USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 50
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six, that the deceased served In tie army, navy or marine corps of the United States in any war In which It has been engaged, sucb recital shall appear upon the permit. The board of health, or Its agent, upon receipt of such statement and certificate, shal forthwith countersign it and transmit it to the clerk of the town for regis ration. The person to whom the permit ls so given and the physician certiying the cause of death shall thereafter furnisb for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop. 114, Sec, 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county tbe body of such a person, he shall forthwitb go to the place where the body lies and take charge of the same; . . . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a buman body or the ashes thereof which have been brought into the commonwealth until be has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground In which the interment le made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
Tbe fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deatbs only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to sucb deatbs only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician Is absent from home when the certificate of deatb is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths 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 means 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 ls very important, 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, however, 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
-
RM R-302
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
1
PLACE OF DEATH
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
363
Registered No.
141
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
Henry W.Wilson
2 FULL NAME
(If deceased is 304 Pleasant
Harried, widowed or divorced woman, give also maiden name.) Winthrop
(a) Residence. No.
(Usual place of abode)
hospital
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
5a If married, widowedMer pigensdet T. Harvoy HUSBAND of
(or) WIFE of
(Husband's name in full)
55
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8
58
2
AGE Years
Months
Days
If less than 1 day
Hours ..
.. Minutes
Usual
9 Occupation :
Clerk Selective Service BoatQue to.
Industry 10 or Business :
Il Social Security No ..
12 BIRTHPLACE (City)
(State or country)
East Boston, Mass.
PARENTS
14 BIRTHPLACE OF
Norway
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Emma Anderson
16 BIRTHPLACE OF MOTHER (City)
Sweden
( State of country)
Soldforsi Home Hosp
Hecores
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
July 1 1945
19
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19
IJUSTERY CERTIFY,
Jrhall y attended deceased 40mn
Im ...
19
July 1
.45
19.
death is sald to
have oocurred on the date stated above, at
m.
Duration
Gastric hemorrhage
"hrs".
? Cancer of stomach
?
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
Date of
which death should be charged sta- tistically.
What test confirmed diagnosis ?
20 Was disease or injury In any way rolated to oooupation of deceased ?.
If so, specify.
A.Roubloy
(Signed)
(Address)
Sol lers "Home
Date
19
7/1 19.
M.
Winthrop, muss.
21 PLACE OF BURTAR,"
CREMATION OR REMOVAL ..
July24, 1945( City or Town)
DATE OF BURIAL
John Formuloy
19
22 NAME OF
FUNERAL DIRECTORthrop, Mass.
ADDRESS
Reoelyed and filed .
AUG 2 y 1945
19
where dcccased resided)
1
13 NAME OF
FATHER
Charles
Underline the cause to
Of autopsy.
clinical
50mı (e)-1-41-4667
(County) Chelsea
(City " Jawors' Home Hospital No.
(If U. S.
War Veteran,
specify WAR)
20-mn.
(If nonresident, give city or town and State)
19
(Give maiden name of wife in full)
I last saw h
alive on
July 1, 1945
17 Informant ( Address)
M R-302
-
(County)
1
(C'ity or Town)
No. Boston .... Floating ... Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
142
6038
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Baby Girl DeLauretis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
8.5 .... Bowdoin ... St.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
years
months
7 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 8, 1945
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
7./2 /45 .... ,
19.
7/8/45
...
That 1 attended deceased from
19
I last saw h
er .. alive on
7 845. 19
death Is said to
have occurred on the date stated above, at
6;10p.
... m.
Duration
Inimedlate cause of death
Cardio resp failure
Due to.
Colon meningitis
7
dys
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be charged sta- tistically.
What test confirmed diagnosis ?.
... blood culture
20 Was disease or injury in any way related to oocupation of deceased ?
(Signed)
If so, specify
B. M Mc Dona Id
M. D.
(Address)
Bo.ston
Date
7/8/45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross
Malden
DATE OF BURIAL
(Cemetery)
July 9 1945
19
22 NAME OF
FUNERAL DIRECTOR
C DiPietro
Boston ... Mas.s
ADDRESS
JUL 1 3 1945
19
Reoelved and filed
....
