USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 39
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St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
{if so specify WAR)
No
MEDICAL CERTIFICATE OF DEATH
(Usual place of abode)
June
3 DATE OF
DEATH
(Month)
(Day)
(City or town and State)
(Specify type of place)
Injury
(Address)
Boston
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
(How did injury 'occur ?)
IM R-303 A 4:
11.5
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
SEP -61960 AM
INTHE
%
ERK
DRM R-302
THIS IS A PERMANENT RECORD 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 ..
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
1
PLACE OF DEATH
Suffolk
(County ) Chelsea
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Chelsea
(City or Town making this return) 8
350
Registered No.
(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME.
Baby Boy Spires
(If deceased is a married, widowed or divorced woman, give also maiden name.)
( Was deceased a
U. S. War Veteran,
(if so specify WAR,
(a) Residence.
No.
34-B Trident Ave.
1
St
Winthrop, Mass.
( Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ........ wears ....... months ........ days. In place of residence .......... "tars.
.months
....... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June 20, 1960
(Month)
(Day)
(Year)
8 SEX
Male
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDSingle
4 I HEREBY CERTIFY,
That I attended deceased from
Stillborn
to ...
19
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
12
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 :
15 Social Security No. none
16 BIRTHPLACE (City)
(State or country)
Chelsea, Mass.
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
(Signed )
Walter L.Freedman
M. D.
( Address )
USNH Chelsea
Date
6/21/60
Cambridge Cem. Cambridge,Mass. 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
June 22.1960
19
21 w.Spires (father)
Informant
(Address)
Trident Ave. Winthrop, Mass
7 NAME OF
L.A.Willwerth
FUNERAL DIRECTOR
179 Highland Ave. , Somerville
ADDRESS
Received and filed
AUG 3.0 1960
19
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
June 22,1960
19
(Registrar of City or Town where deceased resided)
C
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a) Intrauterine a sphxia
Due To (b)
Hypoplasia of placenta
Due To (c)
17 NAME OF FATHER William B.
18 BIRTHPLACE OF
FATHER (City)
Joanna, So.Carolina
....
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary J.Kellett
20 BIRTHPLACE OF MOTHER (City) South Carolina
( State or country)
UE Joseple a. Tyrrell
50M-9-59-926111
(City or Town)
No .. U.S. Naval.Hospital
CERTIFICATE OF DEATH
9 COLOR
( write the word)
I last saw h ...... alive on
June 20, 1960
have occurred on the date stated above, at3.2.32p.
i.m.
is said to
AUG 361930 IN
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
COPY OF CERTIFICATE OF DEATH
CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE
TOWN OR CITY CLERK'S NO.
179
X
1. NAME OF
DECEASED
(TYPE OR PRINT)
A. (FIRSTI
James
B. (MIDOLEI
C. ILAŞTI
Antonellis
2. DATE
OF
DEATH
July 13, 1960
3. PLACE OF DEATH
A. COUNTY
Belknap
4. USUAL RESIDENCE
A. STATE
M
(WHERE DECEASEO LIVEO. IF INSTITUTION: RESIDENCE
B. COUNTY
Suffolk
B. CITY
OR
TOWN
Laconí a
C. LENGTH OF
STAY (IN THIS PLACE)
10 days
C. CITY (GIVE ACTUAL TOWN OF RESIDENCE. NOT MAILING ADDRESSI.
OR
TOWN
Winthrop
D. FULL NAME OF (IF NOT IN HOSPITAL OR INSTITUTION, GIVE STREET ADORESS OR LOCATION)
HOSPITAL OR
INSTITUTION
Laconia Hospital
D. STREET (IF RURAL. GIVE LOCATION)
ADDRESS
30 beal St.
E. IS RESIDENCE
ON FARM?
NOL
YES
5. SEX
Male
6. COLOR OR RACE 7.
Whit
MARRIED
NEVER MARRIED
DIVORCED
WIDOWED
8. NAME OF HUSBAND OR WIFE (MAIDEN NAME IF WIFE)
Josephine Choppa
9. DATE OF BIRTH
Jan. 27, 1838
10. AGE (IN YEARS
IF UNOER I YEAR MONTHS DAYS
IF UNDER 24 NRS HOURS MIN.
