Town of Winthrop : Record of Deaths 1963, Part 30

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 30


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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3.0;ears.


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


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED,


WIDOWEIWidowed


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


James E .Collins


( Husband's name in full)


12


AGE. 9 1. Years


Months.


Days


If under 24 hours


Hours ,


.Minutes


13 Usual


Occupation :.


Retired .. Forelady


1


14 Industry


or Business Loose Wiles Biscuit Co.


15 Social Security No.


012-10-1443


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


Michael B. Corcoran


18 BIRTHPLACE OF


FATHER (City)


Cork


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Catherine McCondile


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Ireland


21 Informant


Mary ..... O' Meara


(Address)


37 Siren St., Winthrop


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


1


(Signature of Agent of Board of Health or other)


07767


Arena 13 / 963


(Date of Issue of Permit)


1


TV.B . .


A TRUE COPY ATTEST:


PARENTS


6 Winthrop Cemetery Winthrop


Place of Burial or Cremation


(City or Town)


June 15,


19


63


....


7 NAME OF


FUNERAL DIRECTOR


ArthurJ .O' Maley


ADDRESS


Winthrop, Mass.


Received and hled .... JUN 14 1963 .


19


MaryS. Manning


ASST


(Year)


4 I HEREBY CERTIFY,


That Iwattended deceased from


11


19


63


we last saw henlive on ... June


11


19.6.3, death is said to


have occurred on the date stated above, at ... 10:20p.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(Gastrointestinal hemorrhage


Due To


(b)


Aplastic anemia


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Nephrolithiasis.


UNK


Yrs


Was autopsy performed ?


Yes


What test confirmed diagnosis ?


Autopsy


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


If so, specify


(Signature)


M. D.


... Charles.L ... Cley ... M. D ...


(Print or Type Name)


(Address) Ass's .. Dir., Mass .. Con'I .. Hosp ..... Date.


June 11. 63


- 1


rial permit Health ent. OKS


Shore IFICATE


70 Winthrop


TYPE AUSES TH ter one each nd (e) of mean dying, failure , It means compli- cursed


f any, rise to (a), under- last.


contrib- but not terminal on given


2.4


21963 ·cton only nk. 3404


Registrar) |f (Official Designation)


(Was deceased a


U. S. War Veteran,


No


(if so specify WAR)


/


(a) Residence. No ..


66 Shore Road Drive


(Usual place of abode)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


June


11


1963


(write the word)


(Month)


(Day)


April


16., 19 .... 63


to


June


INTERVAL


BETWEEN


ONSET AND


DEATH


UNK


Days


2 Mos


(Kind of work done during most of iworking life)


Charlestown


DATE OF BURIAL


No .. MASSACHUSETTS GENERAL HOSPITAL


I R-301


A TRUE COPY ATTEST:


Williamf. Kane


SEIVED City Registrar


OF TOWY


34 2-4


01


5


155


THRODI


AUG 211963 AM


X


PLACE OF DEATH


Suffolk (County)


Boston


(City or Town)


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


147


OUT - OF - TOWN


(City or Town making this return)


86410


Registered No. death occurred in a hospital or institu ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


Baby Boy Rubitsky


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


(a) Residence. No ..


69 Locust


Winthrop, Mass


St


(Usual place of abode)


4 Hrs. 20 Min.


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


June 19 1963


(Month)


(Day)


(Year)


June 19


BY


CERTIFY


That I attended deceased from


53


19


to.


I last saw


AMalive on


June 19, 1963


death is said to


have occurred on the date stated above, at 2 ... 50 .... P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


DIAPHRAGMATIC


HERNIA


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


TENSION PNEUMOTHORAX


1 Hr


Was autopsy performed?


What test confirmed diagnosis ?


S Was disease or injury in any way related to occupation of deceased No


If so, specify


..........


(Signature)


Lucian C. Legu


M. D.


LUCIAN L. LEAPIE


(Print or Type Name) (Address) 300 Longwood Ave Date June 19.63.


