Town of Winthrop : Record of Deaths 1957, Part 92

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 92


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE. RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


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


CERTIFICATE OF DEATH


Registered No.


266


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


BERNARD B. WOOD


2 FULL NAME


( Was deceased a


ar Veteran, cify WAR)


ly or town and State)


S.


L PARTICULARS


SINGLE (write the word) MARRIED WIDOWED or DIVORCED


e of wife in full)


name in full)


If under 24 hours


Hours ........ Minutes


....


ring most of working life)


from July 30


19 57, to October 18 10 57


and last saw h ... i.m alive all.2 .: Q5Aon .... Oct. 18 .19.5.7.


b. Kind of Business or Industry in which this work was done


15.


7 SOCIAL SECURITY NO.


& BIRTHPLACE (State or Foreign Country)


Mass.


9 OF WHAT COUNTRY WAS DECEASED A CITIZEN AT TIME OF DEATH?


U.S.A.


104. WAS DECEASED EVER IN UNITED STATES ARMED FORCES?


10b. 19 YES, Give war or dates of service .


Witness my hand this. 1&day of ........ October.


.. .. 19.5.7 ...


11 NAME OF FATHER OF DECEDENT


Freek Work


Signature Frank & French


M. D.


Frank S. French


Address .U. S.Public Health ... Serv.Hosp .. , S .. I.N


TypAcci,


13 NAME OF INFORMANT


RELATIONSHIP TO DECEASED ADDRESS


Wathop


Serons Word


14e. Name of Cemetery or Crematory like to Natx Con


14b, Lovation (City, Town or County and


14c. Data of Burial or Cremation 20 26/57


31 FUNERAL DIRECTO


LOMAS E. HALTON


AYE FOR AL PARK


BUREAU OF RECORDS AND STATISTICS


DEPARTMENT OF HEALTH


THE CITY OF NEW YORK


-


·n where death occurred)


(Registrar of City or Town where deceased resided)


25M-8-56-916227


Rev. 9/94) = 142 5 Institution 8 Area-Dist Caute 1 Cause 3 Operation 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 Att-Autop.


......


Certificate of Death


Bore Death


FILED


RICHMOND


Certificate No.


W


-BERNARD


WOOD


Middle Name Last Name


PERSONAL PARTICULARS, (To be filled in by Funeral Director)


MEDICAL CERTIFICATE OF DEATH (To be filled in by the Physician)


Boro-Recid.


2 USUAL RESIDENCE: (s) State ....


MASS.


(c) Post Office uus and Zone.com


WINTHROP


(d) No. 3.2% Presset


it


Ave Ist


(If in rural area, give location) (e) Length of residence or stay in City of New York immediately prior to death por Res.


V01341


3 SINGLE, MARRIED, WIDOWED, OR DIVORCED (write the word)


Murrenit


Nattv. Dec.


4 DATE OF BIRTH OF DECEDENT


(Month) 8 -


(Day


(Year)


8-191


$ AGE


If under 1 year


If LESS than 1 day,


dayı


hrs. or


a. Usual Occupation (Kind of work done during most of working Life, even if retired)


31-


Occupation


(If nos in hospital or institution, gios street and number.)


(d) If in hospital, give Ward No. B-2


16 DATE AND HOUR OF DEATH


(Month)


(Day)


(Year)


Oct.


18


1957


(Hour) 12:05A.


17 SEX


male


18 COLOR OR RACE white


19 Approximate Age 40


20 I HEREBY CERTIFY that (+attended the deceased)"


(a staff physician of this institution attended the deceased)*


I further certify that death + .... wa.s ... not ......... caused, directly or indirectly by accident, homicide, suicide, acute or chroule poisoning, or in any suspicious or unusual manner, and that it was due to NATURAL CAUSES more fully described in the confidential medical report filed with the Department of Health.


· Cross out words that do not apply. t See frat instruction on reverse of cortigente.


