) and (c)
not mean de of dying, art failure, r. It means IS or compli- ach caused
io, if any, f'e rise to Mise (a), je under- gtse last.
duns contrib- dth but not of'te terminal coition given
- apter 137, 191. requires aato print or he cause or of death on rt cates, and 4. Acts of qs'es Physi- pnt or type designature.
-6 -925686
Ashburnham
Was autopsy performed ?
No
What test confirmed diagnosis ?
CLINICAL.
5 Was disease or injury in any way related to occupation of deceased NO
If so, specify
DATE OF BURIAL
No.
3 DATE OF
DEATH
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.
NOV 2 01961 AM
X PLACE OF DEATH
Suffolk (County)
CENS
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.
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
Dr. George H. Schwartz
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
5 Edge Hill Rd.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death2.O.
.years.
... months.
.days. In place of residence.
years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
3 DATE OF
DEATH
November 18
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
19 ............ , to ..
19
-19.
......... , death is said to
have occurred on the date stated above, at
10:30 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
69 Years.
Months .....
Days
If under 24 hours
Hours.
.......
Minutes
13 Usual
Occupation :
Physician
(Kind of work done during most of working life)
14 Industry
or Business:
Medicine
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Benjamin M. Schwartz
17 NAME OF
FATHER
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
Annie Baron
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
21 Mrs. Ida Miller
Informant
(Address)
28 Converse Ave .. Newton
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 1
(Signature of Agent of Board of Health or other)
20,-
(Official Designation)
(Date of Issue of Permit)
Y
S UCTIONS FOR A CERTIFICATE
higiving EOF DEATH
at enter than one for each ) b) and (c)
es not mean of dying, Is teart failure, atc. It means ser, or compli- Which caused
it's, if any, Hive rise to ause (a), nghe under- Hause last.
onions contrib- to eath but not # the terminal edition given
: hapter 137, f 54. requires to print or t cause or death on ce ficates, and ers, Acts of retires Physi- to int or type une - signature.
7 NAME OF
FUNERAL DIRECTOR
Paul ... R ........ Levine
ADDRESS 470 Harvard St., Brookline
Received and filed
November 20, . 1961
John a. Clave
PARENTS
(Signe
Arthur (O. Murray,
I. D.
OF MOTHER
Arthur C. Murray (PRINT OR TYPE SIGNATURE), Winthrop Board of Health
18 Nov 1961
6
Ohel Jacob
Woburn
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
November
20
61
-
Was autopsy performed?
NO
What test confirmed diagnosis? post-mortem judgement
5 Was disease or injury in any way related to occupation of deceased ? A.O ... If so, specify
sudden
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
MARRIED
WIDOWED Single
or DIVORCED
I last saw h ........ alive on
(Usual place of abode)
20
U. S. War Veteran,
(if so specify WAR)
WW I
PHYSICIAN - IMPORTANT
(Was deceased a
2 FULL NAME
Registered No.
No. 5 Edge Hill Rd
₹: R-301A 1
M-9-59-926662
Due
(b)
Presumably Coronary Occlusion
Boston
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE 53/18
DATE OF DISCHARGE
577-19
RANK, RATING
IST LT
ORGANIZATION AND OUTFIT
Medical CAPS
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.
NOV 2 01901 18
R-301A 1
TICTIONS JR L ERTIFICATE
living F DEATH n enter e lan one eor each ) and (c)
& not mean di of dying, art failure, c. It means as or compli- sich caused
tier, if any, L'e rise to use (a), ge under- Wise last.
dims contrib- Rith but not to he terminal co ition given
apter 137, M1. requires anto print or he cause or death on emlicates, and . Acts of eq'res Physi- Int or type nd signature.
1-62-925686
PLACE OF DEATH
Suffolk. (County )
Winthrop
(City or Town)
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