Town of Winthrop : Record of Deaths 1948, Part 45

Author: Winthrop (Mass.)
Publication date: 1948
Publisher:
Number of Pages: 524


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 45


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he 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 hody is to be huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


The Tuffilment 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 disahled hy 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 resulting septicemia), and hy the action of chemical (drugs or poisons)," thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled hy 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 morhid 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 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 husiness, report the usual occupation prior to retirement. Children not gainfully employed may he 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 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


.


. .


M R-302


PLACE OF DEATH


Suffolk (County)


Chelsea


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.


2682.1


S (If death occurred in a hospital or inetitution, give ite NAME instead of etreet and number)


2 FULL NAME


Mrs. Emily (n) Anderson


(If deceased ie a married, widowed or divorced woman, give aleo maiden name.)


(a) Residenoe. No.


70 Pebble Ave


St.


Winthrop.


Mass


(Usual place of abode)


Hosp


years


months


daye.


in this community


yrs.


moe.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE


5 SINGLE


(write the word)


May 16, 1948'


Female


White


MARRIED


WIDOWED


or DIVORCED


Married


(Month)


(Day)


(Year)


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


AGE 50 Years Months Days


If less than 1 day .Hours. Minutes Due to.


Usual


9 Ocoupation :


Housewife


industry


10 or Business :


none


11 Soolal Seourity No.


12 BIRTHPLACE (City)


Marlboro


(State or country) N .H.


Major findings:


Of operations.


Date of.


should be charged sta- tietically.


14 BIRTHPLACE OF


FATHER (City)


(State or country)


England


Of autopsy What test confirmed diagnosis?


20 Was disease or Injury in any way related to oooupation of deceased ?.


If so, speolfy


Thos . J . Mathieu


M. D.


(Address)


USNH


5/16/48 Date


19


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


Evergreen Leominster


(Cemetery)


(City or TownMass


19


DATE OF BURIAL


6. 19 48


A TRUE COPY.


Joseph & Tyrrell


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


5/17/48


19


Received and filed 19


AUG 2


19.4.8


(Registrar of City or Town where deceased resided)


50m-(b)-6-44-14607


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


of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


PARENTS


15 MAIDEN NAME


OF MOTHER


Hannah Morrison


immedlate oause of death Hypertensive Heart


Disease MyocardialInfarction


Due to.


Other conditions


(Include pregnancy within 3 months of death)


Physician


Underline the cause to which death


13 NAME OF


FATHER


Orlando Morrison


18 DATE OF


DEATH


19 I HEREBY CERTIFY,


April15


19 ... 4.8 .. , to.


May .... 16


194.8


That I attended deceased from


last saw h


er alive on May 16


19.48 death Is said to


have occurred on the date stated above, at 6:35P m.


Duration


61


1


No.


(City or Town)


U. S. N. H.


St.


(If U. S.


War Veteran,


speolfy WAR)


no


(If nonresident, give city or town and State)


Length of stay : In hospital or institution ...


(Before death)


(Specify whether)


22 NAME OF


FUNERAL DIRECTOR


Reynolds Funeral Parlor


ADDRESS


Winthrop St., Winthrop, Mass


17 InformantJohn L. Anderson


I Relation in any


(Address)70 Pebble Ave., Winthrop


(Signed)


Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased


50m (e)-1-41-4667


17 Francis C. Obler


Informant


(Address)


31 College Ave. , Medford.


A TRUE COPY.


ATTEST :


(Registrar of city or town where death occurred)


19 48. DATE FILED June 10


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


June 9, 1948


DEATH


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


Sept. 6.


19 .... 4.7


to.


That I attended deceased from


June9,


19.


4.8


I last saw h.


er


alive on


June 7,


19 40 death is said to


have occurred on the date stated above, at


2. P.M.


.m.


Duration


Immediate cause of death


Arteriosclerosis


10 Yrs.


Due to ..


