USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 33
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St.
INTERVAL
BETWEEN
ONSET AND
DEATH
WINTHROP
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.
(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.
JUN 2 17 1960 ; .
T
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
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME
J.ane .... M ........ Toomey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
829 Shirley 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
40 ,
.years
months .. ........
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
3 DATE OF
DEATH
June
28
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
no /
1926 to June 28
1960
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Michael Toomey
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
.. 8.3 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)
Ireland
Cork
17 NAME OF
FATHER
Edward Baldwin
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Estelle Farmer
Informant
(Address)
141 Meridian St. E. Boston
7 NAME OF
FUNERAL DIRECTOR
Arthur J.O'Maley
Winthrop Mass
ADDRESS
Received and filed JUN-3-0-1960 19
(Registrar)
PARENTS
ned) Jaeplethegame
M. D.
OF MOTHER
Mary A. Hartnett
(Address)
Tige Washington aos- (PRINT OR TYPE SIGNATURE) Joseph GREGORIE Date
6/29 1960
6
Winthrop Cemetery Winthrop
Place of Burial or Cremation DATE OF BURIAL July 1, 1960
(City or Town)
5 days
Due To
arteriosclerosis -
(c)
generalized
gro.
OTHER
SIGNIFICANT
Hypertension
CONDITIONS
essential
Was autopsy performed?
no
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? 120 If so, specify
2.3
No.
Winthrop ... Community. Hospital
Registered No.
1.45
[(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)
UCTIONS FOR CERTIFICATE
agiving EOF DEATH ot enter than one s for each .b) and (c)
t's not mean 0 of dying, s eart failure, tc. It means 0, or compli- sich caused
itis, if any, ve rise to use (a), g he under- use last.
ndons contrib- o ath but not to he terminal culition given
:- napter 137, 14. requires iar to print or the cause or o death on er icates, and r , Acts of eq res Physi- o Int or type nd signature.
1-6-1-92 5686
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Padku Glercount (Signature of Agent of Board of Health or ,other) Ledtil, Attrice €/30/60
(Official Designation)
(Date of Issue of Permit) /
MARRIED
widowed
or DIVORCED
I last saw h.
Oralive on
June 28, 1960, death is said to
have occurred on the date stated above, at 8:30Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Bouclespneumonia
(a)
...
(Terminal)
48hs
Due To
(b)
Cerebral Hemorth
age
Female
White
St.
ConTene . 6.24= Expinzul 28
I R-30\'F 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 les of practice : (1) Attending physicians will certify to such deaths only as those of JUN-201960 44 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.
July 24, 1874
To be filed for burial permit with Board of Health or its Agent.
146
S(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, {if so specify WAR) no
(a) Residence. No.
142 Pleasant Street
St.
Winthrop
(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
3 DATE OF
DEATH
June.
30, 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
1.27
19:50
to.
6-30, 1960
I last saw h.s ..... alive on
6.25
1960, death is said to
have occurred on the date stated above, at
11:08 am.
INTERVAL
BETWEEN
ONSET AND
DEATH
(or) WIFE of
· (Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
85
11
6
Years.
Months.
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 :
15 Social Security No.
030-07-6235A
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
John Sullivan
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 b. King .......
M. D.
Myron N. King M. D.V
(PRINT OR TYPE SIGNATURE)
(Address) 222 Pleasant St Date 6/30
6 St. Mary's Cemetery, Holliston
(City or Town)
Place of Burial or Cremation
July 2,
60
19
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS
174 Winthrop St., Winthrop
Received and filed July 1, 1960
(Registrar)
PARENTS
18 BIRTHPLACE OF
Cambridge
FATHER (City)
(State or country)
Massachusetts
19 MAIDEN NAME OF MOTHER Elizabeth Dolan
20 BIRTHPLACE OF
Cambridge
19
60
MOTHER (City)
Massachusetts
(State or country)
Edith M. Christopher
21
Informant
(Address)
P.O. Box 226 , Mattapoisett
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)
(Date of Issue of Permit)
(Official Designation)
UCTIONS FOR CERTIFICATE
giving OF DEATH ›t enter n:han one s for each ,b) and (c)
e's not mean O of dying, eart failure, , tc. It means %, or compli- sich caused
its, if any, I ve rise to use (a), & he under- use last.
dons contrib- o ath but not to he terminal culition given
: apter 137, 14. requires lar to print or he cause or o death on er cates, and r , Acts of eq res Physi- o int or type nd signature.
