USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 40
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FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
(Signature of Agent of Board of Health of other) Healthe Officer 7/31/59
(Official Designationy (Date of Issue of Permit)
East Boston
(b)
Due To
ARTERIO-SCLEROTIC
HEART DISEASE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING. ORGANIZATION AND OUTFIT
SERVICE NUMBER
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 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.
.
.P
AUG - 31553 A1
C-3 081 984 U-16614
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
121
To be filed for burial permit with Board of Health or its Agent. 2788
Registered No. . ..
f(If death occurred in a hospital or institution.
St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT WWII ( Was deceased a U. S. War Veterao. if so specily WAR)
(a) Residence. No.
28 Cummings Avenue
(L'sual place of abode)
xxx S. Weymouth, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death O years O months 7days. In place of residence Lif, Gars months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
MARRIED
4I HEREBY CERTIFY.
That I attended deceased from
March 12,
. 19 59. to
March 19,
. 19
59
have occurred on the date stated above, at 9:40a m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Chronic glomerulonephritis(years with uremia (weeks-months). (a)
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE 42 Years
O Months
0 Days
If under 24 hours
Hours
Minutes
13 l'sual
Occupation :
Oil Burner Servicoman
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No. 021 10 3550
16 BIRTHPLACE (City)
(State or country)
Newton
Mass.
17 NAME OF
FATHER
EDMUND REARDON
PARENTS
18 BIRTHPLACE OF
FATIIER (City)
BROOKLYN
(State or country )
NÃO VORA
19 MAIDEN NAME
OF MOTIIE
CATHERINE (OCONNELL)
20 BIRTHPLACE OF MOTHER (City) (State or country )
DAGLIDENGE
¿Winthrop Cemetery
Place of Burial or Cremation
DATE OF BURIAL
March 23
159
Winthrop
(City of Town)
7 NAME OF
FUNERAL DIRECTOR
Maurice Kirby
210 Winthrop St., Winthrop,
Mass.
ADDRESS
Received and filed ,
19
(Registrar)
years
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
YES
What test confirmed diagnosis ?.
Autopsy & clinical
findings
5 Was disease or injury in any way tetted to occupation of deceased ? no
If so, specifyze
(Signed).
Melvin_
arme lant
Hanulant
(Address)
VAH, BOSTON, MASS.
Date
M. D. Mar.19 1.59 19
21
Informant
V.A. Hospital Records, 150
(.Address) S, Huntington Ava. , Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death as filed with me BEFORE the burial or transit permit was issued: [. 17915 (Signature of Agent of Board of Health or other) Mar 21, 1959
(Official Designation)
(Date of Issue of Permit)
=
RUCTIONS FOR . CERTIFICATE giving OF DEATH not enter than one for each (b) and (c)
does not mean e 01 dring. heart failure. etc. It means se or compli. which caused
43
as, if any. gave rise to (a) the under- Cause last.
tions contrib. death but not the terminal condition gives
Chapter 137 , 1954, requires ns to print or e cause or of death on tificatea. AP. 46,99 9 & AP. 114 :$45, AP. 38 $6.)
25 1859
O-80-923666
1
No.
Veterans Administration Hospital
2 FULL NAME .. John S, REARDON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
3 DATE OF
DEATHI .
March
(Month)
19,
(Day)
1959
(Year)
10a If married, widoyen, or divorced
HUSBAND of
Rita Walters
(Give maiden name of wife in full)
(or) WIFE of (Husband's name in full)
Due To
Hypertensive heart disease.
(b) .
OUT - OF - TOWN
MR-301A
-THIS IS A NENT RECORD si cally APPROVED yrik or black r ter ribbon.
A TRUE COPY ATTEST:
RECEIVE
AUG 2 5 1359 /1
C+3 081 984 U-16614
Suffolk
(County)
Boston
(City of Town)
The Commomuralth 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.
2788
Registered No.
(If death occurred in a hospital or tustitution.
St. [give its NAME. instead of street and number)
PHYSICIAN - IMPORTANT ( Was deceased a U. S. War Veteran, (if so specify WAR) WWII
xxx S. Weymouth, Mass.
(If nonresident. give city or town and State)
Length of stay: In place of death O years O months 7days. In place of residence
Lifars
months
days.
