USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 11
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Did injury occur in or about home, on farm, in industrial place, or in
Leonard activin M. D.
35M-11-59-926662
M R-303 A 1
4 I HEREBY 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.) PNEUMONITIS
If under 24 hours
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: FEB SOL
(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 al sent 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 poison) 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
X
M R-301A
-
PLACE OF DEATH
Suffolk
Doston
('is of lown)
The Commonwealth of Massachusetts) UT - OF - TOWN JOSEPH D. WARD 00316 SECRETARY OF THE COMMONWEALTH To he filed for burial permit with Board of Health or its Agent. DIVISION OF VITAL STATISTICS STANDARD Registered No. CERTIFICATE OF DEATH
Veterans Administration Hospital
[(If death occurred in a hospital or institution.
St. ¿ give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT
[(Was deceased a
{ U. S. War Veteran,
lif so specify WAR)
WW 2
(If deceased is a married, widowed or divorced woman, give also maiden name.)
36 Tewksbury
St.
Winthrop, l'ass.
(a) Residence. No.
il'smal place of abode )
(If nonresident, give city or town and State)
Length of stay . In place of death.
years
months
-1
days. In place of residence
years
... months .. ........
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Wale
9 COLOR
White
10 SINGLE (write the word)
MARRIED
WIDOWEDMarried
of DIVORCER
I HEREBY
January 3'
19
CERTIF
January 9
to
14
10a If married, widowed of brad ford HUSBAND of
(Give maiden name of wife in full)
xxxxxxxxXXXXXXXXXXXXXXX
XXXXXXXXXX, death is said to
have occurred on the date stated above, at 12;55 A -M !.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Occlusion of circumflex right
(a)
coronary artery with acute
myocardial infarction
Due To (b)
INTERVAL
BETWEEN
11 IF STILLHORN, enter that fact here
DNSET AND
12
DEATH
24 Hrs
62
AGE
Years ..
5
Months
Days
If under 24 hours
.Hours ...
.Minutes
13 L'sual
Occupati
:Asst. Supt. Strect Dept.
(Kind of work done during most of working life)
14 Industry
or Business :
Town of Winthrop
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Herbert G Batchelder
IX BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
lass.
19 MAIDEN NAME
OF MOTHER
Roslyn Ferren
DU BIRTHPLACE OF
MOTHER (City)
(State of country)
Mass.
Taunton
6 Winthrop Cemetery, Winthrop, Mass.
Place of Ilurial or Cremation
(City or Town)
19 60
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
180 Winthrop.St. ,Winthrop, Mass
1 JAN1 2- 190
Received and Gled/ .:
partis
(Registrar)
PARENTS
Mary Batchelder
(Wife)
21
Informant
(Address)
36 Tewksbury St., Winthrop Lass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Jacqueline Carey
(Signatur of Agent of Board of Health or other)
615 2
(-11-60
(Official Designation)
(Date of Issue of Permit)
....
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ), (b) and (c)
does not mean code of dying. as heart failure. a, etr It means trase, or compli. which caused
I !?
dition:, if any. ch sure rise to ce cause (a1. ing the under. & cause last.
Due To (c)
OTHER
SIGNIFICANI
CONDITIONS
Was autopsy performed ?
Yes
What test confirmed chagnosis ?
Autopsy & laboratory
findingo
No
5 Was chisease or injury in any way related t.Poccupation of deceased ? If so, specify
(Signed)
M D.
Henry E.Simmons, M.D.
(PRINT OR TYPE SHINATURE)
VA Hospital, Boston
Date .
Jan. 9 10 00
(Addre
January
9
1960
3 DATE OF
DEATH
( Month)
(Day)
VA (Year)
That A attended deceased from
68'
(or) WIFE of
( Husband's name in full)
Allston
anditions contrib. to drath but not I to the terminal condition given
e - Chapter 137. of 1954. requires crans to print of the cause or s of death on certificates, and ter 48. Acts of requires Physi - to print or type under signature. cal examiner raived sdiction IAR 23 1960 OM-6-59.925686 -
2 FULL NAME
Cornelius H. MATCHELDER
60
DATE OF BURIAL .
January ...
.........
