USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 55
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No undertaker or other person shall bury a human body or the ashes thereof which bave been brought into the commonwealth untli he has received a permit so to do from the board of health or Its agent appointed to issue such permite, or if there is no such board, from the clerk of the town where the hody is to be buried or the funeral is to be held, or from a person appointed to have tbe care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths 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 such deaths 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 death is needed.
(3) Medical Examiners will investigate and certify to ali 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 foliowing 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 la 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
R-302
1
PLACE OF DEATH
SUFFULA (County)
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
160
(City or town making return)
Registered No.
6710
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Baby Girl Vaccaro
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
210 Woodside Ave
St.
Winthrop Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or institution
(Before death)
(Specify whether)
years
months
6
days.
In this community
yrs.
mos.
6
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jul 29/45
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
7/23/45
19
That I attended deceased from
to
7/29/45
19
I last saw h ....... e.r ... allve on
7. 29 /4.5
19
., death Is sald to
have occurred on the date stated above, at
6.300a ..
.. m.
Duration
Immediate cause of death
Bronchopneumonia
12 hrs
7 IF STILLBORN, enter that faot here.
8 AGE Years Months. 6 Days
If less than 1 day .Hours. Minutos
Usual
9 Oooupation :
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City).
(State or country)
inthrop Mass.
13 NAME OF
FATHER
Ralph A Vaccaro
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
E Boston Mass.
15 MAIDEN NAME
OF MOTHER
Elizabeth A Austin
16 BIRTHPLACE OF
MOTHER (City)
E Boston Mass.
(State or country)
17 Informant. (Address)
Grand mother Mrs. .... S. Vaocaro
A TRUE COPY:
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Aug 3/45
19
Received and filed SEP 1 1 1945 19
(Registrar of City or Town where deceased resided)
25M-(f)-11-12 10716
3 SEX
Female
4 COLOR OR RACE|
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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
Due to.
Aspiration of feeding
Due to.
Other conditions.
Prematurity
since birth
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings:
Of operations
which death
Date of
should be
Of autopsy prematurity
What test confirmed dlagnosis ? Phys .... exam
charged sta- tistically.
20 Was disease or Injury in any way related to occupation of deceased? If so, specify
(Signed)
W.FitzHugh
M. D.
(Address)
300.Longwood ... Ave Date.
7/20195
...
21 PLACE OF BURIAL,
Winthrop
(Cenietery)
(City or Town)
DATE OF BURIAL
Aug-3/45
19
22 NAME OF
FUNERAL DIRECTOR
A ... B ... Marsh
ADDRESS
Winthrop Mass.
CREMATION OR REMOVAL
Winthrop
Relation, if any
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
A
.... BOSTON
No. Infants Hospital
(If U. S.
War Veteran,
speolfy WAR)
1
M R-302
1
PLACE OF DEATH
SUFFOLK (County)
OVIVYEN
The Commontoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
161 (City or town making return)
Registered No.
6838
( If death occurred in a hospital or institution, St. give its NAME inetead of street and number)
2 FULL NAME
Pauline Doucette/
(If deceased ie a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
66 .... Centre ... S.t
........ St.
Winthro.p ... Mass ..
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
3 monthe 26 daye.
In this community
13 yre.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August 6, 1945
(Month)
(Day)
(Year)
19 |
HEREBY, CERTIFY
Apr 1045
19
Aug 6/45
19.
That /l attended deceased from
I last saw h ... er ....... alive dug ... 645
, 19
death Is sald to
have occurred on the date stated above, at.
7 .; 30a
.. m.
Duration
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
8 AGE .. 39 Years .Months. Days
If less than 1 day
Hours ...........
Minutes
Usual
9 Oocupatlon :
Housewife
Adenocarcinoma site unknown
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Metastatic ... adenocarcinoma
Date of
Underline he cause to which death should be charged sta-
Of autopsy
Path repeat of biopsy
What test confirmed diagnosis ?
20 Was disease or injury in any way related to oocupation of deceased ?
If so, speolfy
TE Kilfoyle
( Signed)
M. D.
(Address)
Boston
Date. 8./6 /4.59
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or Town)
DATE OF BURIAL
Aug8/45
19
22 NAME OF
FUNERAL DIRECTOR
J F O' Maley
ADDRESS
Winthrop Mass.
