USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 7
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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
125.
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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