USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 69
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50M.11-55.916145
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
July2
19 56
to
July 29
19 56
I last saw h ........ alive on
.
July
2019.56 death is said to
have occurred on the date stated above, at 8:10g .... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE.
Portal cirrhosis, nutritional
CONDITIONS
12 hr
Was autopsy performed?
Yes
Autopsy.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed)
C L Clay
M. D.
(Address)
Mass Genl Hos pDate.
19
PARENTS
21
Informant
(Address)
John F Theall
A TRUE COPY
ATTEST: Martes H. Mackie
(Registrar of City or Town where death occurred)
DATE FILED
Aug 2
.56
19
No ....
Nass Genetal Hos pt
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
3 DATE OF
DEATH
July 29 1955
INTERVAL BETWEEN ONSET AND DEATH
OTHER
SIGNIFICANT
Pulmonary edema, severe
R-302 1
,
1
D
R-302 1
PLACE OF DEATH
SUFFOLK ROSTONI
(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)
7057 130
Registered No.
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
George S. Andosca
(If deceased is a married, widowed or divorced woman, give also maiden name.)
36 Wilshire St.,
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.
1
days. In place of residence.
.years.
months.
........ days.
MEDICAL CERTIFICATE OF DEATH
Aug 2, 1956
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Aug 1
56
Aug 2
That I attended deceased from
56
19
to.
I last saw
himlive on
Aug 2
19.
56
death is said to
11: 45p.
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Uremia
Due To Gouty Nephritis
? 3 yrs
OTHER
Gouty Arthritis
12 yrs
Was autopsy performed? What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify ..
(Signed)
H. King
M. D.
(Address)
MMH
8-2
56
19
Winthrop Cemetery, Winthrop, Mass 6
Place of Burial or Cremation (City or Town) DATE OF BURIA Aug 6 1,56
7 NAME OF
FUNERAL DIRE
Richard C. Kirby
917 Bennington St., E. Boston
Received and filed.
OCT30 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)
MARRIEDM
WIDOWEMarried
or DIVORCED
10a If married,
Margaret Rigone
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 4
Years
10
Months
25 Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Barber
14 Industry
or Business :
Self-employed
15 Social Security No .....
none
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
John Andosca
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER Philomena
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Italy
21 Informant Margaret Andosca (wife) (Address)
A TRUE COPY
AT Parles of Mackie
(Registrar of City or Town where death occurred)
DATE FILED
Aug 7, 1956
19
X
A .A.
3 DATE OF DEATH 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
50M -11-55-916145
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)
-
(Was deceased a
U. S. War Veteran,
no
if so specify WAR)
30
19
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH
3 yrs
(Kind of work done during most of working life)
PARENTS
Date
Mass. Memorial Hospital No.
X
PLACE OF DEATH
SUFFOLK BO'S (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)
73.78 1
§ (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.)
42 Atlantic 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 ...
.8.
.days. In place of residence3
.. years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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
AGE57
Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Compositor
(Kind of work done during most of working life)
14 Industry
or
Business :
Printing
15 Social Security No ...
011-01-2252
16 BIRTHPLACE (City)
(State or country)
Boston.Mass ..
17 NAME OF FATHER Johnston McDermott
18 BIRTHPLACE OF
Bostan Mass.
FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Mary E Calhoun
20 BIRTHPLACE OF
East Boston Mass.
MOTHER (City)
(State or country)
21 Informant. (Address),
Katherine McDermott
A TRUE COPY
ADDRESS
Received and filed. NOV 2 1956 19
(Registrar of City or Town where deceased resided)
8 Days
OTHER SIGNIFICANTCerebral infarct,left CONDITIONS
Years
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.
(Address)
Mass. General Hospt
Date
Holy Cross Malden Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
August 16/56 19
50M .11.55-916145
(Month)
August .13/56 (Day) (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
August .... 5 19 .... 56
to
August 13
19
56
I last saw himlive on
August, 13/56
have occurred on the date stated above, at
9:45A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL
BETWEEN
ONSET AND
DEATH
(a) Broncho .... pneummia
Due To
Confluent bilateral
(1) 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, See. 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 oeeurred in your eity or town in ease the deceased resided in another eity or town Due To (c)
1 R-302 1
Registered No.
