USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 66
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. . . Chap. 114, Sec. 46. G. L., (Tercentenary Edition).
٤ ١سيثين
RULES OF PRACTICE
The fulfillment of the purpose of these laws qalfs 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 deathsonly 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. frPhysigiape:
explanatory instructions on face side of standard certificate oude th. 21959 /11
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, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
X
-
Essex
(County) Danvers
1
(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)
226
Danvers State Hospital, HathorneSt. give its NAME instead of street and number) No.
2 FULL NAME
BlancheE. McElree ...... (Hodgdon)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 18 Hale Avenue Winthrop,Mass ..... St
(Usual place of abode)
Length of stay: In place of death ........... years ..
5 months 3 days. In place of residence. ......... years ........ months ............ days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
Female White
MARRIED
WIDOWED
or DIVORCEarried
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
Arthur McElree
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 15 Years 1
Months.
10 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 ..... unknown
16 BIRTHPLACE (City) Cambridge (State or country)
OTHER
Generalized Arteriosclerosis
SIGNIFICANT
CONDITIONS
yrs
Was autopsy performed?
no
Clinical&Laborator
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. 12/16/ 58
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
December 18,
19
5$
7 NAME OF
Alfred B. Marsh
FUNERAL DIRECTOR Winthrop, Mass.
ADDRESS.
Received and filed.
JAN 11 1960
.19.
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER
(City).
Unknown
(State or country)
19 MAIDEN NAME
OF MOTHER
Bessie, m.n. unk.
20 BIRTHPLACE OF
MOTHER (City) ........
(State or -country)
Unknown
Mary E. Sheehan
21
Informant
(Address)
Hathorne, Mass.
A TRUE COPY Daniel J. Toomey
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Dec. 21,
19.59
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. 1 .. )
25M-2-58-922072
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December 16. 1959 (Year)
(Month)
(Day)
4 I HEREBY CERTIFY, That I attended deceased from July 13 ,19 .... 5.9 to ... Dec., 16,
19. 5$
I last saw h ....... live on Dec. 16, 19. 59 death is said to
have occurred on the date stated above, at 2:45am.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Broncho neumonia with
Vinus Infection
Due To (1)
Due To
(c)
PLACE OF DEATH
-302
Registered No.
§(If death occurred in a hospital or institution,
(Was deceased a
U. S. War Veteran,
no
if so specify WAR).
(If nonresident, give city or town and State)
Retired Factory Worker
17 NAME OF
FATHER
Herbert Hodgdon
Winthrop Cemetery-Winthrop
.
1
JAN 1 1 1960 AM
2-301A 1
TIONS
RTIFICATE
ing DEATH enter n one r each and (c)
not mean of dying, rt failure, It means or compli- h caused
if any, rise to se
(a), under- se last.
ens contrib- Ath but not e terminal Rtion given
Capter 137, .. requires To print or cause or death on cates, and Acts of 'es Physi- ent or type signature.
21,1954
59-925686
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
Winthrop Community Hospital
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 227
[(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)
102 Winthrop Shore Drive St.
(If nonresident, give city or town and State)
35
Length of stay: In place of death
......
.... years.
1
months
20
.days.
In place of residence.
.years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
19
195.9.
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
October 31 1959 .December 19
59
I last saw heralive on
December .... 18
.... , 19.9 ...... , death is said to
have occurred on the date stated above, at
12:25a .m.
INTERVAL
BETWEEN
ONSET AND
DEATH
7 wks
12
AGE81
Years.
5
Months.
6
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.
Last Boston
16 BIRTHPLACE (City)
(State or country)
Mäss
17 NAME OF
FATHER
August Rausch
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
Louise Wohlschlegel
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Boston
(PRINT OR TYPE SIGNATURE) (Address) 73 .... Bartlett Rd .. Date. 12/19 19 59
6 Woodlawn
Everett.
Place of Burial or Cremation
Dec. 22
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS winthrop Mass
19
(Registrar)
PARENTS
21
Informant
(Address)
Muriel C Lenth
102 Winthrop Shore Drive
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)
12/21/973
(Official Designation)
(Date of Issue of Permit)
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME
Charlotte (fiausch)
Lenth
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
C Henry Lenth
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Acute myocardial infarction
(a)
Due To
(b)
Hypertensive & Arteriosclerotic
heart disease
2 yrs
Due TGeneralized arteriosclerosis (c) ......
... 5 yrs
OTHER Cerebral embolism with left SIGNIFICANThemiplegia & bleeding CONDITIONS peptic ulcer)
4 wks
Was autopsy performed?
no
What test confirmed diagnosis? clinical & laboratory
5 Was disease or injury in any way related to occupation of deceased ? no .. If so, specify
(Signed)
M. Traunstein
M. D. M. Traunstein, Jr. , M. D. /V
(City or Town)
19
59
Received and filed
PERSONAL AND STATISTICAL PARTICULARS
11 IF STILLBORN, enter that fact here.
010-09-9432
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 following 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 un- related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
DECEIVED
TO!
