USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 70
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6 Yinthrop
Place of Iturial oi Cremation
Winthrop
(City or Town)
DATE OF BURIAL
October 19
1958
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with moc BEFORE the buffal or transit permit was issued :
(Signature of Agent of Board of Health or other)
10-1759
5-72352
(Official Designation )
(Date of Issue of Permit )
M R-30YA
.THIS IS A NENT RECORD. se only : APPROVED ink or black writer ribbon.
TRUCTIONS FOR IL CERTIFICATE
1 giving I OF DEATH not enter : than one e for each (b) and (c)
does not mean de of dying. heart failure. lets It means Ist. of compli- which caused
the
- ka:e mute to ( a) ...... last
ON1.
death but not n the terminal ondition git.en
Chapter 137. 1954, requires ans to print or e cause or
gof death on
rtificates CAP 46 : : 9 & AP 114 45. 142 0 81960 al Director: ase use only BACK Ink.
BIO-56.923666
, 2º In
rar
5 YEARS
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
2 FULL NAME
That T attended deceased from
A TRUE COPY ATTEST:
Charles H Mackie
JAN 2 0 1960 4M
247
OUT - OF9807OWN
To be filed for burlal permit with Board of Health or Its
Registered No.
2 FULL. NAME. Lena Guttel
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No 7 Elmwood Court
St.
Winthrop
(If nonresident, give city or town and Staie)
Length of stay. In place of death
years
months 23days. In place of residence
9
years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
Female
White
MARRIED
WIDOWED
or DIVORCED
10a li married. widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or ) WIFF. of
Louis D. Guttel
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
64 Years
Months
. .. Days
If under 24 hours
Hours . . Minutes
13 l'sual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No ..
16 BIRTIIPLACE (City)
(State or country)
Russia
OTHER
SIGNIFICANT
CONDITIONS
Entero-vesical-vaginal fistula
23days
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
(Signed)
@ihClay
Chorles L. Cloy, M.D.
(Address)
Ass't Die., Mass. Gen'l Hosp .. Date 10/16
.. 19 59
Sharon Mem Park Sharon Mass. Place of Burial oi Cremation (City or Town)
October 18 59
21
Informant
(Address)
Louis D. Guttel 7 Elmwood Ct. Winthrop
I HEREBY CERTIFYIthat a satisfactory standard certificate of death was hed with me BEFORE the initial of transit permit was issued:
7 NAME OF
FUNERAL DIRECTOR
Henry Levine
470 Harvard St. Brookline Mass. H.Urileavait 6 22360
ADDRESS
OCT 20 1OZ
19
J(If death occurred in a hospital or institution,
St. (give its NAME. instead of street and numher)
No PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) -
10 SINGLE
(write the word)
Married
4 I HEREBY CERTIFY.
That T'attended deceased from
Sept.24
.1259.00
Oct.
17
. 1959
Telast can he Blive on Oct.
17 . 1959 . death is said to
have occurred on the date stated above, at 9. A. M. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bronchopneumonia
(a)
unk
Due (b) To Carcinomatosis
18 mos
(c) Due To Careinoma of Ovary
2 yrs
17 NAME. OF
FATHER
Julian Yorks
PARENTS
18 BIRTIIPLACE OF FATHER (City) (State or country )
Russia
19 MAIDEN NAME
OF MOTHER
Sarah (Unknown)
20 BIRTIIPLACE OF
MOTHER (City)
(State or country )
Russia
VAR 08 1960 al Director: se use only C.ACK Ink.
00.50.023008
PLACE OF DEATH
SUFFOLK
(County)
1
BOSTON
(City or Town)
MASSACHUSETTS GENERAL HOSPITAL
No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
MR-301A
- THISIS A NENT RECORD. only APPROVED link or black Friter ribbon.
'RUCTIONS FOR L CERTIFICATE giving OF DEATH
not enter than one e for each (b) and (c)
does not mean de 0' dvinr. heart failure. etc. It means it is comple. U RICA 75
on', if any, za:e mare to (.). the under. cause last
iftomt contrib. . death but mot o the terminal condition sites
Chapter 137. 1944, requires ns to print or 4 of of death on rtifcates AP 46 : : 9 & 6 AP 114 45. DATE OF BURIAL
, M. D.
