USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 92
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12
AGE 60 Years ... 7 Months 12 Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation:
Salosman
(Kind of work done during most of working life)
14 Industry
or Business:
Advertising
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Masachudotta
17 NAME OF
FATHER
Henry Mitting
18 BIRTHPLACE OF
FATHER (City)
Groenfield
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Julia M. Costello
20 BIRTHPLACE OF
Fitchburg
MOTHER (City)
(State or country)
Massachusetts
21
Informant
VA. Homital Records
(Address) 150 So. Huntington Avc. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Cx Mariano E15196 (Signature of Agent of Board of Health or other) nov 24.58 -
(Official Designation) (Date of Issue of Permit)
X
-301A 29 492 2 5
TIONS 1 TIFICATE
ing DEATH enter n one reach and (c)
mot .... of dying, rt failure, It means or compli- & caused
if any. rise to («). under- e last.
contrib. h but not terminal tion given
spter 137, , requires o print or cause or death on cs tes.
2
1959
60M-1-58-921876
OUT
OF - TOUT To be filed for burial permit with Board of Health or its Agent. , ....
Veterans Administration Hospital
S(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
INTERVAL BETWEEN ONSET AND DEATH months
years
Fitchburg
PARENTS
25
A TELE COPY ATT L.
GE R. Lar
SECELE
FEB -21959 MM
403 214 144 268 -30LA
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
OUT - OF - TOWN
To be fled for burial permit with Board of Health or its Agent.
Registered No.
11094
St. (give its NAME instead of street and number) -
2 FULL NAME
Frederick W. DREI
(If deceased is a married, widowed or divorced woman, give also maiden name.)
-
U. S. War Veteran,
if so specify WAR) MY I
(a) Residence.
No.
106 Bellevue Avenue
St. Winthrop, Mass
(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 OF
DEATH
November
26
1958
(Month)
(Day)
NA
(Year)
4 I HEREBY CERTIFY. That attended deceased from
November 24, 1958, to November 26
19.5.8
XXXXXXXXXX death is said to
have occurred on the date stated above, at
5:55 P.m.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
65Years
11Months ... 29Days
If under 24 hours
___ Hours _._ Minutes
13 Usual
Occupation :
Guard
(Kind of work done during most of working life)
14 Industry
or Business:
Merchants National Bank
15 Social Security No. 029-05-9772
16 BIRTHPLACE (City) East_Boston
(State or country)
Massachusetts
17 NAME OF
FATHER
Fred D. Drew
18 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Nellio E. Knowlton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lino
Rockland
. Winthrop Como tory
Place of Burial or Cremation
(City or Town)
Winthrop
DATE OF BURIAL
November 29
19 58
7 NAME OF
FUNERAL DIRECTOR Reynolds Funeral Home
ADDRESS
180 Winthrop St. ,Winthrop, Mass.
DEC - 2 1358
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
Legal
WIDOWED
or DIVORCEDSeparation
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Acute antero-septal and posterior
(a) myocardial infarctiong due to --
total occlusion of left and right
coronary artery.
(b) 2.Severe emphysema of lungs.
3.Sovere congestion and edema
Due To of lungs.
(c)
days
years
years
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis?
Autopay
S Was disease or injury in any way related to occupation of deceased ?. No
If so, specify
peci Paul JKelleran
(Signed).
Paul J. Sålloran
M. D.
(Address) VA Hospital, Boston Date .Nov. 27_1958
PARENTS
21
Informant
VA Hospital Records
(Address)150 So. Huntington Ave, Boston
I HEREBY CERTIFY that - satisfactory standard certificate of death as filed with me BEFOU. the burial or transit permit was issued:
(Signature of Agent of Board of Health or other) 6219 (Official Dengnation)
(Date of Issue of Permit)
1.B. v
TIONS
TIFICATE
ing DEATH enter . ... each and (c)
of dying, rt failure, compli- ceused
1
eny, rise to (.), last.
contrib. Å but not terminal
pter 137. requires o print er cause er death .. cates.
JOM-1-58-921876
1959
Received and filed ... Charles it.
