Town of Winthrop : Record of Deaths 1954, Part 78

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 78


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).


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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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