USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 9
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Arthur W. Sullivan
Registered No.
"(If death occurred in a hospital or institution.,
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
E.w.m
5%
INTERVAL BETWEEN ONSET AND DEATH 1 Month
3 4Bars
or
Business :
PARENTS
(Address)
Destin LS.AT
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 hy 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 a last 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 Examineri 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 difuse resulting from injury or infection related to occupation, the sudden deaths-of persons for 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 ...
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 .OVIETEM CERTIFICATE OF DEATH
BOSTON
(City or Town making this return)
22
$ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME Baby Boy Cohen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 9L: Shore Drive
Winthrop, Mass
St
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ..
months.
2
days. In place of residence.
........ years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OFJanuary
DEATH
3 1957
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan 2
19
57
Jan
3
19 57
I last saw h ........ alive on
have occurred on the date stated above, at
6:20P
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Hyaline Membrane Disease
(b) Prematurity
Casaarian Section
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?.
What test confirmed diagnosis?
N.c
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
R Hochman
M. D.
(Address)
Beth Israel Hospbate
1-4
19 57
orkmens Circle Com 6
W Roxbury
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. Jan 6 1957
7 NAME OF FUNERAL DIRECTOR BF Solomon
ADDRESS.
Brookline, Mass
Received and filed. FEB 211,457 ... 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
Single
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
2 Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF FATHER Hyman M Cohen
PARENTS
18 BIRTHPLACE OF
Boston
FATHER (City) (State or country) Mass
19 MAIDEN NAME OF MOTHER Gladys Ł Morgan
20 BIRTIIPLACE OF MOTHER (City) (State or country) Mass
Newburyport
21
Informant
Father
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Jan 9
57
19
1
No.
Beth Israel Hospt
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1
Due To 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) 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.)
1
tq Jan 3, 19 5 / death is said to
INTERVAL BETWEEN ONSET AND DEATH
1 day
Boston
5031.11.55.016148
R-302 1
RECEIVED
OF TOWN
FICE
11 12. 1
10.
G
CLERK
-
Is
6
HROP
FEB 2 01957 AM
X
R-302 1
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF VICTEM
CERTIFICATE OF DEATH
Registered No.
23
New England Center Hospt. Boston
§ (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.)
169 Orient Ave.
East Boston Mass. St
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death .......... .. years. .. months. 2 .days. In place of residence. ......... years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Jan. 3/57
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan. .............. , 19 ... 57 ... , to Jan.3.
I last sawgb ..... alive on Jan.3
1957 death is said to
have occurred on the date stated above, at 11;50PM.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Bronchospasm
LO Ming
6 Yrs
OTHER
CONDITIONS
Pulm. emphysema
Was autopsy performed ?........ No What test confirmed diagnosis? aggravated by dust in
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed) M H Chalfen
M. D.
(Address) Nem Eng.Ctr.Hospte 1-4 57
19
Winthrop Cem-Winthrop Mass .
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Jan .7/57 19
7 NAME OF FUNERAL DIRECTOR
F. J Magrath East Boston Mass.
ADDRESS
Received and filed.
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX M
9 COLOR
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVORCED
Married
10a If married, widowed, or divorced HUSBAND of
Raimondi
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.61 Years
Months.
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Bak er
(Kind of work done during most of working life)
14 Industry
or Business :
Self Employed
15 Social Security No ..
16 BIRTHPLACE (City).
(State or country)
Sicily ..
17 NAME OF FATHER Giacomo LaCascia
baker WIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Anna-
20 BIRTIIPLACE OF
MOTHER (City).
(State or country)
Italy
21 Informant (Address)
Mary LaCascia
IRegelen d Mackie 20
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Jan. 15/57
19
X
1
PARENTOS
50M1.11.55 916145
6 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 eity or town Due To (c)
(City or Town making this return)
No.
Gaspare LaCascia
(Was deceased a U. S. War Veteran, if so specify WAR)
W
(If nonresident, give city or town and State)
19.
