USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 78
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Injury
Nature of
(How did injury occur?)
Injury
If so, specil
Alphonse F .Budreski
704 No .Main
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.)
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?
(City or town and State)
25m-(c)-11-49-900.475
PLACE OF DEATH
nabist
1 R-305 1 STAL COVERANI
Alvin D. Lolfe
(Was deceased a
No.
U. S. War Veteran,
-
PARENTS
1. 5
RECEIVED
NOV -.: АТ
X
Essex .....
(County)
Lynn
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lynn
(City or town making return)
Registered No .. 231
J(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
2 FULL NAME.
(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.
(Usual place of abode)
15 Mermaid Ave.
St.
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.......
years2
months 14 ..
days. In place of residence. .. ..... years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 31, 1954
(Month)
8 SEX
emale
9 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED Wid.
4 I HEREBY CERTIFY,
That I attended deceased from
Jan ....... 20
54
19 ..
to ..
Oct ....... 31
1954
I last saw h.e.r ....... alive on ...
Oct. 31
54
death is said to
have occurred on the date stated above, a5:150.
m.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Horace R ...... Albertson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE2
Years
5. .. Monti6
.Days
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation:
Nurse
14 Industry
or Business:
Nursing Home
15 Social Security No.048-20-123.3.
16 BIRTHPLACE (City) ....... Watertown
(State or country)
Mass
OTHER
SIGNIFICANT
CONDITIONS
Anemia, cachexia ₿ mo.
Major findings: Of operations
Date of operation
None
Was autopsy performed ?.
No.
What test confirmed diagnosis?
X-rays
5 Was disease or injury in any way related to occupation of deceased ?.... NO.
If so, specify ...
Carroll C. Miller
MP
20 BIRTHPLACE OF
MOTHER (City)
N.B.
(Signed).
(Address) 304 Humphrey St. Bu, 10/31/54
Woodlawn Creamatory, Everett 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Nov ...
3.
1954
Alfred B. Marsh
7 NAME OF
FUNERAL DIRECTOR
174 Winthrop St.
Winthrop
ADDRESS
Received and filed
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
Lowell
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Susan L. Smith
(State or country)
Canada
21 Informant MTS. John R. Condon (Address) 15 Mermaid Ave., Winthrop
A TRUE COPY,
ATTEST Client
(Registrar of City of Town where death occurred)
DATE FILED November 3, 54
V 1. V
WRITE PLAINLY , WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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.) 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,
25M.(B) 11-51-905807
PLACE OF DEATH
M R-302 1
No.
Lynn Hospital
Doris H. Albertson
(Day)
(Year)
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) ..
.Carcinoma .... of ..... ]f.
abt.
Kidney c metastases to
2 yrs.
Longs ANTEO -Due To CEDENT (b) CAUSES
Due To (c)
(Kind of work done during most of working life)
17 NAME OF
FATHER
George H. Gellispie
...
11-9-54
19
10 SINGLE
(write the word)
RECEIVED
M R-302 1
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.) 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,
PLACE OF DEATH
Suffolk
(County)
Bouton (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 of town making return)
:32
Registered No.
8818
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Bernard I ... Nuzzo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
453 Meridian St
..... St.
(If nonresident, gr Fyrt Bosco of town and State)
Length of stay: In place of death. .. years. months. ..... .days. In place of residence. years .months. .. days.
Life
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
Bist/12/5/
ear)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct.2 5/1
I last saw
alive on
19
death is said to
have occurred on the date stated above, at.
INTERVAL BE-
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ..
Yearsg.
Months
Days
If under 24 hours
Hours.
.. Minutes
13 Usual
Occupation:
Chiropodist
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston Mass :
Major findings:
Of operations
Date of operation
. Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way Wellthis land I bor tory
If so, specify.
N.O
(Signed).
M. D.
(Address). L J Marks Date 19.
6
VAH Bos ton Mass. 10-12 5/1
Place of Burial or Cremation throp Cen-"(City of Town"SS" DATE OF BURIAL Oct 16/54 19
7 NAME OF
FUNERAL DIRECTOR
Richard C Kirby
East Boston Mass.
ADDRESS
NOV 2 0 1954
19
Received and filed
(Registrar of City or Town where deceased resident)
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
(write the word)
.
