USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 13
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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 les 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.
1:
MAR = 81960 1.
X PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
55
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) No.
PHYSICIAN - IMPORTANT
2 FULL NAME
Margaret. A ...... Smalley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 10 Prospect St.
St.
Brockton Mass
(L'sual place of abode)
Length of stay : In place of death.
5
.. years .. .
... months
days. In place of residence.
.......
years. ...... .
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 7, 1960
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOW'ER
or DIVORdowed
4I HEREBY CERTIFY,
June
19 5%
to .......
That I attended deceased from
march
19.60
I lagt saw he.Y.alive on
3 march, 1960, death is said to
have occurred on the date stated above, at
3:15 Pm.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
86
12
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
None
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Thomas Murray
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
19 MAIDEN NAME
OF MOTHER
Celia Doherty
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
6 Norfolk Cemetery
Norfolk .... Mass
Place of Burial or Cremation
DATE OF BURIAL
March
(City or Town)
60
19
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop ... Mass
Received and filed 3-4-66 19.
(Registrar)
PARENTS
21 Informant (Address)
Town Hall Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or, transit permit was issued: Table C.Percaunter -
(Signature of Agent of Board of Health or other)
Health Chicle 3/9/60
(Official Designation)
(Date of Issue of Permit)/
X
- (b)
(Esophageal Hiatus Hernia
Due To (c)
Senility
OTHER
SIGNIFICANT
CONDITIONS
Terminal Pneumonia link
Was autopsy performed?
no
What test confirmed diagnosis ?
clinical- x-ray
5 Was disease or injury in any way related to occupation of deceased ? no If so, specify
(Signed)
arthur C. Murray
Arthur C. Murray
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date .... 8 March 60
10a If married, widowed, or divorced
HUSBAND of
Thomas H. Smallcy
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Anemia secondary
INTERVAL
BETWEEN
ONSET AND
DEATH
1 yr
(a)
Esophageal Diverticulum
10 yrs
JCTIONS OR CERTIFICATE
iving 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, ve rise to ause (a), the under- ause last.
ions contrib- eath but not the terminal ndition given
Chapter 137, 54. requires s to print or cause or f death on ificates, and 48, Acts of uires Physi- rint or type er signature.
-59-925686
R-301A 1
To be filed for burial permit with Board of Health or its Agent.
Mount's convalesCENT Homme 104 Highland Ave
[(Was deceased a {U. S. War Veteran, {if so specify WAR)
(If nonresident, give city or town and State)
(write the word)
15 Social Security No.
Boston
O.A. Ass't records
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 les 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 -01960 TM
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Middlesex (County)
Cambridge
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
(City Cambi Towe making this return)
56
No .. Holy Ghost Hospital, Cambridge , Mass ...... St. ?
2 FULL NAME Dawn Bennett
(If deceased is a married, widowed or (hvorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No ....
(Usual place of abode)
20Neptune .... Avenue ............. Winthrop Massachusetts. (If nonresident, give city or town and State)
Length of stay: In place of death ........... years ......... months ... 8 ..... days. In place of residence ....... ] .. years ..........
months
......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March 11
(Day)
(Year)
1960
(Month)
4 I HEREBY CERTIFY,
That I attended deceased from
December .... 3 19 .... 59,
to.
March 11
19 .. 60
I last saw heralive on March-11-
1960., death is said to
-
have occurred on the date stated above, at
9:50 秒
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a) .... Congenital Heart Disease.
(Interatrial septal defect)
Due To
(1)) Pulmonary Congestion with Patchy Atelectasis
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
Ies
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) Richard M. Dart M. D.
Holy Ghost HospitalDate.
3/12
19 60
6
Winthrop Winthrop. Maes
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
March 14
1960
7 NAME OF
FUNERAL DIRECTOR
Maurice W. Kirby
ADDRESS.
Winthmp
Hass.
March 14
1960
9 ......
Received and filed
APR 5 1960
(Registrar of City or Town where deceased resided)
8 SEX
9 COLOR
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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
AGI
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:
None
15 Social Security No ....... Meme
16 BIRTHPLACE (City)withwop (State or country)
17 NAME OF
FATHER
Kenneth Bannett
18 BIRTHPLACE OF
FATHER (City) ..... Boston
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHERDelores Crowe
20 BIRTHPLACE OF
MOTHER (City)
Winthrop
(State or country)
Mass.
