USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 30
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No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the tommonwealth until he has received a permit so to do from the board of health orits agent appointed to issue such permits, or if there is no such board; front the clerk of the town where the body is to be buried or the funeral is to be held, or fromla person appointed to have the care of the cemetery or burial ground in which the interment is made.
. . Chap. 114, Sect 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 willcertify 16 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 physicianswill 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 deallis 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
......
S ( r S r a T C 5 a r T 1 e C
C 1 - t - 1 1 1
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
BOSTON
(City or Town making this return)
Registered No.
2334
87
y
$ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Fugene J NcCarthy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
215 Pleasant
Winthrop, Mass
St
(If nonresident, give city or town and State)
months.
......
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCEDHarried
4 I HEREBY CERTIFY,
That I attended deceased from
Mer 7 19. 52
to .. Mar 18
19.
57
Mar 13, 19 57, death is said to
I last saw h ........ alive on
have occurred on the date stated above, at
9:51A
.. m.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.60 Years.
Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Attorney
(Kind of work done during most of working life)
14 Industry
or Business:
N.E. Power Co
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
Last Poston
Mass
17 NAME OF FATHER
Frank D Mccarthy
18 BIRTHPLACE OF
FATHER (City)
Poston
(State or country)
Mass
19 MAIDEN NAME OF MOTHER Mary P Donovan
20 BIRTHPLACE OF
MOTHER (City)
Eoston
(State or country)
Mass
21 Informant. (Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED Mar 26 1 57
1.8
Due To (b) (c) Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town 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
50ML 11.55 916145
(Signed) J I Robert M. D.
(Address)
LL1 Stuart St
Date. 3-18 19 57
6 Winthrop Cem Place of Burial or Cremation
Winthrop
(City or Town)
DATE OF BURIAL
Mar 21 1957
7 NAME OF FUNERAL DIRECTOR A J CIMaloy
ADDRESS
inthrop Mass
Received and filed JAY 13 ,1957 19
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
HUSBAND of
Katherine Moran
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a)
Coronary thrombosis
Malignant Hypertension
3 yrs
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? NO
What test confirmed diagnosis? Physical Exam
5 Was disease or injury in any way related to occupation of deceased? If so, specify ...
PARENTS
Wifc.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No ... (Usual place of abode)
Length of stay: In place of death ............ years. months. .days. In place of residence. 50 years
3 DATE OF
DEATH
March
18
1957
(Month)
(Day)
(Year)
No
4141 Stuart
7
R-302 1
RECE'VEM
B
5
MAY 1 31957 AT
M R-305 1
PLACE OF DEATH
(County) BROOKLINE
(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
BROOKLINE
(City or town making return)
Registered No.
245
88
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME ..
John A .Hunter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
no
(a) Residence. No.
121 Tafts Avenue
(Usual place of abode)
St.
Winthrop ...
Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death.
........... years.
months
1 3/4 hrs
days
In place of residence.
2.years
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
male
10 COLOR OR RACE
white
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED widowed
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.)
Arterio-sclerotic hypertensive heart
disease with acute Coronary Occlusion
(sudden death)
5 Accident, suicide, or homicide (specify)
no
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?
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
no
.Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased? ....
If so, specify
Thomas P Kendrick
(Signed)
ust Washington St
M. D.
(Address)
Brookline, Mass
Date A.D.C IJ 1957
DATE OP BURIAL April 15 1957
& NAME OP
PUNERAL DIRECTOR
John C Kelly
ADDRESS
286 Meridian St. East Boston, MasATTEST:
Received and filed.
MAY 13 1957
19
...
11a If married, widowed, or divorced
HUSBAND of.
Mary A. Doherty
(Give maiden name of wife in full)
(or) WIPE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE.62 .... Years.
Months.
.Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
Superintendent
15 Industry
Dry Goods
or Business:
16 Social Security No ..
.025-09-1212
WestQuincy
17 BIRTHPLACE (City)
(State or country)
Massachusetts
18 NAME OP
PATHER
Hugh Hunter
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Scot land
20 MAIDEN NAME
OF MOTHER
Elizageth Harvey
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
Roger J Hunter
7
.Holy Cross ... Cemetery. .... Malden, Massachusetts
Place of burial, or Cremation.
(City or Town)
22
Informant
(Address)
121 Tafts Avenue
Winthrop, Mass.
A TRUE COPY.
(Registrar of City of Town where death occurred)
DATE PILED
April 17
1957
....
(Registrar of City or Town where deceased resided)
PARENTS
25M-5-52-907046
1
NORFOLK
No. 9.SewallAvenue
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.)
3 DATE OF
DEATH
April
11
1957
(Month)
(Day)
(Year)
no
(Kind of work done during most of working life)
غذاء
MAY 1 31957 ."
R-302 1
Boston
(City or 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. 3622
$ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
John H A Moran
(If deceased is a married, widowed or divorced woman, give also maiden name.)
42 Harbor View Ave.
S
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months.
13.days. In place of residence.
3.7 .years.