11A. USUAL OCCUPATION (KIND OF WORK
DONE DURING MOST OF WORKING LIFE. EVEN IF RETIREO)
Cook (retired)
118. KIND OF BUSINESS OR
INDUSTRY
Cooking
12. BIRTHPLACE ICITY OR TOWN, STATE
OR FOREIGN COUNTRY)
13. CITIZEN OF WHAT
COUNTRY?
SA
14. FATHER'S NAME
Pasquale Antonellis
15. MOTHER'S MAIDEN NAME
(first name unknown) lassa
16. WAS DECEASED EVER IN U.S. ARMED FORCES?
(YES, NO. OR UNKNOWN) [ (IF YES. GIVE WAR OR OATES OF SERVICE)
no
17. SOC. SEC. NO.
030-03-0556
18A. INFORMANT
Mrs. Jos phine Antonellis
188. ADDRESS
39 Geal St. Winthrop, Mass.
19. CAUSE OF DEATH (ENTER ONLY ONE CAUSE PER LINE FOR (A). [B]. ANO (CI
PART I DEATH WAS CAUSED BY,
Metastatic Carcinoma
CONDITIONS. IF ANY. WHICH GAVE RISE TO ABOVE CAUSE (A). STATING THE UNDER. LYING CAUSE LAST.
DUE TO (81
Carcinoma of
DUE TO (C)_
PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART N'AI
20. WAS AUTOPSY
PERFORMED?
YES
NO
21A. ACCIDENT
SUICIDE HOMICIDE
21C. TIME
OF
INJURY
MONTH
DAY
YEAR
NOUN
M.
21F. CITY, TOWN OR LOCATION
COUNTY
STATE
22. I attended the deceased from
12:45
m on the date stated above; and to the best of my knowledge, from the causes stated.
23A. SIGNATURE
rapp
(DEGREE OR TITLE)
238. ADDRESS
39 Main St. Laconia
23C. DATE SIGNED
7/13/60
V
24A. BURIAL
CREMATION
ENTOMBMENT
REMOVAL
248. DATE
7/16/60
24 C. NAME OF CEMETERY OR
CREMATORY,
Holy Cross Cemetery
24D. LOCATION (CITY. TOWN. OR COUNTYI
Malden, Mass.
-
IF ENTOMBED
24E. PLACE OF BURIAL
INAME OF CEMETERYI
LOCATION (CITY. TOWN. COUNTY)
(STATE)
DATE
25. FUNERAL DIRECTOR'S SIGNATURE
ADDRESS
COUNTERSIGNED -AGENT (CITT BO. OF NEALTNI
L.J. Slovacky M.D.
DATE
7/13/50
DATE REC'D BY TOWN OR CITY CLERK
July 22, 1960
CLERK'S OWN SIGNATURE
Kenneth R. Dunlap
CLERK OF
Laconia, N.l.
A true copy, Attest:
Kenneth. R. Dunlap Clerk of Laconia, N.M.
Dated July 22 1960
VS 17
C.O. 18648-10-57-25M
MEDICAL CERTIFICATION
Adrenal
failure due to bilateral adrenalectomy
21B. DESCRIBE HOW INJURY OCCURRED (ENTER NATURE OF INJURY IN PART 1 OR PART II OF ITEM 19.)
21D. INJURY OCCURRED
WHILE AT
WORK
AT WORK
NOT WHILE
21E. PLACE OF INJURY (E. G., IN OR ABOUT
NOME, FARM. FACTORY. STREET. OFFICE BLOG .. ETC."
July 4, 1960
, to July 13, 196and last 5010
Ker
alive on July 13,1960
him
Death occured at
. 11
(MONTH)
(OAY)
(YEAR)
BEFORE AOMISSION.)
Italy
IMMEDIATE CAUSE (A1.
INTERVAL BETWEEN
ONSET AND DEATH
2+ yrs
3+yrs
(STATE)
Laconia
AUG 1 11 0%.
R-301A 1
"UCTIONS FOR ACERTIFICATE
ugiving
EOF DEATH
ot enter nthan one s for each ),b) and (c)
e's not mean 0 of dying, eart failure, tc. It means or compli- vich caused
us, if any, ve rise to nuse (a), he under- luse last.
kions contrib- bath but not hthe terminal t dition given
hapter 137, 54. requires to print or cause or death on ficates, and 8, Acts of Wires Physi- J'int or type 1ªr signature.
