USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 23
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3 DATE OF
DEATH
February
20
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That i attended deceased from
February 16 160
to ..
February 20
60
19
death is said to
have occurred on the date stated above, at
5:00 A
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Pneumonia
Due To Chronic brain syndrome due to (b) arteriosclerosis with dementia .... 1 Yr
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
Clinical & laboratory
findings
S Was disease or injury in any way related tooccupation of deceased ? If so, specify
(Signed)
Summe Throw
M. D.
Sidney H. Widrow
(PRINT OR TYPE SIGNATURE)
VAH Boston, Mass.
Date
Fe b. 20 1 60
(Address)
6
Holyhood Cemetery
Brookline ... Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 23
19.6.0
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS 79 Atlantic St., Winthrop, Mass.
Received and filed Hob 25 HEL
..... 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED Single
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
Years ...
63
9
Months
12
Days
If under 24 hours
Hours ...........
.Minutes
13 Usual
Occupation :
Steamship Business (Retired)
(Kind of work done during most of working life)
14 Industry
or Business :
CinciA
15 Social Security No.
Dorchester
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
John
2
18 BIRTHPLACE OF
Boston
FATHER (City)
....
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Mary Harris
20 BIRTHPLACE OF
MOTHER (City)
....
Boston
(State or country)
Massachusetts
21
Informant
Margaret C. Cusick
(Address) 26 Sagamore Ave. Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: codice.
(Signature of Agent of Board of Health or other)
1/ F 12526
2-22-60
(Official Designation) (Date of Issue of Permit)
1
RM R-301A 1
STRUCTIONS FOR AL CERTIFICATE
In giving JE OF DEATH
not enter tre than one ise for each (1, (b) and (c)
does not mean ode of dying, heart failure, ", etc. It means d'ase, or compli- n which caused
mtions, if any, gave rise to 01 cause (a), l' the under- ni cause last.
C.ditions contrib- death but not ed o the terminal se condition given
it: Chapter 137, c 1954. requires Suns to print or cause or death on es of rtificates, and ot: 48, Acts of quires Physi- i print or type ijer signature.
12 6 1960
-
M-59-925686
X Suffolk
No.
Veterans Administration Hospital
f(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
JOHN F. CUSICK
f(Was deceased a
₹ U. S. War Veteran,
WWI
(Usual place of abode)
INTERVAL
BETWEEN
ONSET AND
DEATN
3 days
......
PARENTS
A TRUE COPY ATTEST: Charles Ht mackie City Registrar
-
:
MAY 2 61960 1.7
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of MassachusettsT - OF - TOWN8 EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH To be filled for burial permit with Board of Health or its Agent. DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No. 02384
MASSACHUSETTS GENERAL HOSPITAL
[(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME.
Joseph Finamore
(If deceased is a married, widowed or divorced woman, give also maiden name.)
-
NO
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No
(Usual place of abode)
80 Shirely
St
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death .........
years.2 months
days. In place of residence
2 Gears.
_.___ months .....
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Febuary
26
19 60
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
February 24, 1960
to.
Febuary
26
19
60
WPlast saw himlive on .
Febuary
26, 19 __ 60, death is said to
have occurred on the date stated above, at
2P.
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Pulmonary Emphysema
(a)
Due To
Chronic Bronchitis
- (b)
Due To (c)
OTHER
Carcinoma of laéynx
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? If so, specify.
Chelar
M. D.
Charles L. Clay, M.D. (Address).Ass't.Dir., Mass. Gen't Hosp.) Date 2/26/ .19.60
6
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
March 1
7 NAME OF
FUNERAL DIRECTOR.Richard .C. Kirby Inc.
ADDRESS
917 Bennenington st E.B.
Received and filed!
HAR & 1960
19
Charte
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
married
10a If married, widowed, or divorced
HUSBAND of
Adeline Cogliano
(Give maiden name of wife in full)
(or) . WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
6 5years
Months .....
.Days
If under 24 hours
.. Hours ...... Minutes
13 Usual
Occupation :
Tailor
(Kind of work done during most of working life)
14 Industry
or Business :
Own Business.
15 Social Security No ....
033-26-3048
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
John Finamore
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER Gionna UtoL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
Mrs. Adeline Finamore
(Address) 80 Shirly Sta Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filea with me BEFORE the burial or transit permit was issued: Liodice. Laitue h
(Signature of Agent of Board of Health or other)
E 12686
2.27-60
(Official Designation) (Date of Issue of Permit)
RM R-301A
.B .- THIS IS A IANENT RECORD. Use only TE APPROVED :krink or black ewriter ribbon.
