USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 49
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U. S. War Veteran, WWI
(if so specify WAR)
(Usual place of abode)
.........
(Registrar)!| (Onthaal Designation)
(Give maiden name of wife in full)
RECEIVED
TOWA
OF
A TRUE CUNY ATTEST:
Wichauf. Kane
1340 Li
CLERK
6
WIN
RO
City Registrar
JAN 1 01964 AM
X
PLACE OF DEATH
WORCESTER
GRAFTON
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
GRAFTON (City or Town making this return) 251182
Registered No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
Louis C. Sanderson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
240 Pleasant Street
St
Winthrop, Mass.
(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
9 SEX
Male
10 COLOR
White
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Single
12 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13
AGE .. 6.8.
Years.
9
„Months ..
.. 12 Days
If under 24 hours
.Hours
.. Minutes
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
IF ACCIDENTAL, was injury causally related to the death ?
15 Industry
or Business :
None
16 Social Security No.
None
17 BIRTHPLACE (City)
(State or country)
Boston, Mass
18 NAME OF
FATHER
Charles W. Sanderson
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Bos.t.on., ..
20 MAIDEN NAME
OF MOTHER
Carrie S. Peterson
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston,
Mass .
22 Grafton, State Hosp. Records
Informant
(Address)
North Grafton, "ass.
A TRUE COPY
ATTEST:
Registrar of City or Town where death occurred)
DATE FILED
December 3,
63
19
(Registrar of Clty or Town where deceased resided )
PARENTS
(Signed) Walter F. Mahoney, M. D. M. D.
(Address) Westboro, Mass. Date
Nov.23 1.63
Hillcrest Cemetery, N. Grafton 7
Place of Burial or Cremation. November 29,
19
DATE OF BURIAL
8 NAME OF
Misiaszek Funeral Home
FUNERAL DIRECTOR
250 Main St., S. Grafton,
ADDRESS
Received and filed
DEC 11 1963
19
SOM-3-62-932695
ORM R-305 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at THIS IS A PERMANENT RECORD
(City or Town)
No.
(Usual place of abode)
45
8
3 DATE OF
DEATH
(Month)
(Day)
public place ?
Manner of
(Specify type of place)
Injury
(How did injury occur ?)
Nature of
Injury
While at work?
No
as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided
Where did
Injury occur ?
(City or town and State)
November 23, 1963
(Year)
4 I 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.)
Sudden Death, Presumably Coronary Thrombosis.
Did injury occur in or about home, on farm, in industrial place, or in
No
Was autopsy performed ?
No
6 Was disease or injury in any way related to occupation of deceased ?
If so, specify
None
14 Usual
Occupation :
(Kind of work done during most of working life)
Not
Learned
((Was deceased a
U. S. War Veteran,
No
(if so specify WAR)
8
(City or Town) 63
Grafton State Hospital
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
E TOW;
ORGANIZATION AND OUTFIT12.1
SERVICE NUMBER
5
......
HROP.
DEC 1 11963 AM
X
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No. 252
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
(a)
Residence. No ......
1.5 .... Pleasant ..... Park ..... Road
St
(If nonresident, give city or town and State)
Length of stay: In place of death 50 ears. ....... months .......... days. In place of residence .......... years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December 2 .1963
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
.
October 1963
to ...
1962
I last saw h ..... ,alive on
Dec
1963
have occurred on the date stated above, at 4: 19 hm.
death is said to
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cerebro Vascular Occlusion)
INTERVAL BETWEEN ONSET AND DEATH 6 mes
Due
(b)
Cerebral Arteriosclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed?
NO
What test confirmed diagnosis ?
clinical
5 Was disease or injury in any way related to occupation of deceased 10 If so, specify. ......
(Signature)
Elcarlos Libe quan
M. D.
CHARLES LIBERMAN
(Print or Type Name)
(Address) WINTHROP CLASS
12/2/ 1963
Holyhood Brookline Mass
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 5
19.63
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop Mass.
Received and filed
DEC 4 - 1963
19.
(Registrar)
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEH dowed
DIVORCED
UNKNOWN
11 If marrie
Allider RorcedHoward
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE 86 .. Years ..
.. Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most working life)
14 Industry
or Business :
Comercial Artist
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country )
Germany
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
Anna Loefler
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Germany
21 Informant
Veronica Preg ....
