Town of Winthrop : Record of Deaths 1963, Part 47

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 47


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


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54


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.


(2) Board of Health physicians will certify to such deaths only as those of'M 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.


1


Statement of Cause of Death .- Physicians: see explanatory instructions. on face side of standard certificate of death.


6


THROP.


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 bodypat 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.


91963 EM


RM 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


Registered No.


239


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


illard Amos W, Crooks


PHYSICIAN - IMPORTANT


2 FULL NAME


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


34 Thornton Park


(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 :........ years .......


... months ... ] .. 2days. In place of residence5.5.years ..


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


Married


MARRIED


WIDOWED


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


Grace Caroline Ford


HUSBAND of


(or) WIFE of.


(Husband's name in full)


12


AGEZ.3 ... Years. 9.


Months.


6


Days


If under 24 hours


Hours ........


Minutes


Due To


(b) Carcinoma of Prostate


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


None


Was autopsy performed ?


None


What test confirmed diagnosis? Clin. & Lab.


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


(Signature)


Mourir Trause S/ Ein, NC M. D.


Maurice Traunstein, Jr., M.D.


(Print or Type Name)


(Address) 73 .... Bartlett .... Rd. ........... Dat Nov. 20 19 63 Winthrop, Mass.


6 Woodlawn Creamatory


Everett, Mass.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


November 22 ,1963


.19.


7 NAME OF


FUNERAL DIRECTOR


alfred B. March


ADDRESS


174 Winthrop St. Winthrop,


Received and filed


NOV 2.2 1963


19


(Registrar)


A TRUE COPY ATTEST:


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Philedelphia


19 MAIDEN NAME


OF MOTHER


Helen Willard


20 BIRTHPLACE OF


MOTHER (City)


Malone


(State or country)


New York


21 Informant


Mrs ...... Amos .... W. Crooks ...


( Address)


34 Thornton Park, Winthrop


Mas HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Laspl & Serianni (2)


(Signature of Agent of Board of Health or other)


Health Officer


nov. 22. 1963


(Official Designation)


(Date of Issue of Permit)


J V. VB


3 DATE OF


DEATH


November


20


19.6.3.


(Month) (Day)


(Year)


4 I HEREBY CERTIFY, That I attended deceased from


Nov ......


6


150


to .. Nov ....... 20


63


I last saw Imalive on .. N.o.v ....... ].9.


19 .... 6.3death is said to


have occurred on the date stated above, at .. 6:10.2 .m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Generalized carcinbmatosis


INTERVAL BETWEEN ONSET AND DEATH


1 yr.


33 yrs.


Occupation :


Engineer


(Kind of work done during most working life)


14 Industry


or Business :


Air Conditioning Co.


15 Social Security No.


012-01-4537


16 BIRTHPLACE (City)


Malone


(State or country )


New York


17 NAME OF


FATHER


Warren Crooks


-932382


r burial permit d of Health Agent. CTIONS


OR ERTIFICATE


R TYPE CAUSES CATH enter an one or each ) and (c)


s not mean of dying, cart failure, c. It means or compli- ich caused


s, if any, ve rise to use (a), he under- use last.


ons contrib- ath but not the terminal dition given


Withrop


(City or Town making this return)


St


(If nonresident, give city or town and State)


(Give maiden name of wife in full)


13 Usual


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RECEIVED


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OFFI


2


CLERK


W


5


RULES OF PRACTICE


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


NOV 2 21963 AM


(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.


71 12 1 ...


1


PLACE OF DEATH


1 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)


23 THORNTON PARA No.


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


PHYSICIAN - IMPORTANT


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


NC


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of deat


36 years 16 months.


days. In place of residence Ste years


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


November


29


1963


DEATH


(Month)


(Day)


(Year)


4


I HEREBY CERTIFY,


That I attended deceased from


Nov 27 19 63 to Nov 29


to ..


63


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


Nov


27


19 ..


6 5 death is said to


have occurred on the date stated above, at


7.10 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Arteriosclerotic Heart Disease


INTERVAL BETWEEN ONSET AND DEATH 1 yr


Due To Arteriosclerosis


(b)


3yrs


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


None


Was autopsy performed?


No


What test confirmed diagnosis ?


Clinical Findings


5 Was disease or injury in any way related to occupation of deceased NO If so, specify ....


(Signature)


John 7. Collins hat5


M. D.


John F. Collins MD


(Address)


2) Bennington


Revere Mass


.Date.