Received and filed
Charles H. Ina
(Signature of Agent of Board of llealth or other)
(Cc5 18
1900
(Official Designation)
(Date of Issue of Permit)
V.B. V
-
INTERVAL BETWEEN ONSET AND DEATH
3 DATE OF
DF.ATII
October (Monthi
(('sual place of ahode )
A TRUE COPY ATTEST: Charles it. Mackie City kesistrar
248:
The Commonwealth of MassachusettsOUT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To he filed for burial permit with Board of Health or Its Agent. 1.0014
Registered No.
J(If death occurred in a hospital or institution.
St. (give its NAME instead of street and number)
2 FULL NAME-
Maryanna DOROTHY CORKUM
(Hill)
(CORKHUM)
-
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
586 Shirley St.
St .. Winthrop Mass. (If nonresident, give city or town and State)
(l'sual place of abode)
Length of stay: In place of death
years 1
months 4 days. In place of residence 5 Qears
months
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF October
DEATII
( Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That Yattended deceased from
October
10 19 59
10
October
20
. 19
. death is said to
have occurred on the date stated above, at
10:30P
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) pulmonary edema
- (b) .
Due To idiopathic cardiomegaly Idiopathic cartonejulia
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
pulmonaryemboll, small
1 year
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)
Chorles L. Clay, M.D.
(Address)
Ass'l Dir., Mass. Gon'! Hosp. Date
Oct. 21 19 59
6
Winthrop Cemetery Winthrop, Mass Place of Burial or Cremation (C'ity or Town)
DATE OF BURIAL October 24-1959
7 NAME OF
FUNERAL DIRECTOR
albert To March
ADDRESS,174 Winthrop St. Winthrop, Mass
Rec Charles A. mackie 19
(Registrar)
8 SF.X
9 COLOR
10 SINGLE
(write the word)
MARRIED
married
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND c(
(Give maiden name of wife in full)
(or) WIFE of
Lindsey Arthur Corkhum
(Husband's name in full)
II IF STILLBORN, enter that fact here.
1 year AGE. 59 Years
7 Months 1 Days
If under 24 hours
Hours
Minutes
13 l'qual
Occupation :
housewife
(Kind of work done during most of working life)
14 Industry
or Business :
own home
15 Social Security No.
012-16-3778-B2
16 BIRTHPLACE (City)
New York City
(State or country)
New York
17 NAME OF
FATHER
Frank
Arthur Hill
18 BIRTHPLACE OF
FATIIER (City)
(State or country )
NO a-Scotia
19 MAIDEN NAME
OF MOTHER
Ella Louise Lewis
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21 Informant Lindsey. A. Corkhum
(Address)
586 Shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with be BEFORE the histor trangt permit was issued: Maria Mar Vonalel
(Siknature of Agent of Board of Health or other)
5045 10-23-59
(Official Designation)
(Date of Issue of Permit)
-
PLACE OF DEATH
SUFFOLK ---
1
(County)
BOSTON
(C'ity or Town)
MASSACHUSETTS GENERAL HOSPITAL
No.
X
AR-301A
-THIS IS A NENT RECORD. 1. only APPROVED ink or black riter ribbon.
I RUCTIONS FOR CERTIFICATE
giving OF DEATH
sot enter than one u? for each (b) and (c)
i. does not mean dying. a heart failure. oetc. It means 11 of compli-
34.4 if any. tate five to (0) the under. last
death but not the terminal
Chapter 137. 1954, .requires as to print or . cause or f death 00 tificates. TAP. 46 31 9 & AP 114 :45. 1142 28 1960 el Director: . use only BACK Ink.
, M. D.
PARENTS
PERSONAL AND STATISTICAL PARTICULARS
female
white
59
Welast saw her alive on
October 20
19 59
INTERVAL BETWEEN ONSET AND DEATH
1year
20
1959
PHYSICIAN - IMPORTANT (Was deceased a [1. S. War Veteran, (if so specify WAR)
X
A TRUE COPY ATTEST: Charles it Mackie City Registrar
,
JAN 2 21900 TH
249
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent
10215
CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital or institution, St. I give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran,
{if so specify WAR)
no
(If deceased is a married, widowed or divorced woman, give also maiden name.) 70 floyd St Winthrop St
Winthrop
Mass
6 hrs 55 min
(If nonresident, give city or town and State)
.months days. In place of residence .. years months .days.