No.
Veterans Administration Hospital
[(If death occurred in a hospital or institution,
PHYSICIAN -- IMPORTANT
(Was deceased a
(Usual place of abode)
A TEIC POPY ATTEST:
Mackie Og Reestrar
RECEIVED
TO
OF
11.12
--
1
in
FEB - 21959 AM
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. L.)
(a) Residence. No.
42 Irwin
(Usual place of abode)
3 DATE OF
DEATH
Nov.28,
158
(a)
c extensive Metastases
Due To
(b)
Due To
(c)
ASHD C Cong. Failure
Was autopsy performed?
vos.
What test confirmed diagnosis ?
DATE OF BURIAL
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
CONDITIONS
G I Hemorrhage
Dec. 2, 1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
to
Dec. 2, 1958
19
I last saw h ... ]Malive on
Dec. 2, 1958, 19, death is said to
have occurred on the date stated above, at
12:05 Pm.
INTERVAL BETWEEN ONSET AND DEATH
? 4 mos
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED Widowed
or DIVORCED
10a If married, widowed, or divorced Rose Butler
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 74 Years.
.Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Retired Painter
Occupation :
(Kind of work done during most of working life)
14 industry
House Painter
or Business:
15 Social Security No ...
021-07-8930
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Samuel David Dorris
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Unknown
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Sarah Rebecca (C.N.B.L.)
Unknown
20 BIRTIIPLACE OF
MOTHER (City)
(State or country)
Russia
21 Alexander Dorris
Informant
(Address)
27 Ardmore Rd., West Newton
7 NAME OF
Torf Funeral Service Inc
FUNERAL DIRECTOR
151 Washinton Ave., Chelsea
ADDRESS
Received and filed. 1-13-59 19
25M-0-56-918227
PLACE OF DEATH -
MIDDLESEX
(County) NEWTON
(City or Town)
Newton Wellesley Hospital No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
NEWTON
(City or Town making this return)
Registered No.
713 270
§ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Charles Dorris
(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
Winthrop, Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death.
........... years.
.. months.
5
days. In place of residence
.years.
months.
.days.
16
. MEDICAL CERTIFICATE OF DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Carcinoma of Prostate
OTHER
SIGNIFICANTGastric Ulcer c Massive
?
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify. No
(Signed)
Diane Johnson
M. D.
(Address)
N.W.H.
Date
Dec. 2, 19.58
6
Onichty .... Cemetery
Melrose
Place of Burial or Cremation (City or Town)
Dec. 4, 1958 19
A TRUE COPY
Monte M. Babos
ATTEST:
(Registrar of City or Town where death occurred )
DATE FILED
Dec. 8, 1958
19.
V.BV
R-302 1
(Registrar of City or Town where deceased resided)
(write the word)
RECEIVED
; L.i.
6
JAN 1 31959 AM
PLACE OF DEATH
SurTUL
(County)
Boston (City or 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 filed for burial permit with Board of Health or Its Agent& r
No. Veterans Administration Hospital
2 FULL NAME
Eugene B. LiNCn
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
41 Cutler
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ..____ years.
months_23 days. In place of residence.
H
_months.
.__. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
3
1958
(Month)
(Day)
IVA
(Year)
4 I HEREBY CERTIFY. Thatattended deceased from
November 10 19 58
to
December 3
19.58
XXXXXXXXdeath is said to
have occurred on the date stated above, at
12:35Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Recent anteroseptal myocardial
infarction
INTERVAL
BETWEEN
ONSET AND
DEATH
Weeks
Due To
Atherosclerotic coromary
(b)
thrombosis
Weeks
Due To
Carcinoma of the esophagus
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Yes
Autopsy & Clinical
What test confirmed diagnosis ?.... findings
5 Was disease or injury in any way related to occupation of deceased ?. no
If so, specify
(Signed).
, M. D.
(Address)
VAH Boston, Mass.