( Address)
15 Pleasant Park Road
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ruxph 16.
(Signature of Agent of Board of Health or other)
Health officer
Diamber + 1963
(Official Designation) 6
(Date of Issue of Permit)
T V.B.
1
Winthrop (City or Town)
No ...........
15 Pleasant Park Road
Joseph F. Preg
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
2-932382
ORM R-301
for burial permit ard of Health ts Agent. RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means e, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
(Usual place of abode)
(City or Town making this return)
17 NAME OF
FATHER
Joseph Preg
TOW 11.22
73
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
6
HROP.
DATE OF DISCHARGE.
RANK, RATING
DEC. . A1963.AM
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
)
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
67 Atlantic Strect
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
253
f(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
2 FULL NAME.
Grace (Peters) Tibbetts
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
( Usual place of abode)
67 Atlantic Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
50
ars.
months ... ... days. In place of residence years.
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December 6, 7763
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
-
That I attended deceased from
ec.
1963
to.
Tec. 6,
1963
19
I last saw h.@lalive on
December 6.
1953
death is said to
have occurred on the date stated above, at 8:45 F.Im.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cerebral Thrombosis
(b) Due ToArter'orclerosis
5 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
none
Was autopsy performed?
no.
What test confirmed diagnosis ?
Minimal Findings
5 Was disease or injury in any way related to occupation of deceased ? ...... If so, specify " Solar 7. Collins net (Signed) M. D. Gen F. - lin3, ID (PRINT OR TYPE SIGNATURE)
(Address) 27 Tarrington Ct, Date Dec. C, 1963
6
vijutimon oninthron
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Dec. 10
19
7 NAME OF
FUNERAL DIRECTOR . Howard ~ Reynold:
ADDRESS A.A intimo2 12:
Received and filed
DEC 9- 1963
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED'
iloned
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Wesley Tibbetts
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
98
6
5
Months.
Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
Houselife
(Kind of work done during most of working life)
14 Industry
or Business :
Own Home
15 Social Security No.
Westport
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
Alfred Peters
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Adelaide Cann
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scoti-
21 El.iur Tilbetts
Informant
(Address)
57 Atlantic St. nuithop, Mis
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Devanna (P)
(Signature of Agent of Board of Health or other)
Health Officer
Decevalor y 1963 5
(Official Designation)
(Date of Issue of Permit)
-301A 1
IONS
TIFICATE
ng. DEATH nter n one each and (c)
not mean f dying, t failure, It means r compli- caused
if any, rise to e (a), under- e last.
s contrib- h but not terminal ion given
pter 137, requires print or ause or leath on ates, and Acts of s Physi- t or type ignature.
925686
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT f(Was deceased a {U. S. War Veteran, (if so specify WAR)
52
TAGE
Years.
None
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(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.
LERK
OF
MIN
NTHRO
G.
OFFIC
WINTI
89/16 030
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 prison engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- Hotel Cc. For a person who had no occupation whatever write none.
...
X 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 he filed for buriaf permit with Board of Health or its Agent.
254
(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
2 FULL NAME
imie F. vir (Fox)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 165 Bowdoin It.
St.
(If nonresident, give city or town and State)
Length of stay : In place of death .......... ... years.
months .
2
days. In place of residence.
years
months .. ...
.days.
29
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED)
WIDOWEDWidowed
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Lockhart L.
(Give maiden name of wife in full) muir
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
53
Years.
Months.
24Da
Days
If under 24 hours
Hours ...........
Minutes
13 Usual
Occupation :
comemaler
(Kind of work done during most of working life)
14 Industry
or Business :
at home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
George H. Fox
18 BIRTHPLACE OF
Dewsbury
FATHER (City)
(State or country)
Onels_id
19 MAIDEN NAME OF MOTHER Louisa Downes
20 BIRTHPLACE OF MOTHER (City) (State or country)
Uland
(Address WINTHROP MASS Date.
