USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 27
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22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop
Received and filed
APP . .. 1943
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
2 FULL NAME
(Usual place of abode)
3 SEX
4 COLOR OR RACE!
Female
White
5a If married, widowed, or divorced
HUSBAND of
7 IF STILLBORN, enter that fact here.
8
62
AGE
Years.
3
Months
11
Days
9 Occupation :
10 or Business :
11 Social Security No.
.No
12 BIRTHPLACE (City)
East Boston
14 BIRTHPLACE OF
FATHER (City)
Lonsdale
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Chatham
(State or country)
Mass.
17
Helen Irene Jones
Informant
( Address)
Winthrop
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should he made forthwith and transmitted on Form R-302 to the clerk
copies of returns or acatns recorded during the previous month which occurred in your city or town in case the deceased
( State or country)
Mass .
5 SINGLE
(write the word)
MARRIED Widow
WIDOWED
or DIVORCED
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve years
If less than 1 day
Hours
Minutes
Usuai
Clerk in Tax Collector's off ..
Industry
Town of Winthrop
13 NAME OF
FATHER
Samuel Augusta Snow
( State or country)
Rhode Island
15 MAIDEN NAME
OF MOTHER
Lucy Emma Jones
Relation, if any Sister
A TRUE COPY.
8. Tay
ATTEST :
(Registrar of city or town where deatk occurred)
DATE FILED
March 15
19
45
Underline the cause to which death should be
deoeased
from
(If U. S.
War Veteran,
speolfy WAR)
-
Hospital
-
IM R-302
Suffolk
PLACE OF DEATH
(County)
1
BONton
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return) 2730'1 ....
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Albert Winerip
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20 Lewis St
St.
Winthrop Mass
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
4
days.
(If nonresident, give city or town and state)
In this community __ yrs.
.sסות
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4 COLOR OR RACE' 5 SINGLE
White
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
(Month)
(Day)
(Year)
.. ,
19 | HEREBY CERTIFY.
3/14/43
19
That I attended deceased from
to ..
3/10/43
19
I last saw b .... ].m.alive on.
3/10/13, 19
death is said
to have occurred on the date stated above, at ....
3:14Pm.
Duration
Immediate cause of death ..
Bronchopneumonia
3 GS
Due to? Cerebral accident
4 ays
Industry
10 or Business:
Boston American
11 Social Security No ..
011-01-9381
12 BIRTHPLACE (City)
(State or country)
Poland
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?..
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify
(Signed)
$ Stearns
M. D.
(Address)
Boston
Date
3/12/43
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Beth Israel
Everett
DATE OF BURIAL
Mar 19, 1943
19
22 NAME OF
FUNERAL DIRECTOR
J H Levine
ADDRESS
Boston Mass
Received and filed
19
(Registrar of City or Town where deceased resided)
SOmi-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
15 MAIDEN NAME
OF MOTHER
18 BIRTHPLACE OF
MOTHER (City)
(State or country) Poland
17
Informant
(Address)
(.
Relation, if any
wile
A TRUE COPY.
Pr. Francis J. Tay.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Mar 22 1943
19
18 DATE OF
DEATH
Mar 18, 1943
5a If married, widowed, or divorcedSadie Paskowitz HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Aga of husband or wife if alive.
55Years
7 IF STILLBORN, enter that fact here.
8
AGE 5.6
Years
Months.
Days
If less than 1 day
Hours.
Minutes
unemia
2 ... dys
Usual
9 Occupation:
Newspaperman
Due to
Generalized arteriosclerosis
13 NAME OF
FATHER
Pinkus Winerip
Underline the cause to which death should be charged sta- tistically.
Date of.
(Cemetery)
(City or Town)
No. Beth ... Israel ... Hospital
.............
Registered No
C .. 1943
(If U. S.
War Veteran,
specify WAR)
سعد
كل ساس
ا
M R-305
No.
2 FULL NAME
3 SEX
Male
(or) WIFE of
AGE
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
PARENTS.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
25m-10-'39. No. 8427-g
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible
(State or country)
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
x
married
5a If married, widowed, or divorced
HUSBAND of
agath Denisi
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive .Years
7 IF STILLBORN, enter that fact here.
8
65
Years
Months.
Days
If less than I day
Hours ..
Minutes
Cafe
13 NAME OF
FATHER
Lowi tavoli
15 MAIDEN NAME
OF MOTHER
Unknown
17 Loni avoti
Relation, if any Jan
East Boston
A TRUE COPY.
Edward Allowed
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
april 5.
