Town of Winthrop : Record of Deaths 1961, Part 7

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 7


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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Winthrop (City or Town)


No. 131Terrace .... Avenue


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.


30


§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


2 FULL NAME


James ..... Conrad ..... Nelson


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


12 River Road


(Usual place of abode)


St.


(If nonresident, give city or town and State)


years.


.months ..


............. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


February


5


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


December 1958


to.


19


I last saw h/ malive on


18 Jan


1961, death is said to


have occurred on the date stated above, at


2:45 pm


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Carcinomatosis


(a)


(b)


Due To Carcinoma of esophagus


3 yrs


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


-


Was autopsy performed?


no


What test confirmed diagnosis? operative removal


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)


Date 7 Feb 19 61


Winthrop Cemetery Winthrop, Mass


Place of Burial or Cremation (City or Town)


DATE OF BURIAL February 8,1960


7 NAME OF


FUNERAL DIRECTOR


alfred 13. Marts


ADDRESS 1.74 Winthrop St.Winthrop Mass,


Received and filed


FEB-8-1961


.......... 19.


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


white


9 COLOR


10 SINGLE


(write the word)


widowed


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divoreed.


Ragnhild Olivier Jakabsen


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


.69


Years ...


10 Months.


2.0.Days


If under 24 hours


Hours ...........


.Minutes


13 Usual


Occupation :


self employed


14 Industry


or Business :


paint and paper hanger


15 Social Security No.


030-10-7944


16 BIRTHPLACE (City)


(State or country)


Norway


17 NAME OF


FATHER


Yohan Nillssen Bjune


18 BIRTHPLACE OF


FATHER (City)


Ramnes


(State or country)


Norway


19 MAIDEN NAME


OF MOTHER


Karen Yoneyang


20 BIRTHPLACE OF


MOTHER (City)


Ramnes


(State or country)


Norway


Mrs. George M. Ogle


Informant (Address) 131 Terrace 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)


HO ang


705-08-1961


(Official Designation)


(Date of Issue of Permit)


UCTIONS OR CERTIFICATE


giving OF DEATH t enter han one for each b) and (c)


s not mean of dying, eart failure, tc. It means or compli- hich caused


as, if any, ive rise to ause (a), he under- ause last.


ions contrib- eath but not the terminal dition given


Chapter 137, 54. requires s to print or cause or death on ificates, and 18, Acts of ires Physi- rint or type er signature.


59-925686


PARENTS


(Address) Winthrop


6


Registered No.


PHYSICIAN - IMPORTANT [(Was deceased a


U. S. War Veteran,


{if so specify WAR)


N.O.


Length of stay: In place of death. ......... .years. ....... ... months. 1.4 days. In place of residence. 34.


That I attended deceased from


INTERVAL


BETWEEN


ONSET AND


DEATH


6 mo


(Kind of work done during most of working life)


Tons berg


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE. OF TOM


DATE OF DISCHARGE


RANK, RATING


. ...


5


SERVICE NUMBER.


WINTHROP MAGS. "5 .. E.


FEB - 81961 AM 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.


ERK


ORGANIZATION AND OUTFIT


F


X PLACE OF DEATH


HE unty


Winthron (City or Town)


No. Harflower Nur in


The Commomuralth 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.


31


ftf death occurred in a hospital or institution, St. ? give its NAME instead of street and number)


PHYSICIAN - IMPORTANT [(Was deceased a NO { U. S. War Veteran, lif so specify WAR)


2 FULL NAME


William: Franklin Keith


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. 110 Grovers


( U'sual place of abode )


Length of stay: In place of death. .years. 11 months. ....... days. In place of residence.


50


years


months


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Feb


(Month)


(Day)


(Year)


19


61


4 I HEREBY CERTIFY,


That ,I attended deceased from


Oct


60,


to ...


reb.


6


....


I last saw h.w


iralive on


Feb. 6


1967


death is said to


have occurred on the date stated above, at


8 cm.


INTERVAL BETWEEN ONSET AND DEATH


7-25


51


Due Toptor osclerotic re:rtdisatse (b)


Due To (c)


SIGNIFICANT


OTHER


Decubitus rt heel


....


CONDITIONS


2 70


Was autopsy performed ?


What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ? If so, specify no


(Signed) arcaplan M. D.


A. V. Carlan, 1


(PRINT OR TYPE SIGNATURE)


(Address) 705 Princeton Date 2-7


1967


forgat Mil. s Crematory


oston


Place of Burial or Cremation February 9.


(City or Town)


19.67


7 NAME OF T'he eli Mine


FUNERAL DIRECTOR


august


colon fi Anc


ADDRESS 376


St. Brookline


Received and filed FEB ( 1901


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX liale


9 COLOR


White


10 SINGLE


(write the word)


MARRIED)


WIDOWED widoWed


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


florence C BT.


