USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 69
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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
ran supposed to have died by violence, or by the action of ResiCs 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. Crap BB, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
aker or other persons shall bury a hunian body or the ashes thereof have been brought into the commonwealth until he has received a permit 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 r the funeral isttegbe held, or from a person appointed to have the care of the emetery or burial ground in which the interment is made.
OFFI0 Chap. 314. Lec. 16. G. L .. (Tercentenary Edition).
5
..
·RULES OF PRACTICE
6
THE Run of the purpose of these laws calls for the observance of the follow- ing r
(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 & ysicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths 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 WW 2
DATE OF ENTERING MILITARY SERVICE.
Dec. 1942
DATE OF DISCHARGE In reserves at time ofdeath
RANK, RATING Lt. Com.
ORGANIZATION AND OUTFIT. ....... U.S.N.R.
SERVICE NUMBER ....... 210024
--
-
54 7056
BIRTH NO.
1. NAME OF DECEASED (Type or Print) Gerard CAFFREY
3. PLACE OF DEATH: A. Baltimore City, Maryland
B COUNTY
4. USUAL RESIDENCE ( Where deceased lived. If institution 1 residence
A. STATE
Massachusetts
before admission)
B. FULL NAME OF
(If not in hospital or institution, give street address or
HOSPITAL OR
INSTITUTION
U.S.Public Health Service Hosbitad CITY OR TOWN
Baltimore 11, Maryland
Winthrop
( If outside corporate limits, write KURAL and give
township)
V -18
D. STREET ADDRESS (If rural. give location)
158 Highland Avenue
c Length of stay in Baltimore 13
5. SEX
6. COLOR OR RACE
male
white
7. SINGLE. MARRIED.
WIDOWED, DIVORCED (Specify)
single
7-11-05
9 AGE Un yrare) ------ last birthday ) |Monthe Days Hours Mm. 49
104. USUAL OCCUPATION (Givekind of work done during most of working life. even if retired) Oiler
100. KIND OF BUSINESS OR
Shipping
INDUSTRY
13. FATHER S NAME
John Caffrey
15 WAS DECEASED EVER IN U. S ARMED FORCES1 (If yes. give war or dates of service) (Yes, DO of Uni DOWD) No
16. SOCIAL
SECURITY NO
17 INFORMANT
Records, USPHS Hospital, Baltimore 11,Md.
18. 16/x 1 DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (This does not mean the mode of dying. e. g .. CAI heart failure, asthenia, etc. It means the disease. injury or complication which caused death.) DUE TO
ANTECEDENT CAUSES
DISEASES OR CONDITIONS, IF ANY, GIVING RISE TO THE ABOVE CAUSE (A) STATING THE UNDERLYING CONDITION LAST.
(8)
DUE TO
(C)
MEDICAL CERTIFICATION
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO THE DEATH BUT NOT RELATED TO THE
roy ho gottion Is
DI A F OR CONDITION CAUSING IT. ........ .... .....
IF OPERATION WAS RELATED TO CA OF DEATH. ENTER IN
PART I CR PART TI
LIA ACCIDENT WAS UNDERLYINGOI OR CONTRIBUTINGO CAUSE OF DEATH NOTIFY MEDICAL EXAMINER)
2 10. PLACE OF INJURY (e. g., in or aboul bome, form, factory, street, office bldg.,etc.)
21C. WHERE QID (If in Balti
INJURY OCCUR?
210 TIME (Minih. OF INJURY
Davi () a ) (Heur)
21F HOW DID INJURY OCCUR!
2 I certify that (I) (this hospital) attended the deceased from June 7th, 1954
August 20th, 19 54 , that KX (we) last saw the deceased alive on August 20th 19 54
and thit death occurred at 10:15 p. m., from the causes and on the date stated above
230 ADDRESS
29C DATE S
24A. BURIAL. CREMA- .TION REMOVAL (Spielfy)
24B. DATE
24C NAME OF CEMETERY OR CREMATORY ZAD LOCATION ILE, TOGET TO Starei
6 21-654 Whetherup Shoes freit
DATE RECEIVED BY LOCAL'REGISTRAR
REGISTRAR S SIGNATURE
25 FUNERAL DIRECTOR
ADDRESS
UG 22 1954 Huntington Williams MY
VS. 150
234 9 NATURE D hunfood SASur D USPHS Hospital, Baltimore 11, Md.