12,
A TRUE COPY ATTEST: Charles #. I Mackie City Registrar
OUT - OF - TOWN
PARENTS
18 BIRTIIPLACE OF
FATIIER (City)
(State of country)
Ireland
19 MAIDEN NAME
OF MOTHIER
Bridget Jorton
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
Ireland
21 "ed. Records Boston State Hospital 591 Morton St. Dorchester 25 lass. Informant (Address)
7 NAME OF l'ary J. Burns
FUNERAL DIRECTOR
111 nter Steroxbury, Mass.
Received and filed
Charles H
7 .- accent
( Registrar)
8 SEX
9 COLOR
10 SINGLE
(write the word )
MARRIED
WIDOWED
of DIVORCED
Single
4I HEREBY CERTIFY.
. 19
That I attended deceased from
JAN. 7, 1060. to JAN,
4
60
I last saw helalive on
JAN. 9,
. 19 60. death is said to
have occurred on the date stated above, at
3:50 Pm
10a If married. widowed, or divorced
IUSHAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE78
Years
Months
Days
If under 24 hours
Hours . - Minutes
13 t'qual
Occupation :
Factory Worker
(Kind of work done during most of working life)
14 Industry
or Business:
Candy factory
15 Social Security No ..
Mong knorm
16 BIRTIIPLACE (City)
(State or country)
Tass.
Boston
OTIIER
SIGNIFICANT
CONDITIONS
Sigmoid Volvulus
2 days
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)
Cafert
(Address)
Boston Stali
Greene, M. D. Half. Date 1-9-1963
6
Tope, Boston
XXXXX87/1960x
(City of Town)
Place of Burial or Cremation DATE OF BURIAL January 27, 1960
ADDRESS
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
To be filed for burial permit with Board of Health or Its Agent. 00898
No. BOSTON STATE HOSP.
J(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)
NO
St. throp
cif
nonresident, give city or town and State)
Length of stay: In place of death 43 years 3 months 19 days. In place of residence
years
months
days.
MEDICAL CERTIFICATE OF DEATII
3 DATE OF
DEATII
JAN. 9, 1960 (Year)
(Month)
(Day
INTERVAL BETWEEN ONSET AND DEATH 30MIN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
acute Coronary Thrombosis
(a) .
Due To (b) -
Due To (c)
PLACE OF DEATH
1
B .- THIS IS A ANENT RECORD. Use only TE APPROVED k ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean node or drink. as heart failure. a. Its. It means state or romph- which caused 4.20
litsons. if any. face rise to 1
(a). az the under- cause
last.
editions contrib - - > to death but not to the terminal condition giren
e :- Chapter 137, of 1954, requires cians to print or the cause of s of death on certificates. CHAP. 46. 99 9 & CHAP. 114 :$ 45, CHAP. 38 $ 6.} IR 23 1960
OM-10-50.923000
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the hurtial or panert permit was issued :
(Signature of Agent of Board of Health or other)
E 24751
1/26/60
(Official Designation)
(Date of Issue of Permit)
Registered No.
2 FULL NAME. CUNNINGHAM Annie.
( If deceased is a married, widowed of divorced woman, give also maiden name.)
(a) Residence. No.
(L'sual place of Ahode ) 400 Revere St.,
PERSONAL AND STATISTICAL PARTICULARS
117 NAME OF
FATIIER
Timothy Cunningham
1
MR-301A
A TRUE COPY ATTEST:
4. Macker
The Commonwealth of Massachusetts UT - OF - TOWN
45
To be filed for burial permit wilh Board of Health or its Ass? 00271
Registered No.
f(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
NO
U. S. War Veteran,
if so specify WAR)
-
(a) Residence. No. 201 Shirley. St. (Usual place of abode)
12
st.Winthrop, Mass.
10 (f
(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
Male
White
10 SINGLE
MARRIED
WIDOWED
E DIVORCED
Marriedd)
DEATH
(Month) (Day)
(Year)
4 I HEREBY CERTIFY ,
That weattended deceased from
Dec. 28. 19 59. in Jan.
Q
, 1950
wb last saw himlive on
Jan . 9
, 19.60, death is said to
have occurred on the date stated above, at
9:500 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Metastatic Carcinoma
- (b)
Due To
Carcinoma of Duodenum
Due To (c)
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)
Charles L. Clay, M.D.
