USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 27
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MAS
No undertaker or other person shall bury of other rise 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, tbe-clerk of the town where the person died; and no undertaker or other puton shapekomme a human body and remove it from a town, from one cemeteryu another om one grave or tomb other than the receiving tomb to another .inthe 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 whichit 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
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 dierk 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 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
4
No. 455 Shirley Street
§(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
2 FULL NAME Phyllis Alexandra Savino (Kennedy)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
455 Shirley Street
(Usual place of abode)
Length of stay: In place of death .......... years .......... months ......... days. In place of residence .... years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
married
female
white
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Carl Savino
(Husband's name in full)
12
AGE 60 Years 3
.. Month:2.9
.Days
If under 24 hours
Hours ... .
Minutes
13 Usual
Occupation :
retired waitress
(Kind of work done during most working life)
14 Industry
or Business :
restaurant
15 Social Security No ....
034-20-7876
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Frank Alexander Kennedy
18 BIRTHPLACE OF
FATHER (City)
Rouses .... Point
(State or country)
New York
19 MAIDEN NAME OF MOTHER Bernice May Oakes
20 BIRTHPLACE OF
MOTHER (City)
Charlestown
(State or country)
Massachusetts
6
Winthrop Cemetery
Winthrop,
Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
19 July 6 1963 afeel B Marche
ADDRESS
....
174 Winthrop St. Winthrop
Received and filed JUL 8 - 1963 19
(Registrar)|
A TRUE COPY ATTEST:
PARENTS
21 Informant
Carl Savino
(Address) 455 Shirley St. Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death 1.1&& led with me BEFORE the burial or transit permit was issued: Falak
(Signature of Agent of Board of Health or other) (MB)
Health Office
July 51963
(Official Designation) (Date of Issue of Permit)
V.I.
1
1
R-301
- 1
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
(City or Town making this return)
Registered No.
133
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
NO.
St
(If nonresident, give city or town and State)
3 DATE OF
DEATH
July
4
1963
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
October 1933
to ......
July 4
1963
I last saw hexalive on
July
2 1, 1963, death is said to
have occurred on the date stated above, at 9:50 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Coronary Occlusion.
Due Totypertensive Arterioselevatic
(b)
Due To
Heart Disease
(c)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes Mellitus
2 yrs
Was autopsy performed?
No
What test confirmed diagnosis? (@fini
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signature)
Charles
Liberman
M. D.
CHARLES
FIBERMAN
(Print or Type Name) (Address) WINTHROP MAZS Date
East Boston
contrib- but not erminal given
VotER (R) 267 wash AVE
ial permit Health nt. IS
ICATE
YPE USES 1
r ne ich (c)
mean dying, failure, means compli- caused
any, e to (a), nder- last.
182
INTERVAL
BETWEEN
ONSET AND
DEATH
1 day
8yrs.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECEIVED
OF TOWA
OFFICE (
11.12 1
CLERK
WII
5
6
MASC
HROP
JUL #81963 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 fromn 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 bad been given up or changed, or if the deceased bad 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.
Y
PLACE OF DEATH
SUFFOLK
(County)
. IN HALUP (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
(City or Town making this return)
STANDARD CERTIFICATE OF DEATH
Registered No.
134
[(If death occurred in a hospital or institution, .St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Bernard Baldassaro
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
84 Orient Ave., E.Foston
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months
35
days. In place of residence.
2
as.
.. months ..
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
male Achite
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWA
(write the word) Inarried
11 If married, widowed, or divorced EstherStalazzo HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
If under 24 hours
.. Hours ...
.... Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
laity of Boston
15 Social Security No.
024-03-3187
Bailen
16 BIRTHPLACE (City)
(State or country)
mars
17 NAME OF
FATHER
Pasquale Baldassaro
18 BIRTHPLACE OF U
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria Martignetti
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maly
Esther Baldassaro
21 Informant
(Address)
84 Orientave.E.B.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 6.
(Signature of Agent of Board of Health or other)
Winter Officer
July 6 1943
(Date of Issue of Permit)
X
A TRUE COPY ATTEST:
3
1963
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
6/1
19.63
to ...
7/5
That A attended deceased, from
1969
I last saw h/4.alive on
7/
19 death is said to
have occurred on the date stated above, at
3KP.
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) CIRRHOSIS OF LIVER
Due To WITH JAUNDICE AND (b) ASCITES
1 MO
Due To (c)
LEUKEMIA -CHRONIC
2YRS
Was autopsy performed?
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased 0 If so, specify
(Signature) myron n. 15mg M. D. MYRJON N. KIN @ MAT (Print or Type Name)
7/5 1063 (Address) VIL PLEASANT ST cuma InThe Date ..... Holy Cross Cemetery malden 6
I'lace of Burial or Cremation (City or Town)
DATE OF BURIAL
July - 8
63
19.
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
374 Broadway Som, Mass
Received and filed
JUL 8 -1963
19
(Registrar) || (Official Designation)
12
R-301
al permit Health t.
5
CATE
PE JSES
h (c) mean dying, ailure, means ompli- caused
ny, to (α), der- ast. ontrib- ut not minal given
1
No ...
WIN HELP COMMUNITY HUSETTAL
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
no
(Usual place of abode)
JULY
3 DATE OF
DEATH
INTERVAL
BETWEEN
ONSET AND
(or) WIFE of
DEATH
12
56
6.210.
