USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 34
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coused
332
litions, if any, h gove rise to e cause (o), Ung the under. comse last.
nditions contrib- o deoth but not h to the terminal condition given
- Chapter 137. 1954. requires Hans to print or he cause or e of death on hertificates, and 48, Acts of :quires Physi- , print or type ider signature.
L_ 14 1960
0 11-59-926662
PLACE OF DEATH
Suffolk (County) Boston
(City or Town)
Beth Israel
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Hospital
150
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent. 04 296
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)
NO.
(a) Residence. No.
(Usual place of abode)
181 Grovers Ave.
St.
Winthrop, Mais
(If nonresident, give city or town and State)
Length of stay: In place of death ............. years ...
.......
.months.
.... days. In place of residence .. 25 ... years ..
months.
........... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
male
white
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
4/16
19 60
to .............
That I attended deceased from
4/16
19
60
I last saw him alive on
4/16
, 19 60, death is said to
have occurred on the date stated above, at
6:30 P.m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cerebral Vascular Accident
DEATH 1 day
20 years
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Hypertensive Lauscular 30 year
Disease
Was autopsy performed ?
No
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? Nic If so, specify
(Signed)
quillard!
Willard
Harris
(Address)
(PRINT OR TYPE SIGNATURE)
Beth Israel Hospate
4/16-1960
6 Winthrop ..... Cemetery Winthrop Mass
Place of Burial of Cremation (City or Town)
DATE OF BURIAL April18,1960
7 NAME OF
FUNERAL DIRECTOR ...
alfred 3. Marsl
ADDRESS
174 Winthrop St .Winthrop Mass
APR 2 1 4960 19
Receivedand filed
Chark
à tracke
- (Registrar)
1729
14-18-60
(Official Designation)
(Date of Issue of Permit)
1
3 DATE OF
DEATH
April
(Month)
(Day)
16
1960
(Year)
10 SINGLE
(write the word)
widowed
10a If married, widowed, or divorced
HUSBAND of
Mary Cohen
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ..... 7.4 Years ........
4.Months.
6. Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
retired sales Mgr
(Kind of work done during most of working life)
14 Industry
or Business :
Met. Life Ins. Co.
15 Social Security No. .
013-03-6302
16 BIRTHPLACE (City).
(State or country)
New York
New York
17 NAME OF
FATHER
Bernstein
18 BIRTHPLACE OF
FATHER (City)
Russia?
(State or country)
unable to obtain
19 MAIDEN NAME
M. D.
OF MOTHER
11
t1
20 BIRTHPLACE OF
MOTHER (City)
t1
11
11
(State or country)
Russia
Informant
Alan ... R ....... West
63 Egmont St Brookline
I HEREBY CERTIFY that satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: , operator
No.
2 FULL NAME.
Bernstein, Joseph
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PARENTS
- (b)
cerebral Atherosclerosis
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
>
M R-301X
1
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
Child rens aHospital 300 Longwood Av.,
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent.
01205
[(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,
2 FULL NAME
Quigley, Joseph P.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if so specify WAR)
(a) Residence. No.
2 Undine Av.,
Winthrop,
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death.
... years.
months
7
days. In place of residence .............. years .....
months ....
9
.days.
Hospital
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED SINGLE
or DIVORCED
4 I
HEREBY
April
9
19.
to ..
......
60
19 ........ , death is said to
have occurred on the date stated above, at
... m.
INTERVAI. BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
.. Months ....
.. Years ...........
9
.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.
MEDFORD
17 NAME OF
FATHER
16 BIRTHPLACE (City)
(State or country)
Josefst Quigley
18 BIRTHPLACE OF
New BEDFORD
....
FATHER (City)
(State or country)
19 MAIDEN NAME
Sanders
M. D.
OF MOTHER
SHIRLEY THORPE
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
CANORIDIE
(Address) Date ..
