USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 8
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Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49
16 BIRTHPLACE (City)
New York City
(State or country)
17 NAME OF FATHER Abraham Tanger
Parce Hardnen AD
Rita ... Rubin
No.
New England Center Hospital
( If nonresident, give city or town and State)
8 SEX
Male
A TRUL COPY ATTEST Charles it. IMackie City Respir 1
OF TOM
"11.12.
ILCITÁ
1
6
N
THRONE
APR -51962 PM
AI R-303
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes MILLILAL LAAMINERS should state CAUSE AND MANNER OF N. D .- WRITE PLAINLY WITH INFARINA DI .CU PMM .... of Death. See reverse side for additional information. See also Chap. 38, ff €, 20; Chap. 46. 11 ), 10; Chap. 114,
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10), requires physicians to insert a recital to that effect.
1
(('nunty ) BOSTON
(City or Town)
Che Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN
To be filed for burial permit with Board of Health or ita Agent.
36
01230
Registered No.
En route to Massachusetts General Hospitaloccurred in a hospital or institution,
St. ¿ give its NAME instead of street and number) No.
HARRIET
RUNCIE (Doig)
2 FULL NAME
( First Name)
(Middle Name)
(Last Name)
[ ( Was deceased a
U. S. War Veteran,
[il so specify WAR)
(11 deceased is a married, widowed or divorced woman, give also maiden name.)
92 Marshall Street,
St.
Winthrop,Mass.
(l'sual place ol 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
3 DATE OF
DEATH
February
3,
1.962
(Month)
(Day)
(Year)
41 HEREBY CERTIFY that I have investigated the death of the person above named and that the CAUSE AND MANNER thereof are as follows : (Il an injury was involved, state fully.) Coronary artery disease . Acute myocardial infarction.
9 SEX
Female
10 COLOR
White
11 CITIZEN
OF U.S.
YES
NOC
12 SINGLE
MARRIED
DIVORCED UNKNOWN
12a 11 married, widowed, or divorced
HUSBAND) of
(or) WIFE of
John ....
(Give maiden name of wife in full) .Runcie (Husband's name in full)
13 DATE OF BIRTH 1/15/20
14 AGE.SI .Years
.. J
.Months ....
.... Da
If under 24 hours .. Hours .......... ... Minutes
IS Usual
Occupation :
Housev. DEc. (Kindof work done during most of working life)
16 ndutry Ar lluuness: ....
home
Social Security
No.
None
18 BIRTHPLACE (City)
(State or country)
Scotland
19 NAME OF
FATHER
Andrew Doig
20 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
21 MAIDEN NAME
OF MOTHER
Jane Gray
22 BIRTHPLACE OF MOTHER (City) (State or country) Scotland
23
Informant
Joir Buncie
(Address)
Bast Hampstead .i.h.
1 HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit perTEit was issued
A NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop, Lass.
5 - 1962 meint did ntel TER. 7 49,62
2
u
.
11. 11
PARENTS
Boston (Print or Type Nane) Date
2/3
1.62
(Address)
7 winthrop Place of Burial, or Cremation. Feb 6
DATE OF BURIAL
Tinthrop (City or Town) 19 52
20-1
19 44-48. SOM - 3.61 -930213 0
PLACE OF DEATH
SUFFOLK
6 Was discant or injury in any way related tooccupation of deceased ?..
If so, speers .....
(Signed)
(Specify type of place)
Manner of Injury
(How did injury occur ?)
Nature of
Injury
While at work ? Was autopsy performed
No
ir
Did injury ocutr in or about home, on farm, in industrial place, of public place ?
5 Accident suicide, at homicide (specify)
Date and hour of injury 19 ..
IF ACCIDENTAL, was injury causally related to the death ? Where did Injury occur ?
(City or town and State)
42
PHYSICIAN - IMPORTANT
(a) Residence. No.
(Il nonresident, give city or town and State)
V.B.V
M. D. Michael A Luongo M.D.
Charles H. Mackie City Registrar
PECE VED
OF TOM
11 7% .
-19
8
*
6
INTHEDE
APR -51962 PM
M R-301 1
(County)
BOSTON
(City or Town)
The Commonwealth of falassarquartis KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT -
TOWN
To be filed for burial permit with Board of Hea !. or its Agent.
37
01319 Registered No.
No.
H. 2 FULL NAMECharlesAHoward
(First Name) ( Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence No
226 Main Street
St.
Winthrop, Massachusetts
( If nonewoent. the city or trup and State)
Sara A way
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
5
1962
(Month) (Day)
(Year)
8 SEX
Male
9 COLOR
White
10 CITIZEN
OF U.S.
