Town of Winthrop : Record of Deaths 1957, Part 56

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 56


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John 7. Celina


M. D.


(Address)27Bennington St.


Date ..


Aug ...... 2919 ... 57


6


Revere 51 Massachusetts St.Michaels Boston Mass Place of Burial or Cremation (City or Town)


DATE OF BURIAL August 31 19.57


100M.11.55.916145


301A 1


ONS


IFICATE


ag DEATH ater one each nd (c)


ot mean dying, failure, It means compli- caused


f any, rise to (a), under- last.


contrib. but not terminal on given


pter 137, requires print or ause or leath on cates.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed wwith me BEFORE the burial or transit permit was issued : Malbh Dirianne


HOL


(Signature of Agent of Board of Health or other) alt $30/5/


(Official Designation )


(Date of issue of Pernfit)


X


Registered No.


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


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


Domenica Marguerita Buffa


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


PARENTS


Over


5 yrs


over


15 yrs


OTHER


SIGNIFICANT


CONDITIONS


Arthritis


Over 5 yrs


No .. 370 Main Street


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.


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.


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 clerk 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 anlast 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


..........


TH


NON RESIDENT


CERTIFICATE OF DEATH FLORIDA


11478


REGISTRAR'S NO.


PLACE OF DEATH & COUNTY Broward


CODE NO.


2. USUAL RESIDENCE ( Where deconced Hood !! inetstufien: Rondenes bofors admission) STATE Massachusetts b. COUNTY Suffolk


A. CITY TOWN OR LOCATION


e. IS PLACE OF DEATH


INSIDE CITY LIMITS?


Fort Lauderdale


YES


NO .


e. CITY. TOWN. OR LOCATION Winthrop


e. IS RESIDENCE INSIDE CITY LIMITS? YES & NO


4. NAME OF


If not in hospital, fire street address!


ON A FARMI


HOSPITAL OR INSTITUTION "Holy Cross Hospital


. LENGTH OF STAY IN 18 1 day


d. STREET ADDRESS 70 Quincy Ave.


YES


NO G


-


NAME OF DECEASED Type a pris !!


WILLIAM


LESTER


HARRINGTON


S SEX


6 COLOR OR RACE white


MARRIE


NEVER MARRIED


& DATE OF BIRTH 7/28/91


9 AGE (In prera last birthday) 65


IF UNDER 1 YEAR


UNDER 24 HAS.


Male


WIDOWED


DIVORCED


100 USUAL OCCUPATION (Gire kind of trork dene |100 KIND OF BUSINESS OR INDUSTRY during most of werking hje, even if rettw) Engineering Contract Mer. Corn.


11 BIRTHPLACE (State or foreign country) Massachusetts


CITIZEN OF WHAT COUNTRY! USA


13. FATHER S NAME


14 MOTHER'S MAIDEN NAME Jennie Sanderson


"illian Geor-e Harrington


15 WAS DECEASED EVER IN U S. ARMED FORCES!


16 SOCIAL SECURITY NO. 17 INFORMANT'S SIGNATURE


Hallo & Hamming


no -


023-05-7405


Lighthouse Point, Pomnand B


18 CAUSE OF DEATH [Enter only one cause per fine for (a). (0) and (e) ) PART & DEATH WAS CAUSED BY IMMEDIATE CAUSE (4)


INTERVAL BETWEEN L ONSET AND DEATH hours


Conditions, if my. which pare rung to


DUE TO (6)


Coronary artery discese


years


Mering the under. lying ceuse last


DUE TO (e)


PART IL OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART I(a) 4201


WAS AUTOPSY PERFORME DI YES NO .


200


200 DESCRIBE HOW INJURY OCCURRED (Enter nature of injury in Part I or Part II of item 18.)


ACCIDENT


HOMICIDE


20c TIME OF


Hour Month, Day, Year


BURY


..


20/ CITY. TOWN. OR LOCATION COUNTY


STATE


200 INJURY OCCURRED WHILE AT WORK


NOT WHILE AT WORK


21 I attended the deceased from Death occurred at


535


m on the data stated above, and to the best of my knowledge, from the causes stated


224 SIGNATURE


(Degree


r.D.


220 ADDRESS


1814NE. 25th st Pompano


224. DATE SIGNED 7/23/57


230 BURIAL, CREMATION Re noVAI


230 DATE 4/24/57


230 LOCATION (City, fewen, or cosa/])


Suffolk


Mass.