10a If married, widowed, or divorced
HUSBAND of.
(Give malderoth
Hamel
Wite in Yun)
-
P ... m.
TWEEN ONSET
AND DEATH
4 Days
etiology
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
17 NAME OF
FATHER
Bernard Nuzzo
-
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Rose Tutela
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
(Address)
llospt Records Boston
A TRUE COPY
ATTESTE
Pharma
(Registrar of/City or Town where death occurred)
DATE FILED
Oct.18/54
19
-
PARENTS
25M-3-53-909098
WRITERMINUT, WETIT ONFAVING DAGS INS ITTIS IS APERMANENT RECORD ANTE
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
"Pneumonia of unknown
to
Oct.
12
......
No.
Veteran.I.s ... Adm, Hospt ... Boston
-
(Was deceased a
U. S. War Veteran, 1
if so specify WAR) ..
T. V. #11
3
(or) WIFE of
oon Business
RECEIVED
11.12
3
5
0
NOV30 AM
Entered Service July 6,1943 Discharged Sept. 25,1944 Private Xxxx U S Army Service No. 31365554
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-305 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Y
X
PLACE OF DEATH
Essex (County)
Denver.
(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
Danvers
(City or town making return)
233
J(If death occurred in a hospital or institution.
St. \ give its NAME instead of street and number)
James F. Leonard
(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)
38 ... Beach .... Road
St. JAG (If nonresident, give city or town and State)
Length of stay: In place of death 7 years. 4 17
days. In place of residence. ...... .years .months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
26. 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.)
Cerebral Arteriosclerosis
Diabetes .Mollitus
Fracture of s & Left Ribs
5 Accident, suicide, or homicide (specify).
.....
Accident
Date and hour of injury
October 18, 19
54
Where did
Denvers State Hospital
Injury occur ?.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place? ..... sublie Place (Specify type of place)
Manner of
Injury
Fell Down
Nature of
(How did injury occur?)
Injury
FRACTURE ... Ribs
While at work?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Ralph F. Foss
M. D.
(Address) Perbody, Mass, Date 19
7 Winthrop Cemetery
Place of Burial, or Cremation.
DATE OF BURIAL.
October
28
19.
8 NAME OF
FUNERAL DIRECTOR
Maurice N. Kirby
ADDRESS
Winthrop, Mass
Received and filed
NOV 18 1954
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
Widowe
11a If married, widowed, or divorced
HUSBAND of.
Cavanaugh
(Give maiden name of wife in full)
(or) WIFE of .....................
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
70
5
AGE
Years
Months
7
.Days
If under 24 hours
Hours ....
.. Minutes
14 Usual
Occupation:
Laborer
(Kind of work done during most of working life)
15 Industry
or Business :.
16 Social Security No.
17 BIRTHPLACE (City) ......... Ineland
(State or country)
-
18 NAME OF
FATHER
Joun Leonard
PARENTS
19 BIRTHPLACE OF
FATHER (City).
(State or country)
Ireland
20 MAIDEN NAME
OF MOTHER
Mary Wholly
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
..
Hry
C. Shee.an
22
Informant
(Address)
nethorne, less.
A TRUE COPY
COPY Arthur Albay
ATTEST:
(Registrar of City or Town where death occurred)
love.iber
7
DATE PILED
19 54
V
Registered No.
Danvers Siate Hospital, H thorne
No.
2 FULL NAME
1 R-305 1
25M.5.52.907046
Ireland
... ...
.inthnon
(City or Town)
5)
(write the word)
RECEIVED
OF TOW;
11.12
1
1
5
6
NOV18 AM
X BOFFOLK (County)
REVERE 12-7-54
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
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)
No
(a) Residence. No. 6) SpraGue
St.
Revere
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death. .years months /7 days. In place of residence.
38
.. years.
.. months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Nov
2
1954
(Month)
(Year)
8 SEX
to.
9 COLOR OR RACE
White
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of.
PATRICKE FLANAGAN
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 77
Years
10 Months
28
.Days
If under 24 hours
Hours ..
.Minutes
13 Usual
House WIFE
(Kind of work done during most of working life)
14 Industry
or Business:
AT Home
15 Social Security No.
16 BIRTHPLACE (City) IRELAND (State or country)
17 NAME OF
FATHER
UNADIL TO LEARN
18 BIRTHPLACE OF
.
