Town of Winthrop : Record of Deaths 1963, Part 15

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 15


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).


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death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6 , as amended by Chap. 632, Sec. 4, Acts of 1945.


No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do 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 body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.


Chap. 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


The fulfillment of the purpose of these laws dalls 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. ili


(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. 6


NTA AROtPhysicians: see explanatory instructions Statement of Cause of Death on face side of standard certificate of death.


Statement of Occullion. Fred@Statement of occupation is very import- ant, so that the relative healthfulness ofwaridas 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


RM R-301A 1


nditions, if ony, ich gove rise to ve couse (0), ting the under- ng cause lost.


Conditions contrib- to death but not d to the terminol te condition given )


e .- Chapter 137, of 1954, requires c'ans to print or the cause


or s of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.


M-11-59-926662


PLACE OF DEATH


SUFFOLK


(County) WINTHROP


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


Registered No.


20


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


2 FULL NAME


Catherine F. Crosby.


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


20 Centre St.


St.


Winthrop


Length of stay: In place of death


5


.. years.


........... months .............. days. In place of residence ....


5 years months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


April


17


1963


DEATH


(Month)


(Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED Single


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY


-et


1963


to.


April 17


19


I last saw


Er alive on


April 17


19 63


death is said to


have occurred on the date stated above, at


1: 3 0 P. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Bronchial


Pneumonia


INTERVAL


BETWEEN


ONSET AND


DEATH


10 days


11 IF STILLBORN, enter that fact here.


70


12


AGE


Years


Months.


Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :


Sorter (retired)


(Kind of work done during most of working life)


14 Industry


or Business :


Retired Laundry


15 Social Security No.


OII 05 9490


16 BIRTHPLACE (City)


(State or country)


Chelsea


Mass.


17 NAME OF


FATHER


Michael Crosby


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland®


19 MAIDEN NAME


OF MOTHER


Rose Ann Mckinnon


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Conn.


21 Informant (Address)


Ann Crosby 20 Centre St. Winthrop


(Sister)


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 20 63


19


7 NAME OF FUNERAL 325 Chelsea St. East Boston.


ADDRESS


Received and filed APR 2-3 1963 ....... ... 19 ..


(Registrar)


PARENTS


(Signed) Nathaniel P. Danoff M. I).


Nathaniel P Danoff


(PRINT OR TYPE SIGNATURE)


(Address) 37 Princeton St


Date .....


April 18 1963


6 Holy Cross


Malden.


Frederick J. Magrath.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued: triple E Leranni (?) ASignature of Agent of Board of Health or other) Health officer april 22, 1963


(Official Designation)


(Date of Issue of Permit)


TV


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


(a)


Due To Cerebral Vascular


(b)


accident


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


What test confirmed diagnosis ?


63


That I attended deceased from


(if so specify WAR)


(a) Residence. No.


(Usual place of abode)


PHYSICIAN - IMPORTANT


[(Was deceased a


U. S. War Veteran,


NO


(If nonresident, give city or town and State)


No.


20 Centre St.


FASE PETIT


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


NSTRUCTIONS FOR CAL CERTIFICATE


In giving SE OF DEATH do not enter ore than one use for each a), (b) and (c)


is does not mean mode of dying, as heart foilure, nia, etc. It means lisease, or compli- s which caused


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


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


5


-


RULES OF PRACTICE


IN


6


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 offlas the84963 AM 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.


FORM R-301


for burial permit Board of Health its Agent. TRUCTIONS FOR IL CERTIFICATE


T OR TYPE OR CAUSES DEATH not enter re than one se for each ), (b) and (c)


does not mean ode of dying, s heart failure, , etc. It means ease, or compli- which caused


itions, if any, k gave rise to e cause (a), og the under- cause last.


nditions contrib- o death but not to the terminal condition given


PLACE OF DEATH


Suffolk (County)


PasToro 5-7:63


LIBERTATE


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)


§(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. No ....


34 A Bunker Hill St.


(Usual place of abode)


Charlestown, Mass.


