USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 54
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North Reading.
(City or Town making this return)
Registered No.
29.
139
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Charles Fagone
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .... (Usual place of abode)
4 Upland Rd.,
St.
Winthrop, Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.......... years.
months.
days. In place of residence.
16years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATHI
July
30
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
19
to ...
19
I last saw h ........ alive on
19
death is said to
have occurred on the date stated above, at
m.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Heart Disease presumably coronary Sclerosis
Due To
(1))
Sudden death
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?.
5 Was disease or injury in any way, related to occupation of deceased ?.. If so, specify ... Had attack ... at work
Yes
(Signed)
ThomasP. Mevlin
M. D.
(Address)
Stoneham, .... Mass.
Date
7/30
1958
6 Holy Cross Cemetery
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
August
4,
19.5.8
7 NAME OF
FUNERAL DIRECTOR Anthony P. Rapino
9 Chelsea St.,
East Boston, Mass.
ADDRESS
Received and filed.
AUG 7 1958
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
HUSBAND
of
10a If married, widowed, or divorced
Angelina Scaperotti
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE47
Years.
Months .......
... Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Foreman
(Kind of work done during most of working life)
14 Industry
or Business:
Reading Construction Co ...
15 Social Security No ....
Unknown
16 BIRTHPLACE (City)
(State or country)
Nass.
Boston,
17 NAME OF
FATHER
Santo Fagone
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Antonetta Fortunato
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Informant (Address) 4 Upland Rd., Winthrop, Mass.
A TRUE COPY
Rutten. Sullivan
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 31,
19.
58
V
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.)
5011.11 55.916145
PLACE OF DEATH
Middlesex (County)
No. 148 Park St.,
Malden, Mass.
PARENTS
Angelina Fagone
(Wife)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
That I attended deceased from
6
AUG -61958 PM
X
PLACE OF DEATH
Suffolk (County)
Locton (City or Town)
STANDARD CERTIFICATE OF DEATH
with Board of Hestery or its Agent.
40 03370
2 FULL NAME Daniel T. Felch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 62 Fawicy ave. winthrop, Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death years months 2 days. In place of residence 42 years
months_ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL, PARTICULARS
3 DATE OF
DEATH
L'arch
28
1958
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY.
That I attended deceased from
-March 4
19
19 58
59, 10
March. 28.
I last saw h m alive on
Harch 28
.19 58
death is said to
have occurred on the date stated above, at
6:00 a. m.
INTERVAL
BETWEEN
ONSET AND
DEATH 2 weeks
3 MON.
Due To (c)
OTIIER SIGNIFICANT CONDITIONS
Was autopsy performed ?
YES
What test confirmed diagnosis? AUTOPSY & TOILE BAM.
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signed).
Herbert A. Heerlen
. M. D.
(Addres 1176 HARRISON AVE
Date 3/28
1958
Winthrop_Cemetery 6
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL March 31, 19 58
7 NAME OF
FUNERAL DIRECTOR Alfred B. Marsh
ADDRESS
174 Winthrop St.
Winthrop
Received An
APR - 7 1958 Charles H. Mackie
(Registrar)
8 SEX
male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
marrded
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of Lillian Isobel Shattuck
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 80 Years
2 Months 27 Days
If under 24 hours
Hours
Minutes
13 Usual
retired meat salesman
(Kind of work done during most of working life)
Occupation :
14 Industry
or Business:
retail
15 Social Security No. 023-07-0159
16 BIRTIIPLACE (City) Hyde Park
(State or country)
Mas8.
