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