Town of Winthrop : Record of Deaths 1961, Part 20

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 20


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51


20 BIRTIIPLACE OF


MOTHER (City)


White River Jct.


(State or country)


Vermont


21 Informant Fred.A. Baumeister


(Address)


12 Prospect Ave Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate ul death was filed with me IUMFORE the burial or transit permit was issued: Mass. 8 Camere


(Signature of Agent of Board of Health or, other)


1482 4-4-61


(Official Designation)


(Date of Iaque of Permit)


Vi!


R-301A 1


UCTIONS FOR CERTIFICATE


cíving


OF DEATH ot enter than one for each b) and (c)


al dring. heart failure, Is It means . no compli.


. if any, 111 111 10 41 (4). the under- euse last.


eath but not the irrminal adition given


Chapter 117, 024, requires s to print or rausr or death on


C


430.


COM-5-57-920345


| 14 1961


PLACE OF DEATH


3 DATE OF


DEATH


April


2


1961


(Year)


(Month) (1)ay)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) ARTERIOSCLEROTICHEART Di'S.


INTERVAL BETWEEN ONSET AND DEATH 15yrs


Due To GEN ARTERIOSCLEROSIS (b)


20grs


Due To (c) ..


OTHER


SIGNIFICANT


CONDITIONS


RHEUMATOIDARTHRITIS LOUIS


16 BIRTIIPLACE (City)


(State or country)


VERSIONI.


Mass


10a If married, widowed, or divorced


IlUSHAND of


(Give maiden name of wife in full)


(Was deceased a U. S. War Veteran, if so 'specify WAR)


(a) Residence. No. (Usual place of abode)


Length of stay: In place of death years _____ months


CERTIFICATE OF DEATH


Registered No. 03235


6


5


A TRUE COPY ATTESTI


Charles H. Mackie


HECEVED


City Registrar


TOWA


CFF


1 .


ERK


6


-


OP


JUN 1 41961 AM


PLACE OF DEATH


BOSTON (County) MASS


(C'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 91


To be filed for burial permit with Board of Health or its Agent.


Registered No.


CHILDREN'S HOSPITAL MEDICAL CENTERIf death occurred in a hospital or institution. St.7 give its NAME instead of street and number)


HARRIS RUDGIN


2 FULL. NAME ..


(First Name)


(Middle Name)


(Last Name)


( If deceased is a married, widowed or divorced woman, give also maiden name.)


171 SHORE DRIVE, WINTHROP, MASS


St.


( If nonresident, give city of town and State)


Length of stay: In place of death. ..... years ..


.. months.


days. In place of residence ..


4 years 10 months 21 days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATI


APRIL. 7,


196.1


( Month)


(Day)


(Year)


8 SEX


MALE


9 COLOR


WHITE


MARRIED


WIDOWED


or DIVORCED


SINGLE


4 I HEREBY CERTIFY, That I attended deceased from


APRIL .7 ...... , 6.1 ....... .. APRIL ..........


161


....


I last saw hi malive on APRIL 7 61 ...... , death is said to have occurred on the date stated above, at 5:15pm. INTERVAL BETWEEN GNSET AND


DEATHI WAS CAUSED BY : IMMEDIATE CAUSE


(a) SUB ARACHNOID


HEMORRHAGE.


Due lo (b)


INTRACRANIAL METASTASES


Due To


(c)


DISSEMINATED NEUROBLASTOMA.


PEAR


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


YES-


What test confirmed diagnosis?


AUTOPAY.


5 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


4 Silvestro


M. D


PERITONE


( Address)


300LONGWODER THESIGNATUAPRIL 8, 61


Date.


· TIFERBETH ISRAEL OF WINTHROP-EVERETT


Place of Burial or Cremation


(City or Town)


7 NAME OF


FUNERAL DIRECTOR


ARNOLD GOLOU


ADDRESS 1668 BERLINSi BRUJeANIE


Received and Gled ........... !


2


(Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


BOSTON MASS


(State or country)


19 MAIDEN NAME


OF MOTHER


LOUISE BARSKY


20 BIRTHPLACE OF


MOTHER (City)


(State-or country)


BOSTON MASS


HAROLD KOVITZ


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me) BEFORE the burial or transit permit Sugsich conad NJ16244


( Signature of Agent of Board of Health or other) april 9 196/


(Official Designation)


(Date of Issue of Permit)


UCTIONS OR CERTIFICATE


iving F DEATH t enter han one for each b) and (c)


's mot medm of dying. cars failure. tr. It means . or compli- kirk caused


s. i! amy, vr rise to anse (a). he under. use lust.


ions contrib. uth but not the terminal dition given


193.4


C


Chapter (37. 754. lequieres s to print or cause or t death on outu ales, and 48. Arls of ures Physi- print or type er signature.