WINTHULP


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


DEC


2


,65


7 NAME OF


FUNERAL DIRECTOR


MAURICE WITIRBY


ADDRESS WINTHROP


Received and filed


DEC 2 - 1963


19.


(Registrar )


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE-


9 COLOR


WHITE


10 SINGLE


MARRIED


(write the word)


WIDOWED


DIVORCED


INKNOW


WIDOWED)


11 If married, widowed, or divorced HUSBAND of EDWARD


(Give maiden name of wife in full)


NEGUÉA.


(or) WIFE of


(Husband's name in full)


12


50


AGE


Years


Months. . .


Days


If under 24 hours


Hours ........


Minutes


13 Usual


Occupation.


HOME MAYER


(Kind of work done during most of working life)


14 Industry


or Business


HOME


15 Social Security No MONE


16 BIRTHPLACE (City) E HST 20194 (State or country )


17 NAME OF


FATHER


MICHAEL WINSTON


18 BIRTHPLACE OF


FATHER (City).


IRELAND.


(State or country)


19 MAIDEN NAME


OF MOTHER


MARV MITCHELL


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


IRELAND


21 Informant


EDUARD U RECUENTOP


23 THORNTON, PAPRIY.


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


(Signature-of Agent of Board of Health or other)


Health officer


die 2. 1963


(Official Designation)


(Date of Issue of Permit)


TVA


2-934553


RM R-301


or burial permit rd of Health Agent. CTIONS OR CERTIFICATE


R TYPE CAUSES EATH


t enter пап опе for each b) and (c)


s not mean of dying, eart failure, c. It means or compli- hich caused


ts, if any, ve rise to anse (a), he under- ause last.


ions contrib- eath but not the terminal dition given n.C


(Print int or Type Nan same ) 30 Nov je 63


WINTHROP7


PARENTS


(Address)


Registered No.


240


2 FULL NAME


HELEN W. (Winston) Keough


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


23 THORNTON PARK


St


(City or town and State)


19


(a)


6


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RECEIVED.


11


.POWA 10.1. 12


W


6


5


UP MASS


GLERK


RULES OF PRACTICE


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


Attending physicians will certify to such deaths only as those disease un~ 1982


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.


OFFI


NOW


RM R-301


r burial permit d of Health Agent. CTIONS R ERTIFICATE


R TYPE CAUSES ATH enter an one or each ) and (c)


s not mean of dying, cart failure, c. Il means or compli- ich caused


s, if any, ve rise to use (@), he under- use last.


ons contrib- ath but not the terminal dition given


PLACE OF DEATH


X Suffolk (County) Winthrop 1 (City or Town) 6 Grandview au No.


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


STANDARD CERTIFICATE OF DEATH


Registered No.


241


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


Fannie I Lang


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


(Was deceased a


U. S. War Veteran,


if so specify WAR)


10


(a) Residence. No.


(Usual place of abode)


In place of death - years 7 months - days. In place of residence


45 €


.. years ......... months .......


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


That I attended deceased from


August 15,


63


NOV.


`29


19


63


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


NOV ..... 27,


16.3, death is said to


have occurred on the date stated above, at


1:25p .m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


generalized carcinomatosis


(a)


Due Toadenocarcinoma of the


(b)


rectum


Due To


none


(c)


OTHER


SIGNIFICANT


CONDITIONS


none


Was autopsy performed? ... n.O.


What test confirmed diagnosis? Clinical & laboratory


17 NAME OF


FATHER


(C.BL) Jakoritz


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


e. B.L.


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


Russia


Lebanon Lodge Peabody


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


Dec /


1963


7 NAME OF


NERAL


Jor Funeral Survie trc


Chelsea


ADDRESS


Received and filed


NOV 2-9 1963


19


(Registrar)


PARENTSK


21 Informant


John asquith


(Address)


6 Grand View an Wintry


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Roept & Servanne (B) (Signature of Agent of Board of Health or other) Health officer november 2 9, 1963


(Official Designation).


(Date of Issue of Permit)


ik


A TRUE COPY ATTEST:


M. D.


Maurice Traunstein /Jr ..


M.D.


(Address)


73 BarET&EE"PRName) Dat


Nov. 29 63


Winthrop, Mass 102152


6


November


29


1963


8 SEX


9 COLOR


Finale White


10 SINGLE-


MARRIED


(write the word)


Widowg


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


Clarence 2, Lang


(or) WIFE of


(Husband's name in full)


12


82 Years.


.Months.


