USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 12
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14 Industry or Business:
15 Social Security No ..
None
16 BIRTHPLACE (City)
East Boston
(State or country)
Massachusetts
17 NAME OF
FATHER
George W. Foote
18 BIRTHPLACE OF
FATHER (City).
Yarmouth
(State or countryNova Scotia, Canada
19 MAIDEN NAME
OF MOTHER
cannot learn
20 BIRTHPLACE OF
Liverpool
MOTHER
(State or country Nova Scotia, Canada
21 Records-Metropolitan State
Informar.
(Address) SP. 475 Trapolo Rd, Waltham,
A TRUE COPY
James J. Carroll
ATTEST:
(Registraf of City or Town where death occurred)
DATE FILED
March 10,
60
19
X
3 DATE OF
DEATH
Feb.
21,
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Dec. 1,
58
Feb. 21,
19
to
19
60
I last saw h ... Kalive on
Feb. 21
150
death is said to
have occurred on the date stated above, at
2:55 AM
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Chr. myocarditis
Due To (b)
OTHER
None
SIGNIFICANT
CONDITIONS
Ho
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
no
(Signed)
Henry L. Pelkus
M. D. Met. State Hosp.Waltham
(Address)
Date
2/21/160
Met-Fern Cemetery, Waithan
Place of Burial or Cremation
March 10,
DATE OF BURIAL
(City or Town) 60 19
49
Lexington
(City or Town making this return)
CERTIFICATE OF DEATH
Registered No.
S(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME FOOTE Lilly B.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No ...
cannot learn
(Usual place of abode)
Winthrop
Mass ..
(If nonresident, give city or town and State)
Length of stay: In place of death ........ years .. 2 ...... months/1.
.days. In place of residence.
......... years.
months ........... days.
MEDICAL CERTIFICATE OF DEATH
PLACE OF DEATH
Middlesex (County)
Lexington
(City or Town)
No. Metropolitan State Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
A R-302 1
1.5.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
PARENTS
It under 24 hours
15 yrs
INTERVAL BETWEEN ONSET AND DEATH
APR -- 4 1000
X
Suffolk
(County)
Revere
(City or Town)
No. Revere Memorial Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Revere
(City or Town making this return)
Registered No. 50
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
(Baby Boy)
(If deceased is a married, widowed of divorced woman, give also maiden name.)
(a) Residence. No ... 95 Shirley (Usual place of abode)
Winthrop
(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
3 DATE OF
DEATH
February
25,
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Feb. 25,
19
60
to
Feb.
25
1960
I last saw himlive on
-Feb. 25 .......... ,
16Q., death is said to
have occurred on the date stated above, at
4:20 P.
... m.
INTERVAL BETWEEN ONSET AND DEATH
2hrs.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
10 SINGLE
MARRIED
WIDOWER
or DIVORCEDgle
(write the word)
Male
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.
Months ..
.Days
If under 24 hours
4
Hours ....... Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ...
5 BIRTHPLACE (City).
(State or country)
Mass.
17 NAME OF
FATHER
Frederick Tolman
18 BIRTHPLACE OF
FATHER (City).
Revere
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHERMary Moody
Chelsea
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
21 Margaret Yates (Address) 95 Shirley St., Winthrop
A TRUE COPY
ATTEST:
DATE FILED
(Registrar of City or Town where death occurred)
March
1
60
(Registrar of City or Town where deceased resided)
PARENTS
(Signed) Guy A. DiStasio M. D.
221 Beach St.
(Address) Revere-
Date ..
2/26
1960
Woodlawn 6
Everett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February
29
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reymolds
ADDRESS Winthrop
Received and filed ..
MAR 14 1960
19
25M-2-58-922072
PLACE OF DEATH
M R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. 1 .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Bilateral Atelectasis
(b)) Due To Prematurity
uhrs.
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased ?.... n.Q. If so, specify
-Revere
(Was deceased a
U. S. War Veteran,
if so specify WAR)
.
X PLACE OF DEATH
Suffolk (County )
Winthrop
(City or Town)
Bay View Nursing Home
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
51
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
f(Was deceased a ¿U. S. War Veteran, No
[if so specify WAR)
Dorchester, Mass.
(If nonresident, give city or town and State)
Length of stay : In place of death
1
.years.
5
months. ....... .days. In place of residence
years ..
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 3, 1960
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWEDWidowed
or DIVORCES-
4 I HEREBY
CERTIFY
58
March 3,
That I attended deceased from
19.60
I last saw h.
Lilive on
.. ,
, to March 2,
19. 60
death is said to
have occurred on the date stated above, at
6:10 a. m.
INTERVAL BETWEEN ONSET AND DEATH
2 yrs.