MEDICAL. CERTIFICATE OF DEATII
3 DATE OF
DEATH
10
/31/59
(Day)
(Year)
(Month)
4I HEREBY CERTIFY 120 PM 10/31/ 7 to.
5
That | attended deceased from
im
10131
I last saw h. Talive on
£45 pm 10/3, 195%, death is said to
have occurred on the date stated above, at
8: 45 Pm.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
( a )
Prematurity
Thie To (b)
Due To (c)
(111 F.R SIGNIFICANT CONDITIONS
W'as autopsy performed ?
no
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
no
(Signed) H. Anne Hughes M. 1).
H. Anne Hughes
(PRINT OR TYRE SIGNATURE)
(Address) . Beth Israel Passionate 11/1 1959
Winthrop Cemetery, Winthrop 6
Place of Burial or Cremation DATE OF BURIAL NOV. 2. 19.5.2
7 NAME OF FUNERAL DIRECTOR Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received And filed .... NOV - 3 4958 19. Charles " Macham)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
W
ASINGLE (write the word)
MARRIED
Single
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 1F STILLBORN, enter that fact here.
12
AGE
Years
Months
Days
If under 24 hours
6 Hours 55 Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRT11PLACE (City)
(State or country)
Biston
Mass
17 NAME OF
FATHER
Roger Tallini
18 BIRTHPLACE OF
FATIIER (City)
Arlington
(State or country)
Mac6.
19 MAIDEN NAME
OF MOTHER
Verna Paci
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maso.
21
Roger Tallini
Informant
(Address)
70 Floyd St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
Was Ned with me BEFORE he burial or
wasit permit was issued:
Jacqueline
Cales
(Signature ol Agent ol Board of Health or othery
51309
10-30-59
(Official Designation) (Date ol Issue of Permit)
×
IM R-301A -
1
ITRUCTIONS FOR HIL CERTIFICATE
RIVIng !; OF DEATH d not enter le than one ne for each 5. (b) and (c)
does not mean de of dying. heart failure. etc. It means fiase, or compli. which caused
ions. if owy, gave rise to ramie (a). the under. comse last.
Editions contrib- death but not o the terminal econdition given
w. Chapter 137 81954. requires Fins to prini or e cause or of death on rtihcales, and 48. Acts of quires Physi. prini or type der signature
AN 22 1960
01-6-59-925686
PLACE OF DEATH
Suffolk
(County ) Boston Town) Beth Israel No. Baby Girl Tallini
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
Hospital
2 FULL NAME.
(a) Residence No. (l'sual place of 'abode )
Length of stay
In place of death ... ...... years
X
PARENTS
Boston
(City or Town)
H'
A TRUE COPE ATTEST:
-
-TOM
civil
6
JAN 2 21960 CH
250.
2 FULL NAME .. JOAQUIN FERRIERA Ferreira
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 215 Woodside Axe .
(\'sual place of ahode)
Length of stay: In place of death years
3 weeks months days. In place of residence 30 ears months .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November (Month) (Day)
12, 1959 (Year)
4 I HEREBY CERTIFY . That Yattended deceased from
Oct. 27,
1959. ৳ Nov. 12,
19
Hast saw himalive on Nov . 12,
. 19 59. death is said to
59
have occurred on the date stated ahove, at
11;55Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Laryngo-tracheo-bronchitis
INTERVAL BETWEEN ONSET AND DEATH any
Due To (b) -
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Acute pyelonephritis Infarction, Right kidney ank gos
W'as autopsy performed ?
Yes
What test confirmed diagnosis?
Autojas y
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Charles L. Clay, M.D.
(Addresa) Ass't Dir., Mass. Gon'! Hosp.| Date 11/12/ 1959
6
New Calvary Cemetery, Boston Place of Burial or Cremation ity or Town)
DATE OF BURIAL November 14th 1959
7 NAME OF FUNERAL DIRECTOR Richard C. Kirby, Inc ADDRESS 917 Bennington St. , E.Boston Charles it Lacks 19
NOV 16 1858 (Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEY
Male
9 COLOR White
IO SINGLE
MARRIED
WIDOWED
of DIVORCED
(write the word)
Widowed
10a If married, widowed, or divorced
IfUSBAND of
Mary
M.
