Town of Winthrop : Record of Deaths 1957, Part 25

Author: Winthrop (Mass.)
Publication date: 1957
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 25


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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16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF


FATHER


John Doherty


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Penn.


19 MAIDEN NAME


OF MOTHER


Mary E. Lockwood


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Cannot be learned


21 Mary Doherty


Informant


(Address)


25 Read St., Winthrop


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


arch


11.


......


1957


·


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. (See Chap. 46, Ser 12, G. L.)


25M (E)-6-50-902253


PLACE OF DEATH


I R-302 1


(City or Town) Grover Manor Ne


spital


No.


Arthur F. Doherty


(Was deceased a


U. S. War Veteran,


if so specify WAR)


No


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


Im March .... 8.


I last saw h


.alive on ..


3:45 A:


PERSONAL AND STATISTICAL PARTICULARS


10 SINGLE


(write the word)


1 year


DATE OF BURIAL.


A TRUE COPY


winthrop


RECEIVE


1


6


APR 2 91957 11


X


PLACE OF DEATH


(County)


(City of 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 this return)


Registered No.


2540 81


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


2 FULL NAME. Edwin F Silck


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


(a) Residence. No ..


615 Bennington


St ...... East .... Boston. ... Moss


(If nonresident, give city or town and State)


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


N


months .20 days. In place of residence 13 years.


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


March


10


1957


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Dec 18, 19 56,


to


Mar


10


1957


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


19


death is said to


have occurred on the date stated above, at


12.30A .m.


INTERVAL BETWEEN ONSET ANO DEATH


11 IF STILLBORN, enter that fact here.


12


AGE 43 Years 7


Months.


29 Days


If under 24 hours


Hours .....


.Minutes


13 Usual


Occupation :


Boiler Maker


(Kind of work done during most of working life)


14 Industry


or Business


Navy Yard


Boston


15 Social Security No ..


011-01-6524


16 BIRTHPLACE (City).


(State or country)


Mass


Winthrop


17 NAME OF FATHER Albert Silck


PARENTS


18 BIRTHPLACE OF


FATHER (City)


East Boston


(State or country)


Mass


19 MAIDEN NAME OF MOTHER Delia Connolly


20 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


Mass


21 Informant (Address)


A TRUE COPY


ATTEST:


Charles:


(Registrar of City or Town where death occurred)


Received and filed.


WAY F _ 1957


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEDMarried


10a If married, widowed, or divorced


HUSBAND of.


Elizabeth ... Bertucelli


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) .. Arteriosclerotic heart ..... disease with old anterior Due To and posterior myocardial (b)


infarctions with con- gestive heart failure


yrs


Due To


(c)


Pulmonary infarction


unkn


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)


W Mercer


M. D.


(Address)


VAH, .... Boston


Date


3-10


57


6


Winthrop Cem Winthrop


Place of Burial or Cremation


DATE OF BURIAL


(City or Town) Mar 13 1957


7 NAME OF


FUNERAL DIRECTOR


L M Morton


ADDRESS


Nalden Mass


SOM . 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 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. (See Chap. 46, Sec. 12, G. L.)


R-302 1


Vet.Adm Hos.pt No.


(Was deceased a


U. S. War Veteran,


if so specify WAR)


WW II


(Usual place of abode)


.......


VA Hospt.Records


DATE FILED Mar 20 19.57


RECEIVEO


OF TOW


11 12


CLERK


6 5


MAY -61957 AM


R-302 1


PLACE OF DEATH


Suffolk


(County)


Chelsea


(City or Town)


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


Chelsea


(City or Town making this return)


121 122


Registered No.


S(If death occurred in a hospital or institution,


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


WWI


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


53 Loring Rd.,


S


Winthrop. Mass.


(If nonresident, give city or town and State)


Length of stay: In place of death.


Tears.


2 months Lays. In place of residence years.


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


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Married


10a If married, widowed, or divorced


HUSBAND of.


Marie L. Mackenzie


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.


6.6Years.


QMonths ...


1.9ays


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Retired Fire Captain


(Kind of work done during most of working life)


14 Industry


or Business:


Town of Winthrop


15 Social Security No ......


cannot be learned


16 BIRTHPLACE (City)


(State or country)


Lynn, Mass.


17 NAME OF


FATIIER


Francis


PARENTS


18 BIRTHPLACE OF


FATHER (City) Maplewood, Mass.


(State or country)


19 MAIDEN NAME


OF MOTHER


Louella L.Barker


20 BIRTHPLACE OF


MOTHER (City).


