Town of Winthrop : Record of Deaths 1963, Part 14

Author: Winthrop (Mass.)
Publication date: 1963
Publisher:
Number of Pages: 574


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 14


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54


MAR 5


....


Besin


.....


M. D.


PARENTS


1


19 63.


16 Days


NMASSACHUSETTS GENERAL HOSPITAL


-


A TRUE COPY ATTEST: Charles H. Mackie City Registrar


RECEIVED


OF


TOW;


17.12 7


OFFICE


10.


i).


CLERK


5


6


DR. MARS


APR 1 1 1963 AM


,


FORM R-301


led for burial permit Board of Health or its Agent. INSTRUCTIONS FOR CAL CERTIFICATE


NT OR TYPE E OR CAUSES OF DEATH do not enter ore than one use for each a), (b) and (c)


is does not mean mode af dying, as heart failure. nia, etc. It means disease, or compli- " which caused


"ditions, if any, ich gave rise to ove ramse (a), ling the under- ng cause last.


Conditions contrib- to death but mat ed to the terminal se condition given ).


21/ -


Jurisdiction


waived by Medical Examiner


PR 1101963 8


2-62-932382


PLACE OF DEATH


TOWN


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


65


(City or Town making this return)


02430


Registered No.


((If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


2 FULL NAME


Louis Biggi


(If deceased is a married, widowed or divorced woman, give also maiden name.)


PHYSICIAN - IMPORTANT - ( Was deceased a U. S. War Veteran, if so specify WARY No.


(a) Residence. No


(Usual place of abode)


18 Hours


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 D.VTE OF


DEATH


March


2


1963


(Year)


(Month)


(Day)


4IHERENY CERTIFY , That I attended deceased from


March ..........


19 63 ..... 1 March .. 2


1.63


I last saw himlive on March 2.


... 1,63


,death is said to


have occurred on the date stated above, at3 :00 A ... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Pneumonia


Due To


Chronic congestive


(b)


Due To


(c)


heart failure


OTHER


SIGNIFICANT


CONDITIONS


Coronary heart disease


Was autopsy performed?


What test confirmed diagnosis?


5 W'as disease or injury in any way related to occupation of deceased ? If so, specify


(Signature)


M. D. Raymon S. Riley


(Address)


6 Old Calvary


Boston


Place ol Burial or Cremation


(City or Town)


DATE OF BURIAL March .. 5,1963


19


7 NAME OF FUNERAL DIRECTOR Arthur S. Poroella


ADDRESS 876 Winthrop Ave., Revere


Recormed Ad filed MAR _6 1963 19 Charles A. Mairie


( Registrar )


8 SEX


9 COLOR


(write the word)


Male


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


Single


11 1f married, widowed, or divorced HUSHAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12-24-1888


12


AGE 74 Year, 2


Months


8


1)3y5


Il under 24 hours


Hours ........ Minutes


13 Usual


Occupation


Retired- Shipper


( Kind of work done during most working life)


14 Industry or Business '


15 Social Security No


16 BIRTHPLACE (City).


( State or country 1


Vas8


17 NAME OF John B. Biggi


18 BIRTHPLACE OF


FA111ER (City). ..


(State of country )


Italy


19 MAIDEN NAME


OF MOTHER Theresa Fennochetti


20 BIRTHPLACE OF


MOTHER (City)


(State or country )


Italy


21 InformantMrs . Nellie Christoforo ( Address)


27 Bowdoin St Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE the burial or transit permit was issued: R.R. Josman Jo (Signature ol Agent of Board of Health or other)


15400 13/4/63.


(Official Designation) (Date of Issue of Permit)


-


Boston


(City or Town)


No


--


IT Suffolk


(County)


STANDARD CERTIFICATE OF DEATH


New England Center Hospital


27 Bowdoin St., Winthrop, Mass.


St


WINTHROP


( If nonresident, give city or town and State)


A TRUE COPY ATTEST:


N.E. Center Ho's pitas March 2 63


19


PARENTS


Boston


Rayman 5. Riley


INTERVAL BETWEEN ONSET AND DEATH


120


A TRUE COPY ATTEST: Charles it. mackie City Registrai


RECEIVED


TOW;


OF


OFFI:


RK


00


HROB


APR 11 1963 AM


FORM R-302


WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


PLACE OF DEATH


Suffolk (County)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Chelsea


(City or Town making this return)


Registered No.


