Town of Winthrop : Record of Deaths 1954, Part 69

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


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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