USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 30
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT.
SERVICE NUMBER
RM R-301
1
PLACE OF DEATH
(County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
89.
J(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.)
(Was deceased a U. S. War Veteran, [ if so specify WAR)
(a) Residence. No. (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.
# 15.66
CERTIFICATE OF DEATH
407999
MICHIGAN DEPARTMENT OF HEALTH Vital Records Section
3560
1. PLACE DF DEATH L COUNTY
2. USUAL RESIDENCE L STATE
& COUNTY
. CITY THIS OR VILLAGE
corfurate
write DICHA
C. LENGTH OF STAY (un this place)
& TOWNSHIP. CITY OR VILLAGE Winthrop, Mass.
(If riral, give locatoti)
an full)
FORT WAYNE. HOTEL
408 Temple st.
3. NAME OF DECEASED (Type or Print1
EWIS C.
BRIGGS
27
1950
Af under 24 hours
6. COLOR OR RACE
.Hours ..
Hours
Male
White
Aug. 4th. 1887
62
7
23
100. USUAL OCCUPATION Itive
10b KIND OF BUSINESS &R INDUSTRY
11. BIRTHPLACE (Male or lirico country )
12 CITIZEN OF WHAT COUNTRY!
done during most of working life, even if retired]
Salesman
Desmond Publishing
Massachusetts
71 FATHER'S NAME
14 MOTHER'S MAIDEN NAME
Lewis C. Briggs
Mary Marnix
15. WAS DECEASED EVER IN U. S. ARMED FORCES |16. SOCIAL SECURITY NO. ( Yes, no, or unknown) [ (If yes, give war or dates of service)
17. INFORMANT'S SIGNATURE
ADDRESS
Lewis C. Briggs
Winthrop, Mass.
IL CAUSE OF DEATH
Oneet and Death
Ester only one carte per Inne for tal, (b), and (c)
ANTECEDENT CAUSES
Morind conditions, if any, giving QUE TO /b rise to the above cause e - staling the underlying cause last.
DUE TO e)
II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition caveing death.
TIL DATE OF OPERATIONS 1MG MAJON FINDINGS OF OPERATION
ZE AUTOPSYT
TIL. ACCIDENT SUICIDE HOMICIDE
216. PLACE OF INJURY (e.g .. IR of God TIC. (CITY, VILLAGE, OR TOWNSHIP, home, farm, factory, street, ofice bldg., etc.)
(STATE
Z16. TIME OF INJURY
While at Work
Net While
at Work
22. I hereby certify that I attended the deceased from
10
that I last ane the deceased alive
. and that death occurred at
ML, from the causes and on the date slated above.
234. SIGNATURE
ALBERT E. HARRIS, M. D. CORONEROne or title
W. Zumfly
Clarke.
MAR 2 8 1950
rd certificate of death was it was issued:
DAVE
242 NAME OF CEMETERY, OR CHEMATORY TUL LOCATION (A), T
REMOVAL 12'pecity) Removal
3-28-50
Unknow
Winthrop, Mass ....
25. FUNERAL DORECTORES CIJAYOURE
ADDRESS
B-36
DATE NEAR T-CELL PEU | POLSTRAITS SIG ATURE 128 1954
John .Marie 17311 Fenkell
for other)
of Permit)
STRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean le of dying, such failure. asthenia, neans the disease. plications which leash.
rbid conditions. giving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or " causing death.
50m-(a)-11-49-900.560
TYPE OR PRINT (EXCEPT SIGNATURES) IN BLACK INK-THIS IS A PERMANENT RECORD
LE (write the word)
NON-RESIDENT
BIRTH No.
Local File No.
(Where doopened lived, If institution: remyleber before admmvo
DETROIT. WAYNE COUNTY
low athip)
a city er incorporated village!
Detroit
d. FULL NAME OF (11 not in hospital or tatitetion, give street dire or location) HOSPITAL OR INSTITUTION
0. STREET ADORESS
c. (Laut)
4. DATE OF DEATH
( )car)
9020
7. MAFRIED, NEVER MARRIED. WIDOWED, DIVORCED (tarify) Married
A. DATE VIMATH
1
Minutes
MARGIN RESERVED FOR BINDING
DISEASE DR CONDITION DIRECTLY LEADING TO DEATH"
MEDICAL CERTIFK ATION CORONARY. THROMBOSIS
"This does not mean the mode of dying, such as heart failure, asthere, etc. means the disease, Injury. or complication which caused death
(Hour
Te. INJURY OCCURRED
Z1. HOW DID INJURY OCCUR?
AODALSS
23c, DATE SIGNEO
allete. Harris
420.1
(City or Town)
No.
LEWIS C. BRIGGS
145 Bartlett Road St.
R.TICULARS
RIED WED
FORCED
¿wife in full)
most of working life)
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 seetion 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, See. 9.