19 43.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH. March 19
(Month)
(Day)/
(Y'ear)
19 | 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.) Probable Coronary Luccasi
20 Accident, suicide, or homicide (specify)
Date of occurrence. 19
Where did Injury occur?
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place ?
Manner of Injury
Nature of Injury
While at work?
.Was there an autopsy?
2| Was elseaso or lojury in any way related to occupaticu of deceased ? no
If so, specify
of pa
(Signod)
Murphy
. M. D.
(Address) .. Peabody mariangel
Date 3/10
19 43
22 Winthrop Cem
Place of Burial, Cremation or Removal.
DATE OF BURIAL March VV
19 4
23 NAME OF
FUNERAL DIRECTOR
V. m. Cahill
ADDRESS
Verbally marc.
Received and filed 19
1913
(Registrar of City or Town where deceased resided)
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
PLACE OF DEATH
Escex
(County) Peabody
(City or Town)
350
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Jeabody (City or town making return)
Registered No
{ (If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
(If deceased is a married widowed or divorced woman, give also maiden name.)
215
Pleasant
.....
St.
months
days.
(If nonresident, give city/or town and state)
In this community 3 7yrs.
mos.
days.
(Specify whether)
years
Neuburg Paten I tavoli
(If U. S. War Veteran, specify/WAR) Winthrop
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
1943
PERSONAL AND STATISTICAL PARTICULARS
Italy
-taly
Informant
(Address)
-italy
(Specify type of place)
Winthrop (City or Town)
X
1 R-302
Copies OFreturns or nedins winch occurred in your city or town in case the deceased resided in another city or town at the time
after the elose of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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
50ml-10-'39. No. 8427-f
Suffolk
PLACE OF DEATH
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
No ..
Peter Bent Brigham Hospital
.St.
give its NAME instead of street and number)
2 FULL NAME
James A Herbert W/
(If deceased is a married, widowed or divorced woman, give also maiden name.)
204 Cottage Rd
St.
Winthrop
Mass
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
2days.
In this community 35yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE 5 SINGLE
White
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced Bernice F Burns HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
30
years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
ÄGE.
35
Years
.Months.
.. Days
If less than I day
Hours.
Minules
Usual
9 Occupalion:
Lawyer
Industry
10 or Business:
Law
11 Social Security No.
PARENTS
14 BIRTHPLACE OF FATHER (City)
(State or country)
E Boston Mass
15 MAIDEN NAME
OF MOTHER
Nellie Brickley
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Charlestown Mass
17 Informant (Address)
Relation, if any
.. ( .... wife
A TRUE COPY.
ATTEST:
Francis J. Tay
(Registrar of city or towe where death occurred)
DATE FILED Mar 24, 1943
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Mar 20, 1943
(Month)
(Year)
19 I HEREBY CERTIFY.
2/21/43
19
3/20/13
19
., to .......
I last saw h ... i.m ... alive
3/20/43, 19, death is said
to have occurred on the date stated above, at .. 3 ... 20.p .. m.
Duration
Immediate cause of death.
Lymphoma Hodgkins type
2 yrs
generalized
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
...
Of autopsy
..
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
H W Benjamin
M. D.
(Address) ..
Boston
Dat
3/20/43
21 PLACE OF BURIAL.
CREMATION OR REMOVAL ...... Winthrop Cem
DATE OF BURIAL
Mar 23/43
(Cemetery)Winthroitysay)
19
22 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop MEss
Received and filed.
19
(Registrar of City or Town where deceased resided)
Registered No
2831
S
(If death occurred in a hospital or institution,
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and state)
(Day)
That I attended deceased from
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
John W Herbert
Underline the cause to which death
Date of.
should be charged sta- tistically.
1
M R-302
Suffolk
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)y 74
Registered No
2935
-
No. Mass General Hospital
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
Owen G Evans
(If deceased is a married, widowed or divorced woman, give also maiden name.)
84 Faunbar Ave
St.
Winthrop Mess.
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
7
days.
In this community 9 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Male
4 COLOR OR RACE 5 SINGLE
MARRIED
White
WIDOWED
or DIVORCED
(write the word)
Widowed
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
3/15/43
19
That I attended deceased from
....
3/22/45, 19
.....
to ...
I last saw h
im alive on.
3/22/43
19 ........ ,
death is said
to have occurred on the date stated above, at 3:540
m.
Duration
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8
88
6
Months
12Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Agent (retired)
Industry
Life insurance
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Boston Mass
Other conditions Emboli sm Pulmonary
(Include pregnancy within 3 months of death)
Tempnyema Right
4 dys
hrs
PHYSICIAN
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify.
