USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 17
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(Specify type of place)
PARENTS
Electrician
41
10
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
RECEIVED
TOUS
6 5
MAR10
M R-302 1
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town) St. Elizabeth's wospt. No.
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)
1010
44
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
45 Winthrop St
St
(If nonresident, give city or town and State)
Length of stay: In place of death
....... years ..
.. months.
9
days. In place of residence.
.years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Jan. 29 /55
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased, from
Jan.
29
Jan. 21
55
19
to ..
19
I last saw h ...
imlive on
Jan.29.
19.
death is said to
55
have occurred on the date stated above, at
1:25PM
INTERVAL BE-
(Husband's name in full)
TWEEN ONSET
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
56
10
14
Months
Days
If under 24 hours
.. Hours.
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Waterfront
15 Social Security No.
024-03-1431
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
Samuel Leammon
PARENTS
18 BIRTHPLACE OF
FATHER (City)
England
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary Smith
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Feb. 1/55
19
7 NAME OF
FUNERAL DIRECTOR
R C Kirby
Boston Mass.
ADDRESS
MAR &# 1999
Received and filed.
19
(Registrar of City or Town where deceased resided)
3 Mos.
Due To
hemisphere
ANTE
CEDENT (b)
CAUSES
Due To (c)
Operation;
Astrocytoma left cerebral
hemisphere
1-26-59
Major findings:
Of operations.
Date of operation
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
Biopsy
No.
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify.
(Signed).
St. Elleben's Hospt 1-29 19 77
M. - P.
(Address)
Winthrop
Vem-Winthrop Mass.
21
Informant.
(Address)
Wife
A TRUE COPY
ATTEST!
Ma(Registrar of City of Town where death occurred)
Feb. 3/55
DATE FILED .19.
1 /
Vel
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-10-53-910621
WRITE PLAINLY , WETTTONFADING BLACK INK - THIS IS A PERMANENT RECORD OTHER SIGN
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
left cerebral
Astrocytoma
AND DEATH
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorcedarion L Sloan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Was deceased a
U. S. War Veteran,
Winthrop
AR)
(a) Residence. No.
(Usual place of abode)
20
Samuel Leamon
55
Longshoreman
RECEIVED
OF TOM
11 12
6
5
MAR2 & AM
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible,
after the close of the month in which the death occurred. (See Chap. 46, Sec 12, G. L.)
25M-3-53-909098
PLACE OF DEATH
SUFFOLK BOSTON (County)
(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.
1074
45
1(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 Dolphin Ave
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
........
.years.
months
ろ
12
.days.
. In place of residence.
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
& SEX
Female
9 COLOR, OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Jan 29
55
That I attended deceased
Jan 31
55
19
I last saw }
.alive on.
19
., death is said to
10:15
8
have occurred on the date stated above, at .. m. INTERVAL BE- TWEEN ONSET AND DEATH 3 dys
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
no
What test confirmed diagnosis ?.
EKG
no
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ....... R ..... R ..... Patan
(Signed) ...
62-E-Newton St
1/31
1955.
(Address) Golden Crown Cem
Date
Woburn Mass
6
Place of Burial or Cremation
(City or Town)
Feb 1
.55
19
7 NAME OF
FUNERAL DIRECTOR
.Boston Mas's
ADDRESS
Received and filed.
MAR 25 1955
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Gussie --
20 BIRTHPLACE OF
Russia
MOTHER (City)
(State or country)
Jack Elfant (son in law)
21
Informant
(Address)
A TRUE COPY
harkes H. Imackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED Feb L
19 ... 5.5 .....
10a If married, widowed, or divorced
HUSBAND of.
Shophard Curbing
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
70
AGE
Years
Months.
Days
If under 24 hours
.Hours ..
Minutes
Housework
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No.
Russia
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Kopel Rantz
DATE OF BURIAL
Golov
750 Harrison Ave
No.
