USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 65
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death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons 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, See: 46, G. L., (Tercentenary Edition).
1 1 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 bellside care during a last illness front disease unrelated to any form of injury.
(2) Board, of Health physicians will certify to such deathsonly as those of persons who, thought disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiner's 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 Odatns 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
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,
PLACE OF DEATH
SUFFOLK İ BOS County
(City or Town)
No. Boston City Hosp
wybital
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) 195 8333
Registered No. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
JULIA NAPPI
(If deceased is a married, widowed or divorced woman, give also maiden name.)
104 Highland Ave.,
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(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
9
1955
8 SEX
F
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
Widow
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
8/21
19
to
9/9
5.
19
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
L last saw h.m ......... alive on ........
19 ........ , death is said to
(or) WIFE of.
John Nappi
(Husband's name in full)
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
72 Years.
Months
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Housework
(Kind of work done during most of working life)
14 Industry
or Business:
Own home
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Italy
17 NAME OF
FATHER
John Meloni
Major findings:
Of operations.
Date of operation
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.
(Signed)
MW O' Connell
M. P.
(Address)
BCH
Date
9. 9 ..... 19 ... 55
Malden, Mass.
6 .Holy Cross
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Sep ...... 12
19.55
21
Informant.
(Address)
A TRUE COPY
Charles & Macke
ATTEST;
(Registrar of City or Town where death occurred)
55
DATE FILED
Sep 12
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
Rose Poccio
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Mary Di Pace
7 NAME OF
FUNERAL DIRECTOR
F Magrath
ADDRESS
E .... Boston, ..... Mass
Received and filed
OCT 18 1955
19
-Mos.
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
Coronary heart failure-Days
OTHER
SIGNIFICANT
CONDITIONS
25M-5-55-915025
(Month)
(Day)
(Year)
have occurred on the date stated above, at.
7:00p.
.. m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)Hypertensive arterio-
sclerotic heart disease
That Vidattended deceased
from
XXX.
Winthrop, Mass
RM R-302 1
M R-302 1
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
Beth Israel Hospital 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)
Registered No.
830196
J(If death occurred in a hospital or institution, .St. \ give its NAME instead of street and number)
2 FULL NAME
ALICE H WEINER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
93 Grover Ave.,
Winthrop, Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
.....
.... years.
10
.. months.
days. In place of residence.
.........
.years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
September
9
1955
(Year)
8 SEX
F
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Harry
10 01. 50
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
48
Years
Months.
Days
If under 24 hours
.. Hours.
.Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Louis Levine
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Gertrude - -
20 BIRTHPLACE OF
MOTHER (City)
Ma s(State or country)
Russia
Husband
21
Informant
(Address)
A TRUE COPY
-
ATTEST:
(Registrar of City or Town where death occurred)
55
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
metastatic car-
cinoma
INTERVAL BE- TWEEN ONSET AND DEATH
2mos
+
Due To
breast carcinoma
4yrs +
OTHER
Pleural & peritoneal
2wks
5 Was disease or injury in any way related to occupation of deceased ?.. NO If so, specify
M. D.
Date 9/9
5.5
Liberty Progressive Cem Everett
Place of Burial or Cremation
(City or Town)
Sep 9
19
59
7 NAME OF
FUNERAL DIRECTOR.
E Levine
ADDRESS
Brookline, Mass
Received and filed.
OCT 18 1955
19
ms
(a) Residence. No.
(Usual place of abode)
3 DATE OF
DEATH
(Month)
(Day)
4 I HEREBY CERTIFY,
8/30 19
...
to
I last saw h
eralive on
9/9
ANTE
CEDENT (b)
CAUSES
Due To
(c)
SIGNIFICANT
Major findings:
Of operations.
What test confirmed diagnosis ?.
(Signed)
H Karpman
(Address).
B.I.H
6
DATE OF BURIAL
25M-5-55.915025
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
effusions
That
I
attended deceased from
9/9
19
19.55
death is said to
have occurred on the date stated above, at.1.Q .:. 2.2.g ..... m.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
DATE FILED
Sep 12
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
Date of operation
Was autopsy performed ?.
1.
OCT17
X
PLACE OF DEATH
Suffolk (County)
Bos ton
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bos ton
(City or town making return)
Registered No.
8434 19?
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Albert Polansky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
W W #11
(a) Residence.
No.
(Usual place of abode)
9 Wave Way Ave.
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
3 DATE OF
DEATH
Sept. 13/55
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED Married
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Sept. 10
19
5.5
to.
Sept .13.
