Town of Winthrop : Record of Deaths 1954, Part 41

Author: Winthrop (Mass.)
Publication date: 1954
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 41


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90 | Part 91 | Part 92 | Part 93


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT


SERVICE NUMBER


:


R-301A 1 Winthrop (City of Town)


Bay View Nursing Home No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


annie millman 2 FULL NAME ..


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. 121 Hawthorne (Usual place of abode)


Length of stay: In place of death.


0 years 1 months 14


.days.


In place of residence.


.years


0


.months


0


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR OR RACE


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY


That I attended deceased from


I last saw


alive on


Wlan as 19 / death is said to


have occurred on the date stated above, at .... .m.


DISEASE OR CONDITION


DIRECTLY LEADING Y


TO DEATH (a)


(


INTERVAL BE- TWEEN ONSET ANO DEATH 4 dy


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. P.


Liberty Progressive Place of Burial of Cremation (City or Town)


DATE OF BURIAL


may 26


1.5%


7 NAME OF


FUNERAL DIRECTOR.


Hyman &, Jorf


ADDRESS 15/ Washington alu c/eua


Received and filed. 19


(Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


(CBK)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


21


Informant.


(Address)


/2/ Havvitore et chelsea


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or/transit permit was issued: J ater De Fraper


(Signature of Agent of Board of Health or other) Thatha Mile 526/54


(Official Designation) (Date of Issue of Permit)


X


CTIONS R ERTIFICATE ving DEATH enter an one r each and (c)


es not mean dying, such e, asthenia, the disease, ions which


conditions. rise to the (a) stating ing cause


ns contrib- ath but not disease or sing death.


50M-10-52.908091


PLACE OF DEATH Suffolk (County)


Chelsea 6/8/54


The Commonwealth of Massachusetts DVITTENT 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.


120


Registered No.


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran.


if so specify WAR)


St. Chelsea mass


(If nonresident, give city or town and State)


40


10a If married, widowed, or divorced HUSBAND of .. Jacob


(Give_maiden name of wife in full)


millman


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


74 Years


0


Months.


0


Days


If under 24 hours


Hours . ..... Minutes


13 Usual


Houseunfe


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business:


own home


15 Social Security No ..


nome


16 BIRTHPLACE (City).


(State or country)


Russia


17 NAME OF


FATHER


David Rothstein


109/2


3 DATE OF


DEATH


MAY


25


(Month)


(Day)


1954 (Year)


19


44


to.


May 25.


19 54



(or) WIFE of


Philip Mullinan


Date 15/25 1954


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 imine- 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-cight and July fourth, nineteen hundred and two, and the Mexican border' service of nineteen hundred and sixteen and nincteen hundred and seventcen. 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 hody, 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 T 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 dierk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.


. { Chap. 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to/whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of Mindre have died without recent medical attendance or whose physician is absent Tomhome when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of cheinical (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


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


SUFFOLK (County)


BOS TON


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


CERTIFICATE OF DEATH


BOS TON


(City or town making return)


Registered No:


1214623


J(If death occurred in a hospital or institution. XXSCX give its NAME instead of street and number)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


34 Trident Ave.,


xx


Winthrop Mass


(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


M


9 COLOR OR RACE


W


(write the word)


10 SINGLE


MARRIED


WIDOWED


or DIVORCEDMarried


That


I


attended deceased from


5/26


10a If married, widowed, or divorced


19


5! HUSBAND of


Mary Goldstein


I last saw h ...... i.m .. alive on.


5/26


19


5/death is said to


(or) WIFE of.


(Give maiden name of wife in full)


have occurred on the date stated above, at 8:308


.m.


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a) ....


congestive heart


failure


INTERVAL BE- TWEEN ONSET AND DEATH wks


11 IF STILLBORN, enter that fact here.


84


12


AGE


Years.


Months.


Days


If under 24 hours


Hours


.Minutes


13 Usual


Occupation :


Tanner


14 Industry


or Business:


retired


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


Harry Babson


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


Sarah


-


- -


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


M Babson


7 NAME OF


FUNERAL DIRECTOR


A Golov


ADDRESS


Brookline Mass


Received and filed.


7 1954


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 .....


(Signed).


J Slosberg


M. D.


(Address).


330 Brkl Ave


Date


5/26.1954


Everett (City or Town)


DATE OF BURIAL.


May 27


19.54


21


Informant


(Address)


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


May 28


54


......


... 19 ......


25M-10-53-910621


2 FULL NAME


(a) Residence.


No.


(Usual place of abode)


3 DATE OF


DEATH


(Month)


(Day)


4 I HEREBY CERTIFY,


5/20


19


to


CEDENT (b)


Due To


(c)


Major findings:


Of operations.


What test confirmed diagnosis ?.


