USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 18
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(a) Residence. No.
104 Highland Ave.
(Usual place of abode)
S
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years ..
3
months.
.days. In place of residence .......... years .......... months ........
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
7
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
19
to.
I last saw h ...... alive on .. , 19. death is said to
have occurred on the date stated above, at
4:30 P.M.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
INTERVAL BETWEEN ONSET ANO DEATH
(a)
Due To Presumably Coronary Occlusion (b)
sudden
(c) Arterioscleriotic Heart Disease
OTHER
SIGNIFICANT
CONDITIONS
Nove
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 .
(Signature)
Arthur C. Murray
(Print or Type Name ) Waschrof Board of Health Dat 10/May 1962
... St ..... Pauls .... Cemetary ...
Arlington
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
may
11-
1962
7 NAME OF
FUNERAL DIRECTOR
Arthur S. Porcella
ADDRESS 876 Winthrop Ave., Revere
Received and filed
MAY10-1962
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
Single
11 If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE. 85. Years
1 bionths.
10Days
If under 24 hours
Hours ... .... Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most working life)
14 Industry or Business:
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country )
Ireland
17 NAME OF
FATHER
Jeremiah Murnane
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary Burke
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Informant
Revere Bureau of Old Age Ass.
(Address)
City Hall, Revere, 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)
11/162
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH Mount's Rest Home
(City or Town making this return)
Registered No. 93
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
DRM R-301
for burial permit Bird of Health & Agent. SUCTIONS FOR CERTIFICATE
FOR TYPE EDR CAUSES RDEATH E ot enter than one for each (b) and (c)
es not mean e of dying, heart failure. tetc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
Ditions contrib- death but not the terminal ndition given
PARENTS
.
6
-
2 2-932382
(Was deceased a U. S. War Veteran, (if so specify WAR)
19. -
5yrs.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
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 40-02 PH 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 froin 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
................ (County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent. 08:2
94
1
Registered No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Frederick Lewis
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
64 BuchanAn Street
.St.
Winthrop,
Massachusetts
(L'sual place of abode)
Length of stay: In place of death ............ years.
21 days. In place of residence.
13 years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
J DATE OF
DEATH
May11 1962
(Month)
(Day)
(Year)
8 SEX MALE
9 COLOR
WHITE
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed Ar divorced CONWHY
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
13
84 Years.
.Months.
.Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :
SHIPPER
(Kind of work done during most of working life)
15 Industry
or Business :
HALLESALE GROCERS
16 Social Security No.
011-03-3610
NOVA SCOTIA
What test confirmed diagnosis?
clinical ..
S Was disease or injury In any way related to occupation of deceased?
If so, specify
(Signed)
Charles L. Clay, M. D.
(Print or Type Name)
Aus's. Dir., Mass. Con'l. Home Date
May 11 1962
(Address)
GLENWOOD
EVERETT
6
Piace of Burial or Cremation
(City or Town)
DATE OF BURIAL MAY 14 1962
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS
WINTHROP
Received and filed
MAY 15 1962
·
19
Charles & Machu
(Registrar)
PARENTS
18 NAME OF
FATHER
JAMES LEILIS
19 BIRTHPLACE OF
FATHER (City)
(State or country)
NOVA SCOTIA
20 MAIDEN NAME OF MOTHER (UNKNOWN )
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
NOVA SCOTIA
22 Informant (Address) 64 BUCHANAN ST WINTHROP
MRS MARY C LEWIS
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: FPShaca A 08494 (Signature of Agent of Board of Health of other) NOT May13, 1967
(Official Designation)
(Date of Issue of Peymit) TV.E.V
I TRUCTIONS FOR AL CERTIFICATE
giving 18, OF DEATH
not enter de than one e for each , (b) and (c)
adoes not mean Ide of dying, heart failure, etc. It means ise, or compli- which caused
ions, i/ amy, gave rise to cause (a), the under- cause last.
atitions contrib- death but not d'o the terminal & ondition given
Se :- Chapter 137, of 1954 requires cians to print or the cause or s of death on certificates, and er 48, Acts of requires Physi- to print or type under signature. . C
1962
11 Director . vee only ICK Ink. 8 11-930213
-
Due To (b)
Due To (c)
Specific aortitis
yrs.
