USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 23
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HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Domenico Paci
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Pulmonary embolism
(a)
Due To
Hypertensive cardio-vascular
(b)
disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased ?
If so. specify .. ....
(Signed).
Chillon
M. D.
(Address)_Asst Die Mass. Gen'l Hasp. |Date
3/6/
19.59
Winthrop Cem.
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March
9
19 59
7 NAME OF
FUNERAL DIRECTOR
Domenic J. Russo
ADDRESS
407 Main St. Medford . 1959
MAR
PARENTS
-
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
f(If death occurred in a hospital or institution,
MASSACHUSETTS GENERAL HOSPITAL
301A 1
& bat set
No What test confirmed diagnosis?
3 mins
A TRUE COPY ATTESTI Charles it Mackie City Registrar
RECEIVED
6
JUN -11959 /X
×
The Commonwealth of Massachusetts EDWARD J. CRONIN
SECRETARY OF THE COMMONWEALTH T - OF - TOWN
To be filed for burlal permit with Board of Health or 1ts Agent.
Registered No.
02463
ROSTON CITY HOSPITAL
No. .
Philip Giordano
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
NO
if so specify WAR)
39 Grovers Avenue
xx Winthrop,
Mass.
(a) Residence. No ..
(L'sual place of abode)
(If nonresident, give city or town and State)
Length of stay : In place of death ...... years ........
months
days. In place of residence ..
. years
months.
. days.
MEDICAL CERTIFICATE OF DEATH
F DEATH : enter DEATH
3 DATE OF
March 10, 1959
(Month)
(Day was a
D'aviont
19
4 I HEREBY CERTIFY . XXXXXXXXXXXXRK
March _10. 159 . ৳ March ... 10
59
death is said to
have occurred on the date stated above, at _ 3: 30A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Bronchopneumonia.
Due To (b)
Due To (c)
OTHER
Arteriosclerotic Heart
SIGNIFICANT
CONDITIONS
Dis ase moderately
Was autopsy performed?
Decompensated.
What test confirmed diagnosis?
Clinical
5 Was disease or injury inny
If so, specify .
Day related to occupation of deceased?
(Address)
6 St. Michaels
Boston
Place of Burial or Cremation
DATE OF BURIAL Larch 12
7 NAME OF
FUNERAL DIRECTOR Vincent Rapino
ADDRESS
9 Chelsea St. East Boston
Received and fied MAR 1 8 1959 Charles it Mack
19
( Registrar)
8 SEX
Liale
9 COLOR
White
10 SINGLE
(write the word)
MARRIED Widowed
WIDOWED
or DIVORCED
10a If married. widowed, or divorced nie Bolduzzi
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
90
Months
Days
If under 24 hours
_. Hours ....... Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business :
Years
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Frank Giordano
18 BIRTHPLACE OF
Italy
FATHER (City)
(State or country )
19 MAIDEN NAME
OF MOTHER
Karia (unknown)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Martin Guida
Informant
(Address)
"701 Belmont Belmont Lass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was bled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
1779
3-11-54
(Official Designation)
(Date of Issue of Permit )
1
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
CERTIFICATE OF DEATH
22
R-301A
HIS IS NT RECORD. only PPROVED « or black er ribbon.
CTIONS
ERTIFICATE
ving
or each 1) and (c)
of dying. rart failure.
of compli- Tich
last.
411 if any. se rise to (.). he
eth but not the terminal dition sites
hapter 137. 14, requires to print er cause er death .a Acates.
(P. 46. 119 & . 114 $$ 45. AP. 38$ 6.)
11 1959
PARENTS
M. D.
(Signed)
BOSTON CHE HOSPITAL 3-10-59
(City or Town) 1,59
DIVISION OF VITAL STATISTICS STANDARD
f(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
PERSONAL AND STATISTICAL PARTICULARS
INTERVAL
BETWEEN
ONSET AND
DEATH
1 wk.
-
A TRUE COPY ATTEST Charles it Mackie City Registrar
.
1
11.1
1
€
6
2
JUN -1.1959 ("!
301A I
LIONS SIFICATE
DEATH ater
each sad (c)
dving. failure. " means · compit-
3 - rise to f
(*).
last.
ri but not
Itemsal -
OTHER
SIGNIFICANT
CEREBRO VASCULAR
CONDITIONS
ACCIDENT REPEATED
Was autopsy performed? No
What test confirmed diagnosis ?_
PHYSICAL
EXAM.
S Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
Ramona
a. Villamay, M. D.