19
6 CAMORIOTS
CARARIO99
Place of Burial or Cremation DATE OF BURIAL
APRIL 18
19
7 NAME OF FUNERAL DIRECTOR DANIEL - OBRIEN
ADDRESS CARA RIOTS Ha55
Received and filed
APR 20 TyOU
19
Charles H. IMACHINE! ·
80
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Yes
Was autopsy performed ?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) R. Wyour
PARENTS
Joseph Quigley
21
Informant
(Address)
2 UNDINS AUS WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death wasscaled whh mo # FORE the burial er transit permit wasissued:
(Signature of Agent of Board of Health or other)
E13920
4/17/60
(Official Designation) (Date of issue of Permet)
X
I TRUCTIONS FOR IL CERTIFICATE
n giving : OF DEATH d not enter le than one le for each , (b) and (c)
does not mean de of dying. heart failure, etc. It means se, or compli- which caused 3
656
5
loms, if any, gave rise to camse (a), the under- cause last.
ditions contrib- death but not I, the terminal ondition given
Chapter 137, 5 :954. requires cns to print or e cause or of death on (tificates, and € 48. Acts of quires Physi- t print or type Mler signature.
14 1960
M-59-92 5686
April
16
60
(Month)
(Day)
(Year)
,
That L attended deceased from
April
16
60
19
I last saw h ........ alive on
1m
April
16
....... 1.25 P
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Convulsions
(a)
Due To
CNS DAMAGE
(b)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
3 DATE OF
DEATH
(Usual place of abode)
CERTIFICATE OF DEATH
Registered No.
Boston
(City or Town) 60
(PRINT OR TYPE SIGNATURE)
A TRUE COPY ATTEST: x Charles ist. Mackie
City Registrar
JUL 1.1000 kč
X
IM R-301A
3 .- THIS IS A ANENT RECORD. Ise only LE APPROVED : ink or black writer ribbon.
I TRUCTIONS FOR IL CERTIFICATE
1 giving S OF DEATH d not enter ao than one a & for each (8 (b) and (c)
hi does not mean nie of dying. heart failure, etc. It means disse. or compli- which caused
dons. if any. ch gave rise to ve cause İN
(a). the under- it cause last.
ontions contrib .. t death but not the terminal € audition given M.c.
te Chapter 137, 0:1954, requires icas to print or ' cause or 's Y death on 1 (tificates. C.AP. 46, 95 9 & CHP. 114 $$ 45, : (AP. 38$6.) Director: as use only IL CK Ink. U ... 1.4.1960
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.
f(If death occurred in a hospital or institution, St. (give its NAME instead of street and numher)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
61 Wilshire
Winthrop,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if sq specify WAR)
Mass .
NO
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death ........ years ........... months
days. In place of residence ..
(If nonresident, give city or town and State)
36
years
....... months .....
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
20
1960
(Day)
(Year)
4 I HEREBY CERTIFY,
April 20 60
April
That'I attended deceased from
60
20
19
wę last saw h
1MAve on
April
20
19
death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Coronary heart disease
Due To
- (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
and congestion
/hr.
Was autopsy performed?
What test confirmed diagnosis?
yes autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so. specify .....
(Signed) Chorios L. Clay, M.D. (Address).Ass's Dir., Mass. Gan'l Hosp ... Date.
M. D.
4/21/19 60
WINTHROP CEM. WINTHROP, MASS 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL April 23 19
Jutaul. Haverão
, NAME OF FUNERAL DIRECTOR ADDRESS 42 Communiquedes The Boston Du
Received and filed. APR 2 6 1960 19
artes
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
WIDOWED
MARRIED
WIDOWED
or DIVORCED
10a If married, widowedet divorced HUSBAND of
FONTAINE
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
60 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:
CONTRACTOR
15 Social Security No ......
020-30-5472
16 BIRTHPLACE (City)
(State or country)
GREECE
17 NAME OF
FATHER
ANGELO KOUTROUBA
18 BIRTHPLACE OF
FATHER (City).
(State or country)
GREECE
19 MAIDEN NAME
OF MOTHER
MARIGO CARACASES
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
GREECE
2' BESSIE KORITSAS
6 Informant (Address) 66 WILSHIRE ST WINTHROPLYA
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial gt transit permit-was issued: Jacqueline Carly (Signature of Agent of Board of Health or other) 78/2 4 -22-60% $38
(Official Designation) (Date of Issue of Permit)
V.F.V
..
PARENTS
OUT - OF - TOWN 152
To be filed for burial permit with Board of Health or its Agent.
MASSACHUSETTS GENERAL HOSPITAL
No.
