USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 21
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
Suffolk untv
-
Winthrop
(City of Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No
89
ftf 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
2 FULL NAME
( If deceased is a married, widowed or divorced woman, give also maiden name.) 2IO WebsterSt. (a' Residence. No. St l'sual place of abode)
East Boston, Mass.
(If nonresident, give city or town and Stale)
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
April
(Month)
(Day)
19
1960
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIEDSingle
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
4-4-60 19
to .....
That I attended deceased from 4-19- 60 19.
I last saw h .... Yalive on
Apri
19, 1960, death is said to
have occurred on the date stated above, at
10 509AM
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Pulmonary Infarction
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12 80
10 days AGE.
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 :
retired
15 Social Security No.
cnb1.
16 BIRTHPLACE (City)
.....
(State or country)
17 NAME OF
FATHER
Lawrence Hennessy
18 BIRTHPLACE OF
Fast Boston
FATHER (City)
(State or country)
Mo.s.g ..
19 MAIDEN NAME
Ellen McDonald
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
East Boston
Mass.
21 James L. Hennessy
(Address) Informan3000 Russell Rd Alexandria Va.
I HEREBY CERTIFY tbat a satisfactory standard certificate of death way filed with me BEFORE the burial or transit permit .was issued:
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath
ADDRESS East Poston
Received and filed APR-20-1960 19
(Registrar)
PARENTS
6
Forest Hills ..
Poston
4-19-60
Place of Burial or Cremation April 22
(City or Town) 60
DATE OF BURIAL 19
10 day
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
Xray's. E.K.9
5 Was disease or injury in any way related to occupation of deceased ? a. If so, specify
(Signed)
(Address)
M. D. Joseph Campbella (PRINT OR TYPE SIGNATURE) 321 Summers, Laa Boston 19
PERSONAL AND STATISTICAL PARTICULARS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To
Hypertensive heart
(b) aliseuse
ilns, if any, tave rise to cause (a), gthe under- ause last.
n'ions contrib- o eath but not I the terminal dition given
: Chapter 137, 54. requires is to print or .. til
cause or death on cificates, and r18, Acts of eaires Physi- o rint or type r.er signature.
R-301A: 1.7
10
L
"UCTIONS FOR CERTIFICATE
igiving OF DEATH ot enter than one s for each b) and (c)
es not mean o of dying, steart failure, etc. It means , or compli- Which caused
M1.59-925686
(Signature of Agent of Board of Health or other)'
Health officer 4/20/60
(Official Designation) (Date of Issue of Permit)
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hospital No. Mary A. (Hennesey ) Hennessy
East Poston, Mass.
bookeeper
Due To
Congestive heart
(c)
failure
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 rece.it 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 hy 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 pur uits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had heen 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)
2-7 -7-5
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
[(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)
90
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
333 Maverick St., East Boston, St. (Usual place of abode)
(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
April
26
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Cibul 26, 1960
to.
That I attended deceased from
19
I last saw h ........ alive on
19
......... , death is said to
have occurred on the date stated above, at
... m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Stillborn
Due To (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
(Signed)
Jours El dualta
Louis Schraffa
M. D.
(Address)
ITBennington WEB
? Date.
4/20 19 6.0
6 Holy Cross
Malden
(City or Town)
Place of Burial 6r Cremation
DATE OF BURIAL
april 28
1960
7 NAME OF
Anthony P. Rapino
ADDRESS
9 ChelseaSHE, B-Ston
Received and filed APR 2.6 1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
MARRIED)
WIDOWED
or 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 IF STILLBORN, enter that fact here. Stillborn
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)
Winthrop, Mass
17 NAME OF
FATHER
Giovanni Falzone
18 BIRTHPLACE OF FATHER (City) (State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Marabello, Natala
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
East Boston, Mass.
21 Giovanni Falzone
Informant
(Address)
333 Maverick St., E. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Palle. Cercaun (Signature of Agent of Board of Health or other ??
Heallele Officer
4/26/60
(Official Designation) (Date of Issue of Permis)
UCTIONS FOR CERTIFICATE
agiving OF DEATH ot enter than one for each b) and (c)
es not mean of dying, reart failure, tc. It means MAP, or compli- hich caused
ins, if any, Ive rise to ause (a), sthe under- ause last.
