USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 59
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If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
Designen
(Kind of work done during most of working life)
years 14 Industry
or Business:
Boats
15 Social Security No.
16 BIRTHPLACE (City) ..
(State or country)
Winthrop Mass
17 NAME OF
FATHER
George Turnbull
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Winsor Nova Scotia
19 MAIDEN NAME
OF MOTHER
Annie Fraser
20 BIRTHPLACE OF
MOTHER (City)
NovaScotia
(State or country)
Edna .... Turnbull
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
Aug 9
19 55
DATE FILED
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
N.J.Nadler
no
M. D.
(Address)
Date 8/6 19.5.5
6 Winthrop Com Winthrop (chybstown) Place of Bu DATE OF BURIAL. Aug 9 1955
7 NAME OF
FUNERAL DIRECTOR ..................... Rods
ADDRESS
Winthrop Mass
Received and filed
SEP 20. 1955
19
25M-10-53-910621
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.)
Due To
Arterio .... sclerotic
ANTE
CEDENT (b)
CAUSES
heart disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation.
.. Was autopsy performed ?.
yes
What test confirmed diagnosis ?.
EKG
21
Informant
(Address)
9 COLOR OR RACE
(write the word)
LAV
No. Now England .Contor Hospital
ms.
RECEIVE
TO!
...
6
THROP.
SEP20 AM
M R-302 1
PLACE OF DEATH
SUFFOLK- (County) 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.
7337177
[(If death occurred in a hospital or institution,
..... St. Į give its NAME instead of street and number)
2 FULL NAME ..
Sarah Berlinen.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
40 Trident Ave
......
St.
Winthrop .... Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years .....
.months.
2.days. In place of residence.
40 years
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Aug 6, 1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Aug 4
19 55
to.
Aug 6
......
19 55
I last saw h ... @.J ..... alive on Aug 6, 19 55 death is said to have occurred on the date stated above, at 5:20 pm. INTERVAL BE- TWEEN ONSET
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Harry .... Berliner
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.69 ... Years
.Months.
Days
If under 24 hours
Hours ......
.Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business:
At ... Home
15 Social Security No.
16 BIRTHPLACE (City)
Poland
(State or country)
17 NAME OF
FATHER
Abraham Henoch
PARENTS
18 BIRTHPLACE OF
FATHER (City).
Poland
(State or country)
19 MAIDEN NAME
OF MOTHER
Nacha Boyla
20 BIRTHPLACE OF
MOTHER (City)
Poland
(State or country)
Francis Aronson
7 NAME OF
FUNERAL DIRECTOR
AGolov
ADDRESS Brookline.Mass.
Received and filed
SEP 20 1955
19
(Registrar of City or Town where deceased resided)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
WRITE PLAINET, WITH ONFADING BLACK INK - THIS IS APERMANENT RECORD
ANTE
CEDENT (b)
CAUSES
Due To
colon
Due To (c)
OTHER Partial colectomy
SIGNIFICANT
May 1954
Major findings:
Carcinoma of the colon
Of operations.
Date of operation May ...... 1.9.51 .... Was autopsy performed ?.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D. (Signed). S Steinberg
(Address) J ..... M ... H.
Date ...
8/6
1955
6 Workman's Circle Place of Burial or Cremation
(City of T Boston DATE OF BURIAL Aug ..... 7. 1955
21
Informant
(Address)
A TRUE COPY
DATE FILED
Aug 9
19
55
25M·10-53-910621
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
No. Jewish Memorial Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
DISEASE OR CONDITION Hepatic coma duleAND DEATH
DIRECTLY LEADING
to carcinomatosis
TO DEATH (a) ... of ...... the liver.primary
carcinoma of the
(Kind of work done during most of working life)
RECEIVE
Tilla.
THROP
SEP20 AM
R-302 RUT REMONT ST.
1
Danvers
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
148
(If death occurred in a hospital or institution, Danvers State Hospital, Hathorne, 3Sove its NAME instead of street and number) No.
2 FULL NAME
Hattie Freeman
( Bemis)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 125 Cliff Ave., Winthrop, Mass, St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
3
.years.
2
months
10
days.
In place of residence.
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August 19, 1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
ug. 1
52
19
to
Aug.
