USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 49
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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 terins, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
PLACE OF DEATH
Suffolk (County)
Winthrop. (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To he filed for hurial permit with Board of Health or its Agent.
Registered No.
219
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. Winthrop Community Hospital
2 FULL NAME Thomas F. Corbett (First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 15 Summit Avenue
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months
days. In place of residence 2.Q .... years
.months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
15 1961
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVOREmried
4 I, HEREBY CERTIFY,
L'CC.15
19w/, to
022. 12
That I attended deceased from
19
€1
I last saw h .. L.Malive on
19 ....
death is said to
have occurred on the date stated above, at
.. m.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Cerebral hemoronaa2
(a)
Due To
(h)
arteriosclerosis -gea
Due To
(c)
Itapertension
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
120
(Signed)
OJoseph Gregorie
(PRINT OR TYPE SIGNATURE)
(Address)
1944 Washington Date
6 Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December 19 1961
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass.
Received and filed DEC-18-1901 19
PARENTS
19 MAIDEN NAME
OF MOTHER
Bridget Kilcoyne
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
21 Informant
JuliaCorbett
(Address)
15 Summit Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the hurial or transit permit was issued:
(Signature of Agent of Board of Health or other)
12/18/61
(Registrar) (Official Designation)
(Date of Issue of Permit)
TV.B.
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
n giving : OF DEATH not enter e than one ie for each , (b) and (c)
does not mean de of dying, heart failure, etc. It means iase, ar compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but nat da the terminal canditian given
a :- Chapter 137, sf 1954. requires sians to print or the cause or s of death on Elcertificates, and fer 48, Acts of requires Physi- aro print or type inder signature.
-6 0-928145
11 IF STILLBORN, enter that fact here.
12
63
AGE
Years.
Months.
.Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation :
S. S. Clerk
(Kind of work done during most of working life)
14 Industry
or Business :
Steamship
15 Social Security No.
022-03-8363
Roxbury
16 BIRTHPLACE (City) (State or country) Mass
17 NAME OF
FATHER
Michael Corbett
18 BIRTHPLACE OF
FATHER (City)
M. D (State or country) Ireland
10a If married, widowed, or, divorced Petzke.
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
(write the word)
[(Was deceased a U. S. War Veteran,
PHYSICIAN - IMPORTANT
[if so specify WAR)
(Usual place of abode)
-
01
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
Ti
6
HI
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.
DEC 181961 AM
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
7 Siren 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.
250
S(If death occurred in a hospital or institution, St } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a { U. S. War Veteran, {if so specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay : In place of death
3.9 years.
... .. months . days. In place of residence.
8 SEX
Male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDrried
10a If married, widowed, or divorced a Thurs ton HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Il IF STILLBORN, enter that fact here.
12
AGE75.
Years ....
Months.
0
Days
If under 24 hours
Hours.
.........
Minutes
13 Usual
Occupation :
Salesman
(Kind of work done during most of working life)
14 Industry
or Business :
Meat
15 Social Security No.
01-201-6854
West Tremont
16 BIRTHPLACE (City)
(State or country)
Jaine
17 NAME OF
FATHER
Nathan Reed
18 BIRTHPLACE OF FATHER (City) (State or country) Laine
19 MAIDEN NAME
OF MOTHER
Emma Mitchel
20 BIRTHPLACE OF MOTHER (City) (State or country) Maine
Georgia Reed
21 Informant (Address) 7 Siren 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)
(Official Designation)
(Date of Issue of Permit)
6-59-925686
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
december 17
1961
(Month)
(Day)'
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
19.
to.
19
I last saw h ........ alive on
19 ............ , death is said to
have occurred on the date stated above, at
5:00 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Natural Causes
INTERVAL BETWEEN ONSET AND DEATH
(b)
To: Presumably Coronary
Occlusion/
Du
Arterioscleratic Heart Disease
(c)
OTHER SIGNIFICANT CONDITIONS
NO
Was autopsy performed?
What test confirmed diagnosis ? post mortem judgement
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify.
(Signed) Arthur C. Murray M.D (PRINT OR TYPE SIGNATURE) (Addres) hop Guarda Helt Date 18 Dec 1961
6
woodlawn Crematory
Everett
Place of Burial or Cremation
DATE OF BURIAL
Dec. 20
19
7 NAME OF
FUNERAL DIRECTOR
Howard C Reynolds
ADDRESS
winthror, liass.