Reoelved and filed
SEP 1 1-1945
19
(Registrar of City or Town where deceased resided)
25M-10-11-12 10716
3 SEX
Female
PARENTS
v. iltutto vi uns record during the previous month which occurred in your city of town in case the deceased
Industry
10 or Business :
11 Social Security No ..
14 BIRTHPLACE OF
15 MAIDEN NAME
OF MOTHER
(State or country)
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
(State or country)
4 COLOR OR RACE
White
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)
(or) WIFE of
Ulysse.
J' Doucet
(Husband's name in full)
Own. Home.
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
13 NAME OF
FATHER
Leo Le Blanc
FATHER (City)
Nova Scotia
Emily Ward
16 BIRTHPLACE OF
MOTHER (City)
Nova Scotia
Relation, if any
Husband
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Aug 9, 1945
19
TON
(City or Town)
No.
Carney Hospital
(If U. S.
War Veteran,
specify WAR)
Immediate cause of death Circulatory .... collapse.
Due to.
Metastatic lesions of adenocarcinoma
SUFFOLK ...
M R-302
1
PLACE OF DEATH
(County) BOSTON (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
-
(If death occurred in a hospital or institution,
St. give its NAME instead of street and number) r
2 FULL NAME
Rachel Bennett
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
8.8 .... Circuit .... Rd.
St.
Winthrop .... as.s.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
months
18 days.
In this community 3
y rs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug 12/45
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
7/24/45
19
to ..
That /12/45
19
1 last saw h ...... e.l .... alive on.
8/11/45
19
death Is sald to
have occurred on the date stated above, at
5;4.0a
.m.
Duration
Immedlate cause of death
Uremia.
3wks
7 IF STILLBORN, enter that fact here.
8
AGE ..... 6.3 ... Years.
Months.
.Days
If less than 1 day
Houra .........
Minutes
Usual
9 Occupation :
Housework
Own home
12 BIRTHPLACE (City)
(State or country)
Newfoundland
13 NAME OF
FATHER
Philip Penney
14 BIRTHPLACE OF
FATHER (City)
Newfoundland.
Catherine Lewis
Newfoundland
Laughter Dorothy-Hur Relation, if any
A TRUE COPY
ATTEST :
(Registrar of Aug 177/45
occurred) 19
vujues ut returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
25M-(f)-11-12 10716
3 SEX
Female
(or) WIFE of
Industry
10 or Business :
11 Social Security No ..
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.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
(State or country)
4 COLOR OR RACE
"hite
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give. maiden name ofgriffinfull)
(Husband's name in full)
6 Age of husband or wife if alive years
Due to.
Carcinoma of ovart
6mos
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 sta- tistically.
Of autopsy
What test confirmed dlagnosis ?
20 Was disease or injury in any way related to oocupation of deceased ?.
If so, specify
(Signed)
F W Ingersoll
M. D.
(Address)
Boston
Dat8/12.459.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Holy Cross
Malden
DATE OF BURIAL
Aug 15/45.
.19
22 NAME OF
FUNERAL DIRECTOR
Charles H Treanor
ADDRESS
Boston .Mass.
Received and filed
SEP 1 1 1945
19
( Registrar of City or Town where deceased resided)
162
No.
New England Deaconess Hospital
(City or town making return) ·
Registered No.
7051
(If U. S.
War Veteran,
specify WAR)
attended
deceased from
(Cemetery )
(City or Town)
DATE FILED
RM R-302
Hampden
(County)
The Conunontwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Westfield
(City or town making return)
1
Westfield
(City or Town)
No. Westfield State ... Sanatorium
St.
(If death occurred in a hospital or institution,
give its NAME instead of strect and number)
2 FULL NAME
Ernest Boutillier
(a) Residence. No.
55 Sunnyside Ave.
(Usual place of abode)
Hospital
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE!
White
MARRIED
WIDOWED
or DIVORCED
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
60
7 IF STILLBORN, enter that fact here.
8
If less than 1 day
Hours ...
AGE .
66
Years
Months
16Days
Usual
9 Occupation :
Laborer
10 or Business :
11 Soolal Security No ..
024-01-5528
12 BIRTHPLACE (City)
Fast ..... Boston
(State or country)
Masg.
13 NAME OF
FATHER
James W. Boutillier
14 BIRTHPLACE OF
FATHER (City)
Boston,
15 MAIDEN NAME
OF MOTHER
Sarah Boutillier
PARENTS
. .....-. , WIIn ONFADING BLACK INK - THIS IS A PERMANENT RECORD
Industry
Army Base, Boston, Mass.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug. 18,
1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
.June
4
19.4.5
to
August 18, 19 45
I last saw h.