1-6 -- 925686
PLACE OF DEATH
Suffolk (County) Winthrop
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
(City of Tech ROP CONValesCENT HOME 142 Pleasant No.
2 FULL NAME
Emma E. Sullivan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
2 1/2
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)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Urama
Due To
NEPHROSCLEROSIS
(b)
(c)
GENERAL ARTERIOSCLEROSIS VALERIO-SCLEROTIC HEART DIS
OTHER
Cambridge
SIGNIFICANT
CONDITIONS
NONE
2 YRS
+
[ R-301A 1
Registered No.
V. B.
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.
WO 0961 % 100
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.
()
F
X
M R-301A
.- THIS IS! A NENT-RECORD. Is bnly : APPROVED Ink or black writer ribbon.
TRUCTIONS FOR C. CERTIFICATE
giving S.OF DEATH
Itnot enter o. than one e) for each a (b) and (c)
isdoes not mean me of dying. a heart failure, id etc. It means Wie. or compli- s which caused
diins, if any, have rise to le
cause (a). ing the under- last.
: >Chapter 137, of 154, requires clis to print or u cause of death on ce ificates. CHP. 46, 55 9 & CHP. 114 $$ 45, CIAP. 38$6 J 14 1960 Irc Director: ISiuse only .A K Ink.
M-8-56-923666
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
OUT - OF - TOWN
To be filed for burial permit with Board of Health
43959
Registered No.
[(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME
Elizabeth Mullen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(a) Residence. No ..
25 Moore St.
(Usual place of abode)
St
Winthrop,
Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years ......... months.
days. In place of residence ..
... years.
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
7, 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That weattended deceased from
60
19
wblast saw h .... Mive on
April 7,
19.60, death is said to
have occurred on the date stated above, at
1;50₽
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Branchopneumonia
Due To
Carcinoma of sigmoid with
(b)
Obstruction of bowel
mens
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Terforation of Greinera
with abscess
un
days
0
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)
Chi@low
M. D.
(Address).Ast-t Dir. Mass. Gen
Charles L. Clay, Gosp- Date.
4-7- 19.60
6 Patentino Att
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. April 11 1960
7 NAME OF
Sullivan Broo Rechauffe
ADDRESS 30 Sommy Sh Mastica HA
Received, and filed ..
APR 1 3 1960
19
Charles H Machine
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
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 81 Years.
Months
Days
If under 24 hours
.Hours ....... Minutes
13 Usual
Occupation :
Telephone Supervisor
(Kind of work done during most of working life)
14 Industry
or Business:
Telephone
15 Social Security No.
none
16 BIRTHPLACE (City) Peterworo (State or country)
PARENTS
17 NAME OF
FATHER
Edward Madden
18 BIRTHPLACE OF
FATHER (City).
Peterboro n. H
(State or country)
19 MAIDEN NAME
OF MOTHER
Elizabeth Maddon
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Peterboro n7
21 Charles Madden
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial, o; transit permit was issued :
(Signature of Agent of Board of Health or other)
4-6-60
7630
(Official Designation) (Date of Issue of Permit)
1
No.
Massachusetts General Hospital BAKER MEMORIAL
if so specify WAR)
8 SEX
Female white
March 3,
19
60. April . 7.
INTERVAL
BETWEEN
ONSET AND
DEATH
4 days
Mions contrib .. toleath but not - the terminal ndition given .
A TRUE COPY ATTEST: Charles it Mackie City Registrar
JUL 1 -1520 48
1
PLACE OF DEATH
Atsea-Pacific Ocean (County) 250 miles West of Astoria, Oregon (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or Town making this return) 149
Registered No. .....
{ {If death occurred in a hospital or institution. St. ¿ give its NAME instead of street and number)
No ... On board Maryland Trader
STANDARD CERTIFICATE OF DEATH STATE OF OREGON BOARD OF HEALTH -- PORTLANO "'S
STATE FILE NO.
NUMBER
67 MSa 2-P=50-50.
PUBLIC HEALTH SERVICE
DATE RECEIVED
APR 2660.