6


Winthrop.Com


Place of Burial or Cremation


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


heart disease


May


26


1954


(Year)


ANTE


Due To


arteriosclerotic


yrs


OTHER


? Addison's Disease


SIGNIFICANT


CONDITIONS hyponatremia, hypoglycemia -?


Date of operation


Was autopsy performed ?.


M R-302 1


Beth Israel Hospital No.


BEN JAMIN BABSON


(Was deceased a


U. S. War Veteran,


if so specify WAR)


6


(Kind of work done during most of working life)


M 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.


1678 122


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME ..


Dorothy E Sammartino


(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)


119 .... Povero ... St ...


.....


..........


St. Winthrop Mass


(If nonresident, give city or town and State)


Length of stay: In place of death.


years ..


months5


days. In place of residence ..


29 .. years


... months.


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR OR RACE


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That Iattended deceased from


5/23/54


19


to


5/27/54


19


WE last saw h.


er


alive on


19


death is said to


have occurred on the date stated above


7.0.1:00


m.


TO DEATH (a)


INTERVAL BE- TWEEN ONSET AND DEATH 5 days


11 IF STILLBORN, enter that fact here.


12


AGE.29 ..... Years2.


.Months3


Days


If under 24 hours


Hours ....


.Minutes


13 Usual


Occupation:


none


(Kind of work done during most of working life)


14 Industry


or Business:


at home


15 Social Security No ..


.none


16 BIRTHPLACE (City).


(State or country)


Bos.t.an


17 NAME OF


FATHER


Frank Sammartino


18 BIRTHPLACE OF


FATHER (City)


Boston


(State or country)


19 MAIDEN NAME


OF MOTHER


Theresa Amerina


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Boston


winthrop - winthrop


6


Place of Burial or Cremation


6/1/54


(City or Town)


DATE OF BURIAL. 19


7 NAME OF


FUNERAL DIRECTOR


Win throp


H S Reynolds


ADDRESS


Received and filed


MUN 7101


19


........


(Registrar of City or Town where deceased resided)


20 yrs


ANTE


CEDENT (b)


CAUSES


Due To


Epilepsy


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


none


no


Date of operation.


What test confirmed diagnosis ?.


PARENTS


21


Informant


(Address)


2a


Frank Sammartino


A TRUE COPY


Charles & Mackie


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


...... .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 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-10-53-910621


5 Was disease or injury in any way related to occupation of deceased?


If so, specify ... "Class


19


Date


5/2 8/54


M. D.


(Signed).


(Address)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING,tus epilepticus


Single


3 DATE OF


DEATH


May 27/54.


Mass Gen Hosp No.


123


(1949 Revision of Standard Certificate) CERTIFICATE OF DEATH


COPY


STATE OF MAINE


1. PLACE OF DEATH


a. COUNTY


Cumberland


2. USUAL RESIDENCE (If institution: residence before admission) Write RURAL, if so.


a. HOUSE ADDRESS


343 Stevens Avenue


b. TOWN


Write RURAL, if so.


Portland, Maine


c. LENGTH OF STAY


(in this place)


P. O.


State


Portland, Maine


d. FULL NAME OF (If not in hospital or institution, give House Address)


HOSPITAL OR


INSTITUTION


Maine General Hospital


Town


County


State


3. NAME OF


DECEASED


(Type or Print)


a. (First)


FRANCES


b. (Middle)


HILDA


c. (Last)


VAN HOOSEN


4. DATE·


OF


DEATH


(Month)


May 27,


(Day)


(Year)


1954


5. SEX


Female


6. COLOR OR RACE


White


7. MARRIED, NEVER MARRIED,


WIDOWED, DIVORCED (Specify)


Widowed


8. DATE OF BIRTH


June 10, 1883


9. AGE (In years


last birthday)


70


If under 1 Yr. | If under 24hrs. Mos. Hrs. Min. 11


10a. USUAL OCCUPATION (Give kind of work done during most of working life, even if retired) At Home


10b. KIND OF BUSINESS OR IN-


DUSTRY


11. BIRTHPLACE (Town & State or foreign country)


Boston, Mass


12. CITIZEN OF


WHAT COUNTRY?


13. FATHER'S NAME


Isaac Blair


15. WAS DECEASED EVER IN U. S. ARMED FORCES?


(Yes, no, or unknown) | (If yes, give war or dates of service)


16. SOCIAL SECURITY


NONone


17. INFORMANT


George Blair


18. CAUSE OF DEATH Enter only one cause per line for (a), (b), and (c)


MEDICAL CERTIFICATION


INTERVAL BETWEEN YINSET AND DEATH Ihrs plus


*This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death.


ANTECEDENT CAUSES


Morbid conditions, if any, giving DUE TO (b) Art. Sclerotic heart disease, old


rise to the above cause (a) stating


the underlying cause last.


myocard infarct congestive failure


DUE TO (c)


II. OTHER SIGNIFICANT CONDITIONS


Conditions contributing to the death but not


related to the disease or condition causing death.