Providence, R.I.


(State or country)


21 Hospital Records


Informant


(Address)


A TRUE COPY


ATTEST:


Graph a Tyrrell


DATE FILED


( Registrar of City or Town where death occurred ) Mar. 13,1957


19


Y


2 FULL NAME. (a) Residence. No. ( Usual place of ahode) hospital MEDICAL CERTIFICATE OF DEATH 3 DATE OF Mar.12,1957 DEATH (Month) Dec. 27 19 56, to Mar.12 I last saw himlive on DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) . Pulmonary emphysema Due To (b) Broncho-asthma (c) OTHER SIGNIFICANT CONDITIONS Was autopsy performed? yes What test confirmed diagnosis ?. autopsy 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 Coronary heart disease


INTERVAL BETWEEN ONSET ANO DEATH


?


?


?


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


(Signed)


Eleanor S. Wang


M. D.


(Addre Soldiers' Home Date 3/13/57 19


Winthrop Cem. , Winthrop, Mass. 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL .. Mar. 16,1957 19


7 NAME OF FUNERAL DIRECTORReynolds Fun . Service


ADDRESS 180 WinthropSt., Winthrop


Received and filed April 15, 1957 19


(Registrar of City or Town where deceased resided)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


19.57


Mar.12.


.. , 19 .... 5.7 death is said to


have occurred on the date stated above, at


6:05p .


50M.11 55 916145


No ..


Soldiers' Home Hospital


Howard A. Perkins


(Was deceased a


U. S. War Veteran,


if so specify WAR)


*ECE'VOO


-


5


APR 1 51957 %!


Enlisted7/24/17 Discharged 4/28/19 1 Pfc. M.G.Co., 101st Inf. 62987


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-305 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. (See Chap. 46, Sec. 12, G. L.)


PLACE OF DEATH


(County)


(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.


123


2726


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


2 FULL NAME.


Elmer ......... Stowell


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


(a) Residence. No. 854 Winthrop Ave


stevere Mass


(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


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


March ...


15


1057


(Year)


(Month)


(Day)


9 SEX


M


10 COLOR OR RACE


11 SINGLE


MARRIED


WIDOWED


or DIVORCEDSingle


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.)


11a If married, widowed, or divorced


HUSBAND of.


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


0


Years.


Months.


15


Days


If under 24 hours


Hours.


Minutes


14 Usual


Occupation:


Guard


(Kind of work done during most of working life)


15 Industry or Business:


16 Social Security No.


-


-


17 BIRTHPLACE (City)


(State or country)


Mas's


18 NAME OF.


FATHER


Ferdinand Stowell


19 BIRTHPLACE OF


FATHER (City).


(State or country)


Maine


20 MAIDEN NAME


OF MOTHER


Josephine Springford


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


22 Mrs F Stowell ( sister-in-law)


Informant


(Address)


A TRUE COPY.


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Mar


25


1957


25M.5.52-907046


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


(Signed) R. Ford M. D.


(Address) Bos.t.on


Date 3 - 16 57


7winthrop.Com


Place of Burial. of Cremation.


Winthrop


(City or Town)


DATE OF BURIAL.


Mer ....... 9


8 NAME OF


FUNERAL DIRECTORA .... S ..... Porcella.


ADDRESS Reyero Mass


Received and filed


MAY


1951


19


(Registrar of City or Town where deceased resided)


PARENTS


Revere


Manner of (Specify type of place)


Injury


(How did injury occur?)


Nature of Injury


While at work? .Was autopsy performed?


5 Accident, suicide, or homicide (specify).


Date and hour of injury. .19


Where did


Injury occur?


(City or town and State)


Did injury occur in or about home, on farm, in industrial place, or in public place?


"Arteriosclerotic heart disease


1 R-305 1


No. Boston Veterans Hospt (DOA)


(Usual place of abode)


(Was deceased a


U. S. War Veteran,


if so specify WARYL !..... 2.


(write the word)


RECEIVED


OF TOW


1/ 12


SERK


ثـ


HROB


MAY -91957 /H


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


OFTON


(City or Town making this return)


Registered No.


2734 1


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


2 FULL NAME Elizabeth .Wood


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


7 Vine Ave


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 ..


lį .... days. In place of residence.


30years


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


March


17


1957


(Month) (Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Mar


17 ... , 19.5.7


Mar 14 19 ... 5.7, to


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


Mar .......


.... , 19.5.7, death is said to


have occurred on the date stated above, at


10: 30P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Pulmonary Embolism, bilateral


Due To


(b)


Thrombophlebitis


Due To


(c)


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). C.L. Clay M. D.