... nonths
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or d HUSBAND of
Mary Louise Walsh
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
75
Years
8
20
Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Ass 'st Supt. of Mail
(Kind of work done during most of working life)
14 Industry
or Business :
U S Post Office
15 Social Security No.
Non e
16 BIRTHPLACE (City)
(State or country)
17 NAME OF FATHER Hugh F Moran
18 BIRTHPLACE OF
FATHER (City)
(Statc or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Margaret Connelly
(Signed)
C L Clay
M. D.
(Address)
Masg. General Hospt
4-13
57
19
St Joseph's Cem-West Roxbury
Place of Burial or Creination" (City or Town)
DATE OF BURIAL
April 16/57 19
7 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS East Boston Mass.
Received and fled
MAY 2417
19
(Registrar of City or Town where deceased resided)
0
vr. .
(b) (c) 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) 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
5031.11.55.916145
5.
PLACE OF DEATH
Suffo lk
(County)
(a) Residence. No ... (Usual place of abode)
April 13/57 . (Day) (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
April 7 19 57
to ...
April .13
19.
5.7
I last saw himalive on
April 13
1957
death is said to
have occurred on the date stated above, at 9;55A m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Uremia
INTERVAL BETWEEN ONSET AND DEATH 4 Days
5 Yrs
Due To
Hypertensive arterio
sclerotic heart disease with
congestive heart failure
3 Wks
17 Yrs
OTHER
Diabetes mellitus
SIGNIFICANT CONDITIONS
Was autopsy performed? What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify.
PARENTS
Mass.
MOTHER (City). (State or country )
Wife
TRUE COPY
El Luackie
ATTEST:
(Registrar of City or Town where death occurred )
DATE FILED April 17/57 19 .. ....
(Was deceased a
U. S. War Veteran,
if so specify WAR)
89
3 DATE OF
DEATH
(Month)
Mass. General Hospt.
No. .
21 Informant (Address)
20 BIRTHPLACE OF
Ireland
East Boston Mass.
RECEIVED
TOW
OF
OFFICE
1
-
GLERK
6
THROP
MAY 2 41957 AM
R-302 1
PLACE OF DEATH
Suffolk
(County)
Boston
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Boston
(City or Town making this return)
367350
Registered No.
-
Peter ent Brigham Hospt. No.
$(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Patrick Mulraney
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Fremont
St
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ..
months
33
lays. In place of residence 47 years.
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April 15/57
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
March, 13 57
to
April 15
57
That I attended deceased from
I last saw himalive on
April 15
, 19 57
death is said to
have occurred on the date stated above, at
3 AM
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Carcinoma of stomach
INTERVAL BETWEEN ONSET AND DEATH 2 Mos
11 IF STILLBORN, enter that fact here.
12
AGE.7.1 Years.
.Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Public School
15 Social Security No ..
024-24-9849
16 BIRTHPLACE (City)
Ireland
(State or country)
17 NAME OF
FATHER
Edward Mulraney
18 BIRTHPLACE OF
FATHER (City)
(Statc or country)
Ireland
(Signed)
V M Cass
M. D.
Peter Bent Brigham Hospt 4-15-50 BIRTHPLACE OF Ireland
(Address) Winthrop Cem-Winthrop Mass.
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
April 17/57
19
7 NAME OF
FUNERAL DIRECTOR
A J O "Maley
ADDRESS Winthrop Mas s.
Received and filed MAY 2 # 1951 19
-
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
19 HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
Term.
(b))
Due To
Myocardial infarction
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis?
Clinical
No
5 Was disease or injury in any way related to occupation of deceased? If so, specify ....
YARENTS
19 MAIDEN NAME
OF MOTHER
Bridget McDade
MOTHER (City)
(State or country)
21 Informant. (Address)
Delia Mulraney
A TRUE COPY LA Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
April 18/57
19
V.I. V
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
50M .11.55.916145
(City or Town)
U
CERTIFICATE OF DEATH
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
widowed, or div
Delia Ferrins
Retired Custodian
RECEIVED
OF
TOWA
OFFICE
11 12
ID.
CLERK
V
6
5
1
MAY 2 41957 AM
M R-305 1
PLACE OF DEATH
1 SUFFOLK BOSTON
(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)
3859
Registered No.
J(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.)
4] Ocean Ave.
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 ..
1 months 14
1.8years
.days. In place of residence.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April 23/57
(Month)
(Day)
(Year)
9 SEX
F
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWEWido wed
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.) Broncho pneumonia fracture of femur
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Henry H Block
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
Years
80
Months
Days
If under 24 hours
Hours .....
.Minutes
14 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
15 Industry
or Business:
At Home
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Russ ia
18 NAME OF
FATHER
Max Astrin
19 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
20 MAIDEN NAME
OF MOTHER
Libby -----
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Tifereth Israel of Winthrop-
7 Place of Burial, or Cremation. (City of Town)
DATE OF BURIAL
April 24/57
19
8 NAME OF
FUNERAL DIRECTOR
Murray
Goldman
Malden Mas's.
