USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 60
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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 niedical 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
.....
R-303
1
PLACE OF DEATH
Suffich (anty ) Borta (City or Town) tu to Mass. General Hospital:
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed lor burial permit with Board of Health' or Its Agent. 159
15
Registered No.
01614
f(If death occurred in a hospital or institution, St. Į give its NAME instead of street and nuniber)
2 FULL NAME
Lio W.
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
{if to specify WAR)
No
(If deceased is a married, widowed or divorced weigh, give also inaiden name.).
70 Unaspect dave Winthe
(If nonresident
give city or town and State)
Length of stay : In place of death ..
monthsdays. In place of residence.I.
.. year .........
.month‹
... days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
IO COLOR OR RACE
White
It SINGLE
MARRIED
WIDOWED Married
or DIVORCED
lla Hf married, widowed, or divorce hnn Vasconcellos
HUSBAND of
((iive maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 27
Year«
Months.
Days
If under 24 hour«
.Hours .......... Minutes
14 Usual
Occupation :
Asst .... Purchasing .... Agent
(Kind of work done during most of working life)
15 Industry
or Business :
Wahn .. Co.
16 Social Security No.
017-22-7422
17 BIRTHPLACE (City)
(State or country)
Mass.
Boston
-
IR NAME OF
FATHER
Edmund Clifford
19 BIRTHPLACE OF
FATHER (City)
Boston,
(State or country)
Mass.
20 MAIDEN NAME
OF MOTHER
Margaret Whitney
21 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass.
Ann Clifford
22
Informant
(Adlılre")
70 Prospect Ave. Winthrop
I HERERY CERTIFY that a satisfactory standard certificate of death way hled wy me BEFORE the/burial ur transit perinit was issued :
C
(Signature of Agent of Board of Health of other) 6-3-08
22511
(Official Designation]
(Date of Issue of Permit)
(a) Residence. No.
(U'qual place of abode)
JEDICAL CERTIFICATE OF DEATHI
May
3 DATE OF
DEATH
S Accident, suicide, or homicide (specify
(Specily type of place)
Manner
(Address)
U deceased was a U. S. War Veteran. G.L. Chap. 16, Section 10, requires physicians to insert a recital to that effect.
of Death. See reverse side for extracts from the laws relative to the return of certificatea of death.
DEATH in plain terms, so that It may be properly classified under the International Classification of Causes
Information should be carefully supplied, MEDICAL EXAMINERS should state CAUSE AND MANNER OF
25M -8.57.930750
Y. J .- WRITE PLAINLY, WITH UNFADING BLACK INX-THIS IS A PERMANENT RECORD. Every item of
While at work ?
Was antopsy performed ?
1958
Month)
(Day)
(Year)
4I 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
SAULL
AND LACERATION OF
BRAIN
Date and hour of injury
5/2 1758
Where did
Injury occur ?
(City of town and State)
Did injury occur in qr afruit home, on farm, in inglustrial place, or in
Revere
Mars
public place ?
Public highway
Injury
"Operator al motor car
Injury_occur ? )
Nature is which collided with partial tras
Injury
(Signg)
hunhad / house
M. D.
1058
5%
Malden
7 Holy Cross
l'lace of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
May 5,
19 58
A NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS912 ..... Bennington St.E.Boston
MAY - 8 1958
12
Received any! Charles H. Mackie (Registrar)
PARENTS
6 War disease or injury in any way relased in occupation of deceased?
58
(write the word)
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
SEP 1 71958 AM
R-301A
1
PLACE OF DEATH
Suffolk
SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial .permit with Board of Health or Its Agent. 150
Registered No.
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number) No.
2 FULL NAME
winmnewood Hospital John W Fielding (If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
-
(a) Residence.
No.
62 Washington Avenue ..... Winthrop, sMass.
(Usual place of abode)
" nonresident, give city or town and State)
Length of stay: In place of death years
months 11 days.
In place of residence
2 5cars
. months ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month)
(Day)
( Year)
4|HEREBY CERTIPY.
That I attended deceased from
Aug. 10, ...