SDICTION EED BY IL EXAMINEKY 14 1961 028145


PHYSICIAN - IMPORTANT [ (Was deceased a U. S. War Veteran, (if so specify WAR) No


...


10 SINGLE


(write the word)


10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


Il IF STILLBORN, enter that fact here.


12


AGE ..


.....


Years 10 Months 2/ Day:


If under 24 hours


„Hour .......... Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


-


15 Social Security No ..


16 BIRTHPLACE (City)


(State or country)


WINTHROP MAS5


17 NAME OF


FATHER


SIDNEY RUDEIM


DATE OF BURIAL


APRIL


9


196J


21


Informant


(Address)


IL LEWIS TERRACE; WIMTHAOA


-


R-301A 1


No.


(a) Residence. No. (I'suai place of aluxle) N HOSPITAL 5 Hours 20MIns.


'A TRUE COPY ATTEST:


Charles it. Mackie


City Registrar


TO


OF


-1


/ 1:10


1


LEKK


1 .-


6


WINTHROP.


JUN 1 41961 AM


X PLACE OF DEATH


R-301A - Suffolk (County)


Boston (City 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 Agent.


Registered No. 03557


2 FULL NAME .


Mr. Robert W. Haddow


( First Name)


(Middle Name)


(Last Name)


[(W'ss deres.ed a U. S. War Veteran.


{if so specily WAR) No


(Il deceased is a married, widowed or divorced woman, give also maiden name.)


293 Revere Street


St.


Winthrop. Mass.


( If nonresident, give city of town and State)


Length of stay: In place of death.


...


.years


23


months.


.. days.


In place of residence.


years.


months


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATHI


April


11


196 1


(Month)


(l)ay)


(Year)


4I HEREBY CERTIFY ..


March


19


19 61 10


April 11


That


attended deceased


19


I last saw |


im


alive on April 11


19.61


death is said to


have occurred on the date stated above, at 1: 35 A. .m.


(or) WIFE of


(Husband's name in full;


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) INTRAPULMONARY HEMMORKAGE


mı. if amy. - l'ue To (b) CIRRHOSIS OF LIVER.


Due To (c)


OTHER


SIGNIFICANT RENAL SHUTDOWN,


CONDITIONS


3 days


Was autopsy performed? YES.


What test confirmed diagnosis? lwer hopsin, audurasy


S Was disease or injury in any way related to occupation of deceased? If so, specily Ia


(Signed)


Macurail Cont


MAURICE J. ELUVITZ


(PRINT OR TYPE SIGNATURE)


M. D


(Address) NEW ENGI DEACONESS, Die 4/11 1961


6 Verreen Cemetery Erichton


Place of Burial or Cremation


(City of Town)


DATE OF BURIAL


April 13,


EI


19


21 Emily Haddow Kcaleor


Informant


(Address)


35 Bothwell R.C. SNCCon


2 -: tiscate of death


insit permas wca Losund:


(Signature of Agent of Board of Health or other)


A16327


Aprilia, 1941


(Official Designation)


(Date of Issue of Permit)


-


11 IF STILLBORN, enter that fact here.


12


36


If under 24 hours


AGE


Years.


MonthE ... mmm ... Daya


13 Usual


Occupation:


Service Dent.


14 Industry


or Business :


oil Burner


15 Social Security No. ....


028-12-2200


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Wilson Haddou-


18 BIRTHPLACE OF


Scotland


FATHER (City)


(State or country)


19. MAIDEN NAME


OF MOTHER


Emily Skugin


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Latvia


1


7 NAME OF


FUNERAL DIRECTOR


Bernard S. NcNamara


ADDRESS


110 washington St. Brighton


APR 1+ 1961 19.


(Registrar)


928145


1 14 1961


JURISDICTION WAIVED


No.


New England Deaconess Hospital


f(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number) ...


PHYSICIAN - IMPORTANT


RUCTIONS FOR CERTIFICATE


giving OF DEATH ul enter than one for cach (b) and (c)


ies Mot meJn of dying, heart failure. ti. It means , or compli- which caused


ove rise to rouse (a). the under- cause last.


liomi contrib. roth but mot the terminal ndition given


581


Chapter 137. 1954. requires Đọ từ príng P cause or of death on rt Fiates. and


PARENTS


10a If married, widowed, or divorced


HUSBAND of


an


(Give maiden name of wife la full)


IKIERVAL BETWEEN ONSET AND DEATH 2 hours


- 1yr.