17 NAME OF
FATIIER
George Washington Hancock
FELCH
18 BIRTHPLACE OF
FATHIER (City)
Passumsic
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
Sarah Kennedy
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass,
Holbrook
21 Mrs. Daniel T. Felch
Informant
(Address)
69 Bay View Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with mf BEFORE the burgal of Hansit permit was issued :
Jugend honoch 21787
(Signature of Mygant of Board of leal.h or other)
March 30 19.58
(Official Designation)
(Date of Issue of Permit)
AUG 22 1958
Vliv
NSTRUCTIONS FOR CAL CERTIFICATE In giving E OF DEATH o not enter ore than one use for each ), (b) and (c)
is daes wat mean mode af dving. as heart failure, a. etc. It means sease. of compli- which caused
199
itions. if any, gave rise ta 1 cause (a). as the under- last
ndations contrib -- ta death but not to the terminal canditian given
e :- Chapter 137, of 1954, requires clans to print or the cause or of death on certificates.
SOM-5-57-920345
RM R-301A 1
No.
New England Center Hospital
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
(write the word)
(Give maiden name of wife in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) HEPATO-RENAL FAILURE
Due
DIFUSE CARCINOMATOSIS
(b)
(Usual place of abode)
EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
Registered No.
PARENTS
AUG 2 21953 /M
'A TRUE COPY ATTEST: Charles H. Mackie City Registrar
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 STANDARD CERTIFICATE OF DEATH
1
OUT - OF - TOWN To be filled for burial permit with Board of Health 241 or its Agent. 03500
Registered No.
f(If death occurred in a hospital or institution, St. (give its NAME instead of street and numher) PHYSICIAN - IMPORTANT -
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ...
Little Sisters of the Poor
St
winThere's
(Usual place of abnde) Dudley St., Roxbury
(If nonresident, give city or town and State)
Length of stay: In place of death
0
years
0
12
months days. In place of residence ....... years .. months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
4 x
HEREBY CERTIFY,
That Kattended deceased from
March 21
., 19 58 ... tn April 2
19
58
we
X last saw haMalive on ... April 2
19.50 , death is said to
have occurred on the date stated above, at 9:30p .m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinoma of Lung, Left
Due To
Bronchopneumonia
- (b)
& Pulmonary Emphysema
Due To
Generalized Arteriosclerosis
years
15 Social Security No ..
?
Ireland
16 BIRTIIPLACE (City)
(State or country)
17 NAME OF
FATIIER
Jeremiah BuckLEY
18 BIRT11PLACE OF
FATHER (City)
(State or country )
Ireland
19 MAIDEN NAME
OF MOTHIER
Ellen Lucey
20 BIRTHPLACE OF
MOT11ER (City)
(State or country)
Ireland
21 Informant Long Island Hospital, Boston 69
(Address)
7 NAME OF
Maurice W Kirby
FUNERAL DIRECTOR
ADDRESS
210 Winthrop ST Winther
Received and filed
APR - 8 1958
19
Charles H. Mackie
PARENTS
M. D.
(Address)
Long Island Hospitable 4-3
58
19
6
Place of Burial or Cremation
Joseph BesCon
DATE OF BURIAL
april 5
1258
(City or Town)
BOM-5-57-920345
TR-301A 1
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each b) and (c)
oes not mean of dying. heart failure. tc. It means . or compli- phich caused
250 3. if any, ave rise to rause
(a). the under- last
(c)
INTERVAL
BETWEEN
ONSET AND
DEATH
weeks
11 IF STILLBORN, enter that fact here.
Years
12
AGE 82
1
Months LL. Days
If under 24 hours
_Ilours ...... Minutes
13 Usual
Occupation :
Railroad Worker
(Kind of work done during most of working life)
14 Industry
or Business :.
?
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?. no
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed).
Francisco Pers
days
3 DATE OF
DEATH
April 2, 1958
(Month)
(Day) we
(Year)
10a If married, widowed, or divorced
rgaret Lehan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(llusband's name in full)
(Official Designation)
I HEREBY CERTIFY that a satisfactory standard certificate of death was fred with me BEFORE the burial or transit permit was issued : miasto (Signature of Agent of Board of llealth or other) 7063 4- 3 x
(Date of Issue of Permit)
ons contrib- death but not the terminal adition given
Chapter 137, 954, requires s to print of cause or 1 death 08 tidcates.
