Town of Winthrop : Record of Deaths 1956, Part 46

Author: Winthrop (Mass.)
Publication date: 1956
Publisher:
Number of Pages: 534


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 46


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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No undertaker or other person 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, Sec. 46. G. L., as amended.


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.


.. The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.


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 deathsonly 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 électrical 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


Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify .: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steain railway accident.""Pistol shot! ! wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation By' suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."


If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1)Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING ......


......


ORGANIZATION AND OUTFIT


SERVICE NUMBER


.


1


- (


-


C C 2


×


Suffolk


(County)


Bost m


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


Bo st m


(City or town making return)


3436 15


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.)


207 Revere St.


Winthrop Ma'ss.


(a) Residence. No.


(Usual place of abode)


months


days.


In place of residence.


years


3


months


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


April 9/56


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,


March 18


19


56


April 9


19


56


I last saw h ...........


.. alive on


19


death is said to


have occurred on the date stated above, at.


5:45A .m.


INTERVAL BE- TWEEN ONSET AND DEATH site


Y


12


AGE


Years


9


.10


60


Months.


Days


If under 24 hours


Hours ...


Minutes


13 Usual


Occupation:


Bartender


(Kind of work done during most of working life)


14 Industry


or Business:


Ta vern


15 Social Security No.


134-16-4222


16 BIRTHPLACE (City).


(State or country)


Boston ... Mass.


17 NAME OF


FATHER


James Moran


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary Dyer


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


Holy Cross Malden Mass


6 Place of Burial or Cremation (City or Town) DATE OF BURIAL April ... 12/56 19


7 NAME OF


FUNERAL DIRECTOR


R C Kirby


ADDRESS


Boston Mass.


Received and filed


AL 12 1956


19


(Registrar of City or Town where deceased resided)


10a If married, widowed, or divorced


HUSBAND of.


Anna L Finn


(or) WIFE of.


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Metastatic carcinoma


site unknown


ANTE


Due To


CEDENT (b)


CAUSES


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Major findings:


Of operations.


Nane


Date of operation


clinical and laboratory


5 Was disease or injury in any way related to occupation of deceased ?. If so, specify


(Signed).


John els on


M.


(Address)


VA Hospt Bostapate 4-9


19.


PARENTS


21


Informant.


(Address)


V A Hospt Fecorda


A TRUE COPYLes M.


ATTEST:


(Registrar of City or Town where death occurred)


April 13/56


DATE FILED


19


)RM R-302 1


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible,


25M-5-55-915025


PLACE OF DEATH


(City or Town)


Veteran'


CERTIFICATE OF DEATH Hospt. Boston


No.


Joseph E Moran


(Was deceased a


U. S. War Veteran,


if so specify WAR)


W W #1


St


(If nonresident, give city or town and State)


Length of stay: In place of death


......


... years.


23


That I


attended deceased from


to


-


(Give maiden name of wife in full)


11 IF STILLBORN, enter that fact here.


What test confirmed diagnosis?


Was autopsy performed?


JULIO 1


Entered Service 11-28-17 Discharged 9-30-21 Army Service No. 1436749


1 R-302 1


Bost m


(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 this return)


38 16


§(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.)


(a) Residence. No ...


45 Chester Ave .


St


Win throp


ass.


(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.


30


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED Single


or DIVORCED


(write the word)


10a If married, widowed, or divorced


HUSBAND of.


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


Years


AGE 67


1


Months.


22


Days


lf under 24 hours


Hours ........ Minutes


Due To


(b)


Myasthenia gravis


2 Mos


13 Usual


Occupation:


Ship Builder and


(Kind of work done during most of working life)


14 Industry


or Business :


Steamfitting and Plumbing


15 Social Security No.


010-12-7232


16 BIRTHPLACE (City)


East Boston "ass,


(State or country)


17 NAME OF


FATHER


Cornelius A Sullivan


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary A Harrington


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


Holy Cross Malden Mass.


Place of Burial or Cremation (City or Town)


DATE OF BURIAL April 21/56 19


7 NAME OF


FUNERAL DIRECTOR


A M Kelly


Arlington Mass.