YES X
NO
11 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
4I HEREBY CERTIFY , That Wattended deceased from
January 25, 1962, to February 5
19
62
Pfast sav
himlive on February .5 ..... , 19 62, death is said to
have occurred on the date stated above, at 4:00 p
....
INTERVAL BETWEEN ONSET AND
(a) .... Cerebral ....... Infarction
- Due To Emboli From heart
Due To Rheumatic heart disease (c)
a
Was autopsy performed?
yes
What test confirmed diagnosis?
autopsy.
5 Was disease or injury in any way related to occupation of deceased? Il so, specify
(Signed)
Ch@low
M. D.
Charles L. Clay, M. D.
(Print or Type Name)
(Address) Ass't. Din, Mass. Con'l. Hong Date Feb. 5 19 62
PARENTS
18 NAME OF
FATHER
William A. Howard
19 BIRTHPLACE OF
Melrose
FATHER (City)
(State or country)
Massachusetts
20 MAIDEN NAME
OF MOTHER
Mary M. Follins
21 BIRTHPLACE OF
MOTHER (City)
South Boston
(State or country)
Massachusetts
22
Informant
Veronica.M ... Howard
(Address)
226 Main St. Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burist or transit permit. .
(dion ture ; Agent of Board of Health or other)
5749
2-7-62
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
(Registrar)
Unk yro 5 days
14 L'sual
Occupation :
Truck Driver
(Kind of work done during most of working lile)
15 Industry
or Business: Trimount Bituminous Products
16 Social Security No.
021-05-2747
Boston
17 BIRTHPLACE (City)
(State or country)
Massachusetts
6 HolyCross Malden. ..... Mas.s ...
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 8
19.62
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop Mass
Received MY Par.D.
FEB ...... 9 ... 1962.
... 19
-61-0213
PLACE OF DEATH
SUFFOLK
......
MASSACHUSETTS GENERAL HOSPITAL
f(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, (il so specily WAR) No
SUCTIONS OR ACERTIFICATE
& 'P DEATH it enter renan one se or each .) and (c)
ht not mean od of dying, Mart failure. . c. It means a or compli- fick caused
se under. lise last.
diins contrib. dtk but mot 10 e terminal en tion given
6
es.Chapter 137. of 54 requires iciis to print or tt cause or death on ceificates, and ter 8. Acts of retires Physi- to rint or type un r signature.
al Irecten e to only AC Ink. P 5 -1962
lla lf married.
Veronica M. Gray
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
12 DATE OF BIRTH
October 3, 1903
13
58
Years .........
Months .....
.Days
If under 24 hours Hours ... Minutes
tja, if any, the rise to (b)
OTHER
SIGNIFICANT Pulmonary .... odem and
CONDITIONS
congestion
5 Day 10
25 .2017
V.B.V
A TRUE COPY ATTEST: Charles H. Mackie City Registrat
FECE VED
TO !!
ERK
B
6
APR -51962 PM
X
PLACE OF DEATH
Suffolk (County)
b.a.s.t.on (City or Town)
The Children's
Hospital Medical Ctr.St.
its NAME bo
PHYSICIAN - IMPORTANT
[ ( Was deceased a U. S. War Veteran. lif so specify WAR) no
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
236Shore Drive
St. winthrop
( Usual place of abode)
15Hrs. 40 Min.
(If nonresident, fgive city or town and State)
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
Male
9 COLOR
White
(write the word)
10 SINGLE
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.
12
AGE
Years .....
2
Months .............. Days
If under 24 hours
.Hours ........__ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston, MASS.
17 NAME OF
FATHER
Jean Robin Clarke
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Winthrop
19 MAIDEN NAME
OF MOTHER
Judith Carol Goldov
20 BIRTHPLACE OF
MOTHER (City)
'Scase or country)
Boston
21 Jean Clarke
Informant
(Address)
236 Shore Drive, Winthrop
I HEREBY CERTIFY thata satisfactory standard certificate of death
was filed
with me BEFORE the bortil or Zansit permit was issued:
(Signature of Agent of Board of Health or other)
5768
2-8-62
(Registrar)
PARENTS
1962
Agudath Israel, West Roxbury
6
Place of Burial or Cremacina
/ City or Towa)
DATE OF BURIAL
February 8
00
1962
7 NAME OF
FUNERAL DIRECTOR
Benjamin Birnbach
ADDRESS 10 Washington St. Dorch
Received sod filed
Chanics M
FEB 12 1862 K 19.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
OUT - OF
38
To be filed for burial permit with Board of Health or its Agent.
Registered No.
01369
2 FULL NAME
Scott Clarke
( First Name)
(Middle Name)
(Last Name)
3 DATE OF
DEATH
Feb .6 1962
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY
That I attended deceased from
Feb. F
19.