OTHER
SIGNIFICANT
CONDITIONS
Lobar pneumonia
fewdays
Was autopsy performed?
no.
to .....
19.62
Mast saw himalive on
May
11
death is said to
have occurred on the date stated above, at
INTERVAL
5:30 pm.
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Coronary heart disease
DEATH yrs.
(a)
....
4I HEREBY
CERTIFY,
That
1
Pattended deceased from
April 20
19.62
May
f (Was deceased a U. S. War Veteran.
(if so specify WAR)
(If nonresident, give city or town and State)
No.
MASSACHUSETTS GENERAL HOSPITAL
-
1 ON
IM R-301 1
A TRUE COPY ATTEST:
M. D.
17 BIRTHPLACE (City)
(State or country)
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
OF TOW
12
00
. .
6
15
THROP
JUN - 81962 AM
PLACE OF DEATH
Suffolk (County) Winthrop
(City or Town)
dull 9.000
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 95
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)
no
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. Nantasket Avenue St. Nantasket
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
4
years ..
6 months
„.days. In place of residence. ....... ... years. . months days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX male
9 COLOR
white
MARRIED
WIDOWED single
or DIVORCED
4 I HEREBY CERTIFY,
Dec
1959, to.
May
11
That I attended deceased from
196.2
I last saw h Inalive on
may
10
62
death is said to
have occurred on the date stated above, at
1:50 Pm.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Left Hemiplegia
7 yrs
74
12
AGE
Years ...
.. Months.
.. Days
If under 24 hours
Hours ..........
Minutes
13 Usual
Occupation :
Retired
14 Industry
or Business :
**
Du (c) ....
Arteriosclerosis.
7 yrs
Imos. 17yrs
Was autopsy performed?
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? Vi If so, specify
(Signed)
Clientes
Fiberway M/D. CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE
(Address) WINTHROP Date 5/11/1962
6
Place of Burial or Cremation
DATE OF BURIAL
May 14,
19 62
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS
9 Chelsea t. Last Boston, Mass
Received and filed MAY 14 1962 19.
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Teresa Kanieri
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Frances Pavone (sister-in-law)
17 Brentwood St Malden, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued: RalphE frami
(Signature of Agent of Board of Health or other)
Health Offers
May 13, 1962
(Official Designationy
(Date of Issue of Permit)
UCTIONS OR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
es not mean of dying, heart failure, etc. It means , or compli- hich caused
ns, if any, ve rise to ause (a), the under- ause last.
tions contrib- leath but not the terminal ndition given
Chapter 137, 954. requires is to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.
0-59-92 5686
1
Mount's Convalescent Home Inc. No.
Cesare Pavone
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
11
1962
(Month)
(Day)
(Year)
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
- (b) Hypertension
7yrs
(Kind of work done during most of working life)
15 Social Security No.
unknown
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Isadoro Pavone
OTHER SIGNIFICANCarcinoma of skin CONDITIONS Bronchiechasis.
Holy Cross Cemetery Malden 21 Informant (City or Town) (Address)
To be filed for burial permit with Board of Health or its Agent.
: R-301A 1
10 SINGLE
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : MAY 1 41962 AM
(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
STANDARD CERTIFICATE OF DEATH
Registered No.
96
f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME NETTIE MCMILLAN
( First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
466 Broadway
Chelsea Mass
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death ............ years ..
months.
days. In place of residence
.years.
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 CITIZEN
OF U.S.
YESİ
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Peter
1
McMillan
(Husband's name in full)
12 DATE OF BIRTH
13
AGE
86 Years
.Months
.Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
House Work
(Kind of work done during most of working life)
15 Industry
or Business :
At Home
16 Social Security No.
None
Nova Scotia
17 BIRTHPLACE (City)
(State or country)
Canada
18 NAME OF
FATHER
?
Ackles
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
20 MAIDEN NAME
OF MOTHER
Could not be learned
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
22
Informant
(Address)
Mrs ...
Viva Davis (daughter)
465 Broadway Chelsea 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)
I (Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
(Registrar)
PARENTS
7 NAME OF
FUNERAL DIRECTOR
John G. Welsh
ADDRESS
718 Broadway Chelsea, Mass
Received and filed
MAY 24-1962
19
51-930213
Countersigned by Leonard Atking ASSO.