A physician or officer furnishing a certificate of death as required by the preceding seetion 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 ean 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 inelude 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 elerk of the town where the person died; and no undertaker or other person shallexhume 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 sueh 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 seetion 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 elerk of the town for registra- tion. The person to whom the permit is so given and the physician eertifying 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 elerk or registrar may require .- Chap. 114, See. 45. G. L., (Tereentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as arc 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 samc; . . . General Laws, Chap. 38, See. 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 issuc 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 inade.
Chap. 114, Sec. 46. G. L., (Tercentenary Edition). .
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observanee 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 eare 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 eaused 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 oeeupation, 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, ete. 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
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
+
PLACE OF DEATH
Middlesex (County)
Framingham (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Framingham (City or town making return)
Registered No.
30
No.
Cushing VA Hospital
.......
St. [ give its NAME instead of street and number)
2 FULL NAME Arthur P. Hanson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
37 Wilshire
(Usual place of abode)
St.
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years
4
months.
15.
30
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
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
That I attended deceased
from
to.
May 11
19
50
I last saw
h
im alive on
May 11
1950
death is said to
have occurred on the date stated above, at.
7:40AM,
m.
INTERVAL BE-
TWEEN ONSET
11 IF STILLBORN, enter that fact here.
12
AGE.6.1. Years
.1.
.Months.
4 Days
If under 24 hours
Hours ..
. Minutes
13 Usual
Occupation :
Station Engineer
14 Industry
or Business:
Boston Beer Co.
15 Social Security No ..
Charlestown Mass.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Harvey R. Hanson
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Ella Alhorn
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Winthrop Cemetery,
Winthrop Mass
(City or Town)
DATE OF BURIAL ..
May .... 13 .1950
19
7 NAME OF
FUNERAL DIRECTOR
Cookson Funeral Home
ADDRESS
Framingham, Mass.
Received and filed.
19
UN 9
1950
(Registrar of City or Town where deceased resided)
Mrs ... Lillian J. Hanson
21
Informant
(Address)
37 Wilshire St. Winthrop
A TRUE COPY.
ATTEST:
W. A. Walsh
(Registrar of City or Town where death occurred)
DATE FILED
May 12, 1950
19
.....
(a) Residence. No.
Dec .... 29
19
49
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
SIGNIFICANT
CONDITIONS
(Address)
6
Place of Burial or Cremation
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
Date of operation.
12/7/49
50m-(e)-10-48-24658
DISEASE OR CONDITION
DIRECTLY LEADINGCarcinoma of caecum
TO DEATH (a).
w/ generalized metastases
AND DEATH
mos
OTHER
Massive atelectasis
right lung
days
Major findings:
Metastic carcinoma to spine
Of operations
.. Was autopsy performed ?........ yes
What test confirmed d Pathological specimens
no
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
Joseph W.
O "Neil
M. D.
(Signed)
Cushing VA HOSDate 5/11/50,
PARENTS
10a If married, widowed, or divor
HUSBAND of
Lillian J .Ramsey
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
May 11, 1950
(Month)
(Day)
(Year)
J(If death occurred in a hospital or institution,
(Was deceased a
U. S. War Veteran,
WW I
if so specify WAR)
(write the word)
(Kind of work done during most of working life)
M R-302 1
-
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
BOSTON
(City or town making return)
Registered No.
4538 91.
No. Massachusetts General Hospital
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME.
Anna Kleeman
(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. 92 Quincy Avenue
St.
Winthrop
... Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
months.
8
.days. In place of residence.
38.years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
May
23. 1950
(Day)
(Year)
8 SEX
Female
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
4 I HEREBY CERTIFY,
That I attended deceased from
May 15
19
50
to
May 23, 1950
I last saw
her
alive on
May .... 23, 1950
.... , death is said to
have occurred on the date stated above, at.
8:0.0A.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Embolism, cerebral inst
11 IF STILLBORN, enter that fact here.
· 12
AGE
Years
59
1
Months
7
Days
If under 24 hours
Hours.
Minutes
ANTE Due To Rheumatic heart disease
CEDENT (b)
CAUSES
28
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Colloid goitre
6 yrs
Major findings:
Of operations.
Date of operation
none
. 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. Joseph A. Lichty M. D.
(Signed).
Date 24 May 19 50
(Address).
Mass Gen Hosp.
6
Winthrop Cemetery .Winthrop Place of Burial or Cremation (City or Town)
DATE OF BURIAL
May 26,1950
19
21
Informant
Hans C. Kleeman
(Address)
A TRUE COPY
ATTEST: .
(Registrar of City or Town where death occurred)
Received and filed.
JUN- 9 -1950
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
AnnaL. Rump
20 BIRTHPLACE OF
New York City.
