Town of Winthrop : Record of Deaths 1961, Part 23

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 23


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).


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(Give maiden name of wife in full)


(or) WIFE of


W,11


T. Malloy


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12 12 hrs AGE65 Years 6


.Months.


5


.. Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Nurses Aide


(Kind of work done during most of working life)


24 hrs4, Industry


or Business :


Soldiers Home


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


MaJs


17 NAME OF


FATHER


Michael MeElaney


observations BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Cecilia Doherty


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


Mary C. Malloy


21 Informant (Address) 98 Bund street Ave, Revers I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E. Seriaun Hatte of Agent of Board of Health or other) 6/23/6/


(Official Designation)


(Date of Issue of Pormit)


X


I R-301A 1


RUCTIONS FOR . 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 ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.


11-59-926662


PEVERE


The Commonwealth of Massachusetts 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.


115


Registered No.


PHYSICIAN - IMPORTANT f(Was deceased a U. S. War Veteran,


Length of stay: In place of death. ............ years. months 11 ays. In place of residen 53 years.


8 SEX


Female White


9 COLOR


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Willow


4 I HEREBY CERTIFY,


May ...... 22


, 19 67


to .... June.


21.


1 last saw h.


34


June 21,


19 ..


QHeath is said to


have occurred on the date stated above, at 1. ... O.P.m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Peripheral Circulatory


Collapse


Due To


(b)


CholecystoJe junostomy


Due To (c)


OTHER SIGNIFICANT CONDITIONS Extensive Carcinomatosis primary in Pancreas


Was autopsy performed?


NO


What test confirmed diagnosis ?


Lab. Tests and act


5 Was disease or injury in any way related to occupation of deceased? If so, specify John 7. Cuelina Jul, M. D.


(Signed)


John F: Collins, M.D. (PRINT OR TYPE SIGNATURE) 22


(Address) 27 Bennington . Date .. June 19 '61


6


Holycross


Street, Revere M'aider.


(City_or Town)


Place of Burial or Cremation


DATE OF BURIAL


June


24/1961


7 NAME OF


FUNERAL DIRECTOR


Arthur S. Parcella


ADDRESS 876 Winthrop Av., Per-ere


Received and filed JUN 23 1961 19


(Registrar)


PARENT.SI.


Buiten


INTERVAL


BETWEEN


ONSET AND


DEATH


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OF TO?


u_{}


5


IN


Hi


RULES OF PRACTICE JUN 2.31961 PM


The fulfillment of the purpose of these laws calls for the observan following rules of practice: (I) 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.


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.


116


WINTHROP COM, HOSPITAL


[(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,


lif so specify WAR)


NO


93- SHORE DRIVE, WINTHPCA (Usual place of abode)


MASS (If nonresident, give city or town and State)


Length of stay : In place of death .............. years ............ months 1 days. In place of residence. ........... years ... .months ... ........ days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


MALE


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


SINGLE


or DIVORCED


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12 AGE Years. .Months. Days


If under 24 hours


Hours


............ Minutes


4


45


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 MASS.


17 NAME OF


FATHER


JAMES E. MACLEOD IR.


18 BIRTHPLACE OF


BOSTON


FATHER (City)


(State or country)


MASS.


19 MAIDEN NAME


OF MOTHER


EVELYN BANDEN


20 BIRTHPLACE OF


MOTHER (City)


MIDDLETON


(State or country)


N. H.


21 Informant (Address)


935 SHORE DRIVE-WINTHROP


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph S. Jireann afflenature of Agent of Board of Health or other)


Hi0


June 29-1961


(Official Designation)


(Date of Issue of Permit)


X


RUCTIONS FOR . CERTIFICATE


giving OF DEATH


not enter than one e for each (h) 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 ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.


7 NAME OF


FUNERAL DIRECTOR


MAURICE W. KIRBY


ADDRESS 210 WINTROPST, WINTHROP MASS


Received and filed


JUN 2.9 1961


19


(Registrar)


PARENTS


G.M. Caplan M. D.


(Signed) A.N. CAPLANMO (PRINT OR TYPE SIGNATURE) (Address: 86PRINCETONST.EB Date.


6-28-1961


6 WINTHROP, MASS WINTHROP (City or Town) Place of Burial or Cremation DATE OF BURIAL JUNE 29 1961


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


NO


What test confirmed diagnosis ?


HEREBY CERTIFY


That I attended deceased from


JUNE27,


961, to


to JUNE


2)


I last saw himalive on


19pm.


JUNE


27, 1961


., death is said to


have occurred on the date stated above, at


INTERVAL


BETWEEN


ONSET AND


DEATH


19


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) CONGENITAL ATALECTASIS OF LUNGS


Due To


PREMATURITY


(b)


3 DATE OFJUNE


27,


1961


DEATH


(Year)


(Month) (Day)


BABY BOY MACLEOD


2 FULL NAME ..


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


(a) Residence. No.


No.


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


MI R-301A 1


11-59-926662


JAMES MACLEOD


WINTHROP.COM HOSIPTAL


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


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


2.0 rik


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : C. (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside cafe /duringa' 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 reodd Medich Lorondapse absent from home when the certificate of


Inesdfa or whose physician is (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


UCTIONS OR CERTIFICATE


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


s not mean of dying, eart failure, tc. It means or compli- hich caused


s, if any, ve rise to ause (a), the under- nuse last.


ions contrib- eath but not the terminal dition 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.


928145


PLACE OF DEATH


..... Suffolk (County)


COM'S


Winthrop (City or Town)


The Commonwealth of Massachusetts 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.


