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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