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