USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 42
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(.). the under- aase last.
ons contrib- death but not the terminal adition tions
Føpter 137, Ja, requires to print or
death incates. P. 46.119 & . 114 #45, P 3816.)
- THIS IS A NENT RECORD. only APPROVED ink or black riter ribbon.
RUCTION'S FOR CERTIFICATE giving OF DEATH ot enter than on. for each (b) .nđ (c)
M R-3014
-
(Signature of Agent of Board of Health or other)
I HERERY
April 23. 1059
May "
A TRUE COPY ATTEST: Charles H. Mackie Cily Registrar
RECEIVED
AUG 2 61:03 PM
X
IR-301A
1
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 Y's. or Its Agent
4717
ST. ELIZABETH'S HOSPITAL No.
(MR) FREDERICK W. ROE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
71 BIRCH RD
St.
WINTHROP, MASS.
(If nonresident, give city or town and State)
Length of stay: In place of death ......
years
months
+1/2 hrs.
' In place of residence years
._ months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
(Month)
(Day)
1959
(Year)
4 I HEREBY CERTIFY
19
MAY 11,
54.
to
MAY 11,
13
I last saw HMalive on
-
MAY
.... (1+ _. 1957 , death is said to.
have occurred on the date stated above, at
40 0m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTRACEREBRAL
(a)
HEMORRHAGE
Due To
ESSENTIAL HYPERTENSION
(b)
Due To (c)
OTHER
RHEUMATOID ARTHRITIS
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)
Robert H. aishi
, M. D.
(Address)
St. Elin- Hosp. Date
5/11
19 14
6 WINTHROP MASS, WINTHROP Place ul burial or fremating (City or Town)
DATE OF BURIAL 5/13/59
19
7 NAME OF
FUNERAL DIRECTOY
210 Ninteresse 3/
ADDRESS
Received md fed ...
2MAY 1 3 1959
E. Machine 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
TALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
SINGLE
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in Full)
II IF STILLBORN, enter that fact here.
12
AGE 34 Years
Months
Days
Il under 24 hours
Hours .. . Minutes
13 Usual
Occupation :
BROAKER
(Kind of work done during most of working life)
14 Industry
or Business :
INSURANCE
IS Social Security No. NLF KNOWN
16 BIRTHPLACE (City)
(State or country)
WINTHROP
17 NAME OF
FATHER
LOUIS A QUÉ
18 BIRTHPLACE OF
FATHER (City)
BOSTON
(State or country)
MASS
19 MAIDEN NAME
OF MOTIIER
FLORANCE M. SCHIVEREE
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS
21 LOUIS, AREE WINTHROP
TI BIRCH
I HEREBY CERTICHE
was filled with on Whey Satisfactory standard certificate of death
fuial or trangit permit was Issued:
(Signature of Agent of Boardof Health or other)
2811
05-17-59
(Official Designation)
(Date of Issue of Permit)
-THISAS A ENT RECORD. only APPROVED nk or black iter ribbon.
UCTIONS FOR CERTIFICATE
OF DEATH
t enter than one for each b) and (c)
Des mot mean of dying. heart failure. tc. It means . of compli- which caused
s, i/ any. ve rise to anse
(.). the under- last
ou contrib. rath but not the terminal dition given
Chapter 137. 34, requires to print or cause of death .. ficatel. P. 46, 11 9 & . 114 11 45, P. 3816.)
26 1959 5.
PLACE OF DEATH
SUFFOLK (County)
Registered No.
J(If death occurred in a hospital or institution,
St. (give its NAME instead of street and numher)
2 FULL NAME.
--
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran.
if so specify WAR)
14.0
(a) Residence. No ..
(L'sual place of abode)
That I attended deceased from
INTERVAL
BETWEEN
ONSET AND
DEATH
PARENTS
GLOUCESTER
444
A TRUE COPY ATTEST. Charlar : Rikie City Registrar
-
AUG 2 61253 PM
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF - TOWN
To be filed for burial permit with Board of Health of its Agent. 425 4791
2 FULL NAME
Otis E. Lapham
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 47 Washington Ave.