1. NAME OF DECEASED (Yype or print sii entries in black ink)
Dennis
Thomas
Hickey
2. PLACE OF DEATH A. COUNTY
At soa - Pacific Ocean
Massachusetts
B. COUNTY Suffolk
B. CITY, TOWN. (If outside corporate OR mita, so apgelfy) LOCATION250 miles West
C. LENGTH OF STAY IN 2B
C. CITY. TOWN ·(If outside corporate limita, to specify) OR
LOCATION Winthrop
It not in hopplike. NR. sich address)
D. STREET ADDRESS, RURAL ROUTE, ETC.
On board Maryland Trader INSTITUTION American Trading Co Ship
35 Marshall Street
4. DATE OF DEATH
Month
Day
Year
5. SEX
8. COLOR OR RACE
7. MARITAL STATUS Married
Widowed Record
April
14 1960 Male
white.
n Olvarced 0 Never Married
8. SOCIAL SECURITY NO.
9. USUAL OCCUPATION (Kind. of workt done during most of life)
10. KIND OF BUSINESS OR INDUSYRT American Trading
Co.
F UNDER 1 TEAR
IF UNDER.24 HOURS
12. DATE OF BIRTH .
Month
Day
Tear
13. AGE LAST BIRTHDAY Yrs. 38
Days
December 3 1921
14. BIRTHPLACE (State or Foreign Country)
15. WAS DECEASED A CITIZEN C : Es U. s.
16. IF DECEASED WAS A VETERAN, WHAT WAR?
Boston, Massachusetts
Foreign Country Name of Country
- -.. . ...
.
17. NAME OF FATHER
18. MAIDEN NAME OF MOTHER Josephine Lee
RELATIONENIP TO DECEASED Josephine Hickey ( Mother)
James J Hickey
20. CAUSE OF DEATH (ENTER ONLY ONE CAUSE PER LINE IN (A), ($), AND (C). PART 1: DEATH WAS CAUSED BY! IMMEDIATE CAUSE (A) :
Interval Between Onset and Death (Years, days, hours, etc.) Several years
Conditions, if any. )
DUE TO (B) :
with probable coronary occlusion
5 hours
stating the under- ) lying cause Last
DUE TO (C) :
and beginning myocardial infarction
21. If deceased wes Female, was there n| 22. Wes an Autopsy pregnancy In the past 12 months?
performed?
23. WAE DEATH RESULY DP
24. IF ACCIDENT, DID INJURY
25A. PLACE DP INJURT
251.
CILy
County
State
(Such as Farm, Horne, Forest, etc.)
OCCUR
Accident
Eulelde Homicide
26. TIME OF Hour
Month
(Day
Year
27. DESCRIBE HOW INJURY OCCURRED.
INJURY
a. M.
P. m.
26. CERTIFICATE:
4-14-60
Certify that 1 (offended). (Investigated the death of) the deceased from or en
and that the death "occurred at2 .... p . (date)
I, from the causes and an the date stated above.
4-16-60
812 Exchange St. ,Astoria, Ore.
Cipnaturo)
(Titie) (Address) (Date Signed)
..
29. RESERVED FOR REGISTRAR'S USE
420.1
30A. DECEASED WILL BE
300. DATE
BOC. NANE DF CREMATORY DR CENETERY
30D. LOCATION (City or Yown) Stata
Burled Cremated Removed
Other
1/18/60
Holly Crogg
Malden Mass
:33. FUNERAL OJRECTOR'S SIGNATURE AND ADDRESS
31. DATE RECEIVED BY 32. REGISTRAR'S SIGNATN LOCAL REGISTRAR
Luce-Dayton Funergy
18 1960
JUL 14 1960
X
a TILED
( Registrar of City or Town where deceased resided )
50M-9-59-926111
WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. EVERY ITEM OF INFORMATION SHOULD BE CARE. MARGIN RESERVED FOR BINDING
ORM R-302
AA A A A DWALACK KIDDUN -
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) 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 THIS IS A PERMANENT RECORD
FULLY SUPPLIED. AGE SHOULD BE STATED EXACTLY. PHYSICIANS SHOULD STATE CAUSE OF DEATH IN PLAIN TERMS, SO -
LOCAL REGISTRAR'S
4324
First
Middle
Last
3. USUAL RESIDENCE {If Institution, Elve residence before admission) A. STATE
ensi
11. NAME OF SPOUSE None
022-12-0160
Seaman- wiper
MEDICAL CERTIFICATION
which give rise to )
above cause (s), )
PART II: Other Elgnificant Conditions contributing to Death but not related to the terminal disease or condition given in Part I (n):
No
Unknown
Yes
No
At Work
Not At Work
FORM Y2-1
THAT IT MAY BE PROPERLY CLASSIFIED.
