USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 67
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SPACE FOR ADDITIONAL INFORMATION
M R-301
suffolk
(County)
Winthrop
(City or Town)
notifica 11/9% 45
The Commonmralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Winthrop
(City or town making return)
Registered No 201 ....
§ (If death occurred in a hospital or Institutlon, .St. { give its NAME instead of street and number)
2 FULL NAME .. .... Elizabeth .. Santarpio
(If deceased is a married, widowed or divorced woman, give also maiden name.)
a) Residence.
112 Gladstone St. F. Boston, Mass. .. St.
(Usual place of abode)
(Before) 26 xx
4 years
months
13h . In this community
yra.
mos.
daya.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE |
White
8 SINGLE
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced
HUSBAND of.
(Glve malden name of wife In full)
Vincent Santarpio
(Husband's name In full)
6 Age of husband or wife if alive. 33 years
7 IF STILLBORN, enter that fact here.
8 33 .Years. Months Days
If less than 1 day
.... Hours
Minutes
Housewife
At Home
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
East Boston ass.
13 NAME OF
FATHER
Anthony Rotando
14 BIRTHPLACE OF
FATHER (City) ......
Italy
(State or country)
16 MAIDEN NAME
OF' MOTHER
Haknown
16 BIRTHPLACE OF
MOTHER (City).
(State or country)
Italy
17 Vincent Santander
Relatlon, If any
Informant .............. (Address)
112 Thedetro Its. en00Baratos
I HEREBY CERTIFY that a satisfactory standard certificate of death was fjlyd with ms BEFORE the burial or transit permit was issued: Nu D. Children x (Signature of Agoot of Board of Health orother) Healthe Officer 66/1/45
(Omcial Designatlon)
(Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
OCH
(Month)
31,
4)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
C
18,
19.925 to ..
1945
have occurred on the date stated above, at.
9Am
m.
I last saw het alive on.
19 65, death is said to
Immediate cause of death.
Caramelos
Due to.
Primay (Breasts)
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Major findings: Of operations
Of autopsy
What test confirmed diagnosis ?.
PHYSICIAN Underline the cause to which death should be charged ata- tiatIcally.
20 W'as disease er injury in any way related to occupation of deceased ?. If so, specify.
(Signed)
Cencantan
M. DA
(Address) 156Pm CSTCAN
10-31
21 Foly bus
Place of Burial, Cremation or Removal, 3 (Clty or Town) 45
DATE OF BURIAL
19
22 NAME OF FUNERAL DIRECTOR ADDRESS.
Thickas
Received and filed 19
A TRUE COPY ATTEST: (Registrar)
N. B. WRITE PLAINE YLE
100m(h)-1-41-4695
1 3 SEX (or) WIFE of AGE. Usual 9 Occupation :. PARENTS If deceased was a U. S. War Veteran, G. L., Chap. 46, Sec. 10, requires physician to insert a recital to that effect. See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. .. VAI BILDUIU De carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF Industry 10 or Business :....
PLACE OF DEATH
NO.Winthrop Community Hospital ....
(Nee (Notândo)
PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran? If so, (specify WAR)
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
2 days.z3min.
Duration Important 2 yrs
2yrs
Important
Date of.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shaii forthwith, after the death of a person whom he has attended during his last lilnees, at the request of an undertaker or other authorized person or of any member of the famlly of the deceased, furnlah for registration a standard certificate of death, stating to the hest of his knowledge and helief the name of the deceased, his supposed age, the disease of which he dled, defined as required hy section one, where same was contracted, the duration of his last Iliness, when last seen alive hy the phyalclan or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required hy the preceding section or hy section forty-five of chapter one hundred and fourteen, shaii, if the deceased, to the best of his knowledge and helief, served In the army, navy or marine corps of the United States In any war in which It has been engaged, Insert In the certificate a recitai to that effect, specifying the war, and shall aiso certify in such certificate hoth the primary and the secondary or Immediate cause of death as nearly as he can state the same. For neglect to comply with any pro- vision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen .- General Laws, Chap. 46, Sec. 10.