19
19
55
I last saw h
alive on
er
Aug. 19
19 ..
55 death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Damon Freeman
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Carcinoma of
TO DEATH
(a)
Stomach
TWEEN ONSET AND DEATH Yrs.
11 IF STILLBORN, enter that fact here.
12
AGE
77
Years.
6
5
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :.
Housewife & Nurse
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Mass.
OTHER
Generalized
SIGNIFICANT
CONDITIONS
Arteriosclerosis
Yrs.
Major findings:
Of operations
Date of operation
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
Autopsy
19 MAIDEN NAME
OF MOTHER
Sarah Lord
(State or country)
Mass.
21 Mary B. Sheehan
Informant
(Address)
Hathorne Mass.
A TRUE COPY Arthur To Say
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
August 22,
19.
55
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
George Homer Bemis
18 BIRTHPLACE OF
FATHER (City)
Teston
(State or country)
Mass.
5 Was disease or injury in any way related to occupation of deceased?
If so, specifyAugusta Hayek
M. P.
(Signed) ..
Hathorne,
ass. Date 8/19
19 55
20 BIRTHPLACE OF
MOTHER (City)
East Boston
(Address).
winthrop Cem.
6
winthrop, Lass.
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL.
August 22
19.5.5
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh Fun ..
ADDRESS
winthrop, Mass.
Received and filed
SEP 12 1955
19
25M.(B)-11-51-905807
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.)
X
PLACE OF DEATH
Essex
(County)
(City or Town)
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
have occurred on the date stated above, a
1:25a
.m.
INTERVAL BE-
8 SEX
Female
9 COLOR OR RACE
White
Months
Days
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
winthrop
VISI
-
RECEIVED
OF TOW
1
4
THỊ
SEP12 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 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
DE
(County)
Chelsea
(City or Town) Soldiers
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
405 179
[(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
Abraham H.Rubin
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
53 Trident Ave.,
St.
(If nonresident, give city or town and State)
HoushBlact of pode)
Length of stay: In place of death ...
.years ..
.. months.
18
days. In place of residence ......
.years
.months ....
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Aug.19,1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Aug.1
,55
Aus .19
to ..
I last saw
alive on ...
Aug.19
55
death is said to
have occurred on the date stated above,
2:150.
m.
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a). Atherosclerotic heart disease
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12 62 8
25
Months
.Days
If under 24 hours
Hours.
Minutes
ANTE
Due TCoronary occlusion
CEDENT (b)
CAUSES
Due To
(c)
OTHER
Generalized
SIGNIFICANT
CONDITIONSatherosclerosis
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
no
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased ?. If so, sperffy bert.F.Flynn
(Signed).
(Address Idierst Roma
Bale 19/55
19
winthrop Com. Everett, Lass 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Aug.20,1955
19
7 NAME OF
Henry Levine
FUNERAL DIRECTOR
ADDRESS
Harvard Ave., Brookline, Mass.
Received and filed.
SFP14 1955
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
Russia
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER Rebecca Morrison
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Hospital Records
Informant ...
(Address) soldiers' Home, Chelsea, Lass
A TRUE COPY Souple a Jerrell
ATTEST:
(Registrar of City or Toun where death occurred)
DATE FILED
Aug.19,1955
.....
......
.19
........
V.P.V
10 SINGLE
MARRIED
WIDOWED
or DIVORCED"
(write the word)
Married
10a If married, widowed, or divorced
MIMIC K.Koleman
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 Usual
Occupation :
Salesman
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
213-05-3214
16 BIRTHPLACE (City) ..... Boston ,Hass. (State or country)
17 NAME OF FATHER Hyman
M. D.
8 SEX
Malo
9 COLOR OR RACE
White
WWI
(Was deceased a
U. S. War Veteran,
if so specify WAR).
Winthrop
Mass
(a) Residence. No.
Registered No.
No.
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Ms
AGE
Years
55
·
RECEIVED
TO
SEP 14 A11
Enlisted Aug.19,1918 ' Dec.6,1918 Private Co.B .- 73rd Infantry 12th Division 4188129
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.) 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
X
Suffolk
(County)
Chelsea
(City or Town) Naval Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chel so a
(City or town making return) 406 180
Registered No.