St


(If nonresident, give city or town and State)


......... months ... ... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIEDC


WIDOWEISingle


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12


AG9.0


Years.


Months ..


.. Days


If under 24 hours


Hours ......


Minutes


13 Usual


Occupation :


At ..... Home


(Kind of work done during most working life)


14 Industry


or Business :


15 Social Security No ...


None


16 BIRTHPLACE (City)


Charlestown


Mass


(State or country)


17 NAME OF


FATHER


Jeremiah Horrigan


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHEEllen Reardon


20 BIRTIIPLACE OF MOTHER (City) (State or country) Ireland


21 InformanNorman Horrigan


(Address)


150 Washington Ave., Winthro


I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued: faible & Jevrinne (3) ,(Signature of Agent of Board of Health or other) Health Officer iporel .20, 1/6/3


(Official Designation)


(Date of Issue of Permit)


TI


A TRUE COPY ATTEST:


5 yrs


Due To


(c)


arteriosclerosis


8 yrs


OTHER


Chronic bronchitis &


SIGNIFICANT


CONDITBUimonary emphysema 3 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, spece


(Signature)


M. Traunstein N


M. D.


M.Traunstein Jr .... . M ... D.


(Address)


(Print or Type Name)


73 Bartlett Rd


4-20


19.63


6


Holy Cross


Malden, Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 22 19


63


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS Winthrop .Mass.


Received and hled


APR 22 1963


19


(Registrar)


4 62-932382


1


Winthrop (City or Town)


No.


104 Highland Ave Mounts Nursing Home


Ellen ... E ....... Horrigan


2 FULL NAME


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


Length of stay: In place of death .. 4 years months ........ days. In place of residence 86, ears.


3 DATE OF


April 19, 1963


DEATH


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY, That I attended deceased from


May 9


1958


to ..


April 19


196.3


:


I last saw @ .... alive on


April 15


196.3, death is said to


have occurred on the date stated above, at


.. 8 .:. 3.0.a.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Acutemyocardial infarction


INTERVAL BETWEEN ONSET AND DEATH 1 hr


Due To


(b) Arteriosclerotic ..... HD.


Generalized


PARENTS


6


Registered No.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


TO!


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


6


SERVICE NUMBER.


1


RI


APR 221963 PM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths 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)


Mounts Nursing Home


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.


[(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)


(a) Residence. No. (Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death.


2


years ....


months


.days. In place of residence.


......


... years.


months ..


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


19


1963


(Month)


(Day)


(Year)


That I attended deceased from


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


19


death is said to


have occurred on the date stated above, at


7:30 Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE Death presumably due to (a)


natural causes, probably Due To (b) @ cere brovascular occlusion On basis of past history. Due To


(c)


Winthrop Board of Health.


OTHER


SIGNIFICANT


CONDITIONS


Charles Liberman Mint


Was autopsy performed?


What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ?


If so, specify


(Signed) M D.


CHARLES LIBERMAN


(PRINT OR TYPE SIGNATURE)


(Addres


WINTHROP


Dat


4/19/


19


63


6HolyCross Cemetery


Malden


Place of Burial or Cremation


DATE OF BURIAL Monday , April ... 22, 1963 19 ..


(City or Town)


7 NAME OF


FUNERAL, DIRECTOR


CHESTER V. ZAKSHESKI


ADDRESS


79 Broadway - Chelsea


Received and filed APR 22-1963 19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIEIWidowed


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of ..... Margaret (Balon) GASKA


(Give maiden name of wife in fuli)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


69


AGE


Years.


Months ....


Days


If under 24 hours


.. Hours ...