62
to
Feb. 6
1952
I last saw n.m.alive on
Feb ...
6
16.2 ... , death is said to
have occurred on the date stated above, at ....
4: 10Pm.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
marasmus
Marasmus
Due To
(b)
Mal- nutritional
(c)
Due To Mal-nutritional
Diarrhea-
OTHER
SIGNIFICAarrhea
CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis?
5 Was disease or Injury In any way related to occupation of deceased? If so, specify
(Signed)
John H Mutclell
M. D
te Chapter 137. 01954. requires ions to print or e cause or es of death on hortifeates, and Of: 48. Acts of
eider signature. ial Exam r waived idiction AR 5 - 1962 64-928145
RI R-301A
HSIUCTIONS FOR CA CERTIFICATE
1 giving SEOF DEATH la ot enter of than one us for each ).b) and (c)
es mot meon ws of dying. as heart failure, lePic. It means se .. or compli- kich coused
-
dums, if omy. have rise to 'Ctuuse (a). mythe under Cause lost
om ions contrib- to coth but not Ilithe lenol usdikon siden
John-W Mitchell
(Address 300 Longwood Aven Feb. 7
(Official Designation) (Date of Issue of Permit)
[(If death occurred in a hospital or institution,
A TRUE COPY ATTEST: Charles H, Mackie City Registrar
TOP
0
H1
APR -51962 PM
x
PLACE OF DEATH
Suffolk
(County) Boston
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
39
....
(City or town making return)
Registered No.
014/41
No.
Boston City Hospital
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
46 Main St.
St.
Winthrop
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
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
9 SEX F
10 COLOR
W
11 CITIZEN
OF U.S.
YES
NO
W
12 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
12a If married, widowed, or divorced HUSBAND of (Give maiden name.of wife in full)
(or) WIFE of
Augustus Christopher
(Husband's name in full)
13 DATE OF BIRTH
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
If accidental, was injury causally related to the death ?
Where did
Injury occur ? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place ?
(Specify type of place)
Manner of
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
Richard Ford
M. D.
(Address)
Dat
2/8/62
7
St .Michael Jamaica Plain Place of Burial or Cremation. (City or Town)
DATE OF BURIAL Feb. 12, 1962 19.
8 NAME OF
Alexander F. Thomas
FUNERAL DIRECTOR
22 Oak St., Hyde Park
ADDRESS
....
Received and filed
APR 5 - 1962
19
(Registrar of City or Town where deceased resided)
PARENTS
20 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
21 MAIDEN NAME
OF MOTHER
Josephine Gangemi
22 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
23 Anthony Arno
Informant
(Address)
36 Greenwood Ave., Hyde Park
A TRUE COPY
ATTEST:
Charles & mack
(Registrar of City or Town where death occurred)
DATE FILED
Feb. 13. 1962
19
25M-3-61-930213
WRITE PLAINLY WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER DIDDAL
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided
3 DATE OF
February 7, 1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Multiple fractures. Auto accident Driver of car in collision with abutment. Boston 2/5/62.
14
AGE.I.L.O.Years .......
Months .............. Days
If under 24 hours
Hours ..........
.. Minutes
15 Usual
Occupation :
Bookkeeper
(Kind of work done during most of working life)
16 Industry or Business :
17 Social Security No.
18 BIRTHPLACE (City)
(State or country)
Boston
19 NAME OF FATHER Angelo Arno
[ R-305 1
(City or Town)
Catherine
Christopher
[(Was deceased a
U. S. War Veteran,
No
(if so specify WAR)
A TRUE COPY ATTEST. Charles it. Mackie City Registrar
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
APR -51962 TNT
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE 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.
40 ....
Mayflower Nursing Home, 39 Grovers St. ( give its NAME instead of street and number) No:
Ave.,
2 FULL NAME
Catherine Page
(Davis)
(First Name)
(Middle Name)
(Last Name)
U. S. War Veteran,
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
22 Loring Road
.......
.....
St.
(If nonresident, give city or town and State)
Length of stay:
In place of death ..
.months
4
days.
In place of residence. LO ... years.
months ..
......
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
2
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
August, 19:58
to
march 2
1962
I last saw hE.X.alive on
March 2
, 1962, death is said to
(Give maiden name of wife in full)
(or) WIFE of
HarveyW .Page
(Husband's name in full)
12 DATE OF BIRTH
Oct.6,1878
13
AGES. 3
Years
4
Months.
Days
24
If under 24 hours Hours ........... Minutes
14 Usual
Occupation :
R.N. Rurse
(Kind of work done during most of working life)
15 Industry
or Business :
....