AGUDATH ISRAEL-UPOR 6 Place of Burial or Cremation (City or Town)


DATE OF BURIAL


JUNE 21


1963


7 NAME OF


FUNERAL DIRECTOR


BENJAMIN BIRNBACH.


ADDRESS 10 WASHINGTONSi. DURCH


Received and filed


JUN 2-5-1963


19. Mary E, Manning Wegistrar)


ASST


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


MALE WHITE


10 SINGLE


MARRIED


WIDOWED


(write the word)


DIVORCED SINGLE-


UNKNOWN


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


(Husband's name in full)


INTERVAL


BETWEEN


(or) WIFE of ..


ONSET AND


DEATH


6hrs


12


AGE .......... Y'ears ...


............ 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)


WINTHROP MASS


17 NAME OF


FATHER


HARRY RUBITSKY


18 BIRTHPLACE OF


FATHER (City)


(State or country)


BOSTON.


19 MAIDEN NAME


OF MOTHER


IDA BODKINS


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


BOSTON


21 Informant


HARRY RUBITSKY


(Address)


69 LOCUSTST. WINTHROP


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


17090


6/21/63


(Official Designation)


(Date of Issue of Permit)


X


rial permit Health ent. ONS


IFICATE


TYPE AUSES TH ter one each nd (c)


ot mean dying, failure, It means compli- caused


i amy, rise to (0), under- last. -


contrib- but not terminal om given


1 ex- declined 10.7 3 10


1963


404


R-301


1


The Children's Hospital Medical Center


(Was deceased a


U. S. War Veteran,


(if so specify WAR) ..


NO


(City or town and State)


PARENTS


A TRUE COPY ATTEST:


William& Kance.


City, Registrar


OF TOM:


11.12.


C


00


n


WINTHROP 5 6


AUG 211963 AN


X 1


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


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


148


OUT On


....


(City or Town making this return) Y


116225


[(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.


66 Plummer Avenue


(Usual place of abode)


St


Winthrop


Mass.


(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


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


married


male


11 If married, widowed, or divorced


HUSBAND of


Paula .... Elsie Hubener


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


URK" Dys?


AGE ... 7 2Years ..


.11Months ....


3


Days


If under 24 hours


Hours ....... Minutes


13 Usual


Occupatiretired machinest


(Kind of work done during most of iworking life)


14 Industry


of Business: Wholesale clothing Mfg . Co.


.011-05-5105


OTHER


SIGNIFICANT


CONDITIONS


Pulmonary Edema


Unk Diy


S Social Security No ..


Bilboa


6 BIRTHPLACE (City)


(State or country )


Spain


17 NAME OF


FATHER


Florentino John Isasi


18 BIRTHPLACE OF


FATHER (City)


Bilboa


(State or country)


Spain


19 MAIDEN NAME


OF MOTHER


trene Echevarria


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Bilboa


Spain


21 Informant


RichardA ..... Isasi


(Address)


66 Plummer Ave . Winthrop


HEREBY CERTIFY that a satisfactory standard certificate of death ME hed with me BEFORE the burial or transit permit was issued: . Dorato (Signature of Agent of Board of Health or other)


17214


2/1/63


Date of Issue of Permit)


1 x


A TRUE COPY ATTEST:


PARENTS


Winthrop Cemetery , Winthrop, Mass 6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 1,1963


.. 19.


7 NAME OF


FUNERAL DIRECTOR


alfred to March


174 Winthrop St. Winthrop, ADDRESS


trillian & Kance"


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


That lwattended deceased from


June


21


19.


to


.. 63


June


27 , 19 .


63


we last saw


June


2.7 19.63 death is said to


have occurred on the date stated above, at


7:00p.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Bronchopneumonia, bilateral


(a)


INTERVAL BETWEEN ONSET AND DEATH


Due To (b)


Due To (c)


Was autopsy performed ?


Yes


What test confirmed diagnosis ?


Autopsy


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


If so, specify


.....