21
Kenneth Bennett
Informant
(Address )20 Neptune
AVS Winthrop, Mass
A TRUE COPY
Frederick 14 Burke
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
19
PARENTS
(Address):
Cambridge,
25M-2-58-922072
R-302 1
Registered No. 399
" (If death occurred in a hospital or institution,
e its
PERSONAL AND STATISTICAL PARTICULARS
Single
APR -51080 /"
X
PLACE OF DEATH
Suffolk (County ) Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
57
[(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) No.
Dr Abraham S Shubow
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
144 Shore Drive Winthrop
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death.
.years. ...
.. months
4
days. In place of residence
years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWER
or DIVOR fried
(write the word)
3 DATE OF
DEATH
MARCH 11 1960 (Month) (Year)
(Day)
That I attended deceased from
0
I last saw h& Malive on
March
11
19 60
., death is said to
have occurred on the date stated above, at
2:50 p.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Congestive neut failure
(b) Due To arterial hypertension
Due To (c)
OTHER
cerebral thrombosis (old)
SIGNIFICANT
CONDITIONS
Coronary arteriosclerosis
Was autopsy performed?
no
What test confirmed diagnosis ?
1. Rays. Ccq.
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed)
M. D.
H. B. Greenfield.
44.7 (PRINT, OR TYPE SIGNATURE)
(Address) \N.A.V ......
Mass
Date ..
3-11
19:00
6 MeretzSociety ..... Cem Woburn Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 13
19
60
7 NAME OF
DIRECTOR Henry Levine
ADDRESS
470 Harvard St Brookline Mass
Received and filed
MAR 14 1960
19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Esther Lasker
20 BIRTHPLACE OF MOTHER (City) .Li thawania (State or country)
Charlotte Shubow
21 Informant $144 Shore Drive Winthrop Maps
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me )BEFORE the burial or transit permit was issued: Ralphil Sairam
(Signature of Agent of Board of Health or other)
1.0.
March 13 1960
(Official Designation)
(Date of Issue of Permit)
I. B.V
10a If married, widowed, or divorced
Charlotte Resh
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
62 Years.
.. Months.
Days
If under 24 hours
Hours.
Minutes
13 L'sual
Occupation :
Dentist
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Lithawania
17 NAME OF
FATHER
Morris J. Shubow
18 BIRTHPLACE OF
FATHER (City) .Lithawanda
(State or country)
hapter 137, 54. requires to print or cause or death on ficates, and 8, Acts of ires Physi- rint or type r signature.
59-925686
R-301A 1
CTIONS R ERTIFICATE
iving F DEATH : enter an one or each ) and (c)
s not mean of dying, art failure, c. It means or compli- ich caused
s, if any, ve rise to use (a), he under- use last.
ons contrib- ath but not the terminal dition given
PHYSICIAN - IMPORTANT,
One and
[(Was deceased a {U. S. War Veteran, lif so specify WAR) Two
St.
(If nonresident, give city or town and State)
10
4 I HEREBY CERTIFY
December
19
to ...
56
March 11
19.
INTERVAL
BETWEEN
ONSET AND
DEATH
1yrs
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hospital
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE 4-41
DATE OF DISCHARGE
1946
RANK, RATING
to poTain.
ORGANIZATION AND OUTFIT Medical Corps
SERVICE NUMBER 025-41-15
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 1 61960 ""
X 1 1 PLACE OF DEATH
Suffolk (County) Winthrop
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
58
No.
