USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 49
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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 clectrical 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 hell, or from a person appointed to have the care of the cemetery or burial ground in which the interment is madc.
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 clue 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 no.ie.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
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
25m-(b)-11-49-900,475
PLACE OF DEATH
Essex (County)
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Danvers (City or town making return)
150
Danvers State Hospital Hathorne lass. J(If death occurred in a hospital or institution,
[ give its NAME instead of street and number)
2 FULL NAME MCCLOSKEY ...... Ellen. ( Valleley)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
919 Shirley St ...
St
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
3
.... years ...
5
months.
14 days.
In place of residence.
.. years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August
2
1950
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Separated
or DIVORCEDE
4 I HEREBY CERTIFY.
April 10, 19.
50
to
August 2,
50
That I attended deceased from
I last saw h
eralive on
Augu.s.t ..... 2. ,19.50 death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Arthur McCloskey
(Husband's name in full)
have occurred on the date stated above, at.
8:30 Am.
n.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
Years
AGE8 3.
6
Months.
26
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Unable to work
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Arthur Valleley
18 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Bridget O'Neil
20 BIRTHPLACE OF
MOTHER (City)
Unknown
(State or country)
Ireland
21
Informant
(Address)
Mary E Sheehan
Hathorne Mass
A TRUE COPY
ATTEST:
(Registrar of City be Town where death occurred)
DATE FILED Aug. 14, 1, 50.
1
Greenwood Cem.
Everett, Mass. (City or Town)
DATE OF BURIAL August 4, 19.50
7 NAME OF
FUNERAL DIRECTOR
A. A. Duncan
ADDRESS Somerville, Mass.
Received and filed.
SEP 11 1950
19
(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. Andrew Nichols ITT (Signed)
M. D.
(Address) Danvers Mass.
.Date ..
8/11/1950
6
Place of Burial or Cremation
Was autopsy performed?
No
Date of operation
Clinical
What test confirmed diagnosis ?.
Yrs
ANTE
Due To
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Generalized
Arteriosclerosis
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Unknown
X
Registered No.
(Was deceased a
U. S. War Veteran,
{if so specify WAR).
(a) Residence. No. (Usual place of abode)
RM R-302 1
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 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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25m-(b)-11-49-900,475
PLACE OF DEATH
Suffolk (County) Chelsea
(City or Town) Soldiers' Home Hospital No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
489 151
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
George A.Roberts
(If deceased is a married, widowed or divorced woman, give also maiden name.)
33 Crest Ave.
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
Aug. 3,1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED idowed
4 I HEREBY CERTIFY,
That I attended deceased from
July 22
Aug.3
19
50
19
to.
im
I last saw h
alive on
Aug.3
50
19.
death is said to
have occurred on the date stated above, at
10:10A m. INTERVAL BE-
10a If married, widowed on divorced Neil 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)
Dovere anemia
TWEEN ONSET AND DEATH ?
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
28
.Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation:
Realtor
14 Industry
or Business:
Real Estate
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Chelsea ,Mass
17 NAME OF
FATHER
Charles H.Roberts
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Chelsea, Mas's.
19 MAIDEN NAME
OF MOTHER
Sarah L.Addison
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Chelsea, Mas.s.
Winthrop Cem. Winthrop Mass 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Aug. 4,1950
19
21
Informant
(Address)
A TRUE COPY Souple GTTurrell
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Aug.3,1950
.19
(Registrar of City or Town where deceased resided)
?
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
clinical
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.Koublez
(Signed) .......
(Address) soldiers
"Home"
.Date ..
8/3/50
.19
M. D.
PARENTS
Hospital Records
7 NAME OF
Alfred B.Marsh
FUNERAL DIRETORWinthrop St. winthrop
ADDRESS
Received and filed SEP 2.5 1950
19
(Was deceased a
WWI
U. S. War Veteran.
if so specify WAR)
Winthrop, Mass .
(a) Residence. No. (Usual place of abode)
hospital
19
,50
55
2
(Kind of work done during most of working life)
ANTE
Due ToBronchopneumonia.
CEDENT (b)
CAUSES
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Enlisted 7/15/18 Discharged 12/17/18 Pvt. COTS, Cp.Z Taylor , Ky. 2798393
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
25m-(b)-11-49-900,475
PLACE OF DEATH
Suffolk (County)
Chelsea
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea (City or town making return)
494 152
No.
Chelsea Memorial Hospital
f(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
John Abbott Whorf
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 Washington Ave
St.
