USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 71
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(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deathis caused directly or indirectly by traumatisin (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deathis 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 .- Cause of death mcans the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. -
Statement of Occupation .- Precise statement of occupation is very im- portant, 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 occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. 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, how- ever, 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
ORM R-305
No.
2 FULL NAME
3 SEX
M
(or) WIFE of
Industry
10 or Business :
14 BIRTHPLACE OF
PARENTS
(State or country)
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.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk
(State or country)
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced HUSBAND of
Augusta Hellberg
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
8 AGE. 65.Years Months Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Leather merchant
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
'St. John's, N. B.
13 NAME OF
FATHER
Peter Porter
25m (h)-1-41-4667
PLACE OF DEATH
SUTFOLK
BOSTON (City or Town)
4.14 Broadway
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
8522206
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
James H. Porter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
specify WAR)
(a) Residence. No.
(Usual place of abode)
211 .... CliffAvenue
St.
Winthrop
(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
About Sept 25, 1944
DEATH
(Month)
(Day)
(Year)
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.) Left coronary sclerosis
Old cardiac infarct of It ventricle General arterio sclerosis
20 Accident, suicide, or homicide (specify)
Date of ocourrenoe.
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
publio place ?
(Specify type of place)
Manner of Found dead in his office on Sept
Injury
Nature of
28:, 1944
Injury
While at work?
?
Was there an autopsy?
Yes
21 Was disease or Injury in any way related to ocoupation of deceased ?
If so, specify
(Signed)
W.J. Brickley
M. D.
(Address)
Boston
Date.9/28 44
22
New Calvary Cen. Boston
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Oct.2 1944
19
23 NAME OF
FUNERAL DIRECTOR
E. M. Fitzgibbon
ADDRESS
Dorchester
Received and filed
19
NOV 14 1914
(Registrar of City or Town where deceased resided)
L
=
=
17 A. A.Gallivan
Informant.
(Address)
Relation, if any .Cousin ... )
A TRUE COPY. Francis × 4ans
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Oct. 4, 1944
19
S. Boston
St.
(If U. S.
War Veteran,
no
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
FATHER (City)
St. John's, N. B.
15 MAIDEN NAME
OF MOTHER
Ellen Monahan
16 BIRTHPLACE OF
MOTHER (City)
.S.t ...... Johns., .... N ....... B ..
1
ORM R-302
PLACE OF DEATH r
OLK
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
St. Elizabeth's Hospital
St.
5
(If deatlı occurred in a hospital or institution,
¿ give its NAME instead of street and number)
Dante Bachini
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
162 .... Bowdoin St.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
10
days.
In this community 17 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Teresa Castello
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive 55
years
7 IF STILLBORN, enter that fact here.
8
AGE
55
Years
Months.
Days
If less than 1 day
Hours ...
.Minutes
Usual
9 Ocoupation :
Gardner
Industry
10 or Business :
Landscape
Il Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
Enrico Bachini
14 BIRTHPLACE OF
FATHER (City)
Italy
(State or country)
15 MAIDEN NAME
OF MOTHER
Ortenza Bachini
OK
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17
Informant
(Address)
Enrico Bachini
Relation, if any
Son
A TRUE COPY.
3
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Oot 9 1944
19
18 DATE OF
DEATH
10/5/44
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
9/25/44
19
That, I attended deceased from
to ..
10/5/44
19
I last saw h ..... 1.m .... alive on
10/5/44
19 ..
death Is sald to
have occurred on the date stated above, at
2:30 p.
.m.
Duration
Immediate cause of death
Myocardial infarction
3 days
Due to
Coronary occlusion
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Appendicitis
Date
of
9/25/44
Underline
the cause to
which death
should be
charged sta-
tistically.
Of autopsy
What test confirmed diagnosis?
20 Was disease or Injury in any way related to oooupation of deceased?
If so, specify.
(Signed)
Joseph A. Dorgan
M. D.
(Address)S.t ....... Eliz ..... Hos.p.
Date 10/5/48
21 PLACE OF BURIAL,
Winthrop, Winthrop, Mas8.
CREMATION OR REMOVAL ...
OotCemgtery 1 944
(City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
J. F. O'Maley
.......
ADDRESS
Winthrop
Received and filed NOVIT 1311 19
(Registrar of City or Town where deceased resided)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
50m (e)-1-41-4667
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
1
SOT(County) BOSTON (City or Town)
OSTON
(City or town making return)
8646
6207
Registered No.
(If U. S.
vanity wany
specify WAR)
no
(a) Residence. No.