Dec / 1963
6
int non Cemeter, introp
Place of Burial or Cremation (City or Town) DATE OF BURIAL .De.c ........ 10., 19
1
7 NAME OF FUNERAL DIRECTOR ornest r. Copieno
ADDRESS 147 i trop st., wit ron
Received and filed
DEC 10 1963
19
(Registrar)
PARENTS
21 Informant (Address) 16 Lowdoin Et
1 11EREBY CERTIFY that a satisfactory standard certificate of death Agas filed with me BEFORE the burial or transit permit was issued:
(Signature, of Agent of Board of Health or other) Harett, officer
(Official Designation)
(Date of Issue of Permit)
925686
-301A 1
IONS
TIFICATE
ing DEATH nter n one each and (c)
not mean of dying, t failure, It means r compli- h caused
if any, rise to e (a), under- e last.
-
Due To (c)
0
OTHER
SIGNIFICANT
CONDITIONS
Jueumonía
2 days
Was autopsy performed?
What test confirmed diagnosis ? .
@ linien/
5 Was disease or injury in any way related to occupation of deceased? /h If so, specify
(Signed)
6 Cealles
.. , M D. CHARLES LIBER MAN (PRINT OR TYPE SIGNATURE)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
12/5/
1963
to ....
121
That I attended deceased from
1963
7/
I last saw h& Yalive on
17/7/
1
6.3
19.
death is said to
have occurred on the date stated above, at 6:00 P.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebral Hemorrhage
Due To (b)
3 DATE OF
DEATH
Dec. 7, 1263
PHYSICIAN - IMPORTANT
[(Was deceased a { U. S. War Veteran, no
[if so specify WAR)
(Usual place of abode)
Registered No.
No. Bay View Nursing Home
pter 137, requires print or cause or death on ates, and Acts of es Physi- t or type ignature.
s contrib- h but not terminal ion given
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
RECEIVED ORGANIZATION AND OUTFIT
SERVICE NUMBER.
11
LERK
MINS
6
LAS
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.
DEC 1 01963 . .
RULES OF PRACTICE
5
PLACE OF DEATH
Suffolk (County)
Boston 7-7-64
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
f(Was deceased a
U. S. War Veteran,
[if so specify WAR)
No
(If deceased is a married, widowed or divorced woman, give also maiden name.)
129 Stanwood
St.
Roxbury
(If nonresident, give city or town and State)
Length of stay: In place of death ....
.. years
1
months .
days. In place of residence.
.years.
months ..
.days.
31
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
11, 1963
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
Nov
.- 3
63, 1
to
Dec
11
1963
I last saw himalive on
10, 19 63, death is said to
have occurred on the date stated above, at
9:15Am.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Arterios clerctic Heart Disease
Due Topperalized Arteriosclerosis
3yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed?
What test confirmed diagnosis? Clinical
5 Was disease or injury in any way related to occupation of deceased Ve .. If so, specify
(Signed)
Liberman
M D.
CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE) (Address) WINTHROP MASS Date 12/11/1963
Roxbury Lodge, West Roxbury 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 12,
63
7 NAME OF
Benjamin Birnbach
FUNERAL DIRECTOR
ADDRESS
10 Washington St. Dorch.
Received and filed
DEC 12 1963
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
Bertha Novick
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCE
Married
10a If married, wi
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
82
1yr
Years.
Months.
Days
If under 24 hours
Hours .............. Minutes
13 Usual
Coal Dealer
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Retired
15 Social Security No.
016-12-4878
16 BIRTHPLACE (City)
(State or country)
Poland
17 NAME OF
FATHER
Louis Lefkofsky
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
19 MAIDEN NAME
OF MOTHER
Rachael (CBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Poland
21 Jimmy Lewis
Informant
(Address)
129 Stanwood St. Roxbury
] HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial , or transit permit was issued:
Falph
Dirianne
(Signature of Agent of Board of Health or other)
1 3
Health Milicer
Dec.1.1963
5
(Official Desiggation)
(Date of Issue of Permit)
X
TIONS
RTIFICATE
ing DEATH enter n one each and (c)
not mean of dying, rt failure, It means or compli- h caused
if any, rise to se (a), under- se last.
as contrib- th but not e terminal tion given
apter 137, . requires o print or cause or death on cates, and Acts of es Physi- nt or type signature.
-925686
X
1
-301A
1
Winthrop (City or Town)
No.
Bayview Nursing Home
To be filed for burial permit with Board of Health or its Agent.
255
PARENTS
2 FULL NAME
Solomon Lefkofsky
(a) Residence. No.
(Usual place of abode)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECEIVED
TOW
IF
11.12 1
6
DEC 1 21963 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 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.
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