USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 26
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Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause namc the disease causing death. As related causes, name carlier 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 husincss, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at homc. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- cver, designate the occupation hy 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
SUFFOLK
BOSPORT
(City or Town)
No. Mass. General Hospital
St.
2 FULL NAME
Mary Jane Stinson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
8.0 .... Washington .... Ave
St.
Winthrop ... Mas.s.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution. (Before death)
years
3
months
days.
In this community
30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If ailve years
7 IF STILLBORN, enter that faot here.
AGE 36 Years .Months Days
If less than 1 day Hours. Minutes
Clerk
Department Store
11 Soolal Seourlty No.
025-12-2560
12 BIRTHPLACE (City)
(State or country)
Boston Mass.
13 NAME OF
FATHER
Henry Stinson
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Bostm Mass.
15 MAIDEN NAME
OF MOTHER
De lia Buckley
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston Mass:
17 Informent ...... (Address)
Cousin Francis A Nolan
Relation, if any
A TRUE COPY.
tana's
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Mar .... 5.4.5
19
21 Was disease or injury In any way related to ocoupation of deceased?
If so, speolfy.
(Signed)
W J Briokley
M. D.
(Address)
·Bo.ston ... Mas.s
Date
3/1/45
22
Holy Cross
Malden Mass.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Mar 3/45
19
23 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS
Boston Mass ...
Received and filed.
APR ..... 1 1 1945
19
(Registrar of City or Town wbere deceased resided)
25m (h)-1-41-4667
3 SEX (or) WIFE of Usual 9 Occupation : PARENTS occurred. (See Chap. 46, Sec. 12, G. L.) of the eity or town in which the deceased resided as soon as possible after the close of the month in which the death resided in another eity or town at the time of death should be made forthwith and transmitted on Form R-305 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 :
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Female
White
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.) Valvular heart disease Rheumati.c ... heart .... disease Probably cerebral embolism
20 Accident, sulolde, or homicide (specify) Date of occurrence 19
Where did injury oocur ? (City or town and State)
Did Injury oocur In or about the home, on farm, In Industriai piace, or In publio place?
(Specify type of place)
Manner of
Injury
Nature of
Injury
While at work?
Was there an autopsy?
no
1
PLACE OF DEATH
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
19 55
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
1
(If U. S.
War Veteran,
specify WAR)
(Specify whether)
Mar 1/45
امامك
RM R-302
Lssex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers
(City or town making return)
1 ـــ
Danvers
CERTIFICATE OF DEATH
Registered No.
22
(If death occurred in a hospital or inatitution,
St.
3 give its NAME instead of street and number)
2 FULL NAME
Mary P. Gorman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
39 Waldemar 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
months
18 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
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 Years 80 Months. .. Days
If less than 1 day Hours. ........ .Minutes
Usual
9 Oooupation :
Nursemaid
industry 10 or Business :
11 Social Security No. none
12 BIRTHPLACE (City)
(State or country)
Cambridge
John Gorman
Major findings :
Of operations.
Date of.
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed dlagnosis ?.
clinical
20 Was disease or injury in any way related to oocupation of deceased ?.
If so, speolfy.
(Signed)
Doris M. Sidwell
M. D.
(Address)
DSH
Date .. 3 .... 9.
145
Dorchester
(State or country)
17 mary K. McPhillips Relation, if any
Informant.
(Address)
A TRUE COPY ..
ATTEST :
kisten of city or town where death occurred)
DATE FILED
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
March 3 1945
(Month)
(Day)
(Year)
19
LHEREBY CERTIFY,
That I attended deceased from
Jan ....... 1.5.
19
4.5 to ..... Mar.
3
19.45
I last saw h.
er
allve on
Mar.
3
19
4 5death Is said to
have occurred on the date stated above, at.
11 ... 10P
m.
Duration
Immediate cause of death Arteriosclerotic heart disease2yrs ....
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
13 NAME OF
FATHER
14 BIRTHPLACE OF
Cannot be learned
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
Cannot be learned
21 PLACE OF BURIALSt. Mary S
CREMATION OR REMOVAL
(Cemetery )
3/6/45
DATE OF BURIAL
(City or Town) 19
22 NAME OF
John F. O Maley
FUNERAL DIRECTOR
ADDRESS
Winthrop
19
Received and filed
APR. 1 7.1945
( 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
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the cierk
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
25M-(0)-11-12 10746
PLACE OF DEATH
(County)
(City or Town) Danvers State hospital No.