Ida Gorberg
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass
(a) Residence. No. (Usual place of abode)
3 DATE OF
DEATH
Jan 31, 1955
from
19
Jan 31
55
DISEASE OR CONDITION
DIRECTLY LEADINGocardial infarct
TO DEATH (a).
M R-302 1
WRITE PAINET, WETTT ONFAVING DLAGR INA - THIS IS APERMANENT RECORD
RECEIVED
TO:
1%
D
6
MARZE
M R-302 1
WRITE PLAINET, WITT ONFADING BLACK INS - THIS IS APERMANENT 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-3-53-909098
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
1170 46
Mass General Hospital
(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.)
483 Shirley St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months.
15
30,
.days.
In place of residence.
".years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Feb 2, 1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Jan 18
19
55
That I attended
Feb 2
deceased from
55
19
Feb 2
19.
2.2death is said to
I last saw h
alive on.
7:25 p
m.
INTERVAL BE-
have occurred on the date stated above, at
TWEEN ONSET
11 IF STILLBORN, enter that fact here.
12
83
AGE
Years
Months ..........
.. Days
Laborer
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
Bedford Me
16 BIRTHPLACE (City)
(State or country)
OTHER
SIGNIFICANT
CONDITIONS
(Carcinoma of sigmoid)
resected
10 dy
Major findings:
Of operations.
Carcinoma sigmoid
Date of operation
1/26/55
Was autopsy performed?
yes
What test confirmed diagnosis ?.
Autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ......
C. L Clay
Date 2/3
MGP.
(Address)
Winthrop Cem
Winthrop Nass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Feb 5
155
7 NAME OF
M W Kirby
FUNERAL DIRECTOR ... Winthrop Mass.
ADDRESS
Received and filed.
MAR 28 1955
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Jane Lee
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Wire
21
Informant
(Address)
A TRUE COPY
ze Inactie
ATTEST:
....
(Registrar of City or Town where death occurred)
DATE FILED
Feb 8
19.5.5
V.B. V
8 SEX Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or diverseds Thompson
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINGoncho pneumonia
TO DEATH (a)
AND DEATH 2 days
severe
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
17 NAME OF
FATHER
Alexander Stinson
(Signed).
6
No.
William J Stinson
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass
(a) Residence.
No.
(Usual place of abode)
im
If under 24 hours
Hours.
Minutes
Retired
...
RECEIVED
TOWN
OF
11 17
10.
BLEKK
NIL
C.
5
HROP
MAR28 AM
M R-302 1
PLACE OF DEATH
Suffolk
(County)
Bosta
(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.
132847
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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
sWin the cp Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
.. months.
30
days. In place of residencel
.years
... months ..
.. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY.
That I attended deceased from
to
Feb ......?
155
Feb.7.
1955 ..
death is said to
have occurred on the date stated above, at
7:15P.M.m.
INTERVAL BE- TWEEN ONSET ANO DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ... 35 .. Years. 9 ..
.MontRO
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
Housewife
14 Industry
or Business:
At Home
15 Social Security No ....
None
16 BIRTHPLACE (City) Haverly Mags. (State or country)
17 NAME OF
FATHER
Henry E Tirrell
Major findings:
Metastatic carcinoma of breast
Date of operation ...
.. Was autopsy performed ?.
bowel obstruction due to achegio
1-25-55
What test confirmed diac tiosisind 2-7-55 operational
5 Was disease or injury in any way related to occupation of decentedi mi cal. If so, specify
(Signed)
H.W ... Porers.
M. D.
Date ....?... 7.
6 Place of Burial or emation P en inthe city of Town) -
19
7 NAME OF
FUNERAL DIRECTOR
V A Reynolds
ADDRESS.
Winthrop Mass.
Received and filed
MAR-31-1955
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Boston Mass.
19 MAIDEN NAME
OF MOTHER
Ali œ Harrington
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Somer ville Mass.
A C Doig
Hus band
21
Informant
(Address)
ـخصصطمبدلاً
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Feb. 11/55
.19
......
25M-10-53-910621
No.
