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