USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 21
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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
463
Chapter 137. 54. requires s to print or cause or death on ifcotes, and 18, Acts of ures Physi- rint or type r signature.
Nchen only link. 1 16 1961
8 SEX
Male
9 COLOR
White
10 SINGLE ( wate the word)
MARRIED Married
WIDOWED
or DIVORCED
HEREI
..... wt last aaw h .. ilive on April 26 19. 61, death is said to have occurred on the date stated above, at 5:27am. INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Pulmonary ...... mbol1
2 weeks Usual Occupation : retired carpenter-contractor (Kind of work done during most of working life)
14 Industry
or Business :
self employed
15 Social Security No. .........
- 20 - 0728
Why cocomah
16 BIRTIIPLACE (City)
(State or country)
Nova Scocia
17 NAME OF FATHER Angus MacQueen
5 years
Aprzy offended deceased
6Y
10a If married, widows
Registered No.
2 FULL NAME
A TRUE COPY. ATTEST Charles it Mackie City Registrar
X
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 permis, with Board of Health 01 or its Agent.
04106
Registered No.
f(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 ( specify WARD
2 FULL NAME
Silvio Calla
( First Name )
( Middle Name)
( last Name)
(If deceased is a married, widowed or divorced woman, xive alsa maiden name.)
No 1
(a) Residence. No. .70 Banks
St
Winthrop, Massachusetts
(L'sual place of abode)
( 1! nonresident, give city of town and State)
Length of stay : In place of death .. ... . years .. ... ... months
days. In place nf residence .
years ...
months
days
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
w
10 SINGLE
MARRIED
WINXWED MARRIED
or DIVORCED
( write the word)
3 DATE OF
DEATH
April
27.
1961
(Month)
(Day)
(Year)
4I HEREBY CERTIFY.
Apr1127
19.
61
April
27
61
Toast saw h.imalive onApril
27.
19 ... 6.1, death is said to
have occurred on the date stated above, at 3:50 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
10a If married, widowed, or divorced
HUSBAND of
ConceTTA
GRASSO
(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
O
.. Years.
.Months
3
Davs
If under 24 hours
Hours
Minutes
Due of ascending aortic arch
(b)
with attempted operative
Due To repair (c)
Aortic ..... valvular
Was autopsy performed?
NO.
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Chiclay
M. D
Chorins L. Clay, M. D.
(PRINT OR TYPE SIGNATURE)
(Address)
Asc't. Dir., Mass. Con'l. Hosp.Dale
4-27 ..... 161
6
HOLY CROSS
MALJEN
Place of Vurial or Cremation
(City or Town)
DATE OF BURIAL
MAY 1ST
1961
7 NAME OF
FUNERAL DIRECTOR
RICHARD C KIRBY INC
ADDRESS
017 BENNINGTON ST E. BOSTON
Charles
MAY 2 1961 TI tracke
( Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
AteLINe CENSULLA
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
ITALY
21
Informant
(Address)
70 BANKS ST WINTHROP
MRS. CONCETTA CALLA (WIFE)
I HEREBY CERTIFY that a satisfactory standard certificate of death was fied with me BEFORE, the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
1852
4-28-41
(Official Designation)
(Date of Issue of Permit)
CTIONS
ERTIFICATE
ving F DEATH enter an one or each ) and (c)
not mean of dying. art failure. c. It means or compli- ich caused
. if any, e rise to use (a). ce under- we kast.
ous contrib- ath but not he terminal lition given +5%.
Chapter 37. 54. requires s to print or cause or'. death on ificates, and 8. Acts of wires Phyai- rint or type r signature.
irector 1. only Ink. 11 .16 19611 -8145
PLACE OF DEATH
R-301A 1
OTHER
SIGNIFICANT
CONDITIONS
insufficiency
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
BOSTON NAVY YARD
15 Social Security No.
070-05-2016
16 BIRTIIPLACE (City)
(State or country)
MASS
E. BOSTONi
17 NAME OF
FATHER
NICODEMO CALLA
14 hrsy Usual
SHEET METAL WORKER
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Dissecting .... aneurysm
That Yeattended deceased
19
to ..
Massachusetts General Hospital BAKER MEMORIAL
No.
A TRUE COPY ATTESTA Charles H. Mackie City Registrar
395 R-301A
-
(County) BOSTON
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
01087 105 To be filed for burial permit with Board of Health or its Agent
f(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number) PHYSICIAN - IMPORTANT
[ ( Was deceased a
{[' S. War Veteran.