12
AGE
Years ..
90 11 15
Days
Produce Dealer
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Self employed
15 Social Security No.
None
16 BIRTHPLACE (City) (State or country) Ireland
17 NAME OF
FATHER
Timothy Cronin
18 BIRTHPLACE OF
FATHER (City) (State or country)
Ireland
19 MAIDEN NAME OF MOTHER Nancy O'Connor
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
21 Informant (Address)
Mr. Angello Morello, Attorney, 11 Beacon St. Boston, Mass.
I HEREBY CERTIFY That a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Tereque. &
' (Signature of Agent of Board of Health or other) (Healthe Shiger 3/4/60
(Official Designation)
(Date of Issue of Permix)
(Registrar)
PARENTS
(Signed) 4. Transffrin 0
M. D. M. Traunstein, Jr., M. D.
(PRINT OR TYPE SIGNATURE) (Address) 3 Bartlett Rd. anthrop 52 ass
Date .. Mar. 3, 1960
New Calvary .... 6
Boston. Mass.
Place of Burial or Cremation DATE OF BURIAL
March 5, 19
{City or Town) 60
7 NAME OF BERNARD KELLY & SON, INC FUNERAL DIRECTOR 310 BOWDOIN ST. DORCHESTER, MAISS.
ADDRESS
Received and filed
MAR-4-1960
....... .. 19
X
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
es not mean of dying, heart failure, etc. It means e, or compli- which caused
ns, if any, ave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ndition given
Chapter 137, 954, requires is to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type ler signature.
5-59-925686
Patrick T. Cronin
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15 Olney Street,
(a) Residence. No. Usual place of abode)
St.
75
10a If married, wido AnnterM. Noonan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE Arteriosclerotic heart disease (a)
Due To (b) ...
generalized arteriosclerosis
Due To
(c)
OTHER
Bilateral inguinal hernia 10 yrs.
SIGNIFICANT
CONDITIONS Basal cell carcinoma post auricular region left Was autopsy performed ? NO ... What test confirmed diagnosis? Clinical & laboratory
12 yrs
5 Was disease or injury in any way related to occupation of deceased? NO .. If so, specify
If under 24 hours
Hours.
Minutes
4 yrs.
To be filed for burial permit with Board of Health or its Agent.
No.
R-301A 1
Oct. 22
19
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
MAR-98500 19
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.
X
Suffolk
(County) Winthrop
(City or Town)
41
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH ashington St
Registered No.
52
St. (give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
140 Bellingham
st.Chelsea
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years.
months
days. In place of residence.
............ years .....
months_
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
MARCH
(Month)
(Day)
4 1960 (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
DECEMBER 1954
to
MARCH 4
1960
I last saw her alive on MARCH 4
, 1960, death is said to
have occurred on the date stated above, at
9:10 A
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
BRONCHOPNEUMONIA
Due
ARTERIOSCLERUTIC HEART DISEASE
(b)
9 years
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
EXAMINATION
5 Was disease or injury in any way related to occupation of deceased? NO
If so, specify ... ] Albert Karp
(Signed).
I. Lillest Kamp
SCRESCENT AVE. CHELSEA
3/4
200
Date
Onikchty Society
6
Melrose
Place of Burial or Cremation
March
6
(City or Town)
60
DATE OF BURIAL
19
7 NAME OF
Tori Funeral Srevice Inc
FUNERAL DIRECTOR
Chelsea Mass
ADDRESS
Received and filed
MAR 7 1960
19
(Registrar)
PARENTS
21
Informant -
Ann Barron
(Address)40 Bellingham St Chelsea
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Jacky E. Pereadas y (Signature of Agent of Board of Health or other Jebeck Officer 3/6/60
(Official Designation)
(Date of Issue of Permit)
X
IR-301A
Vi-A-K-6
-THIS IS ENT RECORD. e only APPROVED nk or black iter ribbon.
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means e, or compli- which caused
ns, if any, ave rise to cause (a), the under- last. cause
ions contrib -- > death but not the terminal ndition given
Chapter 137, 954, requires is to print or cause f death on tificates. AP. 46, 85 9 & P. 114 $$ 45, AP. 38$6.)
O.58-923886
PLACE OF DEATH
4-4-20
Bayview Nursing Home No. REBECCA LIPSITZ
[(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Israel Lipsitz
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
72
AGE
Years
Months
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.
None
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
David
Saxe
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
C.B.L.
M. D.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
To be filed for burial permit with Board of Health or its Agent.
(a) Residence.
No.
(Usual place of abode)
INTERVAL
BETWEEN
DNSET AND
DEATH
6 DAYS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
MAR -71960 1:
X
PLACE OF DEATH
Suffolk (County)
X
The Commomuralth of Massachusetts JOSEPH D WARD 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.