8 SEX


Nale


9 COLOR


white


10 SINGLE. - ( write the word)


MARRIPI .. .


WIDOWED


of DIVORCED


(a) Residence, No ( l'anal plaer of abode)


5


Received and fed


de. signature. 1, C.


HEREBY CERTIFYthe Sjed with me BEF Jefe Digory Standard


Boston


(Kind of work done during most of working like)


'A TRUE COPY ATTEST?


Charles it mackie


City Registrac


TOM


,i= ()


7: 12. 1


3 LERK


1


0


8


WINTHROP MA


JUN 1 41961 AM


X PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


The Commonwealth of Mannachusetts 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. 03813


Registered No.


[(If death occurred in a hospital or institution.


St. { give its NAME instead of street and number)


2 FULL NAME


Jennie Gruszecki


(First Name)


(Middle Name)


(Last Name)


(if so specify WAR)


(11 deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. 142. Pleasant Street (l'sual place of abode)


............


St.


Winthrop, .... Massachusetts.


(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


April


18


1961


(Year)


(Month)


(Day)


That we attended deceased from


19 ... 6.1


WE last saw Her.alive on ..... April ... 18. 19 ..... 6.1 death is said to have occurred on the date stated above, at 3:30 pm. INTERVAL BETWEEN


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) OBSTRUctive Emphysema


Due To


(b) Acute TRAcheo Bronchitis


Due To PURutENT. (Staph . )


(c)


OT11 F.R


SIGNIFICANT


CONDITIONS


Was autopsy performed?


yes


What test confirmed diagnosis?


Autopsy


S Was disease or injury in any way related to occupation of deceased? If so, specily


(Signed)


M. D


Charles.L .. Clay,. M. D.


(PRINT OR TYPE SIGNATURE) April 18 61


(Address) Ass't. Dir., Mass. Gon'l. Hocp. Date.


St. Michael's - Bal 6 Place of Burial or Cremation (City or Town) abril - 22 DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


7 H Pochard! Cambri De Mars.


ADDRESS


APR 26 1967


-mar


(Registrar)


PARENTS


16 BIRTHPLACE (Citli (State or country)


NAME OF FATHER


Kulcan 0


18 BIRTHPLACE


FATHER (City


(State or country)


Polan?


19 MAIDEN NAME OF MOTHER Lathering Banyak


BIRTHPLACE Prieten


(State or country)


MOTHER (


21 Informant


Eder. Gruszechi - S (Address) Jose Check


I HEREBY CERTIFY that a satisfactory standard chilicase of death wu fled with me BEFORE the burial or transi: pernht wn imued:


--


-


(Signature of Agent of Board of Health or other)


1725


4-20-61


(Official Designation)


----


(Date of Issue of Permit)


X


dois


10a Il married, widowed, or divorced HUSBAND of


(GivOmtiden name of wife in full)


(or) WIFE of


(Hr and's name in f. ))


11 IF STILLBORN, enter that fact here.


12


63


Years.


Months ......... Days


If under 24 hours


Hours


... Minutes


13 Usual


Occupation:


(Kind of work done during most Of Working with


14 Industry


or Business :


15 Social Security No.


2


Chapter 137. 1954, requires ns to print or e cause or of death on rtifcates, and 48, Aets of quires Physi- print or :ype der signature.


directen se only N 16 196


R-301A 1


UCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each b) and (e)


es mot meGN of dying. røri failure. Ir. It means , or compli- hich caused


wr. if eny. ave rise to amse (€). the under- anse last.


lions contrib. rath but not the terminal adition given


1928145


No.


MASSACHUSETTS GENERAL HOSPITAL


PHYSICIAN - IMPORTANT


[ ( Was deceased a { U. S. War Veteran.


SEX


Hende


9 COLOR


Colite


10 SIE CLE


(write the word)


41 HEREBY CERTIFY,


April ..... 11.


., 19 ...


61 to April 18


HOURS 9 days


'A TRUE COPY ATTEST: Charis it Mackie City Registrar


R-30.A


PLACE OF DEATH


Suffolk


(County)


Boston


(City or Town) ..... ......


