USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 43
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death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L .. (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap, 632. 11.06 Seg. 4. Acts of, 1945.
No undertaker or other persons shall, bury a human body for the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appoimed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which tb interment is made
Chap. 114, Sec. 46, G. L., (Ter prenary Edition)
٠١٠
RULES
PRACTICE
LILLA
The fulfillment of the purpose of these rthe observance of the follow- ing rules of practice:
(1) Attending physicians wil certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deathsonly 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 occupation, 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 import- ant, 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. Children 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
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.
196
S(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Loretta (McLean) Muldoon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Emerson Rd.
Winthrop
St. Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years.
.. months.
13
.days. In place of residence. ............ years ... 3 months. .days.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sept.
1.
1960
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED
Widoweć
HEREBY CERTIFY , That I attended deceased from
4
A4910
19
SET1.1960
I last saw h. . . alive on
aug. 31.
19.60
death is said to
have occurred on the date stated above, at
6 30Am.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William E. Muldoon
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 75
DEATH
1 Day
Years.
9
Months.
1.7 .... 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.
None
East Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Alan G. McLean
18 BIRTHPLACE OF FATHER (City) (State or country) P.E.I.
19 MAIDEN NAME
OF MOTHER
Mary Green
20 BIRTHPLACE OF MOTHER (City) (State or country) P.E.I.
21 Mrs. Mary F. Keane-sister
(Address) 70 Emerson Rd, 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)
2-1960
(Official Desighation)
(Date of Issue of Permit)
X
UCTIONS OR CERTIFICATE
giving OF DEATH
t enter than one for each b) and (c)
es not mean of dying, eart failure, tc. It means , or compli- hich caused
ns, if any, ave rise to ause (a), the under- ause last.
ions contrib- eath but not the terminal sdition given
Chapter 137, 54. requires s to print or cause
or death on ificates, and 18, Acts of ires Physi- rint or type er signature.
6
Winthrop Cemetery,
.Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL September 3 19 60
7 NAME OF FUNERAL DIRECTOR Richard C. Kirby, Inc. ADDRESS 917Bennington St.E Boston
Received and filed
SEP 2 1960
19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased O.
If so, speci FEMTE: 16 Schwart (Sig ) SovaE. H. Schwartz
M. D.
RINT OR TYPE SIGNATURES 19 Pricetu SV 2.1 pt 1. 19 60
(Address)
Date
17
Due To
ATErial Sclerosis.
(c)
1 Yr
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
The
What test confirmed diagnosis ?
INTERVAL BETWEEN ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
CeratraL
Hemorrhage
(a)
Due To
Malignant Hypertension
- (b)
No.
Winthrop Community Hospital
PHYSICIAN - IMPORTANT
((Was deceased a {U. S. War Veteran, [if so specify WAR)
No
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
10 SINGLE
(write the word)
to ..
ENSE PETIT
Registered No.
R-301A 1
59-92 5686
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
SEP - 21960 ("
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 1
UCTIONS OR CERTIFICATE
giving OF DEATH t enter han one for each b) and (c)
es not mean of dying, eart failure, tc. It means , or compli- hich caused
ns, if any, ve rise to ause. (a), the under- ause last.
ions contrib- eath but not the terminal dition given
Chapter 137, 54. requires s to print or cause
or death on ificates, and 8, Acts of ires Physi- rint or type r signature.
·59-925686
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.
197
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Swimm, Ada
(Evans) Ada (Evans) Swimm
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
82 Waldemar Ave.
St.
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years ...
.. months
5
days. In place of residence.
44
.years ..
.months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
SEPT
2
1960
DEATH
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widow
4 I HEREBY CERTIFY , That I attended deceased from
Aug. 29, 1960
to .....
Jest
60
19.
I last saw HEYalive on 2010/11
19.60, death is said to
have occurred on the date stated above, at
1:30 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cerebral Hemorrhage
(b)
Due To
(c)
Hypertension
2yrs
OTHER
SIGNIFICANT
CONDITIONS
Bronchial Pneumonia NO
3 days
Was autopsy performed?
What test confirmed diagnosis
Clinical
5 Was disease or injury in any way related to occupation of deceased ?/ If so, specify
(Signed),
CHARLES LIBERMAN
(PRINT OR TYPE SIGNATURE),
(Address) WINTHROP, MASS Date
19/2/
60
Winthrop
(City or Town) 6 Winthrop Place of Burial or Cremation Sept 3 DATE OF BURIAL 19 60
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop Mass
Received and filed SEP 2 1960 ... 19.
(Registrar)
PARENTS
17 NAME OF
FATHER
Edwin Evans
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Newfoundland
19 MAIDEN NAME
OF MOTHER
Jane Elizabeth Butt
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Newfoundland
21 Dorothy Teeven
Informant
(Address) 82 Waldermar Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Italkh E. Vizcaune
HO:
(Signature of Agent of Board of Health or other) Nept 2-1960
(Official Designation)
(Date of Issue of Permit)
Removed-++
7-13.60
V.B/
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles
H Swimm
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
82
0
Months
.Days
3
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.
None
16 BIRTHPLACE (City)
(State or country)
Mass
East Boston
No.
Winthrop Commnity Hospital
Registered No.
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
(if so specify WAR)
(Usual place of abode)
INTERVAL
BETWEEN
ONSET AND
DEATH
4 days
Due Cerebral Arteriosclerosis 2yrs.
AGE
Years
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.
. THROP.
SEP -21960 /M
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.302 1
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 .
PLACE OF DEATH
Middlesex (County) Cambridgo
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
( Chy of Dawn making this return )
Registered No.
