USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 15
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62
MAR 19
1960
death is said to
have occurred on the date stated above, at
735 pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
ACUTE PULMONARY EDEMA
(a)
....
Due To HYPERTEN SIVE HEART DIS (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
DIABETES MELLITUS.
2YRS.
Was autopsy performed?
NO.
What test confirmed diagnosis ?
CLINICAL.
5 Was disease or injury in any way related to occupation of deceased NO. If so, specify
(Signed)
Myron n. King
M. D.
MYRON MIKING MID
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST WINTHRO ...
Date
19.
6 Winthrop
Winthrop
Place of Burial or Cremation
(City of Town)
DATE OF BURIAL
March
23
1960
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop Mass
Received and filed 482 22 1960
19.
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVOMarried
(write the word)
10a If married, widowed, or divorced
HUSBAND of
Ernest ... Anderson
(Give maiden name of wife in full)
(or) WIFE of ...
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
66
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
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Canada
17 NAME OF
FATHER
Victor Pitre
18 BIRTHPLACE OF
FATHER (City) (State or country)
Canada
19 MAIDEN NAME
OF MOTHER
Gaudin
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
21
Informant
Blanche .Wallace
53 Pleasant Park Road Vint
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial 'or transit permit was issued: RalphC. Jerlances (Signature of Agent of Board of Health of other)
Health
Officer
3/22/00
(Official Designation) (Date of Issue of Permit)
×
TRUCTIONS FOR L CERTIFICATE
giving , OF DEATH not enter e than one e for each , (b) and (c)
daes nat mean de of dying, heart failure, ,etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditians contrib- death but nat to the terminal condition given
- Chapter 137, 1954. requires ans to print or the cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
I-6-59-925686
EXAMINER DECLINED JURISDICTION
MEDICAL
PLACE OF DEATH
Suffolk (County)
To be filed for burial permit with Board of Health or its Agent.
[(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
((Was deceased a { U. S. War Veteran, (if so specify WAR)
(If nonresident, give city or town and State)
That I attended deceased from
INTERVAL BETWEEN ONSET AND DEATH $4HR.
2 x RS.
PARENTS
3/19 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 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.
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
5 Bartlett Rd.
The Commonwealth 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.
64
[(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, {if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
86 Bartlett Rd.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death 42 .years months
days. In place of residence .............. years ... months. .. ....... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED . ..
or DIVORCED
idov.
4 I HEREBY CERTIFY
3/14
60
to ..
3/19
That I attended deceased from
60
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frans B walker
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
81
6
AGE
Years.
3
Months.
Days
If under 24 hours
Hours ..........
.Minutes
Due To
HEART DIS. E angINa
(b)
PECTORIS
1YR.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
NO
What test confirmed diagnosis ?
HISTORY
5 Was disease or injury in any way related to occupation of deceased NO
If so, specify
(Signed)
Myron N. King Myroch Trung
M. D.
222 Pleasant St. Winthrop ,Ma'ss.
PRINT OR TYPE SIGNATURE
222 B
Pleasant St
· Date
3/21/60
19
6
Place of Burial or Cremation
.
-poh 22
(City or Town)
1.0
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
Howred . Reynold
ADDRESS
........
Received and filed
MAR 22 1960
19
(Registrar)
PARENTS
17 NAME OF
FATHER
Samuel Hodgkins
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Ella Park r
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
as
21
Informant
(Address)
Elizabeth "oll rook
I HEREBY
CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Galph ( Jercanning.
(Signature of Agent of Board of Thealth or other)
(Realthe office
3/12/60
(Official Designation)
(Date of Issue of Permit)
V. B.
<
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 1954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
MED
IR-301A 1
JURISDICTION
XFMINER DECLINED
3 DATE OF
DEATH
march
19
1960
(Month)
(Day)
(Year)
I last saw HER DeA
3/19
1960
death is said to
have occurred on the date stated above, at
1:45 Pm.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
ONSET AND
DEATH
(a)
HYPERTENSIVE +
ARTERIO- SCLEROTIC
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
UTM hore
15 Social Security No.
lione
16 BIRTHPLACE (City)
(State or country)
lass .
Boston
Hartucket T .! 16
(Address)
Everett
Registered No.
2 FULL NAME
Mary (Hodgkins) Walker
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
6-59-925686
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.
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. 65
S(If death occurred in a hospital or institution,
St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME.
White. William
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
670 Saratoga St.
St.
East Boston, Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
............. years.
months.
3
days. In place of residence.
years.
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
3
19
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
com 10, 19 GC to
to March 16
That I attended deceased from
1966
I last saw him alive on
March 18
. 1966
death is said to
have occurred on the date stated above, at
6.3 CH m.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
AGE
Years.
.Months.
.Days
If under 24 hours
Hours .............
.Minutes
13 Usual
Occupation :
Carpenter
(Kind of work done during most of working life)
14 Industry
or Business :
Contracter
15 Social Security No.
022 03 0555
St. Brendan's
16 BIRTHPLACE (City)
(State or country)
"Newfoundland
17 NAME OF
FATHER
George White
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Newfoundland
19 MAIDEN NAME
M. D.
OF MOTHER
Margaret Casey
20 BIRTHPLACE OF
MOTHER (City)
.......
Newfoundland
(State or country)
21 Ellen L. White
Informant
(Address)
670 Saratoga St. East Boston
7 NAME OF
FUNERAL DIRECTOR
Leo M. Norton
ADDRESS
287 Main St. Malden
Received and filed MAR 2 1 1960 19
(Registrar)
PARENTS
(Signed)
Fred !' Regan
113 Pleasant A Within
(Address)
(PRINT OR TYPE SIGNATURE)
Fred O 'Regan
Date ......
