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