USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 34
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death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish 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 .- Chap. 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 the body of such a person, he shall 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 persons 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 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 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 follow- ing 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 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
-
SERVICE NUMBER
RM R-302
1
PLACE OF DEATH
(County)
COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No. 107
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
FREDERICK L. WESTCOTT .
(Was deceased a
2 FULL NAME
BUREAU!
EPANTMENT OF HEALTH ROUGH OF MANHATTAN
156-49-102331
Certificate of Death
156-549-102331
Len
ROLBAN 30 PM 8 05
FREDERICK
WESTCOTT
1. NAME OF DECEASED (Print OF Typeturite)
Middle Neme
Last Name
Social Security Number
3 L
PERSONAL PARTICULARS (To be Sted in by Funeral Director)
MEDICAL CERTIFICATE OF DEATH (To be flied in by the Phyricion)
16 PLACE OF DEATH:
Manhattan
(s) NEW YORK CITY: (1) Borough.
Winthrop
0) Ca
151 Winthrop Street
Ave
I 1.
hav
DIA
DII TO
HUBRAND
Anne C. Keith Wescott
10 SEX
19 COLOR OR RACE White
20 Approximnste Ago 47 yrs
DATE OF BIRTH OF
February
10th
.1903
AN CE CA
45
11
19
min
at
this.29 day of .......... January 19.49
(b) that I examined the body and investigated the circum- stances of this death, and
I further certify from the investigation, (complete autopsy)*
· BIRTHPLACE
OF DECEDENTI (A) State ..
Boston
0) Comty
OF WHAT COUNTRY WAS DECEDENT A CITIZEN AT TIME OF DEATH?
United States
Ma, O
10 WAS DECEASED WAR VETERAN? IF SO. NAME WAR
None
PENDING CHEMICAL EXAMINATION.
Dat
0
11 NAME OF FATHER OF DECEDENT
Roy L.
5 V
11 BIRTHPLACE OF FATHER (State or country)
Nave Scotia
Signed ...
I
a. T. Anh
13 MAIDEN NAME OF MOTHER OF DECEDENT
carrie Hurder
0
14 BIRTHPLACE OF MOTHER
New Brunswick
No.
Date.
Chief Medical Essminn 30, 1949
6
..
4
D
OR CREMATION Winthrop Cont. Winthrop, Mass, OR CREMATION
February 3rd, 1949
7 N FI
FUNERAL Metropolitan Funeral Service,
ARFF'S 718 Second Avenue
PERMIT NUMBER
2805
AI
BUREAU OF RECORDS AND STATISTICS
DEPARTMENT OF HEALTH
CITY OF NEW YORK
Rece
(Registrar of City or Town where deceased resided)
h and State)
CULARS
(write the word)
CED
in full)
¥11)
nder 24 hours Hours ........ Minutes
t of working life)
my opinion, death occurred on the date and at the hour stated above and resulted from ( dhawhether ..... Hyatt tabel. onfeide)* (undetermined circumstances pending further investigation) *, and (.) that the causes of death were: .ACUITE .CORROSIVE GASTRITIS:
Wh
Typo Aoch
SI Parasta of Deceased
State of country)
FTIVi Info. by wireRELATIONSHIP TO DECEASED
Anse C. Wescott
Wife
50m-(e)-10-48-24658
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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
THIS CERTIFICATE NOT VALID UNLESS FILED IN THE HEALTH DEPARTMENT DO NOT WRITE IN THIS SPACE. MARGIN RESERVED FOR CODING AND BINDING 2
8
4 I
2 USUAL RESIDENCE: (A) State ...
Ance-Out
(c) Name of Hospital 147 W. 43 St. or Institution (If not in hospital or institution, give street and number.) (d) Length of stay in Hospital immediately prior to death ...
(@) Length of residence or stay in City of New York Sumediately prior to death
(e) If elsewhere than to hospital or own residence, specify character of place of death, as hotel, Hotel office, store, street, taxicab, etc.
