USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 25
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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
5°
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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