19
57.to
May 7,
..
19
I last saw him alive on
5/6/58
19
death is said to
(or) WIFE of
have occurred on the date stated above, at
3:45 Am.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATII (a)
Carcinoma of lungs
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c) .
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
carcinoma of lungs
Of operations
s. GenIlDate of operation
1957
W'as autopsy performed? no
W'hat test confirmed diagnosis?
biopsy
S T'as disease or injury in any way related to occupation of deceased? .
NO
n no. specify,
(Signed)
(Address)
pratat . M. D. 16 dailylau ss Date 0 5/7 1953
Winthrop Cemetery Winthrop, Td19 88. DATE OF BURIAL
May 10.1958
, NAME OF
FUNERAL DIRECTOR
Celpred B. March
ADDRESS 174 Winthrop St. Winthrop 1888.
Received and filed
12 1958 .19 .... Charl & Znakom
10a If married. widowed, or divorced
HUSBAND of
Grace
Evelyn Fielding
(Give maiden name of wife in fully
(Husband's name in full)
11 IP STILLBORN, enter that fact here.
12
AGE9
Years 10 Months 18 Days
If under 24 hours
Hours . Minutes
13 Usual
Occupation :..
Town Assessor
(Kind of work done during most of working life)
14 Industry
or Business:
Tomm of Winthrop
15 Social Security No. .
16 BIRTHPLACE (City) East Boston,
(State or country)
Mass
17 NAME OF
FATIIER
William Henry Fielding
PARENTS
18 BIRTIIPLACE OF
PATHER (City)
(State of country)
England
19 MAIDEN NAME
OF MOTHER
Mary Jane Driscoll
20 BIRTHPLACE OF
MOTIIER (City)
East ... Boston
(State or country)
Mass
21 Informant L'r8. .... Peter .R. ... Tatro (Addre")Box 14 Myrtle Pensacola Fla. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BBRORE the burial or transit permit was issued: it Meade
(Signature of Agent of Board of Health or other)
7649
5-8-0)
(Oficial Designation) (Date of Issue of Permit)
CTIONS R RTIFICATE ing DEATH enter in one reach and (c)
dying. such e. asthenia. the disease. ions which
conditions. rise to the (a) stating
rath but not disease or sing death.
163
SOH- 10-32-900091
7.58
The Commonwealth of Massachusetts EDWARD J. CRONIN OITT - OF - TOWN
3 DATE OF
DEATH
5
58
7.
Widowed
58
Charles it Mack. City Regist
SEP 1 71958 AM
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
OUT - OF - TOWN
To be filed for burial permit with Board of Health of Ita Agent.1 51
2 FULL NAME
Frank Cartwright
(If deceased is a married, widowed or divorced woman, give also maiden name.) 145 Cliff Ave.
(a) Residence.
No.
(Usual place of abode)
Length of stay: In place of death
years
months
days. In place of residence
PERSONAL AND STATISTICAL. PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
10a If married,
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
62 Years
Months
. Days
If under 24 hours
.Ilours_
Minutes
13 Vanal
Occupation :
Broker
(Kind of work done during most of working life)
14 Industry
or Business:
Real Estate
15 Social Security No.
16 BIRTIIPLACE (City)
(State or country)
Everett
OTHER
SIGNIFICANT
Ca. of esophagus
CONDITIONS
? 4 mos .
Was autopsy performed ?.
NO
What test confirmed diagnosis ?. CLINICAL
5 W'as disease or. injury in any way related to occupation of deceased ?.
If so, specily
(Signed)
(Address) Anat. Dir. Maas. Gen'l Hoap.
Date
. M. D.
,58
Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL May_29 1958
19
7 NAMF. OF
FUNERAL DIRECTOR
Ernest P Caggiano
ADDRESS
147 Winthrop St_Winthrop
JUN -2 1958 _19
Haveband filed
Charles H. Mackie
PARENTS .