2 FULL NAME.
Elsi. e. R. Doig
(a) Residence. No.
129 .... Cliff Ave.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Feb.7/55
DEATH
Jan/24
....
I last saw h.er ....... alive on
Metastatic
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
Of operations
(Address)
Carry Hoapt
DATE OF BURIAL
Feb/10/55
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
due to adh sions
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Carcinoma of breast
1 Ir.
Diabetes insipidas
-L Month
OTHER
SIGNIFICANT
Small bowel obstruction
1 Week
10a If married, widowed, or divorced
HUSBAND of.
(or) WIFE of.
(Give maiden name of wife in full)
Andrew Gray Doig
(Husband's name in full)
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 .
Carney Hospt.
(Month)
(Day)
(Year)
(Kind of work done during most of working life)
M R-302 1
-
No. The Children's Hospital
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
222 Pleasant St
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.
.years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Feb 1219 55
to
Feb 14
19.55
I last saw
Ler
... alive on
Feb 2/1
19.5.5 death is said to
7:43 pm.
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
4
Months.
.Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
winthrop Lass
16 BIRTHPLACE (City)
(State or country)
OTHER
SIGNIFICANT
CONDITIONS
Mongolism
Major findings:
Of operations.
Date of operation
Was autopsy performed ?...... no
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) ... I ........ Gibson M. D.
(Address) ..... 00 ..... Longwood .... A.V.O.Date.
19
6 Pride of Boston Com Woburn Mass Place of Burial or Cremation (City or Town) Feb 15
19.55
DATE OF BURIAL
A GOLOV
7 NAME OF
FUNERAL DIRECTOR
Brookline ... Mass
ADDRESS.
Received and filed. 19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
Boston Mass
FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Ray Gerte
20 BIRTHPLACE OF
Boston Mass
MOTHER (City)
(State or country)
Father
21 Informant (Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE PILED
Feb 21 19 5.5.
.....
X
WRITE PLAINET, WITTY UNFAVING PLACE ING - 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-3-53-909098
PLACE OF DEATH
1 SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1539 48
(Was deceased a
U. S. War Veteran,
[ if so specify WAR)
(a) Residence. No.
(Usual place of abode)
2
8
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at.
INTERVAL DE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Pneumonia
ANTE
CEDENT (b)
CAUSES
Due To
Congenital heart
disease
Due To (c)
17 NAME OF
FATHER
Myron N King
8
3 DATE OF
DEATH
Feb 14, 1955
Faith King
1
RECEIVER
OF
TO !!!
11 12 1
9
Min
6
'THROP.
APR-8 AM
M R-302 1
WRITE PLAINLY, WITH ONFADING BLACK INK - THIS IS APERMANENT 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,
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town) US PH S. Hospes
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH 77 Warren St Boston
Bos ta
(City or town making return)
2224 49
Registered No.
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
294 Revere St
Winthrop
Ma SS.
(If nonresident, give city or town and State)
Length of stay: In place of death.
... years ..
months 43 days.
56
In place of residence
years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
(write the word)
Marrie d
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY.
Jan/20
19 55
to ..
1
death is said to
have occurred on the date stated above, at
7:40AMm
INTERVAL BE-
(Husband's name in full)
TWEEN ONSET AND DEATH 6 Weeks
11 IF STILLBORN, enter that fact here.
12
AGE 68
7
Years.
Months
21
.Days
If under 24 hours
.Hours ....
.. Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Merchant Marine
15 Social Security No.
059-16-2343
16 BIRTHPLACE (City)
with
(State or country)
OTHER
SIGNIFICANT
CONDITIONS
Acute pvelonephritis abscess formation-
1 Week
Major findings:
Pelvic abscess
Of operations
Date of operation
2-4-55
Was autopsy performed?
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
M O Lewis
(Signed)
USP HS Hospt Date
3-4
.... , M. De
19.
6
Place of Burial or Cremation
March 7/55
19
DATE OF BURIAL
V A Reynolds
ADDRESS.
