Town of Winthrop : Record of Deaths 1956, Part 68

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


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).


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(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)




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