3/15/
(If U. S.
speolfy WAR)
female
white
(Give maiden name of wife in full)
RM R-302 +
1
PLACE OF DEATH
SUFFOLK
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
2283
Registered No.
23
§ (It dea
( If death occurred in a hospital or institution,
3 give its NAME instead of street and number)
Francis M Ford
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
60 Ocean View
St.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
years
months
1
days.
In this community
yrs.
mos.
1
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Mar 12, 1945
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
3/11/45
19
to
That I attended deceased from
I last saw h.Im
alive on
3/12/45
19 ..
death Is sald to
have occurred on the date stated above, at.
3.,4.5.a.
.. m.
Duration
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8
AGE .... 69 Years ..
8
Months
3
Days
If less than 1 day
Hours.
Usual
9 Occupation :
Retired Soldier
Industry
10 or Business :
USA
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Lansingburg N Y
13 NAME OF
FATHER
Austin Ford
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mar garet Traynor
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Informant ..... Hospital .... records.
Relation, if any
( Address )
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Mar 15/45
19
22 NAME OF
FUNERAL DIRECTOR
Murray ......... Murray.
Revere Mass.
ADDRESS
APR 1 1 1945
19
Received and filed.
( Registrar of City or Town where deceased resided)
Copies of returna of deatha recorded during the previous month which occurred in your city or town in case the deceased
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDSingle
5a if married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Immediate oause of death
Pneumonia., .... lobar .... bilateral
.Minutes Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
none
Date of.
Underline the cause to which death should be charged sta- tistically.
Of autopsy
none performed
What test confirmed diagnosis?
Clin .and .... La.b.
20 Was disease or Injury in any way related to oooupation of deceased? no
If so, speolfy
S J Dalton
(Signed)
Boston Mass
Date
3/12/65
M. D.
(Address)
Troy New York
DATE OF BURIAL
Mar 14/45
19
21 "PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery )
(City or Town)
50m (e)-1-41-4667
(County XV
(City or Town)
No.
Veteran's Administration Facility
St.
WW1
(If U. S.
War Veteran,
specify WAR)
Winthrop Mass.
(If nonresident, give city or town and State)
3/12/45
19
1 ... wk.
M R-302
1
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)
Registered No.
2384 74
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
(Usual place of abode)
46 ... Washington ... Ave St.
Winthrop ... Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution ...
(Before death)
years
months
2
day8.
In this community
yrs.
mos.
2 daye.
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
Married
5a If married, widowed, or dlvoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive 43
years
7 IF STILLBORN, enter that fact here.
8
AGE 52
Years
2 Months
8
Days
If less than 1 day Hours. Minutos
Usual
9 Occupation :
Engineer
Industry
Automatic Sprinklers
10 or Business :
11 Social Security No .....
021-09-1855
12 BIRTHPLACE (City)
(State or country)
Boston Lass.
13 NAME OF
FATHER
James T Kirkpatrick
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
New Brunswick
15 MAIDEN NAME
OF MOTHER
Mary Barry
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Milford Mass.
Relation, if any
17
Informant
(Address)
Wife
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED Mar 1945 19
18 DATE OF
DEATH
Mar 13/45
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
3/11/45
..... , 19.
to
3/13/45.
19
That I, attended deceased from
I last saw h ....
im ... allve on ..
3/13/45
19
death Is sald to
have occurred on the date stated above, at .. 1.1;1Qp m.
Duration
Inimediate cause of death. Right .... cerebral ... hemorrhage hemopericardium and ruptured sorta 3 dys
Due to .... Hypertensive ... heart ... disease
18 mos
Due to
Other conditions
none
(Include pregnancy within 3 months of death)
Major findings :
Of operations
none
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy
above
What test confirmed diagnosis?
autopsy
20 Was disease or injury in any way related to oocupatlon of deceased ?
If so, speolfy
(Signed)
JE Gorroll
M. D.
(Address)
Boston
Date.
3./14/45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
19
22 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS
winthro.p. Mass.