(Usual place of abode)
M
W
No.
19
City or Town of Brattleboro
STANDARD CERTIFICATE OF DEATH STATE OF VERMONT
State File No ......
Registered No.
2. USUAL RESIDENCE OF DECEASED:
(a) State
Mass
(b) County Suffolk
(c) City or town
Winthrop
(d) Street No.
47 Cliff Ave
(If rural give location)
(e) If foreign born, how long in U. S. A .? years
MEDICAL CERTIFICATION
20. Date of death; Month
October
7
3 (c) Social Security
year
1944
hour
545/ A. M.
21. I hereby, certify that I attended the deceased from
Oct. 4
144
... ,
to ...
Oct 7
,
44
that I saw h.im ... alive on
Oct 7
and that death occurred on the date and hour stated above. Immediate cause of death Hemorrhage from Rupture of
Rt ......... Kidney
60
hrs
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
with Hemorrhage
Of autopsy
Rupture Rt. Kidney
22. If death was due to external causes, fill in the following:
(a) Accident, suicide, or homicide (specify) Accident from
(b) Date of occurrence ct 4 1944 football game
Franklin Mass
(City or town)
(County)
(State)
(c) Place: burial or cremationLittleton N. H. GlewwwBig @jury Com in or about home, on farm, in industrial place, in
public place?
Preparatory
School
(Specify type of place) While at work ?. P.Lay (e) Means of injuryfootball 23. Signature Philip H Wheeler (M.D. or che). Address Brattleboro Vt Date signed .... O.c.t. 7
game
1. PLACE OF DEATH:
(a) County
Windham
(b) City or town
Brattleboro
In this community
years, months or days)
3 (b) If veteran,
none
name war
No.
5. Color or
4. Sex male
race
white
6 (b) Name of husband or wife
(Month)
8. AGE:
Years
Months
17
2
Days
22
10. Usual occupation student
11. Industry or business
school
15. Birthplace
Mother Father
16 (a) Informant
(b) Address
Littleton, N. H.
MARGIN RESERVED FOR BINDING-WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT
12. Name
C ........ Edward ...... Magoon
TION is very important.
6 (c) Age of husband or wife if
alive.
.years
7. Birth date of deceased
July
1.2th
1927(27)
(Day)
(Year)
If less than one day
hr.
.min.
9. Birthplace
Littleton,
(City or town)
(State or foreign country)
(City or town) (State or foreign country)
14. Maiden name Gretrude T. Richardson
(State of foreign country) (City or town) Mrs. C. F. Meacham
17 (4) burial (b) Date thereo Oct. 9th 194 H(c) Where did injury occur Mt Hermon (Month) (Day) (Year) (Burial, cremation, or removal)
18 (a) Signature of funeral directoArthur L Rohde (b) Address Brattleboro ........... Vermont. 19 (a) Oct. 10,1944 bettie B. Tupper (Date received local registrar) A & Registrar ustrarie signatured 1 erk
Copy of the Record of a Death filed in the Clerk's office of the during the month of October
208
1944
(c) Name of hospital or institution: Brattleboro Memorial N. H. 1 Bethlehem N .H RECORD. Every item of information 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 OCCUPA- 13. Birthplace Manchester, N. H.
(If not in hospital or institution write street number or location)
(d) Length of stay: In hospital or institution
2 days
(Specify whether
3 (a) FULL NAME
Charles Edward Magoon
6 (a) Single, widowed, married,
divorcesingle
19
1944;
Duration
day.).
OCT 20 1914
I hereby certify that the foregoing is a true copy.
November 1, .....
19. 44 ....
an
......
NOV 24156 PM Section 4074. Non-Residents; Certified Copies. On the first day of each month, he shall make a certified copy of all births, marriages and deaths filed in his office during the preceding month, except births of illegitimate children, whenever the parents of a child born, or a bride or a groom or a deceased person was a resident in any other town at the time of such birth, marriage or death, and shall transmit such certified copies to the clerk of the town in which such parents of a child born, the bride or the groom or the deceased was a resident at the time of such birth, marriage or death; and the clerk receiving such copies shall file the same.
These blanks may be obtained of the Secretary of the State Board of Health.
PH-21A-20M-6-39
ORM R-302
1
(CitysoftRers' Home Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return) 566 209
Registered No.
- (If death occurred in a hospital or institution, ( give its NAME instead of street and number)
Www 1
2 FULL NAME (If deceased is a marriedggidopet forf 1 dan, Fare also maiden name.)
St.
9
(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
Oct. 7, 1944
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | AURTE &B CERTIFY,
i.m., 19.