Received and filed DEC 19 1961
19
PARENTS
2 FULL NAME
Charles Adams Reed
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 Siren Street
St.
(If nonresident, give city or town and State)
2.years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter e than one e for each (b) and (c)
does not mean de af dying, heart failure, etc. It means Ise, ar campli- which caused
ions, if any, gave rise ta cause (a), the under- cause last.
Éditions cantrib- death but nat a the terminal anditian given
e Chapter 137, 1954. requires ins to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
1011 V.B.
1
Sudden
10 yrs
(City or Town) ,61
Registered No.
SPACE FOR ADDITIONAL INFORMATION
- 151
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
DEC 1 91961 IM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
PLACE OF DEATH
Suffolk
PENSEP
(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.
251
Registered No.
f(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Peter Norcott
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 36 Forrest St.
(a) Residence. No.
(Usual place of ahode)
St.
(If nonresident, give city or town and State)
.months .........
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF Dec
DEATH
24
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
Oct 3
1961, to
Dec 24
961
I last saw h.a .. malive on
Dec 23
19 61
-
death is said to
have occurred on the date stated above, at
60% an m.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
caffimatosis
INTERVAL BETWEEN ONSET AND DEATH
Due To
(b)
adenocarcinoma Stomach
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
operation
5 Was disease or injury in any way related to occupation of deceased?
If so, specify NO
(Signed)
H.B. Greenfield
M. D
+47.56 (PRINT OR TYPE SIGNATURE)
(Address) WinthropMass Date. 12-24 19 61
6 Holy Cross
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Dec.
27
19.61
7 NAME OF
FUNERAL
DIRECTOR
Frederick J. Marrath
ADDRESS
325 Chelsea St. E. Boston
Received and filed DEC 26 1961
19
(Registrar)
928145
(Official Designation)
(Date of Issue of Permit)
X
12
51
AGE
Years.
.Months ...........
.. Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
fisherman
(Kind of work done during most of working life)
14 Industry
or Business :
LawrenceSoule
15 Social Security No.
020-14-0783
16 BIRTHPLACE (City)
Harbor Grace
(State or country)
Hewf.
17 NAME OF
FATHER
Michael Norcott
18 BIRTHPLACE OF
FATHER (City)
He foundland ..
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary Ann Fayes
20 BIRTHPLACE OF MOTHER (City) (State or country) Newfoundland
Lorna N. Norcott
21
Informant
(Address)
36 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: st / 11
(Signature of Agent of Board of Health or other)
12,031
1
[ R-301A 150
2 pontos
UCTIONS FOR CERTIFICATE
giving OF DEATH pt enter than one for each b) and (c)
es not mean of dying, heart failure, tc. It means ,or compli- hich caused
ns, if any, ave rise to ause (a), the under- ause last.
ions contrib- eath but not the terminal dition given
Chapter 137, 954. requires ns to print or e cause or of death on tificates, and : 48, Acts of quires Physi- print or type ler signature.
No.
Winthrop Community Hospital
[(Was deceased a
U. S. War Veteran,
no
[if so specify WAR)
Winthrop
Length of stay: In place of death ............ years ............ months ..
7
.days.
In place of residence ..
........ years ........
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWEmarried
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Loma .............
(Give maiden name of wife in fun)
Il IF STILLBORN, enter that fact here.
6 mois
PARENTS
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
Norfolk (County)
Milton
(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
Milton
(City or town making return)
Registered No.
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
[(Was deceased a { U. S. War Veteran,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if so specify WAR)
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death.
3
.. years
.. months.
......
.days. In place of residence.
years
.months.
.. days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR
White
11 SINGLE
MARRIED
(write the word)
Single
or DIVORCED
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.) Presumably Coronary Occlusion Fell Dead
lla If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 65
Years .............
.Months ....
Days
If under 24 hours
Hours.
......
.Minutes
14 Usual
Occupation :
Longshoreman
(Kind of work done during most of working life)
15 Industry
or Business :
Docks
16 Social Security No.
East Boston
17 BIRTHPLACE (City)
(State or country)
Mass.
18 NAME OF
FATHER
Michael Fitzgerald
19 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass.
20 MAIDEN NAME
OF MOTHER
Elizabeth Daly
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
East Boston
22 Mrs. Ziegler
Informant
(Address)139 Winthrop St Winthrop Mass.
A TRUE COPY.