19a. DATE OF OPERA-


TION


19b. MAJOR FINDINGS OF OPERATION


20. AUTOPSY?


K


Yes


No


21a. ACCIDENT


SUICIDE


HOMICIDE


(Specify)


21b. PLACE OF INJURY (e.g., in or about home, | 21c. (CITY, TOWN, OR TOWNSHIP)


farm, factory, street, office bldg., etc.)


(COUNTY)


(STATE)


21d. TIME


OF


INJURY


(Month) (Day) (Year) (Hour)


m.


21e. INJURY OCCURRED


While at


Work


Not While At Work


.....


19 ........ , that I last saw the deceased


.m., from the causes and on the date stated above.


23a. SIGNATURE


Frederick R Brown, Jr


(Degree or title)


M D


23b. ADDRESS


Portland, Maine


23c. DATE SIGNED


5/28/54


24a. BURIAL, CREMA- TIQU, REMOVAL(Specify)


24b. DATE


6/1/54


24c. NAME OF CEMETERY OR CREMATORY


Winthrop


Lot


Sec.


24d. LOCATION (City, town, or county)


Winthrop, Massachusetts


ADDRESS


DATE REC'D BY LOCAL 5/28/1954


REG.


REGISTRAR'S SIGNATURE ..


25. FUNERAL DIRECTOR


Hay and Peabody


Portland, Maine


(1) a community of less than 2,500 population or (2) outside corporate limits of an incorporated place. The Residence


of a deceased infant will be that of mother. In Item 17 the Informant will not be the funeral director unless he is of the


family of the deceased.


21f. HOW DID INJURY OCCUR?


22. I hereby certify that I attended the deceased from


alive on


19.


and that death occurred at


19.


... , to


(State)


FORM C


b. LEGAL


RESIDENCE


Portland, Cumberland, Maine


Days 17


14. MOTHER'S MAIDEN NAME


Jennie Carruthers


I. DISEASE OR CONDITION


DIRECTLY LEADING TO DEATH* (a)


Lobar pneumonia


R-301A 1


PLACE OF DEATH


Suffolk (County)


Winthrop (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.


124


Registered No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME.


Helen Josephine Keyes


(If deceased is a married, widowed or divorced woman, give also maiden name.)


PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)


(a) Residence. No. (Usual place of abode)


59 Sunnyside Avenue St.


(If nonresident, give city or town and State)


Length of stay: In place of death .years. months days. In place of residence. 45.years .. months .days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May


29.


1954


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased


from


april


53


54


to


May


19


I last saw her .....


.alive on


25 April 1954.


s said to


have occurred on the date stated above, at


1:30 P.m.


INTERVAL BE-


TWEEN ONSET ANO DEATH 10 yrs.


11 IF STILLBORN, enter that fact here.


12


AGE


7.5Years


9 Months ..


11 Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :.


retired stationer


(Kind of work done during most of working life)


14 Industry


or Business:


Self employed


15 Social Security No.


none


16 BIRTHPLACE (City)


(State or country)


Orland


Maine


17 NAME OF FATHER John R. Keyes


18 BIRTHPLACE OF


FATHER (City)


(State or country)


B.o.s.t.on


Mass


19 MAIDEN NAME


OF MOTHER


Cybelle Wardwell


20 BIRTHPLACE OF


MOTHER (City)


North Blue Hill


(State or country) Maine


21 Informant Miss Maude J .. .... Keyes


(Address) 59 Sunnyside Avenue


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


Mass ...


Walter S. Dakle


Signature of Agent of Board of Health or other) Thealeto Officer 61154


(Official Designation) (Date of Issue of Permit)


50M-5-52-907046


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


174 Winthrop St Winthrop, 19


Received and filed.


JUN 2-1954


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


white


9 COLOR OR RACE


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


single


10a If married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Parkinson's Disease


ANTE


Due To


CEDENT (b)


CAUSES


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


Major findings:


Of operations.


NONE


Date of operation


What test confirmed diagnosis ?.


Was autopsy performed ?.


Clinical


NO


5 Was disease or injury in any way related to occupation of deceased? NO


Decis arthur @: murray


(Signed).


(Address) Winthrop


Date 31 194 1954


M. _ D.


6 Woodlawn Cemetery. Everett Mass (City of Town)


Place of Burial or Cremation


DATE OF BURIAL June/2 1954; ..... 19


Alfred 13. March


1 5.


RUCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each (b) and (c)


does not mean of dying, such lure, asthenia, ns the disease, cations which th.


id conditions, ing rise to the e (a) stating lying cause


tions contrib- death but not the disease or causing death.


PARENTS


No.


59 ... Sunnyside Avenue


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.


A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.