2 FULL NAME
Andrew Koutrouba
St.
to.
60
INTERVAL BETWEEN ONSET AND DEATH 8 yrs
GEN.
Pulmonary edema
(Month)
1
-
A TRUE COPY ATTEST: Charles it Mackie City Registrar
X
SUFFOLK
(County)
Brighton
(City or Town)
The Commonwealth of Massachusetts UT - OF - TOWN 453 JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent.
STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
2 FULL NAME
Catherine
Toomey
[(Was deceased a
U. S. War Veteran,
No
(a) Residence. No.
874 Shirley
St
(Usual place of abode)
Length of stay: In place of death ............. years ....
... months.
38
days. In place of residence.
15
.. years .............. months .....
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
10 SINGLE
(write the word)
3 DATE OF
DEATH
APRIL
20
1960
(Year)
8 SEX
F
.9 COLOR
WHITE
MARRIED
WIDOWED HARRIED
or DIVORCED
4 I HEREBY CERTIFY,
3-
13
19.60
to ..
That I attended deceased from
4-20
19.60
I last saw he.halive on
4
20
1960
death is said to
have occurred on the date stated above, at
800 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Lymphoma of Stomach
(a) ....
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Philip E. mccarthy
PHILIP E. Mc Carthr, MDO
(PRINT .OR TYPE SIGNATURE)
(Address) St. ELTE' Hosp. Date .....
4-20 1960
6 Holy CROSS
MALden
Place of Burial or Cremation
(3)
(City or Town)
DATE OF BURIAL .... 4-28-1960 19
7 NAME OF FUNERAL DIRECTOR DANIEL F. O'BRIEN
ADDRES 907 MASS AVe, Cambridge
Received and filed
APR 26 1960
Charles & Macke
19
PARENTS
18 BIRTHPLACE CF
FATHER (City)
(State or country)
IRELAND
19 MAIDEN NAME
M. D.
OF MOTHER
MARY CONvey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
21 Joseph Toomey
(Address)
874 Shirley ST- WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was śled with me BEFORE the burial or transit permit was issued: Jacqueline
(Signature of Agent of Board of Health or other)
2811
4-22-60
(Date of Issue of Permit)
ISTRUCTIONS FOR EI:AL CERTIFICATE
In giving LE OF DEATH
o not enter bre than one esse for each f }. (b) and (c)
ri does not mean sode of dying, his heart failure, hea, etc. It means case, or compli- which caused
151
o.itions, if any, 'h'i gave rise la be: cause (a), løg the under- cause last.
(Iditions contrib- lg , death but not te to the terminal u condition given a
115.
ot . Chapter 137. 9 1 1954. requires . sians to print or ne cause or iel of death on h rtificates, and pt 48, Acts of quires Physi- s print or type e 1der signature.
U. 14 1960 5011-59-926662
PLACE OF DEATH
No.
St Elizabeth Hospital
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[if so specify WAR)
.
St.
WINTHROP, MASS
(If nonresident, give city or town and State)
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
JOSEPH F
(Give maiden name of wife in full)
TOOMEY
(Husband's name in full)"
INTERVAL
BETWEEN
ONSET AND
11 IF STILLBORN, enter that fact here.
DEATH
2th
45 Years
.. Months ............
12
AGE ...
.Days
If under 24 hours
.. Hours .......
... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
AT HOME
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
MASS
Charlestown
17 NAME OF
FATHER
BERNARD HARte
..
(Official Designation)
RM R-3014 1
0)2448
PHYSICIAN - IMPORTANT
(Month)
(Day)
A TRUE COPY ATTEST: Charles it Mackie Cit Rel.ar
JUL 1.10CM
MR-301A
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 or its Agent. 4524
No.
2 FULL NAME
Katherine
Grendell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No ..
50 Moore
(Usual place of abode)
St
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months
days. In place of residence
17 years
... months ........... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE (write the word)
MARRIED
WIDOWED
Of DIVORCED MARRIED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
ESSECH Å GRENDELL
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Intra cerebral
hemorrhage
(b) Due To Hypertension
unk
yes.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
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).
Cliclay
, M. D.
(Address).
Charles L. Cloy, M.D.
