USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 86
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(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
November 28
1952
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR OR RACE
W
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDNi dowed
IHEREBY CERTIFY.
1/15
19
44
to
11/28
19
52
I last saw
h
er
alive on
11/28
52
10a If married, widowed, or divorced
HUSBAND of
Louis Brown
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGES6 Years
Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
S 14 Industry
or Business:
At home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Samuel
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Rose
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
DATE OF BURIAL.
Nov .28
1952
21
Informant
(Address)
A TRUE COPY
E Cer Carles & Mackie
ATTEST!
(Registrar of City or Town where death occurred)
DATE FILED
....
Dec 1
.....
19.52
(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 ...
(Signed) .............. Feldman
M. D.
N.o
(Address) 372 Marlboro St
Date 17/28.1952
Lawrence Ave .Cem
6
Place of Burial or Cremation
(City or Town)
W Roxbury
25M-(B)-11-51-905807
7 NAME OF
FUNERAL DIRECTOR.
E Levine
Brookline, Mass.
ADDRESS
Received and filed
DEC 8 1952
19
1.5
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.)
-1.5yr
Due To (c)
OTHER
SIGNIFICANArteriosclerotic &
CONDITIONhypertensive heart disease
-byTS
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?.
No
What test confirmed diagnosis ?.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Left cerebral
hemorrhage
1wk
ANTE
CEDENT (b)
CAUSES
Due ToEssential hypertension
(Give-maiden name of wife in full)
19.
death is 'said to
have occurred on the date stated above, at5:00a
m.
That I attended deceased from
(City or Town)
No.
Rose Finkle Nursing Home
R Gordon
X
RECEIVED
TO !!
OF
11 92
9
8
6
DEC-3
-
-301A 1
PLACE OF DEATH Suffolk (County)
Daslon 12/8/52
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 251
Winthrop Community Hospital No. Baby Boy Thomas 2 FULL NAME ..
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)
nones
st. East Burtin Wars
(If nonresident, give city of town and State)
Length of stay: In place of death. . ..... years. months .. 1 days. In place of residence. .years
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
november 28,
(Month)
(Day)
1952 (Year)
8 SEX
Mace
9 COLOR OR RACE
suite
10 SINGLE
MARRIED
WIDOWED
or DIVORCER
(write the word) Juice
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.
Months
12
AGE
Years
1
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)
mass.
17 NAME OF
FATHER
Joseph St Thomas
18 BIRTHPLACE OF
East Boston
FATHER (City)
(State or country)
muss
19 MAIDEN NAME
OF MOTHER Beatrice Launay
20 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country) mass
21 Informant Arech Str Thon mas
5569 Bennington SV. E. Rcoton
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter S. Baker
(Signature of Agent of Board of Health or other)
Theater Officer
12/3/52X
(Official Designation)
(Date of Issue of Permit)
1
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .......
(Signed)
az capleur MD
M. D.
(Address) 86 Pincetin PT. EB Date 1-28- 1952
6 Kaly Cross Place of Burial or Cremation
malden
(City of Town)
DATE OF BURIAL
Dee.
3
1952
7 NAME OF
FUNERAL DIRECTOR Fredericle ) magnatto
ADDRESS
East Boston
Received and filed
DEG 3 1952
19
(Registrar)
1day
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Cyanosis
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
IN Prematurity
ANTE
Due
atelectasia
CEDENT (b)
CAUSES
aTELECTORis
I last
hum alive on non 28
. 195 2 death is said to
have occurred on the date stated above, at
P. m.
6
Cyaniris-
SOM (8)-1-51 903586
ONS IFICATE
DEATH ter one ach nd (c)
ot mean ng, such asthenia, e disease, s which
tditions, se to the stating cause
contrib- but not sease or g death.
(City or Town)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
569 Bennington
(a) Residence. No. (Usual place of abode)
Registered No.
1
4 I HEREBY CERTIFY.
That I attended deceased from
Nov 27 19 52 nor 28 1952
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 naine 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."D 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 disalir [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
ing
dritttient of the purpose of these laws calls for the observance of the follow- ties of practice ... nding physicians will certify to such deaths only as those of persons Why they have given bedside care during a last illness from disease unrelated to.