No undertaker or other person shali hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not heen buried, until he has received a permit from the hoard 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 person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv- Ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the cierk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such hoard, agent or cierk, as the case may be, a satisfactory written statement containing the facts required hy law to be returned and recorded, which shall he accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or If, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- pioyed hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make auch certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that auch hody shail be returned to the town from which it was removed within thirty-six hours after such removai, unless a permit in the usual form for the re- movai of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-
six, that the i eceased served In the army, navy or marine corps of the United States in any war In which It has been engaged, such recital abail appear upon the permit. The hoard of health, or its agent, upon receipt of auch statement and certificate, ahali forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit la so given and the physician certifying the cause of death shall thereafter furnish for reglatration 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 .- Chap, 114, Sec. 45, G. L., (Tercentenary Edilian),
Medical examiners shaii make examination upon the view of the dead bodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there Is within hla county the body of such a person, he chaii forthwith 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 hury a human body or the ashes thereof which have heen brought into the commonwealth until he has received a permit so to do from the hoard of health or its agent appointed to issue such permita, or if there Is no such board, from the cierk of the town where the body is to be huried or the funeral ls to be held, or from a person appointed to have the 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 ohservance of the following rules of practice:
(1) Attending physicians wili certify to such deaths only as those of persons to whom they have given hedside care during a iast illness from disease unrelated to any form of Injury.
(2) Board of Health physicians wili certify to such deaths only as those of persons who, though disabied 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 all deaths supposably due to injury. These Include not only deaths caused directly or indirectly by traumatism (including resuiting septicemia), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but aiso deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled 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, nat the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principai cause name the disease causing death. As related causes, name earlier morhid conditlona, if any, related to the principai cause and any important complication of the principai cause.
Statement of Occupation .- Precise statement of occupation la very Important, so that the relative heaithfuiness of various pursuits can he known. Make some entry In this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to iliness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at schaal 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-hatel, etc. For a person who had no occupation whatever write nane.
SPACE FOR ADDITIONAL INFORMATION
I R-302
Middlesex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
(City or town making retur
202
Registered No.
1470
2 FULL NAME
Jennie Johnson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
16 Bellevue Ave .
(Usual place of abode)
Hosp
3
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
4 COLOR OR RACE|
female white
5 SINGLE
(write the word)
widowed
18 DATE OF
DEATH
Oct 16 1945
(Month)
(Day)
(Year)
5a If married, widowed, or dlvoroed HUSBAND of
(or) WIFE of
WVi ](fiye maiden mmesoft wife in flyhason
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that faot here.
8
74 Years
5
Months
27
Days
If less than 1 day
.Hours
.Minutes
Usual
9 Ocoupatlon :
Housework
Industry
Own home
10 or Business:
11 Soolal Security No.
Hillsboro
12 BIRTHPLACE (City)
(State or country)
IT.H.
13 NAME OF
FATHER
William Mason Sargent
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Plainfield
(State or country)
U.H.
15 MAIDEN NAME
OF MOTHER
Almira Martin
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Norwich
Vt.
17 Miss Mabel 2 Sargen tRelation, if any
Informant ....
(Address)
146 Coring "t. "ut teinter-)
A TRUE COPY.
ATTEST :
Q.c.t ..... 18 .1945
(Registrar of city or town where death; occurred)
DATE FILED
Of autopsy
What test confirmed diagnosis?
20 Was disease or Injury In any way related to oooupation of deceased?
If so, speolfy.
B. C. Tittlebaum
(Signed)
(Address)
176 Broadway Som
Date.
Cct 43 . 495
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL
Oct Cemetery)
20 1945
Hillside Cem. Townsend
(City or TownylaSS
19
22 NAME OF
FUNERAL DIRECTOR
Inez C Long
ADDRESS
Cambri Up
19
Received and filed
NOV 1 3 ,1945
(Registrar of City of Town where deceased resided)
50m- (b) -6-44-14607
OmDIE Franviner city ur 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.)
1
MARRIED
WIDOWED
or DIVORCED
19 I HEREBY CERTIFY,
July 14
to
19
.45
Oct 16
1945
I last saw h.@ ........... allve on0.c.t ..... 1.6
191.5 .. , death Is sald to
have ooourred on the date stated above, at.
m.
Immedlate oause of death. General Carcinomatosis
Duration 1943
Due to.
probably intestinal
Due to.
Other conditions ..
myocarditis
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Physician Underline the cause to
which death
Date
should be
charged sta- tistically.