MEDICAL CERTIFICATE OF DEATHI
3 DATE OF
DEATH _
March
19,
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
March 12,
. 19 59. 10
March 19,
, 19
XXXXXxxxxxx
. death is said to
have occurred on the date stated above, at
9:40a
m.
INTERVAL
BETWEEN
ONSET ANO
DEATH
Due To
Hypertensive heart disease.
- (b) -.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
W'as autopsy performed ?
YES
What test confirmed diagnosis ?
Autopsy & clinical
findings
5 W'as disease or injury in any way rented tooccupation of deceased? no If so, specify ?!!
(Signed)
Melvin H. Farme lant
(Address)
VAH, BOSTON, MASS.
Date
. 59
¿Winthrop Cemetery
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 23
159
7 NAME OF
FUNERAL DIRECTOR
Maurice Kirby 210 Winthrop St., Winthrop, Mass.
ADDRESS
Received and filed 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
MARRIED
10a If married, widowed, or divorced
HUSBAND of
Rita Walters
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 42 Years
0
Months
Q Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Oil Burner Servicoman (Kind of work done during most of working life)
14 Industry
or Busines‹ :
15 Social Security No.
021 10 3550
16 BIRTHPLACE (City)
(State or country }
Mass.
17 NAME OF
FATHER
EDMUND REARDON
18 BIRTHPLACE OF
FATIIER (City)
(State or country )
UN
19 MAIDEN NAME
MI. D.
OF MOTHE
CATHERINE (OCONNELL)
20 BIRTHPLACE OF MOTHER (City) (State or country)
DiGUIDENCE
21 Informant V.A. Hospital Records, 150 Addres S, Huntington Ava., Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death as hled with me BEFORE the burial or transit permit was issued : E. 17915 (Signature of Agent of Board of Health or other) Mar 21, 1959
(Official Designation)
(Date of Issue of Permit)
-THIS IS A NENT RECORD. se omly APPROVED ink or black riter ribbon.
RUCTIONS FOR CERTIFICATE giving OF DEATH not enter than one for each (b) and (c)
does not mean de or drink. heart failure. etc. It means se. or compli- which caused
143
ons. if any. sure rise to cause
(a), the under- last.
lions contrib. - death but not o the terminal condition given
Chapter 137, 1954, requires ns to print or e cause of of death on rtificates. AP. 46, 95 9 & AP. 114 $$ 45, (AP. 38 $ 6.)
O-50-923666
1
PLACE OF DEATH
Veterans Administration Hospital No.
John S. REARDON
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 28 Cummings Avenue (L'sual place of ahode )
(write the word)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Chronic glomerulonephritis(years)
with uromia (weeks-months ).
59
years
Mar.19
19
Newton
PARENTS
MR-30: A
EN TRUDE COPY ATTISI
-
-
AUG 25153 /1
OUT - OF - TOWN
122 To be filed for burial permit with Board of Health or its Agent. 2786
Registered No.
f(If death occurred in a hospital or institution.
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (M'as deceased a U. S. War Veteran. if so specify WAR)
(a) Residence. No. 12 Sea Foam. Avo., (L'sual place''of abode)
& Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death ..
years
months 22 days. In place of residence
40 years
months
days.
MEDICAL CERTIFICATE OF DEATHI
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
(Month)
20,
(Day)
1959
(Year)
4 I HEREBY CERTIFY,
That i attended deceased from
February 26,. 1959 , 10
larch 20,
59
19
.
K, death is said to
7:15 A,
m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a).
Acute myocardial infarction
Due To
Generalized arteriosclerosis
Years
- (b) -
Due To Amyotrophic lateral sclerosis (c)
OTHER
SIGNIFICANT
CONDITIONS
Alzheimer's Disease
Years
M'as autopsy performed ?
No
What test confirmed diagnosis ?.
Clinical, Lab & X-ray
findings
5 Was disease or injury in any way related to occupation of deceased ? NO
If so, specify
(Signed)
M. D.
(Address) VAR. Boston, Lass. Date
Mer.20
19
.59
6
Sharon Memorial Park, Sharon, Mass. Place of Burial or Cremation (C'ity or Town )
DATE OF BURIAL March 22, 19
59
7 NAME OF
FUNERAL DIRECTOR
Benjamin F. Solomon 420 Harvard St., Brookline, Mass.
Received and filed
March 23 19
59
·P.