(Signed)
T A Devan
. M. D.
(Address)
Boston
Date.
3/2319 43
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Cem
DATE OF BURI
3/26/43
(Cemetery Winthrop Mas)
22 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS
Winthrop Mass
Received and filed. 19
(Registrar of City or Town where deceased resided)
-
50ml-10-'39. No. 8427-f
PARENTS
15 MAIDEN NAME
OF MOTHER
Mary Sullivan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Julia Sullivan
Relation, if any
cousin
Informant.
(Address)
El Faun Bar Ave, Winthrop
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Mar 26, 1943
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Mar 22, 1943
5a lf married, widowed, or divorced HUSBAND of
Mary Cunningham
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Immediate cause of death ..
Broncho pneumonia
Bilateral
4 wks
Due to
Due to
13 NAME OF
FATHER
George K Evans
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
Underline the cause to which death should be charged sta- tistically.
19
.......
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, 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
PLACE OF DEATH
(If U. S.
War Veteran,
specify WAR)
(If nonresident, giye city or town and state)
AGE
Years.
عد مه
M R-302
Suffolkx
PLACE OF DEATH
(County)
Bonton
(City or Town)
No.
Boston City Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return) 75
Registered No. 3049
S
(If death occurred in a bospital or institution,
St. (
give its NAME instead of street and number)
2 FULL NAME
John R Mulrey
(If deceased is a married, widowed or divorced woman, give also maiden name.) 47 Ware Way
St.
(If U. S.
War Veteran,
specify WAR)
Winthrop Mass
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
years
months
3 days.
In this community
yrs.
mos.
3
ays.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Mar 26, 1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
3/23/43
19 ..
.... , to.
3/26/43 19
.......
I last saw h ............ alive on ..
19.
......
death is said
to have occurred on the date stated above, at.
12:058
Duration
Immediate cause of death.
Lobar pneumonia
dys
Due to
Cerebral thrombosis
dys
Due to
Other conditions
(Include pregnancy witbin 3 months of death)
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
M. W ..... O'Connell
M. D.
(Address).
Boston Mass
Date
3/26043.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.St. Joseph's Cem
(Cemetery )Boston (City or Town)
DATE OF BURIAL
3/29/43
19
22 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop .... Mas.s.
Received and filed
DO 1 1943
19
(Registrar of City or Town where deceased resided)
..
PHYSICIAN
Underline tbe cause to which death should be charged sta- tistically.
Albert Mulrey
Informant.
(Address)
49 Hermer St Winthrop
A TRUE COBY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Mar 30, 1943
19
50m-10-'39. No. 8427-f Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time PARENTS
3 SEX
Male
White
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE 50
Years
Months.
Days
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Boston Mass
14 BIRTHPLACE OF
FATHER (City)
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
17
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deccased resided as soon as possible
(State or country)
Boston Mass
4 COLOR OR RACE, 5 SINGLE
MARRIED
WIDOWED
(write the word)
or DIVORCED
Single
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than 1 day
Hours.
Minutes
Usual
9 Occupation:
Attorney at law
13 NAME OF
FATHER
John R Mulrey
15 MAIDEN NAME
OF MOTHER
Marie Kelley
Date of.
That I attended deceased from
(If nonresident, give city or town and state)
-
M R-302
Essex
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Richard Doherty
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
125 Cliff Avenue
St.
Winthrop,
r
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
25days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
single
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
8
AGE84
Years.
Months.
Days
If less than 1 day Hours .. .. Minutes
Usual
9 Occupation:
.Retired .... printer
Industry 10 or Business :
11 Social Security No Cannot be learned
12 BIRTHPLACE (City)
Boston
(State or country) Mass:
13 NAME OF
FATHER cannot be learned
14 BIRTHPLACE OF
FATHER (City) (State or country) cannot be learned
15 MAIDEN NAME
OF MOTHER cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country) cannot be learned
17 Mary K. McPhillips
Relation, if any
Informant (Address) Hathorne, Mass.
A TRUE COPY. ATTEST :
(Registrar of city or town where death occurred),
19
18 DATE OF
DEATH
March
28
1943
ceased
43
I last saw him ........ alive on March .... 28 ..... , 19 ..... 4, death Is sald to have occurred on the date stated above, at 5:35 a. m.
Immediate cause of death.
Bronchopneumonia
3 days
Chronic Myocarditis 14 yrs
portom Generalized arterioscl-
erosis
14 .... yrs.
Due to.
in
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be
charged sta-
Of autopsy
What test confirmed diagnosis ?..
clinical
20 Was disease or Injury In any way related to occupation of deceased?
If so, speolfy Abraham Gardner M. D.