(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 have died withaut recent medical attendance or whose physician is absent DiCome tyhen the derfificate 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
1
PLACE OF DEATH
Bristoly) .Fairhaven (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Fairhaven (City or town making return)
Registered No.
252
........ [(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Charles L. Sylvio
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No. .
Bartlett Road
(Usual place of abode)
......
St. .. Winthrop
1.08.3.0
(If nonresident, give city or town and State)
Length of stay: In place of death.
-
.years ..
....... months.
........ days. In place of residence.25
.. years ............ months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
No.v.a
1.0.4
1952
(Month)
(Day)
(Year)
8 SEX
Malo
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED Sin le
4 I HEREBY CERTIFY,
That I attended deceased from
Aug ...... 15 19.9
to ..........
iov. 10
1952
I last saw
h.i.m ..... alive on ..
NO.V ..
8
.,
19.52. death is said to
have occurred on the date stated above, at.
2:15
1 m.
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).Cerebral
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN. enter that fact here.
hemorrhage
4 days
12
AGE 67 Years
Months.
.Days
If under 24 hours
Hours .....
Minutes
Due To
hypertension
4 years
(Kind of work done during most of working life)
14 Industry
or Business:
solen industry
unkno
13 Social Security No.
032-20-16331
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
. Was autopsy performed ?..... NO
What test confirmed diagnosis ?.
......
None
S Was disease or injury in any way related to occupation of deceased ?............
If so, specify
(Signed)
M. D.
72Address) unty
........ Date .... O.V. .. 10.1922.
6 .4 ......
Place of Buffal or Oremation tory" NyCity or Th Ord.
DATE OF BURIAL
NOV. 12, 1:52
19
21
Informant.
(Address)
illion. Liver
7 NAME OF
FUNERAL DIRECTOR ..... DenfolbwFor
ADDRESS.
127 Chestart St.
Received and filed
DEC .... 2.3.1952
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Emmanuel V. Sylvia
18 BIRTHPLACE OF
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
mary elizabeth Carr
20 BIRTHPLACE OF
MOTHER (City).
New Leaf ,no, mas.
(State or country)
A TRUE COPY
Michal X 0.
ATTEST:
(Registrar of City of Town where death-occurred
DATE FILED
Nov. 12.
......
19. 52
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.)
1
-302
50m-(e)-10-48-24658
13 Usual
Occupation:
Traveling salesman
ANTE
CEDENT (b)
CAUSES
Due To
(c)
generalized
arteriosclerosis
16 BIRTHPLACE (City) ............. @df2 ..... (State or country)
(Give maiden name of wife in full)
(write the word)
No. 583 washington
DEC 23,45219 1
-302
1
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
Denvers (City or town making return)
Registered No.
J(If death occurred in a hospital or institution, Danvers .... Stato ..... Hospital ........ Hathorne ....... St. [ give its NAME instead of street and number) No.
2 FULL NAME Elizabeth Lunney (Gollahan) (If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
253
(a) Residence. No. 279 River Road .....
St
Finthran
(If nonresident, give city or town and State)
Length of stay: In place of death 7 years 2 months 5 days. In place of residence. ...... .years. months .days.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November
18
1952
(Month)
(Day)
(Year)
8 SEX
Female
White
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Loved
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
Jame's(Hisbana's Kaye in full)
11 IF STILLBORN, enter that fact here.
12
months AGE do 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) No.Ads (State or country)
1 955.
17 NAME OF
FATHER
Jeremiah Callahan
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Troland
19 MAIDEN NAME
OF MOTHER
Catherine (Burke)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Informant .. (Address) mary n. Shechen
A TRUE COPY
Hathorne,
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Nov nih 2 27. 10.52
(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
(Signed). Andrer Nichols 350 M. D.
.19 ..... «
6 Place of Burial or tematformetery (City er Town)
DATE OF BURIAL. November 21- 19.5.2
7 NAME OF FUNERAL DIRECTOR .. John F. OLI230
ADDRESS. inthron, Mass.