1' Hosp. Dats Jan. 91960
Crawford St. Cemetery W. Roxbury 6
Place of Burial or Cremjmuary 10 DATE OF BURIAL
7 NAME OF
Henry Levine FUNERAL DIBPFORHarvard -St. Brookline ADDRESS
Received and filed
19
(Registrar) Charles Bl Li
PARENTS
18 BIRTIIPLACE OF
FATHIER (City) (State or country)
Russia
19 MAIDEN NAME
OF MOTHIER
Bessie Feldman
20 BIRTHPLACE OF
MOTHIER (City).
Russin
(State or country)
Mrs . Myer Wolfgang
I HEREBY CERTIFY that a satisfactory standard certificate of death (was filed with me BEFORE the burial or transit permit was issued : C-24310
(Signature of Agent of Board of Health or other) Jan. 10, 1960
(Official Designation)
(Date of Issue of Permit)
00M.10.58-923666
X 1 PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
Massachusetts General Hospital
No.
2 FULL NAME ... Mver Wolfgang
(If deceased is a married, widowed or divorced woman, give also maiden name.)
EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
BAKER MEMORIAL .
RM R-301A
.B .- THIS IS A AANENT RECORD. Use only TE APPROVED chink or black ewriter ribbon.
NSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH
do not enter more than one use for each (a), (b) snd (c)
his does not mean mode of dring. as heart failure, nin. str. It means disease. or comple. which caused
152
"ditions, if any, ich gave rise to :e cause (a), ning the under- cause last.
Conditions contrib. e to death but not ed to the terminal " condition given a)
ite :- Chapter 137, of 1954, requires sicians to print or the cause of es of death on h certificates. ₴ CHAP. 46, 35 9 & CHAP. 114 ': 45, PR 23 11960 ineral Director: lease use only BLACK ink.
. M. D.
(Address)
INTERVAL BETWEEN ONSET AND DEATH 2yrs.
11 IF STILLBORN, enter that fact here.
12 51
AGE .
Years .
Months
_ Days
If under 24 hours
Hours ...... Minutes
Credit Manager
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Consumer Credit
15 Social Security No ...
Russia
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Samuel Wolfgang
2 yrs.
10a If married, widowed, or divorcedbetty Katz
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
3 DATE OF January
Q
(City or Town) 19 69 21 Informant (Address) 204 Shirley st. Winthrop
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
PLACE OF DEATH
Suffolk (Counts )
Boston (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF- TOWN ZU
To be filed for burial permit with Board of Ilealth or its Agent.
00592
Registered No.
{ (If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number) No.
2 FULL NAME
16 chael O'Connell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
21 Douglas
(a) Resilence. No. (U'stial place of abode )
Length of stay: In place of death
..........
... years.
months.
19
.days.' In place of residence
.. years.
months.
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
J. nucry
16
1960
( Month) (Day)
(Year)
8 SEX
Male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
single
of 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
Years
2.
Months ...... 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.
16 BIRTHPLACE (City)
Winthrop
(State or country)
Massachusetts
17 NAME OF
FATHER
Edmund O Connell
Boston
18 BIRTIIPLACE OF
FATHER (City)
(State or country)
Ma88
19 MAIDEN NAME
(Signed)
Bue m. Friedman
. D.
OF MOTHER
Mary McNeil
PAUL M. FRIEDMAN, M.D.
(PRINT OR TYPE SIGNATURES
(Address).
Bost. Flting. Hosp Date1/17
1900
Winthrop
Winthrop
6
Place of Burial or Cremation
DATE OF BURIAL
Jan 19
19.60
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
Ebnest P Caggiano
ADDRESS 147 Winthrop St Winthrop
Received and fie care 19
JAN 2 0 1360 (Registrar)
PARENTS
PERSONAL AND STATISTICAL PARTICULARS
JI HEREBY CERTIFY,
That I attended deceased from
December 28, 159, to January 16
19
60
I last saw himalive on January. 16.
19 60, death is said to
have occurred on the date stated above, at 1:25 p. m.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ONSET AND
DEATH
(a)
CONG. HEART FAILURE
pulmonary edema
Due To
Post operative -division of
(b)
patent ductor arteriosus
Due l'o (c) . .