66


§(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


2 FULL NAME ........


Trying Henry Streeter Jr.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(Was deceased a WWII


U. S. War Veteran,


if so specify WAR, ..


Kor.


(a)


Residence. No ...


16Fremont


(Usual place of abode)


silinthrop, Mass


(If nonresident, give city or town and State)


Length of stay: In place of death. ..... years ...... months ....... Jays. In place of residence .... Sears ...... months .......


.Mays.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Mar.17,1963


(Day)


(Year)


(Month)


4 I HEREBY CERTIFY, That I attended deceased from


....


DOA


19


to ..


I last saw himmalive on


Mar.18


19 .. 65death is said to


have occurred on the date stated above, at


11:45p


INTERVAL BETWEEN ONSET AND DEATH


(a)


Arteriosclerotic heart


Due To


(b)


disease


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)


Harold .... A.Engelke


M. D.


(Address


USNH Chelsea, Hasby 3/18/03


6


......


Winthrop Cem., Winthrop, Mass.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Mar.21,1963


19


(Address)


7 NAME OF


FUNERAL DIRECTOR


Maurice Kirby


ADDRESS


210 Winthrop St . Winthrop, MaasVE COPY


Received and filed


APR 16 1963


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE (write the word) MARRIED WIDOWED DIVORCED UNKNOWN Married


11 If married, widowed, or divorced


HUSBAND of


Elinore ..... M.Perry


(or) WIFE of.


(Husband's name in full)


12


AGE.52. Years ...... .. Months ......


.. Day3


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation :


Retired U.S.Army


(Kind of work done during most working life)


14 Industry


or Business :


U.S.Army.


15 Social Security No ... 0.12-28-4086


16 BIRTHPLACE (City).


(State or country)


Fort Warren Boston Har.


Mass.


17 NAME OF


FATHER


Hugh Streeter


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Nashua, N.H.


19 MAIDEN NAME


OF MOTHERFlla Barraly


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Canada


2I Informant


Mrs.Irving Streeter


16 Fremont St. ,Winthrop, Mass.


ATTEST:


Greple aTyrrell


DATE FILED


(Registrar 61 City or Town where death occurred) Mar.20,1963


19


50M - 10-61.931673


E


Chelsea (City or Town)


No ... U.S.Naval .. Hospital


-


19


Male


White


(Give maiden name of wife in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE --


4


DATE OF DISCHARGE


RECEIVED


RANK, RATING


MSGT


TO !!


ORGANIZATION AND OUTFIT


U. S. Army


SERVICE NUMBER


RA6113435


.....


...


OFF


6 3


INTHROR


APR 1 61963 AM


1


PLACE OF DEATH


Suffolk


1


(County) Winthrop


(City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


(City or Town making this return)


CONSTANTINOS


on) Charles Spanos


PHYSICIAN - IMPORTANT


2 FULL NAME.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


4 Brookfield Road



Winthrop, Mass


(a)


Residence. No.


(Usual place of abode)


2


.days. In place of residence 32


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)


MARRIED


11 If married, widowed, or divorced


HUSBAND of


LIMBEROPOULOS


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE 70 Years.


11 Months.


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


GROCERY


CLERK


(Kind of work done during most working life)


14 Industry


or Business :


RETIRED


15 Social Security No.


027-28-4816


16 BIRTHPLACE (City)


(State or country )


GREECE


17 NAME OF


FATHER


JOHN


SPANOS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


GREECE


19 MAIDEN NAME


OF MOTHER


MARY MOUTOUGLI


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


GREECE


WINTHROP CENTERY - WINTHROP


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL APRIL 13, 19) 63


7 NAME OF


FUNERAL DIRECTOR


Paul @ Dilyable


ADDRESS


336 BROADWAY- CAMBRIDGE


Received and filed APR 11 1963 19


PARENTS


CHRISOULA


SPAHOS


21 Informant


( Address)


4 . BROOKFIELD R.D. WINTHROP


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : j'aiphe &


(Signature pf Agent of Board of Health or other)


Health officin


Capul 11,1963


(Registrar)| (Official Designation)


(Date of Issue of Permit)


A TRUE COPY ATTEST:


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased, from


....