17 NAME OF
FATHER
John Martin Cartwright
18 BIRTHPLACE OF
FATIIER (City)
St. John
(State or country)
New Brunswick
19 MAIDEN NAME
OF MOTHIER
Leonora W. Shea
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cardiff
Wales
21 Leonora Martin
Informant
(Address)
145 Cliff Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was flet pib me BEFORE the burial or transit permit was issued: Meade (Signature of Agent of Board of Health or other)
7911
5-27-58
(Official Designation) (Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than ona for each (b) and (c)
ort not mean 01 heart failure. tr. It means r. of compli- which .
eve rise to (.). 1hr
last.
low contrib .- frath but not the criminal «dition firm
Chapter 137, 954, requires as ta print ar · cause er of death on tificatos.
SOM-3-37-920345
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEAT11
May
(Month)
26
(1)ay)
1958
(Year)
58"
We last sawh -
Imlive on
May
19 .
to
26
:
19.
58
death is said to
10:56a.
have occurred on the date stated above, at m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Bilateral broncho-pneumonia
Due To (b) ...
Due To (c)
INTERVAL BETWEEN ONSET AND DEATH 2 wks .
4 I HEREBY CERTIFY.
May
21
58
May
Thatwas attended deceased from
26
Trehe Mor
yorceMorris
if so specily WAR)
St
Winthrop,
Mass.
(If nonresident, give city or town and State)
5.
years ....
-. months
. days.
MASSACHUSETTS GENERAL HOSPITAL
No.
CERTIFICATE OF DEATH
Registered No.
4525
f(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
no
. 19
-
May 26
- 58
IR-301A 1
Carlos # Mackie C'ir Registrar
SEP 2 91950 KM
X
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Mansarlpinette OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burtal permit with Board of Health = ) or its Agent.
Veterans Administration Hospital
No ..
J(If death necurred in a hospital or institution, St. [give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Kenneth R. SPINNEY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
13 Edward Street
Winthrop,
Massachusetts
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
O years 0
months
7
days In place of residence
months
daya.
MEDICAL CERTIFICATE OF DEATII
PERSONAL AND STATISTICAL PARTICULARS
& SEX Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCED
Married
Boa If married, widowed, or divorced
HUSBAND of
Helen A. Kenney
(Give maiden name of wife in full)
(or) WIFE of (Inshand's name in full)
1) IF STILLHORN, enter that fact here.
12
AGE.47
Years
4 Months 15Days
If under 24 hours
Hours -
Minutes
13 Visual
Occupation :
Veterans Agent
(Kind of work done during most of working life)
14 Industry
or Itusiness :
V.A. (Town of Winthrop)
13 Social Security No.
017-12-8075
Somerville
OTHER
SIGNIFICANT
CONDITIONS
Was autopay performed'
Yes.
What test confirmed diagnosis'
Autopsy & Clinical
fintings.
S Was disease or injury in any way related to occupation of deceased ? NO If an, specify
Selvyn Bleiler
(Signed).
Selvyn Bleifer, M.D.
. M. D.
(Address) VAH, Boston, Lass. Date May 26 19 58
6 Mass. Place nt Rur ninthpop Cemetery, Winthroog or Town) DATE OF BURIAL May_29 19 58
7 NAME. OF FUNERAL DIRECTOR Howard S. Reynolds ADDRESS 180 Winthropggfs., Winthrop, Mass
Received Charles H. Mackie
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATIIF.R fCity)
Somerville
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Jennie L. Dogherty
n BIRTHPLACE OF
MOTHER (City)
(State or country)
Cambridge Massachusetts
21
Informant
V.A. Hospital Records, 150 So.
(Address) Huntington Ave., Boston, Mass.
HEREBY CERTIFY that ITatisfactory standardTertificote of death filed AIth me BEFORE the burial or tranut yofmit was issued : machdonald
(Signature of Agent of Board of Health or other)
2938 5-28-18
(Offiefal Designation) (Date of Issue of Permit)
L
67 750 32 32
CTIONS R ERTIFICATE ving DEATH enter an one or each ) and (c)
at dring. art facture.
. rise to (.).
ne lot
65
ark bat oot he Irrminal
apter 137. 4, requires to print or cause .f death .. Icates.