( Registrar of City or Town where deceased resided)
.M-00-11-12 10716
2 FULL NAME
3 SEX
Female
(or) WIFE of
8
AGE
Years.
Usual
9 Oooupation :
Industry
10 or Business :
11 Social Security No.
14 BIRTHPLACE OF
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
17
Informant
(Address)
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 with beeffred in your city of town in case the deceased
(State or country)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
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 alive
years
7 IF STILLBORN, enter that faot here.
Months
11 Days
If less than 1 day Hours .. ..... .Minutes
12 BIRTHPLACE (City)
(State or country)
Boston Mass.
13 NAME OF
FATHER
John Delauretis
FATHER (City)
Italy
Elizabeth Fotini
Boston
Father (
Relation, if any
A TRUE COPY,
--
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED July 11, 1945
1
Underline the cause to which death
Of autopsy
lumbar tap
(City or Town)
(If U. S.
War Veteran,
speolfy WAR)
(Specify whether)
St.
PLACE OF DEATH
M R-302
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
3 SEX
Ma le
white
8
AGE
Industry
10 or Business :
14 BIRTHPLACE OF
FATHER (City)
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
( Address)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 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 recordço during the previous mondi wieit occurred in your city or town in case the deceased
(State or country)
--
4 COLOR OR RACE|
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Fannie .... E. Thacher
(Husband's name in full)
6 Age of husband or wife if alive 58 years
7 IF STILLBORN, enter that faot here.
58 Years.
7
.Months
8
Days
If less than 1 day
.. Hours
.Minutes
Usual
9 Oooupation :
clerk
Cunard Steamship ... Docks
11 Sooial Security No ... ..
028-01-7645
12 BIRTHPLACE (City)
(State or country)
Boston Mass.
13 NAME OF
FATHER
Arthur J H Lucas
- M-110-11-12 10;16
PLACE OF DEATH
(County)
(C'ity or Town)
No. Peter Bent Brigham
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return
473
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
Henry B Melbourne Lucas
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15 Crest 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
19days.
In this community 8 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 10/45
(Year)
19 | HEREBY CERTIFY,
June .... 2.1/45.
.... ,
19
to
July ..... 10/45 .. , 19.
| last saw h .......¿ m.allve on ...... July ..... 10./4.5 .... , 19
...... , death Is sald to
have occurred on the date stated above, at.
1:20a .m.
Duration
Inimediato cause of death Cerebral sclerosis (artery)
Term.
Due to. Bronchopneumonia (left
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
Underline the cause to which death should be charged ata- tistically.
What test confirmed diagnosis ?
20 Was disease or injury in any way related to oocupation of deceased ?
If so, specify.
AOR Duden
(Signed)
M. D.
(Address)
Boston
Date 7/10/45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
DATE OF BURIAL
(Cemetery )
July 12/45
19
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
A B Marsh
ADDRESS
Winthrop
Received and filed
JUL 13 1943
19
(Registrar of City or Town where deceased resided)
1
15 MAIDEN NAME
OF MOTHER
Carrie Sawyer
17 Informant Son .... M T ... Lucas (
Relation, if any
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
July 12/45
19
Hospital
Registered No.
60942
1
(If U. S.
War Veteran,
speolfy WAR)
(Month)
(Day)
That I attended deceased from
dys
Of autopsy
ـجيب
+
M R-302
- M-10)- 11-12 10746
2 FULL NAME
3 SEX
(or) WIFE of
Usual
9 Oooupation :
Industry
10 or Business :
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
11 Social Security No ..
4 COLOR OR RACE
5 SINGLE
(write the word)
Male
White
MARRIED
WIDOWED
or DIVORCED Single
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
6.9./45 ..... ,
19
to
7/10/45
19
I last saw
Im
alive on
7 /10/45
19
death Is sald to
have occurred on the date stated above, at
4.3.10a .... m.
Duration
Inimedlate cause of death
Acute ... interstitial ... pneumonia
12 hrs
Due to.
Due to
Other conditions.
Infantile eczema
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Adenoidectomy
Date of
6 /22/45
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 oocupatlon of deceased?