SEIGLE, MARRIED, WIDOWED, OR DIVORCED (wilt the tum)
Married
(Month)
(Day)
(Yaur)
(Hour)
17 DATE AND HOUR OF DEATH
January 28. 1949
(Day) [Year) Male
DECEDENT
TT LESS than 1 day,
21. I hereby certify (a) that in accordance with Section 878-2.0 and 873-3.0 of the Administrative Code for the City of New York, I went to, and took charge of the dead body City Mortuary
A Trade, profonles, or partiesar Huf of work done, w cpimmer,
Salesman
Meat
OT! SIG CO
Benj Morgan Vane
M. E. Cuse 246
Winthrop, MYs.
DATE OLIVA
1
eath occurr
AUG P7 1949
DATE FILED
.... 10
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
No.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
...
Non-Resident
First Name
RM R-305 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Manner of Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible Injury occur? 25m-(h)-10-48-24658
PLACE OF DEATH
Plymouth (County)
Wareham
(City or Town)
Tobey Hospital
No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Wareham (City or town making return)
Registered No.
108
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
Walter M. Myszkowski
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Colonial Inn,
Shirley
St.
Winthrop,
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years ...
months ............ days. In place of residence.
.....
.years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE
DEATH
May
12
1949
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
4 I 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.)
Traumatic shock due to fracture
of right femur, right forearm and elbow and internal abdominal in
12 IF STILLBORN, enter that fact here.
AGE
30 Years
Months
Days
If under 24 hours
Hours
Minutes
5 Accident, suicide, or homicide (specify).
Accident
12
Date and hour of injury
2.15 P . M. May
19
49
Where did
Sandwich, Mass.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Highway
(Specify type of place)
Injury
Automobile accident
(How did injury occur?)
Nature of
Fractures & Internal
injurie
Injury
While at work?
No
Was autopsy performed?
No
6 Was disease or injury in any way related to occupation of deceased ?.. No. ...
If so, specify.
(Signed)
Sterling A. McLean
M. D.
(Address)
Middleboro, Mass. Date 5/12 19 49
7
St. Joseph
Chicago
Place of Burial, or Cremation.
22
Informant
Margarite Myszkowski
(Address)
Colonial Inn, Winthrop
A TRUE COPY.
Efrailes & Bates
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed .
SEP 6
1949
19
49
(Registrar of City or Town where deceased resided)
PARENTSP
18 NAME OF
FATHER
Joseph Myszkowski
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
20 MAIDEN NAME
OF MOTHER
Mary Wychik
21 BIRTHPLACE OF
MOTHER (City)
(State or country) Poland
DATE OF BURIAL.
May
16
8 NAME OF
Daniel L. Shea
FUNERAL DIRECTOR
ADDRESS Boston, Mass.
(City or Town) 19 48
14 Usual
Occupation1
Pilot
(Kind of work done during most of working life)
15 Industry
or Business :.
Self
16 Social Security No.
17 BIRTHPLACE (City).
(State or country)
Chicago
juries sustained in automobile acci-13 dent
11a If married, widowed, or divorced
HUSBAND of.
Margarite Bortol
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DATE FILED
May .... 17
19
49
Į (Was deceased a
U. S. War Veteran,
WW 11
if so specify WAR)
Mass.
(a) Residence. No. (Usual place of abode)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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
PLACE OF DEATH
(County) NEWTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
NEWTON
(City or town making return)
Registered No.
360 109
No. 32 Newtonville Ave.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Pearl C. Andrews
(MacIntyre)
·
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No. Beacon Villa
31
Villa.Ave
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
.. years.
months.
days. In place of residence.
.. years.
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July .5 .1949
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
That I attended deceased from
May .... 14
149.
...
to
July .... 5
194,9
I last saw her.
alive on
July .... 5.
1949, death is said to
have occurred on the date stated above, at8 :. 35P.
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a) .. Generalized .... Carcinomatosis
6 mos
12 72
AGE
Years
9
29
Months
.Days
If under 24 hours
.Hours .......
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
Portland Me., High School
or Business:
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Solon
Maine
OTHER
SIGNIFICANT
CONDITIONS
None
Major findings:
Of operations.
None
Date of operation.