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.O.L ....


Years ..


3


Months.


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Liquor wholesales


(Kind of work done during most of working life)


14 Industry


or Business :


Retired


15 Social Security No. none


16 BIRTHPLACE (City)


(State or country)


Tenn9.


17 NAME OF


FATHER


Phineas Keith


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Nel: Hannshire


19 MAIDEN NAME


OF MOTHER


Sare Loses


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Penn


21


Informant


(Address) 2'


Ibot C. Idrich


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph & Terianas (Signature of Agentsof Board of Health or other)


7/10 707. 7/1961


(Official Designation)


(Date of Issue of Permit)


Viv


UCTIONS OR CERTIFICATE


giving OF DEATH et enter than one for each b) and (c)


es not mean of dying, eart failure, tc. It means or compli- hich caused


as, if any, ve rise to ause (a), he under- muse last.


ions contrib- eath but not the terminal dition given


Chapter 137, 54, requires Is to print or cause or death on ificates, and 8, Acts of tires Physi- rint or type r signature.


C


R-301A 1


59-925686


.....


PARENTS


St.


(lf nonresident, give city or town and State)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) car C decor


7067


6


DATE OF BURIAL


Cressona,


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


WID


6


"5


HROP.


RULES OF PRACTICE FEB =71961 AM


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.


RECEIVED


TOW


₹.2


11 12


OFFICE


CEERKŲ


X Suffolk (County) Winthrop (City of Town) No.


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. 32


§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


2 FULL NAME. FTTA


Mae BROWN


(If deceased is a married, widowed or divorced woman, give also maiden name.)


if so specify WAR)


(a) Residence. No.


19 OCEAN VIEW iLATHROP


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay : In place of death .............. years .......


months .8 days. In place of residence.


.......


.years ...


6


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


00


8 SEX


2


9 COLOR


W


10 SINGLE


MARRIED


(write the word)


WIDOWED Widowed


or DIVORCED


(Give maiden name of wife in full)


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGF82 Years ..


0


.Months.


9


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.


none


16 BIRTHPLACE (City)


(State or country)


nova Scotia


17 NAME OF


FATHER


Hubert V. Potter


18 BIRTHPLACE OF


FATHER (City)


Clementsport


(State or country)


nova Scotia


19 MAIDEN NAME


OF MOTHER


Susan J. Freeman


20 BIRTHPLACE OF


MOTHER (City)


Harmony Mills


(State or country)


nova scotia


Muss Harrier Smith


(Address) 19 ocean View &t


7 NAME OF


FUNERAL DIRECTOR


RICHARDSON'S FUNERAL HOME


ADDRESS 48 LAFAYETTE PARK .LYNN


Received and filed


FEB 16 1901


19


(Registrar)


PARENTS


(Signed) Lasede Gregate M. D.


Joseph GREGORIE


(PRINT OR TYPE SIGNATURE)


(Address) 94 Washingtonau Date! 7/10


19.


61


6 Pina Snow Winthrop


Place of Burial or Cremation


DATE OF BURIAL diab. 13


(Chy or Town) 1961


21 Informant


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


thusnature of Agent of Board of Health or other)


11:0


2/10/6/


(Official Designation) (Date of Issue of Permit) X


RUCTIONS FOR CERTIFICATE


giving OF DEATH


not enter than one e for each (b) and (c)


daes nat mean de of dying, heart failure, etc. It means se, or compli- which caused


ions, if any, gave rise to cause (a). the under- cause last.


litians contrib- death but not o the terminal onditian 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 der signature.


11-59-926662


PLACE OF DEATH


MM R-301A 1


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis ?


INTERVAL


BETWEEN


ONSET AND


DEATH


2 plays


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Cerebro Vascular


Accident


Due To


(b) ....


arteriosclerosis


generalized


Due To


(c)


3 DATE OF


Feb .


10


1961


DEATH


(Year)


(Month)


(Day)


4 I HEREBY CERTIFY,


JAN. 2, 1961 to Feb.


9


That I attended deceased from


1961


I last saw h.Amtalive on


Feb


8


19 61


death is said to


have occurred on the date stated above, at


2:10 Am.


10a If married, widowed, or divorced


HUSBAND of


Harry A. Brown


(or) WIFE of


Clementsport


5 Was disease or injury in any way related to occupation of deceased? 170 If so, specify .....


Bay View Rest Home


PHYSICIAN - IMPORTANT


[(Was deceased a


U. S. War Veteran,


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


25000 50


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OF


10


-.


WII


6


5 SE .


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the obsery 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 onlytab tis 54961 AM 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 it the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


×


1


PLACE OF DEATH


Essex (County )


Danvers (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Danvers


(City or Town making this return)


Registered No.