Date 12-4-1958
Holy Cross Cemetery, L'alden, Mass, Place of Burial or Cremation (City or Town)
DATE OF BURIAL December 6 1958
7 NAME OF
FUNERAL DIRECTOR
John Sawyer
ADDRESS329 Bunker Hill St.Charlestown Mass
Received and filed
DEC - 9,95 Charles & Iacute .
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
10a If married, widowed, or divorsed H. Cunning
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
65 Years
10
Months
12 Days
If under 24 hours
Hours __ Minutes
13 Usual
Occupation :
Postal Worker
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
031-28-5968
Boston
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Michael Lynch
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Iroland
County Cork
19 MAIDEN NAME
OF MOTHIER
Bridget Brannigan
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Iroland
21
Informant
VA Hospital Records, 150 So.
(Address) Huntington Ave. , Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : A Meads (Signature of Agent of Board of Health or other) 3.44 12-5-18
(Official Designation)
(Date of Issue of Permit)
X
-301A 1
ICH3
TIFICATE
DEATH ater
each and (c)
/ dying, t failure,
r compli-
15 if dry, rise to (.). last.
contrib .- > but not terminal ion given
pter 137, requires o print or cause death on cates.
PARENTS
Registered No.1-1-360
[(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,
if so specify WAR)
WW I
(Usual place of abode)
50M- 1-58-921876
City Reastrar
RECEIVED
11 12
701
9.
8
.0
FEB - 21959 AM
.302 1
PLACE OF DEATH
Suffolk
(County) Chelsea
(City or Town)
CERTIFICATE OF DEATH
Registered No.
626
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Joseph J. Murray
(If deceased is a married, widowed or divorced woman, give also maiden name.)
49 Pebble Ave.
/ Winthrop, Mass.
(Was deceased a
U. S. War Veteran,
WWII
if so specify WAR)
(If nonresident, give city or town and State)
Length of stay: In place of death. .-.... years.
.months. 1
.days. In place of residence ............ years. months. ... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWEDarried or DIVORCED
10a If married,
HUSBAND of
HoTon surlivan
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
37
1
AGE
Years
Months
5
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business
American Airlines
15 Social Security No.
018-18-6632
16 BIRTHPLACE (City).
(State or country)
Brighton, Lass
17 NAME OF
FATHER
Terrence
PARENTS
18 BIRTHPLACE OF FATHER (City) ..... Boston ,Mass. (State or country)
19 MAIDEN NAME OF MOTHER cannot be learned
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
21 Hospital Records
Informant
(Address)
ATTEST:
Joseph a Terrell
(Registrar of City or Town where death occurred)
Received and filed.
1-15-59
19
(Registrar of City or Town where deceased resided)
3 yrs.
OTHER
Chronic glomerulonephritis
12 yrse
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
M. D.
(Signed).
Soldiers' Home
Date.
12/4/58
19
(Address) Winthrop Cem. , Winthrop, Mass.
Place of Burial or CremationDec . 6, 1958ity or Town) DATE OF BURIAL .. John F. O Maley
19
5011.11.55.916145
2 FULL NAME (a) Residence. No. (hobbitfalde) 3 DATE OF DEATH (Month) Im 19 to .. have occurred on the date stated above, at (b) "disease Due To (c) SIGNIFICANT CONDITIONS Was autopsy performed ?.. What test confirmed diagnosis? L.Lowenstein 6 7 NAME OF resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, (i. 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 yes
MEDICAL CERTIFICATE OF DEATH
Dec.3,1958
(Day)
(Year)
4 I HEREBY CERTIFY,
Dec .3
58
Dec.3
That I attended deceased from
58
I last saw h .
alive on
Doc.3,
1958
death is said to
6:22р.
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Pontine hemorrhage
Due To Hypertensive vascular
INTERVAL BETWEEN ONSET AND DEATH
12 hrs
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Chelsea
(City or Town making this return)
Soldiers' Home Hospital
No.
FUNERAL 7OREAtlantic St. , Winthrop, Lass TRUE COPY ADDRESS
DATE FILED
Dec. 4,1958
.. 19
V. B.
Clerk
19
RECEIVED
, L
JAN 1 9 1053 MM
ENTERED
8/28/40
DISCHARGED
8/21/45
RANK
Pvt.