12 MAIDEN NAME OF MOTHER OF DECEDENT


Underan.


=


OCELITance


ec'd -31-58


FOR STATISTICAL PURPOSES ONLY FOR A CERTIFIED COPY APPLY TO DEPARTMENT OF HEALTH NEW YORK, N. Y.


(City or Town making this return)


156-57-501830


3? 1. NAME OF DECEASED (Print or Typrurite)


First Name


15 PLACE OF DEATH?


(s) NEW YORK CITY : (b) Borough ....... Richmond


(b) Comme


U. S. Public Health Serv. Hos


(c) Name of Hospital or Institution .rundt Staten Island N.Y.


No ..


ADDRESS


DATE FILED ............


19


ฮู้


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. )


X


Suffolk


(County)


Revere


(City or Town)


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


2/7


Revere


(City or Town making this return)


26.


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


1


2 FULL NAME Eve J. Kenney (Wallace) (If deceased is a married, widowed or divorced woman, give also maiden name.)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Winthrop


(If nonresident, give city or town and State)


Length of stay: In place of death ............ years ....


months ............ days. In place of residence. 2 .... years


.months


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


December


30 Day)


1957


( Year)


(Month)


(Day)


4 1 HEREBY CERTIFY,


That I attended deceased from


April 8,


53.


to .. Dee -........


30


197


I last saw @r .... alive on ... De.c ... 29 1957, death is said to have occurred on the date stated above, at 6: 0.5A ... .. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(Acute Pulmonary ..... Edoma


INTERVAL BETWEEN ONSET AND DEATH thrs.


Due (b) Congestive heart


lyr.


failure


Due


(c) CardiacEnlargement


byrs.


OTHER


SIGNIFICANT


CONDITIONS


1


Was autopsy performed ?.


no


What test confirmed diagnosis ?.


Clinical


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


(Signed) Guy ..... A ........ DiStasio M. D.


(Address)


2.21 Peach St.


Dat 2/30


15.7


Revere


Winthrop


Winthrop Place of Burial or Cremation (City or Town)


DATE OF BURIAL January 2.


598


7 NAME OF FUNERAL DIRECTOR Arthur J. O' Maley Winthrop


ADDRESS


Received and filed. JAN 17 1958 19


(Registrar of City or Town where deceased resided)


8 SEX


emale


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED dowed


or DIVORCED


(write the word)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFI


Nicholas E. Kenney


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


AGE


Years.


Months.


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupati


Housewife


(Kind of work done during most of working life)


14 Industry


or Business:


Own Home


15 Social Security No.


16 BIRTHPLACE (City) Boston


(State or country)


Mass


17 NAME OF


FATHERWilliam Wallace


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Meine


19 MAIDEN NAME


OF MOTHER


Catherine Forshner


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Pennsylvania


21 Eva Mccarthy


Informant.


(Address] 6 Fondoin St


Winthrop


A TRUE COPY


ATTEST:


20, 67


(Registrar of City or Town where death occurred)


DATE FILED


December


31


19


57


PARENTS


25M-0-56-918227


PLACE OF DEATH


R-302 1


Registered No.


No Rovere Memorial Hospital


(a) Residence. No.16 ..... Bowdoin ... St .. (Usual place of abode)


1


-


JAN 1 71958 18


Wihr Uto


Suffolk (('onnty)


Boston


DIVISION OF VITAL STATISTICS STANDARD


Nn. The Bakar Memorial James D. Mc Phail 2 FI'LL. NAME


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


(a) Residence. No 6 Grovers Ave.


winthrop, Mass.


( If nontrident, give city in town and State)


Length of alay: In place of death Yanı.


months 2 days In place of realdeme 2


MEDICAL CERTIFICATE OF DEATH


I DATE OF October 39. 1957


DEATH


( Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


That attended deceased from


Oct. 27 .19 $ 7. to


Oct. 29


57


I Just saw himalive nn


Oct. 29


. 39 57, death is said to


have occurred on the date slated alinve, at 11 : 55. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(.)Pulmonary edema, severe


(b)


Due Tn


Coranary heart disease,


severe.