ADDRESS


Received and filed. DJUL 31 1956 19


(Registrar of City or Town where deceased resided)


PARENTS


(Signed)


C L Clay


M. D.


(Address)


Mass, General Hospt


4-18 1 56


19


- 11-55-916145


SÓM.11


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deccased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)


PLACE OF DEATH


Suffolk


(County)


No.


Mass. General Hospt.


Joseph A Sullivan


3 DATE OF


DEATH


April 18/56


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


April 17


19


to ..


April 18


19


56


I last saw h ..... 1mive on


April 18/56eath is said to


have occurred on the date stated above, at


1;15AM


.. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Broncho ... pneummia


INTERVAL BETWEEN ONSET AND DEATH Days


OTHER


SIGNIFICANT


CONDITIONS


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.


Mrs Grace C Phinney


21


Informant.


(Address).^


1


A TRUE CÓPY -


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


April 23/56


L


Registered No.


(Was deceased a


U. S. War Veteran,


if so specify WAR)


56


TURA


JUL31 AM


A R-302 1


PLACE OF DEATH


Suffolk


(County) Bost m


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Bost a


(City or Town making this return)


3872


Registered No.


(If death occurred in a hospital or institution,


St. ¿ give its NAME instead of street and number)


Joseph Connolly


2 FULL NAME.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


162 Herman 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


1


.years.


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April 20/56


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Nov ....... 16


19


55 to


April 20


19


56


I last saw h ........ alive on


19


., death is said to


have occurred on the date stated above, at


8;30A


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Bronchogenic carcinoma


(a)


left upper lobe


INTERVAL BETWEEN ONSET AND DEATH Mos


Confluent broncho pneumonia


Days


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


/ M W O'Connell


M. D.


(Address)


Boston City Hospt


4-2010 56


Mt. Benedict Boston Mass.


6 Place of Burial or Cremation April 23/56(City or Town) 19


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Boston Mass.


ADDRESS


Received and filed


IL 31 1956


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


W


10 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divor


HUSBAND of


Mary J Dubeck


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE65


Years


Months.


.. Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


Retired


or Business :


15 Social Security No ..


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Bartholomew Connolly


18 BIRTHPLACE OF


Ireland


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


20 BIRTHPLACE OF


Ireland


MOTHER (City)


(State or country)


Mrs Mary Connolly


A TRUE COPY


Mack


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


April 24/56


19


Due To (b) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)


50M -11.55-916145


17


WKIIL FLAINLI, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


PARENTS


21


Informant


(Address)


M W Kirby


No ..


Boston City Hospt.


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No ..


(Usual place of abode)


(Month)


Pris on


fficer


Charlestown Mass.


JUL31


ORM R-302 1


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible,


X PLACE OF DEATH


Suffolk


(County)


Bo.st.m (City or Town)


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.


1455118


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.)


24 River Road


Win throp Mass.


St.


(a) Residence. No. (Usual place of abode)


20


(If nonresident, give city or town and State)


Length of stay: In place of death.


.. years ..


1


.. months.


days. In place of residence.


.years.


months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


May 6/56


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


That I attended deceased from


May 5


19 ..... 56,


to


May 6


19


56


I last saw h .... im .... alive on


May 6, 1956.


th is said to


Ann Silva


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DISEASE OR CONDITION


DIRECTLY LEADING


TO DEATH (a)


Uremia


TWEEN ONSET AND DEATH 2 Yrs


11 IF STILLBORN, enter that fact here.


12


AGE


Years


58


Months.


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation:


Laborer


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No ..


16 BIRTHPLACE (City).


(State or country)


17 NAME OF


FATHER


Mathias Cowen


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Bostan Mass.


Date of operation


Was autopsy performed?


Yes


What test confirmed diagnosis ?. autops.y.


5 Was disease or injury in any way related to occupation of deceased?


If so, specify.


CL Clay


M. D.


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May9/56


19


21


Informant


(Address)


A TRUE COPYarles H. Vackra


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED May 11/56


19


VTV ..........


