Town of Winthrop : Record of Deaths 1949, Part 53

Author: Winthrop (Mass.)
Publication date: 1949
Publisher:
Number of Pages: 456


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 53


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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To be filed for bur al per with Board of Health or its Agent


169


Registered No.


[(If death occurred in a hospital or institution,


2 FULL NAME


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


(a) Residence. No. (Usual place of abode)


Length of stay: In place of death


26 .years. months. days. In place of residence .years months .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Oct


(Month)


31 (Day)


1949 (Year)


8 SEX F.


9 COLOR OR RACE


w.


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word) widowed


4 I HEREBY CERTIFY.


That I attended deceased from


may


1949.


to ..


Oct 31


I last saw he.Y .... alive on


Oct 30


1949


death is said to


have occurred on the date stated above, at 8:30 Am.


INTERVAL BE-


TWEEN ONSET ANO DEATH


DISEASE OR CONDITION DIRECTLY LEADINGO TO DEATH (a) Esophage and Cardia.


ANTE


Due To


CEDENT CAUSES


(b) ..


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Major findings:


Of operations.


parce as above


Date of operation July 1948 Was autopsy performed


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased ?.. 0


If so, specify,


(Signed)


1) a Beming To St ER Date 10/31


1969


M. D.


6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL november 2. 1989


7 NAME OF FUNERAL DIRECTOR Vince 2 5 Qui


ADDRESS


Received and filed


NOV 19


(Registrar)


10a If married, widowed, or divorced HUSBAND of Emmanuel


(Give maiden name of wife in full}


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


78 Years


Months 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)


17 NAME OF FATHER I septi neves


18 BIRTHPLACE OF FATHER (City) (State or country)


Situcine


19 MAIDEN NAME OF MOTHER


20 BIRTHPLACE OF MOTHER (City) (State or country)


Datingal


21 Informant


William Brooke


29 Nochanton ina Mentar


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Gallery / (Signature of Agent of Board of Health or other)


1/1/49


(Official Designation) (Date of Issue of Permit) /


X


TRUCTIONS FOR L CERTIFICATE


giving OF DEATH not enter than one e for each (b) and (c)


does not mean of dying, such ailure, asthenia, cans the disease. lications which ath.


bid conditions. ving rise to the se (a) stating erlying cause


itions contrib- he death but not the disease or causing death.


100M-(D)-10-46-24658


(City or Town)


Hacking tom thenicest give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


No


{ if so specify WAR)


St.


26


(If nonresident, give city or town and State)


L


PARENTS


20 mars


44


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 knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required 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.


A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, 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 recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision 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 between 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. G. L. Chap. 46, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit 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 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 tomb other than the receiving 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 clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, 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 insufficient, a physician who is a member of the board of health, or employed by 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 such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be 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 such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal 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 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


T


PLACE OF DEATH


Suffolk (County)


Revere


(City or Town)


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


REVERE


(City or town making return)


170


No. Grover Manor Hospital . j(If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


2 FULL NAME.


Roger Mansfield


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


St.


Winthrop


(If nonresident, give city or town and State)


3


months


3


days. In place of residence


.years.


.months.


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR OR RACE


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


T DIVORCED Widowed


10a If married, widowed, or divorced


HUSBAND of


Mary ..... Brine


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ... 9.3 .. Years.


.X ... Months.


X


.Days


If under 24 hours


.Hours ...


Minutes


13 Usual


Occupation :.


Re.t ........ Sup.t ..


(Kind of work done during most of working life)


14 Industry


or Business:


Sugar .... Refinery


15 Social Security No ...


Unknown


16 BIRTHPLACE (City)


(State or country)


Ireland


17 NAME OF


FATHER


Garrett Mansfield


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Johanna Burke


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21


Informant.


(Address)


26 Charles St. Winthrop


A TRUE COPY.


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED October 14, 19 49


(a) Residence. No.


26 Charles


(Usual place of abode)


Length of stay: In place of death


years


3 DATE OF


10,


DEATH


Oct.


(Month)


(Day)


4I HEREBY CERTIFY,


July


49


19


I last saw


him


.alive on


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


ANTE


Due To


Cardiac


CEDENT (b)


Due To


(c)


OTHER


SIGNIFICANT


none


CONDITIONS


Major findings:


Of operations


Date of operation


What test confirmed diagnosis?


Clinical


26 Wave Way, Ave.


6


.Date.


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


CAUSES


Decompensation


50m-(e)-10-48-24658


1949


(Year)


That I attended deceased from


to


Oct. 10


1949


Oct.


10


1949


death is said to


have occurred on the date stated above, at


9:50 P.m.


INTERVAL BE-


TWEEN ONSET AND DEATH


Arteriosclerotic


Heart Disease


10 yrs


3 mos


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


If so, specify.


