USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 61
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Length of stay : In place of death.
years.
months
3
.days. In place of residence.
years.
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Deco
29,
1960
8 SEX
Lale
9 COLOR
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDWidowed
1960
4 I HEREBY CERTIFY,
That I attended deceased from
Alec 29
60, to ...
1000
25
I last saw h.i'malive on
1000 29
19.60, death is said to
have occurred on the date stated above, at
9 P
.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Branchopneumonia
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.
79 Years.
7 Months 17
.Days
If under 24 hours
.Hours ..........
Minutes
13 Usual
Occupation :
seaman
(Kind of work done during most of working life)
14 Industry
or Business :
Ships
15 Social Security No.
028-05-1857
16 BIRTHPLACE (City)
(State or country)
Nova scotia
lodgeport
17 NAME OF
FATHER
Bonaventure Pothier
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Julienne (CBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21 Mrs. Ladeline I. Pothier
(Address 74 Prescott st., . Bouton
I IIEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit permit was issued:
HF) (thenature of Agent of Board of Health or other) Dec 30/1960
(Date of Issue of Permit)
(Official Designation)
PARENTS
Holy Cross Cemetery, Walden 6
(City or Town) Place of Burial or Cremation DATE OF BURIAL January 3rd 19.67
7 NAME OF
FUNERAL DIRECTOR -
Richard C. Kirby, Inc.
ADDRESS 917 Bennington St., J. Boston
Received and filed DEC. 591960 . 19
(Registrar)
10a If married, widowed, or divorced
HUSBAND of
........... os ...
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To
Hemiplegia
(b)
....
1ml
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
Clinical Exam
5 Was disease or injury in any way related to occupation of deceased : W If so, specify
(Signed)
Louis ESchaffee
M. D.
Louis E Schraffa (PRINT OR TYPE SIGNATURE)
(Address) 19 Benning Tou ST Date De 29 1960
1 R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
oes not mean le of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
litions contrib- death but not the terminal ondition given
Chapter 137, 1954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
6-59-925686
I Bastoni 17-6-1
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.
No.
39 Grovers Avenue, Winthrop
[(Was deceased a U. S. War Veteran, No
(a) Residence. No. ( ['sual place of abode)
4
(Month)
(Day)
(Year)
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.
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.
TO
6
DEC 3 01960 PM
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
132 Loring Road
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
282
[(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)
132 Loring Road
St.
(If nonresident, give city or town and State)
Length of stay : In place of death
years.
. . months. .
.. days. In place of residence.
55
.years
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
30
1960
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY, That I attended deceased from
3 April
19.9.7 ...... , to ........
60
19
29 December
I last saw heralive on
27 December, 1960
death is said to
have occurred on the date stated above, at
5 p.m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral Arteriosclerosis
(a)
Due
(b)
Generalized Arteriosclerosis
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
none
Was autopsy performed?
no
What test confirmed diagnosis ?
clinical
5 Was disease or injury in any way related to occupation of deceased? no If so, specify ...........
Arthur C. Murray. D.
Arthur C. Murray
(Address) Winthrop
Date ..
2 Van 161
6
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
Jan
(City or Town) 3
61
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop .. Ma.s.s
Received and filed
C"
(Registrar)
PARENTS
18 BIRTHPLACE OF
Portland
FATHER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Aldora Paine
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Winthrop
21 Helen Chace
Informant
(Address)
40 Thornton Pk. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Malkh E. Serianni
(Signature of Agent on Board of Health or other)
HO" Jan 3-1961
(Official Designation)
(Date of Issue of Permit)
V.B.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Alphonso W Delcher
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
80
5
11
Months.
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business :
Own home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Mas's
Winthrop
17 NAME OF
FATHER
(Kind of work done during most of working life)
Joyrs
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED Widow
or DIVORCED
(write the word)
2 FULL NAME Mary Edith (Moses) Belcher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
To be filed for burial permit with Board of Health or its Agent.
I R-301A 1
RUCTIONS FOR . CERTIFICATE giving OF DEATH not enter : than one e for each (b) and (c)
loes 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 ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
-6-59-925686
(a) Residence. No. ( Usual place of abode)
45
DEATH
3 yrs.
........ 19
(PRINT OR TYPE SIGNATURE;)
Winthrop
George W Moses
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1 6.265 THROP. V.
JAN - 31961 AM
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.
I R-305 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at
as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
PLACE OF DEATH
Essex
(County)
Lynn
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Lynn (City or town making return)
Registered No.