None
Was autopsy performed?
No
What test confirmed diagnosis ?.
Biopsy
19 MAIDEN NAME
OF MOTHER
Elzada Pierce
5 Was disease or injury in any way related to occupation of deceased? If so, specify (Signed) .F. P. Heath M. D.
(Address) 324 Walnut St NewtonDafelle 7/5/1949
6 ..
Pine
Grove Cemetery, FalmouthForeside
Place of Burial or Cremation
DATE OF BURIAL
July 8, 1949
19
21
(Address)
169 Washinton.St. , Newton, Mass.
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed 19
AUG 1 7 1949
(Registrar of City of Townt where deceased resided)
PARENTS
50m-(e)-10-48-24658
MIDDLESEX
RM R-302 1
ANTE
CEDENT (b)
CAUSES
Due Tocarcinoma Cervix
1 yr
Due To (c)
10a If married, widowed, or divorced
HUSBAND of
John Hearem wennle of wife in full)
Irving L Andrews
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Retired Teacher
17 NAME OFeander F. W. Macintyre FATHER
18 BIRTHPLACE OF
FATHER (City) .... Maine
(State or country)
20 BIRTHPLACE OF
MOTHER (City)
Maine
(State or country)
Robert Swain
7 NAME OF
FUNERAL DIRECTORArchibald C Bellinger
ADDRESS
26 Centre Ave ..... Newton
DATE FILED July 11, 1949
19
(write the word)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
RM R-302 1
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
1
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston (City or town making return)
Registered No. 60840
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
23 Sagamore Ave.
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ... .
. years ...
months.
3
.days.
In place of residence
.....
.. years
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Jul 14/49
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
Jul .12.
19
49.
to
Jul 14
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE
1 Years.
5
Months
18
.Days
If under 24 hours
Hours .. . Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Chelsea Mass.
17 NAME OF
FATHER
Morris Rantz
18 BIRTHPLACE OF
Beverly Mass.
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Anne Staretz
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
M Rantz
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
Jul 18/49
DATE FILED
19
(Registrar of City or Town where deceased resided)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Congenital heart disease
type undetermined
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?..... No
What test confirmed diagnosis ?...
E.K.G.
Chest xray No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
G B Shattuck
M. D.
(Signed)
(Address)
300 Longwood Ave Date 7-14
.19 .. 49
Beth Israel Cem-Everett Mass.
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Jul 15/49
19
H J Torf
7 NAME OF
FUNERAL DIRECTOR ..
Chelsea Mass.
ADDRESS
Received and filed
AUG 1 6 1949
19
PARENTS
50m-(e)-10-48-24658
No.
Infant's Hospt
Robert Rantz
J(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
That I attended deceased from
Jul 14
,49
I last saw h.
i.Talive on
19 49
death is said to
have occurred on the date stated above. at
6 PM
11
21 Informant (Address)
Chelsea Mass.
6
+
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
Boston City Hospital No.
The Commonmralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston (City or town making return)
6127 11
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
39 Moore
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
10
months.
days. In place of residence.
ars .
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4I HEREBY CERTIFY,
Jul 4
19.
49.
to
Jul 14.
19
49
10a If married, widowed, or divorced
HUSBAND of.
Viola Crosby
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
5
Months.
14
Days
If under 24 hours
.. Hours ...
Minutes
13 Usual
Occupation :
Machinist
14 Industry
or Business:
Razor Co
15 Social Security No.
012 09 3717
16 BIRTHPLACE (City)
(State or country)
NY
17 NAME OF
FATHER
Willis Stuart
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Me
Etna
19 MAIDEN NAME
OF MOTHER
Eva Gilbert
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
CN BL
6
Woodlawn. Crematory
Everett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Jul.18 1949
19
7 NAME OF
FUNERAL DIRECTOR
Winthrop
H S Reynolds
ADDRESS
Received and filed
AUG 1 6 1949
19
(Registrar of City or Town where deceased resided)
wks
ANTE
CEDENT (b)
CAUSES
Due TChronic pancreatitis
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Gastro enterostomy
Date of operation
7/9/49
Was autopsy performed?