(Signed)


Charles Liberman.


(Address).


Winthrop


Boston


New Calvary


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Oct. 14


19


45


7 NAME OF


FUNERAL DIRECTOR


T. J. Crosby


ADDRESS


867 Beacon St., Boston


Received and filed.


NOV 1 5 1949


19


. (Registrar of City or Town where deceased resided)


PARENTS


Was autopsy performed?


No


NO


10/10 49°


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


RM R-302 1


CERTIFICATE OF DEATH


Registered No.


(Was deceased a


U. S. War Veteran,


{ if so specify WAR)


Mrs ..... Mary .... Tully


RECEIVER


5


6


NOV 191043 AM


-


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


1


PLACE OF DEATH


Middlesex (County)


Everett (City or Town) Whidden Hospital


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


EVERETT (City or town making return)


Registered No.


No.


Mae L. MoFarland


(Wood)


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


97 Beach Road


Winthrbio specify WAR)


(a) Residence. No. (Usual place of abode)


............... St.


(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


October 10,


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


10-10


49


19


to


19


I last saw h alive on


19


death is said to


have occurred on the date stated above, at


12.400


m.


INTERVAL BE-


DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a)


Acute Coronary


Thrombosis


TWEEN ONSET AND DEATH 1 dy


11 IF STILLBORN, enter that fact here.


12 62


AGE


Years.


4


25


Months.


.Days


If under 24 hours


Hours .....


Minutes


Practical nursing


13 Usual


Occupation:


(Kind of work done during most of working life)


14 Industry


Convalescent Homes


or Business:


024-03- 1447


15 Social Security No.


Z.Boston


16 BIRTHPLACE (City)


(State or country)


Hass.


17 NAME OF


FATHER


Robert 200d


18 BIRTHPLACE OF


FATHER (City)


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Annie Williams


21 Informant (Address)


20 BIRTHPLACE OF Ireland ..... MOTHER (City) (State or country) Lawrence Mcfarland (son) Winthrop Sohow M. CarroQ.


A TRUE COPY.


ATTEST:


(Registrar of City of Town where death occurred)


10-13


19 49


(Registrar of City or Town where deceased resided)


PARENTS


5 Was disease or injury in any way related to occupation of deceased? If so, specify Bloom


(Signed)


Everett


10-11 M. 49


(Address)


.Date.


Winthrop


19


6 Winthrop


Place of Burial or Cremation


(City or Town)


10-13


19.


49


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


Winthrop


ADDRESS.


Received and filed.


NOV 18 1949


19.49


no


Date of operation.


Electrocardiogram


What test confirmed diagnosis ?.


no


50m-(e)-10-48-24658


Due To


ANTE


CEDENT (b)


CAUSES


Due To


(c)


OTHER SIGNIFICANT CONDITIONS


Major findings:


Of operations


.. Was autopsy performed?


1.9.49


8 SEX


9 COLOR OR RACE


wht.


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


That


deceased


from


49


er


10-10


49


10a If married, widowed, or divorced


HUSBAND of.


Vincent verranje ffe in full)


(or) WIFE of.


(Husband's name in full)


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


RM R-302 1


2 FULL NAME


.


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,


DATE FILED


RECEIVED


7


6


NOV18140 M


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


SUFFOLK FOCcountry


(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.


8650 172


No. Mass .... General ... Hospital


.....


...... ·


J(If death occurred in a hospital or institution,


St. \ give its NAME instead of street and number)


2 FULL NAME Elizabeth ... Paterson


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


(a) Residence. No. 125 Cliff Ave


St.


Winthrop


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death


.....


.years.


months.


1 .. days. In place of residence.


2


.. years.


.. months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR OR RACE


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


widowed


4 I HEREBY CERTIFY,


That I


attended deceased from


Oct 14


19


49


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


Oat 14


19 .. 49, death is said to


have occurred on the date stated above, at.


1:21.A.


.m.


INTERVAL BE-


DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) ... Coronary .... thrombosis


TWEEN ONSET AND DEATH 24hrs


11 IF STILLBORN, enter that fact here.


12


AGE .. 82 .... Years.


Months


.Days


If under 24 hours


Hours ..


Minutes


ANTE


Due To.


Arteriosclerosis


unk yra


(Kind of work done during most of working life)


14 Industry


or Business:


At home


15 Social Security No ......


none


16 BIRTHPLACE (City) .. Mechanicville


(State or country)


NY


17 NAME OF


FATHER


George Baxter


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Scotland


19 MAIDEN NAME


OF MOTHER


Jean Millie


20 BIRTHPLACE OF


MOTHER (City)


(State or country) Scotland


6


Hudsonview .... Com.


