Town of Winthrop : Record of Deaths 1961, Part 21

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 21


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


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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