NIANG PHYS. MLD DIRECT
TAFF PHYEL
NOT WHILE AT WORK
m
21€. INJURY OCCURRED WHILE AT WORK
CAUSE OF DEATH Carcinoma of the Larynx
ADDRESS
14. MOTHER'S MAIDEN NAME Margaret A. Buckley
12 CIT ILN OF WHAT COUNTRY? OSA
Massachusetts
11. BIRTHPLACE (State or foreign country ,
8. DATE OF BIRTH
2 Mos. Days
2. DATE OF DEATH August 20. 1954
BALTIMORE CITY HEALTH DEPARTMENT CERTIFICATE OF DEATH
Registered No.
19A DATE OF OPERATION
190. CONDITION FOR WHICH OPERATION
WAS PERFORMED
RECEIVED
NOV1.
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
Barnstable (County)
Barnstable
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Barnstable
(City or town making return)
Registered No.
205 206
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Francis A. Beale Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Loring Road
St.
Winthrop, Mass.
(Was deceased a
U. S. War Veteran.
( if so specify WAR)
(If nonresident, give city or town and State)
Length of stay: In place of death
.......... years.
months.
In place of residence.
.. years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
September
2
1954
(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: (If an injury was involved, state fully.) Injured in auto accident 8-28-54
Expired at C .C. Hogp. from lacerati of .... right.kidney renal failure, uremia ... and ... multipleinjuries
5 Accident, suicide, or homicide (specify).
Accident
Date and hour of injury
1: 3.0AM
8-28
1954
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Public Highway
Injury
Automobile Accident
Multiple injuries with renal
Injury
While at work?
NO
.Was autopsy performed?
....
fatture
No
No
6 Was disease or injury in any way related to occupation of deceased? If so. specify
(Signed)
Joseph T. Boyle
M. D.
(Address) Barnstable, Mass. 9-2 19.
.Date.
5
Winthrop Cem. Winthrop, Mass. 7
Place of Burial, or Cremation.
(City or Town)
19.54
DATE OF BURIAL. Sept. ?
8 NAME OF
FUNERAL DIRECTOR
Daniel E. O'Brien
ADDRESS
907 Mass. Ave. ,Cambridge
Received and filed ORT 15 1934
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR OR RACE
white
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
single
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
n
(Husband's name in full)
12 IF STILLBORN. enter that fact here.
13
19
AGE
Years.
Months
.Days
If under 24 hours
Hours
.Minutes
14 Usual
Occupation :.
(Kind of work done during most of working life)
15 Industry
or Business :.
16 Social Security No ...
Everett Mass.
17 BIRTHPLACE (City).
(State or country)
18 NAME OF
FATHER
Francis A. Beale
19 BIRTHPLACE OF
(East) Boston
FATHER (City) ..
Mass ..
(State or country)
20 MAIDEN NAME Anna L. McDonald OF MOTHER
21 BIRTHPLACE OF
Charlestown, Mass.
MOTHER (City)
(State or country}
Franois A. Beale
22 Informan25 Loring Rd., Winthrop, Mass. (Address)
A TRUE COPY. ATTEST: Shawnand we. De
(Registrar of City or Town where death occurred)
DATE FILED
October 1
19 54
IR-305 1
No.
2 FULL NAME.
(a) Residence. No.
(Usual place of abode)
3 DATE OF
DEATH
Where did
(Specify type of place)
Manner of
Nature of
(How did injury occur?)
25M-5-52-907046
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
Injury occur?
Mashpee, Mass.
(City or town and State)
(write the word)
Chauffeur
Morris Express
PARENTS
(Hyannis) Cape Cod Hospital
RECEIVED
.70"
1
6
HROP.
OCT15 AM
M R-302 -
PLACE OF DEATH
SUFFOLK BOSTONI
(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.
7567.207
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Frances Freedman
(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)
203 Shore Drive
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
months.
.days. In place of residence.
30
.years
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sep 4 1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Sep 4
19 ..
54.
to
Sep 4
19 .. 5.4.
I last saw h
eralive
Sep 4 5€
death is said to
have occurred on the date stated above, at 2:15a ...
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
10a If married, widowed, or divorced
HUSBAND of.
