USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 70
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347 My Pearl U Brualt
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter A: Bakkerg (Signature of Agent of Board of Health or other)
13.50
(Official Designation)
VV
(Date of Issue of Permit)
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME ..
Bally Gril Randall #2"
(If deceased, is a maffied, widowed or divorced woman, give also maiden name.) 347 North Pearl
St.
Brockton
(If nonresident, give city or town and State)
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean de of dying, such failure. asthenia, . means the disease, plications which death.
orbid conditions, giving rise to the ause (a) stating derlying cause
ditions contrib- the death but not to the disease or n causing death.
PARENTS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
Dec
(Month)
31
(Day)
1949 (Year)
PLACE OF DEATH with throp (City or Town) Winthrop Communes Hoteles No.
M R-301A 1
SOM-2-19-25666
(City or Town)
3
19.50
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 persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
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 occup :- 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
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.
101031 8
Mass.General Hospital No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Fred A Gillis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
21 Pleasant Park Road
Winthrop
Mass.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years
months.
1
days. In place of residence.
40
.years
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased
from
49
I last saw h. im ... alive on ....
Nov. 30
19.49
death is said to
10a If married, widowed, or divorcedMary L McCormack
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)
Carcinoma of the
stomach
11 IF STILLBORN, enter that fact here.
12
AGE
62 Years
Months.
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Plumber
(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
Allan D Gillis
18 BIRTHPLACE OF P. E. I.
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Anna Kennedy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
CL Clay
(Signed)
19.
49
Mass. "eneral Hospt Date 12-1
M. , D
Winthrop Cem-Winthrop Mass.
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Dec. 3/49
19
21
Informant
(Address)
A TRUE COPY
ATTEST:
. ......
(Registrar of City or Town where death occurred)
DATE FILED
Dec. 5/49
19
(Registrar of City or Town where deceased resided)
PARENTS
20 BIRTHPLACE OF P.E.I.
MOTHER (City)
(State or country)
Mrs M Gillis
7 NAME OF
FUNERAL DIRECTOR
M W Kirby
ADDRESS Winthrop Mass
Received and filed.
JAN 20 1950
19
50m-(e)-10-48-24658
2 FULL NAME. 3 DATE OF DEATH ANTE Due To CEDENT (b) CAUSES OTHER SIGNIFICANT CONDITIONS (Address) 6 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 Due To (c)
Nov. 30/49
(Month)
(Day)
(Year)
Nov. 30
19
49
to.
Nov. 30
19
have occurred on the date stated above, at
7;02P
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
2 Yrs
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
1
Major findings:
Of operations
None
Date of operation
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical
East Boston Mass.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
RM R-302 1
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
Essex (County)
Danvers
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Danvers (City or town making return)
Registered No. ...
219
hospita
No.
Danvers State Hospital , Hathorne, 1gsff
give its NAME instead of street and number)
2 FULL NAME
Martin J. Curran
(If deceased is a married, widowed or divorced woman, give also maiden name.) Winthrop, Mass.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ..... .years. .months. 9 days.
In place of residence.
.......... years.
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
5
1949
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
4 I HEREBY CERTIFY,
Nov ..
26.
19 ..
49
to.
December 5
19 49
I last saw h
im .. alive on ... N.O.V ...
26
194.9., death is said to
have occurred on the date stated above, at 11:40 pm. INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
82Years
Months.
.Days
If under 24 hours
.. Hours ....
Minutes
13 Usual
Occupation :
Retired barber
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ........
None
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
Nicholas Curran
Major findings:
Of operations.
Was autopsy performed?
No
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased ?... NO If so, specify,
(Signed)
Julius W. Fryer
M. D.
(Address) Hathorne Mass
Date.
12/6
19 49
6
Holy Cross Cemetery, Malden
Place of Burial or Cremation
"City or Towh)
DATE OF BURIAL.
December 8
19 49
21
Informant
Mary E. Sheehan
(Address)
Hathomme mass.
7 NAME OF
FUNERAL DIRECTOR
John C. Kelly
ADDRESS
East Boston
Received and filed
JAN IT 1950
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Elizabeth Wilshire
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
A TRUE COPY.
ATTEST:
Theor
...........
(Registrar of City or Town where death occurred)
DATE FILED
Dec. 10
.19 ..
49
50m-(e)-10-48-24658
Due To
Generalized
ANTE CEDENT (b) CAUSES Arteriosclerosis
Due To (c)
3 yrs
10a If married, widowed, or divorced
HUSBAND of
Bertha N. LaVache
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Bronchopneumonia
OTHER
SIGNIFICANT
CONDITIONS
Date of operation.
Lass
CERTIFICATE OF DEATH
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
That I attended deceased from
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
SUFF ( 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.
1042020
2 FULL NAME
Max Berman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
14 Sea Foam Ave
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.. years
7
months.
days. In place of residence.9.
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Dec 13, 1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
N.O.v ... 28, 19.49 ,
to
vec 12
19
49
I last saw
h
im
... alive on
Dec 12, 1949,
death is said to
have occurred on the date stated above, at
4:30 Am.