Mechanioville NY


Place of Burial or Cremation (City or Town)


DATE OF BURIAL. Oct 19 1949


19


21


Informant


(Address)


Mrs Ruth E Mahone (dau)


7 NAME OF


FUNERAL DIRECTOR


R Bell


ADDRESS Brookline


Received and filed


19


DEC 7


1949


(Registrar of City or Town where deceased resided)


A TRUE COPY.


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Oct 17 1949


19


3 DATE OF


DEATH


Oct 14 1949


(Month)


(Day)


(Year)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


Allen McDonald Paterson


(Husband's name in full)


13 Usual


Occupation :


Housewife


CAUSES


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Rheumatoid arthritis


old


Major findings:


Of operations


none


Date of operation


Was autopsy performed?


yes


What test confirmed diagnosis ?.


Autopsy


S Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed).


CL Clay


M. D.


(Address)


Asst ... Dir .. MGH


Date


10. 14 ... 19 .. 4.9.


50m-(e)-10-48-24658


RM R-302 1


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


Q.ct .... 13.,


19 ...... 49


to


(Was deceased a


U. S. War Veteran,


if so specify WAR)


no


RECEIVE'


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


PLACE OF DEATH


SUFFOLK 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.


J(If death occurred in a hospital or institution,


........


.. St. [ give its NAME instead of street and number)


2 FULL NAME ..


No. Tres Gen Eosp Margaret Tutein (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.


105 Woodside Ave


(Usual place of abode)


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


Oct 15 1949


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


That I


attended deceased from


Sep .29 19.49


to


Oct. 1.5.


19.49


I last saw h. .. O.X. ... alive on


Oot.15


. 19 ..... 4 9death is said to


have occurred on the date stated above. at


8:02 .P ... m.


INTERVAL BE-


TWEEN ONSET


AND DEATH


3min


11 IF STILLBORN, enter that fact here.


12


AGE ..... 7.2.Years.


Months ...


.Days


If under 24 hours


.Hours ....


Minutes


13 Usual


Occupation:


At home


(Kind of work done during most of working life)


14 Industry


or Business:


Home


15 Social Security No.


16 BIRTHPLACE (City).


(State or country)


N


St. John


OTHER


SIGNIFICANT


CONDITIONS


Carcinoma of sigmoid


Intestinal obstruction


2mos


Major findings:


Of operations


Distended bowel


Date of operation


10/6/49


Was autopsy performed ?.. Yes


What test confirmed diagnosis?


autopsy


5 Was disease or injury in any way related to occupation of deceased ?.... O. If so, specify.


(Signed)


"Richardson


M. D.


(Address).


NGH


Date 10/16


19.4.9.


5 ...


.Oak Grove


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Oct.19.1949


19


7 NAME OF


FUNERAL DIRECTOR


R J De Neill


ADDRESS


Revers


Received and filed. 19


JEC 7 1349


(Registrar of City or Town where deceased resided)


PARENTS


17 NAME OF


FATHER


Elias Ross


18 BIRTHPLACE OF


St John


FATHER (City)


(State or country)


N B


19 MAIDEN NAME


OF MOTHER


CNBE


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


CNBL


21


Informant


Dorothy Famos


(Address)


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Oct 19 1949


19


9 COLOR OR RACE


white


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


wwidow


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


"infred h Tutoin


(Husband's name in full)


DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Coronary .... thrombosis


ANTE


CEDENT (b)


CAUSES


Due To


Due To (c)


50m-(e)-10-48-24658


Medford


8 SEX


female


RECEIVE


1


5


6


RM R-302 1


PLACE OF DEATH


(County) ,


SUFFOL


(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) 8847


Registered No.


Mass. General Hospital


.


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


2 FULL NAME


Eva Richardson


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


80 Read St


St.


Winthrop Mass


(a) Residence. No. (Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death


years.


months.


2


days. In place of residence.


.years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Oct. 21/49


(Month)


(Day)


(Year)


8 SEX


F


9 COLOR OR RACE


W


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Single


4 I HEREBY CERTIFY,


Oct ...... 19 ....


19.


49


That


I attended deceased, from


Oct. 21


49


19


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)


Cerebral


Haemorrhage


2 Days


12


44


6


AGE.


Years


Months


29


Days


If under 24 hours


Hours ..


Minutes


ANTE


CEDENT (b)


Due To


Arterio Sclerosis 4 Yrs3 Usual


and


14 Industry


Retail Sales


4 Yrs


or Business:


Unknown


16 BIRTHPLACE (City).


(State or country)


Bethel Maine


OTHER


SIGNIFICANT


CONDITIONS


17 NAME OF FATHER


Arthur Richardson Sawyersville


18 BIRTHPLACE OF


Quebec Canada


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Eloise Goupie


Sawyersville


Quebec Canada.


Pine Grove Cem-South Paris Maine


Place of Burial or Cremation (City of Town)


DATE OF BURIAL


Oct. 24/49


19


21


Informant


(Address)




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