USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 20
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* . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing 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 unrelated 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 occupation, 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 import- ant, 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. Children 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
DRM R-301
afor burial permit ard of Health :s Agent. RUCTIONS FOR CERTIFICATE
CI
OR TYPE OR CAUSES DEATH a ot enter than one for each (b) and (c)
does not mean Je of dying, A heart failure, &etc. It means ose, or compli- schich caused
doms, if any, cfgave rise to cause (a), in the under- Lacause last.
ditions contrib- death but not the terminal Condition given
Suffolk (County)
Winthrop (City or Town)
Che Commonwealth of zuassarhuseiis KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
Registered No. 102
S(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Brendan
J.
Keenan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
87 Washington Ave
St
Winthrop Mass
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death ......... years ......... months.1
.days. In place of residence. 2 years.
months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
WIDOWED
11 If married. widowed. HUSBAND of MARY
divorced L SULLIVAN.
(Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
12
88 years
Years.
Months.
Days
If under 24 hours
Hours.
.Minutes
13 L'sual
Occupation :
BANK
TREAS.
Kind of work done during most working life)
14 Industry
or Business :
BANK
15 Social Security No.
NONE
LAST BOSTONY
16 BIRTHPLACE (City)
(State or country )
NOASS
17 NAME OF
FATHER
HENRY E KEENAN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
IRELAND
19 MAIDEN NAME
OF MOTHER
MARY DOHERTY
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
MISS LOUISE KEEHAN
21 Informant
(Address)
STWASHINGTON AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Pavel C. Jeresvar D
(Signature of Agetit of Board of Health or other) Talet Elever 5 3)
(Official Designation)
1
(Date of Issue of Permit)
>
A TRUE COPY ATTEST:
INTERVAL BETWEEN DNSET AND DEATH 3 hours
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebro Vascular
accident
Due To
(b) ...
mario Sularci.5
Due To
(c) senility
OTHER SIGNIFICANT Myocardial
CONDIT
heart Disease
W'as autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signature)
M. D.
Juseph GREGORIE
(Print or Type Name)
(Address) 194 Washington Like Date ... 5-29 1962
6
HOLY CROSS
MALDEN
Place of Turial or Cremation
(City or Town)
DATE OF BURIAL
VONEL
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS
WINTHROP.
Received and filed 19
MAY 31 1962
(Registrar)|
55,
3 DATE OF
DEATH
May
2.8.
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
,
That I attended deceased from
to ...
m
29
19
60
I last saw hj. Dalive on
may 28 ], 19 62 death is said in
have occurred on the date stated above, at 5.15 m.
4,0
PARENTS
2.2-932382
1
Winthrop Community Hospital No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(If nonresident, give city or town and State)
AGES
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un. related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths 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.
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R-301A 1
STICTIONS OR CERTIFICATE giving OF DEATH t enter han one for each b) and (c)
es not mean of dying, eart failure, tc. It means or compli- hich caused
Luis, if any, ive rise to nuse (a). he under- zuse last.
ions contrib- cath but not the terminal dition given
Chapter 137, 954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type ier signature.
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.
103
[(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,
2 FULL NAME Ruphie (Pendleton) Barclay (First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 173 Pauline Street
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
59
.. months.
days.
In place of residence.
7.0years ............ months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
MAY
29
(Month)
(Day)
1962 (Year)
8 SEX
Female
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY
CERTIFY,
AVG 6
1949
....
to ..
MAY 29
I last saw h.
lalive on
MAY 29
196 death is said to
have occurred on the date stated above, at
445pm.
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
11 IF STILL BORN, enter that fact here.
12
89
5
1
If under 24 hours
AGE
Years
Months.
Days
Hours .............. Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Own home
15 Social Security No.
None
Belfast
16 BIRTHPLACE (City)
(State or country)
"Laine
17 NAME OF
FATHER
Nathan Pendleton
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Unable to obtain
19 MAIDEN NAME
OF MOTHER
Martha Stover
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
21 Robert Barclay
Informant
(Address)
173 Pauline 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 of other)
He ele officer
6/1/62
(Date of Issue of Permit)
T V.B V
1
PARENTS
Winthrop
Winthrop
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
June 1
19 62
7 NAME OF
FUNERAL
DIRECTOR
Howard S Reynolds
Winthrop, Lass
ADDRESS
Received and filed
JUN 1 1962
19
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH 1 HR.