Received and filed
MAR-16-1955
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Thomas E Evans
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass.
19 MAIDEN NAME
OF MOTHER
Frances Murray
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Medical Records
21
Informant.
(Address)
USP.H. S. Hospit
A TRUE COPY& ........
ATTEST: Bor Des Il Ina
(Registrar of City or Town where death occurred) March 8/55
DATE FILED .19 .......
25M-3-53-909098
(Address)
Winthrop Cem-Winthrop Mass .
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass.
from
attended deceased
March 4
19
59
10a If married, widowed, or divorcedleanor Grundy
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Acute peritonitis
with pelvic abscess
forma tion
Due To
ANTE CEDENT (b) CAUSES
Due To (c)
March 4/55
St.
(Was deceased a
U. S. War Veteran.
if so specify WAR)
(a) Residence. No. (Usual place of abode)
No.
Thomas E Evans Jr.
East BostonMass.
East Boston Mass.
Yes
Master Mariner
I last saw
h .... im .. alive on.
March 4
19.55
That I
RECEIVED
TOWA
OF
11.12
6
MAR 1 G
R-301A 1
PLACE OF DEATH
Suffolk (County) Winthrop~
(City or Town) 33 Crest Ave.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial ·permit with Board of Health or its Agent.
50
Registered No.
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME ..
Samuel Patrick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
33 Crest Ave .
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years months. .days. In place of residence .years months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
4
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
May .... ],. 1954 to March 4 .... 55 I last saw him ....... alive on February 28, 19 ...... death is said to
have occurred on the date stated above, at 3: 30 ....... m.
INTERVAL BE- TWEEN ONSET AND DEATH
About
15 yrs
About
3 days
Due To (c)
OTHER
SIGNIFICANT
Chronic Cystitis
CONDITIONS
About
6 mos.
Major findings:
Of operations.
None
Date of operation
None
Was autopsy performed ?.
No
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased ?... N.O.
If so, specify ....
(Signed)
Fyralie w. Lachanson
, M. D.
(Address) Wanieuch mass
Date March 195,05.
Puritan Lawn Memorial Park, Peabody 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 7
55
7 NAME OF
Victoria() Reepurldo
ADDRESS
I80 Winthrop St.
Received and filed MAR 4-1955 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Sarah Purdy
20 BIRTHPLACE
MOTHER (City)
(State or country)
Vermont
21
Informant
(Address)
33 Crest Ave
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter & gallery.
(Signature of Agent of Board of Health or other) Thatthe Officer 3/7/56
(Official Designation)
(Date of Issue of Permit)
V.BY-
ICTIONS OR ERTIFICATE
iving F DEATH tenter han one or each ) and (c)
es not mean dying, such re, asthenia, s the disease. tions which ,
conditions, g rise to the (a) stating ving cause
ons contrib- eath but not e disease or using death.
Chapter 137. 954, requires s to print or use or causes on death
50M-3-54-911887
11 IF STILLBORN, enter that fact here.
12
88
1
AGE
Years
.Months
.7
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Agent
(Kind of work done during most of working life)
14 Industry
or Business:
Life Insurance
15 Social Security No.
031-10-3297
Windsor
16 BIRTHPLACE (City)
(State or country)
Vermont
17 NAME OF
FATHER
Norman W. Patrick
18 BIRTHPLACE OF
FATHER (City)
(State or country) Vermont
Hartland
Friable to Obtain
Norma.
Patrick
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
7
40
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE (write the word) MARRIED Widowed WIDOWED or DIVORCED
10a
If
"su's"ahor AvorceApplin
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
arteriosclerosis.
TO DEATH (a) ...... Hypostatic .... pneumonia.
ANTE
Due To
CEDENT (b)
CAUSES
No.
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 hy section forty-five of chapter one hundred and four- teen, shall, if the ‹leceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme -- diate cause of death as nearly as he can state the same. For neglect to comply- with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China + relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
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
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