The Commonwealth of Cansarhusetia 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 Agent. 03856


Registered No.


f(If death occurred in a hospital or institution,


( give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


Raleigh


Calvin


BROWN


(( Was deceased U. S. War Veteran,


(if so specify WAR)


WII


(It deceased is a married, widowed or divorced woman, give also maiden name.)


120. Croot Avo.


Winthrop, Mass.


Length ot stay: In place of deathG. years. O .. months ... ... days. In place of residence. 3 .. years


... months ........ .. days


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Malo


9 COLOR


Whito


10 SINGLE


MARRIED


(write the word) Married or DIVORCED


10a If married, widowed, or-diyorced


HUSBAND of


Alma


(Give maiden name of wife In full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


63


11


... Years


.Months


24 Days


Minutes


13 Usual


Occupation :


monitor


(Kind of work done during most of working life!


14 Industry


or Business :


Logan Airport, Boston, Mass.


15 Social Security No. ......


Cesar


16 BIRTHPLACE (City)


(State or country)


Illinois


17 NAME OF


FATHER


Elonzo


Elenco Proim


18 BIRTHPLACE OF


FATHER (City)


Casoy


M. D


(State or country)


Illinois


19 MAIDEN NAME


OF MOTHER


Docia can not be learne


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Illinois


Informuant 21 V. A. Hospital records, 150 S. (Address) Huntington Jm Ponten, Maca


I HEREBY CERTIFY that a satisfactory standard certificate of death was bled with me BEFORE the burial or transit permit was asked: NO mcnamara


ADDRESS APR 25 1961 G.CO.


Receiver and hled


Charles It Machen


(Registrar)


PARENTS


Cambridge Com., Cambridge, Mass.


6 Place of Burial or Cremation (City or Town)


DATE OF BURIAL


April 24


67


19


7 NAME OF


FUNERAL DIRECTOR


A. E. Long & Son


1979 Massachusetts Ave .. Cambridge,


14 1961 ....


928145


INTERVAL BETWEEN ONSET AND DEATH 2 yra


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Carcinoma of the lung with


(a)


motastadio-to-the-brain.


....


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


N.o


What test confirmed diagnosis?


Clinical & Lab Finding


S Was disease or Injury in any way related to occupation of deceased? If so, specify


John S. Letelton MD


(Signed)


John.S .Ilton (PRINT OR TYPE SIGNATURE)


(Address) VAR, Boston, Macs . Due Apr. 21 19 67


67


19 ...


C death is said to


have occurred on the date stated abr,ve, at


.... m.


3 DATE OF


DEATH


Apr ..


20


1961


(Month)


(Day)


NA (Year)


That Iattended deceased from


4 1 HEREBY CERTIFY,


.Apr ...... 20


19.


.61


20


., to ..


( First Name)


(Middle Name)


(Last Name)


JCTIONS OR CERTIFICATE


iving OF DEATH t enter han one for each b) and (c)


of dying, cart failure. sc/ 10 means or ror pli. kich oused


-


0 s. if any, ve rise to ause («), he under- last.


ions contrib- cath but mot the terminal dition given


.C .


Chapter 137, 1954. requires ns to print or e cause or of death on tificates, and 48. Acts of quires Physi- print or type der signature. diçal minor clines risdioti


No.


Veterans Administration Hospital


(a) Residence. No.


( Usual place of abode)


(If nonresident, give city or towr and State)


(Siumnature of Agent of Board of Health or other)


1755


4-21-61


(Official Designation) (Date of Issue of Permit)


v.B.


If under 24 hours


A TRUE COPY ATTEST: Charles it mackie City Registrar


TOW


OF


11 12. 1


OFFICE


NIN


CLERK


Co


...


WIN


6


HRO


JUN 1 41961 AM


R-301A


PLACE OF DEATH


Suffolk (County)


Boston


....


(('ity or Town)


The Commonwealth of Cancerqunetto JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


OF - TOWN To be filed for burial permit with Board of Health or its Agent.


Registered No. 03910


[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


(First Name)


(Middle Name) (Last Name)


( If decraved is a married, widowed or divorced woman, give also maiden name.)



4 Linden


.St. Winthrop, Mass.


1.enxth of stay In place of death years ..... ...... months 16lays. In place of residence .. 70


.years


.. months ..


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


April


20


1961


(Month)


(1)ay)


(Year)


41 HEREBY CERTIFY , ThatVE attended deceased from


19.61


April .... 4


19.61 . .. April 20


XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX .. , death is said to


have occurred on the date stated above, at


4 .: 25.P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


1. Bronchopneumonia


INTERVAL BETWEEN ONSET AND DEATH daya


(b)


12. Congestive heart failure


days


Due To (1)


OTHER


SIGNIFICANT


Ancmia


unk


CONDITIONS


Was autopsy performed?