PARENTS
18 BIRTIIPLACE OF
FATIIER (City)
(State or country )
Poland
19 MAIDEN NAME
OF MOTHER
Bessie Kachelnick
(o.k)
30 BIRTHPLACE OF
MOTHIER (City)
(State or country )
Poland
21 (.Valdres Informant VA Hospital Records 150 S. Huntington Ave., Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death
was hij with me BEFORE the burial of transit permit was tequed:
a. mariano
E17901
(Signature of Agent of Board of Health or other)
3/20/59
(Official Designation) (Date of Issue of Permit)
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
Veterans Administration Hospital No.
2 FULL NAME
Aaron OSVAR
( If deceased is a married. widowed or divorced woman, give also maiden name.)
10a If married. widowed, or divorced IIU'SBAND of
Rose
Kachelnick
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE. 68
Years
9
Months
5
Days
If under 24 hours
Ilours
Minutes
13 l'sual
Occupation :
Electrician (Retired )
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
028-20-6405
16 BIRTHPLACE (City)
(State or country)
Poland
17 NAME OF
FATIIER
Hyman Osvar
1 year
13569 MR-301A
110 $12 .- THIS IS A NENT RECORD. se only E APPROVED ink or black writer ribbon.
TRUCTIONS FOR L CERTIFICATE a giving OF DEATH not enter than one e for each (b) and (c)
does not mean de or dring. heart failure. etc. It means se. or compli- which caused
+2011
ons. if any. gare rue to cause (a). the under- last. -
nous contrib. death but not o the criminal condition giren
Chapter 137, 1954, requires ins to print or e cause or of death on rtifcates. AP. 46, 11 9 & AP. 114 $$ 45, HAP. 38$6.)
25 1959 M.S.
10.58-923886
3 DATE OF
DEATH .
Married
of DIVORCED
have occurred on the date stated ahove, at
March
ADDRESS
A TRUE COPY ATTEST: Charles i mackie City Registrar
-
-
1
-
AUG 251050 MM
·
M R-308 1
25 1959
Received and filed
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR OR RACE
11 SINGLE
(write the word)
Male White
MARRIED WIDOWED or DIVORCED Single
lla If married, widowed, or divorced
IUSHAND of
(Give maiden name of wife in full]
(or) WIFE of
(Ilusband's name in full)
12 IF STILLHORN, enter that fact here
13
AGE.19 Years ..
.. Months ....
If under 24 hours
Hours ..
.. Minuies
14 Usual
Occupation :
U.S. Coastguard
(Kind of work done during most of working life)
15 Industry
or Business.
16 Social Security No.
Winthrop
17 BIRTHPLACE (City)
(State of country ]
I8 NAME OF
FATHER
Edward F McSweeney
19 BIRTHPLACE OF
FATHER ({'ity)
(State or country )
Boston
20 MAIDEN NAME
OF MOTHER
Dorothy Harrington
21 BIRTHPLACE OF
MOTHER (CHv)
(State of country)
Boston
22 Edward F Ncsweeney
Informant
(Address)
110 Summit Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued :
(Spenature of Agent of Hard of Health or other)
ELIGE HORASTY
(Official Designation)
( Date of Issue of Permit)
423
Registered No.
03119
death occurred in a hospital or institution,
its NAME instead of street and number )
PHYSICIAN - IMPORTANT
tuvas deceased a U. S. War Veteran.
If deceased is a married. widowed or divorced woman, one also maiden name.)
110 Summit are Winthrop"Plan
nwiths .... ....... days. In place of residence. .. years. months. day».
DATE OF BURIAL
March 30,1959
19
DEATH In plain terms, so that it may be properly classified under the International Classification of Causes
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
Maurice w Kirby
25M.8.57.920750
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Manner of
Injury
Comi
blunt
(Address) Boston Dave 3/87 19 59
PARENTS
A NAME OF
FUNER
210 Winthrop St. Winthrop
ADDRESS
(a) Residence. No. (l'sual place of abode) Length of stay : In place of death ............ years MEDICAL CERTIFICATE OF DEATH 3 DATE OF DEATH 26 (Month) ( 1)as ) 1 1959 (Year) 4I HERENY 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.) RUPTURE OF RIGHT AURICLE WITH HEMOPERICARDIUM Homicide 5 Accident, suicide, or homicide (specify ) Date and hour of injury 3/26 /59 ( Specify type of place ) public place ? ow &d inmry occu Nature of force myung of wheat Injury While af wurk ? Was aiming performed? Mez 6 Was disease or injury in any way related to decurasun of deceased? (Signed) Vital / Tango O. M. D. 7 Place of rinthron If deceased was a U. S. War Veteran, G L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. Where did Injury occur ? (( Hyfor town and State) Did injury occur in or alemnt home, on farm, in industrial place, or in
PLACE OF DEATH Suffolk (County ) Sobton (City of Town )
Che Commonwealth of Massachuselis EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
En route to E. Boston Relief Statatinea.