ADDRESS
Received and filed
MAY 2.9 1957
19
(Registrar of City or Town where deceased resided)
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
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)
25M-5-52-907046
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
Manner of
Injury
Accidental fall
(How did injury occur?)
Nature of
Injury
Fracture of femur
While at work?
Was autopsy performed?
.No
6 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
Michael A Luongo
(Address) 25 Shattuck St, Date 4-23 19
M. D.
51
22
Informant
(Address)
Julian L Block
A TRUE COPY,
ATTEST: .... 0
Charles & Iackie
(Registrar of City or Town where death occurred)
DATE FILED
April 24/57
19
......
5 Accident, suicide, or homicide (specify) ..........
accident
Date and hour of injury.
March 21
57
Where did
Injury occur?
Winthrop Mass.
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place? Home
(Specify type of place)
PARENTS
1.5.
Mass. General Hospt. No.
Ida M Block
(Was deceased a
U. S. War Veteran,
if so specify WAR)
91
(write the word)
RECEIVED
0.
6
MAY 2 91957 Mi
X
PLACE OF DEATH
Suffolk
(County)
Bos ton
(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)
4018
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
92
Winthrop Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.......... years.
.months.
......
.. days. In place of residence.
25
.. years.
.months.
......
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
Widowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frank Gorodetsky
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
82 Years.
Months ..........
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
House wife
(Kind of work done during most of working life)
14 Industry
or Business :
At Home
15 Social Security No.
None
16 BIRTHPLACE (City) Ruggi.a (State or country)
17 NAME OF FATHER Mones Schneiderman
PARENTS
18 BIRTHPLACE OF
Russia
FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Sossel
--
20 BIRTHPLACE OF
Russia
MOTHER (City)
(Statc or country)
21 Informant. (Address)
A TRUE COPY carles & Machen
ATTEST:
(Registrar of City or Town where death occurred)
April 29/57
DATE FILED
19
100 Locust St.
(a) Residence.
No ...
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
4 I HEREBY CERTIFY,
March.,1 19 ....
57
to ..
I fast saw h .. eralive on
April 24, 19 57
have occurred on the date stated above, at
9 PM
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Pulmonary .... edema
heart failure
(c)
OTHER
SIGNIFICANT
CONDITIONS
(Signed
Dr Tan os Tarai
Jewish Mem.Hospt
(Address)
6
Place of Burial or Cremation
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
Universal arterio sclerosis
April 24/57 (Day) (Year)
That I attended deceased from
April 24
57
19
death is said to
INTERVAL BETWEEN ONSET ANO DEATH 2 Days
Due To
Broncho meumonia congestion
(1))
5 Days
Was autopsy performed?
Nme
What test confirmed diagnosis?
Physical examination
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
M. D.
Date.
4-25
19.
57
Anshe Lebovitz Woburn Mass .
DATE OF BURIAL April 28/57 19
7 NAME OF
FUNERAL DIRECTOR Schlossberg & Sons
ADDRESS Mattapan Masg.
Received and filed.
JUN 3 1957
19
(Registrar of City or Town where deceased resided)
I
$ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME Goldie Gor odetsky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No
Jewish Memorial Hospt.
R-302 1
50M.11.55-916145
(City or Town)
Harry Gore
·
JUN~31087 KM
X
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
Bosta
(City or Town making this return)
403393
§(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
George Leet
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Cambridge St.
St
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ..
months ..
0
10
.... days. In place of residence. .years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
April 24/57
(Day)
(Year)
4 I HEREBY CERTIFY,
April 15/ 57
to
April 24
57
19.
That I attended deceased from
I last saw h.1.Malive on
April 24 19
57
death is said to
have occurred on the date stated above, at
10 PM
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Broncho peumia
INTERVAL BETWEEN ONSET AND DEATH 1 Week
Due To Carcinoma of larynx with metastases 3 Yrs
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)
I .Robinson
M. D.
(Address)
Mass Eye & Ear Infe
4-2.519 ........ 57
Winthrop Cem-Winthrop Mass.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL April 27/57 19
7 NAME OF
FUNERAL DIRECTOR
A P Graham
ADDRESS. Woburn Magg
Received and filed.
JUN-3 1957
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
Married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Josephine Doggett
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE65
.Years
7
.Months.
11
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business:
Disabled Veteran
15 Social Security No ..
022-12-0714
16 BIRTHPLACE (City)
(State or country)
East Boston Mass
17 NAME OF FATHER George Leet
PARENTS
18 BIRTHPLACE OF
P.E.I.
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Maud Cook
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Waltham Mass.
21 Informant
Joseph ine Leet
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
April 29/57
19
X
-
.302 1
(h) 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)
50M . 11.55.915145
No. ....
Mass. Eye & Ear Infirmary
Registered No.
W W #1
(a) Residence. No.
(Usual place of abode)
Burlington Mass.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
JUN -- 28 57
X
PLACE OF DEATH
Middlesex (County)
Medford
(City or Town)
ATATE
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF TETEM CERTIFICATE OF DEATH
Medford
(City or Town making this return)
Registered No.
¡ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Emma M. Baker
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