USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 10
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(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 bad been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
R-301A 1
ICTIONS R ERTIFICATE
ving IF DEATH
mi enter an one ebr each () and (c)
in not mean de of dying, Art failure, € It means se or compli- ud'h caused
ion if any, ga, rise to case (a), & under- cae last. diti s contrib- deh but not 0 l terminal oncion given
MED: EXAM CALLED
:- Japter 137, f 19 .. requires ianto print or the cause or of death on cerucates, and 4 Acts. of reques Physi- to plit or type inde signature.
AR : 0 1962
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 be filed for burial permit with Board of Health or its Agent.
48
2 FULL NAME
MARY "BELLE SMITH'' (Mad Quarrie )
(First Name)
(Middle Name)
(Last Name)
f(Was deceased a
U. S. War Veteran,
[if so specify WAR)
NO.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
9. Marshall Street
(Usual place of abode)
Length of stay: In place of death.
.years.
1
months21.
days.
In place of residence 3.4.
.years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
MAR
18
1962
DEATH
(Year)
(Month)
(Day)
8 SEX
female
white
9 COLOR
10 SINGLE
(write the word
MARRIED married
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY
JAN
19.
53
MAR18
That I attended deceased from
62
19.
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Walter Smith
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE CORONARY OCC
INTERVAL
BETWEEN
ONSET AND
11 IF STILLBORN, enter that fact here.
DEATH "
2% to
12
AGE ..
5.6Years.
.4 .... Months ........... Days
If under 24 hours
Hours ..........
Minutes
Due To (b)
ARTERIO-SCLEROTIC 8 HYPERTENSIVE
Due To
HEART DISEASE
(c)
GENERAL ARTERIOSCLEROSIS.
OTHER
DIABETES MELLITUS.
SIGNIFICANT
CONDITIONS
CARINUMA OF CUX VITA
METISTOSIS
ET. MY
Was autopsy performed?
NO
CLINICAL
No
6
Winthrop Cemetery Winthrop, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL
March 21, 1962
19
7 NAME OF
FUNERAL
DIRECTOR.
alfred 3 March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed
19
(Registrar)
PARENTS
17 NAME OF
FATHER
John E. MacQuarrie
18 BIRTHPLACE OF
FATHER (City)
M. D
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Dora MacInnis
20 BIRTHPLACE OF
.
MOTHER (City)
(State or country)
Nova Scotia
21 Informant Walter Smith
(Address)
9 Marshall St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: .Mass (Signature of Agent of Board of Health or other) Health Affiche 3/20/62
(Official Designation)
(Date of Issue of Permit) VIA
Wife
13 Usual
Occupation :
housework
(Kind of work done during most of working life)
14 Industry
or Business :
own home
15 Social Security No.
none
Roxbury
16 BIRTHPLACE (City)
(State or country)
Massachusetts
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
MYRON N. KING M.D
(PRINT OR TYPE SIGNATURE)
(Address) 2228 LEASANT SÍ Date. 3/18 /062
WINTER !!
9yrs
9 YRS.
8 YRS
LaYRS.
ARACT RT. FIBULA 16 DAYS What test confirmed diagnosis?
(Give maiden name of wife in full)
I last saw helalive on
to ..
MAR 15 96
death is said to
have occurred on the date stated above, at
..... m.
St
( If nonresident, give city or town and State)
Registered No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
No. WinthropCommunity Hospital
-DECLINED JURIS DICTION - (a) ......
50-97 45
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
MAR 2 01962 FM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
X PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. 26 Lincoln 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.
50
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Anna Burton Day ( Morgan )
(First Name)
(Middle Name)
(Last Name)
[(Was deceased a U. S. War Veteran,
[if so specify WAR) NO.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
26 Lincoln Street
(Usual place of abode)
Length of stay: In place of death .. ....
.... years ...
....... months.
.days. In place of residence.
7
years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
21
19.6.2
(Month)
(Day)
(Year)
9 COLOR
8 SEX
female
white
10 SINGLE
(write the word)
MARRIEDWidowed
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
SEPT 26, 1956 to MAR 21
62
I last saw h Ralive on
MAR 21
196 2
death is said to
have occurred on the date stated above, at
4. 4 69m.
INTERVAL
BETWEEN
ONSET AND
DEATH
iYR.
11 IF STILLBORN, enter that fact here.
12
AGE
9.4 Years
5
.Months.