(Address).


Mass Gonl Hospt Date


3-18 19. 57


6 Woodlawn ... Cem Place of Burial or Cremation


Everett


DATE OF BURIAL.


7 NAME OF FUNERAL DIRECTOR HI. S Reynold


ADDRESS Winthrop, Mass


MAYA 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


W


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


lidowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


Frank W Wood


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


unkn hraGE.71 Years ... 5.


Months.


13 Days


If under 24 hours


.Hours ........ Minutes


13 Usual


Occupation :.


Housewife


(Kind of work done during most of working life)


day Industry


or


Business:


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF FATHER John Churchill


PARENTS


18 BIRTHPLACE OF


FATHER (City). (State or country) Scotland


19 MAIDEN NAME OF MOTHER Cecelia Reid


20 BIRTHPLACE OF


MOTHER (City) St Johns


(State or country)


NE


Gladys Blankenbeckler


21 Informant (Address)


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Mar


25


57


19


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 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, (. 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


R-302 1


No.


Mass Genl Hospt


(Was deceased a


U. S. War Veteran,


if so specify WAR)


St


INTERVAL BETWEEN ONSET AND DEATH


unkn


Received and filed.


(City or Town) ar 21 19 57


Chelsea


RECEIVED


CLERK


.5


6


MAY -91957


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


PLACE OF DEATH


Suffolk


(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


Bost a


(City or Town making this return)


28115


Registered No.


§(If death occurred in a hospital or institution,


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


Elizabeth Stmer


2 FULL NAME


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


91 Washington Ave.


St


(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.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


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)


George H Stover


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ...


67Years.


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 :


Home


15 Social Security No.


None


16 BIRTHPLACE (City)


(State or country)


East Boston Mass


17 NAME OF FATHER William McCarthy


18 BIRTHPLACE OF


England


FATHER (City).


(State or country)


19 MAIDEN NAME


OF MOTHER


Amio Kelly


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Boston Mass.


Holy Cross-Malden Mass


6


Place of Burial or Cremation


(City or Town)


March 22/57


19


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


M W Kirby


Winthrop Mass.


ADDRESS


Received and filed.


MAY 1 0 1957 19


(Registrar of City or Town where deceased resided)


20 Yrs


(b)


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


Pulmmary congestion


6 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


No


(Signed)


C L Clay


M. D.


(Address)


Mass. Gendal Hospt.


3-19


19


PARENTS


21


George Stoner


Informant.


(Address)


Manchester Meas


A TRUE COPYY


Un COPY Les


ATTEST: (Registrar of City or Town where death occurred )


DATE FILED


March 26/57 19


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


March 19/57


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


March 19


March 18 ..... 57to



19.


I last saw h .... Enlive on


March 1919 ......


5 Heath is said to


have occurred on the date stated ahove, at


4;10A


.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Kyocardia infarction


Due To


Coronary heart disease


INTERVAL BETWEEN ONSET AND DEATH 6 Hrs


50M.11.35 916145


R-302 1


Mass. General Hospt.


No ..


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


Winthrop


Mass.


( Was deceased a


U. S. War Veteran,


if so specify WAR)


RECEIVED


TO


OF


CLERK


-


THROW


MAY 1 01957 AM


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-305 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. (See Chap. 46, Sec. 12, G. L.)


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 MEDICAL EXAMINER'S CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No.


2798 26


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


2 FULL NAME.


Mischa.B.Tulin


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


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No. 58 Birch Road


Isanthrop Mass


(If nonresident, give city or town and State)


Length of stay: In place of death.


.. years.


months.


........ days. In place of residence


16


.years.


.months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


M


10 COLOR OR RACE


W


11 SINGLE


(write the word)


DEATH


(Month)


(Day)


(Year)


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.)


MultipleFracturesSkull


MultipleFracturedRibs


Internal Injuries. Manner to be


determined ...


Still Pending


5 Accident, suicide, or homicide (specify).


Date and hour of injury ... Na ............ 20


157


Where did


Injury occur?


Poston


(City or town and State)


Did injury occur in or about home, on farm, in industrial place, or in public


placeJumpedor fellfrom upper


(Specify type of place)


Manner of tory of burning building


Injury


(How did injury occur?)


Nature ofat Boston Mar 20-1957


Injury


While at work?


?


Was autopsy performed?


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


If so, specify ..


(Signed) W ...... J Frickley


M. D.


(Address)Boston


Date3 .... 20 ...