Due Tn


(c)


120.1


OTHIFR SIGNIFICANT CONDITIONS


Was antopsy perlormed' yes (limited)


What test confirmed diagnosis?


limited autopsy


S Was disease or injury in any way related to occupation of deceased? 11 .0. sperify No


(Signed)


Oh Clay


, M. D


OF MOTHER


MARY


BREEN


-


ASST .. DIR. MASS GEN. RAED.


. GAM GRIVE


NEEDFORI)


(('ity er Tuwn)


Place of Burial of ('remation DATE OF NURIAL Nor. 2


7 NAME OF


ADDRESS


Received


NOV 5 1957 Charles H. Lack


( Registrar)


A SEX


MALE


WHITE


A SINGLE (warte the world


MARRIED


WIDOWED


OF DIVORCED MARRIED


10a If mattied, wie


ISABELLE C. KENNEY


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLHORN, enler that fact here.


unk. Occupation :


( Kind of work done during most of working file)


14 Industry


nr Business:


LUMBER


IS Social Security No


I6 BIRTHPLACE (City)


EAST BISTON


( State of country )


MASS


17 NAME OF


FATHER


JAMES & MC PHAIL


PARENTS


18 BIRTHPLACE OF


EAST BÜSTEN


FATIHIR ('ity)


(State of country }


MASS


19 MAIDEN NAME


D BIRTHPLACE OF


MOTHER (City)


EAST BOSTON


MASS


(State of country )


21


MAS. ISABELLE MC PHAIL


(Address) CERCVERS AVE WINTHROP.


Infiniant


I HIERE.DY CERTIFY that a satisfactory Handlaril certificate nf death was fred with me BEFORE the lamajor transit perry was issued =


«


ʻ


4503 11/1/578 -


(Official Designation )


( Date ol lsane off'ermit)


.


-301A -


TIONS


TIFICATE


Ing DEATH entar . ... each and (c)


... .... of drink . et fadure.


no compli.


1


if .. v. (a).


& but mot


pter 137. requires print er ause of est. .. tas.


PLACE OF DEATH


EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTHUT - OF-TOWN


To be nied for burial permil with Hoard of Health


Registered No.


fill death mcomted in a husjutal oc institution. St give ita NAME. instead of street and number)


PHYSICIAN IMPORTANT


I' S War Veteran, if Att aprtify WAR,


II ....


=


-


....


INTERVAL BETWEEN ONSET AND 12 DEATH unk. mins AGE: 41 Years


--


PERSONAL. AND STATISTICAL PARTICULARS


-


Months


Days


If under 24 hours


Hours


Minutes


13 l'qual


SALSEMAIN


years


HUSBAND of


2 268


2


...


19


( l'anal place of aloode )


'A TRUE COPY ATTEST: Charles it Macke City Ben star


1


. ...


6


?


FEB 211958 TM


1


PLACE OF DEATH


Suff olk (County)


Boston (('ily nt Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


OUT - OF - TOWN To be flied for burial permit with Board of Health of Ba Ageni 10403 Registered Nn.


No. Veterans Administration Hospital Louis J. HARRINGTON 2 FULL NAME


Jill death accused in a hospital or institution, St. FRIVe IT. NAME instead of stert and number) PHYSICIAN IMPORTANT


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


(a) Residence.


Nn.


25 Johnson Ave.,


(\'qual place of abode )


&. Winthrop,


Massachusetts


(II nonresident, Rive city of town and State)


Length of stay! In place nf death years


months


-1days. In place of residence


35 car«


months


days.


MEDICAL CERTIFICATE OF DEATHI


3 DATE OF


DEATH


November


9,


1957


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY.


That A attended deceased Irmm


November 8,. 1,57


, In


November 9,


. 19 57


have occurred on the date stated above, at 2:20 A.m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


() 1. Pulmonary congostion and


edema .