57
INTERVAL BETWEEN ONSET AND DEATH
Due To (b) Bronchial asthma
RECEIVED
OF TO!
11 17
1
6 5
Di
MAR : 41957 PM
X PLACE OF DEATH
Suffolk
(County)
Bosta
(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.
$(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.)
51 Willow Ave.
St
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.
292
In place of residence.
3ears.
6 months.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX M
9 COLOR
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorce fary Cohen HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
19 Day
AGE
Years
Months.
Days
Presser
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Women's Wear
15 Social Security No ...
032-10-0063
16 BIRTHPLACE (City)
(State or country)
17 NAME OF FATIIER Samuel Lipman
18 BIRTIIPLACE OF
Russia
FATHER (City).
(State or country)
19 MAIDEN NAME OF MOTHER
Annie Alpert
(Signed)
M. D.
(Address)
Date.
Ahavas Achim of Revere Everett Mass. MOTHER (City) (State or country )
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Jan. 9/57 19
7 NAME OF FUNERAL DIRECTOR
H J Torf
ADDRESS
Chelsea Mass.
Received and filed. FFE 2017 19
(Registrar of City or Town where deceased resided)
21 Informant
Mary Lipman
A TR Charles 2. Mackie 0
ATTEST:
(Registrar of City or Town where death occurred)
Jan. 11/57
DATE FILED
19
VEV
(b) resided as soon as possible, after the close of the month in which the death occurred. (Sec 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)
5011.11 99.916149
Jan. 8/57
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Jan.8
58
Dec. 13
19 56
to
19
I last saw himalive on
Jan.8
1957
death is said to
have occurred on the date stated above, at 7:45PM
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Vascular collapse
Duc To Multiple embolism
OTHER
Abdominal aortic aneurysm
SIGNIFICANT
Post op.low thigh-amputation
CONDITIONS
Was autopsy performed ?.
What test confirmed diagnosis?
Les
5 Was disease or injury in any way related to occupation of deceased NO If so, specify ...
A Woked1
330 Brookline Ave.
1-8
19
57
PARENTS
20 BIRTHPLACE OF
Russ ia
-
R-302 1
Beth Israel Hospt.
No.
Abraham Lipman
(Was deceased a
U. S. War Veteran,
if so specify WAR)
3 DATE OF
DEATH
INTERVAL BETWEEN ONSET AND DEATH 5 Mins. 12 64
If under 24 hours
Hours ........
Minutes
RECEIVED
OF
TOWA
CLERK
WIA
6
IT
HR
הו
FEB 2 81957 AM
-
X
Middlesex
(County)
Tewksbury, Mass.
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH LLAWY MNIETEM
TEWKSBURY, STATE HOSPITAL AND ... INFIRMARY ..
(City or Town making this return)
$ 25
{ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Emma Cogan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
104 Highland Ave.
SE
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death 0 years. 3 months. 2 days. In place of residence ............ years. months .. ......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE 83
Years
5
Months.
29
.. Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No.
Lowell
16 BIRTHPLACE (City) (State or country) Mass.
17 NAME OF FATHER William Cogan
18 BIRTHPLACE OF
FATHER (City)
Not learned
(State or country)
Ireland
19 MAIDEN NAME OF MOTHER Ellen McCraig
20 BIRTHPLACE OF
Not learned
Ireland
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Jan. 14.
.19.57
21 Informant. (Address)
Hospital Records
......
7 NAME OF
FUNERAL DIRECTOR
Joseph Mahoney
A TRUE COPY
ADDRESS.
187 NesmithSt. Lowell ,MasSTEST:
Received and filed 19
DATE FILED
1/11/57
19.
(Registrar of City or Town where deceased resided)
11,
1957
(Day)
(Year)
That I attended deceased from
to
Jan. 11
19
57
Jan.
11 ...... , 19.57,
death is said to
have occurred on the date stated above, at 2:15 8.m.