ISTRUCTIONS FOR CAL CERTIFICATE In giving IE OF DEATH
o not enter re than one rase for each .. ), (b) and (c)
:'s does mat mean rode of dying, his heart failure, h.a. etc. It means sease, ar compli- in which it
caused 161
Cfitions, if any, et gave rise to &. cause
(a), ling the under- yı cause last.
-
(editions contrib -- > w70 death but not it to the terminal a conditian given (
Tc :- Chapter 137, ts f 1954, requires y: tans to print or le the cause of Is of death on It certificates. ḷ₣ HAP. 46, 55 9 & „ HAP. 114 $$ 45, ÉCHAP. 38%6.) utral Director: 'lise use only _ACK Ink.
101-10-58-923866 JAY 24 1960
INTERVAL
BETWEEN
ONSET AND
DEATH
2Yrs.
30Yrs
7Yrs.
(Signed)
Winthrop Mass.
(write the word)
No.
A TRUE COPY ATTEST: Charles it. mackie City Registrar
MAY 2 41960 24
IM R-301A
B .- THIS IS A ANENT RECORD. Use only 'E APPROVED ‹ ink or black writer ribbon.
¡TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH
i not enter le than one ise for each f, (b) and (c)
I does not mean de of dying, heart failure, etc. It means lase. or compli- , which ,caused 976
lions, if any, gave rise to cause (a). the under- Cause last.
litions contrib -- death but not to the terminal grondition given
Chapter 137, 1954, requires ins to print or le cause or of death on rtificates.
AP. 46, $5 9 & AP. 114 $$ 45, AP. 38 $ 6.)
2
1900
0-50-923806
X 1 PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
FAULKNER
HOSPITAL
(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 LEWIS AVE.
St ..
WINTHROP
MAS.
(a) Residence. No ..
(Usual place of abode)
Length of stay: In place of death. ........ years. . months days. In place of residence ........... years.
months
1/2 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
2
26
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
2-24
1960
to
2 -26
1960
I last saw hechalive on
2- 26
1960, death is said to
have occurred on the date stated above, at 10 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
IMMATURITY
(25 WEEKS
GESTATION)
Due To (b) -..
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 ?YO If so. specify
(Signed)
Isabel S. Money
, M. D.
(Address 1266 Beacon St. Brasfolosite
2-26
1960
WINTHROP CEMETERY, WINTHROP 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
FEBRUARY
29
60
7 NAME OF
ERNEST P. CAGGIANO
FUNERAL DIRECTOR
ADDRES
14) WINTHROP ST. WINTHROP
Received and filed
MAR 2 1960
19 Charles H. Mackie
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
White
10 SINGLE
(write the word)
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.
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)
MASSACHUSETTS
BOSTON
JAMES MICHAEL MARTORANO
18 BIRTHPLACE OF
FATHER (City)
CAMBRIDGE
(State or country)
MASSACHUSETTS
19 MAIDEN NAME
OF MOTHER
CAROL ANN GREEN
20 BIRTHPLACE OF
MOTHER (City)
MILTON
(State or country)
MASSACHUSETTS
21
Informant
ELIZABETH MARTORANO 364 LOCHLAND ST. MILTON
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial, or transit permit was issued : Leastone Liestuch
(Signature of Agent of Board of Health or other)
-
2674
2-27-612
(Official Designation) (Date of Issue of Permit)
X
1
To be filled for burial permit with Board of Health or its Agent.
CERTIFICATE OF DEATH
Registered No.
No. BABY GIRL MARTORANO
The Commonwealth of Mas chusetts - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
99
.
17 NAME OF
FATHER
PARENTS
INTERVAL
BETWEEN
ONSET AND
DEATH
That I attended deceased from
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
A TRUE COPY ATTEST: Charles it Mackie City Registrar
MAY 2 1960 AM
RM R-301A
I.B .- THIS IS A IANENT RECORD. Use only .TE APPROVED ck ink or black ewriter ribbon.
ISTRUCTIONS FOR BAL CERTIFICATE In giving E OF DEATH
) not enter gre than one Rise for each ), (b) and (c)
Is does not mean ode of dying. I heart failure, 1. etc. It means case. or compli- which caused 1536
tions, any, gave rise to cause (a), the under- last.