(or) WIFE of
(Give maiden name of wife in full)
Benjamin D Freedman
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) Acute yocardial
infarct
1 day
12
AGE63
.Years
.Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :.
Housewife
14 Industry
or Business:
Own ... Home
15 Social Security No.
16 BIRTHPLACE (City) ..... Boston Mass. (State or country)
17 NAME OF
FATHER
Joseph Rose
18 BIRTHPLACE OF
FATHER (City) .....
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Gertrude Osoroff
20 BIRTHPLACE OF
MOTHER (City)
Russia
(State or country)
21
Informant
(Address )
Bertram Freedman
A TRUE COPY
Ves A. machine
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
..........
Sep 8
19.5.4
V.B.V.
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city of 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-3-53-909098
5 Was disease or injury in any way related to occupation of deceased ?..... no. If so, specify
(Signed)
I G WOOL
M. D.
(Address) ..
Beth Israel Hosp Date 9/4
1954]
6 .Hand inHand .... Cem
Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Sep .5
19.5
7 NAME OF
FUNERAL DIRECTOR
.... B ........... Solomon
ADDRESS
Brookline .... Mans
Received and filed TT 18 un ... ........ 19
(Registrar of City or Town where deceased resided)
unk
Due To
(c) JURISDICTION DECLINED.
BY MEDICAL EXAMINER
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?...... y.O.S.
What test confirmed diagnosis?
Autopsy.
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED Widowed
or DIVORCED
(write the word)
ANTE
CEDENT (b)
CAUSES
heart disease
Due To
Coronary artery
(Kind of work done during most of working life)
PARENTS
M.S.
Beth Israel Hosp No.
1
OCT10
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.)
J
PLACE OF DEATH
Suffolk (County)
M R-302 1 Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston208
(City or town making return) 7622
Registered No.
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME. Roy IGroenal.] (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.
79 .Woodside .. Ave ..
St.
Winthrop Mass
(If nonresident, give city or town and State)
(Usual place of abode)
Length of stay: In place of death
years ..
.months.
7.
...... days. In place of residence 7.
.. years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sept.6/51:
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That
1
attended deceased from
to
Sept.6.
19 ... 52;
I last saw h .... im ....
... alive on.
Sept.5/54,19
death is said to
have occurred on the date stated above, at
7;14A
m.
INTERVAL BE-
TWEEN ONSET
ANO DEATH
11 IF STILLBORN, enter that fact here.
12
AGE :...... Years .......... Month: 2.
.Days
If under 24 hours
Hours ...
. Minutes
with widespread pulmonary
Due Tmetastases
3 Mos
13 Usual
Occupation:
New-Eng.Tel ... & Tel.
(Kind of work done during most of working life)
14 Industry
or Business:
Telephone
15 Social Security No ..
011-05-1298
16 BIRTHPLACE (City).
(State or country)
East Boston Miss.
17 NAME OF
FATHER
Alfred Greenall
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Annie M Lister.
20 BIRTHPLACE OF
--
MOTHER (City)
(State or country)
England
21
Informant
(Address)
Wife
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED Sept.8/54
19
........
(Registrar of City of Town where deceased resided)
8 SEX
M
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorced
HUSBAND of.
Mary ... E. McMillan
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Carcinoma of esophagus
ANTE
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
.Was autopsy performed ?.
Yes
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?..
No
If so, specify
(Signed)
JA Harley
(Address)
VAH West Foxby Date
.19 ....
M. D.
6 "Place of Burial or ( Winthrop Gem-liathip- "or Town)
DATE OF BURIAL Sept.9/54 19
7 NAME OF
FUNERAL DIRECTOR
Kirby .Funeral Home East Boston Mass.
ADDRESS
Received and filed.
- 18
19
........
PARENTS
25M-3-53-909098
No.
VAH .... West ... Roxbury ... Mass
V.A. V
(Give maiden name of wife in full)
19.
OCT13 . M
ــ جيم
1
Suffolk
(County)
Boston
(City or Town)
Roslindale General Hospt. No.
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)
7985 209
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
364 Winthrop St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years ..
months
3
5
.days. In place of residence.
.. years
months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED Widowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
william Dilling
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
65
12
AGE
Years
11
Months
12
Days
If under 24 hours
.Hours
Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Frederick W Knox
18 BIRTHPLACE OF
Unable to learn
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Lydia A Greenlaw
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to learn
Winthrop Cem-Winthrop mass.