MOTHER (City)
(State or country)
7 NAME OF
Alfred B. Marsh
FUNERAL DIRECTOR
ADDRESS
Winthrop, Mass.
25m-(b)-11-49-900,475
PLACE OF DEATH
SUFFOLK (County)
BOSTON
CERTIFICATE OF DEATH
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
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
yrs 14 Industry
or Business:
At home, housewife
15 Social Security No ... None
16 BIRTHPLACE (City) .....
(State or country)
New York City
17 NAME OF
FATHER
Frederick Puseman
Cholecystitis ....
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Hans Carl Kleeman
(Husband's name in full)
9 COLOR OR RACE
DATE FILED
May 29, 195
19
...
n
+
PLACE OF DEATH LAC
Suťfolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Boston
(City or town making return)
Registered No. 45462
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME. William H O'Brien
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 120 Herman St (Usual place of abode)
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years. .months ... L2 .. days. In place of residence. 2.8.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May 23/50
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
May 11
50
19.
That
I
attended deceased f
from
May 23
50
19
19.
death is said to
have occurred on the date stated above, at
3;50P
m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Hypertensive
arterio sclerotic
ANTE
Due To
heart disease
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
colon
Cancer descending
Mos.
Major findings:
Of operations.
Left colectomy
Date of operation
5-17-50
Was autopsy performed? 5-23-50
What test confirmed diagnosis ?.
autopsy
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify. N A Wilhelm
(Signed).
(Address) ..
.. Boston .. Mass.
Date
5-24
19
6
Place of Burial or Cremation
(City or Town)
7 NAME OF
FUNERAL DIRECTOR.
R C Kirby
ADDRESSEast
Boston Mass.
Received and filed. JUN 9 1950 19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
70
AGE
Years
4
20
.Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Real Estate
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Fast Boston Mass.
17 NAME OF
FATHER
John O'Brien
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Margaret McGovern
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick Can.
Holy Cross-Malden Mass.
DATE OF BURIAL
May 26/50
19
21
Informant
(Address)
Mrs Helen L O'Brien
Wife
A TRUE COPY
ATTEST: Charles H. Znackis
(Registrar of City or Town where death occurred)
DATE FILED
........
May .. 29/50
19
......
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
25m-(b)-11-49-900,475
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
M R-302 1
No.
Peter Bent Brigham Hospital
·
(Was deceased a
U. S. War Veteran,
[ if so specify WAR).
Married
10a If married, widowed, or divorced
Helen L Gleeson
HUSBAND of
(Give maiden name of wife in full)
I last saw h
im
to ..
alive on
May 23
50
(or) WIFE of.
TWEEN ONSET ANO DEATH
Yrs
Own Business
PARENTS
CERTIFICATE OF DEATH
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25m-(b)-11-49-900,475
PLACE OF DEATH
SUFFOLK (County)
WEST ROXBURY (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registere.
4579
93.
Veterans Administration ... Hospital St. ( give its NAME instead of street and number) No.
2 FULL NAME
George F. Nolan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
61 Read
Winthrop, Mass.
St.
(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.20 ... years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
25, 1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
That I attended deceased from
May 23.
19.50 ...
to
M.a.y ......... 25 .........
19 .. 50
I last saw h .............
alive on.
-
19 ........ , death is said to
10a If married, widowed, or divorced
HUSBAND of.
Mary F. O' Brien
(Give maiden name of wife in full)
have occurred on the date stated above. at
12:25
.A
INTERVAL BE-
TWEEN ONSET DEATH 11 IF STILLBORN, enter that fact here.
12
56
9
Years
Months
25
.. Days
If under 24 hours
Hours.
Minutes
hemiplegia
CEDENT (b)
Hypertensive cardio
vascular disease
13 Usual
Pressman
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Newspaper
15 Social Security No.
010-07-8049
16 BIRTHPLACE (City)
(State or country)
Salem, Mass.
17 NAME OF
FATHER
Martin Nolan
PARENTS
19 MAIDEN NAME
OF MOTHER
Mary Hannon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Andover, Mass.
Winthrop Cemetery, Winthrop, Mass
6
Place of Burial or Cremation (City or Town) May 27, 1950 19
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
John F. O'Maley
Winthrop
ADDRESS
Received and filed.
JUN 9 1950
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
May 31,1950
19
DATE FILED
.........
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
DISEASE OR CONDITION DIRECTLY LEADING Cerebral thrombosis O C TO DEATH (a). left middle cerebral artery with rf
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
.Was autopsy performed?
no
What test confirmed diagnosis?
clinical and laborat
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
Eric Stone
M. D.
(Signed).
VAH West Roxbury Date.
5-25-50
(Address)
no
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ry
21 Hospital records, VAH West
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