Winthrop
Milass
(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.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Aug.7,1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
4 I HEREBY CERTIFY,
AUG.1
1950
to .. Aug .... 7
That I
attended deceased from
19 .. 5.0
I last saw
im
Aus.7
19
50death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING,te intestinal
TO DEATH (a) ACL
obstruction
2das
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT Cerebral arterio-
CONDITIONS clerosis
4 yrs
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis?
clinical .... study ..
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed).
A. C. Benjamin
M. D.
(Address) Chelsea.
Date 3/8
1950.
6
Woodlawn Everett Nass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Aug. 10,1950
19
7 NAME OF
FUNERAL DIRECTOR
Albert F.Douglass
ADDRESS
Lexington, Muss.
Received and filed. 19
SEP 25 1950
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE
.78
Years
-
Months .... ..
.Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation :
Shipper
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Lust Boston, Mass.
17 NAME OF
FATHER
John Whorf
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Provincetown, mass.
19 MAIDEN NAME
OF MOTHER
Susan Brooks
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Kittery, Me.
21 Mrs. Leona hird
Informant
(Address)
64 Pine St. Belmont Mass.
ATTEST:
A TRUE COPY Joseph G. Tyrell
(Registrar of City or Town where death occurred) Aug.8,1950
DATE FILED
.19
10a If married, widowed, or divorced
HUSBAND of
Susie Ranney
(Give maiden name of wife in full)
have occurred on the date stated above, at.L.l.p.
m.
INTERVAL BE- TWEEN ONSET AND DEATH
PARENTS .
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
RM R-302 1
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
ESSEX
PLACE OF DEATH
(County) LAWRENU_
(City or Town) 52 Chester No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
LAWRENCE
(City or town making return)
719.53
Registered No.
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.)
24. Underhill
Winthrop
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
3
15
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
August
1950
(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: (IEre Chigny was involved, flaterdirary Thrombosis,
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
omale
10 COLOR OR RACE
white
11 SINGLE
MARRIED
WIDOWED . id owed
or DIVORCED
11a If married, widowed, or divorced
HUSBAND of.
Jumes (Give maiden nameof wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13 72
-
AGE
Years ..
Months
.Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation:
(Kind of work done during most of working life)
15 Industry
own home
or Business:
HonG
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Lenn.
Charles hinh
18 NAME OF FATHER
19 BIRTHPLACE OF
Winchendon
FATHER (City).
(State or country)
20 MAIDEN NAME zabeth-Cannot be learned OF MOTHER
21 BIRTHPLACE OF
Northboro
MOTHER (City)
Mass
(State or country)
Burke
22
Informant U Her ington St., Quincy,
(Address)
A TRUE COPY.
ATTEST:
Mandan 65/16
(Registrar of City or Town where death occurred)
DATE FILED
August
23
150
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased? If so, specifyjulius I. Burgiol
(SignedLawrence. lass. 8-19 -... M.OD. Wadeaster Comstory Auf Dater 2019.
7 Place of Burial, or Cremation. August (City or Town) 50
DATE OF BURIAL Garrett J Burke 19
8 NAME OF
FUNERAL DIRECTOR
Andover, Dass
ADDRESS
Received and filed.
SOF 12 1950
3.20 12-1950
19
.
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
25m-(h)-10-48-24658
5 Accident, suicide, or homteixspecify)
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
nasperify type of place)
Injury
nHow did injury occur?)
Nature of
Injury
no
no
While at work?
Was autopsy performed?
housework
none
(write the word)
St.
(If nonresident, give city or town and State)
Evangeline Purke
RM R-302 1
PLACE OF DEATH
Md sx.
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
893.151
No. Lowell General Hospital
·
J (If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
2 FULL NAME Robert M. English (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. ... 15 Willow Ave (Usual place of abode)
St.
Vinthrer
(If nonresident, give tity or town and State)
Length of stay: In place of death .. .. years. months. days. In place of residence L.Q .... 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
or DIVORCED
Vid owed
4 I HEREBY CERTIFY,
That I attended deceased from
... Aug ...... 25,.
19 .. 50 ...
19 .... 50
I last saw h
i.m.alive on ..... /1.1.1.5 ........ 5 ....... , 19 .... 55 death is said to
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
82
Years.2
Months&
Days
If under 24 hours
Hours ..