2 FULL NAME William
Mc Sweeney
( If nonreside:
. give city of town and State)
A TRUE COPY ATTEST: Charles & Mackie City Registrar
RECEIVED
.
AUG 2 5 1359 11
MR-301A
1
PLACE OF DEATH
SUFFOLK
(County) BOSTON, MASS.
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN
SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
TOWN OU'T To be dled for burial permit with Board of Healthit of its Acent 03208
No The Massachusetts General Hospital
2 FULL NAME Philip Hilton
( If deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No. 10 ORlindo QUE.
Winthrop St .- Mass
(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
3 DATE OF
DEATH
(Month)
(Day)
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
4 I HEREBY CERTIFY, That Yattended deceased from
March 19, 1959, 10 March 29
19
Piast saw hi Malive on March 29,, 1959, death is said to
have occurred on the date stated above, att: 5.5 a.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
12 HRS
10a If married, widetherokillian Hitch
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
64
4
AGE
Years
Months
27
Days
If under 24 hours
_ Hours ... Minutes
13 Usual
Occupation :
MOS ?. Fajn a work done during most of working life)
14 Industry
or Business :
Interior Decorating
15 Social Security No .. 013-16-1536
16 BIRTIIPLACE (City),
(State or country)
ells maine
17 NAME OF
FATHERGeorge Hilton
18 BIRTHPLACE OF
Tells, l'aine
FATIIER (City)
(State or country)
19 MAIDEN NAME
OF MOTIIER
Nellie Eaton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Laine
21 Esther Lillian Hilton
Informant
(Address)
10 Orlando ive., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with mo BEFORE The burial or transit permit was issued : Faogerson
(Signature of Agent - Board of Ifcalth or other)
2134
3-31-5
(Official Designation)
(Date of Lasue of Permit)
Charles H. Black.
10MOS.
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?.
Yes
What test confirmed diagnosis ?..
autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
C. L. Clay. M.D
(Address) Asst. Die, Mass Gent, Hosp Day In. 27.
19.5.7
M. D.
6
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
April 1,
59
(City or Town)
DATE OF BURIAL 19
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS 174 Winthrop St. Winthrom
APR
Received and fled -19
25 1959 10.86023004
.- THIS IS A NENT RECORD. Ise only E APPROVED Ank or black writer ribbon.
TRUCTIONS FOR L CERTIFICATE
a giving OF DEATH not enter e than one e for each (b) and (c)
does not mean de of dying. heart failure, er. 11 means ese. or compli- which caused
ine under- last
death but mot o the terminal condition given
Chapter 137, 1954, requires ns to print or he cause or of death on ertificates. IAP. 46. 11 9 & AP. 114 $$ 45. HAP. 3816.) S.
oRs. s/ aRy. (b) _
Due To
DUODENAL
ULCER
Due To
LEUKEMIA
(c)
=
PARENTS
Registered No.
J(If death occurred in a hospital or institution, St. (give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT (M'as deceased a U. S. War Veteran, if so specify WAR)
(L'sual place of abode)
CERTIFICATE OF DEATH
-
March
29.
1959
(Year)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
GASTRO INTESTINAL
(a)
HEMORRHAGE
A TRUE COPY ATTEST: Charles & Mackie Chy Registrar
DECENI
1
AUG 25/053 /1
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
OUT - OF - TOWN To be filed for burial permit :- with Board of Health _. 1
3820
Veterans Administration Hospital No. ....
John T. FOLEY
(If deceased is a married, widowed or divorced woman, Rive also maiden name.)