28.
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
45 Atlantic
...........
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
0
... years.
Q montê.
.. days. In place of residence
35.
.years ..
.. months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
December 30,1960
9 SEX
male
10 COLOR
white
11 SINGLE
(write the word)
DEATH
(Month)
(Day)
(Year)
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.) Coronary occlusion
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
Years.
.Months .............. Days
-
If under 24 hours
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
If accidental, was injury causally related to the death ?
(Kind of work done during most of working life)
H. P. Hood
15 Industry
or Business :
023-09-1953
Did injury occur in or about home, on farm, in industrial place, or in public place ?
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work ?
yes
Was autopsy performed ? ?
6 Was disease or injury in any way related to occupation of deceased?
If so, spettamund AJamino
(Signed) 181N.Common St.Lynn 12/30/60
PARENTS
20 MAIDEN NAME
OF MOTHER
Sarah F.Alexander
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
"Mass:
22 Mary P. Moynihan
(Address)
45-Atlantic St., Winthrop
DATE OF BURIAL 19
8 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed
1-1-61
19
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred,?
DATE FILED
Jan. 3/61
19
(Registrar of City or Town where deceased resided)
58
14 Usual
Occupation :
Milk Salesman
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
Michael J.Moynihan
19 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass:
Boston
(Address)
.. Date ..
Holy Cross Cem.
Halden
19.
7 Place of Burial, or Cremation. Jän. 3/61
(City or Town)
25M.4-59-925100
the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided
DOA Lynn Hospital No.
George M. Moynihan
[(Was deceased a
{ U. S. War Veteran,
[if so specify WAR)
no
(a) Residence. No.
(Usual place of abode)
MARRIED
WIDOWED
or DIVORCED
single
Hours.
.Minutes
Where did
Injury occur ?
(City or town and State)
16 Social Security No.
E. Boston
(Specify type of place)
THIS IS A PERMANENT RECORD
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 of Town) Vienthin 142 Pleasant St .
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Honra
To be filed for burial permit with Board of Health or its Agent.
Registered No.
284
[(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)
(a) Residence. No.
( Usual place of abode)
1
80 Sagamore Ave
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
DEATH
December .30 ..... 1960
(Month)
.
(Day)
(Year)
4 I
HEREBY CERTIFY
That I attended deceased from
December 21 60 to Dec, 30
19.60
er
I last saw h ........ alive on
Dec ...... 26
19 .... 60, death is said to
have occurred on the date stated above, at ... 5.,.50 ........ P.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Metastatic ... Carcinoma .... of ..... Cervix
PEATH
1 year 12
84
3
11
If under 24 hours
AGE
Years
Months.
.....
Days
Hours. Minutes
13 Usual
Occupation :
None
(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) Mas's
17 NAME OF
FATHER
William Simmons
18 BIRTHPLACE OF
East Boston
FATHER (City)
(State or country)
Nass
19 MAIDEN NAME
OF MOTHER
Lucy
M "
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
East Boston
Mass
6
Woodlawn
Place of Burial or Cremation
DATE OF BURIAL
Jan. 3 61
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop
Mass
Received and filed
. .
(Registrar)
PARENTS
John F. Collins M. D.
(PRINT OR TYPE SIGNATURE)
Dec ... 31
1560
Everett
O.A.A. Records
21
Informant
(Address)
Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: ralph E. Vercanne
astrature of Agent of Board of Health or other)
HO.
Javi 3- 1961
(Official Designation) (Date of Issue of Permit)
X
TRUCTIONS FOR L 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 ne cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
-6-59-92 5686
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Myocardial Infarction
mos
Was autopsy performed?
No
What test confirmed diagnosis ?
Biopsy of Cervix
5 Was disease or injury in any way related to occupation of deceased ? No
If so, specify
"fitur 7
Collina
(Signed)
M. D.
(Address) Revere.,Mas.s., Date ..
(City gr Town)
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEDSingle
or DIVORCEP
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
INTERVAL
BETWEEN
ONSET AND
11 IF STILLBORN, enter that fact here.
(Husband's name in full)
No.
2 FULL NAME Minnie Simmons
(If deceased is a married, widowed or divorced woman, give also maiden name.)
60
19
M R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1.6. THROP. M
JAN = 31961 AM
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
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
No. 321 Princeton St.