Days


If under 24 hours


.Hours ...


Minutes


13 Usual


Proprioter


Occupation


8 mos .


(Kind of work done during most of working life)


14 Industry


or Business.


Down Shop


15 Social Security


No 031-14-5759


16 BIRTHPLACE (City).


(State or country )


Russia


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


(Signature)


6 Grandview Que


St


Winthrop, mass


(City or town and State)


INTERVAL BETWEEN ONSET AND DEATH 3 mos AGES.


(Give maiden name of wife in full)


to


2-934553


(City or Town making this return)


2 FULL NAME


WEGE VED


OF


NOW


ER


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE ...


DATE OF DISCHARGE


6


RANK, RATING


ORGANIZATION AND OUTFIT NOV 2 91963 PM


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.


(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.


7


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)


242 ....


2 FULL NAME


Christopher C. Nugent


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


(a)


Residence. No.


11 Bartlett Parkway


St


(If nonresident, give city or town and State)


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


5.0.


ears.


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


November 30 1963


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


Nov. 6. 190319


to.


NOV. 30, 1963


19


I last saw h.LAlive on


27, 70630.


death is said to


have occurred on the date stated above, at : 35 am.m.


INTERVAL


BETWEEN


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


ONSET AND


DEATH


1 yr


(a) Arteriosclerotic Heart Disease


5 yrs


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


none


Was autopsy performed?


no


What test confirmed diagnosis ?


clinical findings


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


(Signature)


John 7 Concluía 715 M. D. fann I. Collins, I.D (Print or Type Name) (Address) 27 Pennington "t


Trong


Data 2/2/63


6


Winthrop


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


December


3


19


63


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


Winthrop, Mass.


ADDRESS


Received and filed


DEC 2 - 1963


19


( Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


(write the word)


WIDOWEWidowed


DIVORCED


UNKNOWN


11 1f married, widowed, or divorced


HUSBAND of


Mary Dempsey


(or) WIFE of.


(Husband's name in full)


12


AGE .. 8.5 Years.


Months ..


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Proprietor


(Kind of work done during most working life)


14 Industry


Motor Transportation


15 Social Security No.


16 BIRTHPLACE (City)


(State or country )


New Jersey


Newark


17 NAME OF


FATHER


John Nugent


PARENTS


18 BIRTHPLACE OF


FATHER (City) ..


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary J. Pilkington


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Informant


( Address)


John .... Nugent


11 Bartlett Parkway, Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E Vivianne (B) (Signature of Agent of Board of Health or other) Health officer December 2, 1963


(Official Designation)


(Date of Issue of Permit)


T. V. D. V


burial permit of Health Agent. TIONS


RTIFICATE


TYPE CAUSES ATH enter in one r each and (c)


not mean of dying, rt failure, ,It means or compli- ch caused


if any, rise to se (a), : under- se last.


ns contrib. th but not e terminal tion given C.


32382


M R-301


1


No ... 11 ..... Bartlett ..... Parkway


f(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


(Usual place of abode)


Registered No.


A TRUE COPY ATTEST:


(Give maiden name of wife in full)


Due Tp


(b) Arteriosclerosis, generalized


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT.


SERVICE NUMBER


RULES OF PRACTICE


he


The fulfillment of the purpose of these laws calls for the observance Q 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 ont related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as thoseof persons who, though disabled by recognized disease unrelated to any forDof injury, have died without recent medical attendance or whose physicianJis 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 bad 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.


OFFIC


10


E


5


10


"


OF


NIE


11 72


TOWN


MASS.


2


GLERK


RECEIVED


M R-302


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


PLACE OF DEATH


Essex


(County)


Denvers


(City or Town)


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


Danvers


(City or Town making this return)


Registered No.


243


[(If death occurred in a hospital or institution, Danvers State Hospital DanversSt. I give its NAME instead of street and number)


2 FULL NAME.


Florence G. Teel


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


(Was deceased a


U. S. War Veteran,


(if so specify WAR,


no


15 Sturgis St. Winthrop Mass.


St


(If nonresident, give city or town and State)


Length of stay: In place of death.


years.


.... months.


Says. In place of residence .......... years ........


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


August 30, 1963


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFYA


That I attended deceased frony


April 30 19 61 August 30


19


63


I last saw h ...


.Aire on


ugast


3.0


19 6 death is said to


have occurred on the date stated above, at


8:30 a.


INTERVAL BETWEEN ONSET AND


(or) WIFE


(Husband's name in full)




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