USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1939 > Part 106
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5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Singlo
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
If less than 1 day
Hours
Minutes
11 Total time (years)
spent in this
occupation.
Relation, i (
(Registrar of city or town where death occurred)
DATE FILED 19
Vary L Cawthorno
St., .........
........
Ward
(If U. S. War Veteran,
WAR)
(If nonresident, give city or town and state)
yrs.
mos.
Dec 6/39
WE.CEIVL
OF 10!
1
12
1
5
5
8
1
6
HROP MASS
FEB-51940 AM
M R-302
1 3 SEX F (or) WIFE of 7 56 AGE 12 BIRTHPLACE (City) (State or country) 14 BIRTHPLACE OF FATHER (City) PARENTS 17 A TRUE COPY. ATTEST: tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very OCCUPATION important. 50m-11-'36. No. 9080-g N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- (State or country)
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
269
(City or town making return)
Registered No
10742
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
-
(If U. S.
War Veteran,
specify WAR)
2 FULL NAME
Flora Mabel Gilpatrick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
(Usual place of abode)
9141 Shirley
St.,
........
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days .
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December 19 1939.
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give ma
Jothar F Gifpatrick
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
Years Months Days
If lass than 1 day Hours . Minutes
8 Trade, profession, or particular
kind of work done, as spinner,
sawyer, bookkeeper, etc ...
At Home
9 Industry or business In which
work was dona, as silk mill,
saw mill, bank, etc.
Housewife
10 Date deceased last worked at
11 Total time (years)
this occupation (month and
spent in this
12/39
occupation
year).
25
Waltham
Mass.
13 NAME OF
FATHER
Charles F. Chase
Bridgeton,
Maine
15 MAIDEN NAME
OF MOTHER
Mary E. Lemp
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
Relation, if any
Informant
( Address)
9142 Shirley St. Winthrop
(Registrar of city or town where death occurred)
DATE FILED 19
19 I HEREBY CERTIFY, That I attendad deceased from
We
12/9
19.3.9, to
12/19
19.3.9
I Tast saw h.e.K ..... alive on
12/19
19.3.9 .. , death is said
to have occurred on tha data stated above, at. 5:28 m. P.M.
Tha principal cause of death and related causas of importance in order of onset were as follows:
Dateofonset
Carcinoma of bladder
Broncho pneumonia
(b11)
Mo.s.
ds
Contributory causes of importance not related to principal cause:
Supra pubic cystotomy with Nama of operationpart. exc. of carcinate of 12/13/39 What test confirmed diagnosis? Was there an autopsy ?..... e.8
20 Was diseasa or injury in any way related to occupation of deceased? If so, specify.
(Signed)
W. B. Osgood
M. D.
(Address)
Peter B. Brigham H Data 12/20939
21
Mt. Feake
Waltham
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Dec. 22, 1939.
19
22 NAME OF
UNDERTAKER
R. C. Kirby
ADDRESS
East Boston
Received and filed
Dec. 26, 1939.
19
(Registrar of City or Town where deceased resided)
4 COLOR OR RACE
W
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
e of wife in full)
(City or Town)
No.
Peter Bent Brigham Hosp. St.,
.....
..... .Ward
Husband
MI TO
7
S
6
B-31940 MM
R-302
1 No. 3 SEX M (or) WIFE of 7 AGE 63 OCCUPATION (State or country) 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 17 ( Address) A TRUE COPY. important. tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very 50m-11-'36. No. 9080-g A. D. WERIC FLAIRLT, WITH UNTADING INATITIDD DD A PERMANENT RECORD. Every Item of informa- (State or country)
PLACE OF DEATH
(County) Boston
(City or Town)
Mass. General Hosp.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
ROE
(City or town making return)
Registered No.
10948
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
John W. Pepper
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
137 Loring Road
.St., ..
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days. How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
(Month)
(Day)
(Year)
19 I HEREBY
CERTIFY, That ] attended deceesed from
12/28/39
19
12/10/39
19.
... to ..
I last saw
1m
alive on
12/28/39
19.
death Is said
9:40 m. A. M.
to have occurred on the date stated above, at. The principal cause of death and related causes of Importence in order of onset were es follows:
Dateofonset
Pulmonary infarction
3 .... wks.