If so, specify
no
(Signed)
F Haase
M. D.
(Address)
Boston
Date7 .. .. 10/4 59
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or Town)
DATE OF BURIAL
July .... 12/45
19
22 NAME OF
FUNERAL DIRECTOR
Kirby Bros
ADDRESS
Winthrop Mass.
Received and filed
JUL 1 3 19
19
DATE FILED
July 12/45
19
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
Frank Marukelli
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
52 Summit 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
] days.
In this community
yrs.
mos.
Į days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 10/45
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 alive
years
7 IF STILLBORN, enter that faot here.
8
AGE
Years
9
Months
25
Days
If less than 1 day .Hours. ..... .. Minutes
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
Armand Marukelli
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston
15 MAIDEN NAME
OF MOTHER
Lillian Solomon
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
Father. ( Relation, if any
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
1
PLACE OF DEATH
(County )
(C'ity or Town)
No.
Mass. General Hospital
Registered No.
608 ₺
(If U. S.
War Veteran,
speolfy WAR)
(Registrar of City or Town where deceased resided)
9 mos Physician
R-302-
1
PLACE OF DEATH
(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)
Registered No
62$245
-
No .. Veterans Administration Facility
.....
St.
give its NAME instead of street and number)
2 FULL NAME
Nicholas ... Halligan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
149 Main St
Winthrop Mass ...
(If nonresident, give city or town and state)
(Specify whether)
months
4 days.
In this community
yrs.
mos.
4 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE 5 SINGLE
MARRIED
White
WIDOWED
or DIVORCED
Married
(write the word)
18 DATE OF
DEATH.
July 13/45
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
19
to ....
.J.uly .... 13 .. 45 ..
., 19.
I last saw h .... i.m .. alive on ...
.July .... 13, 4 59.
...... ,
death is said
to have occurred on the date stated above, at ....
.2 .;. 15.p.m.
Duration
Immediate cause of death .... Arteriosclerosis .... of .... coronary ... arteries
8 AGE 88 Years 2 Months .. 8 Days
If less than I day Hours. .Minutes
Usual
9 Occupation:
Freight handler (retired)
Industry
10 or Business:
Cunard Wharf E Boston Mass.
Due to
of intestine Senility
1
Uper.
PeritonitisLocalized gangrenous
Other conditions
small ... intestine cause
Major findings :
undetermined
Of operations
Date of.
Of autopsy
see above
What test confirmed diagnosis ?
Autopsy clinicaistically.
20 Was disease or Injury In any way related to occupation of deceased ?
If so, specify
no
(Signed)
H .W .Baxley
.
M. D.
(Address)
Boston
Date 7/13/499 ....
21 PLACE OF BURIAL.
CREMATION OR REMCVAL
Holy Cross
Malden
DATE OF BURIAL
July 16/45
19
22 NAME OF
FUNERAL DIRECTOR
J C Kelly
ADDRESS
JUL 1 2'gston ... Mass ...
Received and filed.
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ire land
15 MAIDEN NAME
OF MOTHER
Judy Dolehanty
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ire land
Relation, if any
17 Informant. (Address)
Hospital records
ATTEST:
A TRUE COPY Dancis . 4 ay
(Registrar of city or town where death occurred)
DATE FILED
July .... 17/45
19
(Include pregnancy within 3 months of death)
PHYSICIAN
12 BIRTHPLACE (City)
(State or country)
Ireland
13 NAME OF
FATHER
John Halligan
Due to
Mesenteric thrombosis and gangrene
(or) WIFE of
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Bridget ..... Guinan
(Husband's name in full)
6 Age of husband or wife if alive 76 years 7 IF STILLBORN, enter that fact here.
11 Social Security No.
Fury tub ustcake Itslaed fa another city of town at the time
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.)
(If death occurred in a hospital or institution,
(Jf U. S.
War Veteran,
specify WAR)
Indian Wars
(2) Residence. No.
(Usual place of abode)
Length of stay : In hospital or institution.
years
(Cemetery)
(City or Town)
Underline the cause to which death should be charged stx-
19
M R-305
SUFFOLK
The Commontorralth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
6263146
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Michael Joseph Michael J Sullivan
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
59 Summit 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
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July 14/45
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
Eunice Patchel
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If alive 40
years
7 IF STILLBORN, enter thst fsot here.
AGE
Years
10
Months.