19
55
HUSBAND of
(Give maiden name of wife in full)
I last saw h .. i.m ..... alive on.
Sept, 13, 19 55
death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Acute anterior polio
myelitis
5 Days
12
AGE
33 Years.
Months.
Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
Furniture Decorator
(Kind of work done during most of working life)
14 Industry
or Business:
Self
15 Social Security No.
024-16-9930
16 BIRTHPLACE (City).
(State or country)
Boston Mass.
17 NAME OF
FATHER
Harry Polansky
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Rose Waxman
20 BIRTHPLACE OF
Rus sia
MOTHER (City)
(State or country)
Lillian Polansky
Wife
7 NAME OF
FUNERAL DIRECTOR
A Golov
ADDRESS.
Brookline Mass.
Received and filed.
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
CL Clay
(Signed)
(Address)
Mass General Hos phate
9-14 M. 5B.
6
Kehillath Israel West Roxbury Mass.
y or Town) DATE OF BURIAL
Place of Burial or Cremation
Sept. 15/55
19
21
Informant
(Address)
A TRUE COPY les H. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Sept. 15/55
.19.
........
VI.V
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, 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
25M·5-55-915025
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
None
Date of operation.
Was autopsy performed?
No
What test confirmed diagnosis ?.
clinical
10a If married, widowed, or divorced
Lillian Bluestein
have occurred on the date stated above, at.
9:53PM
.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
ANTE
Due To
CEDENT (b)
CAUSES
M R-302 1
No.
Mass . General. Hospt.
OCTRE
Entered Service 11-9-42 Fort Devens Mass . Discharged 1-12-46 Rome New York Sgt. 4269th AAF Base Unit Service No. 11116238
X
PLACE OF DEATH
SUFFOLK
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.
1988565
J(If death occurred in a hospital or institution, No. Peter Bent Brichan Hospital
give its NAME instead of street and number)
LILLIAN THOMPSON
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 125 Cliff Ave.,
xxx.Winthrop .Mass
(If nonresident, give city or town and State)
Length of stay: In place of death.
........... years ..
months.
3 days. In place of residence.
... years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED VICOW
4.THEREBY CERTIFY,
9/13
That I attended deceased
9/16
55
WLlast saw
h.O ......
alive on
1955
9:00p.
have occurred on the date stated above, at
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
myocardial infarction
acuto
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Henry .... Thompson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 3 Years.
Months ...... Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Qum hore
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
William Koan
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Annie MacKonzie
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
6 .Winthrop Place of Burial or Cremation
Winthrop Mass
Sep 20
19
21
Informant
(Address)
A TRUE COPY Dalen 7,2
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed.
OCT 24 1500
or . .
(Registrar of Cityjor Town where deceased resided)
ULPARENTS
5 Was disease or injury in any way related to occupation of deceased ?. no
If so, specify ...
(Signed)
(Address)
M. D.
Date.
2/17 19.
(City or Town) 59
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTOR ...
H Reynolds
Winthrop, Mass
ADDRESS
30yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
What test confirmed diagnosis ?.
.Was autopsy performed?
autopsy
25M-5-55.915025
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,
Due To
generalized arterio-
ANTE CEDENT (b) CAUSES sclerosis
...
19
..
to.
9/16
19
death is said to
3 DATE OF
DEATH
Sentember
16
1955
(Month)
(Day)
(Year)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
DATE FILED
Sep 21
19
55
X
M R-302 1
(City or Town)
Ruth Pizzano
10,0
.י
THROP.
ОСТА
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, Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46. Sec. 12. G. L.)
PLACE OF DEATH
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 t wn making return) 199 8958
Registered No.
occurred in a hospital or institution give its NAME instead of street a d numbe )
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
30 Cross
Winthrop,
gg specify WARY
Ma's's
(a) Residence. No.
(Usual place of abode)
St.
(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
3 DATE OF
DEATH
September
29
1955
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR OR RACE
W
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY,
9.1.2.9 ...
19
to
I last saw h ....... e.alive on
9/29
19 .. 55death is said to
have occurred on the date stated above, at
9 : 15р.
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).Intracerebral
TWEEN ONSET ANO DEATH
4hrs
ANTE
Due To
CEDENT (b) CAUSES
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Cerebral palsy
16yrs
Major findings:
Of operations
Date of operation
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.
(Signed).C ..... C.Lay ..
(Address)
MGH
M. D.
Date ......... .......
19
6 Winthrop
Winthrop, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Oct 3
55
19
7 NAME OF
FUNERAL DIRECTOR
Winthrop .....
M.a.s.s.
