USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 46
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does not mean sade of dying, is heart failure, a, etc. It means case, or compli- which caused
1/5%.
itians, if any. gave rise ta cause (a). g the under- cause last.
nditions cantrib- a death but nat to the terminal conditian given
. Chapter 137. 1954. requires ans to print or he cause or cf death on. ertificates, and 48. Acts of quires Physi- print or type der signature.
Examiner nes jurid E.on. 2 1960 1
<- 11-59-926662
JULY
12
1960
(Month)
(Day)
(Year)
That I attended deceased from
.60
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John F. Carney (deceased)
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
76
Years
1
Months.
20
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Mass.
Boston
17 NAME OF
FATHER
William Saddler
JUI - OF - TOWN
RM R-301A 1
No.
Veterans Administration Hospital
Katherine F. Carney
(a) Residence. No.
(If nonresident, give city or town and State)
3 DATE OF
DEATH
8:50
INTERVAL
BETWEEN
ONSET AND
DEATH
A TRUE COPY ATTEST:
inurles it mackie City Registrar
TOWI
ERK
THREE
NOV - 21960 AM
OUT - OF - TOWN
209 To be filed for burial permit with Board of Health or its, 07658
No. Veterans Administration Hospital
2 FULL NAME
Michael F. GUY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
51 Pebble Ave.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
0
.years ..
0
months.
6
tys. In place of reside
Lifeyears.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
July
29
1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
July 23
19.
60
to ..
July
19
60
., death is said to
have occurred or. the date stated above, at
3 :. 30₽
.m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
1. Septicemia due to staph aureus DEATH
(a)
days
yrs.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
Clinical & Lab Findings
What test confirmed diagnosis ?
.....
5 Was disease of injury in any way related to occupation of deceased ? If so, specity
......
(Signed)
Stone M. D. SUMNER STONER
VAH, BostonTYRE SIGNATURE)
(Address) Date ... July .... 29 .19 .60
6 St. Mary's Cemetery, No. Attleboro, Mass. Place of Burial or Cremation (City of Town) DATE OF BURIAL August .... 1 1960
7 NAME OF
De Blois Funeral Home
FUNERAL DIRECTOR
ADDRESS
107 Church St., No. Attleboro, Mass
AUG 2 1960
Receiyed and filed
........ 19.
1
·
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
IOa If married, widowed, or divorced
HUSBAND of
Frances Ganharx Dunham
(or) WIFE of
(Husband's name in full)
I1 IF STILLBORN, enter that fact here.
Years
12
AGE50
6
Months.
3 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Ground Service Man (Aviation)
(Kind of work done during most of working life)'
14 Industry
or Business :
Aviation
15 Social Security No.
W. Rutland
16 BIRTIIPLACE (City)
(State or country)
Vermont
17 NAME OF
FATHER
John GUY
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
19 MAIDEN NAME
OF MOTHER
Ann
Call.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Poland
21 Informant (Address)
FrancesGUY (wife) 51 Pebble Ave Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death w filed with me BEFORE the burial o 2transit permit was issued: David Milan Motional (Signature of Agent of Board of Health or other)
a 10417
7/29/60
(Official Designation) (Date of Issue of Permit)
X
1
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
X
15
RM R-301
ISTRUCTIONS FOR :AL CERTIFICATE 1 In giving E OF DEATH
o not enter ire than one Ise for each ), (b) and (c)
does not mean sode of dying, is heart failure. a, etc. It means rease, or compli- which caused
681.5
itions, if any, h gave rise to ..
cause (@), ig the under- cause last. ,
nditions contrib- o death but not to the terminal condition given
· Chapter 137. . 1954. requires ans to print or he cause or of death on ertificates, and - 48. Acts of equires Physi- › print or type ender signature.
DV 2 1960
M-11-59-926662
Registered No.
S(If death occurred in a hospital or institution, XX give its NAME instead of street and number) PHYSICIAN - IMPORTANT ((Was deceased a U. S. War Veteran,
[if so specify WAR)
WWII
Winthrop, Mass
That
J/attended deceased from
.29
(Give maiden name of wife in fuli)
2. Laennec's cirrhosis, fatty
(b)
nutritional
Due To
PARENTS
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
A TRUE COPY ATTEST:
Charles H. Mackie
City Registrar
.
.