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Mary Agnes Harrington
(If deceased is a married, widowed or divorced woman, give also maiden name.) 144 Shore Drive
St.
Winthrop, flass
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years
.months.
1
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 DIVORCEDarrica
4 I HEREBY CERTIFY,
That I_ attended deceased from
Aug.19
55
Aug.20
1855
I last saw
alive on
Aug. 20
1955
death is said to
have occurred on the date stated above,
3:350.
.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12 24
7
Years
13
Month
.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 .....
none
16 BIRTHPLACE (Cybooklyn, N. Y. (State or country)
17 NAME OF
FATHER
John Derniody
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Brooklyn, N.Y.
19 MAIDEN NAME
OF MOTHER
Hora Casey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Thomas J Harrington
Informant
(Address)
144 Shore Drive Winthrop
7 NAME OF
J.S.Waterman Fun. liome
ADDRESS
497 Commonwealth Ave Boston ATTEST:
Received and filed.
SEP 14 KJ
19
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Thomas J.
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Subarachnoid hemorrhage
19hrs
ANTE
Due To
CEDENT (b)
CAUSES otastatic malignant
Due To malanoma (c)
3
yrs.
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Malignant Malanoma
Of operations ..
77/52
Date of operation
Was autopsy performed?
No
What test confirmed diagnosis?
Microscopic section
5 Was disease or injury in any way related to occupation of deceased? If so, specifyurtland C.Bram, Jr (Signed) ... (Address) .av.al .... o.s.p. C.hel. ..... Date.
6
Holy Cross Cen., Brooklyn, N. Y. Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Aug.24, 1955
19
A TRUE COPY
(Registrar of City or Town where death occurred)
DATE FILED
Aug. 22, 1955
.19
25M-3-53-909098
PLACE OF DEATH
M R-302 1
No.
(a) Residence. No. (Usual place of abode)
1
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
3 DATE OF
DEATH
Aug.20,1955
(Month)
(Day)
(Year)
to ..
8/20/5519
M. D.
Brooklyn, N.Y.
-
SEP 1 &
1
M R-302 1
WRITE PLAINLY, WITH ONFADING 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-10-53-910621
PLACE OF DEATH
S.uf.f.o.1k (County)
Bos .. tm (City or Town) 95 Moreland
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bostan
(City or town making return)
Registered No.
7921 181
f(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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
15 Prescott St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months.
13 days.
In place of residence.
3.9years.
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August 26/55
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
August 13/55
August1926/ 55HUSBAND of.
to
I last saw h
eralive on
August 26/55
4 A
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Hypostatic pneumon:
2 Day
S12
AGE 83
Years
Months
Days
If under 24 hours
Hours .......
.Minutes
13 Usual
Occupation:
Housewife
ANTE
Due To
Coronary thrombosis
CEDENT (b)
CAUSES
with congestive failure
2"Day
14 Industry
or Business :.
Own Home
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Ireland
17 NAME OF
FATHER
John Downing
18 BIRTHPLACE OF
Ireland
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
Elizabeth Shinnick
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Mary Moran
Informant
(Address)
52 Dwinell St West
A TRUE COPY
charles
2. Mackor.
ADDRESS
Received and filed.
SEP2.9 1955
19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify W.Weisman
(Signed)
(Address)
Dor chester MassDate.
8-26- M. 59
.19 ..
6
Place of Burial or Cremation
August 29/55
eŁTown)
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
A J O Maley
Winthrop Mass.
ATTEST:
(Registrar of City or Town where death occurred) August 29/55
DATE FILED 19
V.B. V
Due To (c)
None
OTHER
SIGNIFICANT
CONDITIONS
None
Major findings:
Of operations.
Date of operation
None
Was autopsy performed?
No
What test confirmed diagnosis ?.
clinical
10a
If married, widowed, or divorced
(Give maiden name of wife in full)
Daniel F Murphy
have occurred on the date stated above, at.
m.
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
3 Da
death is said to
(or) WIFE of
(write the word)
Winthrop Mass.
(Usual place of abode)
No.
Han ora J Murphy
Ireland
Holy Cross-Maldne Mass.
(Kind of work done during most of working life)
1
SEPCO
1
X
PLACE OF DEATH
SUFFOLK POSTON
(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.
