USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 44
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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
shall have been delivered to such board, agent or clerk, as the case may be, Uten deathstef persons not disabled by recognized disease, and those of found deadil
IR-301A K. - UNEI.
-
PLACE OF DEATH
Jusfalls (County) Mutual (City or Town)
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.
142
Mmctrop Com, Toask. No. Trainor Mrs annie
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
455 Shirley St. Winthrop St. (If nonresident, give city or town and State)
Length of stay: In place of death years. months. 10 days. In place of residence. 66 years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Hugh 1 gramos
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE/ 4 Years
Months.
.Days
If under 24 hours
Hours .....
. Minutes
13 Usual
Occupation :
Thome
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No. none
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
18 BIRTHPLACE OF FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Mary Murphy
20 BIRTHPLACE OF
MOTHER (City)
(State or country))
Thomas, Tranger
21
Informant
(Address)
Beat It Mineral
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued, Walter . Bakery.
(Signature of Agent of Board of Health or other)
Healthy White 630,53
(Official Designation)
(Date of Issue of Permit)
V.K.
C
1953 (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
1948
June 29
to ...
1953
I last saw her alive on
Janne 24, 19.5, death is said to
have occurred on the date stated above, at. 7 45 A. m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Cerebral hemorrhage
with it. hemiplegie
INTERVAL BE- TWEEN ONSET ANO DEATH 2aks.
ANTE
Due To
arteno sclerotic +
CEDENT (b)
CAUSES hipperlemmer beat pescare
with congestive Due To
(c)
Diabetes mellitus
approx tag 10yes.
OTHER
SIGNIFICANT
CONDITIONS
home -
Major findings:
Of operations.
have -
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) 222 Pleasant St Woodgate 6/24
M. D.
1953
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
July 1
195-
7 NAME OF FUNERAL DIRECTOR ... ADDRESS
FOR Maurice W Tiby
Received and filed JUN 30-1953 19
(Registrar)
3 DATE OF
DEATH
Jane
29
K(Month)
(Dáy)
MURPHY
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)
UCTIONS FOR CERTIFICATE giving OF DEATH t enter than one for each b) and (c)
does not mean of dying, such ure, asthenia, ns the disease, ations which h.
d conditions, ng rise to the e (a) stating lying cause
ions contrib- death but not he disease or using death.
50M-5-52-907046
3 cps.
PARENTS
Registered No.
(write the word)
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 seventecn. 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 he 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 he 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 ih which the interment is made.
. Chap. 114, Sec. 16, . E. (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 & en bedside cate 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 disatied 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 Etathurergyill investigate and certify to all deaths supposably due to injury. 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
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Essex (County)
Danvo .......
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvors
(City or town making return)
Registered No.
143
No. Danvers State IIspital, Hathome
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME.
Walter Pickett
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
46 Franklin
St
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
years ....
نـ
.... months ............ days. In place of residence.
.. years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June .:
(Month)
(ba)
1253
4IHEREBY CERTIFY.
That I
attended deceased from
Hay.
1953
to ..... June
4
15.3.
I last saw h.f ....... alive on ..... Juno
4, 195.3., death is said to
have occurred on the date stated above, at 7 06 pm.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH (a).
Gonoralizod
Arteriosclerosis
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
Arteriosclerotic
CONDITIONS
heart disease
3 yrs
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed).
Julius 7.
M. D.
(Address)
Hat.orno
365. Date 6/12/
6
Lincoln Memorial Cem, Washington Place of Burial or Cremation (City or Town)) .C.
DATE OF BURIAL.
3.0
7 NAME OF
FUNERAL DIRECTOR aurico ............... kirby
Winthrop, Mass.
ADDRESS
Received and filed.
JUL 1 5 1953
19
C
(Registrar of City or Town where deceased resided)
11 IF STILLBORN. enter that fact here.
Years
12
AGE 3
5
28
Montf
Days
If under 24 hours
.Hours.
.Minutes
13 Usual
Occupation :
Janitor
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ..
16 BIRTHPLACE (City).
(State or country)
.Washington
17 NAME OF
FATHER
Ilenry Pickett
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
North Carolina
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
North Comlina
21 Mary 2. Siechan
Informant
(Address)
2thorns
A TRUE COPY Arthur No Say
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
June
15,
19 53
V
8 SEX
Malo
9 COLOR OR RACE
Black
10 SINGLE
MARRIED
WIDOWED
or DIVORCED i dowod
(write the word)
10a If married. widowed, or divorced
HUSBAND of
Cannot be learned
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
25M .(B) -11-51-905807
R-302 1
(Usual place of abode)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
i
.1
0
JUL 15 AM
‹
3
1
1
1 1 1
1
1
1
1
1
INED BY| MED EXAMINER
A R-302 1
PLACE OF DEATH
SUFFOLK BOSTON
(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)
Registered No.
5898 144
1
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
-- DiVita
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
126 Brookfield Rd
(Was deceased a
U. S. War Veteran,
Winthifopecifx WAR
(a) Residence. No.
(Usual place of abode)
4 hrs 5 mins
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
June 26, 1953
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY.
That I attended deceased
from
53
June 26
53
19
...
to.
alive on
June 26, 53.
have occurred on the date stated above, at
6:35p
m:
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
.Years
Months.
