Town of Winthrop : Record of Deaths 1961, Part 49

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


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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