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Brick layer
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Somerville Mass.
13 NAME OF
FATHER
John J Sullivan
14 BIRTHPLACE OF
FATHER (City)
(State or country)
.Wale.s
15 MAIDEN NAME
OF MOTHER
Mary F Donovan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
17 Wife
Relation, if sny
Informant
(Address)
A TRUE COPY.
ATTEST :
Francis
(Registrar of city or town where death occurred)
DATE FILED
July ..... 19., .... 19.4.5.
19
21 Was disease or Injury In any way related to ocoupation of deceased?
If so, speolfy
(Signed)
W. J Brickley
M. D.
(Address)
Boston .... Nas.s
Date ..
7/15/45
22
Winthrop
Winthrop
Place of Burlal, Cremstion or Removal.
DATE OF BURIAL
July .... 17 /45.
19
(City or Town)
23 NAME OF
FUNERAL DIRECTOR
Kirby Bros
ADDRESS
JUL1 32194 throp Mass.
Received and filed
19
(Registrar of City or Town where deceased resided)
1
Where did
Injury occur?
(City or town and Stste)
Did Injury occur In or about the home, on farm, In Industrial place, or In publio place? (Specify type of place)
Manner of
Injury
Collapsed ... and .... died .... quickly ... en
Nature of
route to Hospital
Injury
While at work ?
Was there an autopsy?
no
25m (h)-1-41-4667
3 SEX
Male
HUSBAND of
(or) WIFE of
8
49
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
Copies of returns of deathis recorded during the previous month which occurred in your city of town in case the deceased
Industry
10 or Business :
4 COLOR OR RACE|
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
No.
PLACE OF DEATH
(City or Town) en route to E Boston Relief Station st.
(If U. S.
War Veteran,
specify WAR)
W.W.1
(a) Residence. No.
(Usual place of abode)
Married
19 | HEREBY CERTIFY that I have Investigsted the death of the person above named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Acute cardiac failure Probably coronary sclerosis
20 Acoldent, sulolde, or homicide (specify)
Date of ocourrenoe
19
M R-302
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Suffolk (County)
Revere
(C'ity or Town)
No. Wheaton Nursing Home
The Commontoralth of Massachusetts OFFICE OF THE. SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or town making return)
§ (If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2 FULL NAME
Walter A. Cook
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
76 Bowdoin
St.
Winthrop
Previousisof abedechildren's Hospital, Boston
Length of stay : in hospital or Institution ..... non.e.
(Before death)
(Specify whether)
years
months
days.
in this community
2
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July
24
1945
(Month)
(Day)
(Year)
19 J HEREBY CERTIFY,
July 20
......
to
That
July 23
...
19.
45
I last saw h.j.m ....... alive on.
July23
19 45
death Is said to
have occurred on the date stated above, at.
6:
A .... m.
Duration
Immedlate cause of death Brain .... Tumor.
(Intramedullary Neoplasm)
8
6
Years.
10 Months
.. Days
If less than 1 day
Hours.
.Minutes
Due to.
Usual
9 Occupation :
At School
Industry 10 or Business :
11 Sooial Security No.
12 BIRTHPLACE (City)
East Boston
(State or country)
Mass.
Major findings :
Of operations.
Intrapagaren
edullary Ngopl
·
14 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Doris A. Godfrey
20 Was disease or injury in any way related to occupation of deceased ?
If so, speolfy
D. J. O' Brien
M. D.
(Signed)
(Address)
Winthrop, .... Mas.s ..... Date
7/24.45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Glenwood
Everett
DATE OF BURIAL
(Cemetery)
July 26
(City or Town)
1945
A TRUE COPY.
ATTEST :
Charles B. Lagam
(Registrar of city or town where ticath occurred)
DATE FILED
July 27
1945
22 NAME OF
FUNERAL DIRECTOR
Frederick J. ..... Magrath
ADDRESS
64 Meridian St., East Boston
Reoelved and filed
JUL 1 4 -1945
(Registrar of City or Town where deceased resided)
25M-(0)-11-12 10716
4 COLOR OR RACE
5 SINGLE
(write the word)
Male White
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
London
(State or country)
England
17 Harold H. Cook
ReputHer
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