Generalized Arteriosclerotic


heart disease


10 Yrs.


Due to.


Pulmonary edema


2 Days


Other conditions


None


(Include pregnancy witbin 3 months of death)


Major findings:


Of operations


Physician Underline the cause to


Of autopsy.


Clinical


What test confirmed diagnosis ?. Findings


No


le


(Signed)


366 Broadway, Som


Date


6/1019 48


21 PLACE OF BURIAL,


CREMATION OR REMOVAL ..


Holyhood Cem. , Brook-


Relation if any


line, Mass.


(Cemetery)


(City or Town)


DATE OF BURIAL


June 11, 19.


22 NAME OF William II. McKenna


FUNERAL


DIRECTOR


390


Medford St. , Somerville.


ADDRESS


Received and filed 19


JUL 13 1948


(Registrar of City or Town where deceased resided)


X


RM R-302


Middlesex


The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Somerville


(City or town making return) 1


44$25


1


Somerville


(City or Town)


No.


8. Fairview Terrace ( Somerville Sanatorium) Helen J. Kohler


( If death occurred in a hospital or institution, St.


( give its NAME instead of street and number)


(If U. S.


War Veteran,


specify WAR)


(If deccased is a married, widowed or divorced woman, give also maiden name.) 17 Irwin St., Winthrop, Mass


Length of stay: In hospital or institution.


(Before death)


(Specify whether)


years


10 months


days.


In this community


mog.


days.


PERSONAL AND STATISTICAL PARTICULARS


2 FULL NAME


(a) Residenoe. No.


(Usual place of abode)


3 SEX


F


4 COLOR OR RACE


W


(or) WIFE of


7 IF STILLBORN, enter that fact here.


8


AGE


77


Years


Months.


-


Days


Usual


9 Occupation :


Retired


10 or Business :


11 Social Security No.


12 BIRTHPLACE (City)


Boston


(State or country)


Mass.


14 BIRTHPLACE OF


FATHER (City)


PARENTS


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Germany


of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk


(State or country)


Germany


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)


(Husband's name in full)


6 Age of husband or wife if alive years


If less than 1 day Hours. Minutes


Industry


N. E. Tel.& Tel.Co.


13 NAME OF


FATHER


Joseph Kohler


15 MAIDEN NAME


OF MOTHER


Regina Cast


20 Was disease or injury in any way related to oooupatlon of deccased?


if so, specify


Edward T. Downey


(Address)


Date of


which death


None


should be charged sta- tistically.


PLACE OF DEATH


(County)


Registered No.


St.


(If nonresident, give city or town and State)


Rest Home


RM R-302


Suffolk


(County)


Boston


(C'ity or Town) Palmer Memorial Hospital ( N E D H)


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) Residence. No.


12 Sunset Road


Winthrop Mass.


(Usual place of abode)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


7 Hrs


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE


5 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


18 DATE OF


DEATH


June 29/48


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


June .... 28


19 .. 118.


to.


19


That


1 attended deceased


June


29


48


(or) WIFE of


(Give maiden name of wife in full)


(Husband's name in full;


6 Age of husband or wife If alive


70


years


7 IF STILLBORN, enter that faot here.


8 AGE ... 68. .. Years .. Months. .Days


If less than 1 day Hours.


Minutes


Usual


9 Oocupation :


Housewife


Industry


10 or Business :


Un Home


11 Social Security No.


Ireland


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


John Butler


PARENTS


14 BIRTHPLACE OF


Ireland


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Barett


If so, specify.


No


(Signed)


M. D.


(Address)


81 Bay State Rd.


Date .. 6-29 .... 19.


...... 48


Winthrop Cem-Winthrop Mass.


17


Informant.


(Address)


W ... S. Burrill ( Relaisband)


A TRUE COPY.


22 NAME OF


FUNERAL DIRECTOR


J F O' Maley


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


July.