8112 182
[(If death occurred in a hospital or institution. .. XSC | give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
26 Shirley
Winthrop,
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
Mass
(a) Residence.
No.
(Usual place of abode)
(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
September
1
1955
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widow
4 I HEREBY CERTIFY,
8/30
19
to.
That ICattended deceased from
9/1
55
19
55
19
death is said to
have occurred on the date stated above, at.
9:140
.m.
DISEASE OR CONDITION
DIRECTLY LEADING
Cerebral infarct
TO DEATH (a)
INTERVAL BE- TWEEN ONSET AND DEATH 3days
11 IF STILLBORN, enter that fact here.
12
AGE
64 Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewifo
14 Industry
or Business:
At home
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Nova .... Scotia
17 NAME OF
FATHER
Augusta Saulnier -ok
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Nova Scotia
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed).
(Address)
C Clay
M., D.
Date.9.1
1955
6 Winthrop
Winthrop, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Sep 5
55
19
21
Informant
(Address)
A TRUE COPY
JE COPY Charles 21 Mackie
ATTEST
(Registrar of City or Town where death occurred)
DATE FILED
Sep 6
55
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Mary E Saulnier
-ok
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
Joseph L Burridge
7 NAME OF
FUNERAL DIRECTOR
M Kirby
ADDRESS
Winthrop, Mass
Received and filed.
OCT 6 - 1955
19
10
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-5-55-915025
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,
M R-302 1
No.
Mass .... General .... Hospital
.........
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
George V Burridge
(Husband's name in full)
ANTE
CEDENT (b)
CAUSES
Due To
Cerebral arteriom
sclerosis
5yrs
Due To
(c)
Liabotos mollitus
5yrs
(Kind of work done during most of working life)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
.........
CI last saw h.
er
alive on
9/1
(write the word)
X
MARY BURRIDGE
OST-
X
PLACE OF DEATH
Suffolk (County)
R-301A 1 Winthrop (City or Town)
Winthrop Community Hospital 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
63 Waldemar Avenue
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death ...... years. months 4 days. In place of residence 10years
.months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
MARRIED
WIDOWEDLi
or DIVORCEDdoWed
4 I HEREBY CERTIFY,
9/2
1955
...
to.
That
9/3
19 57, death is said to
have occurred on the date stated above, at.
4 A.
.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING har Pneumonia
TWEEN ONSET AND DEATH tweek
...
ANTE CEDENT CAUSES
Due To
(b)
None
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
MARKED Obesity
years
Major findings:
Of operations.
None
Date of operation
Was autopsy performed? NO
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify, (Signed) .... EA Callahan (Address) Braten Man Date 9/3 ټں19
M. D.
6 Holy Cross Cemetery Place of Burial or Cremation
(City or Town)
DATE OF BURIAL September 7 19.55
Alice M. Kelly
ADDRESS
Received and filed. SEP 6 1955
........ .. 19.
(Registrar)
10a If married, widowed, or divorced
19
55
HUSBAND of.
Gertrude Manning
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE .6.8. Years ......... Months
11. Days
If under 24 hours
.Hours
. Minutes
13 Usual
Salesmanager
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Wholesale Fish Business
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Lass
17 NAME OF
FATHER
Bernard D. Newman
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Harbour Bouchee
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Margaret B. Gillis
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
1
21 Gerard B. Newman
Informant (Address) 58 Brookfield Rd. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter G. Baker
(Signature of Agent of Board of Health or other) .
Sat 6/55
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH t enter han one for each b) and (c)
loes not mean f dying, such ure, asthenia, as the disease. ations which h.
I conditions, ng rise to the : (a) stating ying cause
ions contrib- death but not e disease or using death.
50M-10-52-908091
7 NAME OF FUNERAL DIRECTOR 223 Mass. Ave. Arlington
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.
183
2 FULL NAME Leonard H. Newman (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
3 DATE OF
DEATH
Sept.
Month)
3 1955 (Year)
(Day)
attended deceased from
I last saw him
.... alive on
9/2
TO DEATH (a)
Gloucester
Guysboro County
Malden
Registered No.
10 SINGLE
(write the word)
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.
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