"litions contrib -- > I death but not to the terminal I condition given
t. Chapter 137, 1954, requires lins to print or be cause or of death on :rtlficates. IAP. 46, 55 9 & AP. 114 $$ 45. HAP. 38$6.)
Il Director: to use only I.CK Ink.
X
PLACE OF DEATH
SUFFOLK
(County)
1
BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
JHT - OF - TOWNOO
To be filed for burial permit with Board of Health or its Agent.
12334
f(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME_
Jacob Taplin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
149 River Rd,
St Winthrop, Mass.
(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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX MALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
MARRIED
4 I HEREBY CERTIFY.
Feb.27
,60
19.
to Feb. 28
19
60
Holast saw
HMalive on
Feb.
28
19 60
death is said to
have occurred on the date stated above, at
3:20 Pm.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGERYears.
Months .Days
If under 24 hours
.Hours ...... Minutes
13 Usual
Occupation :
PATTERN MAKER
(Kind of work done during most of working life)
14 Industry
Or Business: CENTURY SPORTSWEAR
15 Social Security No. 225-05-7140
16 BIRTHPLACE (City)
(State or country)
PUESTA
17 NAME OF
FATHER
MORRIS TAPLIN
18 BIRTHPLACE OF
RUSSIA
FATHER (City) ...
(State or country)
19 MAIDEN NAME
OF MOTHER
ETHEL GORODERY
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
GMT. LEBANON-
Place of Burial or Cremation
DATE OF BURIAL FEBRUARY 29
19
7 NAME OF
FUNERAL DIRECTOR
ARNOLD GOLDW
ADDRESS 1668 BEACON ST B'KLINE
Received and filed
MAR 3 1960'
19
Chara
{Registrar),
(Official Designation) (Date of Issue of Permit)
V.B.
.
(c)
Due
ADENOCARCINOMA OF
COLON
3 YEARS
2 days
Was autopsy performed?
YES
What test confirmed diagnosis ?_.
Autorsy
5 Was disease or injury in any way related to occupation of deceased? If so. specify ......
(Signed)
M. D.
(Address).
in Mos
Charle St. Clay. M.Pi Date Feb. 28 19 60
W. ROXBURY (City or Town)
21 Informant.
SUMMER TAPLIN (Address) 149 RIVER RD WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burialyer transit permit was issued : William J. Kane
(Signature of Agent of Board of Health or other) 6971 2 29 60
a
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
3 DATE OF
DEATH
February
28
1960
(Month) (Day)
(Year)
That Wettended deceased from
10a If married, widowed, or divorced
KRAMER
SALLY
HUSBAND of
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
PERITONITIS, GENERALIZED,
(a)
ACUTE
Due To PERFORATED GASTRIC
(b)
ULCER
INTERVAL BETWEEN ONSET AND DEATH 3 days 2 days
OTHER
SIGNIFICANT
CONDITIONS
biLATERAL
BRONchopNeuMONIA
PARENTS
Registered No.
No.
Massachusetts General Hospital BAKER MEMORIAL
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
0
MAY 2 01960 4 !!
101
OUT - OF - LUWNY
To be filed for burial permit with Board of Health or its 022501
No.
Anna Ethel Chase (High)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
92 Herman Street,
St
Winthrop, Mass
(If nonresident, give city or town and State)
Length of stay: In piace of death ........... years
months .
1Q days. In place of residence
.70years ..
........ months. ...... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
February 29 1960
DEATH
(Month)
1
(Day)
(Year)
NO-FHEREBY CERTIFY,
That WEttended deceased from
Leb. 19
-. 1960 ... , to.
February ..... 29,
19
.6.0
Va last saw Her alive on february 29 . 1960
, death is said to
have occurred on the date stated above, at
8:45 Am.
INTERVAL
BETWEEN
ONSET AND
(a) Lobar pneumonia, right upper lobe DEATH
2 days
Due Afteriosclerotic heart disease (b) :
Years
Due To (c)
OTHER
SIGNIFICANT Pulmonary edema
CONDITIONS Diabetes mellitus
Was autopsy performed?
Yes
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed).
Eugenie Espingar
M. D.
(Address).
Eugene C. Eppinger
Peter Bent Brigham Date. Feb. 29, 160.