:1.12
6
til
DEC 211959 CM
1301A 1
110NS
PLACE OF DEATH
X Suffolk (County) Winthrop (City or Town)
·ANT
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
Mayflower Nursing Home No.
PERONI
(If deceased is a married, widowed or divorced woman, give also maiden name.)
118 Bennington St.
St.
East Boston, mass.
(If nonresident, give city or town and State)
Length of stay: In place of death.
1 years.
1
month}
16 days. In place of residence
... years
.. months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Dec.
20
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
Nov. 5,
58
19.
to Dec. 20, 59
19
I last saw hsWalive on
Dec.20
1959'
, death is said to
have occurred on the date stated above, at
11:30 p. m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Generalized Arteriosclerose DEATH
ARTERIOS Clerofic Heart Dz.
24rs
Due To
- (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
NO
men J. Pepi 2) Saratoga St. Bosteza 12/20
M. D. 1959
6 St. Michael Cemetery
Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Dec. 23, 59 19
7 NAME OF
FUNERAL DIRECTOR
9 Chelsea St., East Boston, Mass.
ADDRESS
Received and filed DEC 22-1959 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
widowed
MARRIED
WIDOWED
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
AGE 81
Years.
Months ._...... Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No .....
none
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Clement Peroni
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
not known
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Clement Peroni (son)
Informant
(Address) 118 Bennington St. ,E. Boston, Mass
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)"
5
(Official Designation)
6
(Date of Issue of Permit)
TIFICATE
Ing DEATH nter a one each and (c)
not mean of
dying, failure, It means compli- caused
if any, rise to e
(a), under- last.
2
contrib- h but not · terminal ion given
apter 137, . requires o print or cause or death cates.
50M-1-58-921876
2 FULL NAME John
CERTIFICATE OF DEATH
Registered No. 228
[(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 po specify WAR).
NO
(a) Residence. No. (Usual place of abode)
Maria Voltine
Shoe worker
PARENTS
5 Was disease or injury in any way related to occupation of deceased ? If so, specify ..
Anthony Rapino
1.
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 death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or 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 preceding section or by section forty-five of chapter one hundred and four- teen, shall. if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eightcen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board. from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery. until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form 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. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6 , as amended by Chap. 632. Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deathsonly 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.
SPACE FOR ADDITIONAL INFORMATION
DEC 2 21959 FM
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1-301A 1
TIONS
RTIFICATE
ing DEATH enter in one r each and (c)
not mean of dying, rt failure, It means or compli- caused
if any, rise to se (a), e under- se last.
as contrib- Ith but not le terminal tion given
Capter 137, .. requires to print or cause or death on cates, and . Acts of "es Physi- nt or type signature.
2-925686
PLACE OF DEATH
Suffolk County )
No. Frances
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
229
Registered No.
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
No
lif so specify WAR)
(a) Residence. No.
54 C11If Ave ..
St
(If nonresident, give city or town and State)
(Usual place of abode)
Length of stay : In place of death .............. years ..
months.
2
.days. In place of residence
... years
35
months ..
......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
DEC,
22
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
19.50
.... ,
to ...
Dec. 22
19:59
I last saw h& ...... alive on
Dec22, 15%, death is said to
have occurred on the date stated above, at
10:04Pm
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Mesicardial Infarction
(a)
INTERVAL BETWEEN ONSET AND DEATH
1 hr
Due To
Myocardial Heart
(b) Disease
400
Due To
arteriosclerosis
(c) generalized
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
Joseph Gregorie
IT OR TYPE SIGNATURE) 199 Washington Date 17-27 19 59
(Address)
Winthrop winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December.26
19.59
7 NAME OF
FUNERAL DIRECTOR
Artnur J. O 'Maley
ADDRESS
Winthrop -Mass.
DEC 23 1959
19
Received and filed
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEOU wed
10a If married, widowed, or divorced
HUSBAND of
Phillip Chardon
(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
12
AGE 05
Years
Months.
Days
Hours .....
......
Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business :
Social Worker
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Francis A. Fanning
18 BIRTHPLACE OF
Chelsea
FATHER (City)
(State or country)
Mass
19 MAIDEN NAME
M D.
OF MOTHER
Margaret E. Callahan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Boston
21 Mrs. Elizabeth Doda
Informan
(Address) 181 Highland Ave., 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)
12/23/59
(Date of Issue of Permit)
(Official Designation) د ..
1
Winthrop (City or Town) Winthrop Community Hosp
CERTIFICATE OF DEATH
Chardon
Fanning
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
6
PARENTS
Boston
(write the word)
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