'ions contrib- Death but not & the terminal dition given
Chapter 137, .. .. 54. requires ins to print or t
cause or death on cificates, and r48, Acts of Quires Physi- print or type rer signature.
1.59-925686
R-301A 1
Winthrop (City or Town)
No.
Winthrop ..... Community Hospital
2 FULL NAME Falzone, Baby Boy
To be filed for burial permit with Board of Health or its Agent.
PARENTS
(PRINT OR TYPE SIGNATURE)
INTERVAL
BETWEEN
ONSET AND
DEATH
4/26/20
AGE
Years .........
12
.Months.
Days
10 SINGLE
(write the word)
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.
1
APR & GIOSO TM
[ R-301A -
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter c than one s for each (b) and (c)
les not mean of dying, sheart failure, etc. It means ee, or compli- which caused
uns, if any, save rise to cause (a), the under- ause last.
n'ions contrib- o'eath but not the terminal ndition given
. Chapter 137, f 154, requires is to print or t
cause or death on Mr ificates, and 148, Acts of tuires Physi- print or type per signature.
1.59-925686
PLACE OF DEATH
Suffolk (County)
COM
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.
91
2 FULL NAME
Minichiello, Baby Boy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
{if so specify WAR)
(a) Residence. No.
(Usual place of abode)
2 Suffolk Ave., Revere.
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
april
fonth)
(Day)/
26 1960 (Year)
8 SEX
Male
9 COLOR
White
10 SINGLE (write the word) MARRIEDSingle WIDOWED or DIVORCED
4 I HEREBY
CERTIFY,
That I attended deceased from
19 .. , to ..
19
I last saw h ........ alive on 19. death is said to
have occurred on the date stated above, at
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
INTRA UTERINE AsphyXIA
(a)
INTERVAL
BETWEEN
11 IF STILLBORN, enter that fact here.
ONSET AND
12
DEATH
unk.
AGE
Years ............
Months.
Days
STILLBORN
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. Winthrop, Mass.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Arthur Minichiello
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Woburn
19 MAIDEN NAME OF MOTHER Edith DeAmelio
Revere
(Address)
Date ..
6 Holy Cross Cem malden
Place of Burial or Cremation (City or Town) DATE OF BURIAL may 2,
60
7 NAME OF
FUNERAL DIRECTOR
Paul Buonfiglio
ADDRESS 128
MAY 2 ~ 1900 19 ..
Received and filed
(Registrar)
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
arthur Minichiello
21 Informant (Address) 2 Suffach auf aluce
. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: halble a terranurg.
(Signature of Agent of Board of Health or other)
Healthle officer 5/2/60
(Official Designation) (Date of Issue of Permit) /
To be filed for burial permit with Board of Health or its Agent.
No.
Winthrop Community Hospital
[(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,
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE o (Husband's name in full)
Due To
(b)
CRANIAL ANOMALIES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
YES
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
M. D.
(PRINT OR TYPE SIGNATURE)A
19
SPACE FOR ADDITIONAL INFORMATION
..
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
RULES OF PRACTICE MAY 2 1960 FM
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.
1 PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
No. . .64 Read St.
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.
Regi tered Vo
92
f(If death occurred in a hospital or institution, St į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a {U S. War Veteran, no
{if so specify WAR)
(a) Residence St 64. Read ..... S.t. [ sual place of abode ) Length of stay: In place of death 29 years. months. days. In place of residence years.