27
Days
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :
housework
(Kind of work done during most of working life)
14 Industry
or Business :
own .... home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Wales
17 NAME OF
FATHER
Richard Morgan
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Wales
19 MAIDEN NAME
OF MOTHER
Sarah Burton
20 BIRTHPLACE OF
(State or country) Wales
Mrs. Robert H. Collignon
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass. Hallhe Cteriaune Signature of Agent of Board of Health or other.A
3/23/62
(Date of Issue of Permity
-6-60-928145
FRM R-301A - 1
ISTRUCTIONS FOR EL;AL CERTIFICATE
In giving TE OF DEATH
o not enter ore than one use for each f1), (b) and (c)
; does not mean node of dying, .as heart failure, hia, etc. It means sease, or compli- which caused i
C ditions, if any, kch gave rise to me cause (a), hing the under- eg cause last.
onditions contrib- r to death but not at to the terminal e: condition given
ote :- Chapter 137, 4 % of 1954. requires Fsicians to print or : the cause or ;ses of death on Ith certificates, and Fipter 48, Acts of 1), requires Physi- cis to print or type The under signature.
(Signed)
Myron n. Rua
M. D
MYRON NO. KING M DI
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST WINTHRO
Date. 3/22 /062
Winthrop Cemetery 6 Place of Burial or Cremation
7 NAME OF FUNERAL DIRECTOR Cuped B Marsh
ADDRESS 174 Winthrop St. Winthrop,
Received and filed
19
(Registrar)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William .... Arnold .... Day
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
AREERIL-SCLEROTIC
HEART
4. SENILE PSYCHOSIS
Dis
Due To (b) GENERAL ARTERIOSCLEROSIS
5 YRS
Due To
(c)
OTHER
SIGNIFICANT
DECUBITUS ULCERS.
4mo
CONDITIONS
Was autopsy performed?
Nº
What test confirmed diagnosis? CLINICAL
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
PARENTS
Winthrop Mass . MOTHER (City) (City or Town)
DATE OF BURIAL March 23 62 21 Informant (Address) 26 Lincoln St. Winthrop
IAR 27 1962
TIB
(Official Designation)
Registered No.
St
(If nonresident, give city or town and State)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF3-1 .:
:3.
ERK:
W.Il
5
T
RULES OF PRACTICE MAR 2 71962 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.
X PLACE OF DEATH
Winthrop (County)
Suffolk (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS 2H3L STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
51
Nayflower ..... Nursing ..... Home.
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME Edith (Hewson) Webster
(First Name) (Middle Name) (Last Name)
(If deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay :
In place of death.
.years ........
months.
1.5 ... days. In place of residence. 5.4 ... years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
24
1962
(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
m.
(or) WIFE of
John Archibald Webster
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
7.7Years
3
Months.
3
Days
If under 24 hours
Hours ..........
Minutes
13 Usual
Occupation :
retired owner
(Kind of work done during most of working life)
14 Industry
or Business :
restaurant
15 Social Security No.
051-12-7503
Liverpool
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
Michael J. Hewson
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME OF MOTHER Sophia Goodwin
20 BIRTHPLACE OF MOTHER (City) (State or country) England
Walter H .Webster
21
Informant
(Address)
140 Circuit Rd. Winthrop
I HEREBY CERTIFY , that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass. Facile E Pereacuso
( (Signature of Agent of Board of Health or other) } Thealth Offices 3/24/62
(Official Designation)
(Date of Issue of Permit)
STRUCTIONS FOR DAL CERTIFICATE
In giving LE OF DEATH
› not enter Dre than one case for each f ), (b) and (c)
). does not mean sode of dying, his heart failure, tea, etc. It means io ;ease, or compli- which caused
ditions, if any, olh gave rise to be cause (a), ting the under- yı' cause last.
unditions contrib- mito death but not it to the terminal condition given
Ite :- Chapter 137, of 1954. requires b.icians to print or the cause or es of death on certificates, and ter 48, Acts of .. requires Physi- is to print or type : under signature.
Woodlawn Cemetery, Everett, Mass 6 Place of Burial or Cremation
·
(City or Town)
DATE OF BURIAL March 27, 1963
7 NAME OF
FUNERAL
DIRECTOR
alfred 9 March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed
MAR 28 1962
19
( Registrar)
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED widowed
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cr
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Due To (c)
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
(Signed) M. D.