33


[{If death occurred in a hospital or institution,


Ndanvers ..... State .... Hos.pit.al., .... Hathorne .. , Isa $ Sve its NAME instead of street and number)


2 FULL NAME. Arthur F. Wrightson


(If deceased is a married, widowed or divorced woman, give also maiden name.)


35 Summit Avenue


Winthrop Mass.


(If nonresident, give city or town and State)


Length of stay: In place of death ......


.... years.


11.months .. 2.


.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)


MARRIED


WIDOWED


or DIVORCED


widowed


4 I HEREBY CERTIFY,


That I attended deceased from


March .9.


60


19


to ...


February 11,


19


61


I last saw haAlive on


February ... 11.,19 61 death is said to


have occurred on the date stated above, at 4:20a n.


INTERVAL BETWEEN ONSET AND DEATH


years


12


AGE ..


83 Years


7


20


Days


If under 24 hours


Hours ......


.Minutes


13 Usual


Occupation:


Architectual .... Engineer


( Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security. No.


Unknown


16 BIRTHPLACE (City)


(State or country)


England


17 NAME OF


FATHER


Unknown


Was autopsy performed?


No


What test confirmed diagnosis ? Clinical & Laboratory


5 Was disease or injury in any way related to occupation of deceased ? If so, specify


PARENT


18 BIRTHPLACE OF


FATHER (City)


Unknown


(State or country)


Eng land


( Signed)


Andrew Nichols III


( Address )


Hathorne, Mass.


Date. 2/11/, 19


M. D. 61-


Winthrop Cemetery, Winthrop


DATE OF BURIAL


February 15,


19


61


21


Informant


( Address )


Mary E. Sheehan


Hathorne, Mass.


A TRUE COPY


ATTEST :


Daniel Toomey


(Registrar of City or Town where death occurred)


Received and filed


MAR 8 1961


19


a. Clark


( Registrar of City or Town where deceased realded)


X


I


50M-9-59-926111


3 DATE OF DEATH resided as soon as possible. after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased CONDITIONS


RM R-302


THIS IS A PERMANENT RECORD


6 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)


Dxxx & Arteriosclerotic Heart disease


years


OTHER


Secondary Anemia


SIGNIFICANT


(a) Generalized Arteriosclerosis


10a If married, widowed, or divorced


HUSBAND of


Charlotte .... Westley


(Give maiden name of wife in full)


(or) WIFE of.


( Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


February


11.


1961


(Month)


(Day)


(Year)


) ( Was deceased a


U. S. War Veteran,


No


(if so specify WAR,


(a) Residence. No., ( Usual place of abode )


Alfred Marsh


ADDRESS


7 NAME OF


FUNERAL DIRECTOR


Winthrop, Mass.


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


Place of Burial or Cremation (City or Town)


19 MAIDEN NAME


OF MOTHER


Unknown


Unknown


DATE FILED


February 20, 19


67


Unknown


11 IF STILLBORN, enter that fact here.


1


6


MAR -81961 4H


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


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. 34


[(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)


126 Brookfield Rd.


St.


(If nonresident, give city or town and State)


Length of stay : In place of death ..


10 years ..


months


days. In place of residence.


10


years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Februar


16


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 ...


11


.... m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Natural Causes


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


-


12


AGE GO


Years.


Months.


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. none


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Joseph Lampasona


18 BIRTHPLACE OF FATHER (City) (State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Anna Unknown


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


21


Informant


(Address)


CarmineDi Vita


Morton St Winthrop Mass


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) 2/19/11


(Official Designation)


(Date of Issue of Permit)


VI


Tima UCTIONS OR CERTIFICATE


giving OF DEATH ›t enter than one for each b) and (c)


es not mean of dying, teart failure, tc. It means or compli- which caused


ns, if any, ave rise to ause (a), the under- ause last.


ions contrib- eath but not the terminal sdition given


Chapter 137, 54. requires Is to print or cause or death on ificates, and 18, Acts of hires Physi- rint or type er signature.


C .


7 NAME OF


FUNERAL DIRECTOR.


Ernest P Caggiano


147 Winthrop St, Winthrop.


Received and filed FEB-2-0-1961 ... 19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED)


WIDOWED


or DIVORCEDWidowed


10a If married, widowed, or divorced


HUSBAND of


Frank Di vita


pame of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


Due To D.


Presumably Coronary Occlusion


(b)


Due To


(c)


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.


Arthur C. Murray


(Address)


Winthrop Band of Health fel


61


6


Winthrop


Winthrop Mass


Place of Burial or Cremation


DATE OF BURIAL


Feb 20


(City or Town) 61


PARENTS


ADDRESS


No.


126 Brookfield Rd,


2 FULL NAME


Rose Di Vita ( Lampasona)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


(Usual place of abode)


59-925686


R-301A 1


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER.


11 12


r K


6


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RULES OF PRACTICE FEB 2 01961 AM


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.




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