AGE
(County)
Cambridge
(City or Town)
No.
St.
Misses Foley Sanatorium
-
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
7 Chester St.
(If U. S.
War Veteran,
spoolfy WAR)
r
PLACE OF DEATH
( Sargent
1
*
St.
Winthrop
(If nonresident, give, city or town and State)
That I attended deceased from
ـ- جيد
R-302
Essex
CASEPE
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
203
Registered No.
(If death occurred in a hospital or institution,
St.
2 FULL NAME
Andrew Sturla
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
40 Argyle
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 26
days.
In this community
yrs.
mos.
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 Widowed
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.
8
AGE
67
Years
Months.
Days
If less than 1 day Hours .......... .Minutes
Usual
9 Occupation :
Laborer
Industry 10 or Business :
11 Social Security NCannot be learned
12 BIRTHPLACE (City) buenos Aires
(State or country)
argentina
13 NAME OF
FATHER
Cannot be learned
14 BIRTHPLACE OF
FATHER (City)
Cannot be learned ..
(State or country)
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17
Informant.
M.K.McPhillips
(
Relation, if any
(Address)
A TRUE COPY.
ATTEST :
(Registrar of city of town Where death occurred)
DATE FILED
10/26/15
19
18 DATE OF
DEATH
Oct. 19, 1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
Aug ... 2.3.
...
19 .....
45
, to
Oct ....... 1.9
19.
.4.5
.. alive on
I last saw h ..
im
Oct.
19
495
death Is sald to
have occurred on the date stated above, at.2 ... 55 .... P.
m.
Duration
Immedlate cause of death
Cerebral Thrombosis
1-2
days
Due to.
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 ?
autopsy
20 Was disease or injury in any way related to oocupation of deceased ?
If so, speolfy
Pasquale Buoniconto
(Signed)
(Address)
DSH
Date 0/25/35
M. D.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL Michael's Boston
DATE OF BURIAL
(Cen
10/22/45
19
(City or Town)
22 NAME OF
Michael J. Porcella
FUNERAL DIRECTOR
ADDRESS
Boston ..
Reoelved and filed
NOV 1-4-1945
19
(Registrar of City or Town where deceased realded )
25M-(f)-11-42 10746
Sredthe city vr town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) PARENTS
PLACE OF DEATH
(County) Danvers
1
(C'ity or Town) Danvers State Hospital No.
give its NAME instead of street and number)
1
(If U. S.
War Veteran,
speolfy WAR)
Underline the cause to
which death
Of autopsy
R-302
1
PLACE OF DEATH
Middlesex
(County)
Lexington
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lexington (City or town making return)
204
( If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Helen C. Donoghue
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
105 Bartlett Rd.
(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)
Metropolitan
2
years
1
montis
day's.
21
In this community
yrs.
mos.
days.
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
single
(Month)
(Day)
(Year)
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."
AGE.
8
30
Years
5
Months
20
Days
If less than 1 day Hours. .Minutes Due to.
Usual
9 Occupation :
Stenographer
Industry
10 or Business :
U. S. Army
11 Social Security No ..
Boston
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Charles Donoghue
PARENTS
14 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Bridget A. Sullivan
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 InformantMetropolitan State Hostitym (Address)Waltham, Mass, Records
A TRUE COPY. James & Carroll
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
October
26 19 45
18 DATE OF
DEATH
October 24
1945
19 | HEREBY CERTIFY, That I attended deceased from
September, 31943
....
. to October 24.
19 45
I last saw her
allve on.
October 24, 145, death Is sald to
have occurred on the date stated above, at. 9:20 P ....... m.
Duration
Immediate cause of death
Rheumatic heart disease
12 yrs.
Bronchopneumonia
1 ... day
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings :
Of operations.
Date of.
which death should be chargedsta- tistically.
Of autopsy
none
What test confirmed dlagnosis?
clinical
20 Was disease or Injury in any way related to oocupatlon of deceased?
If so, speolfy.
Elizabeth T. Hill
( Signed) .
Waltham, Mass.
Date.