(Ii nonresident. give city or town and State)
months. ‹lays.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWEnarried
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Anthony ..... D'Angelo
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
59%
.Months
i.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
housework
(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)
Italy
17 NAME OF
FATHER
Joseph Grasso
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Concetta Santasuosso
(Signed)
huvu Carlito Sobra
Marion Corleto Sabia
M. D.
241 MaverIMINISOR. TYLE SIGNOS En4 / 28/60 (Address) Date ...
6St. Michael's
Boston
Place of Burial or Cremation
DATE OF BURIAL
April
30 (City or Town)
60
19
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath
ADDRESS Ea.s.t ..... Boston
Received and filed APR 28 1960 19
(Registrar)
PARENTS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Anthony D Angelo
21 Informant
(Address)
64 Read St. Winthrop
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)
Health Pfizer 4/28/60
(Official Designation)
(Date of Issue of Pormit)
Vi.v
N RUCTIONS FOR C CERTIFICATE
giving S OF DEATH
c'iot enter o than one u': for each a (b) and (c)
s oes not mean me of dying, a heart failure, se etc. It means isse, or compli- s which caused
d'ons, if any, clgave rise to ve cause (a), in the under- g cause last.
o tions contrib- tideath but not the terminal e bndition given 1
e Chapter 137, of954. requires ic is to print or cause or 's of death on i ctificates, and te 48, Acts of ruires Physi- tprint or type u.er signature.
2
)Ni-59-925686
3 DATE OF
DEATH
April
27
1960
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY,
1959,
to ..
That I attended deceased from
april 27
19.6
I last saw he Ralive on
april
212. 1960
death is said to
have occurred on the date stated above, at
4:00 a.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
MetaSTATIC GARCIINOM.
(a)
to liver.
INTERVAL
BETWEEN
ONSET AND
. DEATH
1 yr
Due To
CARCINOMA of
(b)
Rectum.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
DIAbetas.
Was autopsy performed ?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
11 R-301A 1
2 FULL NAME. Emma ..... D.'Angelo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
RULES OF PRACTICE
6
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 related to any form of injury. APR 2 81960 FX
(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 rece.it 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 pur uits 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.
[R-301A 1
PLACE OF DEATH
Suffolk Winthrop
(County)
(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.
Registered No.
93
[(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)
(a) Residence.
No.
204 Cottage Park Rd ..
St
(If nenresident, give city or town and State) 12
(Usual place of abode)
12
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
APRIL
28, 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
DEC.
1950
to.
APRIL 26,
19
60
I last saw helalive on
APRIL ZE, 19 60, death is said to
have occurred on the date stated above, at
6.4.519.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CORONARY THROMBOSIS
(b) Due To COPONORY SCLEROSIS
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
.vi
What test confirmed diagnosis?
ECG, CLINICAL OBSERV
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify.
Harold L, Musgrave
(Signed) Haroli Musgram , M. D. 620 Beach St Per dare april VI 1964
(Address)
6 Main St. Cometery
Hardwick Vt.
Place of Burial or Cremation (City or Town) DATE OF BURIAL. Lar 1 1900
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynold:
ADDRESS intuition Mass
Received and filed APR 29 1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
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)
11 IF STILLBORN, enter that fact here.
12 68
AGE
Years.
19
4
Months
Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation :
Teacher
(Kind of work done during most of working life)
14 Industry
or Business:
Public School
15 Social Security No. OTTE
16 BIRTHPLACE (City) LOVEIT (State or country)
17 NAME OF
FATHER Walter Dutton
PARENTS
18 BIRTHPLACE OF
FATHER (City) .. (State or country) Vermont
19 MAIDEN NAME
OF MOTHER
.ellie
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Vermont
21 Lura C Gushee (Address)204 Cottare Fark RC. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit-permit was issued: ralph E. Vintrainee (Signature of Agent of Board of Health or other)
HE
april 29 - 1960
(Official Designation)
(Date of Issue of Permit)
V.B. V
UCTIONS :OR CERTIFICATE giving OF DEATH ot enter than one s for each , b) and (c)
Des not mean of dying, heart failure, ,tc. It means ', or compli- which caused
is, if any, ve rise to ause (a), the under- ause
last. -
dons contrib -- cath but not t the terminal edition given
-Chapter 137, 54, requires rs to print or cause or death e ificates.
1,5.
50M-1-58-921876
X -
204 Cottere Park Road No.
2 FULL NAME
Alice Nay Dutton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
INTERVAL BETWEEN ONSET AND DEATH 1/2 HOUR
10 YRS.
Due To
GENERALIZED ARTERIOSCLEROSIS
10 YRS
That I attended deceased from
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