Furtado
(Give maiden name of wife in full)
(or) WIFF. of
(Hushand's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 92
Years
Months
Days
If under 24 hours
Ilours
Minutes
13 L'sual
Occupation :
Proprietor
(Kind of work done during most of working life)
14 Industry
or Business:
Tavern
15 Social Security No .. .
No
16 BIRTIIPLACE (City)
(State or country)
Cambridge
Mass.
17 NAME OF
FATIER
Joaquin Ferreira
PARENTS
18 BIRTIIPLACE OF
FATIfER (City)
(State or country)
Portugal
19 MAIDEN NAME
OF MOTIFER
Rita A. Rodriques
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
Portugal
21
Informant
Henry J. Bush-nephew
(Address)5 Ingrid Rd.Weymouth
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the Burial or tranny permit was issued: Jacqueline (Cefest
(Signature of Agent of Board of Health or other)
Nov- 13,1959
-
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts)UT - OF - TOWN EDWARD J. CRONIN To be filed for burial permit with Board of Health or Its Agent. SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD Registered No. 10717 CERTIFICATE OF DEATH
MASSACHUSETTS GENERAL HOSPITAL
No.
J(If death occurred in a hospital or institution, St. \Rive its NAME. instead of street and number)
No PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
St.
Winthrop, Mass
(If nonresident, give city or town and State)
NENT RECORD. Ise only E APPROVED ink or black Writer ribbon.
ITRUCTIONS FOR IL CERTIFICATE a giving OF DEATH
Snot enter uit than one te for each ( (b) .nđ (c)
does not mean dying. heart failure. etc. It means comph-
5 Mons. if eny. gave rise to rause (*). the under. last
Sifton! contrib. death but not o the terminal fromdition giren ›
Chapter 137, 1954, requires lins to print or he cause of @ of death on certificates.
(IAP. 46. 9+ 9 & CAP. 114 :: 45. HAP 3856) 2. 1960 eso use only 1.ACK Ink.
MR-301A
.- THIS IS A
und day's
, M. D.
53210 (Official Designation) (Date of Issue of Permit)
A TRUE COPY ATTEST: -
1 nurles & Mackie City Registrar
JAN 2 21900 0 ::
"BION
A
A R-303. A
-
PLACE OF DEATH
SUFFOLK (''mity ) BOSTON (ity of town)
The Commonwealth of Alassachuseits JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN 251
To be filed for burial permit with Board ot Health of its Agent
Registered No.
10716
MASSACHUSETTS GENERAL HOSPITAL No. ANNIE L.VASCONCELLOS
fili death occurred in a hospital or institution.
St. ¿ give its NAME instead of street and number)
tlf deceased is a married, widowed or divorced woman, give also maiden name.)
62 Sargent Street
St
Winthrop,
Mass
tlf nonresident, give city of town and State)
years
.days.
MEDICAL. CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL. PARTI ULARS
9 SEX
10 COLOR
MARRIED
Female
White
01 DIVORCED
Widowed
lla If married, widowed, or divorced
HUSBAND of
(Give marlen name of wife in full)
(or) WIFE of
Francis C. Vasconcellos
( Husband's name in full)
12 IF STIL.I. BORN, enter that fact here
13
AGE
83.
2
18
Days
Hotte
Minutes
Occupation :
Housewife
I kind of work done during most of working life>
15 Industry
At home
or Business:
16 Social Secunty No.
033-16-9492 A
17 HIRTHPLACE (City)
Boston
(State of country )
Mass.
18 NAME OF
FATHER
Augustus Ratti
PARENTS
I BIRTHPLACE OF
FATHER (')))
( State of country)
Italy
20 MAIDEN NAME
....
M. D.
OF MOTHER
Mary J. Cavagnaro
· 21 BIRTHPLACE OF
MOTHER (C'if: )
Boston
(State of country)
Mass.
22
Informant
AnthonyJ. Vasconcellos-son
(Address)
6 Upham St. W. Peabody, Mass
I HEREBY CERTIFY that a sairdactory standard certificate of death
was hled with me BEFORE the tonal or traykitpermit was issued:
ignature of Agent of Board of Health or other
5327
(Official Designation)
(Date of Issue of Permit)
V.A. A.
2 FULL NAME
(a) Residence. No.
(''sundt place of alerle)
DEAIR
Injury mom ?