Minutes
13 Usual
Dealer
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Hardware business
15 Social Security No.
16 BIRTHPLACE (City) Canden, H. J.
(State or country)
17 NAME OF
FATHER
Robert MoC. English
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Camden, II.J.
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, specifyhn Hoffman
(Signed) Lowell Gent Hosp
.Date.
8/05/ MS8
(Address)
woodlawn Crematory, Everett ,Mass
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
Aug. 29,
1950
7 NAME OF
FUNERAL DIRECTOR.
R. J. DeNeill
ADDRESS
381
Broadway, Revere U8.89
Received and filed
8/31/100
SEP 11 1950.
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Emma Coke
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germantown, Pa.
21 Richard H.English
Informant .....
(Address) MithrOP, NOUS.
A TRUE COPY. -1
ATTESTA
CC Or (Registrar of City or Town where death occurred)
DATE FILED
Director
8/27/50
.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 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
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Cerebral hemorrhage
hra.
ANTE
CEDENT (b)
Due To
Hypertension
10 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Cardiac enlargement
5 yrs
Major findings:
Of operations.
no
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
X
3 DATE OF
DEATH
Aug. 25, 1950
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of
Lillian Smalley
(Give maiden name of wife in full)
have occurred on the date stated above, at . 2 .... 0/212 ....... m. INTERVAL BE- TWEEN ONSET AND DEATH
(Was deceased a
U. S. War Veteran,
if so specify WAR)
٠
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 of town in which the deceased resided as soon as possible
+
PLACE OF DEATH
Suffolk (County) Chelsea (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea (City or town making return)
Registered No.
525 155
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Baby Boy Hill
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
38 Sunnit Ave.
........
St.
Winthrop Mass
(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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
-in. le
4 I HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw h ..........
alive on
19
death is said to
have occurred on the date stated above, at.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Abruptio placentue
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
Stillborn
12
AGE
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)
Chelsea, Mass.
17 NAME OF
FATHER
Lee B.Hill
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Tennessee
19 MAIDEN NAME
OF MOTHER BIRTH
CERT .- > M. Eldridge
The Ina ( cannot be
learned )
6
Woodlawn I.verett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Sept. 6,1950
19
7 NAME OF
FUNERAL DIRECTOR
J. Vincent Murray
ADDRESS.
Rovono Adusg.
Received and filed.
SEP 26 1950
19
(Registrar of City or Town where deceased resided)
21 Record Vilico
Informant.
(Address)
Chelsea laval Hospital
A TRUE COPY
ATTEST:
Joseph G. Tyrell
(Registrar of City or Town where death occurred)
DATE FILED
Sept.6,1950
19
3 DATE OF
DEATH
Aug. 31,1950
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
ANTE
Due To
CEDENT (b)
CAUSES
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
(Signed).
J.G.Allen.Jr
M. D.
(Address).
Navel Hosp
Date
19
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Tennessee
25m-(b)-11-49-900,475
RM R-302 1
No. U. S.Naval Hospital
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
(write the word)
m.
Everett 10/6/50
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
156
CERTIFICATE OF DEATH
Registered No.
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
U.W=1
(a) Residence. No. (Usual place of abode)
St. .
(If nonresident, give city or town and State)
Length of stay: In place of death years. 3 .. months. days. In place of residence 18 .years months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sunt- 1-1950
(Mono)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19 to ....
19
I last saw h
... alive on
19
death is said to
have occurred on the date stated above, at 6A m. INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Due To ANTE CEDENT (b) CAUSES
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 .... . (Signed) (Address)
., M. D.
7-1- 19. 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
Sant-4-1950
19
7 NAME OF
FUNERAL DIRECTOR.
I. E. HundenCo
ADDRESS Enlace-
Received and filed 19
SEP 1 1950
(Registrar)
8 SEX
9 COLOR OR RACE
weili
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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.
12
AGES 3 Years
7
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :.
thorst
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City) (State or country)
e
17 NAME OF FATHER Frederick
18 BIRTHPLACE OF FATHER (City) (State or country)
19 MAIDEN NAME OF MOTHER Esteen ross
20 BIRTHPLACE OF MOTHER (City) (State or country)
n
21 Informant (Address) 68Immense- Simet
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter &Baker
HO
(Signature reef scent of Board of Health or other) Sept 1/50
(Official Designation)
(Date of Issue of Permit)
50m-(b)-11-49-990,560
PLACE OF DEATH
suffire anty)
RM R-301A 1 Willuare (City or Town) 148 and zie ave No.
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.) 68 Simda .....
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.
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