53
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,
2 FULL NAME
Baby Girl Thompson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if so specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay : In place of death ..
... years.
months 2 days. In place of residence .. ......... .years ... months. 2 days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
W
10 SINGLE
(write the word)
MARRIED
WIDOWED Single
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 Years ......... .Months. 2 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) (State or country)
17 NAME OF FATHER Sahn ? Homacos
18 BIRTHPLACE OF FATHER (City) (State or country)
Boston
19 MAIDEN NAME OF MOTHER Elisabeth Support
20 BIRTHPLACE OF MOTHER (City) (State or country) fr
Stanford
21 Informant (Address) Copaplan de Melini
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) Vialle
3/2/60
(Official Designation) UL
(Date of Issue of Permit)
X
UCTIONS OR CERTIFICATE
giving OF DEATH t enter han one for each b) and (c)
es not mean of dying, eart failure, tc. It means , or compli- hich caused
ns, if any, ave rise to ause (a), the under- ause last.
tions contrib- eath but not the terminal ndition given
Chapter 137, 54. requires s to print or cause or f death on tificates, and 48, Acts of uires Physi- rint or type er signature.
7 NAME OF
FUNERAL DIRECTOR
ADDRESS Améliore
Received and filed
MAR 7 1960
19
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH Iday
Due To
Aspiration of luccaus
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify .....
M. D.
(Signed) WILLIAM GLAZIER (PRINT OR TYPE SIGNATURE) (Address) 90 Plekdut St Date: 3/5/60
mélisse
6 Hemming Century Place of Burial or/Cremation (City or Town) DATE OF BURIAL Münch 7 1960
PARENTS
5
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
3/4/60
., 19.
to .......
3/5/60
That
Y_attended deceased from
19
I last saw kom alive on
3.
115
'60
19
death is said to
have occurred on the date stated above, at
3 2%
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Pneumonitis
(a)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
3
CENSE 144 TET
Winthrop (City or Town)
No.
Winthrop Community Hospital
St.
(If nonresident, give city or town and State)
R-301A -
-59-925686
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.
MAR - 71960 11
X
PLACE OF DEATH
Suffolk
230
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
54
2 FULL NAME
Elizabeth L. Keefe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
73 Plummer Ave
(L'sual place of abode )
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
5
11
.months
.24
.days. In place of residence.
years
. months .. ...
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March 6, 1960
(Month)
(Day)
(Year)
JI HEREBY CERTIFY,
That I attended deceased from
Dec. 8,
19 ..
50
to.
March 6,
1960
I last saw
ex alive on
March 5,
19.60
death is said to
have occurred on the date stated above, at
a ....... m.
5.
INTERVAL
BETWEEN
ONSET ANO
DEATH
22 yrs.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVSingle
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.
7.6
ears.
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Retired Bookeeper
(Kind of work done during most of working life)
10 yrs
Due To (c)
OTHER
Senile dementia
SIGNIFICANT
CONDITIONS
Cholelithiasis
7 yrs.
7 yrs.
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. Traunstein, Jr., M./ CD.
(PRINT OR TYPE SIGNATURE) 73 Bartlett Rd.
(Address) Winthrop 52
..... ass Date .. March. .. 7,.19.60
6
Calvary Boston
Place of Burial or Cremation
DATE OF BURIAL
March
9
(City or Town)
19 60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS
Received and filed
MAR 8-1960
19
(Registrar)
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
19 MAIDEN NAME
M. D. OF MOTHER Johanna Shea
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Informant
(Address)
21
Dorothy Riley
207 Woodside Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was flech with me BEFORE the burial on transit permit was issued:
(Signature of Agent of Board of Health or other) Health Offices 3/8/60
(Official Designation)
(Date of Issue of Permit)
I.B.V
UCTIONS OR CERTIFICATE
giving OF DEATH t enter than one for each b) and (c)
es not mean of dying, heart failure, tc. It means , or compli- hich caused
ns, if any, ave rise to cause (a), the under- ause last.
tions contrib- eath but not the terminal ndition given
Chapter 137, 54. requires s to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.
1.5.
-59-925686
(County)
Winthrop (City or Town)
No. 41 .Washington Ave.
[(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
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Arteriosclerotic heart disease
(a)
Due TGeneralized arteriosclerosis (b)
14 Industry
or Business :
Filenes
15 Social Security No.
011-10-3954 A
Boston
16 BIRTHPLACE (City)
(State or country)
Magg
17 NAME OF
FATHER
John Keefe
R-301A - 1
5 YAS
To be filed for burial permit with Board of Health or its Agent.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
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