OUTFIT
Inf.R.A.
SERVICE NO. 1100 3032
. 122
R.302
1
PLACE OF DEATH
Essex
(County) Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(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 Joseph LaRoche
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... 22 Shore Rd., Winthrop, Mass.
St
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ...
9 months ...
4days. In place of residence.
......... years ............ months ............ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Dec ..
5:
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY That I attended deceased from March 1, 58 Dec. 5, 19. to ..
19 58
I last saw h ...
IfWe on
"Dec. 5,, 19 58,
death is said to
have occurred on the date stated above, at
8:20 a.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic Ht.
INTERVAL BETWEEN ONSET AND DEATH
yrs.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEDidowed
or DIVORCED
(write the word)
10a If married, widowed, of divorsedlaski
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Years
12
17.62
8
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 .. 001-10-82 -88
16 BIRTHPLACE (City)
Biddeford, Me.
(State or country)
17 NAME OF
FATHER
John B. LaRoche
18 BIRTHPLACE OF
Unk.
FATHER (City).
(State or country)
Canada
19 MAIDEN NAME
OF MOTHI
Pamala Evanturel
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Unk
Canada
St. James Cemetery, Manchester 6 Place of Burial or Cremation JEc. 8, 1958ity or Town) Conn
DATE OF BURIAL 19
Arthur J. O'Haley
7 NAME OF
FUNERAL DIRECTOR
....... inthrop, Mass.
ADDRESS
Received and filed.
JAN 23 MMOL
19
(Registrar of City or Town where deceased resided)
PARENTS
1. 21
Mary E.
Sheehan
Informant
(Address)
Hathorne, Mas ..
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Dec. 5, 1958
19
X
25M-2-50-922072
yrs.
SIGNIFICANT
CONDITIONS
no
Was autopsy performed?
Clinical&Laboratory
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? If so, specify ..
(Signed)
Andrew Nichols, III
M. D.
(Address) Hathorne Mass
.Date ..
12/5/58
Due To (h)) (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 Due To
1
Danvers State Hospital
No.
(Was deceased a
U. S. War Veteran,
no
if so specify WAR)
(Usual place of abode)
(a)
Disease
Machinist - Retired
OTHER
Bronchial Asthma
RECEIVED
.E. On
11 12
1.
GLE
JAN 2 31959 AM
×
Middlesex
(County) Cambridre
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambri La
(City or Town making this return)
Registered No.
1764
"(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Edmund J. Barry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
& Mgehill pd.
(Usual place of abode)
6
months.
.days. In place of residence.
.months.
.. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED idowed
10a If married, widowed, or divorced Brid et Sheehan
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 ............ Days
If under 24 hours
Hours ........ Minutes
13 Usual
Rotail Cionk
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Grocery
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Richard
. Ferry
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary Flynn
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Ireland
21 Informant y nine Barry
(Address) O
n111 [ Inthron
A TRUE COPY
Frederick st. Kisine
ATTEST:
(Registrar of City or Town where death occurred)
Dec. 9,
19.58
(Registrar of City or Town where deceased resided)
...........
St ...
inthrop
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Dec. 7, 1958
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Dec. 22.
54
19
to ...
Dec. 7 3a
53
19.
I last saw h ....... alive on
,OC. (, 19 50
death is said to
have occurred on the date stated above, at
3:10am
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arnon.1 Arteriosclerosis
(a)
Due To
Sorility
(b))
INTERVAL BETWEEN ONSET AND DEATH
?
?
OTHER
benign Prostatic Hypor-
SIGNIFICANT CONDITIONS
tro Ry
?
Was autopsy performed?
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed) ... 7 17
Francis D. Peters
M. D.
Somerville Date 12/7/ 1953
Holy Cross- vel. ualden
Place of Burial or Cremation december 10, 1,5G
DATE OF BURIAL
Maurice ". inhy
7 NAME OF FUNERAL DIRECTOR 210 inthrop "t. int
ADDRESS
Received and filed. SAN 12 1959 19
(City or Town)
25M-8-56-918227
6 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) 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
R-302 1
PLACE OF DEATH
7 Chester
No.