Received and flied APR 1 1 1945
19
( Registrar of City or Town where deceased resided)
-M-4f)-11-12 10:16
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
PLACE OF DEATH
Suffolk (County)
No.
Mass. General Hospital
James Francis Kirkpatrick
(If U. S.
War Veteran,
speolfy WAR)
(Specify whether)
Alice M Young
Physician
(Cemetery )
Mar 16/45
Town)
RM R-302
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
1
Boston
(C'ity or Town)
Mass. General Hospital No.
( If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
Dora Landen
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
29 Tewksbury st
St.
Winthrop Mass.
(a) Residence. No.
(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
days.
In this community
10 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE;
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Jacob Lanangaff wife in full)
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
AGE66 Years. Months Days
If less than 1 day Hours. Minutes
Usual
9 Ocoupation :
Housewife
Industry
10 or Business :
At -home"
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF FATHER -- Chisick
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant
(Addrene)
Daughter (
Relation, if any
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Mar .... 19, 1945
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Mar 15, 1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
3/14 /45
19
to
3 /15 45
19
19
., death Is sald to
have occurred on the date stated above, at
1.3.01a ...... m.
Inimedlate cause of death.
Carcinoma of the oesophagus
9 mos
plus
Due to.
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
none
Date of
should be charged sta- tistically.
Of autopsy
none
What test confirmed diagnosis ?
Clinical
20 Was disease or injury in any way related to oocupatlon of deceased ?
If so, speolfy
C C Clay
(Signed)
M. D.
(Address)
Boston
Date
3/15/45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ..... Mt .... Lebanon ... Workmen's.
( Cemetery)
DATE OF BURIAL
Mar 16/45
Circle 19
22 NAME OF
FUNERAL DIRECTOR
B ... Schlossberg ... & .... Sons
ADDRESS
Mattapan Mas.s .
Received and filed
APR 1 1 1945
19
( Registrar of City or Town where deceased realded)
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.)
-WM-if)-11-12 10716
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
1
That I attended deoeased from
I last saw h ...... er ... allve on.
3./15/45
Duration
Underline the cause to which death
(City or Town)
Registered No.
2392 25
(If U. S.
War Veteran,
speolfy WAR)
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
1.61
16
No. St. (If death occurred in a hospital or institution, { give its NAME instead of street and number) r
John E.Nolan
2 FULL NAME
(If deceased is a married, widowed of divorced woman, give also maiden name.)
Winthro peoify WAR)
(a) Residence. No.
(Usual place of abode)
hosp.
18
(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
3 SEX
M
4 COLOR OR RACE|
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, SPdivorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband'
45 g13
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8 54
27
If less than 1 day Hours Minutes
AGE
Years
Months .....
Work
Usual
9 Occupation :
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Canada
John
Major findings :
Of operations
Date of.
Physician Underline the cause to which death should be charged sta- tistically.
Of autopsy
clinica1
What test confirmed diagnosis ?
20 Was disease or injury in any way related to ocoupation of deceased ?
If so, specify
Louis J. Rudiger
M. D.
(Address)
Soldiers .!...... Home .. Dat 3.2.0
.. 19
45
21 PLACE OF BURIAL, SS
maldon
CREMATION OR REMOVAL
(Center) , 1945
(City or Town)
19
DATE OF BURIAL
HE
22 NAME OF
FUNERAL DIRECTOR
64 Meridian St. E Boston
ADDRESS
Received and filed
APR .. 1.3 1945
(Registrar of City or Town where deccased resided)
50m (e) -1-41-4667
A TRUE COPY. Joseph G. Tyrell
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
3/20/45
19
19 | HERPER CERTGY, METhat Bartended deceased
Im ... , 19 ......
.... ,
Mar . 20 45
19
6:05p
...
death is sald to
have occurred on the date stated above, at
m.
Duration
Immediate oause of death. Coronary heart disease
18 dä's
Hypertensive heart disease
?yrs.
Due Essential hypertension
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
13 NAME OF
FATHER
14 BIRTHPLACE OF
Ireland
FATHER (City)
(State or country)
Hary Curry
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
Canada
(State of country) Lors! Homo Hosp. Records
17
Informant
(Address)
Relation, if any
(
+
1
PLACE OF DEATH
ch8198a
(cigoritirers' Home Hospital
Registered No.