·69-925686
X
PLACE OF DEATH
Suffolk (County) With
CANSEPET
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH St
To be filed for burial permit with Board of Health or its Agent.
Registered No.
1.80
[(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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Cutler
St.
Winthrop
(Usual place of abode)
Length of stay: In place of death .years .. months. ...... .. days. In place of residence. 3 ... years. months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August
2
1960
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
(write the word) Married
or DIVORCED
4 I HEREBY CERTIFY, That I attended deceased from July 1940 to .... August 2, 1960
10a If married, widowed, or divorced Jennie(ZABRONSKY)
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 ...
76 Years
.. Months ...
Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
Retired Meat Cutter
(Kind of work done during most of working life)
14 Industry
or Business :
Meat Provisions
15 Social Security No.
16 BIRTHPLACE (City) (State or country)
Russia
17 NAME OF
FATHER
Max Fleishman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
,M. D.
OF MOTHER
Dinah
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
(Address)
Mrs Lazarus C. Ogus
48 TEMPIE Ave 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) Treblete Ofrece 8/3/60
(Date of Issue of Permit)
(Official Designation)
(Registrar)
18yrs
Was autopsy performed ?
no
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased? YO If so, specify
(Signed);
Charles hiberman
(PRINT, OR TYPE SIGNATURE) (Address) Winthropmass Date
8/3/ 1960
6
Cong Kenesseth OSRAEL- Woburn
Place of Burial or Cremation
DATE OF BURIAL
Aug
4
(City or Town) 1960
7 NAME OF
FUNERAL DIRECTOR
TORF Funeral Service
ADDRESS
151 Washington Ave Chelsea
Received and filed
AUG 3 1960
19
5yrs
Due To (c)
OTHER
Diabetes Mellitus.
SIGNIFICANT
CONDITIONS
(Day)
I last saw h. I'Malive on August 1, 1960, death is said to have occurred on the date stated above, at 8: 30P. m. INTERVAL BETWEEN ONSET AND DEATH 20yrs
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Hypertensive- Coronary
11 Artery Heart Disease
(b)
· Cardiac Decompensation
Due To
Boston (City or Town)
17 Cutler
No.
HYMAN FLEISHMAN
2 FULL NAME
(a) Residence. No.
(If nonresident, give city or town and State)
(Month)
PARENTS.
a
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
- .
AUG 3 1960 FH
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.
R-301A -
TICTIONS OR L'ERTIFICATE
niving F DEATH It enter chan one se or each )) and (c)
ds not mean dd of dying, art failure, c. It means L or compli- ·ich caused
s, if any, ve rise to use (a), 'e under- use last.
Cons contrib- ath but not he terminal dition given
hapter 137, 4. requires : to print or cause or death on ficates, and 3, Acts of tires Physi- int or type k signature.
(Signed)
(d) suple Fregare
M. D.
Joseph Gregorie
(PRINT OR TYPE SIGNATURE)
(Address) 194 Washingtonche Date .......
8/0- 19
.60
OUT JOSEPH'S
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
AUG
6
19 60
7 NAME OF
FUNERAL DIRECTOR'.
MAURICE W KIRBY
ADDRESS
WINTHROP
Received and filed
AUG 8 1960
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
WIDOWED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in_full)
GEORGE W BEATTIE
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE,
79 Years
Months ..
Days
If under 24 hours
.Hours ...
.Minutes
13 Usual
Occupation :
HOME MANE
(Kind of work done during most of working life)
14 Industry
or Business :
HOME
15 Social Security No. ....
NONE
EAST BOSTON
16 BIRTHPLACE (City)
(State or country)
MASS.
17 NAME OF
FATHER
WILLIAM & LYNCH
18 BIRTHPLACE OF
FATHER (City)
(State or country)
N. Y.
19 MAIDEN NAME
OF MOTHER
MARY L SMITH.
20 BIRTHPLACE OF
BADKLYN
MOTHER (City)
(State or country)
NY.