(PRINT OR TYPE SIGNATURE)
(Address)
Date 19
PARENTS
[( Was deceased a { U. S. War Veteran,
{if so specify WAR)
140 Circuit Road
St.
(If nonresident, give city or town and State)
Registered No.
No.
CIM R-301A 1
16-60-928145
SPACE FOR ADDITIONAL INFORMATION RECEIVED
DATE OF ENTERING MILITARY SERVICE
TOW
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1-1.50
0
ERK
6
2
MAR 2 81962 PM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation: by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
X PLACE OF DEATH
Suffolk
MelROSE 4-6-1962
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
52
Samuel A. Naugh
2 FULL NAME
(First Name)
(Middle Name)
(Last Name)
lif so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
84
Orchard Iane
Melrose
(a) Residence. No. ( Usual place of abode)
Length of stay: In place of death ....... .... years.
2.months days. In place of residence. .years ..
.. months ...........
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
march
25
(Day)
1962
(Year)
8 SEX
Vale
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
arried
4 I HEREBY CERTIFY , That I attended deceased from
march 8, 1962, to
19.62
march 25
I last saw h.J.K.kalive on
March 25, 1962, death is said to
have occurred on the date stated above, at
1
Tm.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Hepatic Failure
Due To
(b)
Carcinoma of the Pancréas
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
Aunguy Brophy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
-10-
(Signed)
& G. De Luca
M. D.
S. A. DE LUCA M.D.
(PRINT OR TYPE SIGNATURE)
(Address)
550 Park Are Date.
Marchio 1962
Puritan Lawn
Peabody
6 Place of Burial or Cremation
DATE OF BURIAL
March 28, 1962
19
7 NAME OF
FUNERAL DIRECTOR
Leslie W. Pike
305 Reach St Revere
ADDRESS
Received and filed MAR 2.8. 1962 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Susan Mac"Tilliams
20 BIRTHPLACE OF
Randolph
MOTHER (City)
(State or country)
Mass
21
Marjorie Waugh
Informant
(Address)
84 Orchard lane Melrose
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burtal or transit permit was issued: Malkle c. Seriauna & (Signature of Agent of Board of Health or othery
Health Officer
3/28/62
(Official Designation)
(Date of Issue of Permit) /
X
11-60-928145
7
ITRUCTIONS FOR DIAL CERTIFICATE
n giving JE OF DEATH
not enter rre than one c: se for each (), (b) and (c)
h does not mean ode of dying, 's heart failure, ent, etc. It means acase, or compli- w which caused h
mitions, if any, h's gave rise to c cause (a), a. g the under- cause last.
Unditions contrib- go death but not e to the terminal as condition given a
Ne :- Chapter 137, c' of 1954. requires hicians to print or F the cause or 1:s of death on a certificates, and h ter 48, Acts of s requires Physi- a. to print or type · under signature.
).M R-301A 1
(County)
PENSE PETIT
Winthrop
(City or Town)
No.
Winthrop Community Hospital
S(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
NO
St
(If nonresident, give city or town and State)
10a If married, widowed, or divorced
HUSBAND of
Marjorie
Rogers
(Give maiden name of wife in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
60 6
Months.
24
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
Auto Dealer
(Kind of work done during most of working life)
14 Industry
or Business :
Automobile
15 Social Security No.
Revere
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Samuel A. Waugh
Days
2 months
INTERVAL BETWEEN ONSET AND DEATH
(Month)
14
To be filed for burial permit with Board of Health or its Agent.
(City or Town)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
TOW.
DATE OF DISCHARGE
RANK, RATING
in
ORGANIZATION AND OUTFIT
8
SERVICE NUMBER
WY
6
RULES OF PRACTICE MAR 2 81962 PM
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.
DRM R-301A 1
INSTRUCTIONS FOR MICAL CERTIFICATE
In giving USE OF DEATH do not enter nore than one ause for each c (a), (b) and (c)
is does not mean u mode of dying, ut as heart failure, st nia, etc. It means hedisease, or compli- uns which caused
nditions, if any, ich gave rise to ove cause (a), ting the under- cause last.
Conditions contrib- ti' to death but not led to the terminal isse condition given " ).
Nte :- Chapter 137, c of 1954. requires h icians to print or the cause or IL:s of death on El certificates, and h ter 48, Acts of ! requires Physi- s. to print or type a · under signature. m.c.
IAR 2 9 1962
COM-11-59-926662
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
Registered No. 53
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
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