(Address) NEW ENGLAND HOSP. Date MARCH 12,1959
6 St. Pauli's Arlington
Place of
March 16,
59
(City of Town)
DATE OF BURIAL 19
7 NAME OF
Maurice w Kirby
FUNERAL DIRECTOR
ADDRESS
210 Winthrop St. Winthrop
ReceivedEnd filed
Charles H. But & LE
19
( Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
10a If married, widowed, or divorced
HUSBAND of
Thomas' " Mult&life in full)
(or) WIFE of
(Ilusband's name in full)
11 1F STILLBORN, enter that fact here.
12
AGE
84 cars
Months
Days
If under 24 hours
Hours ..._ Minutes
13 L'sual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Retired
15 Social Security No.
Unknown
16 BIRTHPLACE (City)
(State or country)
East Boston
17 NAME OF
FATHER
William J Burke
18 BIRTHPLACE OF
St. John N. B.
FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTIIER
Margaret F Ryan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Kevin Mulcahy
21
Informant
(Address)
26 Enfield Rd. Winthrop
HEREBY CERTIFY that a satisfactory standard certificate of death as filed with my BEFORE the burial or rigsmed :
sit permie 1754
(Signature of Agent of Board of Health er other) march 151959
(Official Designation) (Date of Issue of Permit)
1
Registered No.
[(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number) No. HELEN A. MULCAHY PHYSICIAN - IMPORTANT -
( If deceased is a married, widowed or divorced woman, give also maiden name.)
26 ENFIELD RD.
St
(If nonresident, give city or town and State)
Length of stay : In place of death
....
years .....
_ months
days. In place of residence
50years
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MARCH
12
1959
(Year)
(Month)
(Day)
4I HEREBY CERTIFY, That I attended deceased from
MARCH 1. 19 59. to MARCH_12
. 19.59
I last saw her alive on MARCH 12, 1959, death is said to
have occurred on the date stated above, at
12:30
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
UREMIA
INTERVAL
DETWEEN
ONSET AND
DEATH
(a)
Due To ARTERIOSCLEROTIC HYPER
(b)
TENSIVE HEART DISEASE
Due To
NEPHROSCLEROSIS
(c)
PLACE OF DEATH
SUFFOLK (County)
ROXBURY, MASS (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN (OUT - OF - TOWN
23
SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
To be filled for burial permit with Board of Realtb or Its Agent. 12478
NEW ENGLAND HOSPITAL
2 FULL NAME-
(Was deceased a
U. S. War Veteran.
so specify WAR)
no
WINTHROP
(a) Residence.
No ..
(L'sual place of abode)
SOM-11-56-916070
pter 137, requires o priat er
lesth .. estes.
11 1959
PARENTS
Teacher
A TRUE COPY ATTEST: Charles it Mackie City Registrar
RECEIVED
...
6
JUN - 1 1959 44
Copics 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. (Scc Chap. 46, Scc. 12, G. L.) at the time of death should he transmitted on Form R-302 to the clerk of the city or town in which the deceased
Suffolk
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Chelsea
(City or Town making this return)
201
(City or Town)
CERTIFICATE OF DEATH
Registered No.
$ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Marie Nicholson
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) Qtrs. A, Fort Banks
/ Winthrop, Malso specify WAR)
St
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years.
..... months.
days. In place of residence ........... years ..
months.
......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEDing le
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
ACE
Y'ears.
Months .:.......
Days
If
unden S
Houfs.
hours
Minutes
none
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No.
16 BIRTHPLACE (City) Chelsea, Mass (State or country)
17 NAME OF Robert F. FATHER
PARENTS
18 BIRTHPLACE OF FATHER (City) Worcester Mass. (State or country)
19 MAIDEN NAME Doris Beverly Varg OF MOTHER
20 BIRTHPLACE OF MOTHER (City). Worcester, Mass.
(State or country)
21 R. Nicholson (father ) Informant At Banks, winthrop, Mass. (Address)
Joseph a Tyrrell
(Registrar of City or Town where deceased resided)
15 min
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
yes
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify.
H.R. Houston, LIMC
(Signed)
USNh, Chelsea, Mass. Date
5/2/59
Holy Cross, Halden, Hass.
6 Place of Burial or Cremation may 4,1959(City or Town) 19
DATE OF BURIAL
R.C. Kirby
7 NAME OF FUNERA DIETTOBennington St. , F. Boston A TRUE COPY
ADDRESS.