(Usual place nf abode)
(ff nonresident, give city or town and State)
Length of stay: In place of death
years.
months
1 days. In place of residence
.40years
. months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATII ..
(Month)
(Day)
May
12
1959
(Year)
8 SEX
M
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 f HEREBY CERTIFY.
That's attended deceased from
May
12
. 19 59. tn
May
12
19
59
Wq last saw himlive on
May -...
.... 12 -. 19
59 death is said to
have occurred on the date stated above, at - 7:30p m.
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN. enter that fact here.
12
5 days AGE71
Years
3
Months 26 Days
If under 24 hours
Hours ..
Minutes
13 l'sual
Occupation :
Broker
(Kind of work done during most of working life)
14 Industry
of Business:
Grain and Feed
15 Social Security No .....
017-26-1632
16 BIRTHPLACE (City) South Dartmouth (State or country) Mass
17 NAME OF
FATHER
John F. Lapham
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country )
South Dartmouth
Mass.
19 MAIDEN NAME
OF MOTIFER
Annie Sherman
20 BIRTIIPLACE OF New Bedford MOTHER (City) (State or country) Mass.
21
Mrs. Florence Peabody
(Address) 115 Bowdoin St. Dorchester
f HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial har transit permit was issued:
W
(Signature of sunt of Board of Health or other)
2824 5-14-59
(Official Designation)
(Date of Issue of Perimt)
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each b) and (c)
nes mot mean of dying. heart failure. Is It meant or compli. caused
1. if any. i've rise to ause (a). the under- last.
ons contrib- - > rath but not the terminal dition given
Chapter 137, 54. requires s to print or cause of death en ifcates.
ed by er 6 1959
50M-11-56-918978
PLACE OF DEATH
No ..
CERTIFICATE OF DEATH BAKER MEMORIAL MASSACHUSETTS GENERAL HOSPITAL
Registered No.
f(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)
W.W.1
St.
Winthrop, Mass.
(or) WIFE of
(Ilusband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(2) Rupture of abdominal
aortic aneurysm
Due To
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
W'as autopsy performed?
no
What test confirmed diagnosis ? ..
clinical
S Was disease or Injury in any way related to occupation of deceased? If so, specify
(Signed)
@hillary
(Address)
Date
5 13.99
I Hosp.
M. D.
, M. D.
6 South Dartmouth
Place of Burial or Cremation
South Dartmouth
DATE OF BURIAL
May 16,
1959
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS
917_Bennington St. E.Boston
Received and filed MAY 15 1959 19
Charles H. Macke. f
(City or Town)
10a If married, widowed, nr divorced
HUSBAND of ..
(Give maiden name of wife in full)
(write the word)
STANDARD
IR- 01A 1
451
A TRUE COPY ATTEST: Charles it Mackie City Registrar
AUG 2 61CEO PÅ
X 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
CERTIFICATE OF DEATH
Registered No.
¡(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
L'as deceased a
William dy WARI
War Veteran,
St. BOSTON,-MASS.
( If nonresident, give city or town and State)
months .... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF DEATH _ _I MAY
(Month)
25
(Day)
1959
(Year)
4 IHEREBY CERTIFY,
Yay 24,
59
19
F
to
May 25,
19 59
Weast saw Iff alive on
May 25,
19
59. death is said to
have occurred on the date stated above, at 10:42P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Meningitis Acute, purulent Hemophilus influenzae
Due To (b) -
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
yes. Autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
No
(Signed), C. L.Clay, MD
, M. D.
(Address) ASst . Dir. Mass. G n'] Date 5/26/
1959
Winthrop Com. Winthrop Place of Burial or Cropdaten May 27,
(City or Town) DATE OF BURIAL
7 NAME OF FUNERAL DIRECTOR Maurice W Kirby ADDRESS 210 WinthropSt. Winter
- AL 8 1959 19
Received and) filet Char
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
8 SEX
Female White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED
Single
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
INTERVAL BETWEEN 11 IF STILLBORN, enter that fact here. ONSET AND DEATH 12 48hours AGE Years Months 1 Days 12
13 L'sual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ....
16 BIRTHPLACE (City) (State or country)
Boston Nuatt
17 NAME OF FATHER
18 BIRTHPLACE OF
Boston
FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Barlegre Gua Health
20 BIRTHPLACE OF MOTHER (City) (State or country)
Roberto Carroll
21 Informard (Address)
I HEREBY CERTIFY that a catufactory standard certificate of death was filed with me BEFORE He huntal or transit permit was issued: Cx. Ce of erlon
(Signature, of Agent of Board of Health or other)
3008
0 5-26-59
(Official Designation)
(Date of Issue of Permit)
X
I.B .- THIS IS A MANENT RECORD. Ue only TE APPROVED ck ink or black ewriter ribbon.