6
Winthrop Cemetery , Winthrop, Mass
Place of Burial of Cremation
(City or Town)
DATE OF BURIAL Marsh % 1960 19
7 NAME OF
FUNERAL DIRECTOR
Alfred B. March
-ADDRESS
174 Winthrop St. Winthrop,
Received and filed MAR 2 19609 Charles AT Mackie 19
(Registrar)
8 SEX
9 COLOR
10 SINGLE
(write the word)
widowed
female
white
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Louis Abbott Chase
(Husband's name in fuil)
11 IF STILLBORN, enter that fact here.
12
AGE 83Years.
2 ..... 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. 023-05-6457
16 BIRTHPLACE (City)
(State or country)
East Boston
Mass
17 NAME OF
FATHER
Augustus Bonapart Fish
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Lucy Anna Coombs
20 BIRTHPLACE OF
MOTHER (City)
Salem
(State or country)
Mass.
21 InformantMiss. Madelin D. Chase (Address) 92 Hermon St, Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued :
Mass. Jacqueline Cosy.
(Signature of Ageof of Board of Health or other)
70,7
3-2-60.
(Official Designation) (Date of Issue of Permit)
.
PARENTS
·
1
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN
SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
Peter Bent Brigham Hospital
J(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
TRUCTIONS FOR IL CERTIFICATE giving OF DEATH
not enter than one re for each (b) and (c)
does not mean le of dying, heart failure, i etc. It means ise. or compli- s which caused
bons, if any, I gave rise to n cause (a). in the under- & cause last. 1.5.
Itions contrib. t death but not I, the terminal ondition given
Chapter 137, 1954, requires Ins to print or e cause or sof death on rtifcates. (AP. 46, 35 9 & :AP. 114 $$ 45, HAP. 38 %6.)
24 1900
IO.58.923800
M R-301A
-THIS IS A NENT RECORD. se only : APPROVED. ink or black writer ribbon,
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No.
(Usual piace of abode)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
1
A TRUE COPY ATTEST: Charles in Mackie Citv Registrar
MAY 201960 /4
X
PLACE OF DEATH
Suffolk
West Roxbury
(City or Town)
The Commonwealth of Massarh@ffff - OF - TOWN102
JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed lor burial permit with Board of Health or its Agent. 02533
No. Veterans Administration Hospital
HARRY EDWARD GOODWIN
2 FULL NAME.
( ff deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence No.
15 Wheelock St
SP
Winthrop
( l'sual place of abode )
(If nonresident. give citt or town and State)
Length of stay : In place of death.Q
years.
0
months.
26
days. In place of residence
47 years
.. months .
. dlays.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
W
10 SINGLE
(write the word)
MARRIED)
WIDOWED Married
of DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Florence G. Cody
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
66
AGE
Years.
9
Months
4
.Days
If under 24 hours
.. Hours .............. Minutes
13 Usual
Occupation :
Property Utilization Officer
(Kind of work done during most of working life)
14 Industry
or Business :
US-Govt
15 Social Security No. .....
013-05-8925
16 BIRTHPLACE (City)
(State or country)
Somerville, Mass.
17 NAME OF
FATHER
William F. Goodwin
18 BIRTHPLACE OF
FATHER (City)
......
(State or country)
Waltham, Mass.
19 MAIDEN NAME
, M. D.
OF MOTHER
Mary E. Finnerty
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston, Mäss.
21 Mrs .... Florenoe.C. Goodwin --- wife
Informant (Address) Whe lock It Winthrop Pas Seth
I HEBERY CERTIFY that a satisfactory standard cola was filed with me BEFORE the burial or transit perm ?was issued: Jacqueline oscy (Signature Agent of Board of Health or other)
7044
3-3-60-
(Official Designation)
(Date of Issue of Permit)
TRUCTIONS FOR L CERTIFICATE
.
n giving : OF DEATH i not enter le than one I.e Ior each :, (b) and (c)
idoes not mean Ide of dying, heart failure, 1 etc. It means lise, or compli- I which caused 951
Cons, if any, " gave rise to ' cause (a), B
the under- Į cause last.
d'itions contrib. I death but not the terminal ondition given
: Chapter 137, 954. requires ins to print or e cause or if death on (tificates, and : 48, Acts of I uires Physi- tprint or type 1 er signature.
.
.5
124 1960
4-59-92 5686
.....
Received and filed Charles &t Imagine 19.
PARENTS
(Signed)
JAMES BERK
(PRINT OR TYPE SIGNATURE)
(Address) .VAH, .... WestRoxbury Masa ..