June


19 61


to ..


April9


1963


I last saw h.f ... Mive on


April


1963, death is said to


have occurred on the date stated above, at


6:10 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Cerebral Hemorrhage


INTERVAL BETWEEN ONSET AND DEATH 2 days.


Due


(b)


To Arteriosclerosis


2 yrs


(c)


Hypertension


2485


OTHER


SIGNIFICANT


CONDITIONS


None.


Was autopsy performed?


10


What test confirmed diagnosis ?


Clinical


5 Was disease or injury in any way related to occupation of deceased Na. If so, specify


(Signature)


Charles Fritte man


CHARLES


LIBERMAN


(Address)


(Print or Type Name) WINTHROP, MASS Date ..


4/9/ 1963


Registered No.


Winthrop Community Hospital N ʻ


[(If death occurred in a hospital or institution, ....... St. ¿ give its NAME instead of street and number)


w.w.


(Was deceased a


U. S. War Veteran,


if so specify WAR).


I


(If nonresident, give city or town and State)


Length of stay: In place of death .......... years .......... months ...


3 DATE OF


DEATH


April


9


1463


(a)


FORM R-301


ed for burial permit Board of Health r its Agent. INSTRUCTIONS FOR CAL CERTIFICATE


NT OR TYPE E OR CAUSES F DEATH o not enter ore than one use for each a), (b) and (c)


s does not meon mode of dying, as heart foilure, sia, etc. It meons iscase, or compli- s which coused


ditions, if ony, ich gove rise to ce cause (0), ing the under- ng couse lost.


Conditions contrib- to death but not d to the terminal e condition given


2-62-932382


(Month)


CHRISOULA


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


JUNE 27 1918


DATE OF DISCHARGE


NOV


28


1918


RANK, RATING


PVT


ORGANIZATION AND OUTFIT


ARMY


SERVICE NUMBER


366 4433


OF TOW:


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance 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 occA-PR 1 1 1963 PM


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.


17 92 of the O.


İLERK


6


Tr


PLACE OF DEATH


Suffolk


(County)


Winthrop


(City or Town)


No.


47 Shirley 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.


68


[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


(First Name)


( Middle Name)


(Last Name)


( If deceased is a married, widowed or divorced woman, give also maiden name.)


230 Everett


East Boston


(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


female


9 COLOR


white


10 SINGLE


(write the word)


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


19


.. , to ..


19


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Thomas Gizzi


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


76


12


AGE


Years ..


.........


.. Months ...


Days


If under 24 hours


Hours .....


Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


At home


15 Social Security No.


None


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Louis Licciardi


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Maria (unknown)


20 BIRTHPLACE OF MOTHER (City) (State or country) Italy


Helen Piano (daughter)


21


Informant


(Address)


47 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: Caiphí. dereanice (3) (Signature of Agent of Board of Health or other) Health Officer april 16.6 ..


(Official Designation)


(Date of Issue of Permit)


1 X


TRUCTIONS FOR L CERTIFICATE


giving , OF DEATH not enter e than one e for each , (b) and (c)


daes not mean de of dying, heart failure, , etc. It means ase, or compli- which caused


lions, if any, gave rise to cause (a), & the under- cause last.


ditions contrib- death but not ta the terminal condition given


e :- 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.


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 17,


63


19


7 NAME OF


FUNERAL


DIRECTOR


Vincent Rapino


ADDRESS


9 Chelsea St., East Boston, Mass.


Received and filed APR 17 1963 19


(Registrar)


PARENTS


LIBERMANOM. P


(PRINT OR TYPE SIGNATURE)


(Address) L'iutterap


45/18/1963


Holy Cross Cemetery


Malden


OTHER


SIGNIFICANT


CONDITIONS


history Winthrop Board of Health


Was autopsy performed?


