USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 73
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Registered No.
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
John w Burke
(If deceased is a married, widowed or divorced woman, give also maiden name.)
43 leasant
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
Oct
26
1955-
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Feb 28
1952
to
26 October
1955
I last saw him alive on
18 Oct. 1955
death is said to
have occurred on the date stated above, at 4:45 Pm.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
py
12
AGE
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Stationives Engineer
(Kind of work done during most of working life)
14 Industry
or Business:
tarel -6c
15 Social Security No.
16 BIRTHPLACE (City) .........
(State or country)
Lancaster Brass
17 NAME OF
FATHER
ames Buske
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
ecity Arthur@Murray (Signed). (Address) Winthrop Man Date 17/00/1955
6 Place of Burial or Cremation (City or Town
DATE OF BURIAL. Oct 29 1955
7 NAME OF
FUNERAL DIRECTOR:
Charles 4 - Treanor
ADDRESS Load Boston
Received and filed UCI 28 1955 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Unlenown
20 BIRTHPLACE OF MOTHER (City) (State or country) Unknown
21 Informant (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Walter & laker
(Signature of Agent of Board of Health or other) Health Oficer 10/27/50
(Official Designation)
(Date of Issue of Permit)
Garrity
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Arteriosclerotic
Due To
Heart Disease
ANTE
CEDENT (b)
CAUSES
Due To Generalized
(c)
Arteriosclerosis
OTHER SIGNIFICANT CONDITIONS none
50M-5-55-915025
R-301A 1
CTIONS R ERTIFICATE ving F DEATH enter an one r each and (c)
es not mean dying, such re. asthenia. the disease, ions which
conditions, g rise to the (a) stating ing cause
ns contrib- eath but not disease or sing death.
Chapter 137. 54. requires to print or use or causes on death 8.
3
-
2 FULL NAME ..
(a) Residence. No. (Usual place of abode)
35
35.
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
Bb clawed
(write the word)
(Month)
(Day)
8 SEX
m
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
Vrs
yrs
18 BIRTHPLACE OF FATHER (City) (State or country)
treland
M. D.
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 helief the name of the deceased, his supposed age, the disease of which he dicd, 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 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
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 he 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, Sec. 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 injury, 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
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 .(B)-11-51-905807
PLACE OF DEATH
Suffolk (County)
M R-302 1 1 levere
(City or Town)
No. Grover ianon
os ital
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.
221
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
lizabet
lova (ForDy)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 270 leasant Str et
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years.
months ) days. In place of residence 5
years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
wot bor
26.
7055
(Month)
(Day)
(Year)
4I HEREBY CERTIFY,
That I attended deceased from
opt. 70, 1955
to Get
....
19.5
I last saw h.C.] alive on Oct. 26. 19 h, death is said to
have occurred on the date stated above, at12:15A
.m.
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of a77 8 7man]
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Uremia
INTERVAL BE- TWEEN ONSET AND DEATH 2
11 IF STILLBORN, enter that fact here.
12
AGEQ Years Months
.Days
If under 24 hours
Hours ......
.Minutes
13 Usual
Occupation :...
Housena
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No. 037-28-7319
16 BIRTHPLACE (City) Essex Junction (State or country)
17 NAME OF
FATHER
Charles Formy
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?.... no ..
If so, specify ..
(Signed) .....................
(Address) 37 IS
M. D.
venait Date et 26
19,5
Linth
on Cemetery
,
a
Place of Buriat or Cremation
(City or Town)
DATE OF BURIAL ......
October 23
21
InformantRecords, Old fre Dereau
(Address)
7 NAME OF
FUNERAL DIRECTOR owand S. Royalds
ADDRESS
intron, 200.
Received and filed.
NOV JU 1955
.........
19
(Registrar of City or Town where deceased resided)
lays 7 rear
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operation
Carcinoma of rectum
Date of operation.
Was autopsy performed ?.
..... 0.
What test confirmed diagnosis ?.
Pathology
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Vorment
19 MAIDEN NAME
OF MOTHER
Ellon Brown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Vermont
i
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
October
27,
.....
19 55
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 REINET, WITTY ONPAVING DLAVE INS ITIS IS ATERMANENT RECORD ANTE CEDENT (b). CAUSES
8 SEX
9 COLOR OR RACE
Mito
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Usual place of abode)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
idowod
Farcinona of rectum
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 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
3
(County)
(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
OSTON
(City or town making return)
Registered No.
9095 222
J(If death occurred in a hospital or institution, XX give its NAME instead of street and number)
2 FULL NAME.
MARGARET R. DOHERTY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
121 Taft Ave.
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
October.
4
1955.
(Month)
(Day)
(Year)
9 SEX
F
10 COLOR OR RACE
W
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDSingle
11a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Toxemia
Arteriosclerotic heart disease
presumably
accidental
Date and hour of injury
June .... 11
.19 ...
55
Where did
Winthrop
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place? Home
(Specify type of place)
Manner ofClothing accidentally ignited
Injury
(How did injury occur?)
Nature of
Injury
at .... her ... home.,June .... 11.,1955 ..
While at work?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
W Brickley
M. D.
(Address) Boston
Date ...
10/40 55
7 Holy Cross
Malden Mass
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL .. Oct 7
19.55
8 NAME OF
FUNERAL DIRECTOR
J .... Kelly
ADDRESS E .Boston ...... Mass
Received and filed.
NOV 14 195
.... 19.
(Registrar of City or Town where deceased resided)
12 IF STILLBORN, enter that fact here.
13
70
AGE
Years
Months.
Days
If under 24 hours
Hours .....