5 1958
Long Island Hospital No. Dennis Buckley
(Was deceased a U. S. War Veteran,
if so specify WAR)
?
AUG 2 51939 45
- 1
'A TRUE COPY ATTEST: Charles it, Mackie City Registrar
RM R-301A -
PLACE OF DEATH
Suffolk (County)
Boston (City of Town)
No.
Phillips House, Mass. Gen. Hosp. A Dr. Harvey Kelly
f(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.)
if so specify WAR)
WW 1 & 2
200 Pleasant St., Winthrop, Mass.
St.
Winthrop, Mass
( If nonresident, give city of town and State)
months .23 days. In place of residence 47 years months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY.
hat We attended
April 8, 1958
im
April 8, 1958.
, death is said to
10a If married. .. Sweeney
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
75 Years 6
Months 19 Days
If under 24 hours
Hours . Minutes
13 Usual
Occupation :
Physician
(Kind of work done during most of working life)
14 Industry
General Practitioner
15 Social Security No.
014-30-7506-A
East Boston
OTHER
SIGNINGANT COADMARY FARTARy DisCASE.
CONDINONS
unk YRS.
Major findings:
Of operations
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so. specify
M.
D
(Signed)
(ASSt. Dir.Mass . Gen. Hosp. Dax 4-8-58
19
Wt. Auburn Cemetery, Cambridge 6
Place of Burial or Cremation (City or Town)
DATE OP BURIAL
April 12th
1958
7 NAME OF
FUNERAL DIRECTORRichard C. Kirby
ADDRESS 917 Bennington St., E.Boston
Received and filed,
APR 16-1958 .. . 19
....
3 DATE OF
DEATH
April 8, 1958
(Month)
(Day)
(Year)
deceased
from
March 17, 1958
19
West saw h
alive on
3:05pm
m.
have nccurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
PULMONARY Congestion
+ Elena
LINK DAYS
ANTE
CEDENT (b)
CAUSES
RECENT
Myocardial INFARct,
/ no.
(c)
Due To CORONARY Thrombosis
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
John B. Kelly
PARENTS
18 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Elizabeth Little
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
CBL
21
Informant Mrs. Ellen. A. Kelly-wife
(Address)
200 Pleasant St. ,Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health of other) D22043 april10 1958 (Official Designation) Kyate of Issue of Permit)
(
VEV
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burlal permit with Board of Health or its Agent. :1:3295
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(a) Residence. No. (Usual place of abode) Length of stay: In place of death years
NSTRUCTIONS FOR CAL CERTIFICATE
In giving SE OF DEATH o not enter ore than one use for each .). (b) and (e)
his does not mean ode af dying, such failure . asthenia. means the disease. mplscations which death.
orbid conditions. Esting rise to the cause (a) stating nderlying cause 42021 onditions contrib- o the death but not ta the disease or an causing death.
SOM-10-52-908091
(Registrarr)
ATTING LORY ATTEST. Charles A. Mackie City Registrar
AUG 2 71953 PM
X
PLACE OF DEATH
Essex
(County)
(City or town making return)
Registered No.
143
J(If death occurred in a hospital or institution, Danvers State Hospital, Hathorne, Mass st. ( give its NAME instead of street and number)
2 FULL NAME. Evelyn ......... Groan (If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(a) Residence. No.
19 Emerson P.d., Winthrop, Mass.St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ...... ... years. .. months 3 days. In place of residence. ........... years. months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
7Day) 1958
(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.)
Probably coronary thrombosis sudden death
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?
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work? ..... no.
.Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased ?....... }} If so, specify
(Signed) . Ralph G. Rosa M. D.
(Address) Peabody Mass ... Date 7/7/589
7 St. Joseph's Cemetery, . Roxbury Place of Burial, or Cremation. "(City or Town)
DATE OF BURIAL. July 3, 1958 .19
8 NAME OF
FUNERAL DIRECTOR
Richard C. Airby
ADDRESS Zast ..... Boston, .... Mass.