3/11 ....... 19.60
6
Winthrop Cemetery Winthrop, Mass Place of Burial or Cremation DATE OF BURIAL (City or Town) March 4 .19 .... 60
7 NAME OF
FUNERAL DIRECTOR
O'Maley Funeral Home
......
ADDRESS 79 Atlantic St Winthrop, Mass.
MAR 7 1960
.60.
I last saw h. j alive on
3/1/
19.60 ... , death is said to
have occurred on the date stated above, at ... ].2 .... Noon.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinoma bladder
metastatic
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
No
Was autopsy performed ?
.....
What test confirmed diagnosis ?
....
Cystoscopy
5 Was disease or injury in any way related to occupation of deceasedo. If so, specify
3 DATE OF
DEATH
March ... 1, .... 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That
[ attended deceased Irom
2/4/
1960
to ..
3/1/
(Give maiden name "of wife in full)
2 yrs
f(If death occurred in a hospital or institution, St } give its NAME instead of street and number) PHYSICIAN - IMPORTANT
[(W'as deceased a { U. S. War Veteran, {if so specify WAR) WWII
.M R-301A
A TRUE COPY ATTEST: Charles it Mackie City Registrar
- -
HAY 2 21960 61
1
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD A CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent. 02697
No.Douglas
LE
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME Mildred. (If deceased is' Tharried, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
100 Woodside
(Usual place of abode)
Length of stay: In place of death. ... years months 1 days. In place of residence 8 years months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
-March
1, 1960., to ....
March
2
,19.60
HUSBAND of
Plast saw he Rive on Mar.
2 ___ , 19-60, death is said to
(Give maiden name of wife in full)
(or) WIFE of.
Lorenz Garnjost
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 62 Years. 6
Months 2Days
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.
010-20-9573-A
16 BIRTHPLACE (City)
(State or country)
Newton
17 NAME OF FATHER Frederick Winthrop King
18 BIRTHPLACE OF
FATHER (City) (State or country) Nova Scotia
19 MAIDEN NAME
OF MOTHER
Emily Lena Douglas
20 BIRTHPLACE OF
MOTHER (City)_
(State or country) Prince Edward Island
21 Informant Lorenz Garniost
(Address)
100 Woodside Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of cath was wed with me BEFORE the burial or transitdurant was such
(Signature of Agent of Board of Health or other)
70 66 3-7-60
(Official Designation)
(Date of Issue of Permit)
1
-
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
tial
HyperTENSION, ESSIN
4 yrs
Was autopsy performed ?
Yes
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed).
Chillan
, M. D.
Charles L. Clay, M.D.
(Address). Ass's Dir., Mass. Gen'l Hosp. Date.
3/2/60
6
Winthrop Cemetery Winthrop, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL March 4 ,1960 19
7 NAME OF
FUNERAL DIRECTOR
alfred B. March
ReciDy MAR 2 1960 nach 19
(Registrar)
MAY 24 1980
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
female white
10a If married, widowed, or divorced
have occurred on the date stated above, at 5 A -.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) intracerebral Hemorr hage, massive, right
INTERVAL BETWEEN ONSET AND DEATH Iday
OUT - OF - TOWN103
RM R-301A
B .- THIS IS A ANENÝ RECORD. Use Only TE APPROVEO k ink or block ·writer ribbon.
STRUCTIONS FOR AL CERTIFICATE In giving BE OF DEATH I not enter tre than one se for each ), (b) and (c)
1: does not mean ode of dying, s heart failure, e . etc. It means atesc. or compli- H which caused
331 'ions, if any, gave rise to couse
(€). the under- lest .
atitions contrib. death but sot to the terminal condition given
. Chapter 137, 1954, requires i ans to print or he cause or e of death on bertificates. IAP. 46, 55 9 & CAP. 114 $$ 45, HAP. 38$ 6.) al Director: Ese use only. LACK Ink.
C 10-58-923686 1.5.
1
PLACE OF DEATH
Garniost
Ave.
AFTES
Winthrop
(If nonresident," give city or town and State)
A
PARENTS
174 Winthrop St. Winthrop, Mass. Lima No Drivers ADDRESS
MASSACHUSETTS GENERAL, HOSPITAL
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, (if so specify WAR).
2
1960
A TRUE COPY ATTEST: Charles it Mackie City Registrar
MAY 2 @1960 14
OUT - OF - TOWN 104
To be filed for burial permit with Board of Health of
Registered No.
(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
58 Cutler St.
St
Winthrop
(Usual place of abode)
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