OTHER
SIGNIFRANI
CONDITIONS
W'as antopsy performed?
YES
What test conhrmed diagnosis ?
AUTOPSY
5 Was disease or injury in any way related to occupation of deceased? If so, specify
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21
Edmund O Connell
Informant
(Address)21 Douglass St Winthrop
I HEREBY
CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Jacqueline
Casa
(Signature & Agent of Board of Health or other)
6260
1-18-60
(Official Designation) (Date of Issue of Permit)
X
M R-301A .
TRUCTIONS FOR IL CERTIFICATE
n RIVINg E OF DEATH not enter re than one se for each , (b) and (c)
does not mean ade of dying. s heart failure. 1. ele It means cate, or compli- which caused
itions, if any, A Rare rise to
ne the unders cause last
unditions contrib. to death but not to the terminal condition given
Chapter 137. f 1954. requires cians to print or the cause of s of death on certificates, and er 48. Acts of requires Physi' to print or type under signature.
₹ 23 1960
OM-6-59-925686
The Boston Floating Hospital, 20 Ash
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, {if so specify WAR)
St.
Winthrop, Massachusetts
(If nonresident, give city or town and State)
A TRUE COPY ATTEST: Charles A Mackie City Registrar
×
PLACE OF DEATH
1
CE OF
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 filled for burial permit with Board of Health or Its Agent. 01256
Registered No.
Hospit pfff death occurred in a hospital or institution,
. (hive its NAME instead of street and numher)
2 FULL NAMEK BABY Boy DUGGÁN
(If deceased je a married, widowed or divorced woman, give also maiden name.)
286 REVERE
St WINTHROP
MAIS
(If nonresident, give city or (own and State)
Length of stay: In place of death years __... .. months . days. In place of residence ....___ years
months. ..... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
JAN.
31,
1960
(Month)
(Day)
(Year)*
4 I HEREBY CERTIFY,
That I attended deceased from
Jan. 31 . 1960 . to
Jan. 31
, 1960
I last saw himlive on
Jan.31, 1960, death is said to
have occurred on the date stated above, at . at 9:25%. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Prematurity
Pneumonia
Due To (3) -
Due To (c)
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). 3 Shongward Due Date 1/31 1960
6 ST. MICHAELS - BOSTON
Place of Burial or Cremation
DATE OF BURIAL
FEB
4
60
7 NAME OF ANDREWS + REED, INC. 231 BELMONT ST. BELMONT
ADDRES
FEB 8 1000
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
Of DIVORCED
Single
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
5.Hours _..... Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No .... PostIN
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
DANIEL DUGGAN
18 BIRTHPLACE OF
FATHER (City)
CHELSEA
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
MARGARET FLANNERY
20 BIRTHPLACE OF
MOTHER (City) .....
WINTHROP.
Mass
.
(State or country)
21 Informat Juston Lying-in Hospital (Address) 221 Love wasD AVE Bashar
I HEREBY CERTIFY that a satisfactory standard certificate of death was dhed with me BEFORE me butia or Arghsit permit was issued : L'odore faltach
(Signature of Agept of Board of Health or other)
Received and fled Charles H. Inace- FileB.t. 7.1960, E24961/2-3-60
(Official Designation) (Date of Issue of Permit)
MR-301A
B .- THIS IS A ANENT RECORD. Use only E APPROVED k ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH
not enter re than one se for each ), (b) and (c)
is does not mean mode of dring. as heart failure. a. etc. It means sense. or compli- which 763.5. fitions, if any. A gave rise to e
(€). of the under- last.
1
unditions contrib .- 10 death but not I to the terminal condition giren
e :- Chapter 137, of 1954, requires clans to print or the cause or $ of death on certificates. CHAP. 46, 11 9 & CHAP. 114 $$ 45. CHAP. 38$6.) 23 1960
OM.TO.50-923060
PARENTS
Aus coll .. M. D.
(City or Town)
Boston Lying. IN Hospit Alsda! No.
PHYSICIAN - IMPORTANT
cwas deceased a
U. S. War Veteran,
-
if so specify W'AR).
