Town of Winthrop : Record of Deaths 1963, Part 50

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 50


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


RM R-301


1


Winthrop


(City or Town)


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


(City or Town making this return)


Registered No.


256


(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.)


105 Grover; Avenue


St


(If nonresident, give city or town and State) 2


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


22days. In place of residence.


years ...


.. months.


.... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Dec.


12,


1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY,


11/20


63


to ...


12/12


That I attended deceased from


19


63


I last saw h.


.SMive on


Dec ..... 11,


19.63 death is said to


have occurred on the date stated above, at


12:20.18.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Carcinomatosis


Due To


(b)


Primary ... Lesion ... Uterus


Due To


(c)


Carcinoma of the Brain


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


No


What test confirmed diagnosis ?


History and Path


Findings


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


(Signature)


Harold L. Musgrave, M.D.


(Print or Type Name)


(Address)


620 ... Beach ... Street .... Date. 12/12.


1963


Revere


6


Place of Burial or Cremation


(City or Town)


C.c. 16


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


Received and fled


DEC 13 1963


19


( Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Ferale


9 COLOR


Lite


10 SINGLE


MARRIED


WIDOWED


DIVORCED Lido: ed


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of thert


22000


(Husband's name in full)


12


73


22 day


AGE


Years


7


Months


23


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry or Business:


15 Social Security No ... ULL-2-3200


16 BIRTHPLACE (City). (State or country ) Je, fork


17 NAME OF


FATHER


18 BIRTHPLACE OF


FATHER (City)


(State or country) Cn da


19 MAIDEN NAME


OF MOTHER


Mary Motero t


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


Me it . inword.


21 Informant


( Address)


introp Cos mi'y los it 1


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 6. Sirianni (Signature of Agent of Board of Health or other)


(NB)


Health Officer


12/13/63


(Official Designation)


(Date of Issue of Permit)


T


V.H.V


A TRUE COPY ATTEST:


932382


PLACE OF DEATH


Suffolk (County)


Walsh Clough


Winthrop Community Hospital No. Lillian


:burial permit of Health Agent. CTIONS R ERTIFICATE


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


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


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


ons contrib- ath but not he terminal dition given


PARENTS


M. D.


DATE OF BURIAL


19.


2 yrs.


22 days


INTERVAL BETWEEN ONSET AND DEATH


If under 24 hours


Hours ..... .. Minutes


Days


(write the word)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(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


TOM


5


IROP.


DEC 1 31963 PM


RULES OF PRACTICE


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


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


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


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


PLACE OF DEATH


Suffolk


(County) Winthrop


(City or Town)


28 Jones Ave


The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


Registered No.


257


[(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)


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


28 Jane: Ave


St.


Length of stay: In place of death.


4 years


months .. days. In place of residence years. months. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


December


13-


1963


DEATH


(Month) (Day)


(Year)


4 I


HEREBY CERTIFY,


19 to.


19


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


19.


., death is said to


have occurred on the date stated above, at


7. 30 A


m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Presumably Coronary Occlusion


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


Hour


Due To


Natural Causes


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ? If so, specify


(Signed) John 7 Collina Vet M. D.


John F. CollinsMD forwatching


(PRINT OR TYPE SIGNATURE) 2) Bennington St Levere


14 Dac 10 63


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL 19


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


Received and filed


DEC 76 1963


19


(Registrar)


8 SEX


F ... 19


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED -2017


10a If married, widowed, or divorced 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


AGE .....


.. Years.


3


.Months.


r) .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.


1.011


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


JU


18 BIRTHPLACE OF


+


FATHER (City) (State or country) Canada


19 MAIDEN NAME


OF MOTHER


Chausse


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


Canada


21


Informant


(Address)


U


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed , with me BEFORE the burial or transit permit was issued: karph 6 Vivianni (8) (Signature of Agent of Board of Health or other) Health officer December 16, 1963


(Official Designationy


(Date of Issue of Permit) TI


TIONS


TIFICATE


ing DEATH enter 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.


s contrib- h but not terminal ion given


pter 137, requires o print or cause or death on :ates, and Acts of es Physi- it or type signature.


-925686


ENSE


No.


2 FULL NAME


Traud


overturf


(a) Residence. No.