جديد
3
NOV - 21960 AM
-
M R-803
1
SUFFOLK (County)
BOSTON
(City or Town)
The Commonwealth of MassachusettsOUT - OF - TOWN
JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 210
Registered No.
:17835
Massachusetts General Hospital No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
WILLIAM B. VERRY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 Waldemar Avenue,
S
Winthrop,
Massachusetts
(a) Residence. No.
(Usual place of 'abode)
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years .............. months ... L.g .... days. In place of residence ...
40 years.
....... months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
August
2,
1960
9 SEX
10 COLOR
11 SINGLE
MARRIED
WIDOWED)
or DIVORCERdowed
(write the word)
DEATH
(Month)
(Day)
(Year)
Malo
Whit
11a If married,
HUSBAND of
Mary "A". Coakley
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
Accident
5 Accident, suicide, or homicide (specify)
Date and hour of injury
7/19
19.60
IF ACCIDENTAL, was injury causally related to the death?
Where did
Boston, Massachusetts
Injury occur ?
(City or town and State)
Did injury occur
in
Hospitale, on farm, in industrial place, or in
public place ?
(Specify type of place)
Manner of
Fall from bed to floor
Injury
Nature of
Injury
(How did injury occur?)
While at work ?
Was autopsy performed?
No
6 Was disease or injury in any way related to occuration of deceased ?
If so, 9
(Signedy Michael A. Luongo, M.D. BOSTON t or Type Signature) 8/3 1,60
M. D.
(Address) Date
7 Winthrop Came tery Winthrop
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
August.5 1960
19
8 NAME OF
FUNERAL DIRECTOR
O'Maley Funeral Home
ADDRESS
WinthropMass
> AUG $ 1960
19.
(Registrar)
PARENTS
19 BIRTHPLACE OF
FATHER (City Cannot ... be ..... learned
(State or country)
20 MAIDEN NAME
OF MOTHER
Catherine Gpoone
Mccarthy
21 BIRTHPLACE OF
MOTHER (City Cannot be .... learned
(State or country)
22 Catherine Verry
Informant
(Address)
4 Waldemar Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was(filed with ine BEFORE the burial or transit permit was issued: norma V. mac Donalds
(Signature of Agent of Board of Health or other)
9256
8-4-60-
(Official Designation) cit in
(Date of Issue of l'ermit)
.V
InIS IS A PERMANENT RECORD, Every item of
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ ), 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
If deceased was a U. S. War Veteran, G.L. Chap. 46, Sestinia MO, requires physicians to insert a recital to that effect. ·
13 44-48.
35M-11-59-926662
() 2 1960
Received and fled
15 Industry
or Business:
Plumbing Supplies
1
16 Social Security No.
Boston
17 BIRTHPLACE (City)
(State or country) '
Mass
18 NAME OF
FATHER
Joseph Verry
If under 24 hours
13
AGE.87.
Years
Months.
Days
Hours.
......
.. Minutes
14 Usual
Occupation :
Retired .... Salesman
(Kind of work done during most of working life)
....
PLACE OF DEATH
4I HEREBY CERTIFY that I have investigated the death of the person above. named and that the CAUSE AND MANNER thereof are as follows : (If an injury was involved, state fully.) Fracture of femurs bilateral: Bronchopneumonia.
1
[ PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
No
A TRUE COPY ATTEST:
Eneries A. Mackie City Registrar
TOL ...
LERK
NOV -21960 AM
OUT - OF - TOWN
=
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
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.
211 0)7849
[(If death occurred in a hospital or institution, XK [ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
[(Was deceased a U. S. War Veteran, (if so specify WAR)
Korean
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
34 Hawthorne Ave
XX
Winthrop, Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
0
.. years ..
5
.months.2.9.
.days. In place of residence. years .. months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED)
WIDOWED
or DIVORCED
(write the word)
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
29
AGE
Years
9
Months
10
Days
If under 24 hours
Hours .............
Minutes
13 Usual
Occupation :
Free Lance Vocalist
(Kind of work done during most of working life)
14 Industry
or Business:
Music
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Mass
Everett
17 NAME OF
FATHER
Harry
Diamond.
18 BIRTHPLACE OF
FATHER (City)
(State or country) :
Russia
1
19 MAIDEN NAME OF MOTHER Safie Dreibond
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Miriam Gaynor
Place of Burial or Cremation
DATE OF BURIAL
August ......