21
Informant
(Address)
FRANCIS P, LYNCH
4 JUNIMIT. AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Taller C. Jereanus 8
(Signature of Agent of Board of Health or other)
Hallen Wide
8/5 60
(Official Designation)
(Date of Issue of, Permit)
( 9-925686
PLACE OF DEATH
SUFFOLK County ) WINTHROP (City or Town) No. 4 SONNY IT AVE, FLORENCE E BEATTIE LYNCH
The Commonwealth of Massachusetts JOSEPH D. WARD To be filed for burial permit with Board of Health or its Agent. SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No. 181
[(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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4. SUMMIT AVE
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death 5 years months
days. In place of residence 5 6 years months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Aug
3
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY>
1
1998
, to ....
Quy 3)
That I attended deceased from
60
19
I last saw her alive on July 30 1
1.60, death is said to
have occurred on the date stated above, at
6:00 P.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial Heart
(a)
Disease
(b)
arteriosclerosis
generalized
(c)
Due To
Senility
upp
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
PARENTS
BOSTON
BROOKLYN
.......
X
St.
(If nonresident, give city or town and State)
2 FULL NAME
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
RULES OF PRACTICE AUG - 01960 En
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 R-301A 1
RUCTIONS FOR . CERTIFICATE
giving OF DEATH not enter than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means se, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not o the terminal condition given
Chapter 137, 1954. requires ins to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature. 5.
-6-59-925686
PLACE OF DEATH
X SUFFOLKY (County) WINTHROP. (City or Town) CERTIFICATE OF DEATH BAY VIEW REST HOME 41 WASHINGTON AV death
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
182
Margaret (Sherry) Gibbons
(If deceased is a married, widowed of divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
78 Washington Ave St.
(If nonresident, give city or town and State)
Length of stay: In place of death ......... ... years. months 7 days. In place of residence 5 years ... months. .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
august
6
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
July 8, 1968, o.
cmq 6
1960
I last saw herlive on
Cous6 1, 1960
death is said to
have occurred on the date stated above, at
4.40 A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
BRONCHO-PNEUMONIA
(a)
Due To
ARTERIOSCLEROTIC
(b)
HEART DISEASE
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
0
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased /20 If so, specify
(Signed) FRED Ó' REGAN M. D. 113 PLEASANTST WINTHROP MASS SPRINT OR TYPE SIGNATURE)
(Address) 8/6/6 6te 19.
6 ST. MARY'S Lynn
Place of Burial or Cremation
(City of Town)
DATE OF BURIAL . August 9, 1960 19 60
7 NAME OF
FUNERAL DIRECTOR
Maurice W. Kirby
ADDRESS 210 Winthrop St Winthrop
Received and filed AUG 8 1960 19.
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
1
9 COLOR
W
MARRIED
WIDOWED
or DIVORCED
WIPOWOD
10a If married, widowed, or divorced
HUSBAND of
William Gibbons
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 92-
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:
House wife
15 Social Security No. NONE
16 BIRTHPLACE (City)
(State or country)
yass
lynn
17 NAME OF
FATHER
Patrick P. Sherry
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary S. Phelan
Ireland
20 BIRTHPLACE OF MOTHER (City) (State or country)
De Lashin Daniel O Brien
21
Informant
(Address)
28 Washington Ave
I HEREBY CERTIFY tbat 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 of other) He alet Oxices 8/8/60
(Official Designation)
(Date of Issue of Permit)
NO
give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
[if so specify WAR)
10 SINGLE
(write the word)
· (Give maiden name of wife in full)
INTERVAL
BETWEEN
ONSET AND
DEATH
4 day
9. PARENTS
Registered No.
2 FULL NAME.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE AUG - 81960 CM
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
X SUFFOLK. .. . (County) HLIN THIPOP (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.
Registered No. 183
MINTHAON COM. HOST
MANY A HANLON (PMEE)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
93 CLIFF AVE
.St.
(If nonresident, give city or town and State)
Length of stay : In place of death .. ye ............. months. 7 days. In place of residence. 2 .... years .... .. months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCEDIDUNIA
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
JAMES
(Give maiden name of wife in full)
HANLON
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE /1 Years.
Months.
.Days
If under 24 hours
Hours.
.. Minutes
13 Usual
Occupation :
HOME
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No. NONE
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
THOMAS NICE
18 BIRTHPLACE OF
FATHER (City)
BOSTON
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
MARGARET (MIENEY)
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