19.
6
.Woodlawn
Everett
Place of Burial or Cremation
March
22
(City or Town)
60
DATE OF BURIAL
19
8 SEX
M
ale
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
10a If married, widowed, or divorced en I. Lane
HUSBAND of
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Due To
BRONCHO-PNEUMONIA
(b)
Due To
ARTERIC-SCLEROTIC
(c)
HEART DISEASE
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
I R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 1954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
6-59-925686
I/HEREBY CERTIFY that satisfactory standard certificate of death was/filed with me BEFORE-the burial or transit permit was issued: Talle C. (Signature of Agepf of Board of Health or other) Theatthe Office 32 60
(Official Designation) (Date of Issue of Permit)
X
INTERVAL
BETWEEN
ONSET AND
12
DEATH
74
40
To be filed for burial permit with Board of Health or its Agent.
No.
Winthrop Community Hospital
{(Was deceased a ¿ U. S. War Veteran, No lif so specify WAR)
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.
TO:
2
6
MAR 2 1 1960 TXT
.
I R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
6-59-925686
PLACE OF DEATH
SUFFOLK (County)
WINTROP (City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
66
[(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, if so specify WAR)
NO
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death.
12 years
months .
.. days. In place of residence.
25 .. years .. months .. .. .days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
OF DIVORCED MARRIED
HUSBAND of
do BATREE SAVCI
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 52
Years.
.Months.
.. Days
If under 24 hours Hours. .Minutes
13 Usual
Occupation :
ElecTRITION
(Kind of work done during most of working life)
14 Industry
or Business :
ELECTRICAL CONTRACTER
15 Social Security No.
010-12-3422
CHELSEA
16 BIRTHPLACE (City)
(State or country)
MASS.
17 NAME OF
FATHER
HARRY ByNe
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
OF MOTHER
CelLA STERN
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21
Informant
(Address)
38 HAWTHORN AVE WINTROP
I HEREBY
CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Kalph & Semana
(Sigpature of Agent of Board of Health or other)
16.0.
March 21, 1960
(Official Designation)
(Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March
20
1960
(Month) (Day)
(Year)
4 I HEREBY CERTIFY, That .I attended deceased from
August
1947
March 20
60
I last saw h.t.vwalive on
MARCH 20, 1960, death is said to
have occurred on the date stated above, at ...
7:15Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Coronary Occlusion
INTERVAL BETWEEN ONSET AND DEATH 1 hour
Due Coronary Artery Heart Disease
10yrs
(c)
Coronary
Arteriosclerosis
OTHER SIGNIFICANT CONDITIONS Left Hemiparesis.
No
Was autopsy performed ?
What test confirmed diagnosis? Clinical
5 Was disease or injury in any way related to occupation of deceased ? Mos .. If so, specify .......
(Signed)
Charles
Liber man M. D.
CHARLES LIBERMAN
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date ..... 3 20/1960
6
TifexetH ISRAeloFWINTHROP EVERETT
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL 3/2. 1960
7 NAME OF
FUNERAL DIRECTOR
TORF Funeral Service
ADDRESS
CHELSEA
Received and filed MAR 21 1960 19.
(Registrar)
38 HAWTHORN AVE
No.
2 FULL NAME
MORRIS
By Ne
(If deceased is a married, widowed or divorged woman, give also maiden name.)
38 HAWTHORN AVES.
(If nonresident, give city or town and State)
To be filed for burial permit with Board of Health or its Agent.
PARENTS
BEATRICE ByNe
10yrs
1 yr
., to ....
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 aotion 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.
PLACE OF DEATH
Suffolk (County)
winthrop
(City or Town)
No. 57 Sea View Ave,
The Commonwealth 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.
No
67
[(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, lif so specify WAR)
57 Sea View Ave
(Usual place of abode)
St.
(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 21, 1960 (Year)
8 SEX
Male
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED _
Widowed
4 I HEREBY CERTIFY,
MAR 20,, 1959, to.
MARCH 21, 1966
I last saw himalive on
MAR 21
19 60, death is said to
have occurred on the date stated above, at .......
8:15 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
CARCINOMATOS 15
INTERVAL
BETWEEN
ONSET AND
DEATH
(or) WIFE of
( Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
75.
5
Months.
17 Days
If under 24 hours
Hours.
Minutes
13 Usual
Assitance Postmaster
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
U.S. Mail
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
East Boston
Mass
17 NAME OF
FATHER
Edward Cox
18 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
Mass
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
East Boston
Mas8
Winthrop Cemetery 6
Winthrop
Place of Burial or Cremation
March 24 1960 Town)
19
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Ernest P Caggiano
ADDRESS
147 Winthrop St Winthrop
Received and filed 22 10 19
(Registrar)
PARENTS
1
21 Lillisn Smith
Informant
(Address)
57 Sea View Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph C Percance, & (Signature of Agent of Board of Health or other) Healthe Officer 3/2/2/60
(Official Designation) (Date of Issue of Permit)
V.R.V
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
MIS.
6-59-92 5686
2 FULL NAME
Richard D Cox
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
4
4
10 SINGLE
(write the word)
(Month) (Day)
Due
CANCER OF PANCREAS
(b)
1 YEAR
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ?
OPERATION
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed) G. n. Caplan M. D. OF MOTHER Margaret Daly
A. M. CAPLAN MD (PRINT OR TYPE SIGNATURE) (Address 86 PRINCETONSTE. BIST ate 3-21 1960
That I attended deceased from
10a If married, widowed, prdigcedJacobs .
HUSBAND of
(Give maiden name of wife in full)
1 YEAR
Registered No.
I R-301A 1
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.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.