Years
Months
Days
Steam Fitter
OTHER
SIGNIFICANT
CONDITIONS
MYELOGENIUS
10
PARENTS
Lillian Cataldo
CAMARGO
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
TOWI
OFFICE OF
2. 1.12
GLERK
MIN
-
00
MASS
THROP
JUL 81963 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.
01
ermit th
I
WINTHROP
(City or Town)
5 Summit ave
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH · OVIETEM
(City or Town making this return)
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
5 Summit are
(Usual place of abode)
St
(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
3 DATE OF
DEATH
July
9/ 1963
(Month)
(bay)
(Year)
4 IHEREBY CERTIFY , That I attended deceased from
19
to
19
I last saw h ...... alive on
19 ........ , death is said to
have occurred on the date stated above, at
7:10 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Death presumably due to
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To natural
(b)
CAUSES
probably acute coronary
Due To
(c)
Occlusion on basis of
history. Winthrop Board ofHealy SIGNIFICANT CONDITIONS Charles Hiberna, Lung
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signature)
Oleartes Liberman
M. D.
CHARLES
LIBERMAN
(Print or Type Name)
(Address)
WINTHROP
Date ...
7/10/
19 63
Wintherif
Winthrop
6
Place of l'urial or Cremation
(City or Town)
July 11
63
7 NAME OF
FUNERAL DIRECTO Comnest lGaggiano
ADDRESS
147 Wattherch St Maarthorin
Received and filed
JUL 10 1963
19.
( Registrar)
PERSONAL AND STATISTICAL PARTICULARS
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Married
11 If married, widowed, or divorced
Margaret Sitek (Dolan)
(or) WIFE of.
(Husband's name in full)
12
AGE53
Years
8
Months ..
29 Days
If under 24 hours
Hours ...
Minutes
13 Usual
Electrical Tester
Occupation
(Kind of work done during most working life)
14 Industry
or Business :
Electric Motors
15 Social Security No.
16 BIRTHPLACE (City)
(State or country )
man
PARENTS
18 BIRTHPLACE OF
FATHER (City)
C'est Breton
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Delie Connolly.
Boston
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
21 Informant
Margaret Silch
(Address)
5 Summit Que Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Falak 6. Jirianne
(Signature of Agent of Board of Health or other) H.B
Health Officer.
July 10, 1963
(Official Designation)
(Date of Issue of Permit)
1
an
re.
li- ed
ib. sal en
PLACE OF DEATH
SUSfolk
(County)
No. Kenneth & SileK
Registered No.
135
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
22
8 SEX
HUSBAND of
U(Give maiden name of wife in full)
WINTHROP
17 NAME OF
FATHER
albert Silik
DATE OF BURIAL
A TRUE COPY ATTEST:
E
S
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
TO:
ORGANIZATION AND OUTFIT
SERVICE NUMBER
8
16 5 C ..
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 certifyty such deaths only as those of persons to whom they have given bedside caulduring aflastillna'ss 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.
X 1 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.
1
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
2 FULL NAME
Eva Alice (Mills) Knowlton
(If deceased is a married, widowed or divorced woman, give also maiden name.) 26 Amelia Ave
(a) Residence. No.
(L'sual place of abode)
Length of stay: In place of death.
............ years.
months
L.days. In place of residence
27
St.
(If nonresident, give city or town and State)
years
months.
davs.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
JULY
13
1963
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIEI)
WIDOWED
or DIVORCED: 1001
HEREBY CERTIFY
That I attended deceased from
JULY 1 1963 JULY 13/1963, 19
I last saw MEDlive on
JULY 13,, 1963, death is said to
have occurred on the date stated above, at 1.46pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) CARDIAC DE COMPENSATION
2 WKS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William Knowlton
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
79
10
12
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No.
021-18-1914
16 BIRTHPLACE (City)
stonington
(State or country) Laine
17 NAME OF
Butler Lills
18 BIRTHPLACE OF
FATHER (City)
Stonin ton
(State or country)
lainie
19 MAIDEN NAME
OF MOTHER
Laude Henderson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Hampshire
21 Informant
Helen Malone
(Address) 2 11: ave inthevine
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Ralph 6. Sirianni
....
(Signature of Agent of Board of Health or other)
Health Officer
Date 15, 1963
(Official Designation)
(Date of Issue of Permit)
TX
-
ean ing, ure, ans pli- sed
-
rib. not inal ven
37, res : or or on and of si- ype Ire.
(Signed)
912 Caplan
·M. CAPLAN MD
M. D.
(PRINT OR TYPE SIGNATURE)
Date ..
7-13-
19.
مرة
6 ..... intheu.s.
19
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 1
1 3
winthrop
7 NAME OF
FUNERAL DIRECTOR
Howard _ Reynold.
ADDRESS
Juntarop
Received and filed JUL 15 1963 19
(Registrar)
tyas
Due To (c)
OTHER
CARÁNUMATOSIS
IMD
SIGNIFICANT
CONDITIONS
COLOSTOMY
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of decease
If so, specify
0
186 PRINCETONSTRAST
BOSTON
PARENTS
6
4
TE
TH
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, [if so specify WAR)
136
No.
Bay View Nursing Home
Registered No.
1
(b) ARTERIOSCLEROTIC
HEART DISEASE
AGE
Years.
Housewife
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 dertify to such deaths only as those of persons to whom they have given bedside tare during a last illness from disease un- related to any form of injury.
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