2/48


19


Received and filed 19


JUL 12 1948


(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


of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


25M-(f)-11-12 10746


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


PLACE OF DEATH


No.


The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Boston


(City or town making return)


Registered No.


5846 26


Wa


(If U. S.


War Veteran,


speolfy WAR)


St.


(If nonresident, give city or town and State)


30


mos.


dayo.


years


months


days.


In this community


yrs.


19


death Is sald to


have occurred on the date stated above, at


1;30AM


m.


Duration


Inimedlate oause of death


Uremia


4 Das.


Due


Pyelonephritis, chronic bilateral


with inactive rt.kidney


10 Years


Due to.


Other conditions


Diabetes mellitus


"It"Yrs Physician


(Include pregnancy within 3 months of death)


arterio sclerosis,gener alized (Y


Underline the cause to


Major findings :


Of operations.


None


which death


Date of


should be


charged sta-


Of autopsy


as a bove


tistically.


What test confirmed diagnosis ?


Autopsy and tests


20 Was disease or injury in any way related to occupation ALQaeda& urine


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 PLACE OF BURIAL,


CREMATION OR REMOVAL.


(Cemetery)


July 2/48


(City or Town)


19


DATE OF BURIAL


A Marks


ADDRESS


Winthrop Mass.


Katherine Burrill


5a If married, widowed, or dlvoroed HUSBAND of


I last saw h ...... er ..... alive on


June 29


L8


RM R-302


Suffolk


(County)


1.


Boston


(C'ity or Town)


No.


Jewish Memorial Hospital


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Boston


(City or town making return)


5872~


Registered No.


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


Sarah Abramovitz


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


5 Wave Way Ave.


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


years


3 months


28


days.


In this community


yrs.


3


mos.


28 days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


F


4 COLOR OR RACE


W


5 SINGLE


(write the word)


Widowed


MARRIED


WIDOWED


or DIVORCED


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


(Give maiden Hams of tig 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 75 Years Months.


.. Days


if less than 1 day Hours .. ..... .Minutes


Usual


9 Oooupation :


Housewife


Industry


10 or Business :


At Home


11 Social Security No ...


None


12 BIRTHPLACE (City)


(State or country)


Russia


13 NAME OF


FATHER


Charles Goldman


PARENTS


14 BIRTHPLACE OF


Russia


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Mary


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


17 Informant (Address)


C Abrams


Relation, if any Son. changed


A TRUE COPY. Michael Planning


ATTEST :


.....


(Registrar of city or town where death occurred)


DATE FILED


July ......... 6/48


19


18 DATE OF


DEATH


June


30/48


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


March ... 2


19.


48


That I attended deceased from


June .. 30


19


48


[ last saw h.


er ..... alive on.


June 30


1948


, death Is said to


have occurred on the date stated above, at.


1:20P


.m.


Duration


Inimedlate cause of death. Cerebral thrombosis


(recurrent)


3 Das.


Due Gen. arterio sclerosis


? Yrs.


Due to.


Other conditions


Left hemiplegia


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of


Underline the cause to which death should be charged sta-


Of autopsy.


tistically.


What test confirmed diagnosis?


Clinical


20 Was disease or injury in any way related to oocupation of deceased?


If so, specify


(Signed)


L. D. Jacobs


M. D.


(Address)


....


Boston ... Mas.s


Date 6-30 19


18


21 "PLACE OF BURIAL,


Mto Lebanon Baltimanzer


DATE OF BURIAL


(Cemetery )


July 1/48


19


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


Henry Levine


Dorchester Mass:


Received and filed. JUL 12 048 .19


(Registrar of City or Town where deceased resided)


25M-(f)-11-42 10746


PLACE OF DEATH


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


6 MOS.


Physician


No


...


CREMATION OR REMO


.. West ... Rox.


(City or Town)


Name legally


St.


giv


(If U. S.


War Veteran,


speolfy WAR)


Winthrop Mass.


St.


to.