R. Jay haw


LECTOR S JICHA TURE CHISS Pompano Beach Florida


25 DATE RECO. BY LOCAL REG 4-25-57


ADDRESS


Received and filed. SEP 30 1957


19


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


19


(Registrar of City or Town where deceased resided)


return)


itution, umber)


e)


.he word)


tours inutes


: life)


4/23/17


. to


4/23/59


and last saw him


har


alive on


23c NAME OF CEMETERY OR CREMATORY


(State)


REGISTRAR'S SIGNATURE


SOM . 11 08 918148


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, ( ;. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or jown 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 .


The Commonwealth of Massachusetts EDWARD J. CRONIN


164


STATE FILE NO.


302


MEDICAL CERTIFICATION


SUICIDE C


Middle


Last


Month


Year


DATE OF DEATH April


23 1957


Min.


AMgondol is faster


Mr PLACE OF INJURY (e 9, in or ghout home. fer m, factory, street, office Sidg., etc.)


VS-R3 1-1-56 OF MAINE TMENT OF HEALTH AND WELFARE


CERTIFICATE OF DEATH


STATE FILE NO. 68×400 2


165


1. PLACE OF DEATH


&. COUNTY


Lincoln


2. USUAL RESIDENCE Where deceased lived. If institution : residence bofors ad mission


a STATE


Nass.


b. COUNTY


b. CITY, TOWN, OR LOCATION


East Boothbay, Me


c. LENGTH OF STAY IN 1b


1 Week


^. CITY, TOWN, OR LOCATION


Winthrop, Less.


d. NAME OF


HOSPITAL OR


INSTITUTION


(If net in hospital, give street address)


d. STREET ADDRESS


194 Somerset St.


8. 18 PLACE OF DEATH IN RURAL AREA?


YES


e. IS RESIDENCE IN RURAL AREA?


YES O


1. IS RESIDENCE ON A FARM?


YES


3a. NAME OF DECEASED -- First Name


William


| 3b.


Middle Name


Martin


| 3c. Last Name


Brewer


4.


DATE


OF


DEATH


Month


6/19/57


5. SEX


6. COLOR OR RACE


White


7.


Married


Widowed


Divorced 5


8. DATE OF BIRTH


Oct. 11, 1848


9. AGE (In years


last birthday)


68


Hf under 1 year ! If unde: 24 hrs. Days His Mos Min.


10a USUAL OCCUPATION (Give kind of work


done during most of working life, evan if retired)


Mariner


10b. KIND OF BUSINESS OR


INDUSTRY


11 BIRTHPLACE (State or foreign country)


Boothbar Harbor, Me.


12. CITIZEN OF


WHAT COUNTRY?


13. FATHER'S NAME


William A. Brewer


14. MOTHER'S MAIDEN NAME


Ada Hamilton


Address


16. WAS DECEASED EVER IN U.S. ARMED FORCES?


(Yet) po, or unknown) (If yes, give war or dates of service)


17. SOCIAL SECURITY NO.


020-12-9271


18. INFORMANT


Firs Korris Dodge


INTERVAL BETWEEN


ONSET AND DEATH


163X


Conditions, if any,


which gave rise to


above cause (a)


stating the under-


lying causo last.


) DUE TO (b)


DUE TO (c)


PART 11. Other significant conditions contributing to death but not related to the terminal disease condition given in Part I(a)


2J WAS A'ITOPSY


PERFORMED?


YESO NO0


21a. ACCIDENT


SUICIDE


HOMICIDE !


210. PLACE OF INJURY (e.g., in or about home. farm, factory, street, office bldg .. et .. )


2 !! CITY, TOWN, OR LOCATION COUNTY


STATE


ICIAN'S EDICAL INER'S ICATION


ERAL CTOR ND STRAR


24a. BURIAL, CREMATION,


REMOVAL (Soncity)


Burial


24b.


DATE


6/22/57


24c.


NAME OF CEMETERY OR CREMATORY


Union


24d. LOCATION (City town, or county)


Edgecomb, Ke.


(State)


26 DATE RECD. BY LOCAL REG


June 21, 1957


REGISTRAR'S SIGNATURE


A TRUE COPY ATTEST


Boothbay Harbor


OCT : 1957


.