1955
Received and filed NOV 8 .19
(Registrar of City or Town where deceased resided)
.10a If married, widowed, or divorced
55HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact nere.
12
AGE 17. Years .. . 8 Months12 Days
If under 24 hours
Hours . Minutes
13 Usual
at home
Occupation :
(Kind of work done during most of working lile)
14 Industry
or Business :
15 Social Security No ...
027-28-4837
16 BIRTHPLACE (City).
(State or country)
Boston, ..
Mass
17 NAME OF
FATHER
Charles R King
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Boston, Mass
PARENTS
19 MAIDEN NAME
OF MOTHER
Dorothy Lawrence
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Everett, Mass
Charles R King
21
Informant.
(Address)
A TRUE CÓPY
COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Oct 4
55
19
X
(
R-302 1
Mass General Hospital No.
DOROTHY A KING
(Was deceased a
U. S. War Veteran,
10 SINGLE
(write the wo d)
That I
attendcd deceased from
9/29
19
hemorrhage
25M-3-55-915025
H Reynolds
ADDRESS.
ZHRUBA
NOV-8
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 BOSTON
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
BOSTON
(City or town making return)
9026 200
The Children's Hospital No.
J (If death occurred in a hospital or institution, SKI give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
12 Chorry
St.
Winthrop, fiass
(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
October
2
1955
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
9/30
19
That I attended deceased
from
19
55
I last saw h
imalive on
10/2
19 .. 5.5 death is said to
have occurred on the date stated above, at 5:502.
m.
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE
3
... Years ...
7
.. 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.
16 BIRTHPLACE (City)
(State or country)
Winthrop, Mass
17 NAME OF
FATHER
Michacl Dooley
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston, Mass
Date of operation
Was autopsy performed ?..
What test confirmed diagnosis ?.
lumbar .... puncture
5 Was disease or injury in any way related to occupation of deceased? If so, specify ... S Kovy
(Signed).
(Address) .. 300 LongwoodAveDate 10/219 59 M. D.
Winthrop, Mass
Place of Burial or Cremation (City or Town)
DATE OF BURIAL. Oct 4 19
5
Michael Dooley
7 NAME OF
FUNERAL DIRECTOR
F Magrath
E Boston, Mass
ADDRESS.
Received and filed.
NOV IU 1900
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Margaret Banks
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
21
Informant
(Address)
A TRUE COPY track ..
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Oct 5
19 55
M R-302 1
(City or Town)
CERTIFICATE OF DEATH
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
MARRIED
WIDOWED
Si. gle
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
DISEASE OR CONDITION
DIRECTLY LEADING Poliomyelitis
TO DEATH (a)
bulbo-spinal
INTERVAL BE- TWEEN ONSET AND DEATH
3days
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
6 Winthrop
25M.5.55-915025
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
RAYMOND L DCOLEY
to .. 10/2
%
.NOV10
X PLACE OF DEATH
BUTTOLK BOST (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) 201
Registered No.
9043.
No. . Mass General Hospital
J(If death occurred in a hospital or institution, Ctrl give its NAME instead of street and number)
2 FULL NAME JOHN J GRATAM
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Girdlestone Road,
St.
Winth
ass
(If nonresident, give city of 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
M
9 COLOR OR RACE
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
4 I HEREBY CERTIFY,
That I
attended deceased from
9/2619.
to
10/2
19
59
I last saw h .... [.]] ... alive on ...
10/2
19 ... 55death is said to
have occurred on the date stated above, at
6:402
m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
12
71
AGE
Years
.Months.
Days
If under 24 hours
.Hours .....
Minutes
13 Usual
Occupation :
Watchman
(Kind of work done during most of working life)
14 Industry
or Business:
U S Lines
15 Social Security No ...
031-10-5220
16 BIRTHPLACE (City).
(State or country)
Cambridge, Mass
OTHER
SIGNIFICANT
Pulmonery ... omphysoma
CONDITIONS
end fibrosis
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?.
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
C Clay
M. D.
(Address)
MGH
Date
19.
6 Place of Buffal of Cremation
Winthrop, Nass
(City or Town)
21
DATE OF BURIAL Oct 5
19.
5
7 NAME OF
FUNERAL DIRECTOR
F. Magrath
ADDRESS E Boston Mass
Received and filed
NOV 10 1955
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Catherine Fallon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
5
Informant
Ann T Graham
ATTEST:
Echarles H. Mackie
(Registrar of City or Town where death occurred)
DATE FILED
Oct 5
......
.19 ...
55
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-5.55.915025
M.S.
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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