Ww 1
(If U. S.
War Veteran,
St.
18 OATE OF
Mar.20,1945
If. Sullivan
I last saw h
alive on
PARENTS
(Signed)
19
ORM R-302 T
1
PLACE OF DEATH
(County) Chelsou
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
162 My
-
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Daniel F.Twohig
2 FULL NAME
(If deceased is a married widoredzadired'o
woman, give also maiden name.)
Winthrop
(a) Residence. No.
(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
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
18 DATE OF
DEATH
(Month)
(Day)
(Year)
ALIca. G. Didham
19 | HEREBY24ERBIFY, LThat 12Onded deceased
1 last saw h
.alive on.
19
Mal.20
45
19
death is said to
(or) WIFE of
(Husband's namezjn full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
44
AGE
Years
Months.
Days
If less than 1 day Hours Minutes
Shipper
Usual
9 Occupation :
Industry
A. & P. Grocery
10 or Business :
023-10-3875
Il Social Security No.
12 BIRTHPLACE (City)
(State or country)
Halifax ,H.S.
Charles
13 NAME OF
FATHER
Halifax, H.S.
PARENTS
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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
50m (e)-1-41-4667
17
101 Upland Rd. Winthroption, if any
Informant
(Address)
A TRUE COPY.
ATTEST :
Joseph G. Tyrell
(Registrar of city or town where death occurred)
DATE FILED
3/22/15
19
22 NAME OF
A.J.DoNoiil
FUNERAL DIRECTOR LOV.ora ,Mass ..
ADDRESS
Reoelved and filed.
APR 1 3 1945
19
(Registrar of City or Town where deceased resided)
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 ocoupation of deceased ?.
If so, speolfy.
Thomas E. L.allaco
(Signed)
(Address)
Revoro Mass
Date/21
19
M. D
45
OF BURIALOP COM.
Winthrop, Lass.
CREMATION OR REMOVAL
(Cemeter)3, 1940ity or Town)
DATE OF BURIAL
19
Physician
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Duodenal ulcer
Of operations.
gastrectomy
Date of.
3/16/45
14 BIRTHPLACE OF
FATHER (City)
(State or country )
Mary Connors
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
Halifax, N.S.
MOTHER (City)
(State or country & Twohig
wife
Due to.
Due to.
Bleeding duodenal ulcer
1941
Duration
Immediate cause of death. Terminal broncho pneumonia 2das. Subtotal gastrectomy 3 16/45
have occurred on the date stated above, at
10':45A
.m.
19
5a
¡ married, widowe
HUSBAND of
(Give maiden name of wife in full)
Mar.20,1945
(If U. S.
War Veteran,
specify WAR)
St.
30
No.
(Choleoh Memorial Hospital
Suffolk
M R-302
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 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.)
PLACE OF DEATH
Middlesex
(County)
Malden
(City or Town)
No ......... .127 .... Summer
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Malden
(City or town making return)
Registered No.
78
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Vincent .... Capezza
(If deceased is a married, widowed or divorced woman, give also maiden name.)
24 Paine
St.
Winthrop
(If nonresident, give city er town and state)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Lale
4 COLOR OR RACE 5 SINGLE
White
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wire in
in Yunt"
(or) WIFE of
(Husband's name in full)
Years
7 IF STILLBORN, enter thal fact hore.
8 AGE .. Year
.. Months ........ .. Days
If less than 1 day
Hours
Minutos
Usual
9 Occupation:
Due to
General .Arteriosclerosis
Chronic ... Myocarditis
Industry
10 or Business:
Swift-& Co"Ret:
Due to
Hypertension
1I Social Security No.
12 BIRTHPLACE (City)
(State or country)
Italy
13 NAME OF
FATHER
Pasquale Capezza
14 BIRTHPLACE OF
FATHER (City)
.......
(State or country)
15 MAIDEN NAME
OF MOTHER
Italy
Unable obtain
16 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
17 Informant. (Address)
Anthony Capezza (
24 Paine St. winthrop
A TRUE COPY.
ATTESTI
(Registrar of city or town where death occurred) Mar.27,1945
7
DATE FILED
19
......
years
months
2clays.
In this community
(Month)
(Day) (Year) That I attended deccased from
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