.No


What test confirmed diagnosis?


Clinical & Lab Finding;


(Signed)


Robert t Surlar


Robert K. Savpla


(PRINT OR TYPE SIGNATURE)


(Address) VAH Boston, Mass.


April 20 1961


6 ..


Winthrop Cem., Winthrop Mass.


l'lace ní Burial or Cremation


(City or Town)


DATE OF BURIAL April 24 61


19


7 NAME OF


FUNERAL DIRECTOR


Arthur O'Maley


79 Atlantic Streot


ADDRESS Winthrop, .... Lass.


Received any filed APR 2 5 1961 Charlesit Mackie.


(Registrar)


PARENTS


17 NAME OF FATHER William B


18 BIRTHPLACE OF


FATHER (City)


Boston


(State or country) Massachusetts


19 MAIDEN NAME


OF MOTHER


Johanna Ready


20 BIRTHPLACE OF MOTHER (City) (State or country)


21 VA Hospital Records, 150 South


Informant (Address) Huntington Avo., Posto Praca


I HEREBY CERTIFY that a satisfactory standard certificate of death Wasfiled with me ALITIS the budebuy - west:


(Signature of Agent of Board of Health or other)


916556


4/23/66 .........


(Official Designation)


(Date of Issue of permit)


UCTIONS OR CERTIFICATE giving OF DEATH t enter han one for each b) and (c)


's not mean dying. earn failure. in cumpli. caused


&. if any, ur rise to usse (a). kr under. tuJe last.


joms contrib- ath but not the terminal dition given


Chapter 137. 954. requires s to print or cause or of death on tificstes, and 48, Acts of uires Physi- print or type er signature. C.


14 1961


28145


101


CERTIFICATE OF DEATH


No.


Veterans Administration Hospital


RAYMOND J. KENNEY


[( Was deceased a U. S. War Veteran. [if so specify WAR)


(write the word)


8 SEX


Malo


9 COLOR


Whito


10 SINGLE


MARRIED


WIDOWEJidomed


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name la full)


11 IF STILLBORN, enter that fact here.


12


AGE .... 7.0 Years


5.Months


10Days


If under 24 hours


Hours ............. Minutes


13 Usual


Occupation :


Machinist


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


Newbury port


16 BIRTHPLACE (City)


(State or country)


Massachusetts


5 Was disease or injury in any way related to occupation If so, specify


do deceased?


OUT.


.. .


(a) Residence. Nu. ( ['sual place of abode)


(If nonresident, give city of town and State)


A TRUE COPY ATTEST:


Charles A Mackie City Registrar. ECE VED


TOW


LERK


1


6


JUN 1 41961 AM


R-301A 1


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 CERTIFICATE OF DEATH


OUT- OF - TOWN To be filed for burial permit with Board of Health 15972


Registered No.


No.


MASSACHUSETTS.GENERAL.HOSPITAL


Nora Rawston


2 FULL NAME


(First Name)


(Middle Name)


(Last Name)


lif wo sperify WAR)


NO


(a) Residence. No.


( l'sual place of abode)


Length of stay. In place of death


years


months


1 Q.days. In place al residence


25


.. years


month ...


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


April 23, 1961


DEATII


(Month)


(D)av)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


Apr.


13


61


'Apr. 23


.....


19


we last saw er alive on Apr. 23


61


19


death is said to


(Give maiden name of wile in full)


have occurred on the date stated above, at


7:00A.m.


INTERVAL DETWEEN ONCET AND


11 IF STILLBORN, enter that fact here.


24 H


LAGE60


Years .....


Months.


.. Day?


If under 24 hours


... Hours ........... Minutes


Due To


(b) Cerebral ombolus


Due To Myocardial infarction and


(c)


mural thrombus, It. vent


10 daly's Industry


or Business:


U.S. Service Store


15 Social Security No.


1.5-16-9572


Fall River


What test confirmed diagnosis?


autopsy


S Was disease or injury in any way related to occupation of deceased? If so, specily .


(Signed)


@hClay


M. D


Charles L ... Clay,.J. D.