57


Staro Constantino Com


W.Roxbury


Place of Burial, or Cremation.


(City or Town)


Mar .... 22 ........... 7.


DATE OF BURIAL


8 NAME OF


FUNERAL DIRECTOR


P R Levine


ADDRESS. Frookline Mass


Received and filed


MAY 30, 195%


19


"Town where deceased resided)


12 IF STILLBORN, enter that fact here.


13 51


AGE


Years.


Months.


.Days


If under 24 hours


Hours ........ Minutes


14 Usual


Occupation:


Engineer


(Kind of work done during most of working life)


15 Industry


Electronics


or Business:


16 Social Security No.


17 BIRTHPLACE (City)


(State or country)


Russia


18 NAME OF


FATHER


Max Tulin


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


20 MAIDEN NAME


OF MOTHER


Fannie


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


22


Wife


Informant (Address)


A TRUE COPY


ATTEST:


Phar".


(Registrar of City or Town where death occurred)


DATE FILED


Mar


25


19.57


MARRIED


WIDOWED


or DIVORCED Married


11a If married, widowed, or divorced


HUSBAND of.


Helen ... Gordon


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


M R-305 1


SUEFOLK BOSTO


No.


Enroute to P B Brigham Hospt


(Usual place of abode)


3 DATE OF


March


20


1957


25m-(c)-11-49-900.475


PARENTS


TOM


1112


MAY 1 01957 /"


: R-301A 1


PLACE OF DEATH


SUFFOLK. (County) WINTHROP. (City or Town)


CELS


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.


183 W WITHPROP ST.


No. MARGARET A DEMPSEY


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


123 WINTHROP ST. 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


FEMALE


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEWIDOWED


10a If married, widowed, or divorced


HUSBAND of ....


(Give maiden name of wife in full)


(or) WIFE of


PETER J DEMPSEY


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE 45 Y


... Months.


.Days®


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


HOME


(Kind of work done during most of working life)


14 Industry or Business :


15 Social Security No. NONE


16 BIRTHPLACE (City)


(State or country)


CONNI


17 NAME OF


FATHER


THOMAS NOLAN


18 BIRTHPLACE OF


FATHER (City).


IRELAND


(State or country)


19 MAIDEN NAME


OF MOTHER


ANN LANNON


20 BIRTIIPLACE OF


MOTHER (City)


(State or country)


IRELAND


Place of Burial or Cremation (Cit& or Town)


DATE OF BURIAL .. APRIL 6 1957


7 NAME OF


FUNERAL DIRECTOR


Maurice H 1 July


ADDRESS WINTHROP


Received and filed. APR : 195/ 19


(Registrar)


INTERVAL BETWEEN ONSET AND DEATH 2 days


years


Due


(c)


Generalized Arteriosclerosis


years


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis?


clinical


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


athur o. Murray M. D.


(Address)/. Winthrop


Date 5 April 1957


6 WINTHROP


WVINATHROP


PARENTS


MES HAROLD FRENCH


21 Informant. (Address) 123 4 WITHPIP ST WINTHROP


I HEREBY CERTIFY that a satisfactory standard certificate of death pas ffed/with me DEFORE the burial or transit permit was issued:


(Signature of Agent of Board of Health or other) Heatile Glicer 4/5/57


(Official Designation)


(Date of Issue of/Verniit)


X


-


Registered No.


¿(If death occurred in a hospital or institution,,


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


(NOLAN )


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO


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


abril


3


-


1957


(Year)


(Month)


(Day)


4 I HEREBYCERTIFY,


25 March 1957,


3


to.


That Lattendod deceased from


april


1957


I last saw her .. alive on


3 April 1957, death is said to


have occurred on the date stated above, at 11:00 P .m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Cerebral Thrombosis


Cerebral Arteriosclerosis


(b)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


UCTIONS FOR CERTIFICATE


giving OF DEATH


ot enter than one for each (b) and (c)


does not mean of dying, heart failure, etc. It means e, or compli- which caused


ns, if any, ave rise to cause (a), the under- cause last.


tions contrib- death but not the terminal ondition given


Chapter 137, 1954, requires ns to print or e


cause of death on certificates.


100M-11.55-916145


2 FULL NAME.


1


HAMDEN


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 Medical examiners shall make examination upon the view of the dead bodies of an undertaker or other authorized person or of any member of the family of; of persons as are supposed to have died by violence, or by the action of the deceased, furnish for registration a standard certificate of death, stating to the 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. 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.


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-" te "n, 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.




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