Caroline S.West,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
72 Grandview Ave.
(Usual place of abode)
6
6
(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
3
11 1960 (Year)
(Month)
(Day)
That I attended deceased from
1960
I last saw hERalive on
3/9
, 1960
, death is said to
have occurred on the date stated above, at
8 A
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CEREBRAL VASCULAR ACCIDENT
INTERVAL
BETWEEN
ONSET AND
DEATH
2 DAYS
11 IF STILLBORN, enter that fact here.
12
AGE 92 Years.1.0 Months 13 Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation :
At home
(Kind of work done during most of working life)
14 Industry
or Business:
None
15 Social Security No .. None
16 BIRTHPLACE (City)
(State or country)
Gotenberg, Sweden
17 NAME OF
FATHER
Unknown -
Carlson
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Sweden
19 MAIDEN NAME
OF MOTHER
Unknown
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Sweden
21 Ernest W.West.
Informant
(Addres
72 Grandview Ave. , Winthrop,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the &1 or transit permit was issued: Halble 8. Dicianno0 (Signature of Agent of Board of Health or other)
Jieatthe Officer 3/14 60
(Official Designation)
(Date of Issue of Permit),
-THIS IS A 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)
does not mean : of dying, heart failure, etc. It means e. or compli- which caused
ns, if any, ave rise to cause
- (b)
5 yes.
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
(Signed).
Infront- King Min.
M. D.
(Addre 222 Pleasant St
6
Glenwood Cemetery Everett Place of Burial or Cremation (City or Town)
DATE OF BURIAL March14, 1960 19
7 NAME OF
FUNERAL DIRECTOR
J.E. Henderson Co.,
ADDRESS
517 Broadway Everett Mass.
Received and filed
MAR 14 1900
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Andrew .
(Husband's name in full)
4 I HEREBY CERTIFY,
5/3
1955
to
3/11
St
PHYSICIAN - IMPORTANT
Was deceased a
U. S. War Veteran,
if so specify WAR)
none
To be filed for burial permit with Board of Health or its Agent.
(City of Town BayView Nursing Home 41 Washington Aver,
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
0-58-923886
[ R-301A
(a), the under- cause
last.
ions contrib -- death but not the terminal ndition given
Chapter 137, 954, requires s to print or cause or f death on tificates. AP. 46, §§ 9 & P. 114 $$ 45, AP. 38 $ 6.)
Due To
GENERAL ARTERIOSCLEROSIS
4
PARENTS
Date 3/11
19 60
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.
1
MAR 1 41000 ""
PLACE OF DEATH
(County)
WINTHROP
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent.
2 FULL NAME
JAMES HENRY HUDSON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
29 Washington Ave.
St.
Winthrop
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
5
years
months
days. In place of residence
5
years
_months.
days
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MARCH
17
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
MARCHE ,60
Marchi, 1960
to
I last saw himalive on
MARCH 17, 1960, death is said to
have occurred on the date stated above, at
10:40Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
, Coronary Occlusion
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
1 hour
11 IF STILLBORN, enter that fact here.
12
AGE 83 Years.
.Months
Days
If under 24 hours
Hours _.... Minutes
13 Usual
Occupation :
Retired Lumberman
(Kind of work done during most of working life)
14 Industry
or Business:
Charlestown Storage Co.
15 Social Security No ...
012-05-4968A
16 BIRTHPLACE (City)
Boston
(State or country)
Massachusetts
17 NAME OF
FATHER
Michael H. Hudson
18 BIRTHPLACE OF
FATHER (City).
Boston
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Mildred White
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Mass.
21 Mrs. Edward M. Scannell
Informant
(Address)
29 Washington Ave. Winthrop
7 NAME OF
FUNERAL DIRECTOR
FRANK H. CARR
ADDRESS
79 Elm St. Charlestown ,Mass
Received and filed MAR 18 1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
White
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)
5 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
NO
Was autopsy performed?
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signed) Chaires Liberman
M. D. Winthrop, Mes pate 9/18/1960
(Address).
HOLY CROSS
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL March 21,
19.60
50M-1-58-921876
R-301A 1
CTIONS R ERTIFICATE
ving F DEATH enter an one or each ) and (c)
s not mean of dying, art failure, . It means or compli- ich caused
, if any, e rise to use
(a). under- last.
use
as contrib -- ath but not he terminal ition given
hapter 137, 4, requires to print or cause or death on ficates.
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit.permit was issued: Halble C. Seriaumxx.
(Signature of Agent of Board of Health or other)
3/8/60
(Official Designation) (Date of Issue of Permit)
Registered No. 59
29 Washington Ave., Winthrop
[(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)
No
Coronary Artery
(b)
Heart Disease
6
' PARENTS
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.
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