Une To


(11)


2. R.cont posterior


myocardial in arction.


Due To (c)


Cardiomcaly-800 grams


OTHER SIGNIFICANTCarcinoma of prostate with CONDITIONSvertebral metastases. voors


Was autopey performed'


Y03


What test confirmed diagnosis?


Autopsy


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


(Signed)


. M. D.


(Adress) VA Hospital, Poston Mar Nov. 9


1257


7 NAME OF


FUNERAL DIRECTOR


"'aurico W. Virby


ADDRESS 210 Winthrop St. .. inthrop. lass . AOV 14 1957 . Charles H. Machine" ( Registrar)


PERSONAL AND STATISTICAL PARTICULARS


R SEX


9 COLOR


10 SINGLE


( write the word)


MARRIED


WIDOW EDWid owed


of DIVORCED


Nale White


10a If married, widowed, or divorced


HUSBAND of


i ruch


nie Cann


(Give maiden name of wife in Full)


(or) WIFE. ol


( Hushand's name in full;


11 IF STILLBORN, enter that fact hete. 12


Il under 24 hours


Hour.


Minutes


Accountant


(Kind of work done digging most al winking lite)


14 Industry


Dr Business:


Caval


15 Social Security Nn.


16 BIRTHPLACE (City)


( State of country)


Massachusetts


17 NAME OF


FATHER


Edward Harrington


PARENTS


18 MIRTIIPLACE OF


Lowell


FATHER (f'ily)


State of country!


T'assachusetts


19 MAIDEN NAME IF MOTHER "ary Coliton


D BIRTHPLACE OF


MOTHER (f'ily)


(State of country }


Cambridge


Massachusetts


6 Oak Grove Cemetery, Codford, inss.


Place id Burial or Cremation


DATE OF BURIAL


Novombor 11


1.57


(''ity ar Town)


21


Informant


VA Hospital Ricordo


(Alle:)150 So Huntington Avc., Doston


I HEREBY CERTIFY that a satisfactory standard certificate of death


bled with me IttMORE the final of


All vermell was posted


Les; SI.E


Liderail N 18462


Kov 10 195) .


(O)thcial Designation )


(Date of Issue of P'ermit)


-


day


yours


Cambridge


ih but ant e terminal


.


last


apier 137. I. requires to print er ..... . f death .. cales.


.1 or


iction


SOM-3-37-920345


209 5


R-301A -


TIONS R RTIFICATE ving DEATH enter


t each and (c)


01 dying.


(a)


42011


INTERVAL


BETWEEN


ONSET AND


DEATH


day


AGE. 68 Years 5 Months


lbay.


..


..


( Was deceased a U. S. War Veteran,un if so specify WAREN I -


A TRUE COPY ATTEST: Charles it Mackie City Registrar


RECEIVE


-


FEB 2 11958 1X


1


PLACE OF DEATH


SUFFOLK (County)


BOSTON


(City or Town)


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


STANDARD CERTIFICATE OF DEATH


Registered No


Salvatore Lupoli 2 FULL NAME ..


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


(*) Residence. No


138 Partlett Road


(l'aval place of abode)


Length of stay: In place of death


years


months


days. In place of residence


years


month«


day


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


R SF.X


male


9 COLOR


white


10 SINGLE (write the word)


MARRIED


WIDOWED


of DIVORCED


married


10a If married, widowed, or divorced Gelsimina Materese


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE. of


( Ilusbaud's name in fall)


11 IF STILLBORN, enter that fact here.


12


AGF: 39


Years


Months


Day«


If under 24 hours


Minutes


13 I'sual


Self Employed


Occupation :


(Kind of work done during most of working lite)


Proprietor Grocery Store


15 Social Security No.


Unknown


16 BIRTHPLACE (City)


(State of country )


Italy


17 NAME OF


FATHER


Nicola Lupoli


PARENTS


18 BIRTHPLACE OF


FATIIER (City)


(State of country)


Italy


19 MAIDEN NAME


OF MOTHER


Sylvia (unknown)


201 11RT11PLACE OF


MOTHER (City)


(State of country )


Italy


21 Gelsimina Lupoli (wife) Informant (Address) 138 Barlett Rd. , Winthrop, kass. IEREBY CERTIVS' that a satisfactory standard certificate of death Was hled with me HE.FORE the burial or ti ypqit pesant was jeour wishErhard AlsqTE =


(Official Designation)


flinte of lasse of l'ermit) ...


