Town of Winthrop : Record of Deaths 1943, Part 74

Author: Winthrop (Mass.)
Publication date: 1943
Publisher:
Number of Pages: 594


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 74


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6. (a)Single, widowed, married


divorced


Widowed


that I last saw h.


alive on


19


and that death occurred on the date and hour stated above.


years


Immedlate cause of death


natural causes


7. Birth date of deceased


July


(Month)


(Day) (Year)


8. AGE:


Years 62


Months


Days


If less than one day


hr.


min


9. Birthplace


Provincetown


Mass


10. Usual occupation


Retired __ (Merchant)


11. Industry or business


Other conditions (Indude pregnancy within 3 months of death)


PHYSICIAN


12. Name


13. Birthplace (City. town, or county) (State or foreign country)


14. Maiden name


Of operations


15. Birthplace


(City. town, or county) (State or foreign country)


16. (a) Informant's own signature ... Ma88. Charles __ C.Gray(R .W.W.


22. If death was due to external causes, fill in the following:


17. (a) Burial


(b) Date thereof.


Aug .__ 8 ___ 1945| (a) Accident, suicide, or homicide (specify)


(Month), (Day) (Year)


(c) Place; burial xxwwwdixWinthrop Cen.,Winthrop, MEBDate of occurrence


(c) Where did injury occur?


(City or town) (County) (Stato)


(+) Did injury occur in or about home, on farm, in industrial place, in public place?


(Specify type of placo)


While at work? (e) Means of injury


123. Signature


Leon u. Orton


(M. D. or other) M.D.


(Date received- registraf)


Date signed


Aug. 5.


8-8217


U. S. GOVERNMENT PRINTING OFFICE 16-13463 OCT 27 1943


1943


Duration unknown


Due to


Due to


(State or foreign country)


MOTHER FATHER


Mejor findings:


Of autopsy one done


Underline the cause to which death should be charged sta- tistically.


18. (a) Signature of funeral director Richard W. Walton


Bristol


(b) Address


19. (a) Aug. 8.194)3


Myra -- K,EmmonA .;


Ashland, N.H.


Address


3. (b) If veteran,


name war


3. (c) Social Security No.


case


19


., to


19


6. (b) Name of husband or wife


6. (c) Age of husband or wife if


alive


4


1881


1


(b) Address. Winthrop,


(Burial, cremation, or removal)


(If outside city or town limits, write RURAL)


(c) Name of hospital or institution:


(If not in hospital or institution, write streot number or location)


RM R-302


Middlesex


The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Cambridge. (City or town making return)


214


(If death occurred in a hospital or institution, St.


give its NAME instead of street and number)


2 FULL NAME


Edwin Antunes


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


(a) Residence. No.


45 Read Street


St.


Winthrop


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


years


3


months


24ays.


In this community 30


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Aug 19


1945


(Month)


(Day)


(Year)


5a If married, widowed, or divoroed


HUSBAND of


Ethel.


... Vance


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive 50


years


7 IF STILLBORN, enter that fact here.


8


AGE.


5.6 Years.


Months.


Days


If less than 1 day


.Hours .......


Minutes


Usual


9 Occupation :


Printer


Industry 10 or Business :


11 Social Security No. 028-05-3214


12 BIRTHPLACE (City)


(State or country)


Portugal


13 NAME OF


Jessie Antunes


FATHER


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Portugal


(State or country)


Marie Antunes


15 MAIDEN NAME


OF MOTHER


16 BIRTHPLACE OF


MOTHER (City)


Portugal


(State or country)


Ethel Antunes


wi fo


17


Informant


45 Road .St.


( Address)


A TRUE COPY.


Aug 21, 1943


ATTEST :


(Registrar of city or town where death occurred)


DATE FILED


frederick At war


22 NAME OF


FUNERAL DIRECTOR


John F O Maley


ADDRESS


Winthrop Magg


Reoelved and filed.


001-1-1943


19


(Registrar of City or Town where deceased resided)


.....


of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resitled 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 of deaths recorded during the previous month which occurred in your city or town in case the deceased


1


PLACE OF DEATH


(County) Cambridge


(City or Town)


No. Holy Ghost Hoepital


........


3 SEX


4 COLOR OR RACE|


5 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


19 | HEREBY CERTIFY,


That I attended deceased from


Aug 1


1943 .... ,


toAng ..... 2.9


I last saw h ...... i.m ... alive on ..


Aug 18, 193, death Is said to


have occurred on the date stated above, at.8 ..... 26


... m.