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).WinthropMass (State or country)
17 NAME OF
FATHER
Carmen DiVita
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Winthrop Mass
19 MAIDEN NAME
OF MOTHER
Rita Lazzarino
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
WinthropMass
Place of Burial or Cremation
(City or Town)
June 29
1.19 53
DATE OF BURIAL
21
Informant
(Address}
A TRUE OParles H. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
June 30
53
19
5
1
25M-3-53-909098
7 NAME OF
FUNERAL DIRECTOR
E.P.Caggiano
ADDRESS.
Winthrop ... Mass
Received and filed
JUL-1 6-1953"
19
(Registrar of City or Town where deceased resided)
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 LEADINGrebral hemorrhage
TO DEATH (a)
Sepsis
ANTE Due To CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
.....
.no
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ...
(Signed).
A Glenlow MD
M. D
(Address)
30 Longwood AvDate 6/26 19 53
Winthrop Cem
6
Winthrop Mass
PARENTS
Father
No.
The Infant's Hospital
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 of 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.)
(write the word)
I last saw h
er
June 26
19
St.
(If nonresident, give city or town and State)
TOWN
OF
18 92
OFFIC
7
3
7
JUL 16 AM
D
A R-302 1
T
(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)
Registered No. 6021 115
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Mary ...... F Saigoon
(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)
127 Quincy Ave
St
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death.
.......... years.
.months
9 .... days. In place of residence
30years
.months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Inne 29 .... 1953
8 SEX
Female
9 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
That I attended deceased from
..... June .... 20 ... , 19 ... 53 ..
to ......
June ... 29 .......... , 1953
I last saw h ...... O.malive on ........
June .... 29 .... , 19.53 death is said to
have occurred on the date stated above, at 7:50a
.. m.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Webster A Saigeon
(Husband's name in fullf-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a).Multiple pulmonary ....
emboli
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE .... BO Years.
. Months ...
.Days
If under 24 hours
Hours .......
Minutes
ANTE
Due To
CEDENT (b) ..... Myocardial .... infarction
small
recent 14 Industry
4 yrs
or Business:
Own Home
occlusi
otis thrombosis&
artery
OTHER SIGNIFICANFaget's disease rt tibia CONDITIONS Carcinoma left breast 10 yrs
Major findings:
Ischemicleft lowerles with
Of operations
Date of operation ...
6/27/53
Incipient gangrene
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.
(Signed)
V.M.Cass.
M. D.
6/29
19 .... 53
(Address) P Bent Brig Hosp Date.
6 Place Of D thnon from Winthrop. Mass
DATE OF BURIAL.
July 2
19.53
21
Informant.
Eleanor ..... Kirby
(Address)
A TRUE CƠPY
ATTESTY
ardes & Macht
(Registrar of City or Town where death occurred)
DATE FILED .............
July 3
.19.53
C
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Hannah E Green
20 BIRTHPLACE OF
MOTHER (City).
Ireland
(State or country)
7 NAME OF
FUNERAL DIRECTOR.
J F O!Maley
ADDRESS.
Winthran Hace
Received and filed.
JUL 1-6-1953
19
25M-3-53-909098 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
PLACE OF DEATH
(County)
No.
"Peter Bent Brigham Hospital
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.)
Arterio car Left popliteral
12 da
15 Social Security No.
S
16 BIRTHPLACE (City) .... Boston Mass (State or country)
17 NAME OF
FATHER
Patrick O' Connor
(Kind of work done during most of working life)
recent
13 Usual
Occupation :.
Housewife
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
TOWN
JE OF
11.12 1
C,
6
JUL16 AR
R
PLACE OF DEATH.
SUFFOLK (County) BOSTON
(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)
Registered No.
6083.46
Mass General Hospital No.
[(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.)
10 Perkins St
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
.....
... years.
12
.months.
days. In place of residence.
.years.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 3, 1953
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 23
19 ..
53
to
July 3
19
5.3
HUSBAND of
Sarah ... E ... Maloney.
I last saw
h
imalive on
July 39 53
ath is said to
INTERVAL BE-
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Chronic nephritis
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
7.5Years
Months.
15 ays
If under 24 hours
.Hours ..
Minutes
13 Usual
Occupation:
Sign Painter
(Kind of work done during most of working life)
14 Industry
or Business:
Sign Co
15 Social Security No.
Lonacoming Md
OTHER
SIGNIFICANT
CONDITIONS
Portal cirrhosis
years
Major findings:
Of operations.
Date of operation.
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.
(Signed)
L ... R .... Lezer
M. D.
(Address)
MG!
Date ....
7/3 1953
6
Winthrop Com
Place of Burial or Cremation
Winthrop Mass.
(City or Town)
July 6
19 53
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
H S Reynolds
ADDRESS Winthrop ... Mass.
Received and filed.
JUL 16 9052
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
-
(State or country)
19 MAIDEN NAME
OF MOTHER
Martha Mooney
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Dorothy Dunn
21
Informant
(Address)
A TRUE COL
Charles & Mac
ATTEST
Registrar of City or Town where death occurred ........
DATE FILED
..........
July
195.3
.......
...... ........
C
25M-3-53-909098
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.)
A R-302 1
T.
Edward F Dunn
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
35
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
10a If married, widowed, or divorced
(Give maiden name of wife in full)
have occurred on the date stated above, at
9:40a
m.
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
years
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Richard Dunn
RECEIVE.
TOWA
OF
78 12 1
0
IMIN
10
155
JUL16 AM
R-301A 1
PLACE OF DEATH
X Suffolk (County) Winthrop (City or Town) 20 Read No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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