No.
Mass .General Hospt.
Francis H McDermott
(Was deceased a
U. S. War Veteran,
if so specify WAR)
W W #2
DATE FILED
ATTEST:
(Registrar of City or Town where death occurred)
August 17/56
19
VILL ALI DI VID ING DE 1 - 1215 IS A FEKMANENI KELUKU
PARENTS
7 NAME OF
FUNERAL DIRECTOR
A J O'Maley
ath is said to
3 DATE OF
DEATH
Entered Service 9-9-42 Discharged 7-10-43 Pvt. CMC Aviation U S Army Service No. 31201185
R-302 1
PLACE OF DEATH
SUFFOLK BOSTON!
(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)
7663192
S (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Isidore Kaplow, ( legally changed)
(If deceased is a married, widowed or divorced woman, give also maiden name. )
(a) Residence. No.
30 Tewksbury
St ..
Winthrop ... Lass
(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.
Liyears
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
4 I HEREBY CERTIFY,
That I attended deceased from
August 22, 56
to.
August
23
19.
56
I last saw h ........ alive on
Aucust.
23 5 6death is said to
have occurred on the date stated above, at
5:30Pm.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ...
68 Yrs
.Months.
.. Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation :
manager - owner
(Kind of work done during most of working life)
7 70'S 14 Industry
or Business :
Grocery store
15 Social Security No ..
033-16-96/11
OTHER
Myeloid metaplasia
SIGNIFICANT
4following polycythemia
CONDITIONS
vera)
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) CI Clay M. D.
(Address)
Mass Cenl HospiDate.
9-2319 5
6 Jewish Progressive Ce. Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Auf 21, 19 56
21
Informant.
(Address)
Herbert ... Kaplow
7 NAME OF
FUNERAL DIRECTOR
B Schlossberg & SontA TRUE COPY Poparles H. Mackis.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Aug 28
1956
(Registrar of City or Town where deceased resided)
NOT one N. Book
1.50
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 of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
resided as soon as possible, after the close of the month in which the death occurred. (Sec Chap. 46, Sec. 12, G. L.)
50M .11.55-916145
Received and filed.
NOV 8 1956
19
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Sarah
--
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Bussis
Prgrott
16 BIRTHPLACE (City)
(State or country)
Russia
Due To (c)
Due To
(1))
Chronicglomemilem
nephritis
mos
10a If married, widowed, or divorced Cohen
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Tremin
3 DATE OF
DEATH
August
23
1956
(Month)
(Day)
No.
Mass Ceni Hospt
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
ADDRESS Boston, "ass
17 NAME OF
FATHER
Cerson Kaplovitz
١
50M-5-55-915025
7 NAME OF
FUNERAL DIRECTOR
Clichés S. Forcella
ADDRESS 876 Winthrop Ave, Revere, Dass.
Received and filed
OCT 18 1956
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 5,
(Month)
1956 (Year)
8 SEX
female
white
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
4 I HEREBY CERTIFY.
That I attended deceased from
May ....
1,
55.
19
to
October 2,1956
I last saw h.
er
Oct ...
2
19.
56 death is said to
have occurred on the date stated above, at INTERVAL BE- TWEEN ONSET AND DEATH
TO DEATH (a)
ANTE
Due To
Senility
CEDENT (b)
CAUSES
Due To
Generalized
(c)
Arteriosclerosis
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
No
Date of operation.
What test confirmed diagnosis?