E. Boston
St. { give its NAME instead of street and number)
2 FULL NAME
Genieva G. Colson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 11 Prospect Ave
St.
Winthrop. Maes
( Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .... .. years ... 1 months 8
.days. In place of residence 60
.years.
month« ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIE dowed
WIDOWETT
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
WilliamW ....... Colson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ......
.Years ............. Months ............
.. Days
If under 24 hours
Hours .............. Minutes
13 Usual
Occupation :
Housenifo
(Kind of work done during most of working life)
14 Industry
or Business :
Own ..... Homo
15 Social Security No.
None
16 BIRTHPLACE (City)
(State of country)
Masa
17 NAME OF
FATHER
Stephen Grady
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
(Signed) Depla tregame M. D. OF MOTHER Mary A. Glancy
Joseph GREGORIA
...
(PRINT,OR TYPE SIGNATURE)
(Address)
194 Washington Date.
act. 22000
6 Winthrop Cemetery Winthrop Mass
Place of Burial or Cremation
DATE OF BURIAL
October Sty or Town)
60
.19
7 NAME OF
FUNERAL DIRECTOR
O Maley Funeral Home
ADDRESS Winthrop Mass
OCT 2 6 1960
19.
Received and fled .............................................
Charles H. Machine(?)
Che Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OTTT - OF - TOWN To be filed for burial permit with Board of Health
STANDARD
CERTIFICATE OF DEATH
Registered No.
285
[(If death occurred in a hospital or institution.
PHYSICIAN - IMPORTANT
[(Was deceased a U. S. War Veteran, No
(if so specify WAR)
3 DATE OF
October 22. 1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Van.
10℃, to Get, 22
19
60
I last saw halive on
21
60
19.
death is said to
have occurred on the date stated above, at
9:55 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cerebrovascular
accident
Due To
arteriosclerosis
(b)
.......
generalized
Due To
Senility
(c)
........
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
120
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? no. If so, specify ................
PARENTS
21
Informant
(Address)
Winthrop I. Solo Anthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was ffed/with me BEFORE the burial or trapsit permit was issued: Jacqueline Casey
(Signature of Agent of Board of Health or other)-
11159
16-24-E6.
(Official Designation) (Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
Des mot mean e of dying. heart failure. etc. It means e, or compli- which caused
450
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ndition given
Chapter 137. 954. requires ns to print or e cause or of death on tificates, and 48, Acts of uires Physi- print or type ler signature.
1
-59-925686
INTERVAL
BETWEEN
ONSET AND
DEATH
hrs
85
Boston
20 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass
Arthur J
O Haley
'A TRUE COPY ATIV T. Charles H Tracke C. F Strar
OF
TOW
C
-
0
ITH
JAN @21961 AM
PLACE OF DEATH
SUFFOLK (Counts) BOSTON
(('ity or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Az 10631
Registered No.
2 FULL NAME.
John Maynihan
68 BEIRAN ST.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
142.Pleasant .... Street
it'sual place of abode)
St. Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years ..........
months .. 1.O ... days. In place of residence3 ... / ... years ....
months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
26
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That Neattended deceased from
October 2160 .October 26
19 60
Yaast saw hh.Malive on
October 26 1960, death is said to
have occurred on the date stated above, at
3:25 am.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.2.3 ... Years.
.Months ........
.Days
If under 24 hours
Minutes
13 Usual
Occupation :
SALES MAN
(Kind of work done during most of working life)
14 Industry
or Business :
ADV.
15 Social Security No.
NOT KNOWN
CAMBRIDGE.
OTHER
SIGNIFICANT
CONDITIONS
COR PULMONALE
UNK. YEARS
Was autopsy performed?
...
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
M. D.
(Address) ...... Ass't. Dir., Mass. Gen' !. Hosp. Date.
Oct .26 60
6 PATRICKS
Place of Burial or Cremation
DATE OF BURIAL ...
OCT 28
19 64
7 NAME OF
FUNERAL DIRECTOR MAURICE W KIRBY
ADDRESS
WINTHROP
Received and filed
OCT28 1960
19
PARENTS
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
DANIAL MOYNIHAN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
MARY MOYNIHAN OK
20 BIRTHPLACE OF
MOTHER (City)
....
IRELAND
(State or country)
HENRY MOYNIHAN
21
Informant
(Address)
6-BEUCONST WINTHROP
3
I HEREBY CERTIFY that a satisfactory standard certificate of death was ated with me BEFORE the burial or transit permit was issued: Cusack
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