-


3 DATE OF


DEATH


November


9,


1957


(Year)


(Month)


(Day)


4I HEREBY CERTIFY.


ThaWOattended deceased from


November9 19 57 November 9,19 57


. 19


Id last saw himfalive on November 9


. 19 57 , death 1% said to


have occurred on the date stated above, at 2:50 A.


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Cardiac Tamponade


( Hoemo Pericardium )


3 hrs


Due To Dissecting Aneurysm of the


(b)


Aorta


Due To (c)


451


Was autopay performed' What test confirmed diagnosis?


I Was disease or injury in any way related to occupation of deceased?


If sn, specify


·


(Signed)


( Address) Asst . Dir . Mass . Con'lar.


, M. D)


19


6


St. Michael Cemetery


Place of Ilurial or Cremation


City or Town 1


November 13, 57


19


7 NAME. OF


FUNERAL DIRECTOR


9 Chelsea 3t., East Boston, Kass.


Received IJOV 19 1957 Charles H. Mackun


J (If death occurred in a hospital or institution. St. (give ita NAME instead of street and number) PHYSICIAN IMPORTANT


(Was decreased a IS War Veteran, NO


11 sn specify WAR)


Winthrop,


Mass .


St.


(If nonresident, give city of town and State)


...


ATIFICATE


Ing


DEATH enter .. ... r each and (c)


sof .... of dying. rt ledere.


rile to (.). weder. se last.


, contrib. & det sof terminal


apter In. , requires to print er cause or Mesth .n cates.


-301A 1


TIONS


870 2


with Board of Health


No.


MASSACHUSETTS GENERAL HOSPITAL


Vincent "apino


Boston


DATE OF BURIAL


INTERVAL BETWEEN ONSET ANO DEATH


3 hrs


14 Industry


or Business


OTHER SIGNIFICANT CONDITIONS


A TRUE COPY ATTEST:


Charles H . Mackie City Re car


RECEIVE


TOWA


41.12.7


6


FEB 21 1958 FM


1


PLACE OF DEATH


Suffolk (County )


BOSTON (( ity or lownl


Beth Israel No Sidney Gordon 2 FU'1.1. NAME


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


24 Trident


(a) Residence. No. (['qual place of ahode)


Length of stay: In place of death years months


days In place of residence months days.


MEDICAL. CERTIFICATE OF DEATH


J DATE OF


DEATH


Nov


(Month1


1957


(Year )


4IHEREBY CERTIFY.


That 1 attended deceased firm


Nov


10


, 1057


in


NOV


10


I last saw him Alive on


Nov


10. 1957, death is hard to


have occurred on the date stated above, at


3 A


m


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Anoxia


Due To


Bronchial asthma


(11)


Due To (c)


SIGNIFICANT


OTHER


Diabetes mellitus


CONDITIONS


arteriosclerosis heard discede


Was autopsy performed?


no


What test confirmed diagnosis?


none


S Wan disease of injury in any way related to occupation of deceased?


If so, specify


no


(Signed)


Paul R. mintos


, M. D.