(Signature)


ce@la


M. D.


.Charles L. Clay, M. D ...


(Print or Type Name) June 27 63


(Address) Ase's. Dir., Mass. Con'I. Hosp ..... Date.


90 1 . 196 3 rector only Ink.


A R-301


urial permit of Health gent. IONS


TIFICATE


TYPE CAUSES TH nter one each and (c)


sot meon I dying, failure, It means compli- cowsed


if any, rise to e (a), under. e last.


-


s contrib- but not : terminal ion given


3404


(Registrar)|| (Official Designation)


No .. MASSACHUSETTS GENERAL HOSPITAL. Florentino Antonio A Isasi


Registered No.


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


NO ..


3 DATE OF


DEATH


June


27


A TRUE COPY ATTEST:


Williamf. Kane. City Registrar


1/ 12


4


0, 50


M!


55


THROP.


Fair


M: 2 11963 AM


PLACE OF DEATH


ESSEX


(County)


Methuen


(City or Town)


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


149


METHUEN


(City or town making return)


Registered No.


No. D.O.A. Bon Secours Hospital


2 FULL NAME


Everett Mosley


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


71 Sagamore Avenue


St.


Winthrop, Mass.


(a) Residence. No.


(Usual place of abode)


5


(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


3 DATE OF


July


31,


1963


DEATH


(Month)


(Day)


(Year)


9 SEX


Male


10 COLOR


White


11 CITIZEN


OF U.S.


YES


NO


12 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


4I 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.)


Gun Shot Wound, Cerebral


5 Accident, suicide, or homicide (specify)


Suicide


Date and hour of injury


8 P.M.


July 31 1963


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 ?


Manner of


Injury


(How did injury occur ?)


Nature of Injury


While at work ? no Was autopsy performed?


6 Was disease or injury in any way related to occupation of deceased ?... no If so, specify


(Signed)


John .............. Bata.l


M. D.


(Address)


Lawrence.,Ma.s.s ....


Date July 3ho 63


7 Elmwood Cemetery, Methuen, Mass. Place of Burial or Cremation. (City or Town) 63


DATE OF BURIAL August 2


& NAME OF


FUNERAL DIRECTOR


Kenneth H. Pollard


ADDRESS 233 Lawrence St., Methuen, Mas


Received and filed August 16 0 63


PARENTS


21 MAIDEN NAME


OF MOTHER


Malverna Hatfield


22 BIRTHPLACE OF


MOTHER (City)


(State or country)


Kentuckey


23 Mrs. Arlene Lishner


Informant


(Address)


132 Shore Drive Winthrop, Mass


A TRUE COPY.


Conform


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


August


7


63


19


(Registrar of City or Town where deceased resided)


12a If married, widowed, or divorced Lishner


HUSBAND of


(Give maiden name of wife in full)


......


(or) WIFE of


(Husband's name in full)


13 DATE OF BIRTH


Years.


14


AGE.33


11


Months.


18


Days


If under 24 hours


Hours .......


Minutes


15 Usual


Occupation :


Truck Mechanic


(Kind of work done during most of working life)


16 Industry


or Business :


Garvey Trucking Co., Dorchester


17 Social Security No.


CBL


18 BIRTHPLACE (City)


(State or country)


Hamilton,


Ohio


19 NAME OF


FATHER


Harrison Mosley


20 BIRTHPLACE OF


FATHER (City)


(State or country)


Ohio


25M-3-61-930213


12 WINNERSp SheRE DR.


=


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


[(Was deceased a


U. S. War Veteran,


[if so specify WAR)


Korean


1


(Specify type of place)


RECEIVED


OF TOWI


2/ 12. 1


0


C


CLERK


5


6


AUG 1 61963 AM


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


L


PLACE OF DEATH


Suffolk


(County) Winthrop (City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN 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.


Registered No. 150


[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number) No.


2 FULL NAME


Hannah A. Murray


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


72 Cottage Pk. Rd.


St


(If nonresident, give city or town and State)


Length of stay: In place of death 5.


.years.


