USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 68
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).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87
(State or country)
Massachusetts
Hospital Records
21 Informant (Address)
A TRUE COPY
ATTEST:
Supt.
DATE FILED
Jane 30, 1956
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
3 DATE OF DEATH at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased CONDITIONS
50M .11-55.916145
5
PLACE OF DEATH
Middlesex (County)
No
TEWKSBURY STATE HOSPITAL and INFIRMARY
Registered No.
INTERVAL BETWEEN ONSET AND DEATH
mos
Boston
PARENTS
(RegistraY of tifs
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1
PLACE OF DEATH
(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 this return)
619883
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Gertrude E Silver
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 Temple Ave
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years. 2 months. IBays.
In place of residence
30ears
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
(Month)
July 1, 1956
(Day)
(Year)
4 1 HEREBY CERTIFY,
That I attended deceased from
April.18
19
56
to
July 1, 1956
I last saw h ........ alive on July 1, 1956, death is said to
have occurred on the date stated above, at 2:25₽m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Pulmonary edema
? Embolus
1 day
2₺ mos
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
N
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Joseph Silver
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
72
AGE
Fears
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)
Fast Boston
SIGNIFICANT Vascularaccident
wks
Was autopsy performed ?. What test confirmed diagnosis ? clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
CL.Clay
M. D.
(Address)
Mass .Gen Hosp
... Date ... 7 .- 1 19 56
6 Holy Cross
Malden
Place of Burial or Cremation
DATE OF BURIAL
(City or Town) July 5 19 56
21
Informant
John Silver
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 10 ,56
U.R. V.
3 DATE OF DEATH (b) OTHER Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Scc. 12, G. h.) at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased CONDITIONS
50M -11-55.916145
ADDRESS
Winthrop, Mass
Received and filed. OCT 1: 1956 19
(Registrar of City or Town where deceased resided) PRINTER
PARENTS
17 NAME OF FATHER John E Ford
18 BIRTHPLACE OF
FATHER (City).
East Boston
(Statc or country)
Mass
19 MAIDEN NAME OF MOTHER Margaret E Owen
20 BIRTHPLACE OF
MOTHER (City).
East Boston
(State or country)
7 NAME OF
FUNERAL DIRECTOR
A J Oraley
5.
R-302 1
No.
Mass Genl Hospt
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
INTERVAL BETWEEN ONSET AND DEATH
Due To
Carcinoma of bladder
Due To (c) Arteriosclerotic heart disease-Cerebral
OCTAV
M R-305 1
PLACE OF DEATH
SUFFOLI
1 BOS TEunty)
(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
BOSTON
(City or town making return)
Registered No.
63621 84
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Alfred H Qyeenan Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
47 Loring Road St
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
... years.
months .days. In place of residence. .. years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month) (Day)
July8/56 (Year)
9 SEX
M
10 COLOR OR RACE
W
11 SINGLE
(write the word)
MARRIED
WIDOWEDMarried
or DIVORCED
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.) Fracture of skull presumably
11a If married, widowed, or divorced
HUSBAND of
Margaret Regan
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE.48
Years
.Months.
Days
If under 24 hours
Hours ...
.Minutes
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
14 Usual
Occupation :
Switchman
(Kind of work done during most of working life)
15 Industry
or Business:
New England Tel.& Tel.
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Charlestown Mass.
18 NAME OF
FATHER
Alfred H Queenan
19 BIRTHPLACE OF
FATHER (City).
(State or country)
East Boston Mass.
20 MAIDEN NAME OF MOTHER Anna B Burns
21 BIRTHPLACE OF
MOTHER (City)
Burlington Vermont
Father
DATE OF BURIAL
July 11/56
19
8 NAME OF
FUNERAL DIRECTOR
F. J McGrath
ADDRESS.
East Boston MasSTEST:
Received and filed
[OCT 12 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
(Signed)
Richard Ford
M. D.
(Address)
Date ..
.7-8 .... 19 ... 56
Cambridge .... Catholic Cem Cambridge (State or country)
7 Place of Burial, or Cremation. (City or Town)
22
Informant
(Address)
A TRUE COPY.