(ity of town and State)
Mantel of
Fall ta mago
(. Sollteas)
D.ite
$5 44-48.
If deceased was a U. S. War Veteran, GI. Chap. in, Section Bu, requires physicians to insert a recital to that effect.
DEATH in plain terms. so that it may be properly classified under the International Classification of Causes
of Death. See reverse side for additional information. See also Chap. 34, >> 6, 20; C'hap. 16. >> 9, 10; Chap. 114,
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
25M-3-59-924434
N. D .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Nature of
Fracture of femur.
( Month)
(Year)
ITHEREBY CERTIFY that I have investigated the death of the person above named and that the CAUSE AND MANNER thereof are as follows: (ff an mjury was involved, state fully.)
Myocardial infarction following fracture of femur.
Accident
S Accident, suprale, or houtrule (specify).
10/1
59
19
IF ACCIDENTAL, was injury cansally related to the death?
Where did
Winthrop, Mass.
"Hatway home, on form, in industrial place, or in
puhhe pln e ?
A .. autor
No
1. Ws fase my nanny i ans wasted union of deceased?
1.MIKHey Michael A. Luongo,
Boston 11/12 ( Print or Type Signature) 1,59
„Holy Cross Cemetery, Malden Place of Burial, or Crematiem. ('ity of Town) DATE OF HURLA !. November 16th 1,59
11 Richard C. Kirby , Inc. ADDRESS 917 Bennington Ita EBoston
Receiveil and filed
NOV 181055!
פן ...
( Registrai )
(Ratti)
PHYSICIAN - IMPORTANT
( Was deceased a
t'. S. War Veteran,
No
if so specify WAR)
Length of stay : In place of death.
years
1
months.
14 days. In place of residence
8
3 DATE OF
November
12.
1959
( write the word)
tí under 24 hours
12 1960
A TRUE COPY ATTEST: 1
Charles it Mackie
City Registrar
JAN 2 21960 CM
1
252
OUT - OF - TOWIT
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. 10840
No. (Allen)
2 FULL NAME HELEN
ATWOOD
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 46 Washington Ave.
St ..
Winthrop
Mass.
(L'sual place of abode)
Length of stay : In place of death
years
1
months days. In place of residence ..... years
months
days.
MEDICAL CERTIFICATE OF DEATII
PERSONAL AND STATISTICAL, PARTICULARS
3 DATE OF November
DEATII
16,
1959
8 SEX
Female
9 COLOR
White
10 SINGLE (write the word)
Widow
MARRIED
WIDOWED
or DIVORCED
41 HEREBY CERTIFY.
That Yattended deceased from
Nov. 15
. 19
59. t. Nov. 16,
. 19 59
Yast saw he Llive on
Nov. 16, . 1959 . death is said to
have occurred on the date stated above, at
1;35 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Bronchopneumonia,
bilateral
Due To (b)
Due To (c)
OTIIER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis
Y Estopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
(Address)
-O.l.Clay Charles L. Clay, M.D. Ass's Dir, Mass. Gen'l Hosp. Date 11/16/ 159
6 Winthrop
Winthrop Place of Burial or Cremation DATE OF BURIAL
(City or Town)
Nov. 18 1959
7 NAME OF FUNERAL DIRECTOR Howard & Reynolds
ADDRESS Winthrop_ L'ass.
Charles H. mackie 19
( Registrar)
NOV 1 8 1959
INTERVAL BETWEEN ONSET AND DEATH 2days
11 IF STILLBORN, enter that fact here.
12
87
O
26
AGE
Years
Months
Days
If under 24 hours
Hours
Minutes
Housewife (Kind of work done during most of working life)
14 Industry
or Business
At home
15 Social Security No.
021-09-0479
Alendale
16 BIRTHPLACE (City),
(State or country)
NOVA Scotia
17 NAME OF
FATHER
Henry Allen
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country )
Nova Scotia
19 MAIDEN NAME
OF MOTHIER
Arabella Dun
20 BIRTHPLACE OF MOTHIER (City) (State or country) Nova Scotia
21 Informant Records Old Are Acsittance (Address) town of winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed ah me BEFORE the burial or transit permit was issued :
Jacqueline
Comey
Signature
Agent of Board of Health or other)
5361
11-16-59.
(Official Designation)
(Date of Issue of Permit)
THIS IS A ENT RECORD. . only APPROVED nk or black iter ribbon.