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
Sept. 20/54
19
7 NAME OF
FUNERAL DIRECTOR
H S Reynolds
Winthrop Mass.
ADDRESS
Received and filed.
11# 29
19
(Registrar of City or Town where deceased resided)
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.)
2 FULL NAME
(a) Residence.
No.
(Usual place of abode)
3 DATE OF
DEATH
(Month)
(Day)
4 I HEREBY CERTIFY,
Sept. 14
54
Hypertensive
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
SIGNIFICANT
Major findings:
Of operations.
What test confirmed diagnosis?
If so, specify
M Jancaico Jr.
(Address)
6
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,
CONDITIONS
non-traumatic
Sept . 16/54
(Year)
That I attended deceased
Sept. 16
from
54
19
I last saw
Ler
alive on
8;30PM
19
to
Sept.15654
death is said to
have occurred on the date stated above, at
.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
sease
OTHER
Subarachnoid hemorr.
Date of operation
Was autopsy performed?
5 Was disease or injury in any way related to occupation of deceased? NO
(Signed)
22, Han over St Boston
9-16 M. DE 19
21
Informant.
(Address)
Mrs Grimes
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
Sept.21/51
19
DATE FILED
VIV.
M R-302 1
PLACE OF DEATH
Helen Dilling
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Win throp
Mass
(write the word)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
cardiac vascular di
PARENTS
Calais Laine
RECEIVEG
F TOM
11 12
7
.
3
RO
OCT29
AM
X
PLACE OF DEATH
Norfolk (County)
Wellesley
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Wellesley. (City or town making Yeturn)
Registered No.
123 210
j(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
2 FULL NAME .. Anna B. Butler
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No
(a) Residence. No. 5.16 Pleasant Street,
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
8
months
20 days.
In place of residence.
.. years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September 23, 1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan ....
3,
1954
to
Sept. 23,
19
54
I last saw h .... er ... alive on ...
Sept ....
23,, 19 54 death is said to
have occurred on the date stated above, at.
1: 25 ..... P.m.
INTERVAL BE-
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) Br. Pneumonia
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
AGE
Years
.. Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation.
School Teacher
(Kind of work done during most of working life)
14 Industry
or Business:
Public School
15 Social Security No.
none
16 BIRTHPLACE (City) ..
(State or country)
Mass.
East Boston,
OTHER
SIGNIFICANT
Extreme Emaciation.
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
Nc
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased ?.... NO. If so, specify.
(Signed).
Hale Powers
(Address)
Wellesley
Date.
9/23
19 54
6
Holy Cross
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL ..
S.e.p.t ....... 25 .. ,
19.5.41
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O' Maley
ADDRESS
Winthrop, Mass.
Received and filed
11-9-54
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Margaret Queenan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
New Brunswick
21 Mrs. D. Preen
Informant
(Address)
192 Thatcher St. Milton
A TRUE COPY
Mary C. Diteur-
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
September 28,
1954
-
I R-302
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city of 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, Ser 12, G. L.)
25M (E)-6-50.902253
Due TeIndetermined Pulmonary
ANTE
CEDENT (b)
CAUSES
Condition
Due To (c)
3 days 12
56
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
(Usual place of abode)
No.
Wiswall Sanatorium. 203 Grove
M .- P.
17 NAME OF
FATHER
Mathew F. Butler
RECEIVED
1
1.
NOV-0
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.)
DEATH
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,
(c)
25M-(B)-11-51-905807
PLACE OF DEATH
Middlesex (County)
Malden
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Mal den
(City or town making return)
Registered No. ..
211
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Celia Alpert
(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.
209 Cliff Ave
(Usual place of abode)
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death.
........... years.
.months.
58
.days.
In place of residence ..
.20 .. years. ...
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
September 30, 1954
(Month)
(Day)
(Year)
Female
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEMarried
4 I HEREBY CERTIFY.
That I attended deceased from
Aug. 9
1954
Sept. 30
54
I last saw h. e ....... alive on
Sept.29
154
.. , death is said to
have occurred on the date stated above, at 7: 45A.
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE69
.Years
-
Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
Boston
16 BIRTHPLACE (City a.S.S. (State or country)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes Mellitus
5-10yrs
Major findings:
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