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify ...
(Signed)
M W O' Connell
BCH
(Address)
Date
7/11
.19.49
50m-(e)-10-48-24658
=
11
-
21 Viola Stuart
Informant
(Address)
A TRUE COPY
echaelfMan
ATTEST:
....
(Registrar of City or Town where death occurred)
DATE FILED
Jul 19 1949
.19
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
RM R-302 1
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence.
No.
(Usual place of abode)
That I attended deceased from
I last saw h ..
.alive on
19
death is said to
have occurred on the date stated above, at
11:45 A .m.
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Peritonitis
INTERVAL BE-
TWEEN ONSET
AND DEATH
5das
58
(Kind of work done during most of working life)
Rochester
2 FULL NAME ..
Guy Alfred Stuart
35
Married
3 DATE OF
DEATH
Jul 14 1949
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible Injury
25m-(h)-10-48-24658
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(BASTON
Registered No.
6260 112
No.
en route to P B Brigham Hosp
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
24 Lincoln Terr
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
......
.years.
months ..
.......... days. In place of residence.
.years ..
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
(write the word)
DEATH
(Month) (Day)
(Year)
4I 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.) Spontaneous cerebral hemorrhage
11a If married, widowed, or divorced
HUSBAND of
Maude LEgan
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
74 Years
Months.
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation1.
Govemment insp
(Kind of work done during most of working life)
15 Industry
Clothing
or Business:
16 Social Security No ..
St John
17 BIRTHPLACE (City)
(State or country)
N B
18 NAME OF
FATHER
James E Donovan
19 BIRTHPLACE OF
St John
FATHER (City)
(State or country)
NB
20 MAIDEN NAME
OF MOTHER
Margaret Leary
21 BIRTHPLACE OF
St John
MOTHER (City)
(State or country)
N B
7 Winthrop
Winthrop
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
Jul 23 1949
19
8 NAME OF
FUNERAL DIRECTOR
JF Q.Maley
ADDRESS Winthrop
Received and filed. 19
AUG 16 1949
(Registrar of City or Town where deceased resided)
PARENTS
22 Dorothy Vickerson
Informant
(Address)
100m
A TRUE COPYles
ATTEST:
DATE FILED
(Registrar of City or Town where death occurred) Jul 25 1949
19
5 Accident, suicide, or homicide (specify).
Date and hour of injury.
19
Where did Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Collapsed in ambulance en route
(Specify type of place)
Manner of
to hospital
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed?
NO
6 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
(Signed)
W J Brickley
(Address)
Boston
Date.
7/20
19
Thomas J Donovan
(Was deceased a U. S. War Veteran, if so specify WAR) .. .Span
(a) Residence.
No.
(Usual place of abode)
50
3 DATE OF
Jul 20 1949
MARRIED ,
WIDOWEDWidowed
or DIVORCED
Fresh & recent
RM R-305 1
Date of entering military service Apr 26 1898 Date of discharge Rank, rating Organization and outfit
Nov 14 1898 Corp Battery K First Reg Mass Heavy Artillery U S Vol
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
No.
2 FULL NAME ..
3 DATE OF
DEATH
(Month)
I last saw h. . er .. alive on
DISEASE OR CONDITION
ANTE
Due To
CEDENT (b)
CAUSES
OTHER
SIGNIFICANT
CONDITIONS
Of operations.
What test confirmed diagnosis ?.
(Address)
6
Roxbury Lodge
Place of Burial or Cremation
50m-(e)-10-48-24658
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
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
Date of opera
Nov.1947
Jul 24 1949
(Day)
(Year)
4 I HEREBY CERTIFY,
Apr 18 , 19.49
to
Jul 24
19
49
Jul 24
., 19.449, death is said to
have occurred on the date stated above, at
6:10 P.
.. m.
INTERVAL BE-
TWEEK ONSET
AND DEATH
32 yrs
11 IF STILLBORN, enter that fact here.
12
AGE
57 Years.
Months ...
Days
If under 24 hours
Hours . Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No. .
16 BIRTHPLACE (City) ..
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