(Registrar of City or Town where deceased resided)


PARENTS


19 MAIDEN NAME


OF MOTHER


Catherine


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Nova Scotia


Joseph Cowen


7 NAME OF


FUNERAL DIRECTOR


M W Kirby


ADDRESS Winthrop Mass.


Received and filed.


AUG-8 -1956


19


Mis.


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


25M-5-55.915025


Due To Chronic pyelonephritis 16 Yrs


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Hyper tension


4 Yrs


Major findings:


Of operations.


(Signed)


Mass General Hospt 5-6 19 56


(Address)


Winthrop Cem-Winthrop Mass.


8 SEX


M


9 COLOR OR RACE


10 SINGLE


(write the word)


MARRIED


WIDOWEDWidowed


or DIVORCED


have occurred on the date stated above. at.


4:15AM


.m.


INTERVAL BE-


ANTE


CEDENT (b)


CAUSES


....


Mass. General Hospt. No.


George Cowen


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Boston Mass.


RECEIVE


OF TOW


CI


6


INTHROP


AUG-8


AM


X


Suffolk (County)


Revere


(City or Town)


The Commonwealth of Massarhusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


RIVERE (City or Town making this return)


119


Grover Manor Hospital No.


$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


Harry H. Dickson


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence.


No ..


129 River


Road


St


winthrop


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death ........... years ...


months


5 days. In place of residence.


40


.. years.


months .....


.. days.


MEDICAL CERTIFICATE OF DEATH


June


16,


1956


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


June 11


56


June


16


19


to.


im


June


16


1956


death is said to


have occurred on the date stated above, at


10:55 Am


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Tremia


Due To


Cerebral Vascular


accident


Due To


Arteriosclerotic Heart


disease


2yrs .


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


Colored


10 SINGLE


MARRIED ? «


WIDOWED


or DIVORCED


(write the word)


arried


10a If married, widowed, or divorced tta Campbell


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.7.2 Years.


8


Months.


2 Days


If under 24 hours


Hours ........ Minutes


13 Usual


Chauffeur


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Private


15 Social Security No.


029-05-0252


16 BIRTHPLACE (City)


(State or country)


Virginia


17 NAME OF


FATHER


Ilarwood Dickson


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Virginia


19 MAIDEN NAME


OF MOTHER


Leah Reddick


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Cannot Be Learned


21 Etta Dickson


Informant.


(Address)


127 River Rd., Winthrop


A TRUE COPY


ATTEST:


DATE FILED


Registrar of City or Town where death occurred)


June 20,


1.19 56


V.B.


3 DATE OF DEATH (b) (c) 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. 1 .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town OTHER SIGNIFICANT CONDITIONS


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


50M - 11-55-916145


7 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS


inthrop, l'ass.


Received and filed :JUL ... 12.1956 19


(Registrar of City or Town where deceased resided)


INTERVAL BETWEEN ONSET AND DEATH 48hrs


2


weeks


Was autopsy performed?


NO


What test confirmed diagnosis ?.


Clinical si ns


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


James F. Burns


537 roadway


M. D.


(Address)


Everett


Date


June 17, 5%


Winthrop


Place of Burial or Cremation


(City or Town)


Winthrop


DATE OF BURIAL


June


19


56


19


PARENTS


M.S.


PLACE OF DEATH


M R-302 1


Registered No.


2 FULL NAME


(Was deceased a


U. S. War Veteran,


if so specify WAR)


19


56


I last saw h.


.alive on


JUL12


.. .


×


ESSEX


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


LAWRENCE


(City or Town making this return)


610


Registered No.


120


§ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


John F. Roan


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


254 Pleasant


St


(If nonresident, give city or town and State)


Length of stay: In place of death.


........... years.


... months.


days. In place of residence.


1 ..... years.


months ............ days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX Male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


Married


10a If married, widow Harmbet Floyd HUSBAND of (Give maiden name of wife in full)


(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


13 Usual


Occupation :


(kolf fog done during most of working life)


14 Industry


15 Social Security No.


East Boston


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Daniel F. Roan


18 BIRTHPLACE OF


FATHER (City)


Ireland


(State or country)


19 MAIDEN NAME


Maria Mulready


OF MOTHER


20 BIRTHPLACE OF


(State or country)


Harriet hoan


21


Informant.