'Coronary artery atherosclerosis
19. INFORMAMY'S NAME AND
D. NAME OF HOSPITAL OR
:
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
X
RM R-301A
I.B .- THIS IS A MANENT RECORD. Use only TE APPROVED ock ink or black jewriter ribbon.
ISTRUCTIONS FOR ELCAL CERTIFICATE
In giving TE OF DEATH
o not enter re than one lise for each f ), (b) and (c)
1s does not mean ode of dying, A's heart failure, ses, etc. It means lease. or compli- 01 which caused
IRlions. \if gave rise to cause the cause 1.5.
Go'itions contrib .- death but not edo the terminal Decondition given
Chapter 137, ( 1954, requires ik ns to print or e cause or 'sof death on frtificates.
CAP. 46, 55 9 & CAP. 114 $$ 45, (AP. 38$6.) lusi Director: Ke use only JACK 44860 MD.58-923868
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
140
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent.
Registered No.
00201
[(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
2 FULL NAME
JAMES BARRY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
74 Read
St. Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ....._... years.
months
. days. In place of residenceof/ years
..... months_
.... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF April
DEATH
15
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY. That I attended deceased, from
April 11
,60
April
15
60
Im
Plast saw h_
Lalive on
April
15, 1960
death is said to
have occurred on the date stated above, at
9:45A
m.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
(a)
Due To Carcinoma of stomach
- (b)
1+yr
Due To (c)
15 Social Security No ...
BOSTON
16 BIRTHPLACE (City)
(State or country)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?.. No Clinical
What test confirmed diagnosis ?......
5 Was disease or injury in any way related to occupation of deceased ? If so. specify Ch@lay
M. D.
(Address)
6 WINTHROP
WINTHROP
(City or Town)
DATE OF BURIAL.
HAR 18
1940
7 NAME OF
FUNERAL DIRECTOR
MAURICE W. KIRBY
ADDRESS
WINTHROP.
Received and filed
APR 20 1960
19
.
Charles 21. Thactive
PARENTS
19 MAIDEN NAME
OF MOTHER
ELLEN MURRAY
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
21 Informant. ALICE BARRY
(Address) HA READ ST WINTHROP.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of farsit perryit was issued:
(Signature of Agent of Board of Health or other)
213529
(Official Designation)
(Date of Issue of Permit)
..
12 Unk dat AGEd 3 Years Months.
If under 24 hours
...
-Hours ..... Minutes
13 Usual
Occupation :
PROPRIETOR
(Kind of work done during mostof working life)
14 Industry
or Business:
GENERAL TRUCKING
.
17 NAME OF
FATHER
JAMES, BARRY
18 BIRTHPLACE OF
FATHER (City).
(State or country)
IRELAND
(Signed)
Charles L. Clay, M.D.
And't Dir., Mans. Gen'l Hosp .. Date.
4/15/10 60
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE (write the word)
MARRIED
WIDOWED
Or DIVORCED MIOCHED
HUSBAND of Rap4 529 5014
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Lobar Pneumonia
INTERVAL
BETWEEN
ONSET AND
DEATH
19
to
PHYSICIAN - IMPORTANT
.40
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
No ..
MASSACHUSETTS GENERAL HOSPITAL
14/17/20
1
(a), under- last.
Place of Burial or Cremation
A TRUE COPY ATTEST? Charles it. Mackie City Registrar
JUL 1 11000 .7
DRM R-301A 1
.
NSTRUCTIONS FOR I CAL CERTIFICATE
In giving ASE OF DEATH lo not enter ore than one .use for each a), (b) and (c)
s does not mean mode of dying, as heart failure, ia, etc. It meons sease, or compli- which
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