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
December 27th
19 67
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased ?!. O. If so, specify
(Signed)
Frederic Tudor
M. D.
(Address)
Milton .Mas.
Date.1.2-26 161
7 .Holy Cross
Malden, Mass.
Place of "Burial, or Cremation.
(City or Town)
Dec. 29th.
19
61
& NAME OF
FUNERAL DIRECTOR
Maurice W. Kirby
ADDRESS Winthrop, Mass.
Received and filed 19
X
1 -
I R-305 1
..... Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at ..
No. 15.2 ..... Robbins 2 FULL NAME. John Fitzgerald (a) Residence. No. 439 Winthrop (Usual place of abode) MEDICAL CERTIFICATE OF DEATH 3 DATE OF DEATH (Month) 5 Accident, suicide, or homicide (specify) Where did Injury occur ? (City or town and State) (Specify type of place) Manner of Injury (How did injury occur ?) Nature of Injury DATE OF BURIAL 25M-4-59-925100 as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided If accidental, was injury causally related to the death ?
December 26.1961
(Day)
(Year)
Date and hour of injury
19
Did injury occur in or about home, on farm, in industrial place, or in public place ?
While at work?
.Was autopsy performed ?
NO
50
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DEC 2 01001
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
.
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
DEC,
To be filed for burial permit with Board of Health or its Agent.
253
Registered
§(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,
NO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
37 Trident Ave
(a) Residence. No. ( Usual place of abode)
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
8 SEX
MALE
9 COLOR
WHITE
MARRIED
WIDOWED
or DIVORCED
MARRIED
4 I HEREBY CERTIFY
JAN
961
to .........
That I attended deceased from
DEC LY
196/
I last saw hyMM.alive on
12/29
19 61, death is said to
have occurred on the date stated above, at
1° p. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
NEPHROSCLEROSIS -UREMIA
INTERVAL BETWEEN ONSET AND DEATH 3 WKS
Due To
(b)
ARTERIOSCLERUTIC HEART DIS
Due To
(c)
GENERAL ARTERIO SCLEROSI 9
3 YRS
14 Industry
or Business :
RETIRED
OTHER
SIGNIFICANT
CONDITIONS
NONE
15 Social Security No.
NONE
16 BIRTHPLACE (City)
(State or country)
AUSTRIA
17 NAME OF
FATHER
JACOB KATZ
18 BIRTHPLACE OF
FATHER (City)
(State or country)
AUSTRIA
19 MAIDEN NAME
OF MOTHER
LILLIAN
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
JACK KATZ
21
Informant
(Address)
524 CLINTON RD BRL
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Maxph SAcranny (Signature of Agent of Board of Health or other) Howrig Riec . 29/6/2
(Official Designation)
(Date of Issue of Permit)/
1-928145
I R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH
ot enter than one for each (b) and (c)
es not mean of dying,
€ heart failure, etc. It means e, ar compli- which caused
ons, if any, ave rise ta cause (a), the under- cause last.
tians contrib- death but not the terminal nditian given
Chapter 137, 1954. requires ans to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
(Signed)
myson b. King
M. D.
222 PLEASANT ST WINTHROP 52 MAS
(Address)
MYRON N. KING M. Date.
12/29 1961
AMERICAN AUSTREAN WOBURN
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL 1 DEC 2,31 1961
7 NAME OF
FUNERAL
DIRECTOR
BENJAMIN BIRNBACH
ADDRESS 1668 BEACON ST 3KL.
Received and filed
DEC 20 1961
19
(Registrar)
11 IF STILLBORN, enter that fact here.
12
AGE
76 Years.
.......
.Months ............
.. Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation :
FURNITURE
DEALER
(Kind of work done during most of working life)
Was autopsy performed?
No
What test confirmed diagnosis?
CLINICAL + LABORATORY
5 Was disease or injury in any way related to occupation of deceased? /10 If so, specify
PARENTS
St.
45
(1f nonresident, give city or town and State)
10 SINGLE
(write the word)
3 DATE OF
DEATH
DEC
29
1961
(Month)
(Dấy)
(Year)
10a If married, widowed, or divorced
HUSBAND of
IDA HOFFMAN
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
No.
Winthrop Community Hospital
2 FULL NAME Max Katz (First Name) (Middle Name) (Last Name)
[if so specify WAR)
TVB
AUSTRIA
(PRINT, OR TYPE SIGNATURE)
3 YRS.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
DEE 2 SIOCH CH 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.
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