-9 months.


days. In place of residence.


2 years


9


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED,


WIDOWEDWidowed


or DIVORCED


4 I HEREBY CERTIFY,


That I attended deceased from


Feb


1953


19 43, to.


2


I last saw hen alive on


1963, death is said to


have occurred on the date stated above, at


11304m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


CEREBRAL HEMORRHAGE


INTERVAL


BETWEEN


ONSET AND


DEATH


2 deago


Il IF STILLBORN, enter that fact here.


12


86,


AGE


Years


Months


Days


If under 24 hours


... Hours .... Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


ownat home


15 Social Security No ..


none


16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF


FATHER


James Quinn


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Hannah O'Brien


20 BIRTHPLACE OF


MOTIIER (City)


(State or country)


Ireland


21


Informant,


Helen, Powell


(Address) (2 Cottage Pk. Rd. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death


was filed with me BEFORE the burial or transit permit was issucd:


Ralph E Sirianni (0)


(Signature of Agent of Board of Health or other)


Health, officer


(August 5,1963


(Official Designation)


(Date of Issue of l'ermit)


. X


TH


:)


can ng, ure, ans pli- sed


١٠ 0


-


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed? 20 What test confirmed diagnosis ?.


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


If so, specify


(Signed).


Louis 7 Salerno


M. D.


(Ad 175 Pleasant St


Date


1963


6 Holy Cross


Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


August 6,


19


6H


7 NAME OF


FUNERAL DIRECTOR


Frederick J. Magrath


ADDRESS


325 Chelsea St. E. Foston


Received and filed AUG- 5 1863 19


(Registrar)


PHYSICIAN - IMPORTANT (Was deceased a


U. S. War Veteran,


(if so specify WAR)


no


(a) Residence.


No.


(Usual place of abode)


3 DATE OF


DEATH


2


1263


(Month


(Day)


(Year)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


John J. Murray


(Husband's name in full)


Due To


ARTERIOSCLEROSIS


(b)


50M-1-58-921876


I


Winthrop Convalescent Home


TE


ib. - not nal ver 137, res or or


Boston


housewife


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, eighteen 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


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 isso 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


6


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 Mit 19R hpdeaths only as those of


persons who, though disabled by re ob fred doene durelated 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 whosevonly 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


LA


1


PLACE OF DEATH


Suffolk (County )


Winthrop (City or Town)


No.


Sturgis St -bay View Nursing .St. i give i Home


2 FULL NAME


Elinor .... L ...... Howard


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


(a) Residence. No.


15 Pleasant Park Rd.


(Usual place of abode)


Length of stay : In place of death ..


.... ..


.. years.


months.


20 days. In place of residence.


17


.years.


months ..


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


August 4, 1963


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


That I attended deceased from


March


19.


-


.. , to.


I last saw Hab.c.alive on


Aug , 4, 19 h3


death is said to


have occurred on the date stated above, at


1:00 Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


11 IF STILLBORN, enter that fact here.


12


AGE.9.3.


Years.


Months.


.Days


If under 24 hours


.Hours.


... Minutes


13 Usual


Occupation :


At .... Home.


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No. None.


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


Richard Howard


18 BIRTHPLACE OF


FATHER (City) (State or country)


19 MAIDEN NAME


·M D. OF MOTHER Bridget Kennedy


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


Holyhood ... Cemetery Brookline


6 Place of Burial or Cremation DATE OF BURIAL August ?


(City or Town)


19


63


7 NAME OF


FUNERAL DIRECTOR


O' Maley Funeral Home


Winthrop Mass


Received and filed AUG-6-1963 19


(Registrar)


8 SEX


9 COLOR


White


10 SINGLE


MARRIED)


WIDOWED


or DIVORCESingle


10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Cerebro vascular occlusion


(a)


3 days


Due


(b)


Cerebral Arteriosclerosis


5 yrs


Due To


(c)


Generalized Arteriosclerosis


10 yrs


OTHER


SIGNIFICANT


CONDITIONS




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