Due To
(b)
ARTERIO-SCLEROTIC HEART DIS
Due To
* GENERAL ARTERIO SCLEROSE
(c)
syRes
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis? CLINICAL
5 Was disease or injury in any way related to occupation of deceased? A. If so, specify
(Signed)
MYRING NI KING M.D.
M. D.
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT
WINTEREDDate.
5/31 1962
-928145
(Official Designation)
To be filed for burial permit with Board of Health or its Agent.
No.
173 Pauline Street
lif so specify WAR)
St
(If nonresident, give city or town and State)
10 SINGLE
(write the word)
That I attended deceased from
102
(Give maiden name of wife in full)
Robert Barclay
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CEREBRAL VASCULAR ACCT.
Housewife
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE TO !!
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
0
JUN -11962 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.
ORM R-301
for burial permit ard of Health ts Agent. UCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)
Des not mean of dying, heart failure, etc. It means e, or compli- which caused
ms, if any, ave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal indition given C
5 Was disease or injury in any way related to occupation of deceaseded .: If so, specify
(Signature) myron h King M. D. MYRON N. KING MM.D (Print or Type Name) (Address) 221 PLETISANT ST 5/30 1962 WINTHEIR Mass Date.
WINTHROP 6
WINTHROP
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
JUNE
£
2
1962
7 NAME OF
FUNERAL DIRECTOR
MAURICE W MIRBY
ADDRESS WINTHROP.
Received and filed John a. Clarky MAY 31 1962
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
MALE
1
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED
UNKNOWN MARRIED
11 If married, widowed, or divorced
HUSBAND of
PITA ME BURRIDGE
(or) WIFE of.
(Husband's name in full)
12
AGE.
4Gears
Months ..
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
SHEET METAL
(Kind of work done during most working life)
14 Industry
or Business :
HEATING
15 Social Security No.
018-16 -4010
16 BIRTHPLACE (City)
(State or country)
NOVA SCOTIA
17 NAME OF
FATHER
ALVIII J
18 BIRTHPLACE OF
FATHER (City)
(State or country)
NOVA SCOTIA
19 MAIDEN NAME
OF MOTHER
GRACE NI COMEAU
20 BIRTHPLACE OF
MOTHER (City)
NOVA SCOTIA
(State or country)
21 Informant
RITA M SAULNIER.
(Address)
26 SHIRLEY ST WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health' or other) Health Glicer 31 62
(Registrar) (Official Designation) (Date of Issue of Permit)
T VKV
I
Winthrop
(City or Town)
Winthrop Community Hospital No
The Commonwealth of massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
WINTHROP
(City or Town making this return)
104
[(If death occurred in a hospital or institution,
.St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME.
LEONARD J SAULNIER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
26 SHIRLEY ST., WINTHROP
St
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death .......... years ..
..... mo
23
30
1962
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY , That I attended deceased from
JAN
58
to ..
MAX 30
19.
62
I last saw h./Malive on
MAY
30
19.6 , death is said to
have occurred on the date stated above, at 1221
... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE PULMONARY EMBOLUS
(a)
MULTIPLE
Due To
(b)
ACUTE MYOCHILDITIS
Due To ACUTE PNEUMONITIS (c)
SWIG
OTHER
SIGNIFICANT
CONDITIONS
NONE
INTERVAL BETWEEN ONSET AND DEATH
14Hrs.
4.wks
Occupation :
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(If nonresident, give city or town and State)
days. In place of residence / 4 years. .months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
2-932382
PLACE OF DEATH
SUFFOLK
(County)
Was autopsy performed?
YES
What test confirmed diagnosis ?
CLINICAL Y GROSS
PARENTS
Registered No.
(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
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.