(Registrar of City or Town where death occurred)
DATE FILED July 17/56 19
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 . .. ...
25m-(c)-11-49-900.475
place?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of Injury
While at work?
Was autopsy performed?
Did injury occur in or about home, on farm, in industrial place, or in public
Where did Injury occur? (City or town and State)
accidental fall into M.T.A. pit at
Boston ........... July .... 8/56
PERSONAL AND STATISTICAL PARTICULARS
(Was deceased a
U. S. War Veteran,
if so specify WAR)
2 FULL NAME
Boston City Hospt. No.
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which thentheceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another cil of town Due To (c)
2 FULL NAME
Arthur Samuel .Cashman
Residence. No ...
35 Wadsworth St.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
(Day)
12,
1956
(Month)
(Year)
4 1 HEREBY CERTIFY,
That I attended deceased from
June 28,
56
July 12
INTERVAL
56
19.
have occurred on the date stated above, at
DEATH WAS CAUSED BY: IMMEDIATE CAUSE -
BETWEEN
ONSET AND
DEATH
48Hrs
19.
56
I last saw
h.
inte on
July 12,
19.
death is said to
6:20A
.m.
(a)
Myocardial Infarction
Due To
Arteriosclerotic Heart
(b)
Disease
4 Years
SIGNIFICANT
Was autopsy perfa mapathectomy
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased?
No
If so, specify
(Signed)
Walter Kaye
M. D.
(Address)
Faulkner Hosp.
.Date
7/12/
19
Sharon Mem. Park Cem. Sharon, Mass
6
Place of Burial or Cremation
(City or Town)
July
13,
DATE OF BURIAL.
19
Henry Levine
7 NAME OF
FUNERAL DIRECTOR
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Secy [2.( ;. ... )
CONDITIONS
artery left lumbar
....
6 Dys
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a ]
f married, widowed, omdiverteon Kaitz
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
56
AGE
Years.
Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
AssIt. treasurer
(Kind of work done during most of working life)
14 Industry
or
Business:
Credit Union
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Russia
17 NAME OF
FATHER
Moses Cashman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Ida Kaplan
20 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
Russia
Marion Cashman
Informant
(Address)
Winthrop, Mass ..
A TRUE COPY
charles H. IMachine
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July
20,
19
56
(Registrar of City or Town where deceased resided)
PARENTS
50M -11-55-916:45
X
SUFFOLK BOSTON {County)
(City or Town)
No
Faulkner Hospital
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)
6429:85
Registered No.
$ (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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St
winthrop,
Hass.
(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.
JEG CUTLER
Pete. 3
PLACE OF DEATH
1 R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
OTHER Thrombosis left tibialliDys.
ADDRESS.
Brookline, Mass.
Received and filed [OCT 23 195 : 19
5621
VISV
1.
as ..
RECEIVED
TOMA
1
.......
+
OCT2 3
€
I R-302 1
-
PLACE OF DEATH
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or Town making this return)
Registered No.
6755186
§(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Elizabeth ......... Brooks
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20."inthrop.
St
inthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ..
.. months ..
17days. In place of residence.
30years
.months ...
... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
1
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Harry I Brooks
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
72 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)
South Boston
(State or country)
Mass
17 NAME OF FATHER Patrick McDonough
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary Joyeo
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Informant (Address)
Husband
DATE OF BURIAL
7 NAME OF
ERAL DIRECTO
A J nivaley
ADDRESS Winthrows
OCT 29 9900 888
19
Received
and filed
(Registrar of City or Town where deceased resided)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 30
56
19
3 DATE OF
DEATH
July 23 1956
(Year)
(Month)
(DayY
4 I HEREBY CERTIFY,
That I attended deceased from
July 6, 1956,
to
July 23
19
56
I last saw h ........ alive on
July 23, 19.56 death is said to
have occurred on the date stated above, at 5:15 0 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a) Hepatic coma
(1)) Liver necrosis
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
(Signed)
G.Gendrop
M. D.
(Address)
Carney Hosp
.Date
7-23
56
winthrop
6 winthrop Cer Place of Burial or Cremation
(City or Town)
July 26 1956
50M .::. 55.916145
Due To 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)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
1.4 51
No.