(PRINT OR TYPE SIGNATURE)


(Address) Ass't. Die., Mass. Gen' Hosp. Date Apr. 23. 61


Winthrop .... Cemetery Winthrop


6


l'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 26


19.61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


ADDRESS Winthrop Mass


Received and filed


19


(Registrar)


PARENTS


17 NAME OF


FATHER


Austin Tierney


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Annie Maloney


20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland


21


Robert Rauston


Informant


(Address)


459 Winthrop St., Wintbrer


I HEREBY CERTIFY that a satisfactory standard certificate of death way filed with me BEFORE the burial or transit permit was issued: Jane


(Signature of Agent of Board of Health or other)


1 796


4-25-61


(Official Designation)


(Date of Issue of Permit)


ICTIONS OR CERTIFICATE


iving F DEATH t enter han one for each b) and (c)


's not mean of dying, cars failure. tr. It meani or compli. hick caused


s, if any, ve rise io ause (a). he wasder. use last.


ions contrib. ath but not the terminal dition given


Chapter 137, 954. requires ns to print or cause or of death on tihcates, and 48. Acts of utres Physi- print or type er signature. n. a. irector e only 174 1961 928145


11 } K


FKTIFY


That we attended deceased


19


10a Il married, widowed, or divorced


HUSBAND of


(or) WIFE ol


Robert Rawston


(Ilusband's name in lull)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Infarction, It. cerebral hemisDEATH


pho re-


24 hrby Usual


Occupation :


Clerk


(Kind of work done during most of working life)


OTIIER


SIGNIFICANT


CONDITIONS


16 BIRTHPLACE (City)


(State or country)


Mass


Was autopsy perfnrmed?


Yes


S(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. ..


(1( deceased is a married, widowed or divorced woman, give also maiden name.) 457 Winthrop St. Winthrop, Mass.


(If nonresident, give city of town and State)


TRUE COPY ATTESTI Charles it. mackie City Registrar


RECEIVED


OF


TOWA


OFFi.


N !!


LERK


.


6


WINTHROR


JUN 1 41961 AM


X


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


The Commonwealth of flassarhusrits 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 Agent. 103


041017


No. MASSACHUSETTS GENERAL. HOSPITAL William John Mac Queen First Name) (Middle Name) ( Last Name)


[(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number) PHYSICIAN - IMPORTANT [ ( Was deceased a {U. S. War Veteran. (if so specify WAR) ....


( If deceased is a married, widowed or divorced woman, give also maiden name. )


31 Charles Street


Winthrop, Massachusetts SI


(a) Residence. No.


( l'sual place of abode)


( If nonresident, give city of town and State)


Length of stay:


In place of death.


years.


months


1 1days. In place of residence


40


ears.


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


April


26


1961


(Month)


(Day)


(Year)


April 15 19.


CERTIF


61


to. ..


19


HUSBAND) of ...


Joyce Helena Baker


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILL BORN, enter that fact here.


AGE.


.7.8Years ...


3 Months 13 Days


If under 24 hour.


Ilours


Minut


Due To


(Thrombophlebitis, leg veins


Due To (c)


OTHER


SIGNIFICANHypertensive heart disease


CONDITIONSCerebral infarcts


Was autopsy performed?


yes


What test confirmed diagnosis? .. autopsy ..


S Was disease or Injury in any way related to occupation of deceased?


If so, specify


(Signed)


Charles L. Clay. L.D.


( PRINT OR TYPE SIGNATURE)


(Address) Aus's Dir, Mass Gon' Hosp. Date April 26 61


Winthrop Cemetery Winthrop, Mass 6


Place of Burial or Cremation (City of Town)


DATE OF BURIAL April 29,1961


7 NAME OF FUNERAL DIRECTOR Ciefred 13.Mars


ADDRESS


174 Winthrop St. Winthrop


MAY 2 1961 4.19


Charles & Mach


( Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Whycocomah


M. D


(State or country)


Nova Scocia


19 MAIDEN NAME


OF MOTHER


Sarah Maclean


20 BIRTHPLACE OF


Whycocomah


MOTHER (City)


(State or country)


Nova Scocia


Mrs ...


John W MacQueen


Informant


(Address)


31 Charles St. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was bled with me BEFORE the burial or transit permit was loved


Mass.


Drmchamada


(Signature of Agent of Board of Health or other)


1854


4-28-41


(Official Designation)


(Date of Issue of Permit)


4.13


R-301A 1


CTIONS


ERTIFICATE


ving P DEATH enter an one or each ) and (c)


not mean of dying. art failure. . It means or compli- ich caused


. if any, e rise to


-


e under- ue last.


-


as contrib- tà but not he terminal ition riven




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