INTERVAL BETWEEN ONSET AND
(a)
Terminal bilateral bronchhaDEATH
pneumonia
days
Due To Hypertensive heart disease yrs (b)
yrs.
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
No
PARENTS
(Signed)
Felipe P. Novo
M. D.
(Address)
T. S. H. and I., Tewksbury
Date
1/11/
19.
57
MOTHER (City).
St. Patrick's Cemetery ,Lowell Mass 6
. (State or country)
ress )
50.1.11.55.916145
(a) Residence. No ... (Usual place of abode) 3 DATE OF DEATH January (Month) 4 I HEREBY CERTIFY, Oct. 9, 56 19 I last saw h ..... . Mive on (c) OTHER SIGNIFICANT - CONDITIONS Was autopsy performed? Yes What test confirmed diagnosis? Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To Nephrosclerosis resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. 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
PLACE OF DEATH
No.
TEWKSBURY STATE HOSPITAL and INFIRMARY
Registered No.
(Was deceased a U. S. War Veteran, if so specify WAR)
(Registrar of City or ffown where death occurred)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
OF TOI
17.
6
MAR :- 41957 PM
R-302 1
PLACE OF DEATH
Suffolk
(County)
Revere
(City or Town) Grover
anorHospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or Town making this return) .......
26
No. Annie Gaddis ( Jennings)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
22 Read Street
(a) Residence. No .. (Usual place of abode)
Length of stay: In place of death.
....... years.
3
months
days. In place of residence.
......... years.
months ..........
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
Widow
WIDOWED
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
James Caddis
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
81
AGE
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 :
At home
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
england
17 NAME OF
FATHER
Richard Jen in s
18 BIRTHPLACE OF
FATHER (City).
(State or country)
En land
19 MAIDEN NAME
OF MOTHER
Lucy Ann ( Cannot be/
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
21 rs. - red Benven
Informant
(Address)
22 00 Read et.
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Janu ry
16,
.. 19.
(Registrar of City or Town where deceased resided)
12,
1957
(Month)
(Day)
(Year)
4 I HEREBY
Sept . 26
CERTIFY,
56
19 Janto to ..
12
57
19.
I last saw h. alive on 19. death is said to
1:23P.
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Uremia
(a)
Due To Coronary heart disease
(b)
Due To Diabetes Mellitus
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
Clinical siens
What test confirmed diagnosis?
5 Was disease or injury immy way related to occupation of deceased? If so, specify ...
(Signed) ..
James F. Burns
M. D.
537 roadway
(Address) .... Lvorett
Date.
1/12
57
19
Winthrop
6
Place of Burial or Cremation
January
19
7 NAME OF
FUNERAL DIRECTOR
aurice ". Kirby
210 Inthrop St., Winthrop
ADDRESS
Received and filed. 19
2yrs.
5yrs.
5031.11.55.916145
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, 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
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
Jan.
That I attended deceased from
51
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND 14 DEATHS
St
Winthrop
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
16
Registered No.
$ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PARENTS
learned )
winthrop
(City or Town)
57
DATE OF BURIAL.
57
r.,3.
Fousewife
R-302 1
PLACE OF DEATH
Suffolk
(County)
Revere
(City or Town) Grover Manor Hospital No ..
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or Town making this return)
28
$ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Harriet Jane Murphy (Lodge)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
66 Shore Drive
S
(a) Residence. No .. (Usual place of abode) 1 6
Length of stay: In place of death. ..... years ....
.. months.
.. days. In place of residence.
... years.
months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
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)
william
uriny
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
82
12
AGE
Years
Months.
Days
If under 24 hours
Hours .......
Minutes
letired housekeeper
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Winthrop Com unity Losp.
15 Social Security No ..
016-26-9252
16 BIRTHPLACE (City)
(State or country)
laine
17 NAME OF
FATHER
William Lodre
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Jane Black
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
reenwood Cemetery, Jonesport, "aide 6
(City_or Town) Place of Buiten fremont January 17 DATE OF BURIAL. 19
57
21 "'re. Harry Shell
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