Carney Hospt
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No ....
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
1 R-302 1
PLACE OF DEATH
SUFFOLK BOSTOfCounty)
(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)
1
6867187
No. Massachusetts .... General ..... Hospital
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Melvina Streeter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Pleasant St ...
Winthrop, Mass.
St
(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
July
26,
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
to. July 26
19
56
Welast saw h ... e.Mve on
July 20,,
19 ...... 5,Ceath is said to
have occurred on the date stated above, at 5:30₽ .m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE .
(a) Pulmonary ... edema
INTERVAL BETWEEN ONSET AND DEATH
Hrs.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Herbert Streeter
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
77 ears
1QIonths.
19ays
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business:
Housework
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF FATHER George A. Smith
18 BIRTHPLACE OF
FATHER (City)
(State or country)
East Boston
Massachusetts
19 MAIDEN NAME OF MOTHER Margaret Morrell
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
East Boston
Woodlawn Cem. Everett, Mass. 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
July 28,
19
56 21
Informant.
(Address)
A TRUE COPY
harles it Inac
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
August
1,
19
56
(Registrar of City or Town where deceased resided)
6Mca
OTHER
SIGNIFICANT
Cerebral .... odema
Hrs.
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 ..... L. .... Clay
M. D.
(Addre Mass. Gen. Hosp.
Date.
19
7 NAME OF
FUNERAL DIRECTOR
W. R. Carafa
ADDRESS Chelsea, Mass.
Received and filed
[OCT 30 1900
19
PARENTS
Gertrude Caiofe
Chelsea, Mass.
50M.11-55.916145
3 DATE OF DEATH (b) Due To (c) Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town 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 CONDITIONS
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
. l'
Registered No.
( Was deceased a
C. S. War Veteran,
if so specify WAR)
That I WEnded deceased from July 11, 19 .. 56
Due To
Calcific aortic stenosi
(Kind of work done during most of working life)
East Boston
Massachusetts
FORM VS-R3 1-1-56. . STATE OF MAINE DEPARTMENT OF HEALTH AND WELFARE
CERTIFICATE OF DEATH
STATE FILE NO. 05392
05 KIL
1. PLACE OF DEATH
a. COUNTY
Hancock
L STATE
Mass.
b. COUNTY Suffolk
CITY, TOWN, OR LOCATION Casting
C. LENGTH OF STAY IN 1b
1 WEEK
(If not In hospital, give street address)
d. STREET ADDRESS
IS PLACE OF DEATH IN RURAL AREA?
YES O
NO F
IS RESIDENCE IN RURAL AREA?
YES O
NO B
f. IS RESIDENCE ON A FARM? YES O NO &
3a. NAME OF DECEASED - First Name
ALICE
1 3b. Middle Name I 1
1 3c .. Last Name
Month
Day
Year
5. SEX f
6. COLOR OR RACE
7. Married D
Never Married
8. DATE OF BIRTH
9. AGE (In years Uf under 1year ! if under 21. br last birthday) Mos Day's Hrs |Min.
DECEDENT PERSONAL DATA
TYPE OR PRINT NAME
14. MOTHER'S MAIDEN NAME Not Known
15. NAME OF SPOUSE (If Married)
Not
Known
17. SOCIAL SECURITY NO.
25 Vill Address AVE
Winthrop, Mass
19. CAUSE OF DEATH (Enter only one cause per line fo (a), (b), and (c).) PART 1. DEATH WAS CAUSED BY: IMMEDIATE CAUSE (2). Myocardial infarction
CAUSE OF DEATH
PLEASE TYPE OR PRINT
PART II. Other significant conditions contributing to death but not related to the terminal disease condition given in Part 1 (a)
20. WAS AUTOPSY PERFORMED? YESİ NOO
21a. ACCIDENT
SUICIDE
HOMICIDE
21b. DESCRIBE HOW INJURY OCCURRED, (Enter nature of injury In Part I or Part II of Item 18).