(a) Residence. No .. (Usual place of abode)
INTERVAL
BETWEEN
ONSET AND
DEATN
A TRUE COPY ATTEST: Couches A. Inackie City Registrar
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
. OF - TOWN 48
To be filed for burial permit with Board of Health or Its Agf 1516
No. Howard 2 FULL NAME MLY. Frank Jenkins
( If deceased is a married, widowed or divorced woman, give also maiden name.)
95 Somerset Av. Winthrop, Mass . St.
(a) Residence. No. (l'susl place of sbode) Length of stay: In place of death years months 11days. In place of residence 45 ears
(If nonresident, give city or town and State)
months
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Februar"
8
(Month)
(1)ay)
(Year)
4 I HEREBY CERTIFY . That Iattended deceased from
January 28 .. 19
to
February 8
"Plast saw h lohlive on
February 2. 19 50death is said to
have occurred on the date stated shove, at 5.20 am
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) . l'yocardial infarction
Due ToCoronary Arteriosclerotic
(b) -
5yrs
Heart Di_case
Due To (c)
OTHER
SIGNIFICANT
Carcinira of Prostate
CONDITIONS
Broncho Inouronia
6yrs
7 days
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Charles L. Clay, M.D. (Address) Ass't Dir., Mass. Gen'l Hosp. . Date
Fob. 3,1960
6 Holyhood Cemetery, Brookline, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL
February 10,1960 19
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh.
ADDRESS 174 Winthrop St . Winthrop, Mass.
Received and filed FEB 11 1960 19
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
white
10 SINGLE
( write the word)
MARRIED Widowed
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
86 ears
7
Months
3 Days
If under 24 hours
... Hours ... Minutes
13 L'sual
Occupation :
Banking
(Kind of work done during most of working life)
14 Industry
or Business :
Trust -Officer
15 Social Security No ..
025-01-3352
16 BIRTIIPLACE (City)
Brookifno
(State or country)
New York
17 NAME OF
FATHER
William H. Jenkins
18 BIRTHPLACE OF
FATIIER (City)
Boston
(State or country)
Massachusetts
19 MAIDEN NAME OF MOTIIER Katherine Grey
20 BIRTHPLACE OF
MOTIIER (City)
London
(State or country)
England
21
Informant
(Address)
Margaret M. Jenkins 95 Somerset Ave Winthrop
I HEREBY CERTIFY that s satisfactory standard certifieste ol death was filed wah me BEFORE the burial or transit permit was issued:
ASignature of Agent of Board of Health or other)
6.6.5X
2 -9-60
(Official Designation) (Date of Issue of Permit)
-
Massachusetts General Hospital PHILLIPS HOUSE
J(If desth occurred in a hospital or institution,
St. (give its NAMIE instead of street and numher)
PHYSICIAN - IMPORTANT (Was deceased a
U. S. War Veteran, (if so specify WAR). NO.
TRUCTIONS FOR L CERTIFICATE a giving OF DEATH
not enter e than one e for esch , (b) sad (c)
does not mean de of dring. heart lastare. . etc. It means all. of compli. which caused
tions, if any, gave rise to cause
(a). & the under. last
ditions contrib- n death but not to the terminal condition giren m.S. :- Chapter 137, f 1954, requires lans to print or the cause of of death on certificates. HAP. 46. 95 9 & HAP. 114 '$ 45, CHAP. 38 $6.) ral Director: se use only ACK Ink. AR. 23 1960 A. TO-58-923888
PARENTS
. M. D.
-
Registered No.
male
. 19 50.
Louisa Smith
INTERVAL
BETWEEN
ONSET AND
DEATH
10days
MR-301A
-THIS IS NENT RECORD. se only APPROVED ink or black writer ribbon.
'A TRUE COPY ATTEST: Charles H. Mackie City Registrar
6 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c) 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. L .. )
25M-2-58-922072
7 NAME OF
Lee M. Fraser
FUNERAL DIRECTOR ...
245 Main St. Waltham
ADDRESS
Received and filed.
APR-7-1960
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female White
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWOD
or DIVOREEBELO
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
AGELO VIQ
28
Days
Hours ........ Minutes
13 Usual
None (I11)
Occupation :
(Kind of work done during most of working life)
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