(Usual place of abode)


(If nonresident, give city or town and State) 60


PERSONAL AND STATISTICAL PARTICULARS


(write the word)


That I attended deceased from


- (b)


-301A 1


PARENTS


(Address)-


+


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 GLOG3, IM 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.


M R-302


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.) . at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased THIS IS A PERMANENT RECORD


PLACE OF DEATH


Middlesex (County)


Stoneham


(City or Town)


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


Stoneham


(City or Town making this return) 258


Registered No.


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


2 FULL NAME


James Ruggiero


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


113Revere


S


(If nonresident, give city or town and State)


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


8


days. In place of residence.


15


2years


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


December 15, 1963


DEATH


(Month)


(Day)


(Year)


I HEREBY CERTIFY


,63


to ..


12/15


19.63


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


12/15


12.63


death is said to


have occurred on the date stated above, at


12:30p.


คิว.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Pneumonitis, myocarditis


INTERVAL


BETWEEN


ONSET AND


DEATH


(a)


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis ?


X-ray - EKG


5 Was disease or injury in any way related to occupation of deceased3Q .. If so, specify


(Signed)


John Verdone, M.D.


M. D.


(Address)


Medford,Mas ;.


Date ...


12/17


1963


6 Holy Cross Cem. Malden


Place of Burial or Cremation


December 18,


1,63


7 NAME OF


FUNERAL DIRECTOR


Anthony P. Rapino


ADDRESS


9


Chelsea St., 2. Boston, Ma.s.


Received and filed DEC .2.3 1963 19


(Registrar of City or Town where deceased resided)


8 SEX


nale


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


married


11 If married, widowed, or divorced


Josephine Antonelli


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


64


AGE


Years.


Months ............ Days


If under 24 hours


Hours ......


.. Minutes


13 Usual


Furniture dealer


Occupation :


(Kind of work done during most working life)


14 Industry


Self employed


or Business :


15 Social Security No.


15-20-0333


16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF


FATHER


Nicholas Ruggiero


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Maria Clericuzio


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Italy


Josephine Ruggiero (wife)


21 Informant


(Address)


113 Revere St., Winthrop, Mas.


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


December 18,


.19.63


-


TV-


1


No


New Eng. San. & Hosp.


(Was deceased a


U. S. War Veteran,


no


{ if so specify WAR,


Winthrop


(a) Residence. No.


(Usual place of abode)


'That I attended deceased, from


50M - 10-61.931673


(City or Town)


DATE OF BURIAL


Boston


PERSONAL AND STATISTICAL PARTICULARS


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


TOR


ORGANIZATION AND OUTFIT


SERVICE NUMBER


11. 7


6


NTHR


DEC 2 31963 PM


M R-301


-


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No


143 Court Road


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


(City or Town making this return)


Registered No.


259


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


2 FULL NAME


Heather lizabeth (Kitson) Thomas


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


(a)


Residence. No ......


723 Court 2020.


........


(Usual place of abode)


Length of stay: In place of death ..... Syears .......... months ........


days. In place of residency ...... years. ........ months .......... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


widowed


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


Edward Armstrong Thomas


82


12


AGE.84Years ... 2.


.Months .... 2.0Days


If under 24 hours


Hours ......


Minutes


13 Usual


Occupation :


housewife


(Kind of work done during most working life)


14 Industry


or Business :


own .... home


15 Social Security No ...


22-10-0619


16 BIRTHPLACE (City)


(State or country )


Massachusetts


17 NAME OF


FATHER


John Kitson


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Elizabeth Patton


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


England


21 Informant


Barbara .. E. Thomas


143 Court Road , Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death Man Gled with me BEFORE the burial or transit permit was issued: Kaipto do. Sivann (8)


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


December 18 1963


(Official Designation) &


(Date of Issue of Permit)


A TRUE COPY ATTEST:


32382


TYPE CAUSES ATH 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


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


If so, specify


Polar 7. Celuia Suto


M. D.


(Signature)


7. ConTing. i.D.


(Print or Type Name)


(Address)


......


27 Tonnington It. Date


Tbc.


7/13 7962


AT ,


Winthrop Cemetery, Winthrop, Mass 6


Place of Burial or Cremation


(City or Towrt)


DATE OF BURIAL December 18, 1963


19.