IUCTIONS FOR CERTIFICATE
giving OF DEATH
ot enter then one for each (b) and (c)
of dying. heart failure. ·te It means r. or compli- chich 491. any.
(a). the
last
Chapter t37. 954, requires is to print or cause or t death on tifcates. AP. 46 >5 9 & AP 114 :45. 22 1960 Il Director: He use only JACK Ink.
PLACE OF DEATH
SUFFOLK
....
(County )
-
BOSTON
(City or Town)
MASSACHUSETTS GENERAL HOSPITAL
f(If death occurred in a hospital or institution.
St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Month) (Das)
(Year)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE, of
Ernest Atwood
(Husband's name in full)
13 l'sual
Occupation :
, M. D.
Registered No.
12
(If nonresident, give city or town and State)
IR-301A
Tion, contrib. death but not the terminal Adition .....
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
JAN 2 21930 [ ...
C
Act
PŁY
SE
10 4
Fu
P
10
C
IR-301A
- THIS IS A IENT RECORD.
-
BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
253
OUT - OF - TOWN
To be filed for burial permit with Board of Health or Its 1'0929
Registered No.
2 FULL NAME ..
EDWARD F.
WALKER
SR.
(If deceased is a married, widnwed or divorced woman, give also maiden name.)
) Residence.
4 Summit Ave.,
(l'sual place of abode)
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay. In place of death
years
months
9 days. In place of residence
2
years
months
days.
MEDICAL CERTIFICATE OF DEATHI
3 DATE OF November
DEATII
17,
1959
(Month)
(Day)
(Year)
4I HEREBY CERTIFY.
That Yattended deceased from
Nov.9,
19
59. ... Nov. 17,
. 19
59
Melast saw h
alive on
Nov. 17,
, 19
59 death is said to
have occurred on the date stated above, at
4;20 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Aspiration of Gastric Content
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here. -
12
AGE
5Ficars
Months
. Days
If under 24 hours
Ilours
Minutes
13 l'sual
Sales Manager
(Kind of work done during most of working life)
Occupation :
14 Industry
or Business :
Trucking Co.
15 Social Security No.
015-16-7747
16 BIRTIIPLACE (City) (State or country) Mass.
17 NAME OF
FATHER
Joseph Walker
18 BIRTHPLACE OF
Boston
FATIIER (City)
(State or country )
Mass.
19 MAIDEN NAME
OF MOTHER
IF Gathering Driscoll
Boston
21 Mrs Kathleen F. Walker
Informant
(Address)
4 Summit Are, win, You.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Signaturof Agent of Board of Health or other)
5398
11 19-54
(Official Designation)
(Date of Issue of Permit)
the
(a). under. last.
Moms contrib. death but mot the terminal
Chapter 137, 954, requires s to priot or cause of [ death on tificates. AP. 46. 95 9 & P. 114 :45, AP 38 $6.)
I Director: . use only ACK Ink.
0.00.023866
PLACE OF DEATH
SUFFOLK
(County)
MASSACHUSETTS GENERAL HOSPITAL
[{If death necurred in a hospital or institution, St. (give its NAME instead of street aod number) -
PHYSICIAN - IMPORTANT ( Was deceased a no U. S. War Veteran, if sn specify WAR)
10 SINGLE
(write the word)
Married
10a If married, widnwed nr
HUSBAND of
Katliteen L. Broussard
(Give maiden name of wife in full)
(or) WIFE of
(Ilushand's name io full)
Due To
To Bleeding Gastric Ulcers.
(b)
Due To
Portal CinihoJAS
(c)
OTHER
SIGNIFICANT
CONDITIONS
Hepatic Failus
4 days.
Was autopsy performed ?
yes
What test confirmed diagnosis ?
autopsy
S Was disease or injury in any way related to nccupatinn of deceased? If so, specify
(Signed)
(Address)
Charles L. Clay, M.D.
&'s Dir., Mass. Gen'l Hosp. Date 11/17/ 1959
6
St.
Place nf burial or Cremation
Josepho Boston
(City of Town)
DATE OF BURIAL November 21, 59
7 NAME OF FUNERAL DIRECTOR John To. Kelly
ADDRESS 286 Meridian St.,
Rece Charles H. Latte 19 JAN 22 1960 OV T 3 1959 (Registrar)
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