Received and filed. JUN 9 1999 19
50M -11-55-916145
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY May 2 59 May 2
That I
attended deceased from
59
I last saw
alive on
May 2
59
19.
death is said to
2:40A:
have occurred on the date stated above, at
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a) Prematurity with
Due To immaturity
PLACE OF DEATH
R-302 1
(County) Chelsea
U. S.laval Hospital
No
(Was deceased a U. S. War Veteran,
(a) Residence. No. (Usual place of abode)
15mins
3 DATE OF
DEATH
May 2,1959
(write the word)
19
to.
19.
M. D.
(Address)
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
May 4, 1959
19
HERETY
JUN - 91959 0:1
-301A I
TIONS
RTIFICATE
ing DEATH enter in one r each and (c)
not mean 01
dying, rt failure. It means or compli- caused
if any, rise to (a), under- last.
contrib- th but not e terminal Fion given
apter 137, requires o print or ausc or leath on
cates.
PLACE OF DEATH
Suffolk
(County)
inthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent.
25
[(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)
200
(a) Residence.
No.
(Usual place of abode)
22 Cross St. inthrop, Mass. St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ...__ years months 33 days. In place of residence. years. months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED/
or DIVORCED
SILVER
(write the word)
MARRIED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
If under 24 hours
Hours
Minutes 15B
13 Usual
Occupation :
Music BoxEsCab DRIVER'
(Kind of work done during most of working life)
14 Industry
or Business :
RETIRED
15 Social Security No.
028-03-4852
16 BIRTHPLACE (City)
(State or country)
RUSSIA
17 NAME OF
FATHER
SAMUEL BARENBOIM
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
OF MOTHER
LEIYA
RIMELMAN
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21 Informant.
HILDA BARENBOIM
(Address)
22 CROSS 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 (or other)
Thedette Oficer
5/4/59
(Oficial Designation)
(Date of Issue of Permit)
P.BU
3 DATE OF
DEATH
May
(Month)
(Day)
3 1959 (Year)
4 I HEREBY CERTIFY
Jani, 1947
to
May
3
That I attended deceased from
1.59
May 3
1959, death is said to
I last saw huplive on
have occurred on the date stated above, at 2:20A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Coronary
Artery Heart
Disease
Due To
Cardiac Decompensation
2yrs.
Due To (c)
OTHER
SIGNIFICANT
None
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)
Charles Lebenman . D.
(Address). Wirthemup Date 5/3/054
6
SUDLICOVE
Place of Burial or Cremation
DATE OF BURIAL MAY 4 1959
BENJAMIN BIRNBACH
5 1859 19
Received and filed
(Registrar)
PARENTS
50M-1-58-921876
X
No .. inthron Community Hospital
Barenboim, Isidor
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4
INTERVAL 12 :58 BETWEEN DNSET AND DEATH 5 yrs Years Months Days
- (b) .
e
7 NAME OF
FUNERAL DIRECTOR
10. WASHINGTON ST. DORCHESTER
ADDRESS
EVERETT (City or Town)
Registered No.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
physician or registered hospital medical officer shall forthwith, after the th of a person whom he has attended during his last illness, at the'request n undertaker or other authorized person or of any member of the family of deceased, furnish for registration a standard certificate of death, stating to the t of his knowledge and belief the name of the deceased, his supposed age, the ase of which he died, defined as required by section one, where same was tracted, the duration of his last illness, when last seen alive by the physician officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
physician or officer furnishing a certificate of death as required by the ceding section or by section forty-five of chapter one hundred and four- , shall, if the deceased, to the best of his knowledge and belief, served in the y, navy or marine corps of the United States in any war in which it has been aged, insert in the certificate a recital to that effect, specifying the war, and ll also certify in such certificate both the primary and the secondary or imme- te cause of death as nearly as he can state the same. For neglect to comply Chap. 114. Sec. 46, G. L., (Tercentenary Edition). h any provision of this section, such physician or officer, shall forfeit ten dollars. the purposes of this section and of sections forty-five, forty-six and forty-seven RULES OF PRACTICE aid chapter one hundred and fourteen, the word "war" shall include the China ef expedition and the Philippine insurrection, which shall, for said purposes, be med to have taken place between February fourteenth, eighteen hundred and The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice, ety-eight and July fourth, nineteen hundred and two, and the Mexican border (Attending physicians will certify to such deaths only as those of persons rice of nineteen hundred and sixteen and nineteen hundred and seventeen. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body town, or remove therefrom a human body which has not been buried, until he received a permit from the board of health, or its agent appointed to issue h permits, or if there is no such board, from the clerk of the town where the son died; and no undertaker or other person shall exhume a human body and love it from a town, from one cemetery to another, or from one grave or tomb er than the receiving tomb to another in the same cemetery, until he has eived a permit from the board of health or its agent aforesaid or from the clerk he town where the body is buried. No such permit shall be issued until there 11 have been delivered to such board, agent or clerk, as the case may be, atisfactory written statement containing the facts required by law to be urned and recorded, which shall be accompanied, in case of an original