Oct ...
GGEleattended deceased from
4.4
19
I last saw h
alive on
7.05 01
death is sald to
have occurred on the date stated above, at.
m.
Immediate dalis@ Bt Ídeath
Malignant hypertension
Puracion
3"
2 mos .
Due to
Due to.
Hypertensive heart
disease
Other conditions.
(Include pregnancy within 3 months of death)
Major findings:
Of operations.
Date of ... cifnicar
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to ocoupation of deceased ?. If so, specify.Paul .... L'einsaft
M.
(Signed)
Soldiers! Home
10/9
84
(Anthrop Cem. Wpathrop.19.a.s.s .
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Oct ... 10.,1944
DATE OF BURIAL
John F. O'Maloy
19
22 NAME OF
FUNERAL DIRECTOR
Winthrop, Mass.
ADDRESS
Received and filed. 19
(Registrar of City or Town where deceased resided)
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
50m (e)-1-41-4667
A TRUE COPY.
Joseph G. Tyrrell
ATTEST :
(Registrar of city or town where death occurred)
1
.19
DATE FILED
10/9/44
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, & Hørcey . Sheehan
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than 1 day
Hours.
Minutes
Usual 9 Occupation : Fledtrical Business
Boston, Mass.
St . Johns, N.B.
Milford, Mass
Relation, if any
Suffolk
PLACE OF DEATH
Chelybà
No.
Charles N. Nickerson
St.
(If U. S. War Veteran,
Winthropremit war
(Usual place of abode)
hospital
1
(a) Residenoe. No. 3 SEX 4 COLOR OR RACE| Male White HUSBAND of (or) WIFE of 6 Age of husband or wife if alive 7 IF STILLBORN, enter that fact here. 46 O 14 8 AGE Years Months. Days treasurer Industry 10 or Business : Il Social Security No. 12 BIRTHPLACE (City) (State or country) Charles M. 13 NAME OF FATHER 14 BIRTHPLACE OF FATHER (City) 15 MAIDEN NAME OF MOTHER PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or costosp . Record's 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-302 to the clerk (State or country) Annie Ruddy
?mos.
Physician Underline the cause to which death should be charged sta- tistically.
(Cemetery)
(City or Town)
ORM R-302
PLACE OF DEATH -
(City or Town)
No.
Gallups Island
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
8833610
Registered No.
(If death occurred in a hospital or institution, St. { give ite NAME instead of street and number)
2 FULL NAME
Joseph Johnston
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
168 Brookfield Rd.
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 12 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct 11, 1944
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFY,
March ... 1/43
19
That I attended deceased from
to
Qot 11/44
19
1 last saw h.
im
alive on
Oot 11/44
19
......
death Is sald to
have occurred on the date stated above, at11:05.a.
.m.
years Immediate cause of death Coronary .... occlusion
7 IF STILLBORN, enter that fact here.
Years
8
AGE 63
5
Months.
3
Days
If less than 1 day
Hours ............ Minutes
Usual
9 Occupation :
Engineering officer
Industry
U.S.Maritime Service
Il Social Security No .....
012-18-5118
12 BIRTHPLACE (City)
(State or country)
St. John, N. B.
13 NAME OF
FATHER
James Johnston
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Martha
--
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Relation, if any (Wifo
A TRUE COPY.
ATTEST :
(Registrar of city of town where death occurred)
DATE FILED
Oct 16 1944
19
22 NAME OF
FUNERAL DIRECTOR
H. S. Reynolds
ADDRESS
Winthrop .... Mass.
Received and filed
NOV 10 1914
19
(Registrar of City or Town where deceased resided)
should be
charged sta-
tistically.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to ocoupation of deceased ?
no
if so, specify
(Signed)
G. G. McAuley
M. D.
(AddressGallups Island
10/11/49
21 PLACE OF BURIAL,
Winthrop, Winthrop, Mass.
19
CREMATION OR REMOVAL ..
(Cemetery)1 944
(City or Town)
DATE OF BURIAL
Oct 14
Physician
Major findings :
Of operations.
Underline the cause to which death
Date of.
13 yrs
Due to.
Duration
6 Age of husband or wife if alive 63
(write the word)
Married
5a If married, widowed, or divorced HUSBAND of
Grace Cooper
(Give maiden name of wife in full)
(Husband's name in full)
3 SEX M (or) WIFE of PARENTS 17 Informant (Address) 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 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 10 or Business :
50m (e)-1-41-4667
OFFOLK CON (County)
1
(If U. S.