Ass't Dir., Mass. Gen'l Hosp. Date.
4/25/ 1960
6 WINTHROP
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. APRIL 28
1966
7 NAME OF
FUNERAL DIRECTOR MAURICE W KIRBY
ADDRESS
WINTHROP
Received and filed
APR 2 8 1960
Charles H. Mackie
(Registrar)
19
PARENTS
18 BIRTHPLACE OF
FATHER (City).
BOSTON
(State or country)
19 MAIDEN NAME
OF MOTHER
KATHERINE HERBERT.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
iCHAGE
MAIS DONITHY MADONNA
21
Informant
SUMODEEST WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Opersone
(Signature of Agent of Board of Health or others 789 11) 4-26-60
(Official Designation) (Date of Issue of Permit)
.
15 Social Security
NOT KNOWN
BOSTON
16 BIRTHPLACE (City)
(State or country)
MAIS
17 NAME OF
FATHER
IGNATIUS
ÉCODE
ortions contrib- I death but not d> the terminal e ondition given ).
doms, if any, ci gave rise to couse (a). the under- ' cause last. 5.
te Chapter 137, o 1954, requires iens to print or e cause or sof desth on tificstes. CAP. 46, 55 9 & CAP. 114 $$ 45, U 14 1960 eil Director: K. use only BACK ink.
ON 0.58-923886
PLACE OF DEATH
1
.- THIS IS NENT RECORD. se only I: APPROVED N ink or black writer ribbon.
UTRUCTIONS FOR NL CERTIFICATE
i giving S OF DEATH Enot enter MI thsa one L'e for each (1 (b) snd (c)
h does not mean nie of dying, a heart foilure, Hi etc. It means lisse, or compli- is which caused
331.
11 IF STILLBORN, enter that fact here.
12
AGE 7.3 Years
Months
Days
If under 24 hours
... Hours ....... Minutes
13 Usual
Occupation :
HOME MARER
(Kind of work done during most of working life)
14 Industry
or Business:
HOME
INTERVAL BETWEEN ONSET AND
DEATH 1 day
3 DATE OF
DEATH
April
25,
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
April .24,. 19_60 to ... April 25
160
" last saw h Entive on April 25,, 19 60 death is said to have occurred on the date stated above, at 8; 15.AMm.
[(If death occurred in a hospital of institution,
St. [give its NAME instead of street and number)
Registered No.
. ,
MASSACHUSETTS GENERAL HOSPITAL
WINTHROP
.
A TRUE COPY ATTEST: Charles it Mackie City Registrar
X PLACE OF DEATH
SUFFOLK
(County)
DORCHESTER
(City or Town)
CARNEy HOSPITAL
f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) ....
2 FULL NAME
FRANCIS
X.
Hurley
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[if so specify WAR)
(a) Residence. No.
(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 ..
.months .............. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
26
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
Apr.
18
19
60,
to
Apr.
26
19
60
I last saw h/M alive on
Apr.
26 1960
death is said to
have occurred on the date stated above, at
7:50 Am
INTERVAL
BETWEEN
ONSET ANO
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
SubarAchNoid
Hemorrhage
Due To
CONocNiTAL Aneurysm
(b)
cerebral
ArTery
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
yes - limited To head
What test confirmed diagnosis ?
Autopsy
No
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Gualberto B. Mejia
M. 1).
GuAlberto
B.
MellA
...... (PRINT OR TYPE SIGNATURE)
(Address)
CARNES
Hosp
Date ..
Apr. 26 1,60
6
St .Joseph's
Place of Burial or Cremation
DATE OF BURIAL
W. Roxbury
(City or Town) April29 .. 19.6.0
7 NAME OF
FUNERAL DIRECTOR
The McDonald Funeral Home
ADDRESS 461 Commonwealth Aye ... Boston
Received and filed. .......
MAY 2 1960
... 19
......
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Karrfed
or DIVORCED
10a If married, wid, YdraceA Cronin
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 ..... 32 .. Years ............
.Months ...