1353 198
No Guardian Hospital 85 Otis St.
St. { give its NAME instead of street and number)
2 FULL NAME
Helen Daly
(Dasey)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
5 Irwin St.
sinthrop,
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years.
months.
2days. In place of residence.
3,8
Pears
months.
„days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
September 6, 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
September 4,60
195
.... ,
I last saw h.
enlive on
September 5,19 00 death is said to
have occurred on the date stated above, at
4:30a.
.m.
INTERVAL BETWEEN ONSET AND DEATH
Bmos .
Due To (h)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
Biopsy
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify.
no
(Signed)
Francis ". Smith
M. D.
Guardian Hosp.
Sept.6, 60
Benedict Cem. Boston
6 Place of Burial or Cremation Sept. 9,
(City or Town) 60
DATE OF BURIAL
19
7 NAME OF FUNERAL DIRECTOR Winthrop
Maurice .. Kirby
ADDRESS.
Received and filed ...... OCT 4 4960 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED.
or DIVORCEmarried
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles I. Daly
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 67
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.
nons
16 BIRTHPLACE (City)
Brookline
(State or country)
Lass.
17 NAME OF
FATHER artin Dasey
18 BIRTHPLACE OFIreland
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Anne Flaherty
20 BIRTHPLACE OF Brookline
MOTHER (City) .... Hass.
(State or country )
21 Charles Daley
Informant ............
(Address) 5 Irwin St. Winthrop
A TRUE COPY
Frederick it Burke
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Sept. 5, 19 60
V.K.V
PARENTS
25M-2-58-922072
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Oat Cell Carcinoma of
(a) the lung
to September 6,,
19 60
What test confirmed diagnosis?
(Address)
Date.
Home
§(If death occurred in a hospital or institution,
¿ swas deceased a
U. S. War Veteran,,
if so specify WARTO
OCT - 41950P.
PLACE OF DEATH
Suffolk. (( )unt: )
Winthrop (('ity or Town)
The Commomuralth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
193
Winthrop Nursing Home 142 Pleasant St.
[(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, No
{if so specify WAR)
118 Woodside Ave (a) Residence. No. ( l'sual place of abode)
St. Winthrop
(If nonresident, give city or town and State)
Length of stay : In place of death .. . years .1 months days. In place of residence. .A.]years. ....... .... months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Leht
8
1960
(Year)
(Month)
(Day)
That /I attended deceased from
I last saw he alive on
9.18
1966, death is said to
have occurred on the date stated above, at
1. 30 pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
CORONARY THROMBOSIS
(a)
Due To ARTERIOSCLERUTIC (b) HEART DISEASE
5mg
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? 12G If so, specify
(Signed) ., M. D. FRED OREGIAN 1/2
PRINT OR TYPE SIGNATURE) Chien
(Ad V13PLEASANTST.
9/0 1565
6 Holyhood Brookline Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Sept 10, 1960 19
7 NAME OF FUNERAL DIRECTOR Richard.C ... Kirby Inc. ADDRESS 917 Bennington St. E.B.
Received and filed 19
SEP 9 1960
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
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
7.8 Years.
Months.
Days
If under 24 hours Hours .... .Minutes
13 Usual
Occupation :
Retired
(Kind of work done during most of working life)
14 Industry
or Business :
School ...... Teacher
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Boston
17 NAME OF
FATHER
Dennis J. Leahy
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
19 MAIDEN NAME
OF MOTHER
Katherine B. Mclaughlin
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
21 Informant La ...... Donald Grimes
(Address) woodside Ave. inthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with. me BEFORE the burial for transit permit was issued: Mackh & Vibrante (Signature of Agent of Board of Health or other) Jakr. 9/60
(Official Designation)
(Date of Issue of Permit)
VV.
ICTIONS OR CERTIFICATE
iving OF DEATH t enter han one for each b) and (c)
s not mean of dying, eart failure, tc. It means ,or compli- hich caused
is, if any, ve rise to nuse (a), he under- muse last.
ions contrib- ath but not the terminal dition given
hapter 137, 54. requires to print or cause or death on ficates, and 8, Acts. of ires Physi- int or type r signature.
59-925686
R-301A 1
No.
2 FULL NAME Margaret T. Leahy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
8 SEX
Femake
White
4 I
HEREBY
CERTIFY,
2/1
1959.
to ..
71
1960
INTERVAL
BETWEEN
ONSET AND
DEATH
2 kg.
PARENTS
To be filed for burial permit with Board of Health or its Agent.
-
TON
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER ... SEP ... 01960
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
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No. 200
St. (give its NAME instead of street and number) No. Winthrop Community Hospital
2 FULL NAME Warren A. Dick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 166 Hichborn St
St.
Revero
(If nonresident, give city or town and State)
Length of stay: In place of death. years months 3 days. In place of residence. 10 .years
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Sept.
(Month)
(Day)
That I attended deceased from
13
, 1960
I last saw himmalive on
Sept. 12, 1960, death is said to
12.15 4 m.
have occurred on the date stated above, at INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis? EKG
5 Was disease or injury in any way related to occupation of deceased ? No If so, specifyacry J. Wiener M. D
(Signed)., Harry J. Wienen insel M. D.
(Address)
Rettore
Inoso Date 9/12/160
6 Woodlawn Cemetery
Everett
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL Sept 16, 1960
19
7 NAME OF
FUNERAL DIRECTOR
Leslie W. Pike
ADDRESS
305 Beach St. Revere
Received and filed.
SEP 15 1960
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
RoseSpataro
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
46Years
6
Months
9
.. Days
If under 24 hours
Hours __ Minutes
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