Nursing
16 Social Security No.
East Boston
17 BIRTHPLACE (City) (State or country) Mass.
18 NAME OF
FATHER
Joseph Davis
19 BIRTHPLACE OF FATHER (City) (State or country) Ireland
20 MAIDEN NAME
OF MOTHER
Mary Baker
21 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
22 Richard B. Page-son
Informant
(Address)
22 Loring Rd., 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)
3/3/68
(Official Designation)
(Date of Issue of Permit)
A
TICTIONS
L'ERTIFICATE
Giving F DEATH enter ean one se or each ) and (c)
d not mean d of dying, art failure, F. It means amor compli- ich caused
tio, if any, Be rise to se (a), under- @se last.
-
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Broncho pneumonia
1day
Was autopsy performed?
NO
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
NO
(Signed)
CHARLES LIBERMAN
(Print or Type Name)
(Address)
Winthrop, Mass Date.
3/3/1962
Winthrop Cemetery, Winthrop 6 Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 5th
19.6.2
7 NAME OF
DIRECTORRichard .C .Kirby Inc.
ADDRESS917 Bennington St., E. Boston
Received and filed
MAR 5 1962
19
(Registrar)
A TRUE COPY ATTEST:
8 SEX
9 COLOR
10 CITIZEN
OF U.S.
YESX
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
Female
White
la If married, widowed, or divorced HUSBAND of
have occurred on the date stated above, at
6,00
12 m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cerebral Arteriosclerosis
INTERVAL BETWEEN ONSET ANO DEATH 2yrs,
Due To (b)
dans contrib- dith but not tore terminal contion given
e Chapter 137, of 54 requires cins to print or th cause or 5 death on ci ficates, and e 8, Acts of rires Physi- to int or type ur - signature.
61 213
I R-301 1
Registered No.
S(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
{(Was deceased a
r
No
(a) Residence. No. (Usual place of abode)
PARENTS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
.7
ORGANIZATION AND OUTFIT
SERVICE NUMBER
8
1
6
HYROR
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls 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.
R-301A 1
STUCTIONS OR AL:ERTIFICATE
n iving
E F DEATH
It enter renan one se or each .) and (c)
ds not mean od of dying, sart failure, ,c. It means cos or campli- sich caused
ta, if any, tt'e rise ta use (a), ge under- Base last.
ndins contrib- o ath but not tothe terminal coition given
e: hapter 137, of 54. requires cia. to print or th cause or death S celficates, and ter 8, Acts of retires Physi- to int or type uns - signature.
,
-60-3145
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.
41
No. Winthrop Community Hospital
S(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Joseph
(First Name)
(Middle Name)
(Last Name )
J.
Mahoney
[ (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.)
237 Woodside Ave
St.
Winthrop.
(1f nonresident, give city or town and State)
Length of stay: In place of death.
.. years.
.months.
9. .. days. In place of residence.
24
.. years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,,
11/12
61, to.
march 3
19
62
I last saw h./Malive on
Marche 3
19 62, death is said to
have occurred on the date stated above, at
10:0.97m
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Carcinoma of
Due To (c) leftN ung'Epidermond 14 MIR
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis? Surgery a Path-report
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
JOSEAG GREGORIE
(PRINT, OR TYPE SIGNATURE)
(Address) 19 4 Washington2 3/3 19 60
6 Holy Cross Cemetery Malden Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL March 6 1962
7 NAME OF
FUNERAL
DIRECTOR
Madeline G. Casey
ADDRESS
205 Washington Ave Chelsea
Received and filed
MAR-5 1962
19
(Registrar)
PARENTS
17 NAME OF
FATHER
Daniel Mahoney
18 BIRTHPLACE OF
FATHER (City)
Chelsea
(State or country)
Massachusetts
19 MAIDEN NAME OF MOTHER Mary Murphy
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Elizabeth F. Mahoney
Informant
(Address)
237 Woodside Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health or other)
3/5/62
(Official Designation)
(Date of Issue of Permit)
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Vice President Retired
(Kind of work done during most of working life)
14 Industry
or Business :
Fickinnon & Mckenzie
15 Social Security No.
010-09-3173
16 BIRTHPLACE (City)
Chelsea
(State or country)
Massachusetts
69
12
AGE
Years.
3
Months
20
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Carcinomaros 15
3 DATE OF
DEATH
March
3
1962
(Month)
(Day)
(Year)
That I attended deceased from
10a If married, widowed, or divorced F. Holland
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
22 M. D
Registered No.
(a) Residence. No.
(Usual place of abode)
SPACE FOR ADDITIONAL INFORMATION
7
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
OF
THROP
MAR - 51962 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.
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