10/24
M., D- 45
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Holy Cross, Malden
(Cemetery)
DATE OF BURIAL
Oct. 27
(City or Town)
1945
FUNERAL
DIRECTOR
22 NAME OF
F. J. Crosby
12
Warren St.Roxbury
ADDRESS
Reoelved and filed
NOV 1 3 1945.
19
(Registrar of City or Town where deceased resided)
wa we tily or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
25M-(0)-11-12 10746
No.
(City or Town) Metropolitan State Hospital
St.
Registered No.
(Address)
(Give maiden name of wife in full)
R-302
Middlesex
(County)
Cambridge
(City or Town) Holy Ghost Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambriame
(City or town making return)
205
Registered No.
14.9.5
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2 FULL NAME
Robert W Farrington
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
35 Enfield
(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
5 days.
In this community
yr8.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
single
5a if married, widowed, or divoroed 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 72 Years Months. Days
If less than 1 day Hours. .Minutes
Usual
9 Ocoupation :
Messenger Service
10 or Business:
11 Soolal Seourity No ..
12 BIRTHPLACE (City)
(State or country)
Bust Boston
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary Mc Carthy
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 Mrs Ellen M Skehan ( Relation is any Informant (Address) 35 Cufield Rd Winthrop
A TRUE COPY.
ATTEST:
Oct 24 1945
(Registrar of city or town where death occurred)
DATE FILED
.19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct 24 1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Oct 19
1945.
.. , to
Oct 24
1945
I last saw h.i.m
... alive
Oct
24
1515 .. , death is said to
have ooourred on the date stated above, at
11.50
Duration
Immediate cause of death Cerebral Hemorrhage
Left Hemiplegia
July
1945
Due to.
Second Cerebral Hemorrhage
Due to.
Rt Hemiplegia
3dys
Other conditions.
Como
(Include pregnancy within 3 months of death)
Major findings:
Of operations.
Date of
should be
charged sta- tistically.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury in any way related to-occupation of deceased ?. NO ...
If so, specify
(Signed) ........................... d.1.03.
M. D.
(Address) Holy Ghost Hospotet :1519 15
21 PLACE OF BURIAL,
Holy Cross Cem Malden
CREMATION OR REMOVAL
(Cemetery )
(City or Town)
DATE OF BURIAL
Oct
27
1945
19
22 NAME OF
FUNERAL DIRECTORRichard ..... C .... Kirby.
ADDRESS
17 Bennington Of Boston
Received and filed
NOV 1 3 1945
(Registrar of City or Town where deceased resided)
Som- (b) .6-44-14607
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.)
x
1
PLACE OF DEATH
No.
(If U. S.
War Veteran,
spoolfy WAR)
Winthrop
St.
That I attended deceased from
(Give maiden name of wife in full)
Industry
Own Business
Physician Underline the cause to which death
13 NAME OF
FATHER
Dennis Harrington
M R-301
= Suffolk +
(County) Winthrop (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
206
Registered No.
§ (If death occurred in a hospital or institutlon, St. [ give its NAME instead of street and number) PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran? If Bo. (specify WAR)
(a) Residence. No ..
(Usual place of abode)
g Willow Terr.
St
(If nonresident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
-months -days.
In this community
yrs.
n108.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Single
8. If married, widowed, or divorced
HUSBAND of
(Glve 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 fact here.
8
AGE
Years
Months ...
Days
If less than 1 day
.Hours NO ... 5 Minutes
11 Social Security No ...
12 BIRTHPLACE (City).
(State or country)
maso.
13 NAME OF
FATHER
Foster@Shaw
14 BIRTHPLACE OF
FATHER (City) ...
Dover
(State or country)
New Jersey
18 MAIDEN NAME
OF MOTHER
Dorothy Reid
Winthrop
(State or country)
Mass.
17 Foster Shaw
Relation, if any Father
(Address)
9 Willow Terr.
Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with m. BEFORE the barid or traneit permit was issued : Www.D. Children (Signature of Agent of Board of Health or other) Theatthe Officer 11/5/45
(Oficial Designatlon) (Date of Issue of Pormit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
....
(DAY)
4
1945 / (Year)
19 HEREBY CERTIFY !!
1945
to
That I attended deceased from
I last saw h ... tuy).alive on.
HA, 4. 19 44 death is said to
6.20 %
m.
have occurred on the date stated above, at .....
Immediate cause of death.
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