2 FULL NAME
Iwas deceased a U. S. War Veteran, if so specify WAR)
No
3 Years
DATE FILED
V. BV
PARENTS
JAN 1 2 1059 AM
7
PLACE OF DEATH
Suffolk (County)
1
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 or Its Agenti & rsa 5
Veterans Administration Hospital No.
2 FULL NAME
Julius DE LEVA
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No. ....
1050 Shirley
St.
Winthrop,
Massachusetts
(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 10 years .. ....... .. months ... _ days.
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
8 SEX
Male
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
4 I HEREBY CERTIFY,
That Latrended deceased from
December12, 19 58, to
December 14,
. 19 58
10a If married, widowed, or divorced,
IIUSBAND of
Kathryn Pulsifer
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 67 Years
6
Months 4
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Postal Carrier (Rotired)
(Kind of work done during most of working life)
14 Industry
or Business :
U.S. Government
15 Social Security No ...
CEBL
16 BIRTHPLACE (City)
(State or country)
ELONY NAPLES
ITALY
17 NAME OF
FATIIER
Antonio De Leva
18 BIRTHPLACE OF
FATIIER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Ernestine Palma
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
Italy
21
Informant
VA Hospital Records
(Address150 S. Huntington Avo., Boston
I HEREBY CERTIFV that a satisfactory standard certificate of death was Hed with me BEFORE the burial or transit permit was issued : et miada (Signature of Agent of Board of Health or other)
12-17-08
(Official Designation)
(Date of Issue of l'ernut)
V
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
14.
1958
(Month)
(Day)
(Year)
XxxxxxxxxxxxxxxxXXXXXXXXXXXXXXXXXXXXXXXX death is said to
have occurred on the date stated above, at
12:40 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral vascular accident
INTERVAL BETWEEN ONSET AND DEATH
2 Days
Due To
Thrombosis of major cerebral
(b)
vessel ? basilar.
2 Days
Years
Years Years
Was autopsy performed
No
What test confirmed diagnosis ?_.
Clinical & laboratory
indings
5 Was disease or injury in any way related to occupation of deceased ?No If so, specify
(Signed).
J.F. Katz
, M. D.
(Address)
YAH, Boston, Lass.Date.
12-14-
. 19.58
6
Winthrop Cemetery Hint rop, lass,
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December _17
1558
7 NAME OF
FUNERAL DIRECTOR
Alfred B. larsh
ADDRESS 174 Winthrop St. , Winthrop, Mass
DEC 1 5 1958
Received and filed
(Registrar). A4:
PARENTS
CERTIFICATE OF DEATH
Registered No.
11812
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,
if so specify WAR) ...... MY I
UCTIONS FOR CERTIFICATE gIvIng OF DEATH ot enter than one for each b) and (c)
des nat mean af dying, heart failure, tc. It means . ar campli. which caused
352 u, if any, ave rise ta ause
(a), the under- ause last.
ans contrib -- > rath but wat the sorminal aditian given
Chapter 137, 54, requires to print or cause or desth 00 lficates. P. 46,519 & P. 114 $$ 45, AP, 38 $ 6.)
: 2 1533
-88-923666
(c)
Due To
Arteriosclerosis.
OTHER
SIGNIFICANT
Hypertension,
CONDITIONSOld Anterior myocardial
Inrare
(a)
.1 30 [ R-301 0/908 THIS IS A ENT RECORD. e only APPROVED nk or black iter ribbon.
RECEIVED
17
11.12
Ci
-
6
FEB =21959 MM
A TRUE COPY ATTEST: Charles At Mackie City Registrar
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
OUT - OF - TOWN
To be filed for burlal permit with Board of Health Healthy 6 or Its Agent.fy 11757
Veterans Administration Hospital No.
2 FULL NAME
Durando COLANGELO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... .
104 TaftsAve.
sx Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months
7 days. In place of residence .5 .... years ...
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