RM R-302


PLACE OF DEATH


Suffolk (County)


Boston


(City or Town).


Boston Lying In Hospital


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Boston


(City or town making return)


St. (If death occurred in a hospital or institution, give its NAME instead of street and numher)


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


275 Main


(Usual place of abode)


St.


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


years


months.


days.


In this community


yrs.


mos.


daye.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


M


4 COLOR OR RACE


5 SINGLE


(write the word)


Single


MARRIED


WIDOWED


or DIVORCED


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


have occurred on the date stated above, at


9:05AM


m.


Duration


6 Age of husband or wife if alive years


7 IF STILLBORN, enter that faot here.


8


AGE


Years ..


Months.


Days


If less than 1. day


...... Hours ....... Minutes


Usual


9 Oooupation :


Industry


10 or Business :


11 Social Security No.


Boston Mass.


13 NAME OF


FATHER


Edward A Sprague


PARENTS


14 BIRTHPLACE OF


Boothbay Harbor Maine


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Lillian Wigginton


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Wise Virginia


17 Informant. (Address)


Boston LyingatIn Hospt


A TRUE COPY


ATTEST :


Registrar of city or town where death occurred)


DATE FILED


.19


P


Other conditions


(Include pregnancy within 3 months of death)


Physician


Underline the cause to


Major findings :


Of operations.


which death


Date of


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, specify


D E Reid


(Signed)


(Address)


221 ... Longwood ... Ave.


Date.


6-30


19


18.


21 "PLACE OF BURIAL,


CREMATION OR REMOVAL


Calvary Cem-Waltham Mass.


DATE OF BURIAL


July 5/48


19


(City or Town)


22 NAME OF


FUNERAL DIRECTOR


G M Linehan


ADDRESS


Boston Mass.


Received and filed.


JUL 12 1948


.19


(Registrar of City or Town where deceased resided)


X


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.)


25M-(f)-11-42 10746


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk


No.


Baby Boy Sprague


(If U. S.


War Veteran,


speolfy WAR)


June 30/48


18 DATE OF


DEATH


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


June .... 30.


18


to


That I attended deceased


June 30


19


I last saw h ... im ..... allve on


June 30


,48


death Is said to


Inimediate cause of death Atelectasis


Due to rematurity


Due to.


12 BIRTHPLACE (City)


(State or country)


NO


1


Registered No.


59128


Winthrop Mass.


RM R-302


Suffolk


(County)


Boston


(C'ity or Town)


No.


Mass.General Hospital


The Commonmoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Boston


(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


George C Wilfert


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residenoo. No.


600 Shirley


St.


Winthrop


Mass.


(Usual place of abode)


Length of stay: In hospital or institution


(Before death)


years


monthg O


days.


In this community


yrs.


mos.


10


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


M


4 COLOR OR RACE


W


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)


have occurred on the date stated above, at


7:22AM


m.


Duration


6 Ags of husband or wife If alive years


7 IF STILLBORN, snter that faot here.


8 AGE 71 Years 4 Months


17 Dayı


If less than 1 day Hours .. .Minutos


Usual 9 Oocupation :


Assembly Man Retired


· Industry


10 or Business :


General Electric


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


Germany


13 NAME OF


FATHER


John N Wilfert


14 BIRTHPLACE OF


Germany


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Barbara Thierauf


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Germany


17


Informant


(Address)


G C Wilfert Jr.


Relation, if any


DATE OF BURIAL


July 3/48


19.


22 NAME OF


J S Waterman & Sons


FUNERAL DIRECTOR


ADDRESS


Boston Mass.


Rsoeived and filed.


JUL 12 1948


19


DATE FILED


18 DATE OF


DEATH


June 30/48


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


That


- attended deceased


June


19


3


....


I last saw h


im ... alive on.


June 30


48


...


19.


death Is said to


Immediato cause of death


Leukemia,lymphatic


chronic


6 Yrs"


Due to


Due to


Other conditions.