War Veteran,
no
speolfy WAR)
Winthrop
4 COLOR OR RACE|
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Due to.
Coronary sclerosis
Other conditions
(Include pregnancy within 3 months of death)
...
M R-302
1
PLACE OF DEATH
Middlesex
(County)
Cambridge (C'ity or Town) Holy Ghost Hospital
No.
2 FULL NAME
Mary Caffrey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
158 Highland Ave.
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 1 1months 24days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
7.
4 COLOR OR RACE|
W.
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
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 faot here.
8 AGE. 7.2.Years. Months Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
At home
Industry
10 or Business :
Housewife
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Ireland
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy.
clinical
What test confirmed diagnosis ?
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed)
... Dudley
M. D.
(Address)
Holy Ghost
Hosp .. 10 /139 44
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Mrs Margaret HartyRelation, if any
Informant
(Address)
504 Beacon St. Boston
A TRUE COPY.
ATTEST:
Oct 14, 1944
(Registrar of city or town where death occurred)
.19
22 NAME OF
FUNERAL DIRECTOR
M. H. Dockray & Son
ADDRESS
44 High st canton
Received and filed MY 1944 19
DATE FILED
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct 12, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
O.c.t ..... ]
19.44
to
Oct
.12
That I attended deceased from
1944
I last saw h ....
... e.r.alive on
Oct
12
19 .4.4death Is sald to
have occurred on the date stated above, at.
7
20 Pm.
.. m.
Duration
Inimediato cause of death
Cerebral Hemorrhage
Paralysis
1yr
Due to.
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
13 NAME OF
FATHER
Thomas Caffery
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
PARENTS
25M-(f)-11-42 10746
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
..
Registered No.
1359-11
-
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
(If U. S.
War Veteran,
speolfy WAR)
(City or town making return)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
21 PLACE OF BURIAL,
CREMATION OR
St Mary Cem
Canton
(Cemetery)
(City or Town)
DATE OF BURIAL
Oct 16 1944
19
(Registrar of City or Town where deceased resided)
1
(Give maiden name of wife in full)
15 MAIDEN NAME
OF MOTHER
Margaret Galligan
A R-302
Essex
(County)
1
Danvers
(City or Town)
No.Danvers .... Stato .... 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.
212
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Marguerita C. Baird
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
82 .... Freemont
(Usual place of abode)
st.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
....
years
months
17
days.
In this community
yrs.
mos.
daye.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
DEATH
married
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Se.p.
.2.6 ... ,
19
44 to .....
Oct.
That I attended deceased from
13
19
44
I last saw h.e.I ......... alive on
Oct. 13, 19 44 death Is sald to
have occurred on the date stated above, at8 ... 55P.
m.
Duration
Immedlate cause of death.
·Acutemyocardialfailure.
3 days
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
clinical
What test confirmed diagnosis ?
20 Was disease or injury in any way related to cocupation of deceased ?.
If so, specify
(Signed)
Flora M . Remillard
M. D.
(Address)
DSH
Date:
10/2019 44
21 "PLACE OF BURIAL,Winthrop
CREMATION OR REMOVAL ..
(Cemetery)
(City or Town)
DATE OF BURIAL
10/16/44
19
22 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop.
Received and filed 19
(Registrar of City or Town where deceased resided)
=
City or rown where deceased regidadi
1
Usual
9 Oooupation :
at home
Industry
10 or Business :
11 Social Security No ...
none
12 BIRTHPLACE (City) Somerville
(State or country)
13 NAME OF
FATHER
Joseph H. Clarke
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Malden
15 MAIDEN NAME
OF MOTHER
Mary F. Tibbets
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Augusta,
Me .
17 M.K. McPhillips
Informant
(Address)
DSH
A TRUE COPY.
ATTEST:
al restar wars
(Registrar of city or town where death occurred)
DATE FILED
10/24/44
19
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-801 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
25M-(f)-11-42 10746
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE George P.Baird
g name in full)
60
6 Age of husband or wife If alive years
7 IF STILLBORN, enter that faot here.
8
AGE 63 Years.
Months.
Days
If less than 1 day
.Hours.
Minutes
18 DATE OF
Oct. 13, 1944
(If U. S.
War Veteran,
speolfy WAR)
Winthrop
( .... Relation, if any
PLACE OF DEATH
A R-302
PLACE OF DEATH
Essex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
1
Danvers
(City or Town) Danvers State Hospital No.
St.
S (If death occurred in a hospital or institution, give its NAME instead of etreet and number)
Walter S. Hill
2 FULL NAME
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
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