5
,60
7 NAME OF
FUNERAL DIRECTOR
Levine
ADDRESS
470Harvard St. Brookline, Mass
Received and filed AUG 0
1
19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Richard B. Jailson
., M. I).
Dr ..... Richard.Gibson (PRINT OR TYPE SIGNATURE) (Address) ... VAH ... Boston, .... MaSS ....... Date ..
Aug 4 19 60
6 Sharon ... Memorial Park, Sharon,. Mass 21
(City or Town)
Informant
(Address)
34 Hawthorne Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificat was led with me BEFORE the burial or transit permit was issued:
Of death
(Signature of Agent of Board of Health or other)
910505
8/4/60
(Official Designation) (Date of Issue of Permit)
٦
M/R-301A 1
TRUCTIONS FOR L CERTIFICATE
n giving : OF DEATH not enter e than one se for each , (b) and (c)
does not mean de of dying, heart failure, etc. It meons ase, or compli- which coused
wions, if any, gove rise to couse (o). the under. couse lost.
iditions contrib- deoth but not do the terminal condition given m. s.
e Chapter 137. 1954. requires cns to print or c cause or s of death on ctificates, and e 48. Acts of muires Physi- tprint or type uler signature.
C/ 2 1960
W.1-59-926662
August
3
1960
(Month)
(Day)
(Year)
Feb. 5
19
4
HEREBY
CERTIFY
to
August'3
60
That, y aftended deceased from
19
in ...
death is said to
have occurred o1. the date stated above, at
1: 30 Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Bronchopneumonia, bilateral
INTERVAL
BETWEEN
ONSET ANO
DEATH
(a)
days
Due To
Adenocarcinoma os sigmoid Colon
(b)
with extension to abdominal wall
Due To
&
metcestceses; to liver
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Los
What test confirmed diagnosis ?
Autopsy
1 yr
No.
Veterans Administration Hospital
CERTIFICATE OF DEATH
Registered No.
2 FULL NAME
Gerald Diamond
(Usual place of abode)
Life
3 DATE OF
DEATH
A TRUE COPY ATTEST:
Charles A. Mackie City Registrar
T !!!
ERK
6
DROP
NOV - 21960 AM
PLACE OF DEATH
SUFFOLK ('minty ) BOSTON (City or Town)
F.
is
The Commonwealth of Massachusetts UT - OF - TOWN JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS 212 STANDARD CERTIFICATE OF DEATH
NEW ENGLAND DEACONESS HOSPITAL No.
[(If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
MRS. AGNES E. LARKIN (ABBOTT) ( If deceased is a married, widowed or divorced woman, give also maiden name.)
[{\'as deceased a V. S. War Veteran, "if so specify WAR)
No
(a) Residence. No.
34 THORNTON PARK
( Usual place of abode )
Length of stay: In place of death
years ..
months ..
19 days. In place of residence 50
.. years ..
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
AUGUST
5
1960
(Year)
(Month)
(Day)
That I attended deceased from
1 last saw hE Ralive on
AUGUST 4 , 1960, death is said to
have occurred on the date stated above, at
4:38
Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) HateRio - Selexotic
heart disease
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was antopsy performed ?
NO
What test confirmed diagnosis?
ECG
5 Was disease or injury in any way related to occupation of deceased: No If w, specify
(Signed>
Daudz Brownlee 1. 1.
TOGORA E BROWNIE
(PRINT OR TYPE SIGNATURE)
(Address)
BROOKLINE
Dat 5 DUG 1 60
With- p Costela, WasThro 6
Place of Burial of Cremation
(City or Towny
DATE OF BURIAL
AUF
8,
7 NAME OF
FUNERAL DIRECTOR
Afred B. March
ADDRESS Jearcop ST. Winthrop
Received and filed
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
10 SINGLE
MARRIED
(write the word)
Windows L
of DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
( Give maiden name of wife in full)
A. Walter Lar RIN
(Husband's name in full)
1I IF STILLBORN, enter that fact here.
AGE
12
79 Years
Months
Days
If under 24 hours
.Hours ...........