NSTRUCTIONS FOR CAL CERTIFICATE In giving SE OF DEATH
o not enter ore than one use for each ), (b) and (c)
is does not mean mode of dring. as heart failure. a. etc. It means sease. or compls- which caused
4
ition, if any, gave rise to (a). if the under- last.
ditions contrib -- > o death but mot to the terminal condition giren
:- Chapter 137, f 1954, requirea iana to print or the cause of of death on certificates. HAP. 46, 95 9 & HAP. 114 '; 45, CHAP. 38 $6.)
27 1959 .10-58-923686
2 FULL NAME BARBARA CARROLL ( If deceased is a married widowed or divorcio
410
woman, give also maiden name.)
BARNES AVENUE
(a) Residence. No .. (U'sual place of abode)
Length of stay : In place of death years months days. In place of residence years
OUT - OF - TOWN
To be fled for buriti permit 5 with Board of Health & or Its Agent 5201
No.
MASSACHUSETTS GENERAL HOSPITAL
Ro.
( write the word)
(Husband's name in full)
If under 24 hours
. Hours - Minutes
PARENTS
That WEttended deceased from
6
RM R-3014
A TRUE COPY ATTEST:
Charles it !" . a.K .. City Reur +-
·
AUG 2 71009 /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
OUT - OF - TOWN To be filed for burial permit with Board of Health 5525
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. give its NAME instead of street and number)
2 FULL NAME Charles Andrews
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
107 Bowdoin
St.
Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay : In place of death years 2 months days. In place of residence years months 3 days.
MEDICAL CERTIFICATE OF DEATII
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
iViLITE
IO SINGLE
(write the word)
MARRIED
WIDOWED
DINO
SINGLE
10a If married. widowed, or divorced
HIUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Hushand's name in full)
11 IF STILLBORN, enter that fact here.
2 day SAGE
Years
Months
3 Days
12
If under 24 hours
Hours
Minutes
13 l'sual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTIIPLACE (City)
(State or country)
WIRTHRIN MISS
17 NAME OF
FATHER
CHARLES D AND PEUS
18 BIRTIIPLACE OF
FATIIER (City)
(State or country )
MASS
19 MAIDEN NAME
OF MOTIIER
ALICE P. MILLILEA
30 BIRTIIPLACE OF
MOTIIER (City)
(State or country )
BOSTON
//1155
21 CHARLES
Informant
(Address)
41 PLEASANT ST Ckyare
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the hund or transit yt was issued : Marina Mac Donald (SignAure of Agent of Board of licalth of other)
Received and file
Charles & Mac Lie 3/24
6-8-59
(Official Designation) (Date of Issue of Permit)
X
(Month)
(Day)
(Year)
We HEREBY CERTIFY, Thati Attended deceased from
June 2,
. . 159 . to June
3
. 19 59
Wielast saw himlive on _ June
3 -. 19.59 . death is said to
have occurred on the date stated above, at
9 :50Pm
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) ...
Prematurity
28 weeks gestation
770 Due To (b) oms, if any. gave rise to (a). the under- last. - Due To (c) .
OTIIER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Challan
M. D.
C. L. Clay
(Address) Asst. Die. Mass Gen. Hose Prate 6-4-
1959
6
I-INTHISLE Place of Burial of Cremation
WINTHROP
(City or Town)
DATE OF BURIAL JUNE 5 1954
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
(Registrar)
MR-301A
.- THIS IS A NENT RECORD. se only APPROVED ink or black riter ribbon.