1m ... alive on.
Aug ..
18.
... 19.45 death is said to
have oocurred on the date stated above, at
4:20A.
m.
Duration
Immediate cause of death
Advanced pulmonary
tuberculosis
Due to.
Due to.
Other conditions
Arteriosclerosis
Physician
(Include pregnancy within 3 months of death)
Major findings :
Of operations
no
Date of
Underline the cause to which death should be charged sta- tistIcally.
Of autopsy
See above
What test confirmed diagnosis? Autopsy X-Ray
If so, speolfy.
"Sputum
20 Was disease or injury In any way related to occupation of deceased ?
no
(Signed)
PhoebeClover
Westfield San.
Dato.
19
8/18
M. P.
(Address)
21 PLACE OF BURIAL,
CREMATION OR REMOVALWinthrop-Winthroplags.
(Cemetery)
(City or Town)
1945
.2.2
22 NAME OF
FUNERAL DIRECTOR
Richard White
ADDRESS
147 Winthrop ... St. Winthrop
Received and filed
SEP 1 1 1945
19
DATE FILED
5 SINGLE
(write the word)
Married
5a If married, widowed, or divoroed
HUSBAND of
Jessie Galbraith
6 Age of husband or wife if alive years
Minutes
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
Informant.
Hospital Records
(
xongany
(Address)Westfield State Sanatorium
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
Aug.
21,
19
45
Registered No.
163
(If U. S.
War Veteran,
specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
St.
Winthrop Mass
(If nonresident, give city or town and State)
years
2
months
14days.
In this community
yrs.
2
mos. 14 days.
PLACE OF DEATH
17 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.) resided in another city or town at the time of death should he made forthwith and transmitted on Form R.802 to the clerk (State or country) Mass.
50m (e)-1-41-4667
DATE OF BURIAL
Aug ..
(Registrar of City or Town where deceased resided)
8 mos.
M 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-802 to the clerk Cyprien VI returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
SUFFOLK
PLACE OF DEATH
(County) BOSTON (C'ity or Town) Beth Israel Hospital
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
164
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Celia Silverman
(If deceased ia a married, widowed or divorced woman, give also maiden name.)
284 River Rd
st."inthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months 8 days.
In this community
yrs.
mos. 8
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
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Aug .12/45
19
That I attended deceased from
to
Aug
19/45
19
... e.r ......
.Aug .19 /45
19.
death Is said to
have occurred on the date stated above, at
9/108
.. m.
Duration
Immediate cause of death. Acute ... myocardial ... infarct.
7 IF STILLBORN, enter that fact here.
AGE ..
Years Months .Days
If less than 1 day
Hours .........
Minutes
Usual
9 Occupation :
Housewife.
Industry
10 or Business :
at ... home
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
Austria
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
none
Date of
Physician 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 oocupation of deceased ?
If so, speolfy
no
(Signed)
M Lubin
M. D.
(Address)
Boston
Dat8/19/459
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Ohel Jacoo
Woburn
(Cemetery)
(City or Town)
DATE OF BURIAL
Aug ... 20/45
19
22 NAME OF
FUNERAL DIRECTOR
E. Meltzer
ADDRESS
Roxbury
Received and filed
-PT1 1945
19
( Registrar of City of Town where deceased resided)
25M-(0)-11-42 10746
A TRUE OOPY.
ATTEST:
amais
DATE FILED
(Registrar of city or town where death occurred)
Aug 21/45
19
18 DATE OF
DEATH
Aug 19/45
Female
White
5a If married, widowed, or divorced
HUSBAND of
Kaix midivermanife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
.72
years
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Austria
(State or country)
15 MAIDEN NAME
OF MOTHER
Muttle
---
16 BIRTHPLACE OF
MOTHER (City)
Austria
(State or country)
17
Informant
(Address)
Husband
(
Relation, if any
Registered No.
72.06
(If U. S.
War Veteran,
speolfy WAR)
(a) Residenoo. No.
(Usual place of abode)
No.
1
8
70
Due to ...
Arterioscleroti.c ... heart ... disease
Due to
13 NAME OF
FATHER
Hirsh Waldman
1
RM R-305
SUFFOLK (County BOSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
165
Registered No.