Minutes


13 Usual


Occupation :


Laborer


(Kind of work done during most of working life)


14 Industry


or Business :


Bldg. - Wrecking trade


15 Social Security No. 015-18-3080


16 BIRTHPLACE (City)


(State or country)


Poland


17 NAME OF


FATHER


cannot be learned


Tu'da


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Poland


19 MAIDEN NAME


OF MOTHER


cannot be learned


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Poland


21 Laurel Shaughnessey


Informant (Address) 173 Shurtleff St Chelsea


I HIEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kaiple É derauni 631


(Signature of Agent of Board of Health or other)


Zenith Office Cibul 22, 1463


(Official Designation)


(Date of Issue of Permit)


1 X


ISTRUCTIONS FOR AL CERTIFICATE


In giving E OF DEATH o not enter re than one use for each ), (b) and (c)


does not mean mode of dying, as heart failure, ia, etc. It means sease, or compli- which


caused


ditions, if any, ch gave rise to ce cause (a), ing the under- & cause last.


onditions contrib- to death but not I to the terminal condition given


::- Chapter 137, of 1954. requires cians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type ander signature.


M1-6-59-925686


Chelsea 5-7-63


ČIMSE PETITE


No.


2 FULL NAME


Alexander STUNDZIO


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


6%- 3Rd ST


32 Spruce-St., Chelsea, Mass.


St.


4 I HEREBY CERTIFY, 19 ., to ... 19


INTERVAL


BETWEEN


ONSET AND


DEATH


PARENTS


Registered No.


IM R-301A 1


RECEIVED


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OF TO!V;


LERK:


-31


1 ... 6.2


N


HROP


APR- 221963 MM


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 oard of Health its Agent. TRUCTIONS FOR L CERTIFICATE


TOR TYPE OR CAUSES 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


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


nditions contrib- o death but not to the terminal condition given


PLACE OF DEATH


Suffolk (County)


DERTA


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


STANDARD


CERTIFICATE OF DEATH


Registered No.


73


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Kenneth Morrill Godfrey


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


16A. Wheelock Street


St


(If nonresident, give city or town and State)


months .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


20


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


Clone, 16, 19 63, to


Cipro 20


1963


I last saw h. @live on


Hp-VI 19, 196 death is said to


have occurred on the date stated above, at


2:20Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


myocardial


Heurt


DiscuJe


Due To


(b)


arteriosclerosis


Due To


(c)


Chrance Valuciler


OTHER


SIGNIFICANT


CONDITIONS


Heart Disease


Was autopsy performed?


What test confirmed diagnosis ?


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


(Signature)


2 M. D. U JUSTAn GREGORIE


(Print or Type Name)


(Address) 194 Washington Date


7/10


19€


Winthrop Cemetery, Winthrop, Mass 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


alfred 3 March


ADDRESS


174 Winthrop 'St. Winthrop,


Received and filed


APR 23 1963


19


(Registrar)|


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


Married


male


white


II If married, widowed, or divorced


HUSBAND of


Vera Thorne Littlefield


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12


AGE6.7 ... Years .. ]. Q. . Months .. 1.3. Days


If under 24 hours


Hours ........ Minutes


13 Usual


retired guard


Occupation :


(Kind of work done during most working life)


14 Industry


or Business:


Mass. Institute of Tech.


15 Social Security No.


010-09-8908


16 BIRTHPLACE (City). (State or country) Mass


17 NAME OF FATHER Frank Warren Godfrey


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Wakefield


Mass.


19 MAIDEN NAME


OF MOTHER


Alice Morrill


20 BIRTHPLACE OF


MOTHER (City).


Melrose


(State or country)


Mass


Mrs. Kenneth M. Godfrey


16A. Wheelock St. Winthrop


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


(Signature of Agent of Board of Health or other)


Health Oficir


april 23 1963


(Official Designation) (Date of Issue of Permit)


T. V. K. V


-


Winthrop


(City or Town)


No


16 A. Wheelock Street


(Was deceased a U. S. War Veteran, (if so specify WAR) NO ..


(a)


Residence. No.


(Usual place of abode)


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


w .. years ..


.. months


4 Days. In place of residence ......


40


(City or Town making this return)


PARENTS


April 23,1963


19


21 Informant


(Address)


Wakefield


400


eneralized


INTERVAL BETWEEN ONSET AND DEATH


52-932382


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. APR 2-21063ch deaths only as those of (2) Board of Health physicians will dertuyl 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.




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