.Minutes
13 Usual
Occupation :
housewife
(Kind of work doge during most of working life)
14 Industry
or Business :
At Home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Fryeburg, no/nc
17 NAME OF
FATHER
Owen Abbott
18 BIRTHPLACE OF
FATIIER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Harriet Riley
20 BIRTIIPLACE OF
MOTHER (City)
(State or country)
M2.18
Mrs. Daniel H. Stevens
21 Informant (Address) En Tratan Ph. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjat or transit permit was issued: Patricia Vaughany (Signature of Agent of Board of Health or other) 9270 8-5-60
(Official Designation) (Date of Issue of Permit)
X
1
TRUCTIONS FOR IL CERTIFICATE
n Riving OF DEATH not enter e than one se for each . (b) and (c)
does not mean dr of dying. heart failure. . etc. It means usr, or compli- which caused
tions, if any, gave rise to rause (o). : the under. rouse last.
ditions contrib- drath but not to the terminal condition given
s.
/ 2 1960
111-59-926662
X SEX Female White
I HEREBY CERTIFY
60, 10 AUGUST 5
1º60
JULY 17
INTERVAL BETWEEN ONSET AND DEATH
1 year
PARENTS
Registered No 1, 865
St. WINTHROP, MASS
(If nonresident, give city or town and State)
Brownfield
M R-301A/ 1
A TRUE COPY ATTEST: Charles it Mackie City Registrar
TO.V.
1
UFFA
NOV -21960 AM
PLACE OF DEATH
SUFFOLK {Count: )
BOSTON (City of Town)
The Commonwealth of MassachusettsOUT - OF - TOWN JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permis with Board of Health or its Agent. 08025
Registered No
f(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
EVELYN M. CONE (Baumeister)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 63 Harbor View Road il'sual place of abode )
45
Ï0
20
length of stay : In place of death .......... ... years .....
.months.
12
.days. In place of residence
years ...
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
August
8
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
July
27
19.
to ......
60
August
8
19
60
19 ...
death is said to
have occurred on the date stated above, at
.. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Metastatic Carcinoma to
Brain
Due To
(b)
Adenocarcinoma of bowel
or carcinoma of ovary
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Pneumonia
Was autopsy performed?
Yes
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
-
Sumner Frank, M. D.
(PRINT OR TYPE SIGNATURE) 170 Morton St. J. P Date ..
8-8,60
6 Winthrop
Winthrop
Place of Burial or Cremation
Aug.
DATE OF BURIAL
19
(City,of Town) 60
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop Lass.
Received and filed ....
AUG 2 195 9 ....
5 4. Mackie
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE (write the word)
MARRIED)
WIDOWED
or DIVORCEDLar. ied
IOa If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Charles'E Cone
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
45
10
20
If under 24 hours
Hours ..............
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own home
15 Social Security No.
16 BIRTHPLACE (City.).
Huit trop
(State of country) LECS.
17 NAME OF
FATHER
Fred & Baumeister
18 BIRTHPLACE OF
FATHER (City)
(State or country)
L'ass.
Somerville
19 MAIDEN NAME
OF MOTHER
Elizabeth Knox
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lass.
21 Charles B Cone
Informant/
(Address)63 Harbor View Ave. Winthrop, Lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: miss Paciencia Vaughan par (Signature of Agent of Board of Health of other)
E9310
aug. 191560
(Official Designation)
(Date of Issue of Permit)
V.b
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which
caused ,
170
ons, if any, gave rise to cause (a), the under. cause last.
tions contrib- death but not the terminal ndition given 5.
Chapter 137, 954. requires is to print or : cause or f death on tificates, and 48. Acts of uires Physi- print or type er signature.
V 2 1960
.59-925686
1
No.
LEMUEL.SHATTUCK HOSPITAL
PHYSICIAN - IMPORTANT
[(Was deceased a U. S. War Veteran, lif so specify WAR)
St
Winthrop
( If nonresident, give city of town and State)
I last saw
her
August
8
3:35 a.
INTERVAL
BETWEEN
ONSET AND
DEATH
weeks
mos.
PARENTS
Winthrop
(Address)
(Signed) Jumper Frank M. D.
68
(Give maiden name of wife in full)
12
AGE.
Years.
Months ..
Days
1 R-301A
A TRUE COPY ATTEST:
Charles H. Mackie City Registrar
RECEIVED
TO !;
OFF
LERK
5
NOV - 21960 AM
X
RM R-303 B
Every Item of
(a) Residence. No. (Usual place of abode) 3 SEX & COLOR White Hale Sa If married, widowed, or divorced HUSBAND of Usual 8/2 PARENTS If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect 9 Occupation: of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the Internetional Classification of Couses information should be cerefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF 11 Social Security No. lione
SUFFolk Suffolk (County) Barton 1 (City or Town) Mass Genl Hosp No ... Hans Froelich PLACE OF DEATH 2 FULL NAME.