( 1.ast Nanic)
[if so specify WAR)
W.W.IL
( If dleceased is a married, wislowed ur divorced woman, give also mailen name.)
25 Underhill Street, Winthrop
(a) Residence. No. ( U'smal place of abode)
1.ength of stay In place of death 0 years 0 months 2 days. In place of residence. years ..
(If nonresident, give city or town and State) 3
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word )
MARRIED
WHOWEIMARRIED
or DIVORCED
10a If married,
HUSBAND of
COSTELTHE RUTLEDGE
(Give maiden name ol wife in lull)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGES.Z ._. Years
..... Months.
.. Days
!! under 24 hours
Hours
.Minutes
13 Usual
Occupation :
WAITER
(Kind of work done during most of working life)
14 Industry
or Business :
ESSEX TUD Shop INC.
15 Social Security No.
......
017-05-1840
BOSTON
16 BIRTHPLACE (City)
(State or country)
$1.55
17 NAME OF
FATHER
VINCENT FALLON
:8 BIRTHPLACE OF
FATHER (City)
BOSTON
(State of country)
MASS.
19 MAIDEN NAME
OF MOTHER
JULIA DELAHANTY
20 BIRTHPLACE OF
MOTIIER. (City)
(State of country)
MASS
(Address) 20 Unda LeiPSI the Torch
HEREBY CERTIFY that isfiled with me BEFORE of transit Permit-was issued:
satisfactory standard certificate of death Edward Callela
(Signature of Agent of Board of Health of ther)
A16689
April 28, 1961
(Official Designation)
(Dates Issue of Permit)
Y -
3 DATE OF
DEATH
April
27
1961
(Month)
(Day)
(Year)
4f HEREBY
CERTIF
61
pr11 25
19 ...
{ last saw h.lmlive on .
April 27
19.
death is said to
.61
have occurred on the date stated above, at ....
1:00 am
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Septicemia
Due lo
(b)
Pulmonary Abscess
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Yes
What trat confirmed dingnemis?
5 Was disease or injury in any way related to occupation of deceased?
II so, specify
(Signed)
Bemong Stad
M. D
Benson S. Charif, M.D.
(PRINT OR ,TYPE SIGNATURE)
(Address) 249 River St., . Date:
April 28.61
Dole Gross
Malden
Place of Burial or Cremation
(City or Tawn)
( DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
John T. White
ADDRESS /85 J andon THE Boston
Received and filed MAY - 1961 crc Nt Inache ( Registrar)
BOSTON SANATORIUM
No.
2 FULL NAME
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one Ior each b) and (c)
es wat mcan of dying, heart failure. tr. It means . or compli- A, h caused
ms. if amy. are rise to aus (a). the under- ause last.
liens contrib- rath but mat the terminal adition given
52%.
Chapter 137. 1954 requires
ie cause or of death on ruhcates, and 48. Acıs of queres Physi print or type der signature.
on
30 1961
528145
PLACE OF DEATH
SUFFOLK
WALTER E. FALLON
( First Nanie)
( Middle Name)
St.
months.
Registered No.
PARENTS
BOSTON
May 61 21 Informant
INTERVAL BETWEEN ONSET AND
April 27
That
I guyended deceased from
61
10
C
Ot Ropear
X PLACE OF DEATH
Suffolk (County)
E. 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 - TOW To be filed for burial permit with Board of Health or ita Agent. 04209
Registered No.
Princeton-Shelby Nursing Home No.
St . f(If death occurred in a hospital or institution. St. } give its NAME instead of street and number)
2 FULL NAME Mary Ann Davy ( First Name) (Middle Name) ( Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
140 River Road
.St.
Winthrop, Massachusetts
( If nonresident, give city or town and State)
Length of stay: In place of death
years
1
.months .. 21.days. In place of residence
52. years ..
months. .
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
29
19.61
(Month)
(Day)
(Year)
8 SEX
female
9 COLOR
white
10 SINGLE
( write the word )
widowed
MARRIED
WIDOWED
or DIVORCED
4I HEREBY CERTIFY, That I attended deceased from
APRIL 26
1954
APRIL 29
1961
I last saw }
has .. alive on
APRIL 28, 1961, death is said to
have occurred on the date stated above, at 1:55 Am.
INTERVAL BETWEEN ONSET AND
DEATH
Due To
(5)
ARTERIOSCLEROSIS
7YEARS
10 YEARS
7 years
IS Social Security No.
none
East ..... Boston
Was autopsy performed?