inter- nt, by a satisfactory certificate of the attending physician, if any, as required by . or in lieu thereof a certificate as hereinafter provided. If there is no attending ysician, or if, for sufficient reasons, his certificate cannot be obtained early ugh for the purpose, or is insufficient, a physician who is a member of the board health, or employed by it or by the selectmen for the purpose, shall upon plication make the certificate required of the attending physician. If death is used by violence, the medical examiner shall make such certificate. If such a rmit for the removal of a human body, not previously interred, from one town another within the commonwealth cannot be obtained early enough for the rpose. the certificate of death made as above provided and in the possession of e undertaker desiring to make such removal shall constitute a permit for such noval; provided, that such body shall be returned to the town from which it was moved within thirty-six hours after such removal, unless a permit in the usual rm for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, DEL (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 Lan's, 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 sp to do from the-board of health or its agent appointed to issue such permits, or if there is no such board, from the dierk of the town where the body is to be buried For the funeral is to be held, or from a person appointed to have the care of the centetery or burial ground in which the interment is made.
to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical 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.
PACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
ANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
X PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
226 Main
St.
The Commonwealth of Massachusetts EDWARD J. CRONIN 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.
f(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME Mary J. Gray
( Clancy
)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
226 Main St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ... ... years.
months
days. In place of residence 40
years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWER
or DIVORCEowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John F. Gray
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 82 Years.
Months
Days
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
Own Home
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
James Clabcy
18 BIRTHPLACE OF
FATHER (City)
Waterford
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Ellen Cunningham
20 BIRTHPLACE OF
MOTHER (City)
Waterford
(State or country)
Ireland
21 Informant Veronica .... Howard (Address) 226 Main St. . Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued : Talkle O Pereanne 8 (Signature of Agent of Board of Health or other)
Thealti Officer
5/6/59
(Official Designation)
(Date of Issue of Permit)
1 U.B.V
TIONS
IRTIFICATE
Tring C
DEATH enter tin one r each and (c)
not mean of
dying, rt failure, It means or compli- h caused
if any, rise to re
(a). under- last.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Senility
menifita
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
NO
(Signe
H. B. Buenfeld
, M. D.
447 Shirley St
(Address) winthrop Mass
Date
Mays 1:59
6
Holy Cross
Place of Burial or Cremation
Malden Mass
(City or Town)
DATE OF BURIAL May 8, 19.59
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS
Received and filed MAY 6 1959
19
(Registrar)
(Day)
4.
1959.
(Month)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
to
may
19
59
, 19 39, death is said to
have occurred on the date stated above, at
8:15Pm.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
uremia
Uremia
Due To
arteriosclerosis-renal
(b)
Arteriosclerosis - renal
6 mes.
Waterford
PARENTS
50M-5-57-920345
R-301A 1
contrib. h but not terminal ion given
apter 137, , requires o print or cause or death cates.
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
3 DATE OF
DEATH
May
Tast saw h. Malive on
No.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the ath of a person whom he has attended during his last illness, at the request an undertaker or other authorized person or of any member of the family of de eased, furnish for registration a standard certificate of death, stating to the st of his knowledge and belief the name of the deceased, his supposed age, the ease of which he died, defined as required by section one, where same was ntracted. the duration of his last illness, when last seen alive by the physician officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the eceding section or by section forty-five of chapter one hundred and four- en, shall. if the deceased, to the best of his knowledge and belief, served in the my, navy or marine corps of the United States in any war in which it has been gaged, insert in the certificate a recital to that effect, specifying the war, and all also certify in such certificate both the primary and the secondary or imme- ate cause of death as nearly as he can state the same. For neglect to comply th any provision of this section, such physician or officer, shall forfeit ten dollars. or the purposes of this section and of sections forty-five, forty-six and forty-seven said chapter one hundred and fourteen, the word "war" shall include the China lief expedition and the Philippine insurrection, which shall, for said purposes, be emed to have taken place between February fourteenth, eighteen hundred and nety-eight and July fourth, nineteen hundred and two, and the Mexican border rvice of nineteen hundred and sixteen and nineteen hundred and seventeen. L. Chap. 46, Sec. 10.
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