( Address)


7 NAME OF


FUNERAL DIRECTOR


alfred B. March


ADDRESS


174 Winthrop St Winthrop


Received and filed


DEC 18 1963


19


( Registrar )||


PHYSICIAN - IMPORTANT


-


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


N.O.


St.


Linthrop


hagenhy etts.


(If nonresident, give city or town and State)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


December 15, 7063


DEATH


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY , That I attended deceased from


19


to.


19


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


19


death is said to


have occurred on the date stated above, at


5:45 pm ..


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Coron= Occlusion


Due To


Natural cances


(b)


Due To -...


mal for the "introp


fare of grith


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis? olininal findings.


INTERVAL


BETWEEN


ONSET AND


DEATH


1 hr.


(Husband's name in full)


(or) WIFE of.


Boston


burial permit of Health gent. TIONS !


RTIFICATE


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT.


SERVICE NUMBER


1


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.


2.


ERIK


6


IT


DEC 1 81963 AM


1


PLACE OF DEATH


Suffolk


(County)


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


WINTHROP


(City or Town making this return)


Registered No.


260


[(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.) 224 Court Rd


St


Winthrop


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


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Marked


11 If married, widowed, or divorced HUSBAND of Charles Jordan


(or) WIFE of


(Husband's name in full)


AG


11


Months.


10


.Days


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation


(Kind of work done during most of working life)


14 Industry


or Business.


at Home


15 Social Security No ... Boston


16 BIRTHPLACE (City) ..


(State or country )


Masa


17 NAME OF


FATHER


Louis Vincent


18 BIRTHPLACE OF


FATHER (City) ..


(State or country)


Boston


Mass


19 MAIDEN NAME


OF MOTHER


Lignes Kelly


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


Preston


Maso


21 Informant ..


agnes Dooley.


(Address)


224 Court Rd Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was, filed with me BEFORE the burial or transit permit was issued: Dupl /6 Vivianne (3)


(Signature of Agent of Board of Health or other)


Health officer


December, 8 1963


(Official Designation)


(Date of Issue of Permit)


TRE.V.


A TRUE COPY ATTEST:


(Day)


(Year)


4 IHEREBY CERTIFY, That I attended deceased from


Dec. 13,19 63


19.


63


to.


Dec. 16.


I last saw helalive on


Dec. 16


19.6.3, death is said to


have occurred on the date stated above, at .....


19:35 D.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Metastatic Carcinoma


6 mos


Due To


Frimay carcinom of Forel


(b)


3 gms


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


none


Was autopsy performed?


20


What test confirmed diagnosis ?


Pa 2010ar Specimen


5 Was disease or injury in any way related to occupation of deceased ? .. ]20 If so, specify A


(Signature)


Prin 7. Collins neto


M. D.


......


John T. Collins,'D


(Print or Type Name)


(Address)


27 Farmington St.


.Date .. Dec. 778 63


6


l'lace of Burial of Cremation


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Ernest Playqueño


ADDRESS


147 Winthrop at Winthrop


Received and filed


DEC 18-1963


19


(Registrar)|


934553


M R-301


· burial permit I 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, e rise to se (a), e under- se last.


ns contrib- th but not e terminal ition given


Winthrop (City or Town) 224 Court Rdl No. Marie O Jordan


(Vincent)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


No


(a) Residence. No. (Usual place of abode)


2


3 DATE OF


DEATH


December 15, 1963


(Month)


INTERVAL BETWEEN ONSET AND DEATH


(Give maiden name of wife in full)


12


71


Years.


Estouscurte


PARENTS


Scituate Musa


Dec 19


1963


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


*


::


.. 5


NTHROP


RULES OF PRACTICE DEC 1 81963 AM


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.


10:


T


LERKŲ


M R-301


burial permit of Health gent. IONS


TIFICATE


TYPE CAUSES TH nter n one each and (c)


not mean of dying, t failure, It means compli- À caused


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


s contrib- h but not terminal ion given


934553


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Mali


9 COLOR


Itute


-2


10 SINGLE


(write the word)


MARRIED


WIDOWED


DIVORCED


UNKNOWN Widowed


11 If married, widowed, of divorced


HUSBAND of


Jackie? Jennings


(Give maiden name of wife in fully


(or) WIFE of.


(Husband's name in full)


12


AGE


. Years 2


Months: 29


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation


(Kind of work done during most of working life)


14 Industry or Business.




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