TRUCTIONS FOR L CERTIFICATE giving OF DEATH
not enter : thsa one e for esch (b) and (c)
does not mean de of drink. heart failure. etc. It means ue. or compli- which caused
itions contrib. death but mot o the terminal condition giten
Chapter 137. 1954, requires ins to print or e
csuse or of desth on rtifcstes. IAP. 46,99 9 & AP. 114 $$ 45, HAP. 38 $6.)
2₡ 1959 10.5- 923886
NO.BAKER MEMORIAL, MASSACHUSETTS GENERAL HOSPITAL
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
NO
if so specify WAR)
(L'sual place of abode)
3 DATE OF
DEATII
June
3,
1959
PARENTS
NATICK1
A TRUE COPY ATTEST: Charles H. Mach City Registrar
RECEIVE
AUG 2 71:30 /1
MR-301A I
PLACE OF DEATH
SUFFOLK
(County) DORCHESTER
(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 188 To be filed for burial permit with Board of Health or its Agent. 5864
Registered No.
f(If death occurred in a hospital or institution, St. (give its NAME instead of street and number)
PHYSICIAN -IMPORTANT
2 FULL NAME ._
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 TEMPLE AVE
WINTHROP
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years ..
3
months
days. In place of residence 25
years
months_ __ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
June
12
1959
(Month)
(Day)
(Year)
3-6
HEREBY CERTIFY
9
6-12
19
1
I last saw jer,
"alive on
6-12
19
59. death is said to
have occurred on the date stated above, at
.12.55 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Acute Cardiac Decompensation
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
General Arteriosclerosis
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis'-
no
S Was disease or injury in any way related to occupation of decay' If so, specify
(Signed)
True "denger Ant: M. D.
2
(Address)
517 l' Vistuna ten Si Date 6/ 12 /259
6
Pine
Varduali, Auburn, Maine
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL 19 59
June 15
7 NAME OF
FUNERAL DIRECTOR
Howard_S_Reynolds
Winthrop, Wass.
ADDRESS
Received and filed JUN 22 1958 Charles H. Jackie
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ifushand's name in full)
11 IF STILLBORN, enter that fact here.
12
AG24
Years 17
Months
Days
If under 24 hours
Hours
Minutes
13 l'sual
Occupation :
None
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No. .
None
16 BIRTHPLACE (City)
(State or country)
Laine
Auburn
17 NAME OF
FATHER
Augustus Kerrill
18 BIRTHPLACE OF
FATHER (City)
(State or country)
l'aine
Auburn
19 MAIDEN NAME
OF MOTHER
Julia -
C.N.D.j.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Auburn
L'aine
21
Informant
Guy Edwards
(Address) arlington Mass.
I HEREBY CERTIFY that a satisfactory Mandard continuate of death was filed with me BEFORE the burial of Mansit perhit/wa) issued; Marcia
1 Guales
Syknature of Agent of Board of Health of weber)
3246
Rifficial Designation)
(Date of Issue of Permit)
VBV
RUCTIONS FOR .CERTIFICATE giving OF DEATH not enter than one for each (b) and (c)
does not mean e of dying. heart failure. etc. It means se. or compli- which caused 34.1
gave rise to the under- last.
-
ions contrib- - > death but not the formaal adition gırm
Chapter 137, 1954, requires ns to print or e cause or of death on tifcates.
60M-1-68-921970
7 1959
NEPONSET VIEW HOSPITAL
No. . GEORGIA MERRILL
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. -
(Usual place of abode)
6
That I attended deceased from
59
19
7yrs
PARENTS
· ( Registrat)
A TRUE COPY ATTEST: Parles it Mack. City Registrar
AUG 2 71053 /4
R-302 1
PLACE OF DEATH
Suffolk
(County) Chelsea
(City or Town) Chelsea Memorial Hospital No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
Registered No.
337 189
$(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Sadie Barkham
2 FULL NAME
(If deceased.is a married, widowed or divorced woman, give also maiden name.)
303 River Rd.
1
winthrop,
Mass.
(If nonresident, give city or town and State)
1
Length of stay: In place of death.
.. years.
months.
1
days. In place of residence.
... years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
July 18,1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY July 13. 59
19
I last saw 1 Alive on July 18, 1959
death is said to
have occurred on the date stated above, at
8:55A.
m
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Antero-septal and posterior
Due To myocardial infarction
OTHER
Arteriosclerotic
SIGNIFICANT
heart disease
1 yr.