Duration


Immediate cause of death .... Carcinoma ..... of .. Base of tongue


c metastas68


to neck


Sept


1942


Due to


Due to.


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of


Physician Underline the cause to which death should be charged sta- tistically.


Of autopsy What test confirmed dlagnosis?


20 Was disease or injury In any way related to oooupatlon of deqpeed ?.


If so, speolfy


(Signed) Georg.6 ......... Connor.


M. D.


(Address) 9.22MasTe ...


Date ..... 4.11 ..... 199 .... 4.3


21 PLACEion BE


CREMATION UR REMOVAEm. Winthrop.


Au (CemetTry) 1943


(City or Town)


DATE OF BURIAL


19


50m (e)-1-41-4667


Relation, if any


Registered No.


1.27


(If U. S.


War Veteran,


specify WAR)


M


ORM R-302


Suffolk


The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Chelsea


(City or town making return)


Registered No.


586


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


Francis J.Rogers


2 FULL NAME


(If deceased is a married, widowed or divorced


woman, give also maiden name.)


56 Sargent


(a) Residenoe. No.


(Usual place of abode)


hospital


7


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution


(Before death)


(Specify whether)


years


months


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


4 COLOR OR RACE!


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


5a If married, widowed, Jor divorcedS . Sullivan


HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


6 Age of husband or wife if alive 49


years


7 IF STILLBORN, enter that fact here.


55


2


15


8


AGE


Years.


Months.


.. Days


If less than 1 day


Hours.


.. Minutes


Supervisor


Usual


9 Oocupation :


U. S. Government


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


¥chtel


13 NAME OF


FATHER


14 BIRTHPLACE OF


Billerica, Mass.


FATHER (City)


(State or country)


bridget Gavin


15 MAIDEN NAME


OF MOTHER


16 BIRTHPLACE OF


MOTHER (City)


(State or countyharital Records


Relation, if any


A TRUE COPY.


ATTEST:


(Registrar of city or, town where death occurred)


DATE FILED


9./14/43


19


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


79 Atlantic St.Winthrop


Reoelved and filed OCT 1 , 1943


.19


(Registrar of City or Town where deceased resided)


50m (e)-1-41-4667


3 SEX M (or) WIFE of PARENTS 17 Informant (Address) 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-802 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD Industry 10 or Business :


PLACE OF DEATH


1


(City or Town) Soldiers' Home Hospital No.


St.


Winthrd


(If U. S.


War Veteran,


specify WAR)


World 1


St.


Sept . 14, 1943


(Month)


(Day)


(Year)


19 | HEREBY, CERTIFY,


That I attended deoeased, from


19


to .. Sept . 14 43


19.


I last saw h.


.. alive on


have oocurred on the date stated above, at


Duration


Immediate cause of death bogis


not


....


known.


Due to.


Due to.


Hypertensive heart


ot


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations


Date


of ...


should be


Laboratory charged sta-


tistically.


What test confirmed diagnosis ?


20 Was disease or Injury in any way related to oooupatlon of deceased ?.


If so, speolfy ..


Timothy F.Pogan


(Signed)


Soldiers' Home


9.1.14., M. 6.3


(Address)$.y


+1 Pate ..........


19


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Sort. 17, 1043


(City or Town)


DATE OF BURIAL


(Cemeter})


J. F. O.P. Long


19


Underline the cause to which death


disease


known


Of autopsy


Ireland


18 DATE OF


DEATH


Sept. 14


7:15 A:


m.


death Is sald to


Suffolkx


The Commontucatth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF


CERTIFICATE OF DEATH


S


( If death occurred in a hospital or institution,


St.


{ give its NAME instead of street and number)


Samuel Shapiro


2 FULL NAME


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


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No.


(Usual place of abode)


49 Sagamore Ave.


St.


winthrop


Mass.


(If nonresident, give city or town and State)


Length of stay: In hospital or institution.


( Before death)


( Specify whether)


years


months


1 __ days.


In this community


yrs.


mos.


14


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


September


15


(Month)


(Day)


( Year)


19 | HEREBY CERTIFY,


That I attended deceased from


Sept ..


1


19


43


to


Sept. 1519.


43


I last saw h.


im


.. alive on


Sent. 15 19 413 death Is said to


have occurred on the date stated above, at 9.25 p. m.


Duration


Immediate oause of death


Carcinoma of rectum


mos


Due to


Due to. Hypertensive and


Ician Arterioscleroticheart disease yrs. Other conditions. (Include pregnancy within 3 months of death)


Major findings :


carcinoma of rectum


Of operations


Date


of 9/1/1/43


Underline the cause to which death should be charged sta- tistically.