Was autopsy performed ?. Clinical Observation
5 Was disease or injury in any way related to occupation of deceased?
IE so, s
Santo D Auszeit,
1956
(Address)
M. D.
(Signed)
Vero Beach Le tue Octis
6 Holyhood
Brookline , Mass
Place of Burial or Cremation (City of Town)
DATE OF BURIAL
October 8,
0 56
21 Gilbert F. Quinn Jr.
Informant (Address) 110 Crest Ave., Revere, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Nale H. Tanglang. (Signature of Agent df Board of Health or other)
Cher Board of Kallt 10/17/56
(Official Designation)
(Date of Issue of Permit) X
-
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Gilbert F. Quinn Sr.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
3 day SAGE.
95
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
At home
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
none
Boston,
....
Mass.
17 NAME OF
FATHER
William O'Kelley
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
...
19 MAIDEN NAME
OF MOTHER
Margaret Diamond
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
PARENTS
Registered No.
193
2 FULL NAME. Margaret E. Quinn
(o'KELLEY)
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. 110 Crest (Usual place of abode)
Asr.e .. ,
.Revere, ... Mass
(If nonresident, give city or town and State)
Length of stay: In place of death 1 years 4 .. months. 12,
.days. In place of residence
56
.years
.. months
days.
MEDICAL CERTIFICATE OF DEATH
PENERE
Suffolk (County)
Winthrop (City or Town)
No.
11.6.56
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial ·permit with Board of Health or its Agent.
A R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, osthenio, ans the disease. cotions which th.
id conditions. ing rise to the e (o) stating lying cause
tions contrib- e deoth but not the disease or rousing death.
Chapter 137. 1954, requires ns to print or cause or causes th on death tes.
PLACE OF DEATH /
Mount SPest Home CollelessET Hows
(If deceased is a married, widowed or divorced woman, give also maiden hame.)
(Day)
.alive on
12.10 P.M
DISEASE OR CONDITION
DIRECTLY
Bronchial Pneumonia
16 BIRTHPLACE (City) ..
(State or country)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the cleath of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he ‹lied, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the dierk 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., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. . These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
X - PLACE OF DEATH
Suffolk
(County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
194
S(If death occurred in a hospital or institution,, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Grace Veronica Ahearn (Butler)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20 Lincoln Terrace St
(a) Residence.
No ..
(Usual place of abode)
29
Length of stay: In place of death. years. months. days. In place of residence.
29. .years. months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
7 ,
1956
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
SEPT 12,
.. ,
1956
to ..
October 7
1956
I last saw hE Falive on
195.6., death is said to
have occurred on the date stated above, at
5:30 pm
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CARCINOMATOSIS
Due
PRIMARY - BREAST.
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? no If so, specify.
(Signed)
a. n. Caplan
M. D.
(SEGPRINCETONSTE. BOSTON Date 10-8-
1956
6 Winthrop Cemetery Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL October 10, 19.56
7 NAME OF FUNERAL DIRECTOR Ernest P. Caggiano
ADDRESS.
147 Winthrop St., Winthrop
Received and filed OCT 1956 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
10a If married, widowed, or divorced HUSBAND of ........ (Give maiden name of wife in full)
(or) WIFE of ... James Ahearn
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
62
Years
2
Months.
6
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Home
15 Social Security No.
16 BIRTHPLACE (City).
Chicago
(State or country) Illinois
17 NAME OF
FATHER
Pierce Butler
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
19 MAIDEN NAME OF MOTHER Mary Ducey
20 BIRTHPLACE OF MOTHER (City). (State or country) Ireland
21 James Ahearn Informant. (Address) 20 Lincoln Ter. Winthrop
IHEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : 10 5/96
(Signature of Agent of Board of Health or other)
Che Board of Health 10/8/56
(Official Designation) NATe.
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH lot enter than one for each (b) and (c)
does not mean e of dying, heart failure, etc. It means > se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
tions contrib- death but not ) the terminal ondition given
. Chapter 137, 1954, requires ins to print or 1e cause or of death on ertificates.
1.5.
[ R-301A 1
No.
20 Lincoln Terrace
Registered No.
no
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
-
OCT 7,
INTERVAL BETWEEN ONSET AND DEATH
100M-11-55-916145
.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
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