Contributory causes of importance not related to principal cause:
Pulmonaryembolism
10.
.. min ..
Name of operation
Date of
What test confirmed diagnosis?
Was there an autopsy?Y.e.s
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
N. C. Baker
M. D.
(Address)
Ass t. Director Data 2/28 19 39
21
Woodlawn-Everett
Place of Burial, Cremation or Removal.
(City or Town)
Relation, if any
DATE OF BURIAL
Dec. 30, 1939
19
22 NAME OF
A. E. Long & Son, Inc.
UNDERTAKER
ADDRESS
1979 Mass. Ave., Cambridge.
Received and filed
Jan. 2, 1940.
19
(Registrar of City or Town where deceased resided)
Informant
Raymond T. Sewall (None
232 Bay State Rd.
Boston
ATTEST:
James Q. Burke
(Registrar of city or town where death occurred)
DATE FILED .19.
(write the word)
18 DATE OF
DEATH
December 28, 1939.
5a If married, widowed, or divorced HUSBAND of
Alma G. Forristall
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
4
Years
Months 25
Days
If less than 1 day
Hours
.Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Factory Manager
9 Industry or business In which
work was done, as silk mill,
saw mill, bank, etc ..
Franklin Calk Co.
10 Date deceesed last worked at
this occupation (month and
year)
1929
11 Total time (years)
spent in this
occupation
25
12 BIRTHPLACE (City)
Chelsea
Mass,
Pepper
16 MAIDEN NAME
OF MOTHER
Sarah W.
St.,
Ward
(If U. S.
War Veteran,
specify WAR)
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
TO
198
5
6
MASS
HROP
FEB-51940 AN
R-302
1
PLACE OF DEATH
Middlesex
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lexington (City or town making return)
Registered No.
111
(If death occurred in a hospital or institution, S
St. (
give its NAME instead of street and number)
2 FULL NAME
Peter Barclay
(If deceased is a married, widowed or divorced woman, give also maiden name.)
170 Pauline
St.
Winthrop, Mass.
(a) Residence. No ....
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
5
29
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE 5 SINGLE
White
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
59
Years ..
11
Months .. 4 ...
... Days
If less than 1 day
Hours.
Minutes
Usual
Painter
9 Occupation:
Industry
Last worked: About 1928
10 or Business:
......
11 Social Security No ..... Boston
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Peter Barclay
14 BIRTHPLACE OF
Cannot learn
PARENTS
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Margaret Trotter
16 BIRTHPLACE OF
Cannot learn
MOTHER (City)
(State or country)
Scotland
"Metropolitan State Hosp. Records) Informat (Address) Waltham, Massachusetts
A TRUE COPY.
James. I Carroll.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED Dec. 26,
19
39
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
December 24, 1939
(Month)
(Day)
(Year)
19
LHEREBY CERTIFY.
October 14.
1958
.. ,
That I attended deceased from
to.
December 24.
,19. 39
I last saw h .. im
alive on.
December 24, 39
death is said
to have occurred on the date stated above, at
7:16 P
m.
Duration
Immediate cause of death ....
Cirrhosis of Liver
10 yr's
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Of autopsy
yes
Clinico-path@stically.
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify
(Signed)
Emeridf Friedman
M. D.
(Address)Met. State Hosp .... Date12/24639
21 PLACE OF BURIAL, aftham
CREMATION OR REMOVALWinthrop ..
(Cemetery) lass
Com.
Winthrop
DATE OF BURIAL
12/27/189
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
170 Winthrop St .Winthrop Mass
Received and filed
19
(Registrar of City or Town where deccased resided)
50m-10-'39. No. 8427-f
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Lexington Medical and Surgical Bldg. M&S] No .... Metropolitan ... State .... Hospital
(If U. S.
War Veteran,
268
specify WAR)
(If nonresident, give city or town and state)
years
Relation, if any
(Chy or Town)
Underline the cause to which death should be charged sta-
What test confirmed diagnosis?
.Logical
no
RECEIVED
OFFICE
LUM
GLERK
-5
IP MASS
MAY201940 Ml
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