What test confirmed diagnosis?


20 Was disease or Injury in any way related to oocupation of deceased?IO


If so, specify.


(Signed)


R. R. Shapiro


M., D.


(Address)


B.I. Hospital


Date


9/1519 43


21 PLACE OF BURIAL, Puritan Cem.


Woburn Mass,


CREMATION OR REMOVAL


(Cemetery)


(City or Town)


DATE OF BURIAL


Sept. 16 19%


22 NAME OF


FUNERAL DIRECTOR


M ....... Stanetsky.


ADDRESS


Boston


19


(Registrar of City or Town where deceased resided)


MARGIN RESERVED FOR BINDING


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


PLACE OF DEATH


(County) Roston


1


(City or Town)


No.


Beth Israel Hospital


BOSTON (City or town making return)


Registered No.


845316


THIS IS A PERMANENT RECORD


50m (e)-1-41-4667


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED Widowed


or DIVORCED


5a If married, widowed, or divorced HUSBAND of


Mary Blender


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive years


7 IF STILLBORN, enter that fact here.


AGE 75 .Years .. Months. Days


If less than 1 day


Hours


Minutes


Usual


Dry Goods Store Prop.


Industry 10 or Business :


11 Social Security No ..


none


12 BIRTHPLACE (City)


(State or country)


Russia


13 NAME OF


FATHER


Isaac H. Shapiro


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Ada


-


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


17


Informant


Celia Berger


D'avanter (Address)


A TRUE COPY.


Francis


8. Jan


ATTEST :


(Registrar of city or town where death occurredy.


DATE FILED


Sept. 20


19


43


same


Of autopsy


9 Occupation :


(Give maiden name of wife in full)


FORM R-302


3 SEX


M


1943


Received and filed


OGT-13-1313


ORM R-302


Essex


(County)


Danvers


(City or Town)


No. Danvers State Hospital


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Danvers


(City or town making return)


Registered No.


217


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


William P. Natale


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


(a) Residence. No.


114 Pleasant


WWinthrop


(If nonresident, give city or town and State)


Length of stay : In hospital or Institution


(Before death)


(Specify whether)


years


1


months


20days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


4 COLOR OR RACE


white


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


married


5a If married, widowed, or divorced


HUSBAND of


Clara ... R ....... Moody.


(Give maiden name of wife iu full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive 8.3


years


7 IF STILLBORN, enter that fact here.


8


AGE


Years.


.. Months.


Days


If less than 1 day


Hours .........


.. Minutes


Usual


Retired Real Estate Dealer


11 Social Security No.


cannot be learned


12 BIRTHPLACE (City)


Cambridge


John Peter Natale


14 BIRTHPLACE OF


FATHER (City)


(State or country)


"Italy


15 MAIDEN NAME


OF MOTHER


Emma Burns


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


M.KaMcPhillips


DSH


Relation, if any


A TRUE COPY


ATTEST :


(Registrar of city or town where death occurred)


DATE FILED 9/27/43


19


18 DATE OF


DEATH


Sep. 17, 1943


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


July


28


That I attended deceased from


19


4,3 to.


Sep ...


17


1943


alive on


I last saw h


im


Sep.


17,, 19 43


death Is sald to


have ocourred on the date stated above, at.


10 .... 15A .... m.


Duration


Immediate cause of death


Arteriosclerotic heart disease3yrs


Due to.


Due to.


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of


should be charged sta- tistically.


Of autopsy


What test confirmed diagnosisclinical


20 Was disease or Injury in any way related to oooupatlon of deceased ?.


If so, speolfy


(Signed) Abraham .... Gardner


M. D.


(Address)


DSH


D 2/23/199


21 PLACE OF BURIAL,


Winthrop Winthrop


CREMATION OR


(City or Town)


DATE OF BURIAL


9/20/43


19


22 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS


Winthrop


Received and filed OCT 15 1943 19


(Reglatrar of City or Town where deceased resIded)


50m (e)-1-41-4667


1


PLACE OF DEATH


St.


(If U. S.


War Veteran,


specify WAR)


(Usual place of abode)


2 FULL NAME


3 SEX


male


83


9 Occupation :


Industry


10 or Business:


13 NAME OF


FATHER


PARENTS


17


Informant


(Address)


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


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


Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased


(State or country)


Physician Underline the cause to which death


بسبب


سبيبـ


RM R-302


Middlesex (County)


Tewksbury


(City or Town)


No. Tewksbury State Hospital and Infirmary


The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


IEWASDURI SIATE HOSPITAL and INFIRMARY TEWKSBURY, MASSACHUSETTS (City or town making return)


Registered No. 352 18 ..


