USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 6
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ditions contrib. death but not o the terminal condition given
PLACE OF DEATH
X Suffolk (County)
3-7-63
LIBERTATE
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
(City or Town making this return)
STANDARD
CERTIFICATE OF DEATH
Registered No.
25
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
James D . Hoy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
(Usual place of abode)
1
Length of stay: In place of death years 6 months
days. In place of residence ......... .years .......... months .. .... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED
EMARRIed
HUSBAND of
MARC ARet New Hook
(Give maiden name of wife in full)
12 (or) WIFE of. 76 AGE/ INTERVAL BETWEEN ONSET AND DEATH 2/6/69 Years .. Months .. .. . Days
(Husband's name in full)
If under 24 hours
Hours ........ Minutes
13 Usual
CustodiÁN
Occupation
(Kind of work done during most of iworking life)
14 Industry or Busine U.S. Postal Service
Ret.
15 Social Security No.
16 BIRTHPLACE (City) (State or country) BOSTONMASS
17 NAME OF FATHER DANIEL Hoy
18 BIRTHPLACE OF FATHER (City) (State or country)
LYNN
MASS.
19 MAIDEN NAME
OF MOTHER
ANNie Kennedy
20 BIRTHPLACE OF MOTHER (City) ... (State or country)
Boston MASS
MARGARET HOY
(Adres 16 Lexington Ave, E, Bostony
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other) Wraith Officer 3/4/63
......
62-933404
A TRUE COPY ATTEST:
(Registrar)|| (Official Designation)
(Date of Issue of Permit)
X
(Month) (Dây)
4 IHEREBY CERTIFY
May 20, 19 62
to
Feb- 71
That I attended deceased from
I last saw himalive on
Jan
26
..... 19 69 death is said to
have occurred on the date stated above, at
€.15pm
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Coronary Thrombosis
(a)
Due TeGeneralmed Arteriosclerosis
(b)
Due To
Hipertensión
(c)
OTHER SIGNIFICANT CONDITIONS
Diabetes Mellitus
Was autopsy performed? What test confirmed diagnosis ? Cemal Eran
5 Was disease or injury in any way related to occupation of deceased ? 221 If so, specify
(Signature) Louis Ssalyfta M. D. LOUISE SCHROFFA
(Address
Holy Cross MALden
Place in Burial or Cremation
(City or Town)
DATE OF BURIAL
Feb 9
63
7 NAME OF
Frederick JIMAGRATH
ADDRESS East Boston
Received and filed
FEB 8 1963
19
male
St
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
No.
JO LexINGtory St Ave
E. Boston
(City or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF DEATH feb 6 1963 (Year)
1963
10 um
10 you
Name) 19 Bennington ST. 1(Primer ET) 2-7 19 63
PARENTS
1
Winthrop (City or Town)
Mounts Convalescent Home N
2 FULL NAME
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE FEB -81963 FM
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) Medieal 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.
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 se, 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
2-932382
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
Female white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word) widowed
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of ....
Joseph Tecovvero
(Give maiden name of wife in full)
(Husband's name in full)
12
84
3
13
Months.
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most working life)
14 Industry
or Business:
at Home
15 Social Security No ....
16 BIRTHPLACE (City)
(State or country}
Italy
17 NAME OF
FATHER
nicholas Buscale
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria Lucchese
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Italy
Mrs Mancy De Giacomo
21 Informant ( Address) 47 Wilshire St 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. firianne
...... ....
ASignature of Agent of Board of Health or other)
Devitt officer
7. 1. 12. 1963
(Registrar) | (Official Designation)
(Date of Issue of Permit)
1 X
3 DATE OF
DEATH
(Month)
(Day)
10
19623
(Year)
4 IHEREBY CERTIFY , That I attended deceased from
19 4.2
19 64
I last saw h ..... lalive on
Feb
196 3, death is said to
have occurred on the date stated above, at
9:5-5pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Carcinomaturis
(b)
Due To (c)
OTHER
Chronic Valvular
CONDITIONS
heart disease
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify)
(Signature)
M. D.
Joseph GREGORIE
(Print or Type Name)
(Address) Holy Cross 6 I'lace of furial or Cremation
Malden Mass
(City or Town)
DATE OF BURIAL
Feb 13
,63
7 NAME OF
FUNERAL DIRECTOR
Ernest Plaggique
147 Winthro/ St Winthrop
ADDRESS
Received and filed
FEB 12 1963
19
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)
1
PLACE OF DEATH
County) Winthrop
(City or Town)
Mayflower Leat Home Nursing Maria Tesorero (Curiale)
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.) 48 Wilshire St
(a) Residence. No ..
(Usual place of abode)
3
.days. In place of residence. 13
St
(If nonresident, give city or town and State)
.. years .......... months .......... days.
26
Registered No.
[(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)
no
Length of stay: In place of death .......... years .......... months.
MEDICAL CERTIFICATE OF DEATH
to.
1.2b
10
INTERVAL
BETWEEN
ONSET AND
DEATH
monsieur
AGFO 7 Years
Due To areimeine of liver
110
PARENTS
16
Y Suffolk
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 medicali 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)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATHOME
To be filed for burial permit with Board of Health or its Agent.