.. Days
If under 24 hours
.. Hours .............. Minutes
13 Usual
Occupation :
Agent
(Kind of work done during most of working life)
14 Industry
or Business :
AmericanAirlines
15 Social Security No. ......
16 BIRTHPLACE (City)
(State or country)
Boston
17 NAME OF
FATHER
Daniel Hurley
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Bos.t.on
19 MAIDEN NAME
OF MOTHER
Eileen M. Hurley ok.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
21 Mrs .Elleen M ..... Hurley
Informant
....
(Address)
12 Pierview Ave Beachmont
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed) with me BEFORE the burial or transit , permit wis -issued: E. W. Cellakou V.4.9. (Signature of Agent of Board of Health or ther) E 14178 4-28-60.
(Official Designation) (Date of Issue of Permit) X
STRUCTIONS FOR DAL CERTIFICATE
In giving LE OF DEATH
› not enter Tre than one cise for each ). (b) and (e)
h does not mean ode of dying, h's heart failure, et, etc. It means cease, or compli which caused 154.
n'tions, if any, ihn! gave rise to ba cause (a). faig the under- vis cause last.
CIditions contrib- lg ) death but not le to the terminal as condition given
ot . Chapter 137, 1 . 1954. requires si ins to print or ze cause or se! of death on thortificates, and pt 48. Acts of , quires Physi- print or type le der signature.
14,960
50 11-59-926662
The Commonwealth of MassachusettsOUT - OF - TOWN
155
JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent.
STANDARD CERTIFICATE OF DEATH
Registered No.
04610
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
WW 11
137
Court Road
St.
WINThrop
MASS
of
.
PARENTS
That I attended deceased from
RM R-301A -
A TRUE COPY ATTEST: Charles it Mackie City Registrar
JUL LIEN.
1
X PLACE OF DEATH
Suffolk (County) Boston
(City or Town)
No.
Mass klemoriel.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
156
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Baby boy
Davis
(Was deceased a
U. S. War Veteran,
[if so, specify WAR)
(a) Residence. No.
5 A Pearl Que
St
Winthrop Hass.
(Usual place of abode)
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
Goril
27
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
19
....... , to ...........
19
I last saw h ........ alive on
4 15/A
19
death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
EryThroblastosis
Fetalis
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ...
.Years .............. Months ...........
... Days
If under 24 hours
Hours ..
47
.. 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)
MASS
-
17 NAME OF
FATHER
alvin Davis
18 BIRTHPLACE OF
Chelsea
FATHER (City)
(State or country)
·Mass
19 MAIDEN NAME
(Signed)
Phillip twerk
M. D.
OF MOTHER
Eleanora Cardigan
PHILLIP STUICH, UND.
(PRINT OR TYPE SIGNATURE)
(Address)
Hass knew. trop
6
Winterof
Wintherg
Place of Burial or Cremation
DATE OF BURIAL
4/30
60
(City or Town)
19
.................
7 NAME OF
FUNERAL DIRECTOR
Ernest Plaggano
ADDRESS
147 Winthrop St Willery
Received and filed MAY 3 1960 Charles & Macke
19.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
itale
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)
(a)
Due To
Prematurity
(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 ? If so, specify
PARENTS
21
Informant
alvis Navio
(Address) 07 Pearlave Winterog
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: QFN201
(Signature of Agent of Board of Health or other) Ahit 30 . 968
(Official Designation)
(Date of Issue of Permit)
STRUSTIONS FOR DAL CERTIFICATE
In giving LE OF DEATH 1 › not enter rre than one cise for each ). (b) and (c)
h daes nat mean ode of dying. 's heart failure. es, etc. It means cease, or campli- of which caused
72
or tions, if any, hi gave rise ta ha cause (a). alg the under- ris cause last.
Ciditians contrib- z > death but not lato the terminal Is. condition given
Ot. Chapter 137, 1954, requires si ins to print or le cause or ie: of death on h rtificates, and pt 48. Acts of quires Physi- S print or type e der signature.
1_ 14 1960
5011-59-926662
Date ..... 4/27 19. 60 MOTHER (City)
20 BIRTHPLACE OF
Winthrop
......
(State or country)
Mars
.....
(If nonresident, give city or town and State)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Hospitals
RM R-301A
Boston
A TRUE COPY ATTEST: Charles it Mackie City Registrar
JUL 1. 1.200
MIR-301A
-THIS IS A NENT RECORD.
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
157
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME Mabel F. Lewis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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