254 Pleasant St. , Winthrop,


(Address)


A TRUE COPY


ATTEST:


(Registrar of City'or Town where death occurred)


1


DATE FILED


July


3


.1956


(Registrar of City or Town where deceased resided)


PARENTS


George W. Desmet


(Signed) ..


10 Amesbury St.


6-27 , 158.


19


(Address) Date.


Winthrop Cemetery, Winthrop, Mass MOTHER (City) Ireland .


6 Place of Burial or Cremation


JunCity ortwn)


56


DATE OF BURIAL.


19


7 NAME OF


Arthur J. OHaley


FUNERAL DIRECTOR Winthrop, Muss.


ADDRESS


Received and filed 19


27 1956


(Month)


(Day)


(Year)


4 1 HEREBY CERTIFY,


June 21


50


- That I attended, deceased front


June


19 50


56.


I last saw h. .... alive on


3.30 p.


have occurred on the date stated above, at .. m.


DEATH WAS CAUSED


BY: IMMEDIATE CAUSE


Thrombosis


Coronary


3


Due To


Coronary Art. Disease ]


Arterio Sclerosis & Hypertensive or Business: Due To


(c) Vascular Disease


5 yrs.


Was autopsy performed ?.


E.K.G.


What test confirmed diagnosis?


no


5 Was disease or injury in any way related to occupation of deceased? If so, specify.


50M -11.55.916145


3 DATE OF DEATH (a) (b) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town OTHER SIGNIFICANT CONDITIONS


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


M.s.


PLACE OF DEATH


(County) LAWRENCE


(City or Town)


Lawrence General Hospital


No ..


( Was deceased a U. S. War Veteran,


Winthrop, Mangify WAR)


(a) Residence. No ...


(L'sual place of abode)


3


4.0


MEDICAL CERTIFICATE OF DEATH


June


19 June ..... 27


a death is said to -


INTERVAL BETWEEN ONSET AND


watchman


yr.


no


1 R-302 1


JUL10


X


PLACE OF DEATH


Essex


(County)


Danvers


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH


Danvers


(City or town making return)


121


Registered No.


J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)


2 FULL NAME


Bridget Lazzari


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(Maiden name Bridget Lazzari)


¿Was deceased a


U. S. War Veteran,


if so specify WAR)


No


St.


Winthrop, Hlass.


(If nonresident, give city or town and State)


Length of stay: In place of death


1 years 0 months.


7


days. In place of residence.


......


.. years ..


months


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


June


29,


1956


(Month)


(Day)


(Year)


4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)


Cerebral Hemorrhage.


diabetes


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


Female


10 COLOR OR RACE


White


11 SINGLE


MARRIED


WIDOWED Widowed


or DIVORCED


11a If married, widowed, or divorced


HUSBAND of.


(Give maiden name of wife in full)


(or) WIFE of.


Augusto Lazzari


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


13


AGE


79 Years.


6


Months


11


Days


If under 24 hours


.Hours ...


Minutes


14 Usual


Occupation :.


Housewife


(Kind of work done during most of working life)


15 Industry or Business :.


16 Social Security No ...


Unknown


17 BIRTHPLACE (City).


(State or country)


Italy


18 NAME OF


FATHER


John Lazzari


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


20 MAIDEN NAME


OF MOTHER


Marie Dellatte


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


22


Informant


(Address)


Hathorne, Mass.


A TRUE COPY.


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


July


9, 19 56


X


RM R-305 1


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible 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 MABAIN


25M-5-52-907046


(Address) Peabody, Mass.


Date 6/30


19 56


7 St. Michael's


Boston, Ilass


Place of Burial, or Cremation. (City or Town)


DATE OF BURIAL July 5, 19 56


8 NAME OF


FUNERAL DIRECTOR


Richard C. Kirby


ADDRESS.


East Boston, Mass.


Received and filed.


JUL -19 1956


19


....


(Registrar of City or Town where deceased resided)


PARENTS


6 Was disease or injury in any way related to occupation of deceased? If so, specify.




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