-
PHYSICIAN - IMPORTANT ( Was deceased a U. S. War Veteran. "MI II if so specify WAR)
St. Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death .. years __ months 20 days. In place of residence Lifar, .. months ... - days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDMarried
or DIVORCED
4 I HEREBY CERTIFY.
That I friended deceased from
Larch 24,
. 19 59, 10
April 13,
19
59
XXXXXXXXXXXXXXXXX, death is said to
have occurred on the date stated above. at 11:50 Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
1. Duodenal ulcer with
hamorrhage
Due To
2. Carcinoma of pancreas
(b) -
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Diabetes mellitus
yra
Was autopsy performed ?
No
What test confirmed diagnosis' Clinical&Lab Findings
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed) James Dorr , M. D.
(Address) VAH_Boston, . l'ass. Date
19
Winthrop Com., Winthrop, 6
Mas8.
Place of Burial or Cremation (City or Town) DATE OF BURIAL April 17, 19
59
7 NAME OF FUNERAL DIRECTOR Maurice Kirby 210 Winthrop St.,
Winthrop, Masa.
Received and filed
APR
19
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
312 MR-301A 367 104 B .- THIS IS A ANENT RECORD. Use mly TE APPROVED ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE
In giving OF DEATH
not enter e than one se for each , (b) and (c)
does not mean ode of dring. s heart failure. . etc. It means rose. of comph.
tions. if any. gave rise to (. ). the under- last
ditions contrib. o death but not to the terminal condition gives
- Chapter 137, 1954, requires ans to print or be cause or of death on certificates. HAP. 46. 11 9 & AP. 114 : 45, CHAP. 38 16.) 26 1959 MAIS.
.10.56-923 ...
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Halifax
(State or country )
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Lary O'Donnell
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
East Boston Massachusetts
21
Informant
VA Hospital Records
(Address) 150 S. Huntington Ave., Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
ADDRESS
April
(Month)
13,
(Day)
1959
(Year)
10a If married, widowed, or divorced
IIUSBAND 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 51 Years O
Months
23 Days
If under 24 hours
Hfours
Minutes
13 Usual
Occupation :
Curtain Salesman (Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No. U
East Bost on
16 BIRTIIPLACE (City)
(State or country)
Massachusetts
7 NAME OF
FATIIER
James P. Foley
Registered No.
[(If death occurred in a hospital or institution, St. (give its NAME instead of street and number) -
2 FULL NAME
(a) Residence. No. 23 Fremont (L'sual place of abode)
Jessica Grainger
INTERVAL
BETWEEN
ONSET AND
DEATH
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
1
157
A TRUE COPY ATTEST: Charles A. Mackie City Registrar
AUG 2 61159 PX
PLACE OF DEATH
Suffite
anty ) Stotitan (''ity of Town)
Che Commonwealth of Massachuselis EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT .. OF - TOWN To be filed for burial permit with Board of Health or its Agent.
Registered No.
3797
S(If theath occurred in a hospital or institution. St. ? give its NAME mstead of street and number)
na
PHYSICIAN - IMPORTANT
( Was deceased a
. U. S. War Veteran,
wfify WAR)
no
(a) Resilence. No. (l'anal place of alunde)
Length of stay : In place of death .............. years
months ......
L ____ days. In place of residence
.. years .....
months.
days
MEDICAL. CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OY
DEATH
14 ( Day )
1959 ( Year)
9 SEX
Female
10 COLOR OR RACE
White
(wtHe the word)
Wedenied
la Hf married, widowed, or divorced
HUSBAND of
(ouenanden name of wife in lull)
(or) WIFE of
Iyer Rosenburg
(Inshand's name m full)
12 IF STILLBORN, enter that lact here.
13
.56
AGE.
Years.
-
Dass
Months
If hader 24 hours Hours . . .. Minutes
14 Usual
Occupation
(kind of work done sharing most of working hle)
15 Industry
or Business
Retailelecting
16 Social S
CIO- 30 - 9410
17 BIRTHPLACE (City)
(State of country )
Besten mais
18 NAME OF
FATHER
Harry Byne
T.
19 BIRTHPLACE OF
FATHER (City)
(State or country )
Russia
20 MAIDEN NAME
OF MOTHER
Celia Stern
21 BIRTIEPLACE OF
MOTHER (City)
(State of country )
Ruavia
Ratti Cheloren Place of Burial, or Cremation.
(C'ily or Town)
DATE OF BURIAL
april 16
1959
8 NAME OF
FUNERAL DIRECTOR of Zurnal device 2 sec
ADDRESS IST Washington Dc Chelsea
Received-and fled
Charles & Macke
19
22
Informant
Lerneed Raplan
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