DEATH DUE TO EXTERNAL VIOLENCE
21c. TIME OF
INJURY
Hour &.m. p.m.
Month, Day, Year
21d. INJURY OCCURRED WHILE AT NOT WHILE WORK O AT WORK O
210. PLACE OF INJURY (e.g., in or about home, farm, factory, street, office bidg., etc.)
22b. PHYSICIAN: I hereby certify that I attended the deceased from
to 7/27/36 and last saw him alive on 27
Death occurred .
at 5 PM
m on the date and from the causes stated above,.
23a. SIGNATURE
Robert
(Degree or title) Russell
23b. ADDRESS Penobscot.
23c. DATE SIGNED 7/27/ 56
24a. BURIAL, CREMATION, REMOVAL (Specify)
24b, DATE 7/31/56
24c. NAME OF CEMETERY OR CREMATORY Mit auburn
24d. LOCATION (City, town, or county) Cambridge Nass (Stato)
Burial 25. FUNERAL DIRECTOR
ADDRESS
26. DATE RECD. BY LOCAL REG 7/29/56
REGISTRAR'S SIGNATURE - A TRUE COPY, ATTEST. 27
Reynolds Funeral Itorne
Winthrobad ress
Crawford
4. DATE OF DEATH July 27 '56
Widowed
Divorced
abr. 16 1864
100 USUAL OCCUPATION (Give kind of work done during most of working life, even If retired)
10b. KIND OF BUSINESS OR INDUSTRY
11. BIRTHPLACE (State or foreign country)
12. CITIZEN OF WHAT COUNTRY?
13. FATHER'S NAME
16. WAS DECEASED EVER IN U.S. ARMED FORCES?
(Yes, no, or unknown) (If yes, give war or dates of service)
18. INFORMANT IRENE Conant
INTERVAL BETWEEN ONSET AND DEATH
Conditiona, if any, ) DUE TO (b) which gave rise to above causa (a) stating the under- DUE TO (c). lying cause last.
21f. CITY, TOWN, OR LOCATION
COUNTY
STATE
222. MEDICAL EXAMINER: I hereby certify that death occurred at the time and from the causes stated above, and that i. held an (investigation) (autopsy) on the re- mains of the deceased as required by law.
PHYSICIAN'S R MEDICAL EXAMINER'S RTIFICATION
FUNERAL DIRECTOR AND REGISTRAR
C. CITY, TOWN, OR LOCATION
Withrop,
Mass
d. NAME OF
HOSPITAL OR
Casting Community Hood
2. USUAL RESIDENCE Where deceased lived. If institution : residence before admission
PLACE OF DEATH AND USUAL RESIDENCE
-
05392
Form Approved Budget Bureau No. 68-R442
ynolds Funeral Home
Anthrop, Ma88. Dear Sir:
Aug. 16, 1956
It is essential that death certificates be complete and correct in every articular. You are therefore requested to make every effort in your power to secure the information indicated by red X's.
You need not furnish information except where indicated by red X's.
STATE FILE NO.
1. PLACE OF DEATH & COUNTY
USUAL RESIDENCE Where decesebd lived. If Institution : residence before admission
Han cock
& STATE Mass.
b. COUNTY Suffolk
b. CITY, TOWN, OR LOCATION
LENGTH OF STAY IN 1b
CITY, TOWN, OR LOCATION Winthrop
Casting
d. NAME OF HOSPITAL OR INSTITUTION
(If not In hospital, give street address)
d. STREET ADDRESS
18 PLACE OF DEATH IN RURAL AREA?
IS RESIDENCE IN RURAL AREA?