Was autopsy performed ?.
Electrocardiograms
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
John F. Pepi
M. D.
821 Saratoga St .F.Boston Date.July199.1959 walnut Grove Cen. , Methuen, mass 6 Place of Burial or Cremation July 21ci 9519mn)
DATE OF BURIAL 19.
Irest P.Caggiano FUNERAL DIRECTORinthrop St., Winthrop ADDRESS
Received and filed. AUG 17 1959 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED WIDOWED 175 or DIVORCEDI dowed
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
George A.
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
69
4
25
If under 24 hours
AGE ...
Years ...
Months ...
Days
Hours ........ Minutes
Entertainer
sual
Occupation :
(Kind of work done during most of working life)
Show Business
15 Social Security No ..
BIRTHPLACE (City ) .....
(State or country)
Philadelphia, Pa.
17 NAME OF
FATHER
18 BIRTHPLACE OPhiladelphia, Pa. FATHER (City). (State or country)
19 MAIDEN NAMEIary Hamilton OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
Philadelphia, Pa.
(State or country) James B. Tiffin
(Address)
Informan 60 State St. , Boston, Mass.
21
A TRUE COPY
ATTEST:
Joseph a Tyrrell
(Registrar of City or Town where death occurred)
DATE FILED
July 20,1959
19
3 DATE OF DEATH (b) Due To (c) (Address). 7 NAME OF 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 .. ) 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
50M - 11-55-916145
12 hrs
14 Industry
or Business:
126-07-2263
Francis A.Mills
PARENTS
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
That I attended deceased from July 18,1959
19
INTERVAL BETWEEN ONSET AND DEATH
RECEIVED
1
AUG 171939 4#1
COPY OF CERTIFICATE OF DEATH
CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE
TOWN OR CITY CLERK'S NO.
220
1. NAME OF
DECEASED
(TYPE OR PRINT)
A. [FIRST)
B. (MIDOLE)
C. (LAST)
FITZGERALD
2. DATE
OF
DEATH
IMONTH)
TOAY)
(YEAR)
July 31, 1959
3. PLACE OF DEATH
A. COUNTY
Merrimack
4. USUAL RESIDENCE (WHERE OECEASEO LIVED. IF INSTITUTION: RESIDENCE
B. COUNTY
A. STATE
Massachusetts
Suffolk
B. CITY
OR
TOWN
New London
C. LENGTH OF
STAY (IN THIS PLACE)
52 hrs.
C. CITY (GIVE ACTUAL TOWN OF RESIDENCE, NOT MAILING ADDRESS).
OR
TOWN
Winthrop
D. FULL NAME OF (IF NOT IN HOSPITAL OR INSTITUTION, GIVE STREET ADDRESS OR LOCATION)
HOSPITAL OR
INSTITUTION
New London Hospital
D. STREET (IF RURAL. GIVE LOCATION)
ADDRESS
21 Court Road
E. IS RESIDENCE
ON FARMY
YES
NO E
5. SEX
Female
6. COLOR OR RACE 7.
White
MARRIED
NEVER MARRIED
DIVORCED
WIDOWED
8. NAME OF HUSBAND OR WIFE (MAIOEN NAME IF WIFE)
Michael J. Fitzgerald - Deccased
1925
9. DATE OF BIRTH
10. AGE (IN YEARS
LAST BIRTHOAY)
78
IF UNDER 1 YEAR MONTHS OAYS
IF UNDER 24 NRS HOURS MIN.
11A. USUAL OCCUPATION (KINO OF WORK
OONE DURING MOST OF WORKING LIFE. EVEN IF RETIRED)
Housewife - At Home
11 B. KIND OF BUSINESS OR
INDUSTRY
Boston, Mass.
13. CITIZEN OF WHAT
COUNTRY?