Na
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
No
(Signed)
Warsely Chaney appplatone
M. D
DOROTHY CHENEY APPLETON
(PRINT OR TYPE SIGNATURE)
(Address) 197 Woodside QUE B315 APRIL 29 1961
6
Winthrop Cemetery, Winthrop, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
May 1,2961
7 NAME OF
FUNERAL DIRECTOR
Defect 13. Mars
ADDRESS
174 Winthrop St. Winthrop, Mass,
Received und filed
MAY ....
3. 1961
ulas 4 tracks
(Registrar)
. PARENTS
17 NAME OF
FATHER
Mark Evans
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
unable to obtain
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lowell
Massachusetts
21 Mrs. Fred .H. Ererbeck
Informant
(Address)
140 River Road, Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Jacqueline Dorato
(Signature of Agent of Board of Health or other)
1887
5 1.61
(Official Designation)
(Date of Issue of Permit)
CTIONS R ERTIFICATE
ving P DEATH enter an one or each ) and (c)
of dying. wt failure,
e rise to use
(c), e under- use last.
as contrib- tth but mot he terminal ition riven
26.
Chapter 137, 54. requires 1 to print or cause or death on ificatea, and 48. Acts of uirea Physi- rint or type er signature. C .
| 16 196 28145
R-301A -
-
OTHER
SIGNIFICANT
CONDITIONS
DIABETES MELLITUS
11 IF STILLBORN, enter that fact here.
12
AGE
8.7Years
4
Months.
1.5 Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
housewife
14 Industry
or Business :
own .... home
(Kind of work done during most of working hfe)
Due To
(c)
HYPERTENSION
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles William Davy
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) GENERALIZED ARTERIOSCLEROSIS
(a) Residence, No. ( l'sual place of abode)
PHYSICIAN -- IMPORTANT f ( Was deceased a . U. S. War Veteran.
[if so specify WAR) NO.
16 BIRTHPLACE (City)
(State or country)
Massachusetts
or compli- ich caused
A TRUE COPY ATTESTI Criarles it Mackie City Re istrar
PLACE OF DEATH
Suffolk
(County)
Bostan
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
1.07
To be filed for burial permit with Board of Health or its Agent.
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME JOHN A. FLYNN ( First Name) (Middle Name) (Last Name)
( If deceased is a married. widowed or divorced woman, give also maiden name.)
70 Waldemar Avenue
x
x Winthrop, Mass.
(If nonresident, give city of town and State)
Length of stay: In place of death . years ... .... .months 27
days. In place of residence
1 if gears.
... months .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
29
1961
(Month)
(Day)
(Year)
That VAttended deceased from
61
nave occurred on the date stated above, at 8:00 Pm. INTERVAL BETWEEN OHSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Carcinoma of the lung with
and hrain metastas se
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis? Clinical & Laboratory
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
60
tomas
HARVES L. FRITZ
(PRINT OR TYPE SIGNATURE)
(Address)
VAH Boston, Lass. Date.April 29 1961
6 Holy Cross
Maldon
l'lace of Burial or Cremation
(Clty or Town)
DATE OF BURIAL May 2 19.61
7 NAME OF FUNERAL DIRECTOR Arthur J. O!Maley ... 79 Atlantio Street Winthrop, Mass.
ADDRESS
Franked and filed MAY 1 1961
.19 France , H track
( Heristrar )
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWER Arri od
or DIVORCED
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
2
AGE ... 62 ... Years .......
4 Months 25 Days
If under 24 hours
.. Hours ...
Minutes
13 Usual
Occupation :
Watohman
(Kind of work done during most of working hfe)
14 Industry
or Business :
Fish .... Pier
15 Social Security No.
013-01-7991
East Boston
16 BIRTHPLACE (City)
(State or country)
Massachusetts
PARENTS
17 NAME OF
FATHER
William J. FLYNN
18 BIRTHPLACE OF
FATHER (City)
Bostan
M. D.
(State or country)
Massachusetts
19 MAIDEN NAME OF MOTHER Mary E. Fulham
20 BIRTHPLACE OF MOTHER (City) Bosta, (State or country) Massachusetts
21
Informant
(Address)
Huntington Ave., Boston, wass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit perm.( was Lmued. parcel y In' Hemato (Signature of Agent of Board of Health or other)
1905 5 /a /ti
(Official Designation) (Date of laque of l'ermit)
1
VB
-- --
dors mat meam de of dying. heart failure. etc. It means se, or compli- which caused
ions, if amy. gave rise to (ouse (a). the under- cause last.
ditions contrib- droth but not o the terminal condition given
163
. Charter 137. ( 1954. requires ans lo print of the cause of of death on ertifica!es and r 48. Acts of equires Physi o print or type nder signature
,C .