Received and filed AUG .... ................... 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Female
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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.
80
13
AGE
Years
Months.
Days
If under 24 hours
Hours .....
.. Minutes
14 Usual
Occupation:
Nurse -- Retired
(Kind of work done during most of working life)
15 Industry
or Business:
Unknown
16 Social Security No ...
Unknown
17 BIRTHPLACE (City)
(State or country)
Unknown
18 NAME OF FATHER John Green
PARENTS
19 BIRTHPLACE OF
Unknown
FATHER (City).
(State or country)
N.S. , Canada
20 MAIDEN NAME OF MOTHER Unknown
Unknown 21 BIRTHPLACE OF MOTHER (City) (State or country) Unknown
22 Informant (Address)
ilary E. Sheehan
Jass.
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
\
1936
X
1
Danvers
(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
Danvers
R-305
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.) 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
25M-8-56-910227
(Specify type of place)
AUG 1 81958 AM
X
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN
severe SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(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 .... MpbelTorrey ..
(If deceased Is a married, widowed of divorced woman, give also maiden name.)
(a) Residence. No.7. Labde Highland Ave.
(Usual plac
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years. months 76 days. In place of residence 40 years. months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Justh)
18 (Day)
1958
Year)
4 1 HEREBY CERTIFY,
That I attended deceased from!
July 2, 1958, to July
1.8
158
I last saw @r. alive on
July
18.
58,
death is said to
have occurred on the date stated above, at
12:45P .... m.
INTERVAL
BETWEEN
ONSET AND
DEATH
48hrs.
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
Harry Austin Torrey
(or) WIFE
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGB.6.
.... Year ?.
Months3
Days
If under 24 hours
Hours ......
.Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business :
Own home
15 Social Security No ......
none
16 BIRTHPLACE (City) ..... Boston
(State or country)
Massachusetts
17 NAME OF
FATHER
Samuel James Byrne
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Jamaica
(State or country)
West Indies
19 MAIDEN NAME
OF MOTHERAnna Adelaide Adams
20 BIRTIIPLACE OF
MOTHER (City)
(State or country)
U. S. A.
21 Arthur Torry (Address) NI Cliff Ave. Winthrop
A TRUE COPY
ATTEST/
(Registrar of City or Town where death occurred)
DATE FILED
July
24,
58
19.
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
(write the word)
emale
White
10 SINGLE
MARRIED
WIDOWEDidowed
or DIVORCED
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Uremia
(1))
Coronary Heart disease
Atrial Fibrillation
byrs.
Due To
Cerebral vascular
accident
18days
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 James F. Burns, M. D.
M. D.
537 Broadway
Date 7/18
58
Pine Grove Cemetery,
Place of Burial or Cremation
Brunswick, Me.
City or Town)
58
19
DATE OF BURIAL
July
23,
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRES2 74 Winthrop St., Winthrop
Received and filed. 19
25M-8-56-918227
Due To
(c)
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
OTHER
SIGNIFICANT
CONDITIONS
R-302 2. 4 If AVE.
1
No .. Grover Manor Hospital
"{ Byrne )
silinthrop
(Was deceased a
U. S. War Veteran,
if so specify WAR)
%. 10.
(Kind of work done during most of working life)
(Addres
Everett
AUG 1:31950 AM
×
-
Barnstable
(County) Barnstable
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Barnstable
(City or Town making this return)
194
No. (Hyannis ) Cape Cod Hospital
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Alfred William Moore
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
46 Beach
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.........
.. years
months.
days. In place of residence
65
70
15s
13 hrs.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, wideystar Raymond Moore
HUSBAND of
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
65
7
15
AGE
Years
Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
Maintenance
or Business :
15 Social Security No
013-26-4243
16 BIRTHPLACE (City).
Winthrop, Mass.