(Address) 330 Brookline Ave Date Nov 10 1- 59


Agudath Achim


Woburn


Place of lurial or Cremation


(City of Town)


Informant


DATE OF RU'RIAL


November 10,


57


21


Dora Gordon


Very, 24 Trident Avc., Winthrop


7 NAME OF


FUNERAL DIRECTOR


Benjamin Birnbach


ADDRESS


10 Washington St. Dorchester


NOV 19 1957


Received


Charles H. Mackie


PERSONAL AND STATISTICAL. PARTICULARS


A SEX


Male


White


10 SINGLE


Iwrite the words


MARRIED


Married


of DIVORCED


la If married, widowed, tomat katz


111'SHAND Af


(Give maiden name of wile in falli


(or) WIFE of


(finsband's name in full)


11 IF STILLHORN, enter that fact here.


Yrale Months Days


If under 24 hours


11 .1117%


Minutes


Sexton


( Kind at was done dung mest of work .; ! te)


14 Incluretry


Cong. Trforeth Israel


15 Social Security No.


027-16-0239


16 111R1111L.ACE (City)


Russia


(State or country ]


17 NAME OF


FATHER


Moses Aaron Gordon


18 WIRTIIPLACE OF


Russia


FATIIER (t'ity)


( State or , mintiv)


19 MAIDEN NAME


OF MOTHER


Deborah Lipsky


DO BIRTHPLACE OF


MOTHER (City)


(State or untntry )


Russia


filed with me BEFORE the final of leguan peninit was soleil 1 19101111 at at Hoped of 11.


18415-


Gibral Designation)


( Date of lesue af P'ermit) ...


Kongred 3-13.58


PARENTS


The Commonwealth of Massachusetts EDWARD J. CRONIN


SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


OUT - OF - TOWN To be fir f far burial primit with l'ont of Health


STANDARD


CERTIFICATE OF DEATH Hospital


PITY' ICIAN IMPORTARI


No I' S War Veteran. if so specify WAR)


Ave


Winthrop, Mass


St.


( If nonresident, give city of town and State!


CERTIFICATE


lving OF DEATH t enter ban one for each b) end (c)


... ... .... 01


It meant


Air A


11 @ny.


raik but not the formand


lait


Chapter 137, 54. requires t to print of cause death ..


MED. EXAMINER


R.301A 1


UCTIONS


=


INTERVAL


BETWEEN


ONSET AND


DEATH


2 hrs


12


64


yrs


241


Yrs


A TRUE COPY ATTEST: Charles it Mackie City Registrar


RECE YSO


1 !


1


-


3


FEB 211958 MM


1


X


PLACE OF DEATH


SUFFOLK BOSTONty)


(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


272


272


BOSTON. (City or town making returp) 10787


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.)


(Was deceased a


U. S. War Veteran,


209 289 Shirley St


Winthrop Mas's.


St.


(If nonresident, give city or town and State)


Length of stay: In place of death


.years.


1


months.


days.


In place of residence.


... years.


.months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


10 COLOR OR RACE


11 SINGLE


MARRIED


WIDOWED


or DIVORCED


Jennie M Bartlett


(write the word)


Married


(Month) (Day) (Year)


4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Fracture of hip 'broncho


11a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


92


13


AGE


Years


Months .... Pays Works THE


If under 24 hours


Hough. .... Minutes


14 Usual


Occupation :


(Kind Fire Workgst of working life)


15 Industry or Business:


16 Social Security No ..


Boston Mass


17 BIRTHPLACE (City).


(State or country)


18 NAME OF FATHER


19 BIRTHPLACE OF


Rochester N H


FATHER (City) (State or country)


20 MAIDEN NAME


OF MOTHER


Salom Mass


Ellen M Bickford


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Wife


22 Informant (Address)


A TRUE COPY.


ATTEST


Charles & Track


(Registrar of City or Town where death occurred)


DATE FILED


Feb/14/57


19


......


(Registrar of City or Town where deceased resided)


PARENTS


6 Was disease or injury in any way related to occupation of deceased ?.


If so, specify.


(Signed)


Richard Ford


(Address) Date. .19.