YES O NO O
YES O NO O
NO O
3 NAME OF DECEASED -First Name
3b. Middle Name
30. Last Name
4. DATE OF DEATH
Month
Day
Your
Alice
5. SEX
COLOR OR RACE
7 Married [
Nover Married D
8. DATE OF BIRTH
9. AGE (In years last birthday)
July 27 1956 ILunder 1year if under 24 hrs Mos Pays Hrs Min
Widowed D Divorced D
10a USUAL OCCUPATION (Give kind of work done during most of working life, even if retired) XXX Housewife
106. KIND OF BUSINESS.OR INDUSTRY
11 BIRTHPLACE (State or foreign country)
12. CITIZEN OF WHAT COUNTRY?
13. FATHER'S NAME
14. MOTHER'S MAIDEN NAME
15. NAME OF SPOUSE (If Married)
16. WAS DECEASED EVER IN U.S. ARMED FORCES?
17. SOCIAL SECURITY NO.
18. INFORMANT
Address
(Yes, no, or unknown) (If yes, give war or dates of service)
19. CAUSE OF DEATH (Enter only one cause per line fo (a), (b), and (c).) PART 1. DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a).
INTERVAL BETWEEN ONSET AND DEATH
Conditions, if any, which gave rise to abovo cause (a) stating the under- lying cause last.
DUE TO (b)
DUE TO (c).
PART II. Other significant conditions contributing to death but not related to the terminal disease condition given In Part I(a)
20. WAS AUTOPSY PERFORMED? YESO NOO
21a. ACCIDENT
SUICIDE
HOMICIDE
21b. DESCRIBE HOW INJURY OCCURRED. (Entor nature of Injury in Part | or Part II of Item 18).
21c. TIME OF
Hour
Month, Day, Year
f. 18 RESIDENCE ON A FARM? YES O
Crawford
XXXXX New Hampshire
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service National Office of Vital Statistics
p.m.
21d. INJURY OCCURRED WHILE AT WORK D AT WORK
NOT WHILE
21. PLACE OF UMURY (e.g., or about time, farm, factory, street, office bidg., etc.
CITY, TOWN, OR LOCATION
COUNTY
STATE
221.
MEDICAL EXAMINER: I hereby certify that death occurred et the the causes stated above, and that I held an (Investigation) (autopey) the re- nine of the deceseed as required by law.
PHYSICIAN . I hereby certify that I attended the deceased from and last saw him alive on m on the date and from the causes stated above.
Death scourred
23a SIGNATURE
(Degree or title)
2010, ADDRESS
23c. DATE BIGNED
24a BURIAL, CREMATION REMOVAL (Specify)
24b. DATE
240. NAME OF CEMETERY OR CREMATORY
24d. LOCATION (City, town, ar county) (State)
25.
FUNERAL DIRECTOR
ADDRESS
26. DATE RECD. BY LOCAL REG
27. REGISTRAR'S SIGNATURE -- A TRUE COPY, ATTEST-
Prompt return of this form will be greatly appreciated. A penalty envelope, which requires no postage, is enclosed
Very truly yours, your Latrack
Signature of person supplying information or correction
Special Agent, U. S. Public Health Service State Department of Health and Welfare Augusta, Maine
61.3036
X
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or Town making this return)
189
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Charles E Theall, Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
. (a) Residence. No .. 83 Woodside Ave
Winthrop, "ass.
St
(If nonresident, give city or town and State)
Length of stay:, In place of death ............ years.
months
2.hays. In place of residence.
142 years
.months .........
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, ogrgivarged Agnes Sweeney 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.
78
Months Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Clerk
(Kind of work done during most of working life)
14 Industry
or Business:
Suffolk Downs Pace Track
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
Boston
17 NAME OF
FATHER
Charles Fdwin Theall Sr.
18 BIRTHPLACE OF
Montreal
FATHER (City)
(State or country)
Canada
19 MAIDEN NAME
OF MOTHER
Mary Brett
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
1883
Winthrop Cem
Winthrop
Place of Burial or Cremation
(City or Town)
Aug .....
19 56
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
A B Harsh
ADDRESS.
Winthrop. Lass
Received and filed. OCT 29 1956 19
(Registrar of City or Town where deceased resided)
0
V.B. V
(a) 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 intwhich, 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)
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.