Received and filed DEC -2 4 1952 19
25m-(b)-11-49-900,475
(Usual place of abode) MEDICAL CERTIFICATE OF DEATH ANTE Due To CEDENT (b) CAUSES Due To (c) Major findings: disease Of operations. (Address) 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 deathis winch octunicu in your city of town in case the deceased resided in another city of town at the time Date of operation Was autopsy performed? after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
OTHER
SIGNIFICANT
CONDITIONS
Hypertensive heart"
years
What test confirmed diagnosis ?.
Clinical & Laborator
TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Cancer of Stomach
4 I HEREBY CERTIFY, That I attended deceased from Sept. 13, 19.51. to Nov. 18, ... , 195.2 ... I last saw hey. .... alive on Nov. 18, ... 19 ..... A.death is said to have occurred on the date stated above, at 7:00 P.m. INTERVAL BE-
(write the word)
X
RECEIVED
TO:
1
11 12
,1
6 5
THROW
DEC25
PLACE OF DEATH
SUFFOLK! BOSTON
(City or Town) 818 Harrison Ave.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
10475254
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.)
(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
3 DATE OF
November
28
1952
DEATH
(Month) (Day)
(Year)
9 SEX
M
10 COLOR OR RACE
W
(write the word)
11 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
11a If married, widowed, or divorced
HUSBAND of
Frances
Hartford
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
51
Years
8
.Months.
14
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :
Guard
(Kind of work done during most of working life)
15 Industry
or Business:
Gillette Safety Razor Co.
16 Social Security No.1.20-16-7410
Boston
17 BIRTHPLACE (City)
(State or country)
Mass.
18 NAME OF
FATHER
Samuel Clayton
19 BIRTHPLACE OF
FATHER (City)
(State or country)
England
20 MAIDEN NAME
OF MOTHER
Annie Heaton
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
22
Informant
(Address)
Wife
A TRUE COPY. LO
tardes
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed.
DEC 1.6.1952
19
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased? ...
If so, specify
(Signed) R .... Ford
M. D.
(Address)
Dat
11/2019 52
Winthrop
7
Winthrop
Place of Burial, or Cremation. Dec 1,
DATE OF BURIAL
(City or Town) 58
19
8 NAME OF
FUNERAL DIRECTOR
R .... Kirby
ADDRESS E-Boston
25m-(c)-11-49-900.475
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
T.
305
1
No.
PERCY E CLAYTON
(Was deceased a
U. S. War Veteran,
WW II
if so specify WAR).
Winthrop, Mass.
47 Beacon
St.
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, stats fully.) Acute coronary insufficiency due to
widespread severe coronary athero". sclerosis obliteration of the left anterior descending artery and edema .f ...... a.thero. clerotic ..... plague ..... in the ... right circumflex branch
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?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of Injury
While at work?
. Was autopsy performed? . Yes.
PERSONAL AND STATISTICAL PARTICULARS
DATE FILED
Dec 2,
.19 ..
52
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION & OUTFIT SERVICE NUMBER
- 6/30/42 3/25/43 Private - Battery E 207 Coast Artillery (anti-aircraft) 31137425
RECEIVED
OF
TOW
11 12 1
€
3
6
THRI
DEC16/95211
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
25M (A)-8-50-902 592
PLACE OF DEATH
Suffolk County) Withray
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agent.
Registered No.
255
J(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME ...
Charlotte Cheam (If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so apecity WAR) Mans
(If nonresident, give city or town and State)
Length of stay: In place of death. ......
... years. 8 .months. .days. In place of residence. ...... .. years. .months .days.
MEDKRL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
OF December 3, 1952
(Month)
(Day)
(Year)
9 SEX
Female Salute
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Cherm AhERN
marquei
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 .....
Willian
(Give maiden name of wife in full)
(or) WIFE o
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
66
AGE
Years.
Months.
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation:
maid
(Kind of work done during most of working life)
15 Industry
or Business:
Mc Jean Hospital
16 Social Security No.
none.
17 BIRTHPLACE (City).
(State or country)
mars
18 NAME OF
FATHER
montaque ODonnell
19 BIRTHPLACE OF
FATHER (City).
(State or country)
Po Sland
20 MAIDEN NAME
OF MOTHER
ann me Gehvary
21 BIRTHPLACE OF MOTHER (City) (State or country) P.C. Island
22 Informant
marion Chave Ahogy
(Address) DO Pleasant @ Startup Mais.
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