N: RUCTIONS FOR CERTIFICATE
giving S. OF DEATH
icot enter io than one it: for each a(b) and (c)
s'oes not mean n'e of dying, heart failure, etc. It means B se, or compli- which caused
dons, if any, igave rise to E cause (a), the under- cause last.
Due To (b)
Due To (c)
OTHER
Fructis RED
HIP
CONDITIONS treated GT M. Q. HOSPITAL
Was autopsy performed?
NU
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
HU
(Signed)
MORRIS CLAYMATA
198 CHESTNUT SK
M. D.
(Address)
(Print or, Type Name)
Clientec more MAY2, 2
Morris #. Clayman, M.D.
Woodlawn Cemetery, Everett, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL May 24. 1962
INTERVAL BETWEEN ONSET AND DEATH 3 wee$
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(3) CONGESTIVE HEART
FAILURE
230g
....... m.
have occurred on the date stated above, at
3 DATE OF
DEATH
May
21,
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIF
Jan 1
58
, to ...
MAY 21
That I attended deceased from 6
Female
White
[ ( Was deceased a U. S. War Veteran, (if so specify WAR)
No
St.
(If nonresident, give city or town and State)
To be filed for burial permit with Board of Health or its Agent.
(City_or Town) Mount's Convalescent Home No. 1.04 .Highland Avenue
Chelsea 5-25-62
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OM R-301 0° 1
IR
:- Chapter 137, f 1954 requires ians to print or the cause or of death on certificates, and For 48, Acts of equires Physi- o print or type kinder signature.
5/22/62
X
last saw himalive on
MAX
2 1, 196, death is said to
o itions contrib- t death but not the terminal ndition given
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
1
RULES OF PRACTICE MAY 2 41962 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 froin 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 (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.
97
S(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) No.
2 FULL NAME Mary Ellen.
Greer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
73 Chester Avenue
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In place of death .. . . .. .. years ...
2
months
days. In place of residence.2.5 .... years ........ . .. months ..
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
19
1962
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
van
1
That I attended deceased from
1962
I last saw h@ .. Yalive on
May
14
19.62, death is said to
have occurred on the date stated above, at
7:30 A.m.
INTERVAL BETWEEN ONSET AND DEATH
3yrs
12
AGE9.4
.8.
Years.
Months 0
.. Dạvs
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
Lester
BIRTHPLACE (City
(State or country)
England
Gr
17 NAME OF
FATHER
Jonathan Hutchinson
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21
Informant
John Naw
(Address)
7 Walnut St. Saugus, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Mass.
Kalple E Seriande
(Signature of Agent of Board of Health or other)
Health glicer
5/22/62
(Official Designation) /C
(Date of Issue of Permit)
Tiilor
ISIUCTIONS FOR CERTIFICATE
giving SIOF DEATH ot enter sì than one for each (b) and (c)
pes nat mean me af dying, 1 heart failure, Wetc. It means See, or campli- which caused
lions, if any, Agave rise ta cause (a), the under- cause last.
-
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
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.
(Signed)
Charles Liberman
M. D.
OF MOTHER
Ann Davis
CHARLES LIBERMAN
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date .. 5/19/ 1562
6 Porbest Hills Cemetery Boston (City or Town)
Place of Burial or Cremation
DATE OF BURIAL
May 22,1962
7 NAME OF
FUNERAL DIRECTOR
ADDRESS 174 Winthrop St. Winthrop,
Received and filed MAY 22 1962 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
single
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Arteriosclerotic Heart Disease
Due To (b)
....... .......
PARENTS
RI R-301A -
nitians cantrib- hdeath but nat the terminal inditian 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.
16-59-925686
WinthropConvelescent Home
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
[(Was deceased a U. S. War Veteran, {if so specify WAR)
NO.
St.
Winthrop, Mass
1962
to.
MAY 19
(Cefull B Marty
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
TOW:
8
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THROP.
RULES OF PRACTICE The fulfillment of the purpose of these laws calls for the obseMAY 2 21962 AM 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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