ORM R-301
i for burial permit ard of Health ts Agent. N: RUCTIONS FOR CERTIFICATE 1
N OR TYPE SEOR CAUSES MIDEATH
inot enter 10 than one at: for each .
is joes not mean ale of dying, a heart failure, etc. It means use, or compli- which caused
id'ons, if any, agave rise to cause (a), the under- cause last.
Colitions contrib- Il death but not do the terminal ondition given
PLACE OF DEATH
X SUFFOLK (County) 1 WINTHROP (City or Town) WINTHROP COM. HOSP.
Che Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
{(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.
(a)
Residence.
(Usual place of abode)
41 44 HILLSIDE AVE
St
(If nonresident, give city or town and State)
years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
Dec ........ 20
195.4
to ...
May ..... 31
19
6.2.
I last saw kmalive on
May ..... 31
196.2 death is said to
have occurred on the date stated above, at6 .:. 5.5 ...... p.m.
INTERVAL BETWEEN ONSET AND DEATH
8 mos
Due To (b)
Due To
"Severe hypertrophic arthritis 4 yrs OTHER SIGNIFICANTGeneralized .... arterio ... CONDITIONSclerosis 2 yrs
Was autopsy performed?
no
What test confirmed diagnosis ? Clinical ........... lab ..
5 Was disease or injury in any way related to occupation of deceased ? no If so, specify
(Signature)
M. Traunstein N.
M. D.
M.Traunstein Jr ..... MCD.
(Address) 73Bartlett Rd. Date
6-1
62
WINTHROP WINTHROP
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
VONE
4
1962
7 NAME OF
MAURICE W. KIRBY
FUNERAL DIRECTOR
ADDRESS WINTHROP
Received and filed '
JUN 1-1962
.19
8 SEX
MILLE
9 COLOR
WHITE
(write the word)
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN MARRIED
11 If married, widowed, or diyorced -
HUSBAND of
MARY
EXPITTS) MORAM
(Give manden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
AGE 745 ears
Months ..
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
RESTAURANT PROP-
(Kind of work done during most working life)
14 Industry or Business :
15 Social Security No ...
032-03-3900
16 BIRTHPLACE (City)
(State or country)
BOSTON MASS
17 NAME OF
FATHER
JANIES MORAN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
IRELAND
19 MAIDEN NAME
OF MOTHER
MARY DRYER.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
MASMARY E MORAN
21 Informant,
(Address)
4 J HILLSIDE AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph Sirianni
(NO)
(Signature of Agent of Board of Health or other)
4.0
June 1 4 1962
(Date of Issue of Permit)
1 VBV
A TRUE COPY ATTEST:
262-932382
.
(Registrar) || (Official Designation)
(City or Town making this return)
Registered No.
105
2 FULL NAME.
DANIEL A MORAN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Length of stay: In place of death .......... years .......... months. 2 days. In place of residence. 36
31
1962
PERSONAL AND STATISTICAL PARTICULARS
PARENTS
(Print or Type Name)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(Carcinoma of urinary bladder
with metastasis
(b) and (c)
11
SPACE FOR ADDITIONAL INFORMATION
TO:
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
.
5
RANK, RATING
8
6
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JUN -11962 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 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.
FORM R-301
I for ourial permit oard of Health its Agent. STRUCTIONS Fon OTAL CERTIFICATE
VET ..
RIT OR TYPE JE: OR CAUSES DEATH not enter fre than one ase lor each 0), (b) and (c)
h does not mean lode of dying. Ik heart failure, et, etc. It means drase, or compli- on which caused
o tions, if any, Aus gave rise to because (a). air the under- vin cause last.
Coditions contrib- to death but not le to the terminal as condition given
331 .c. no
el Directon Der use only IL.CK Ink.
M -62-932382
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
(City or Town making this return)
106
f(If death occurred in a hospital or institution, St. ( give it. N.VME. instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME. Lillian Mc Laren
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Avenue.
22 Ocean Strent
(Usual place of abode)
1.cugth of stay : In place of death ......... years. ....... months ... „days, In place of residence 4 y ve
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