INTERVAL BE-
11 IF STILLBORN, enter that fact here.
12
80
AGE
Years.
Months
Days
If under 24 hours
.Hours
Minutes
13 Usual
Retired clothier
Occupation :
(Kind of work done during most of working life)
14 Industry
Clothing
or Business:
15 Social Security No.
?
16 BIRTHPLACE (City).
(State or country)
Russia
17 NAME OF
FATHER
Joshua Berman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Rachel
CNBL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Barney Berman
Informant.
(Address)
7
7 NAME OF
FUNERAL DIRECTOR
H J Torf
ADDRESS.
Chelsea
Received and filed.
JAN-2-8-1950
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Cerebral vascular
TO DEATH (a)
accident
TWEEN ONSET AND DEATH abt 7wks
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
none
Date of operation.
Was autopsy performed?
yes
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify F D Nalfindon
no
M. D.
(Signed)
(Address) ... B.I.H.
Date .12 /13
.19.4.9
6 .
Sharo Tfila
Place of Burial or Cremation
Boston
(City or Town)
DATE OF BURIAL.
Dec 14 1949
19
PARENTS
A TRUE COPY-
ATTEST:
(Registrar of City or Town where death occurred) Dec 15 1949
DATE FILED
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,
no
if so specify WAR)
Winthrop
(Usual place of abode)
married
10a If married, widowed, or divorced
Leah Brickton
1
50m-(e)-10-48-24658
No. Beth IsraelHospital
NECEITES
1
JAN2 81950 PX
RM R-302 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
B.O.S. T.O.N. (City or town making return)
Registered No.
1077221
j(If death occurred in a hospital or institution. St. \ give its NAME instead of street and number)
2 FULL NAME
MARY J GILLIS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 1.47 .... WINTHROP.
St.
WINTHROP
(If nonresident, give city or town and State)
Length of stay: In place of death
.years ..
months ...... 4.0.days. In place of residence.
2 ... years.
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
SINGLE
4 I HEREBY CERTIFY,
That
I attended deceased from
.Q.E.C ........ J.
19 .... 4.9 .. , to ..
......
DEC .... 2.1
19 ..
49
I last saw h. ER
alive on
DEC
19
19
death is said to
have occurred on the date stated above, at
11:15Am.
INTERVAL BE- TWEEN ONSET
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
CORONARY SCLEROSIS
WITH ACUTE CONGESTIVE FAILURE
AND DEATH
1-2YRS
12
AGE
7.3 Years.
Months.
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
HOUSEWORK
(Kind of work done during most of working life)
14 Industry
or Business:
A.T .... HOME.
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
CAPE BRETTON N. S
17 NAME OF
FATHER
NEIL GILLIS
18 BIRTHPLACE OF
FATHER (City)
C.AP. E .... BR.E.T.IO.N.
(State or country)
NOVA SCOTIA
19 MAIDEN NAME
OF MOTHER
MARY MCNELL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
G.A.P.E .... BR.E.T.T.ON ··· · N ··· S ..
DATE OF BURIAL.
DEC 24
19
21
Informant
MR.S ..... J ..... C.R.O.S.B.Y.
(Address)
147 WINTHROP ST WINTHROP
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS W .. I.N.T.H.ROP
Received and filed
JAN- 2-8-195060 27
49
(Registrar of City or Town where deceased resided)
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
19
........
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
ANTE
CEDENT (b)
Due To
DIABETES MELLITUS WITH
ARTERIOSCLEROSIS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
NO
(Signed)
E ... H .... H.OMMEL
M. D.
(Address). .. 1.96 .... DORCHESTER .... A.y Pate. 2/22 19. 49
HOLY CROSS CEM MALDEN Place of Burial or Cremation (City or Town)
4
PARENTS
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
6 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 50m-(e)-10-48-24658
3 DATE OF
DEATH
DEC.2 .1949
(Month)
(Day)
(Year)
.......
(Usual place of abode)
No. II REVERE ST
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
1
JAN2 01950 FX
RM R-302 1
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
- Essex (County)
Danvers (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers (City or town making return)
Registered No. 222
1(If death occurred in a hospital or institution, Danvers State Hospital, Hathorne, Massive its NAME instead of street and number) No. .
2 FULL NAME .. Junetta Truax (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. Winthrop, Mass. St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
4
months.
9
days. In place of residence.
.. years
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
21
1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
August .... 12 19 ..
49
to.
Dec. 21
1949
I last saw h
er alive on
Dec. 21 1949
death is said to
have occurred on the date stated above, a
2:25 a.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
13 yrs AGE 24 Years 1
.Mon
Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation :
Clerical
(Kind of work done during most of working life)
14 Industry
or Business:
Jordan Harsh Co.
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Pennsylvania
17 NAME OF
FATHER
Elmer Truax
Major findings:
Of operations
Date of operation
Was autopsy performed ?......... No
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify .. Paul B. Jossman M. D.