V. B.V


DENT ONAL ITA E ON NAME


USE OF ATH


E TYPE PRINT


ATH TO ERNAL ENCE


21c. TIME OF


INJURY


Hour


a.m.


p.m


Month, Day, Year


21d. INJURY OCCURRED


WHILE AT


NOT WHILE


WORK


AT WORK


21b. DESCRIBE HOW INJURY OCCURRED (Enter nature of injury in Part I or Part II of item 18).


28. PHYSICIAN: I hereby certify that I amunded the deceased trum / _".


and Just saw him alive off / 19/57


. Death occurred


23a. SIGNATURE Deane Hutchins


(Degree or title)


23h.


ADDRESS


Boothbay Harbor


23c. DATE SICH .. D


n/20/07


22a. MEDICAL EXAMINER: I hereby certify that death occurred at the time and from the causes stated above, and that i heid an (investigation) (astripsy) on the re- mains of the deceased as required by !aw.


at


A mon the date and from The causse status a) .


months


19. CAUSE OF DEATH (Enter only one cause per line fo (a), (b), and (c).)


PART 1. DEATH WAS CAUSED BY:>:{ }


IMMEDIATE CAUSE (a)


15. NAME OF SPOUSE (If Married)


E OF H AND UAL DENCE


Day


Year


1


1


Nevor Married


RECEIVED


OF TOW


OCT - 81957 24


-302


1


Nahant


(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 ToNatedin this return)


Registered No. 43 166


"(If death occurred in a hospital or institution,


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


2 FULL NAME Kathryn O'Connor (Cassidy) (If deceased is & married, widowed or divorced woman; also maiden name.)


(a) Residence. No .. 175 Main (Usual place of abode)


.......


štinthrop.


Mass


(If nonresident, give city or town and State)


Length of stay: In place of death. .......... years. months .... 2.7.days. In place of residence. 45 years months. .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


July 6, 1957


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


June .20, 19.57,


to July 6,


1957


I last saw Oralive on


July 5


157


death is said to


have occurred on the date stated above, at


8.40 A


.. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Multiple Sclerosis


INTERVAL BETWEEN ONSET AND DEATH 7 yrs


11 IF STILLBORN, enter that fact here.


12


AG59 Year9


Month25


... Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


At Home


15 Social Security No.


024


10 2183D


16 BIRTHPLACE (City)


(State or country)


Mass.


Boston


OTHER SIGNIFICANTA te Myocarditis CONDITIE Gute Convective Failure 12 hrs


2 hrs


Was autopsy performed?


no


What test confirmed diagnosis?


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


(Signed)


Henry J .Oberson


M. D.


(Address)


Lynn, Mass.


Date July 6 1957


Winthrop Cem. 6


Winthrop


Place of Burial or Crematioy uly 9.


DATE OF BURIAL.


,57


7 NAME OF FUNERAL DIRECTOR 180 Winthrop St. Winthrop, Mass


ADDRESS


Received and filed. SEJOT. 24,19.57 19


(Registrar of City or Town where deceased residcd)


PARENTS


18 BIRTHPLACE OF


CNBL


FATHER (City).


(State or country)


N. Y ..


19 MAIDEN NAME


OF MOTHER


Frances Reagan


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Boston


Mass.


21 Informant James O' Connor (Address175 Main St. l'inthrop,Mass.


A TRUE COPY


Leon mu. Nelano


ATTEST:


(Registrar of City or Town where death occurred)


July 7, 1957


19.


Due To (1) 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)


50M1-11-55.9:6145


2


PLACE OF DEATH


Essex (County)


No. Rockledge Manor Nursing Home


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWERLA,


or DIVORCELOWed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


John Henry O' Connor


(or) WIFE of.


(Husband's name in full)


17 NAME OF


FATHER


Michael Cassidy


(City or Town) 19:


Victoria A.Reynolds


(Was deceased a


U. S. War Veteran,


if so specify WAR)


:


-


-


.


....


X


PLACE OF DEATH


Suffolk (County)


Boaton Town)


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


CERTIFICATE OF DEATH


Registered No.


7323 Bostan 167 7323


(City or Town making this return)


No ...


2 FULL NAME. Leo A Bonzagni


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


(a) Residence. No ... 42-Russell St.


(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.


25years.