(State or country)
17 NAME OF
Eli Moore
FATHER
18 BIRTHPLACE OF
FATHER
(City)
Newfoundland
(State or country)
19 MAIDEN NAME
OF MOTHER
Cassie Morrow
20 BIRTHPLACE OF
MOTHER (City).
Prince Edward Island"
(State or country)
21 Emma Moore
Informant
(Address)
46 Beach R d. , Winthrop, Mas
A TRUE COPY
Harvard W. Deane
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
July .. 21
19.58
V.B.V
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, (. L.)
6
Place of Burial or Cremation July 2/fity or Town) 58 DATE OF BURIAL 19
7 NAME OF FUNERAL DIRECTOR Winthrop, Mass.
Howard S. Reynolds
ADDRESS
Quy 27 1955
Received and filed.
(Registrar of City or Town where deceased resided)
INTERVAL BETWEEN ONSET AND DEATH 1 da.
Due To Arteriosclerotic heart
(b)
disease
10
yrs.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
No
Was autopsy performed ?.
What test confirmed diagnosis?
Ekg.
no
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Robert S. Thrope
M. D.
Hyannis, Mass.
Date
7-20-
19.
58
(Address):
Winthrop Com.
Winthrop, Mass.
25M-8-56-916227
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
July
1958
DEATH
(Month)
(Day)
(Year)
4 1 HEREBY CERTIFY
That I attended deceased from
July 20
58
July 20
19
58
19
I last saw
Im
alive on
July 20
158
, death is said to
have occurred on the date stated above, at
7:10p
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial infarction
(a)
PLACE OF DEATH
R-302 1
CERTIFICATE OF DEATH
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
(write the word)
(Give maiden name of wife in full)
Supervisor
PARENTS
11
AUG 271958 AM
-302
1
PLACE OF DEATH
Suffolk
(County) Chelsea
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS TEM COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
446
Registered No.
347
Soldiers' Home Hospital No.
S (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
George Bernard Mackenna
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
249 Washington Ave.
/
Winthrop,
Mass.
if so specify WAR)
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ...
(Us hospital 1 months .. 1 .. Ways. In place of residence .5 years.
.months ...
...... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Aug . 4, 1958
DEATH
(Month)
(Day)
(Year)
HEREBY CERTIFY
That I attended deceased from
4 6/23/
19%
to
1m
8/4/58
19
, death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)Gastro-ontestinal hemorrhage
5 da
Due To
Gastric ulcer
(b)
Due To (c)
OT11ER SIGNIFICANT CONDITIONS
yes
Was autopsy performed?
gross oxam
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
Norman Atkin
(Signed}:
Soldiers'Home
8/5/58
Date
19
(Address); Winthrop Cem. , Winthrop, Mass.
6 Place of Burial or CremationAug. 7 ,1958ity or Town)
19
7 NAME OF
FUNERAL DIETTWood Ave., Winchester, MagsTRUE COPY
ADDRESS
SEP - 1958
19
Received and filed.
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED!
or DIVOREEDdOwed
10a If marrieda ridoged onrings
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
1278 7
23
Months.
.. Days
If under 24 hours
Hours ........ Minutes
13 Usual
Postal Clerk-Retired
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
U.S.Post Office
15 Social Security No ..
none
16 BIRTHPLACE (City) Nova Scotia (State or country)
17 NAME OFJom B. FATHER
PARENTS
18 BIRTHPLACE OF
Nova Scotia
FATHER (City)
(State or country)
19 MAIDEN MAury Lewis OF MOTHER
20 BIRT11PLACE OF
MOTHER (City).
(State or country)
Nova Scotia
21
Hospital Records
Informan91 Crest Ave.,Chelsea
(Address)
DATE OF BURIAL.
Fenton H.Norris
ATTEST:
Joseph a. Tyrrell
Registrar of City or Town where death occurred)
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