FATHER (City)
(State or country)
IREIANA
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).
andrewCatano
M. D. (Address) 603 Broadway Ren Date nov. 2.1954
o Holy Cross Cemetery MAIder Place of Burial or Cremation (City or Town)
DATE OF BURIAL November 4 1954
7 NAME OF FUNERAL DIRECTOR William J. Killian
ADDRESS 1 SpraGue ST Povere
Received and filed NOV 1 1954 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
UNAble To LEARN
20 BIRTHPLACE OF
MOTHER (City)
IRELAND
(State or country)
21 Informant. Thomas FLANAGAN
(Address) 61 SpraGue ST. Rovere.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Bakers
(Signature of Agent of Board of Health or other)
Thealite Officie
11/3/54
(Official Designation) (Date of Issue of Permit)
X
(Day)
That I attended deceased from
4 I HEREBY CERTIFY,
Feb
50
nor 2
105/
to ...
I last saw hele ....... alive on
nor. 2
125%, death is said to
have occurred on the date stated above, at.
8 A.m.
INTERVAL BE- TWEEN ONSET AND DEATH
17 day
Due To arteriosclerosis (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
CARDIAC FAILURE
1 day
50M-5-52-907046
PLACE OF DEATH
STRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter re than one se for each , (b) and (c)
is does not mean e of dying, such failure, asthenia, means the disease, plications which eath.
bid conditions, giving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or causing death.
M R-301A 1 Winthrop (City of Town) Wintwurde ConvalesosxT rbn 2 142 PLEASANT. S.T. No. BridGET (MUNNelley FLANAGAN 2 FULL NAME
To be filed for burial permit with Board of Health or its Agent.
234
(If deceased is a married, widowed or divorced woman, give also maiden name.)
10 SINGLE
(write the word)
· (Give maiden name of wife in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
CereBRAL Hemorrhage
ANTE CEDENT CAUSES HyperTENSION
4 years
Major findings:
Of operations.
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 ninetcen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town. from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health. or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital. as required by, section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not 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 in which the interment is made.
Chap. 114, Seć. 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 injuny, 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
M R-302 1
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.) 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 50m-(e)-10-48-24658
×
PLACE OF DEATH
FRANKLIN (County)
ORANGE
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
ORANGE
(City or town making return)
235
Registered No.
J (If death occurred in a hospital or institution, t. ( give its NAME instead of street and number)
2 FULL NAME Elizabeth Frances (Marden) Jones
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 125 Coid Road
St.
Winthrop,
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
3 years
3
months
28
days. In place of residence.
.....
... years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE
DEATH
November
4,
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
January ..... 1,
19 .. 54.
to
November 4,
1954
I last saw
h.e.r.
.live on November 4, 1954 death is said to
have occurred on the date stated above, at
3:40 A.
m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
83 Years
11
21
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Housewife
15 Social Security No0.12-12-9270 D
16 BIRTHPLACE (City)
(State or country)
Canada®
17 NAME OF FATHER Albert M. Marden
18 BIRTHPLACE OF
FATHER (City).
Roxbury,
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Mary J. Frazer
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
21
Informant.
Mrs Grace H Mullen
(Address) 75 East Main St.
Orange, Mass
A TRUE COPY.
Alberto Anderson
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
November
4,
1954
(Registrar of City or Town where deceased resided)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Harry M. Jones
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Acute Congestive Heart
Failure
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
Arterio Sclerosis
?
Major findings:
Of operations ..
Date of operation
Was autopsy performed?
No
What test confirmed diagnosis ?.
Physicial & Clinical
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify Harold R. Mahar M. D.
(Signed)
(Address) .... Orange ..... Mass,
Date Nov. 4, 19.54
Mount Auburn Cemetery, Cambridge, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
November
6,
1954
7 NAME OF
FUNERAL DIRECTOR
Roy A Ward
ADDRESS.
Orange, Mass
Received and filed.
11-8 - 54
19
3mos
Months.
Days
Quebec
PARENTS
Eastern Star Home No.
WRITE PLAINLY, WITH ONFADING BLACK INK - THIS IS APERMANENT RECORD
RECEIVEI
NOV-8- N. 9.A.M.
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.) 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,
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