Winthrop Cem-Winthrop Mass


7 Place of Burial, or Cremation No v. 20/57 (City or Town)


DATE OF BURIAL. 19


8 NAME OF


FUNERAL DIRECTOR


M W Kirby


ADDRESS Winthrop Mass


Received and filed. 19


25m-(c)-11-49-900.475


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


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.)


Manner of


(Specify type of place)


Injury


(How did injury occur?)


Nature of


Injury


While at work?


Was autopsy performed?


5 Accident, suicide, or homicide (specify).


Date and hour of injury


.19


Where did Injury occur? (City or town and State)


Did injury occur in or about home, on farm, in industrial place, or in public place?


pneumonia senility


accidental fall on sidewalk


Winthrop Sept. 11/57


3 DATE OF


DEATH


NOV. 17/57


if so specify WAR).


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


George F McDuffee


Hill Top Hospt No.


M R-305 1


George F McDuffee


RECEIVE


٠٠


1


6


انات


FEB 2 41958


٦


MR-301A 1


PLACE OF DEATH


SUFFOLK (County)


BOSTON


(City or Town)


CERTIFICATE OF DEATH


MASSACHUSETTS GENERAL HOSPITAL


No.


2 FULL NAME HAUSER, Alice


(if deceased la a massed, widowed or divorced woman, give also maiden name )


(a) Residence. No. 435 Shirley St., Winthrop, Mass. ( L'aval place of ahore)


(If nonresident, give city of town and State )


Length of stay: In place of death yenTy months days. In place of residence years months days,


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX 9 COLOR


10 SINGI.E. (write the word)


MARRIED


WIDOWED


of DIVORCED


10a If married, widowed, or divorced HUSHAND of (Give maiden name uf wife in full)


. -..


(off WIFE, af


(Ilusband's name in full)


11 IF STILL.HORN, enter that fact here.


12/7


AGE


Years


/WK


1


Months


17,


Days


If under 24 hours


Hours


Minutes


13 I'siral


Occupation :


(Kind of work done during most of working life)


14 Industry


IS Social Sremity No.


*71.5


237


16 BIRTHPLACE (City),


10


(State of country)


17 NAME OF


FATHER


IR BIRTHPLACE OF


naplo tonitein


FATHER (City) (State of country)


19 MAIDEN NAME OF MOTHER


20 BIRTHPLACE OF MOTHER (City) (State or country )


nil to obtain


19 21 Infin mant (Address)


I HEREBY FFREILY that a satisfactory standard crititicate of death wA. I. with me Itt FORE. the burial of transit primot gas lasted


- 4961 12-2-57


(Official Designation)


( Date of Issue of Permit)


11221


Registered No.


J(If death occurred in a hospital or institution, St. [Rive its NAME, instead of street and number) PHYSICIAN IMPORTANT


( Was deceased a IS Was Veterant, if so sperify WAR)


CERTIFICATE


giving OF DEATH ant enter than one for each (b) and (c)


. n' disme. heart failure. = " no compli


.... lait


Tinni contrib death Aur ant


Chapter 137. 1954, requires na to print er e cause er of death en rtincates.


SOM 2 27.920345


6 Place of Burial or Cremation


DATE. OF BURIAL


Dor.


DLC 4 1957


Received atil still charles H. I nacks


INTERVAL BETWEEN ONSET AND DEATH


Due To (b)


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


What test confirmed diagnosis'


yes autopsy


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


(Signed)


. M. D


(Address) Asst . Dir . "ass .Gen' ],Jale Dec. 1,1, 57


(City of Town]


7 NAME OF


Nov.


30


1957


(Mm.th)


(Day)


(Year)


4 I HERERY CERTIFY.


Nov. 29 1 57. to


NOy,


30


Ci last saw Gr alive on Nov.


30,.657


. 19


57


denth is said to


have occurred on the date stated above, at 10:25P.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Bronchopneumonia,


bilat., ackte, Severe


J DATE OF


DEATII


RUCTIONS


EDWARD J. CRONIN




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