(Include pregnancy within 3 months of death)


Physician


Major findings :


Of operations


None


Dats 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, spsoify


J.S Lichty


(Signsd)


(Address)


Mass. General Hospt Date 6-30;


M.1-8


21 PLACE OF BURIALForest Hills Cem. Boston


CREMATION OR REMOVAL.


(Cemetery,


(City or Town)


A TRUE COPY.


ATTEST :


(Registrar of city or town where death occurred)


July 6,1948


1


19


(Registrar of City or Town where deceased resided)


:


1


PLACE OF DEATH


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


25M-(f)-11-42 10746


Of autopsy


Underline the cause to


which death


PARENTS


Barbara Mayer


June ... 20.


19 ... 18


to


(If U. S.


War Vstsran,


speolfy WAR)


(If nonresident, give city or town and State)


(Specify whether)


Registered No.


589329


1


[ R-301 A


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. If deceased was a U. S. War Vetaran, G. L. Chap. 46, Section 10, requires physicians to insert a racital to that effect.


PLACE OF DEATH


Suffolk (County) Winthrop (City or Town) 64 Moore Street.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


To be nica for bunlar perint with Board of Health or its Agent.


Registered No.


130


St.


{ (If death occurred in a hospital or institution, {


give its NAME instead of street and nun.ber)


PHYSICIAN - IMPORTANT


2 FULL NAME


Arthur James Glassett


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(Was deceased a U. S. War Veteran, if so specify WAR)


(a) Residence. No. 64 Moore Street St.


(Usual place of abode)


NO


years


months


days.


In this community


41yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


Male


4


COLOR OR RACE


White


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Married


18 DATE OF


DEATH


July


6


1948


(Year)


(Month)


(Day)


5a If married, widowed or divorced


HUSBAND of .. . Margaret O'Shea


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive


41


years


7 IF STILLBORN, enter that fact here.


8


AGE


4.9 Years.


5


Months


24


Days


If less than 1 day


Hours


Minutes


Usual


9 Occupation:


Clerk


Industry


10 or Business:


Gasoline Station


11 Social Security No.


12 BIRTHPLACE (City)


(State or Country)


East Boston


13 NAME OF


FATHER


Thomas Glassett


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or Country)


East Boston


15 MAIDEN NAME


OF MOTHER


Elizabeth Whelan


16 BIRTHPLACE OF


MOTHER (City)


(State or Country)


England


20 Was disease or injury in any way related to occupation of deceased?


Hermann IS Lava.


(Signed)-


(Address: 626 Huntablice Manden


Date./


M. D. 1940


21


Winthrop Com-tery


Winthrop


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


July


.8.


19 4.8


22 NAME OF


FUNERAL DIRECTOR


Richard C. Kirby


ADDRESS 17 Bennington St., E. Boston


Received and Filed


19


JUL 8 1948 (Registrar)


Duration IMPORTANT


Due to Coronary 1 trombosu


Due to


Coronary inter seckomoly.


Other conditions (Include pregnancy within 3 months of death)


Major findings:


Of operations


Date of


Of autopsy


Phys . Exam.


What test confirmed diagnosis?


17 days. 2 year.


IMPORTANT


Physician Underline the cause to which death should be charged sta- tistically.


Mrs. Margaret Glass( Relationif any)


17


Informant


(Address)


64 Moore St., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued: Walter & Maker (Signature of Agent of Board of Health of other) Health Officer 7/7/48 (Official Designation) (Date of Issue of Permit)


MEDICAL CERTIFICATE OF DEATH


19 From: 20 .


I HEREBY CERTIFY,


That I attended deceased from


19


I last saw h.alive on


July S . 1970, death is said to


have occurred on the date stated above, at 5.30% m. Immediate cause of death


100M-7-46-19068


1


No.


Length of stay: In hospital or institution


(Before death)


(Specify whether)


(If nonresident, give city or town and State)


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his kuowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.




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