SOM-11-56010070
3 DATE OF
DEATH
May
(Month)
26
(Day)
1958
VA
(Year)
That I attended deceased from
. 19 58
XXXXXXXXXXXXX death is said to have occurred on the date stated above, at 2:10 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) . 1. Pulmonary embolism and thrombosis, bilateral.
trxk 2. Obesity, familiar (385 1bs
3. Essential_hypertension,
moderate, with cardiac
hypertrophy (600-grama)
INTERVAL BETWEEN ONSET AND DEATH
Days.
.Years
Years
16 BIRTIIPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Chester Spinney
WW II
U. S. War Veteran, if so specify WAR)
(a) Residence. No.
(('sual place of ahode)
(Was deceased a
Registered No26:
4THEREBY CERTIFY,
May 19
. 19
58. in
·
May 26
nr rompli-
R-301A -
A TRUE COPY ATTESTS Charles it Macke. City Registrar
SEP 1 91950 /H
+ PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN OUT SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
OF - TOWN
To be filed for burlal permit with Board of Health or 11s Agent.11.03
Registered No ..
05585
Peter Bent Brigham Hospital No. ...
George
2 FULL NAME ..
Leonard Conant
(II deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a U. S. War Veteran, il ao specify WAR)
W.W.1.
(a) Residence, No ..
25 Villa Avenue
(Usual place ni abode )
Winthrop,
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
years _ ...
month 20
days. In place nf residence 25years
.... months ..... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Jüno
Day)
1958
Year)
4 WOHEREBY CERTIFY.
ThatWattended deceased from
May
12 . 158 .. .. Juno
1
19 58
Wolast saw hilalive on
Juno
1
. 19.58, death is said to
have occurred on the date stated above, at11:00 do m.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ONSET AND
DEATH
(a)
Myocardial infarction
(b) . Coronary atherosclerosis
Due To
(c) .- Bronchopneumonia
OTHER
SIGNIFICANT
Acute ulcer_of_duo-
CONDITIONS
demim, peptia
Was autopsy performed ?..
What test confirmed diagnosis?
Autopsy
Yes
$ Was disease or injury in any way related fo occupation of deceased ?.. 11 so, specify -.
(Signed)
Victoria Can
, M. D.
(Address)
P. Bent_Brigham HospDate June
1, 19 58
6 Mount Auburn Cemetery, Cambridge, Place of Turial or Cremation
DATE OF BURIAL
Juno- 19587
7 NAME OF
Wilfred B. March
FUNERAL DIRECTOR
ADDRESS 174- Winthrop Jtwinthrop, Mass. 10,1958
Rowery and Bled Charles H Mache 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
"Thite
10 SINGLE
(write the word)
MARRIED
Married
WIDOWED
or DIVORCED
1da It married, widowed, or divorced
HUSHIAND of
Irono Wheeler
(Give manifen name
(or) WIFE nl
(Husband's name in full)
11 IF STILLBORN, enter that Iaet here.
12
AGE_63Years 11Month 27 Days
If under 24 hours
-
. Ilours ... Minutes
13 Usual
Occupation :
5 years sal CAM's Ine during most of working life )
14 Industry
or Business Electrical supplies
15 Social Security Nn. 010-09-6223
(State or country)
16 BIRTHPLACE (City)
-
Auburn
Laine
PARENTS
17 NAME OF
FATIIER
Frank Clarko Conant
18 BIRTIIPLACE OF
FATIIER (City)
Charlestom
(State or country)
Mass.
19 MAIDEN NAME OF MOTHER
20 BIRTIIPLACE OF
Eva May Laughton
MOTHER (City)
Solon
Masfflate or country)
Maino
·21
Informant
(Address)
Mrs. Leonard G. Conant
I HEREBY CERTI Y HA4 .AY.A., W.hAlla HABte of death was filed with me BEFORE the burial nr transit permit was issued : MU Hame
(Hgnature of Agent ol Hloard of lleaith or other)
80251
6.4-SV
(Official Designation) (Date of Issue of Permit)
.