30 1961
0928145
M R-301A -
TRUCTIONS FOR L CERTIFICATE
(a) Residence. No. ( l'sual place of abode )
No.
Veterans Administration Hospital
Registered No.
[{ Was deceased a U. S. War Veteran. {if so specify WAR) WWI
(write the word)
4 I HEREBY CERTIFY.
April 2
19.
April 29
19
10% If married, widar & diverseTurgeon
HUSBAND of
---
VA Hospital Records, 150 South
Riving OF DEATH not enter than one e for each (b) and (c)
A TRUE GUYS ATTESTS
Charis it mackie City Registran Lite :
X PLACE OF DEATH
SUFFOLK
Suffolk (County)
R-301A 1 BOSTON
Boston ('ity or Town)
. The Commonwealth nt fdansarquartis JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permita with Board of Health rtils 04320
Registered No.
[(11 death occurred in a hospital or institution, St. ) give us NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Jean Britcher
(Forrest)
( Fint Name )
( Middle Name )
(last Name)
( II deceased is a married, widowed or divorced woman, give also maiden name )
46 Nevada Street
St.
Winthrop, Massachusetts
(a) Residence. No. ( l'sual place of abode )
( 11 nonresident, xive city or town and State)
Length of stay. In place of death
years.
months
days. In place of residence
6
year-
months
days
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Harrand
DEATH
(Month)
(1)ay)
(Year)
HEREBY
CERTIF
61
May
"2
to.
Wy last saw h @ live on
May
2
19 61, death is said to
9:258
have occurred on the date stated above, at
.. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
uremia
(.)
Due To
(b)
Dialretic nephropathy
Due To
(c)
Diabetesmellitus
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
.yes
What test confirmed diagnosis?
autopsy.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D
Charles Lo Clay. M. D.
(PRINT OR TYPE SIGNATURE)
(Address) Ass's .. Diz., Moas .. Gan'l. Hesp ... Date.
May 2 .1061
6
Woodlawn
Place of Burial or Cremation
(Clty or Town)
DATE OF BURIAL
May 5
61
7 NAME OF
FUNERAL DIRECTOR
Mabel G. Curnane
505 Broadway, Everett, Mass.
ADDRESS
Received and filed MAY 8 1961 19 16 1901 Charles H Inachina
PARENTS
Scotland
19 MAIDEN NAME
OF MOTHER
Cafe. Ross
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
21 Rey mond Britcher
Informant
(Address)
46 Nevada St, Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death watfiled with, me BEFORE the burial or transit permit was iwurd .
(Signature ol Agent of Board of Health or giber ),
1957
5-4-61
(Official'Designation)
(Date of Issue ol Permit)
-
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name ol wife in luif)
(or) WIFE of
Raymond Britchar
(Husband's name in full)
II IF STII.I.BORN, enter that fact here.
12
AG: 37
Years ....
.Months
Days
Co-owner
13 Usual
Occupation :
........
(Kind of work done during most of working life)
14 Industry
or Business :
029-30-8629
15 Social Security No.
Montreal
16 BIRTHPLACE (City)
(State or country)
Canađa
17 NAME OF
FATHER
John Forrast
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Pat Shop
11 under 24 horas
.Hours
Minute.
20 YAS
32yrs
19
....
attended deceased
61
April 19 ..
of dying.
if any, rise to se (a). under- last.
si contrib- th but not · serminel sion given
60.
hapter 137. ;4. requires to print or csuse or death on Scates, and B. Acts of res Physi- int or type signature.
only
145
TIONS 1
RTIFICATE
ing DEATH enter n one r esch and (c)
Il means or compli.
-
INTERVAL
BETWEEN
OHSET AND
DEATH
2 yrs
3 DATE OF
May
2
1961
It Was deceased a 1'S War Veteran (if so pretty WAR)
No.
MASSACHUSETTS GENERAL HOSPITAL
Everett
..
9 IKLE COPY ATTESTI
M R-302 1
X PLACE OF DEATH
Ess.cx
(County)
Lynn
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lynn
(City or Town making this return)
Registered No.
109
"(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Mary Ciampa
(Powers)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...... 13Paine
(Usual place of abode)
Length of stay: In place of death .... ears ... .months.6
...... days. In place of residence.4 ..... years ....
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of ...