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


2 FULL NAME


George


.. Boutin


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


(a) Residence. No.


225 River Road


ŚŁ


Winthrop


(If nonresident, give city or town and State)


Length of stay : In hospital or Institution.


(Before death)


(Specify whether)


3


years LO months


16 days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Ilale


4 COLOR OR RACE|


Thite


5 SINGLE


(write the word)


Single


MARRIED


WIDOWED


or DIVORCED


5a If married, widowed, or divorced HUSBAND of


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive years


7 IF STILLBORN, enter that fact here.


8


AGE


41


Years


9


25


If less than 1 day


Hours.


Minutes


Usual


9 Occupation :


Rigrer


Industry 10 or Business :


11 Social Security No ..


12 BIRTHPLACE (City)


inthron


(State or country)


Tras's


13 NAME OF


FATHER


Gerard Boutin


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Not learned


(State or country)


Canada


15 MAIDEN NAME


OF MOTHER


Ella La Voix


16 BIRTHPLACE OF


C'elsea


MOTHER (City)


(State or country)


17


Informant


(Address)


Hospital Records


Relation, If any


A TRUE COPY.


ATTEST:


C. Winthings Houghton mSupt.


(Registrar of city or town where death occurred)


DATE FILED


Couto ber 20


..... 19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


September


19


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


NOV.


3


19.


39


Sept. 10


to


19


43


I last saw h ........ j.m.alive on ....


1.0 ...... , 19 .... 4.3death Is said to


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


10:45 ... 2m.


Duration


Immediate cause of death Multiple Sclerosis


6 VRS


Due to.


Due to.


Other conditions


Cystitis ; Trophic Ulcers


Physician


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of


Underline the cause to which death should be charged sta- tistically.


Of autopsy


What test confirmed diagnosis ?.


Clinical


20 Was disease or injury In any way related to oocupatlon of deceased ?......... O


If so, speolfy.


(Signed)


Kurt C. Lessy


M. D.


(Address)


T. S. H. & I., Tewksbury


Date ..


9-20943


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Holy Cross ...


aldon


(Cemetery)


(City or Town)


DATE OF BURIAL


September 23


19


22 NAME OF


FUNERAL DIRECTOR


R. C. Kirby


ADDRESS


Boston, 100


Reoelved and filed


OCT 2.9 1943


19


(Registrar of City or 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-802 to the clerk Copies of returna of deaths recorded during the previous month which occurred in your city or town in case the deceased


WIIIL PLAINLY.


1


PLACE OF DEATH


(Usual place of abode)


(If U. S.


War Veteran,


( soity WAR)


1943


That I attended deceased from


(Give maiden name of wife in full)


Months


Days


1


M R-305


PLACE OF DEATH


SUFFOLK (County) BOSTON


(City or Town)


Mass. General Hospital


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH


BOSTON


(City or town making return)


869350


Registered No.


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


2 FULL NAME Matthew J. Lambert


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


(a) Residenoe. No.


(Usual place of abode)


82 Waldemar Avenue


St.


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution


(Before death)


(Specify whether)


years


months days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


September


23


(Month)


(Day)


(Year)


2119 I 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.) Spontaneous cerebellar hemorrhage Glioma left cerebellartobe love Hypertensive Heart disease; said to have been in motor collision at Boston Les. 23. 1943


20 Acoldent, suloide, or homloide (specify) Date of occurrence 19


Where did Injury occur ? (City or town and State)


Did injury oocur in or about the home, on farm, in industrial place, or in pubiio place? (Specify type of place)


Manner ofSaid to have been in a m. tor


Injury


Nature of


collision at Boston on Sept 22 1943


Injury


While at work ?


.Was there an autopsy ?.


yes


21 Was disease or Injury In any way related to occupation of deceased?


If so, speolfy


"J. Brickley


M. D.


(Signed)


(Address)


Boston, Mass.


Date.


9-23


19


43


22


winthrop Cem.


iinthrow,


ass .


Piace of Burial, Cremation or Removal.


(City or Town)


Cent. 27


43


DATE OF BURIAL


19


23 NAME OF


FUNERAL DIRECTOR


J. F. O'Yaley


ADDRESS


Winthrop, ass.