OUT - OF - TOWN
214
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 08140
J(If death occurred in a hospital or institution,
.. Ward
give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
26 Beacon St
St ..
.Ward,
Winthrop, MASS
(If nonresident, give city or town and State)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
aug
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
Fractured Law Crushed Larynx Massive Hemorrhage Aspiration Automobile Accident.
Winthrop. Mass
20
IN WHAT CITY OR TOWN
A4912, 1960
WAS INJURY SUSTAINED?
(Signed) ...
Jeange W. Centi
M. D.
(Address)
25 Skatuce
.Data.
1,60
21 PLACE OF BURIAL.
CREMATION OR REMOVAL
Winthrop Writshrop
(Cemetery)
(City or town)
DATE OF BURIAL
avg. 16
22
NAME OF
UNDERTAKER
Maurice W. Krby
ADDRESS
Coin these Winthrop
Received and filed
AUG 1 6 1960
19
(Signature of Agent of Board of Health or other)
910686 (Officia! Designation)
9/13/60
(Date of Issue of Fermitf
(write the word) SINGLE
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN. enter that fact here.
8 AGE 11 Years .. 7 Months .. -.... Days
If less than 1 day
Hours
Minutes
und Gas Service Ditt.
Industry
Service Station
Germany
13
NAME OF
FATHER
arnold Froelich
FATHER (City)
Stalk
(State or country)
Germany
15
MAIDEN NAME
OF MOTHER
Geotrode Ernst
Jermanci
17 36 Leaconst
Relation, if any .. )
Informant (Address) Winthrop Hass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or stapelt permit was issued
OV 2 1960
10 or Business : 14 BIRTHPLACE OF 16 BIRTHPLACE OF MOTHER (City) (State or country) · OM-3-06-922107 N. B. - WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. 12 BIRTHPLACE (City) (State or country)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
13 1960
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
no
if so specify WAR)
Charles H. In a Refere
X
A TRUE COPY ATTEST:
Charles H. Mackie City Registrar
WERK
HO
6
NOV -21960 AM
X
SUFFOLK
(County)
WINTHROP
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
215
No.
Hermon Street Winthrop
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
CHARLES H. LASKEY, JR.
PHYSICIAN - IMPORTANT
(Was deceased a
no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
U. S. War Veteran,
if so specify WAR)
271 Chelsea Street,
East Boston
(a) Residence. No.
(Usual place of abode)
St
(If nonresident, give city or town and State)
Length of stay : In place of death ...
„years ....
months ..
days. In place of residence ..
.... years.
months ....
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
October
1,
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows : (If an injury was involved, state fully.) Asphyxia due to hanging.
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in fu I)
12 IF STILLBORN, enter that fact here.
5 Accident, suicide, or homicide (specify)
Suicide
Date and hour of injury
10/1
19
60
IF ACCIDENTAL, was injury causally related to the death?
Where did
Winthrop, Massachusetts
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
Police headquarters.
(Specify type of place)
Manner of
Suspension by strip of blank-
Injury
(How did injury occur?)
et.
While at work ?
Was autopsy performed?
Yes
6 Was disease or injury in any way related to occupation of deceased?
If so, specify1.1.
(Signed)" ...
Michael A. Luongo, M. D.
.. , M. D.
Boston 10/1 .60
(Address)
Date
19.
7 Woodlawn Cematery Everett
Place of Burial, or Cremation.
DATE OF BURIAL
October 4,
160
19
8 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS
9 Chelsea St. , East Boston, Mass.
Received and filed
OLT 3 1960
19
(Registrar)
PARENTS
19 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Masso
20 MAIDEN NAME
OF MOTHER
Helen DeFeo
21 BIRTHPLACE OF
MOTHER (City)
(State or country )
Boston
Mass.
22
Informan
719 Hale St. , Beverly Farms , Mass.
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)
Official Designation)
(Date of Issue of Permit)
X
RM R-303 A 1
PLACE OF DEAT
DEATH 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 §§ 44-48. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of Nature of Injury 3SM-II-59-926662
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