What test confirmed diagnosis?


INTERVAL BETWEEN DNSET AND DEATH


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Death Presumably due to


(a)


Due Tonatural causes probably (h) acute cerebro vascular Due Toocclusion based on medical (c)


That I attended deceased from


I last saw h ........ alive on


19 ...


........ , death is said to


have occurred on the date stated above, at


6:30 am


St.


Registered No.


Angelina. Gizzi


[(Was deceased a U. S. War Veteran, (if so specify WAR)


no


(1f nonresident, give city or town and State)


MARRIED


WIDOWED Widowed


or DIVORCED


3 DATE OF


April


13.


1963


E9-4-9


M R-301A 1


50-928145


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


CHARLES


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


c. : " ERK


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians willcertify to such deaths only as those of persons to whom they have given bedside cafe 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


(County)


Winthrop


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


f(If death occurred in a hospital or institution,


St. (give its NAME instead of street and number)


2 FULL NAME


Samuel


Nager


(If deceased is a married, widowed or divorced woman, give also maiden name.)


39 Grovers Ave.


St


Winthrop


(If nonresident, give city or town and State)


Length of stay: In place of death


4


ears.


months


days. In place of residence.


...__ years


months ..._. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


APRIL 13, 1963


(Month)


(Day)


(Year)


8 SEX male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


divorced


or DIVORCED


4 I HEREBY CERTIFY


That I attended deceased from


MARCH IS, 1958


to


APRIL 13


19


63


.


I last saw h. Malive on


APRIL 11, 1963, death is said to


have occurred on the date stated above, at


8 00 p.m.


10a If married, widowed or dixogcedein


HUSBAND off. da


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


If under 24 hours


.. Hours ...... Minutes


13 Usual


Occupation :


painter


(Kind of work done during most of working life)


14 Industry


or Business:


retired


15 Social Security No. none


16 BIRTHPLACE (City)Minsk, Russia (State or country)


OTHER


CHRONIC BRONCHITIS


SIGNIFICANT


CONDITIONS


5 YRS


Was autopsy performed ?


ovo


What test confirmed diagnosis? CLINICAL


NO


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


PROCRESCENT AVE


Date


4/13


1963


Tifereth Isreel Cem. Everett 6


Place of Burial or Cremation


April 14


DATE OF BURIAL 19


7 NAME OF


Murray Goldman


ADDRESS174 Ferry St. Malden


Received and filed


19


(Registrar)


PARENTS


17 NAME OF


FATHER


Samuel


18 BIRTHPLACE OF Russia FATHER (City) (State or country)


19 MAIDEN NAME


OF MOTHER


Fannie(unknown )


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


Russia


21


Irving Neger-brother


Informant 29 . Nichols St. Everett.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Lasph


(Signature of Agent of Board of Ilcalthi or other)


Health Officer


(Official Designation)


(Date of Issue of Permit)


Cifocal 1, 19 63


X


1


.


MR-301A 1


TRUCTIONS FOR L CERTIFICATE giving OF DEATH not enter e than one e for each (b) and (c)


does not mean de of dying, heart failure, ,etc. It means ase. or compli- which caused


ions, if any, gave rise to cause (a), the under- last.


ditions contrib- - death but not to the terminal condition given


· Chapter 137, 1954, requires ans to print or he cause OT of death on ertificates. C . 1


50M-1-68-921876


(City or Town)


No.


Mayflower Nursing Home


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO


(a) Residence.


No.


(Usual place of abode)


4


PERSONAL AND STATISTICAL PARTICULARS


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


GENERALIZED ARTERIO -


(a)


SCLEROSIS


INTERVAL


BETWEEN


ONSET AND


DEATH


15Yes


74


Years


Months


Days


Due To (b)


Due To (c)


(Addressy


, M.D. M. D.


(City or Town) 63


(Address)


To be filled for burial permit with Board of Health or its Agent.


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.


A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eightcen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a


permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the




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