Frank Ciampa
"(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE .. r .... Years ..?...
Months ....... 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 ..
16 BIRTHPLACE (City).
East Boston
(State or country)
wasS.
17 NAME OF
FATHER
Willian Powers
18 BIRTHPLACE OF
FATHER (City)
Alexandria
(State or country)
Virginia
19 MAIDEN NAME
OF MOTHER
Georgianna Morton
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
New York
Frank Ciampa
41 Paine et
Winthrop
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed. 19
PARENTS
(Signed)
Clarence London
M. D.
(Address)
Lynnview Hosp.
Date.
June 2/67
Winthrop Cem.
6
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
June 5,
61
19
.....
21
Informant
(Address)
A TRUE COPY Albut YHilyen ATTEST
( Registrar of City or Town whele death occurred)
DATE FILED
June 6/61
19
X
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
I 1 (c) 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 Due To
16 1961
(Registrar of City or Town where deceased resided)
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinomatosis, general-
ized
Due To
(b)
Carcinoma of endometrium
1 yr.
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased ?....... If so, specify.
25M-8-56-918227
3 DATE OF
DEATH
June 1, 1961
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
to .......
June I
on
61
er June 1 ..... 67death is said to
have occurred on the date stated above, at
4:45 pm
(Was deceased a
U. S. War Veteranmo
if so specify WAR
St.
Winthrop
Lass.
(If nonresident, give city or town and State)
No ..... Lynnview Hospital
-RECEPTOR CITY GEERKOC ++ FIGE
JUN 9 9 45 AN '61 V
LYNH. HASS.
RECEIVED
OF TOWA
11 12. 1
OFF !!
/12
CLERK
8
R
JUN 1 61961 AM
R-301A 1
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
Registered No.
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) No. 12 Lewis TERRAchi
2 FULL NAME
George
GOLDSTEIN
AKA GOULD
[(Was deceased a
¿ U. S. War Veteran,
{if so specify WAR)
WWI
(If deceased is a married, widowed or divorced woman, give also maiden name.)
12 Lewis Terrace
.St.
(If nonresident. give city or town and State)
Length of stay : In place of death.
25 years.
months
.days. In place of residence ....
25 years.
months ..........
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
June
2
1961
(Month)
(Day)
(Year)
4 I
HEREBY
CERTIFY,
That I attended deceased from
19
19
I last saw h ........ alive on
death is said to
have occurred on the date stated above, at
5:05 PmM.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
NaturalCauses
(a)
Due To
Presumably Coronary Occlusion
(b)
sudden
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
ro
What test confirmed diagnosis ?Post -mortem judgement
no
5 Was disease or injury in any way related to occupation of deceased ? If so, specify se Arthur C. Murray 19 MAIDEN NAME JESSIE (Signed .D. OF MOTHER Bessin
HAMILTON
HiFiKace
HIMMELFARB)
20 BIRTHPLACE OF MOTHER (City) (State or country)
ADA COULD
21
Informant
(Address)
12 Lewis TerRACK
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)
Received and filed
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
Which
10 SINHILE
MARRIED
WIDOWED
or DIVORCED
(write the word)
MARAIKO
10a If married, widowed
HUSBAND of
DA GDITH
(GeWIRTZ) GOULD
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
AGE.
12
62
Years.
4 Months 8
Days
If under 24 hours
Hours ...
.Minutes
13 Usual
Occupation :
ACCOUNTANT
(Kind of work done during most of working life)
14 Industry
or Business :
GeorgE GOULD Acer
15 Social Security No. 033-26-4064
16 BIRTHPLACE (City)
(State or country)
EAST Boston
MASS
17 NAME OF FATHER ARTHUR GOULD GOLDSTEIN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
PARENTS
SHARON MEMORIAL PARK 6
Sharon
Place of Burial or Cremation
DATE OF BURIAL
JUN
4
(City or Town)
1961
7 NAME OF FUNERAL DIRECTOR FISKER memoRIAL CHAPEL ADDRESS 61/2 WARREN ST LABORLiMCL
C.
09-925686
(Official Designation)
(Date of Issue of Permit)
ACTIONS OR CERTIFICATE
iving F 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 huse (a), he under- tuse last.
ons 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 signature.
POSSIA
(Address)
Arthur C. Murray, I.D.
(PRINT OR TYPE SIGNATURE)
winthrop board of health 2 June, 61
INTERVAL BETWEEN ONSET AND DEATH
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT
(a) Residence. No.
(Usual place of abode)
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 les 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.
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