Town of Winthrop : Record of Deaths 1960, Part 43

Author: Winthrop (Mass.)
Publication date: 1960
Publisher:
Number of Pages: 596


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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