(Signed).
(Address) Hathorne, Mass.
Date
12/23 19 49
Winthrop Cemetery
Winthrop
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 23 ....
19.49
7 NAME OF
FUNERAL DIRECTOR.
Maurice Kirby
ADDRESS Winthrop, Mass,
Received and filed
JAN IT 1956
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Pennsylvania
19 MAIDEN NAME
OF MOTHER
Lena Edith Clark
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Pennsylvania
21
Informant
(Address)
Hathorne Mass.
Mary E. Sheehan
A TRUE COPY.
ATTEST:
1710
(Registrar of "City or Town where death occurred)
DATE FILED
Dec. 30
10 49
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
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)
Endocarditis
Subacute Bacterial
ANTE
Due To
CEDENT
CAUSES
(b)
Due To (c)
Mc.Conisberg
OTHER
SIGNIFICANT
CONDITIONS
50m-(e)-10-48-24658
8 SEX
Female
White
9 COLOR OR RACE
RM R-305 1
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
PLACE OF DEATH
MIDDLESEX
(County) NEWTON
(City or Town)
No. 114 Cherry
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
NEWTON. (City or town making return) 681 223 Registered No.
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Albert J. B. Graham
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
114 Cherry
St.
1
(Usual place of abode)
(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
3 DATE OF
DEATH
Dec.
26
49
(Month)
(Day)
(Year)
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.)
11a
If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
54
9
11
AGE Years
Months
.Days
If under 24 hours
Hours ........ Minutes
14 Usual
U. S. Navy - retired
Occupation:
(Kind of work done during most of working life)
15 Industry
or Business:
16 Social Security No.
East Boston, Mass.
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
John William Graham
19 BIRTHPLACE OF
County Manahan, Ireland
FATHER (City)
(State or country)
20 MAIDEN NAME
OF MOTHER
Ellen Blakely
21 BIRTHPLACE OF
County Foermah, Ireland
DAN >>1850
2 Informant lanche E.O. Graham sister
(Address) 1111 Vannest Avs., Trenton 8, N. J.
A TRUE COPY.
ATTEST:
Ernas!
(Registrar of City or Town where death occurred)
DATE FILED
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
Coronary sclerosis
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?
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
No
.Was autopsy performed?
No
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) T.Morton .. Gallagher. M. D.
(Address)Newton
7 Winthrop Cemetery, Winthrop Mass.
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL December 28 1049
8 NAME OF
FUNERAL DIRECTOR
ADDRESS
26 Centre Ave. Newton Mass
Received and filed 19
No
PARENTS
Date 1 2/26
149
....
MOTHER (City)
(State or country)
25m-(h)-10-48-24658
(Specify type of place)
...
Was deceased a I and II
U. S. War Veteran,
if so specify WAR)
West Newton
Mass.
(write the word)
JAN-2 1:50
JAN 1 V 1550
RM R-302 1
PLACE OF DEATH
SUFFOLK Coup BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
1441
(City or town making return)
1101821 ...
No. Mass ........ Memorial .... Ho.s.p.i.t.al
¡(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME Lillian J Bishop (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.
24 Cherry
St.
Winthrop,
Las.s.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.years
.months
27
.. days. In place of residence.
67 years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
December
31
19/19
(Month)
(Year)
(Day)
That I attended deceased from
I last saw h ... er ..... alive on.
Dec 31
19 .1.9death is said to
have occurred on the date stated above, at.
6:45 am.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
67 Years
2
Day
Months.
18 Days
If under 24 hours
Hours ..
Minutes
13 Usual
House Keeper
Occupation:
(Kind of work done during most of working life)
·14 Industry
or Business:
Private Family
15 Social Security No ...
16 BIRTHPLACE (City).
(State or country)
B.o.s.t.o.n., ..... Mas.s ...
17 NAME OF
FATHER
Joseph Whalon
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Worcester Mass.
Date of operation
no
Was autopsy performed?
yes
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
P Bonnet, Adm MICH
M. D.
(Address)
Boston
Date 12/31
199
6
Winthrop,
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Jan 3, 1950
19
7 NAME OF
FUNERAL DIRECTOR.
John C Kelly
ADDRESS
Boston
Received and filed
JAN 2,8 -1950
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Mary E Gannon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Informant.
(Address
Michael F Riley
A TRUE COPY
MickJon 4, 195 away
ATTEST:
(Registrar of City of Town there death occurred 0
DATE FILED
19
3 DATE OF
DEATH
O.K.by Dr Leary
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
(Signed)
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
Due To
(c)
50m-(e)-10-48-24658
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)
Ruptured Esophageal
varices
6 hrs
Due To
Portal Cirrhosis of
ANTE
CEDENT
CAUSES
Liver (Alcoholic)
5 yrs
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
Dec 5
1949
to
Dec. 31
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Arthur ... E ... Bishop
(Husband's name in full)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Registered No.
Ireland
Arteriosclerotic Heart
Disease
RECLIVE:
JAN2 31950 FX
-
E
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