USA
14. FATHER'S NAME
Patrick Tegnan
15. MOTHER'S MAIDEN NAME
16. WAS DECEASED EVER IN U.S. ARMED FORCES? 17. SOC. SEC. NO.
IYES, NO. OR UNKNOWNI | (IF YES. GIVE WAR OR OATES OF SERVICE)
no
-
-
18A. INFORMANT
Thomas Fitzgerald
18B. ADDRESS
81 Bancroft Rd., Melrose, Mass.
19. CAUSE OF DEATH (ENTER ONLY ONE CAUSE PER LINE FOR IAI. (B), AND (C)
PART I DEATH WAS CAUSED BY,
IMMEDIATE CAUSE (A)
Infarction of Bowel with Gangrene
INTERVAL BETWEEN
ONSET AND DEATH
2 Days
CONDITIONS. IF ANY.
WHICH GAVE RISE TO ABOVE CAUSE TA). STATING THE UNOER. LYING CAUSE LAST. DUE TO (C).
PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART IA)
20. WAS AUTOPSY PERFORMED?
YES
NO
21A. ACCIDENT
SUICIDE HOMICIDE
21B. DESCRIBE HOW INJURY OCCURRED (ENTER NATURE OF INJURY IN PART | OR PART II OF ITEM 19.)
21D. INJURY OCCURRED
WHILE AT
WORK
AT WORK
NOT WHILE
21E. PLACE OF INJURY (E. G .. IN OR ABOUT HOME. FARM. FACTORY. STREET. OFFICE BLDG .. ETC.'
21F. CITY. TOWN OR LOCATION
COUNTY
STATE
22. I attended the deceased from July. 29, 159 ., to July 31, 159. and last saw
Death occured at
8 PM
her
Msnlive on
July 31159
m on the date stated above: and to the best of my knowledge, from the causes stated.
23A. SIGNATURE
John H. Ohler MD
(DEGREE OR TITLE)
23B. ADDRESS
New London, N. H.
23C. DATE SIGNED 7-31-59
MEDICAL CERTIFICATION
Arteriosclerotic Heart Disease with Auricular Mutter
21C. TIME
OF
INJURY
MONTH
OAY
YEAR
HOUN
M.
DUE TO (B)
Mesenteric Thrombosis
2 Days
-
12. BIRTHPLACE (CITY OR TOWN, STATE
OR FOREIGN COUNTRY)
BEFORE AOMISSION.)
ELIZABETII
TERESA
X
(STATE)
IF ENTOMBED 24E. PLACE OF BURIAL
INAME OF CEMETERY)
LOCATION ICITY. TOWN. COUNTY) (STATE)
DATE
25. FUNERAL DIRECTOR'S SIGNATURE
ADDRESS
Walton W. Chadwick, New London, N. H.
COUNTERSIGNED -AGENT (CITT DO. OF HEALTH)
DATE
DATE REC'D BY TOWN OR CITY CLERK
Aug. 1, 1959
CLERK'S OWN SIGNATURE
William F. Kidder
CLERK OF
New London
i 17 1959 live copy, Iller.
2 sieder
Clerk of
New London
Dated. Aug. 10 19.59
VS 17
C.O. 18648-10-57-25M VE.V
24A. BURIAL.
ENTOMBMENT
CREMATION REMOVAL
248 DATE 8-3-59
24 C. NAME OF CEMETERY OR CREMATORY Holy Cross Cemetery
24D. LOCATION ICITT. TOWN, OR COUNTY) Malden, Massachusetts
PLACE OF DEATH
Suffolk (County) Winthrop Mass (City or Town)
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.
No. inthron Community Hospital
2 FULL NAME Eugene Dasch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
44 Cottage Park Rd
(Usual place of abode)
St
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death _......... years.
months
days. In place of residence ..
2 9years.
.months ..
....... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
AUG
2
1959
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
FEB
19.
50
AUG 2
1957
I last saw h/Malive on
AUG 2
19
57, death is said to
have occurred on the date stated above, at
111- A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
RUPTURED AORTIC ANEURYSM
AORTIC ANEURYSM-
(b)
Due To ARTERIO-SCLEROTIC HEART
DISEASE
WITH ANGINA PECTORIS
Due To (c)
OTHER
SIGNIFICANT
RHEUMATOID ARTHRITIS
5YRS
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
10
(Signed)
myson n. Kring
M. D.
(Address) 222 PLEASANT ST. WINTHROP
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