(Signed)
(Add
Hathorne Mass.
Date.
4/2
... 19.
43
21 PLACE OF BURIAL,
winthrop, Cemetery
CREMATION OR REMOVAL
WinthropMass.
(City or Towp
DATE OF BURIAL
Marchego
1443
22 NAME OF
FUNERAL DIRECTOR
Kirby Brothers
ADDRESS
Winthrop, Mass.
Reoelved and filed .. April4.
19.43.
forma Giy
(Registrar of City of Town where deceased resided)
50m (e)-1-41-4667
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk . viuu uuring wir previous month which occurred in your city or town in case the deceased
1
PLACE OF DEATH
(County )
Danvers (City or Town) Danvers State Hospital, Hathorne, Mass
(If U. S.
War Veteran,
speolfy WAR)
IarcKREBY CER IS FY .
19
to
MarcHenders
19.
Duration
Underline the cause to which death
tistically.
PARENTS
DATE FILED
April 4
43
1 R-302
PLACE OF DEATH
(County)
Boatos
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No
31/1/1
No. Mass Eye & Ear Infirmary
1
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Charlotte.R.Downs
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Cliff House
St.
Winthrop Mass
Length of stay: In hospital or institution
(Specify whether)
years
months 11 days.
(If nonresident, give city or town and ftate)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE 5 SINGLE
MARRIED
White
WIDOWED
Or DIVORCEDVidowed
(write the word)
18 DATE OF
DEATH
Mar 29, 1943
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Abram ... P ...... Downs
(Husband's name in full)
to have occurred on the date stated above, at ..
8:300
Duration
Immediate cause of death. Acute hemorrhagic glaucoma
8
AGE
9.2 Years.
8
Months.6
Days
If less than 1 day
Hours.
Minutes
righteye
3 wks
Due to
Arteriosclerosis
10 yrs
Debility Senility
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
York Co Maine
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Mrs.I McNaughton
Relation, if any
friend
Informant.
(Address)
72 Harbor View Winthrop Mass
Tay
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurfed)
DATE FILED
April ....
1943
19
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (Sce Chap. 46, Sec. 12, G. L.) 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
50m-10-'39. No. 8427-f
PARENTS
Lebanon
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury In any way related te occupation of deceased ?
If so, specify
(Signed)
M .... J. King
(Address) ..... Bo.s.ton
Dat
3/29/193
.
M. D.
21 PLACE OF BURIAL.
CREMATION OR REMOVALVinthrop Cem Winthrop
(Cemetery)
(CityMaTsy)
DATE OF BURIAL
Apr 2, 1943
19
22 NAME OF
FUNERAL DIRECTOR
Ches R Bennison
ADDRESS
Withrop Mass
Received and filed.
1943
19
(Registrar of City or Town where deceased resided)
19 | HEREBY CERTIFY,
3/19/43
19.
3/29643
19 ......
to .....
That I attended deceased from
I last saw IR ......... alive on.
3/29/43
, 19 ........
death is said
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
years
Usual
9 Occupation:
Due to
Ether anesthesia
15 ... mihs
Underline the cause to which death should be charged sta- tistically.
Date of.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
170 Cliff Ave
Suffolk
M R-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
37 Shirley St
The Commontoralth of Massacinisetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agepty 78
S ( If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
William Dilling
( If deceased is a married, widowed or divorced
woman, give also maiden name.)
(a) Residence. No. .
37Shirley St
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Male
4 COLOR OR RACEJ
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced HUSBAND of
Helen Knox
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name In full)
55
years
> IF STILLBORN. enter that fact here.
8 AGE 5.8 Years - Months - Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Bookkeeper
Industry
Lumber Co.
10 or Business :
11 Social Security No.
025-05-7566
Aberdeen
12 BIRTHPLACE (City)
(State or country)
Scotland
13 NAME OF
FATHER
James Dilling
14 BIRTHPLACE OF
FATHER (Clty)
Aberdeen
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Margaret Cumming
16 BIRTHPLACE OF
MOTHER (City)
Stonywood
(State or country)
Scotland
17 Helen Dilling Ryilgolf any
Informant ( Address) 37 Shirley St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificats of death was filed with me BEFORE the burial or transit permit was Issued :
(Signature of Agent of Board of Health or other) Mealthe officet 4/3/43 Yo'mcial Designationy ( Date of Issue of Permit)
20 Was disease or injury in any way related to occupation of deceased ?.
If so, spoolfy
(Signed) Louis + Salerno
(Address) 175 Plecat 87
. M. D.
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