R-301A 1
ICTIONS OR CERTIFICATE Hring OF DEATH t enter han one for each ·) and (c)
of dying. part failure.
· of compli- Aich
t'a rise to (€). the
last.
4/201
rath but not the preminel dition girm
Chapter 137. 154, requires s to print or cause er death on Ilacales.
SOM-5-57-020345
17.58
f(II death occurred in a hospital or institution, St.[give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
(Month)
3 weeks
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
6
SEP 1 '71958 AM
PLACE OF DEATH
SUFFOLK
(County)
BOSTON (City or Town)
The Commonwealth of Massachu EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or Its Agents 1556+ 101
Registered No.
No. Suffolk Downs Clubhouse
[(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN --- IMPORTANT
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 70 Edgehill Road, Winthrop
Length of stay : In place of death .. .......... years ... .months .. ....... days. In place of residence 35 (If nonresident, give city or town and State)
.... years ........... months ............ days.
MEDICAL. CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
white
11 SINGLE
MARRIED
(write the word)
or DIVORCED
Ila If married, widowed, or durced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
12 IF STILLHORN, enter that fact here.
13 AGES. 7.Years. 6 Months 2 „Days
If under 24 hours .Hours .......... Minutes
14 Usual
Occupation :
acementand
(Kind of work done during most of working life)
15 Industry
or Business :
Joe Consultant
16 Social Security No. 033-14-8604
17 BIRTHPLACE (City)
(State or country)
18 NAME OF FATHER Eduard Donahue
19 BIRTHPLACE OF
FATHER (City)
(State or country)
20 MAIDEN NAME OF MOTHER
many arthur
21 BIRTHPLACE OF MOTHIER (City) (State or country)
22 Informan ( Addres 70 Be In Donahue
I HERENY CERTIFY that a satisfactory 'standard certificate of death was hled with me IEFORE the burialor transit permit was issued :
ADDRESS 158 Woman Que Whitman
Dreiyal and filed Charles 21 Inacka 1958
(Registrar)
PARENTS
Many M. D
/6/5/ 158
Minithis town Sam Worthing Place of Ilurial, or Cremation.
(City of Town)
DATE OF NURIAL June 9 1050
R NAME OF
25M. 8. 57.930750
1
-303 A 10.1
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
(\'snal place of atxxle) 3 DATE OF DEATH (Month) (Day) 5 Accident, suicide, or homicide (specify) Date and hour of injury Where did Injury occur ? public place ? (Specify type of place) Manner of Naire of lojury While It work? If %. ( Address) Boston ...... ..... If deceased was a U. S. War Veteran, C.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. Injury (How did injury occur?)
June 5 1958
(Year)
4I 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.)
CORONARY OCCLUSION ACUTE MYOCARDIAL INFARCTION
OUT - OF - TOWN
2 FULL NAME
WALTER H. DONAHUE
(Was accented a
U. S. War Veteran,
if so specify WARY WW I
St.
n. (Vendi)
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
B Wies disguise or a jury in any way related meetupation of deceased?
58
YSignafure of Agent of Board of Health or other) DO3207 June 1 1958 (Official Designation) ( Date of Issue of Permit)
A TRUE COPY ATTEST: Charles it Mackie City Registrar
SEP 1 71958 AM
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
"- OF - TOVRI
To be filed for burlal permit with Board of Health.5 or Its Agent.
85688
Peter Bent Brigham Hospital
No. Mrs. Fannie Levitan (If deceased if a married, widowed or divorced woman, give also maiden name.)
[(If death occurred in a hospital or institution,
St. [Rive its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(a) Residence. No ...
149 Locust
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
......
years
months
11
days. In place of residence
32years
months
daya.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
10
1958
(Month)
(Day)
(Year)
Ha HEREBY CERTIFY.
That Dattended deceased from
May 31
1958. 10
June
10
1958
WO last saw heralive on
June
10
. 19 58
10a If married, widowed, nr divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Israel J.Levitan
(Ilushand's name in full)
II IF STILLBORN, enter that fact here.
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