27
MOUNTS REST HOME CONVALESCENT. No ADELAIDE E COLEMAN 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
69 JOHNSON AVE St
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years .. months. 14 days. In place of residence 3 years. months ......... ... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
FEMALE WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
SINGLE
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.
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :
CLERIT.
(RETIRED)
(Kind of work done during most of working life)
14 Industry
or Business:
MACHINERY MFG,
15 Social Security No ....
010-03-8534
16 BIRTHPLACE (City) (State or country) MASS
AMHERST
OTHER
SIGNIFICANT
CONDITIONS
Diabetes Mellitus
10 yrs.
Was autopsy performed?
No
What test confirmed diagnosis?
Clinical
No
(Signed)
Charles Liberman
M. D.
(Address) Winthrop, mass Date 2/12/1962
GUT BRIDGETS
ANTERST MASS
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
FEB 14
943
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS WINTHROP
Received and filed.
FEB 13-1963
19
(Registrar)
PARENTS
17 NAME OF
FATHER
MATHEW COLEMAN
18 BIRTHPLACE OF
FATHER (City).
IRELAND
(State or country)
19 MAIDEN NAME
OF MOTHER
ANNE GLEASON
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
IRELAND
21 AUGUSTINE CAMPONOVO
Informant
(Address)
CY JOHNSON AVE WINTHROP
1 HIEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Purple to Seriana 131 (Signature of Agent of Board of Health or other)
Health officeri
Feb 13,1963
(Official Designation)
(Date of Issue of Permit)
1
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Feb
(Month)
(Day)
12
1963
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Nov. 4,
1962, 0
February 12, 1963
I last saw h.CY .. alive on
Feb
11
19.63, death is said to
have occurred on the date stated ahove, at
6:45 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Arteriosclerosis cerebral
Due To Arteriosclerosis generalized
(h) ...
5yrs
Due To (c)
100M.11.55.916145
-301A 1
TIONS R ERTIFICATE
ving · DEATH enter an one r each and (c)
s not mean of dying, rt failure, . It means or compli- ch caused
, if any, e rise to 15€ (a), e under- se last. -
ns contrib. th but not he terminal lition given
hapter 137, 4, requires to print or cause death on ficates. C
Registered No.
or ir
give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(a) Residence. No .. (Usual place of abode)
INTERVAL 12 BETWEEN ONSET AND DEATH 400ks. AGE 91 Years. .Months ........... .Days
-
5 Was disease or injury in any way related to occupation of deceased ?.. If so, specify ...... CHARLES LIBERMAN
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
T
A physician or registered hospital medical officer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of deathy stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician. or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the, preceding section or by section forty-five of chapter one hundred and four- te n, shall. if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifyingct herwar. and Ohnery or burial ground in which the interment is made.
shall also certify in such certificate both the primary and the secondary of imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall. for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, ~that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General "Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried nos the funeral is to be held, or from a person appointed to have the care of the
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians 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 occupation. the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
.....
ORM R-301
for burial permit ard of Health ts Agent. RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH not enter : than one e for each (b) and (c)
laes nat mean de of dying, heart failure, etc. It means se, or campli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditians contrib- death but nat o the terminal canditian given C .
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
19 CORAL
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH Ave
Registered No.
28
S(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
(a)
Residence. No.
(Usual place of abode)
Length of stay: In place of death.
.. years .......... months .......... days. In place of residence.
.. years.
... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Feb
15.
1963
(Month)
(Day)
(Year)
4 I HEREBY 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
1: 25 pm.
INTERVAL BETWEEN ONSET AND DEATH
(a) Death occurred of 4:25 AM
(b)
Due
Of Feb. 15, 1965. Death apparently
Due
(c)
Todue to natural causes, presumably
acute coronary occlusion basert
SIGNIFICANTON history and medical record
OTHER
CONDITIONS
Winthrop Board of Health.
Was autopsy
What test confirmed diagnosis darles Lebenau hin
5 Was disease or injury in any way related to occupation of deceased ? Mfc. If so, specify ...
(Signature) Cluster Lete way M. D. CHARLES LIBERMAN (Print or Type Name) (Address) WINTHROP, MASS Date 2/15/1963
6 MONTIFIORE SOC,
EVERETT
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
TORF funeral Service
ADDRESS 151 Washingtonrtve Chelsea
Received and filed FEB 18 1963 19.
(Registrar ) ||
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCEDMARRIED
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
SARAH
GOLDMAN
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
AGES 2 Years
Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
CLERKS
(Kind of work done during most working life)
14 Industry
or Business :
RETAIL FOODS
15 Social Security No 034-03-8103
16 BIRTHPLACE (City)
(State or country )
MALDEN MASS
17 NAME OF
FATHER
DAVID MILLER
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
19 MAIDEN NAME
OF MOTHER
BESSIE MILLER, OR)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21 Informant
SARAH MILLER
(Address)
19 CORAL Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
&Signature of Agent of Board of Health or other)
Health Efecin
til-15 1163
(Official Designation)
(Date of Issue of Permit)
TV
I
No
JACOB
MILLER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 CORAL
Ave
St.
(If nonresident, give city or town and State)
8
(City or Town making this return)
2 FULL NAME
62-932382
11
firiania (2)
.....
FEB
17
1963
(write the word)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE FEB 1. 81263 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.
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