Minutes
14 Usual
ret.laundry worker
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business:
Long Island Hospital
16 Social Security No
17 BIRTHPLACE (City) ...... East ..... Boston, ..... Mass (State or country)
18 NAME OF
FATHER
Roger Doherty
19 BIRTHPLACE OF
FATHER (City).
(State or country)
Ireland
20 MAIDEN NAME
OF MOTHER Ellen DeCourcey
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
John A Hunter
22
Informant
(Address)
A TRUE COPY.
Charles H. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Oct 7
.55
M R-305 1
No. .
Long Island Hospital
(Was deceased a
U. S. War Veteran.
if so specify WAR)
(a) Residence. No. (Usual place of abode)
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.) Third degree flame burns of body and .... left .... arm
5 Accident, suicide, or homicide (specify)
25M-5-52-907046
PARENTS
RECEIVE:
OF
٠٠٠
٠٠
٠٠
HOOP
NOV1%
?
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
Worcester (County)
Westborough
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
·Westborough.
(City or town making return)
Registered No.
223
Westborough StateHospital
2 FULL NAME
Elizabeth E. Poote
(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.
109 Circuit Road
.......
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
7
.years.
8
months.
15
days. In place of residence .. ... years ..
months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
13,
19.55
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Dec. 18
52
to.
Oct. 13,
19.5.5.
I last saw h
alive on.
er
Oct. 12
19.5.5, death is said to
have occurred on the date stated above, a
2:35
........ m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINCarcinoma of Left
TO DEATH (a).
Breast with Metastases
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE 9
8
Months 15
Years
.. 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.
St. Albans
16 BIRTHPLACE (City)
(State or country)
ermont
17 NAME OF
FATHER
Francis H. Foote
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
19 MAIDEN NAME
OF MOTHER
Frances Lynch
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
21
Westborough State Hospital
Informant
(Address)
accords
7 NAME OF
Andrew A. Aghy
FUNERAL DIRECTOforcester; Mass.
ADDRESS
Received and filed.
NOV 14 1000
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, specifyiriam L. Gavanin
.Date.
10/13/
M., D.
(Signed)Westboro, 1993.
(Address)
Calvary
Cemetery, Winthrop, Mass.
6
Place of Burial or Cremation
October
14,
(City or Town)
DATE OF BURIAL
10%
A TRUE COPY
anne C. Dunno
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
October
20
19.5.5
X
Vr
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Was autopsy performed?
No
Date of operation
Clinical Findings
What test confirmed diagnosis?
No
10a If married. widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDingle
(write the word)
8 SEX
Female
(Usual place of abode)
(City or Town)
CERTIFICATE OF DEATH
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
No.
M R-302 1
None
TO:
OF
0
THROP
NOV15
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-10-53-910621
PLACE OF DEATH
SUFFOLK BOSTON (City or Town)
Mass. General Hospt.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
"or town making return)
9398221
Registered No.
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.)
Winthrop
Mass .
St.
(If nonresident, give city or town and State)
days. In place of residence.
11 years.
.. months
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Divorced
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
James Charles Romano
(or) WIFE of
(Husband's name in full)
INTERVAL BE- TWEEN ONSET AND DEATH
Days
37
10
26
Months
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Telephone Operator
(Kind of work done during most of working life)
14 Industry
or Business:
N, Eng. Tel.& Tel.Co.
15 Social Security No.
009-07-9913
16 BIRTHPLACE (City)
(State or country)
Bellows Falls ... Vermont
17 NAME OF FATHER Earl H Priest
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mt. Holly Vermont
19 MAIDEN NAME
OF MOTHER
Nathalie Fuller
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Bellows Falls Vt.
Mrs Earl H Priest
30 Bellevue St:
A TRUE COPY
Winthrop Mass.
ATTEST:
Charles
21 Mache
......
DATE FILED
19
.......
(Registrar of City or Town where deceased resided)
PARENTS
10-13'
.. 19.
M.
55
Mass .
ty or Town )
19
7 NAME OF
FUNERAL DIRECTOR
A B Marsh
Winthrop Mass
ADDRESS.
Received and filed.
NOV 28 1955
19
.S.
No ..
2 FULL NAME.
FrancesA Romano
(a) Residence.
No.
30 Bellevue Ave.
(Usual place of abode)
Length of stay: In place of death.
.years
7
.mon
20
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Oct.13/55
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Aug ...... 22.
155
to.
I last saw h ............ alive on
Oct.13
55
have occurred on the date stated above, at
9 .; 11AM ..
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Pulmonary emboli,
multiple
ANTE
Due To
Phlebothrombosis,
CEDENT (b)
iliac
Due To
(c)
type
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
What test confirmed diagnosis ?.
autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
CL Clay
(Address)
Mass .Gen.Hospt .... Date
6
Winthrop Cem-Winthrop
Place of Burial or Cremation
Oct:15/55
DATE OF BURIAL.
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,
CAUSES
left popliteal, right
That I attended deceased from
Oct.13
55
19
19.
death is said to
11 IF STILLBORN, enter that fact here.
12
AGE
Years
-Days
Poliomyelitis., respiratory
8 Week's
Date of operation
.Was autopsy performed?
Yes
21
Informant
(Address)
gist of enty or Town where death occurredy Oct.17/55
(Was deceased a
U. S. War Veteran,
if so specify WAR)
RECEIVED
TO:
6
THROP
NOV28
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,
X
PLACE OF DEATH
SUFFOLK 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
BOSTO!
225 (City or town making return)
9589
Registered No.
[(If death occurred in a hospital or institution, t. [ give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
427 Winthrop
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
October
18
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That 1Cattended deceased from
10/18
55
9/21 19
to
19
death is said to
have occurred on the date stated above, at.
9:05a
.. m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ....
carcinoma of biliary
ducts
-2yrs
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
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