Received and filed


001 1 1913


19


(Registrar of City or Town where deceased resided)


25m (h)-1-41-4667


No. 3 SEX M (or) WIFE of AGE Usual 9 Occupation : 10 or Business : PARENTS occurred. (See Chap. 46, Sec. 12, G. L.) of the city or town in which the deceased resided as soon as possible after the close of the month in which the death resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk Coples of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased Industry Shoe


4 COLOR OR RACE


W


5 SINGLE


MARRIED


WIDOWED


or DIVORCER


(write the word)


7. damm


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


53


6 Age of husband or wife If allve years


7 IF STILLBORN, enter that faot here.


8 58 Years Months.


2 Days


If less than 1 day .Hours Minutes


Shoe Broker


11 Soolal Security No.


030-09-1774


12 BIRTHPLACE (City)


(State or country)


East Boston, Mass.


13 NAME OF


FATHER


Louist Lambert


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Boston, ass.


15 MAIDEN NAME


OF MOTHER


Mary l'agee


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Boston, Lass.


17 Informant (Address)


Relation, if any


A TRUE COPY.


ATTEST :


Francis


( Registrar of city or town where death occurred)


DATE FILED


Cert. 27


43


Deep. 34, Book.I


St.


(If U. S.


War Veteran,


specify WAR)


Winthrop


1943


Married


Leonora Harmond-


1


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 Wwwwwwww ww yout chy of tewe in case the deceased resided in another city or town at the time


50m-10-'39. No. 8427-f


17


Informant.


Oscar Bucknam


Relation, if any son


(Address) 180 Somerset Ave, Winthrop


A TRUE COPY.


ATTEST:


(Registrar of city or down wortdeath occurred)


DATE FILED


Sent. 28, 1943


19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


September


24


1943


(Month)


(Day)


(Year)


IS | HEREBY CERTIEY.


That I attended deceased from


Sept. 24


19.70


..... , to.


19


43


(oz) WIFE of


Alonzo Bucknam


(Husband's name in full)


.years


6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.


8


AGE .. 9.0


Years


7


Months.


2.3Days


lf less than 1 day Hours ......... Minutes


Usual


9 Occupation:


Housewife


Industry


10 or Business:


Own home


11 Social Security No ..


none


Bath


12 BIRTHPLACE (City)


(State or country)


Maine


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings : Of operations


Underline the cause to which death


Of autopsy


What test confirmed diagnosis ?


should be charged sta- tistically.


20 Was disease or Injury In any way related to occupation of deccased ? no


If so, specify.


(Signod)


Harry ............ Campbell.


, M. D.


(Address) ...... 538 High St.


Dat


9/21


19


43


21 PLACE OF BURIAL, CREMATION OR REMOVAL Woodlawn. Cem. Everett (Cemetery) (City or Town)


DATE OF BURIAL


Sept. 27, 1343


19


22 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS


Winthrop, Mass.


Received and filed


OCT 15 1343


19


(Registrar of City or Town where deceased resided)


Y


R-302


PLACE OF DEATH


Middlesex.


(County)


Medford


(City or Town)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Medfor d (City or town making return) 200


Registered No ...


(If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


2 FULL NAME


Adriana ... Bucknam


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


993 Shirley .st.


.........


.St.


Winthrop


(If nonresident, give city or town and state)


(Specify whether)


years


3


months


days.


In this communityLO yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


female


4 COLOR OR RACE 5 SINGLE


MARRIED


white


WIDOWED


or DIVORCED


(write the word)


widow


5a lf married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


I last saw h


Oralive on


Sept. 2 4


., 19 4.3


death is said


to have occurred on the date stated above, at


3. 50Р


.m.


Duration


Immediate cause of death


Chr. Vascular Myocarditis


?yrs


Duc to


Due to


13 NAME OF


FATHER


Unable to obtain


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


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


Date of.


July


1


(1: U. S.


War Veteran,


specify WAR)


(a) Residence. No.


(Usual place of abode)


Length of stay : In hospital or institution.


11050


No.


34 Grove St .mery Rest Home


-301 A


Justalp


(County) Winthrop (City or Town) 366 Pleasant St


The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent. 201


Registered No.


§ ( If death occurred in a hospital or institution, give ite NAME instead of atreet and nuniber)


homas Thomas F. Hawes


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


366 Pleasant


St.


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution


(Before death)


(Specify whether)


yeara


months days.


in this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male Mute


4 COLOR OR RACEJ


5 SINGLE


( write the word)


MARRIED


DI ORSEndowed


5a If married, widowed,




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