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


13 Hrs


PERSONAL AND STATISTICAL PARTICULARS


8 SEX M


9 COLOR


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


10a If married, widowed, or divorced


HUSBAND of


Cecile Haves:


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE.


6LY


Months ...


.. Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Vault.Manager


(Kind of work done during most of working life)


14 Industry


or Business:


F.N. Bank of Boston


15 Social Security No ...


022-07-5:01


16 BIRTHPLACE (City)


(State or country)


Boston M.493.


17 NAME OF FATHER Vincent Bonzagni


18 BIRTHPLACE OF


FATHER (City).


Italy ..


(State or country)


19 MAIDEN NAME


OF MOTHER


Augusta Costa


20 BIRTIIPLACE OF


MOTHER (City)


Italy.


(State or country)


21 Informant (Address)


Cecile Bonzagni-


Wife


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


August 12/57


19


X


1


7 NAME OF


FUNERAL DIRECTOR


A J O'Maley


ADDRESS


Winthrop Mess.


Received and filed. SEPT. 12, 1457 19


(Registrar of City or Town where deceased residled)


PARENTS


(Signed)


M M. Michaels


M. D.


(Address) New Eng.Ctr.Hoopt ....... 8-6


19. 57


6 Place of Burial of Cremation -


DATE OF BURIAL


(City or Town) August 9/57 19


50MI.11.55-916145


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)


-


New England Ctr. Host.


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


(Was deceased a


U. S. War Veteran,


if so specify WAR)


W W


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


(Month)


August-6/57


Year)


4 I HEREBY CERTIFY,


That I attended deceased from


August-6


57


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


im


August-6, 19 ... 57, death is said to


have occurred on the date stated above, at


1;30A-


.... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Hemorrhage cerebral


INTERVAL BETWEEN ONSET AND DEATH 1 Day


About


Due To (b) Acute leukemia


7 Mos


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?.. What test confirmed diagnosis ?.


Bone marrow


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


No


Winthrop Com Winthrop Mass.


19 ....


August 5/ 57 00


Brockline Mass. St


-302 1


302


1


Bostan


(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)


7502


168 1


New England Baptist Hospt. No


S (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.)


45 Atlantic St.


St


Winthrop Mass.


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


Length of stay: In place of death. ......... ... years. 1 .. months 8 days. In place of residence years


30


months.


......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


August 12/57


(Month) (Day) (Year)


4 I HEREBY CERTIFY,


That I attended deceased from


July ..... 3 , 19 57 August 12


19 57


I last saw h ... elalive on


1,30PM


have occurred on the date stated above, at m.


DEATH


WAS CAUSED BY: IMMEDIATE CAUSE


Pulmonary metastasis


(a)


Due To Adenocarcinoma of rt.breast (b)


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


Generalized metastases


18 Mos


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Michael Moynihan


18 BIRTHPLACE OF


East Boston Mass.


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Sarah Alexander


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


East Boston Mass.


Winthrop Cem-Winthrop Mags.


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


August 16/57 19


7 NAME OF


FUNERAL DIRECTOR


A J O'Maley


ADDRESS Winthrop Mass.


Received and filed


SEP 19 194* 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


Widowed


or DIVORCED


10a If married, widowed, or divorced HUSBAND of


five maiden name of wife in full)


Harold" J Lambert


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12 AGE 56 Years


Months.


Days


If under 24 hours


Hours ......


Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


Own Home


15 Social Security No.


East Boston Mass.


None


Was autopsy performed ?. What test confirmed diagnosis ?. Exploration and xrays


No


S Parikh


(Signed).


M. D.


Lahey Clinic


8-12 57


(Address).


Date


19


PARENTS


21 Informant. (Address)


Jeanne Lambert


45 Atlantianthrop Mass


11


A TRUE COPY


ATTEST :


(Registrar of City or Town where death occurred)


DATE FILED August 16/57


19 ..


VVB.


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sce. 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.1: 55.916145


+ PLACE OF DEATH


Suffolk


(County)


WODY HOWHE ISN'T


Rita E Lambert


Registered No.


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(If nonresident, give city or town and State)


to. August 12 57 , death is said to


INTERVAL BETWEEN ONSET AND I'Mos


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


1.5


RECEIVED


CLERK


SEP 1 91957 211


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


Boston


(City or Town making this return) 1.69 7488


Registered No.


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




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