7.29.8
St. (If death occurred in a hospital or institution, 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) Residenoe. No.
(Usual place of abode)
349 ··· Shirley ···· St .···········........ St.
Winthrop .Mas.s.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
yeara
montbs
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
5a If married, widowed, or divoroed HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
8 AGEA.7. .. Years. Months .. 12 ...... Days
If less than 1 day Hours ....... .Minutes
Usual
9 Ocoupation :
none
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
Gloucester Mass.
13 NAME OF
FATHER
John P Silva
14 BIRTHPLACE OF
FATHER (City)
Azore Islands
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Silva OK
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Azores Islands
17 Informant (Address)
Mother
Relation, if any
A TRUE COPY.
trangis
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Aug 24/45
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug 22 45
(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.) Bronchapneumonia Oedema ... brain .... and .... lungs. Alcoholism
20 Acoldent, sulolde, or homicide (specify)
Date of ocourrenoe.
19
Where did
Injury occur ?
(City or town and State)
Did Injury ocour In or about the home, on farm, In Industrial place, or In publio place? (Specify type of place)
Manner of
Injury
Found collapsed in his home
Nature of
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
(Signed)
W J Brickley
M. D.
(Address)
Bo.s.t.on
Date ..
8 /22/45
22
Calvary Cem
Gloucester Mass.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Aug .25/45
19
23 NAME OF
FUNERAL DIRECTOR
J.C.Greely
ADDRESS
Gloucester ... Ma 8.8.
Received and filed
SEP -1-1- 1945
19
(Registrar of City or Town where deceased resided)
25m (h)-1-41-4667
3 SEX Male PARENTS 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 Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased Industry 10 or Business :
PLACE OF DEATH -
1
(City or Town)
No. Boston ... Psychopathic ... Hospital
Manuel ... Silva
(If U. S.
War Veteran,
specify WAR)
8
RM R-305
SUFFOLK BOSTON ..
(County)
1
(City or Town)
No. Mass. General Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
7378166
Registered No.
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
John P White
2 FULL NAME.
(If deceased is a married, widowed or divorced woinan, give also maiden name.)
(a) Residence, No.
(Usual place of ahode)
204 ... Pauline
St.
Winthrop ... Mas.s.
(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
35 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Aug 23/45
(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.)
Acute cardiac failure
Chronic myocarditis
Probably coronary sclerosis
20 Acoldent, sulolde, or homlolde (specify)
Date of ocourrenoe.
19
Where did Injury ooour ? (City or town and State)
Did Injury oocur In or about the home, on farm, In Industrial place, or In
publlo place?
(Specify type of place)
Manner of
InJury
Collapsed and . died .quickly
Nature of
Injury
While at work ?.
Was there an autopsy?
.no
21 Was disease or Injury In any way related to oooupation of deoeased ?
If so, speolfy.
(Signed)
W J Brickley
M. D.
(Address)
Boston
Date.
8/23145
22
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
Aug 27/45
19
23 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop .. Mass
Received and filed
SENTI 1945
19
(Registrar of Clty or Town where deceased resided)
-
5a If married, widowed, or divorced HUSBAND of
Mary G Harvey
(Give maiden name of wife in full)
(or) WIFE of
(Hushand's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
8
AGE .... 6.5 ... Years.
.Months.
Days
If less than 1 day
Hours ..
.Minutes
Usual
9 Occupation :
Conduct.o.r.
11 Soolal Seourity No.
7:00-05-47-14
12 BIRTHPLACE (City)
(State or country)
Lincoln Mass.
13 NAME OF
FATHER
Thomas White
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ellen Cuffe
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17
Informant
(Address)
Son Thomas White
( ...
A TRUE COPY.
ATTEST :
(Registrar of city or town. where death occurred)
DATE FILED
Aug 27/15.
19
Relation, if any
25m (h)-1-41-4667
PLACE OF DEATH
4 COLOR OR RACE[
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
3 SEX Male 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 deaths recorded during the previous month which occurred in your city or town in case the deceased Industry 10 or Business :
(If U. S.
War Veteran,
specify WAR)
Winthrop
M R-302
PLACE OF DEATH
Suffolk (County)
Revere
(C'ity or Town)
No.
Revere .... General .... Hospital
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
(If U. S.
War Veteran,
speolfy WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
207 Cottage Pk Rd.
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
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