117


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Marion Virginia Hewitt ( Sanborn )


(First Name)


(Middle Name)


[(Was deceased a


{ U. S. War Veteran,


(Last Name)


[if so specify WAR) NO.


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


(a) Residence. No.


97 Beach Road


(Usual place of abode)


Length of stay:


In place of death.


years.


months.


days. In place of residence ..


.4.0.years.


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


June


29


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY , .That I attended deceased from


Nav.


19:54


to ...


June


29


1961


I last saw h.p.Yalive on


June 28, 1961, death is said to


have occurred on the date stated above, at


5:30 A.m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Tumor of Brain


INTERVAL BETWEEN ONSET AND DEATH 2yrs,


Due To


(b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


None.


Was autopsy performed?


No


What test confirmed diagnosis? Clinical- Hospital.


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify


(Signed)


Charles


Féle man, M. D.


Charles


Liberman


(PRINT OR TYPE SIGNATURE)


(Address)


Winthrop, mass Date.


6/29/1961


6


Winthrop Cemetery


Winthrop, Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 1


19.67


21


Informant


(Address)


97 Beach Road, Winthrop


Hugh M.Hewitt


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


ADDRESS 174. Winthrop St. Winthrop, Mass.


Walkhe


Vercanne


(Signature of Agent of Board of Health or other)


Ho


/


6/29/6/


Received and filed JUN 2-9-1961 .. 19


0 PARENTS


17 NAME OF


FATHER


James Sanborn


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Maine


Machias


19 MAIDEN NAME


OF MOTHER


Maude Crosby


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Machias


Maine


7 NAME OF


FUNERAL DIRECTOR


Cafel 3 Marsh"


.....


St.


(If nonresident, give city or town and State)


8 SEX


9 COLOR


female


white


10 SINGLE


(write the word)


MARRIED married


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Hugh Mckenzie Hewitt


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ... 5.O ... Years.


0


Months ...


7


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


housewife


(Kind of work done during most of working life)


I4 Industry


or Business :


own home


15 Social Security No.


025-03-411.2


Rockland


16 BIRTHPLACE (City)


(State or country)


Maine


(Registrar) (Official'Designation)


(Date of Issue of Permity


Registered No.


No.


97 Beach Road


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 cttL lastillness from disease un. to whom they have given bedsidethe dustthanly as those of persons 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 bad been given up or cbanged, 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.


PLACE OF DEATH


Suffolk


(County)


Winthrop


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


CERTIFICATE OF DEATH


Registered No.


118


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


PHYSICIAN - IMPORTANT


2 FULL NAME


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


(a) Residence. No.


41 Washington Ave


St.


20


(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


3 DATE OF


DEATH


une


29


1961 (Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


widow


4 I


HEREBY CERTIFY


That I attended deceased from


29


196


I last saw heralive on


2 une 21


19 61


death is said to


have occurred on the date stated above, at


8:30Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


11 IF STILLBORN, enter that fact here.


84


12


AGE


Years ..


Months.


......


.Days


If under 24 hours


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


16 BIRTHPLACE (City)


(State or country)


Maine


17 NAME OF


FATHER


George Wentworth


18 BIRTHPLACE OF


FATHER (City)


Waldo


(State or country)


Maine


19 MAIDEN NAME


OF MOTHER


Lydia Johnson


20 BIRTHPLACE OF


MOTHER (City)


Exeter


(State or country)


Maine


21


Informant


(Address)


Mabelle Masterson


92 Putnam St . Winthrop


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


7 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


ADDRESS


Winthrop


Mass


1961


(Registrar)


PARENTS


(Signed)


Kaseple greg ne M. D. Joseph GREGORIE


(Address)


Date


6-30-1961


6


Winthrop


Winthrop


Place of Burial or Cremation


DATE OF BURIAL


(City or Town)


July 3


..... 19 61


Received and filed


7/3/61


(Official Designation)


(Date of Issue of Permit) 1


RUCTIONS FOR . 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.


litions contrib- death but not o the terminal ondition given


Chapter 137, .954, requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.


11-59-926662


PERSONAL AND STATISTICAL PARTICULARS


te-the word)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Charles Land


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


arteriosclerader


(a)


Heart Disease


Due To


arteriosclerosis


(b)


generalized


(c)


Due To


Senility


OTHER


Huntingtono


SIGNIFICANT


CONDITIONS


chorca


Was autopsy performed?


No


What test confirmed diagnosis ?


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


If so, sperify


2


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


(City or Town) BLYVI USAENUN 41 Washington Ave


No.


Laura E Land


{(Was deceased a


U. S. War Veteran,


{if so specify WAR)


(Usual place of abode)


2


(Month)


(Day)


Jan


1988


to June


(PRINT OR TYPE SIGNATURE)


Belfast


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


I R-301A 1


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


K


C.


A


HROP


RULES OF PRACTICE


The fulfillment of the purpose of these following rules of practice :


JUL-475,1961 AM the observance of the


(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


CTIONS OR CERTIFICATE


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


s not mean of dying, eart failure, c. It means or compli- ich caused


s, if any, ve rise to use (a), he under- last. use


ons contrib- ath but not the terminal dition given


Chapter 137, 954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type ler signature.


C.


928145


PLACE OF DEATH


Suffolk= (County)


Winthrop (City or Town)


No. 45 Nahant Avenue


The Commonwealth of Massachusetts 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.


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


2 FULL NAME


Nellie Pied ( Thompson) Brosseau


(First Name)


(Middle Name)


(Last Name)


[ (Was deceased a 3 U. S. War Veteran,


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


45 Nahant Avenue


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


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED,


WIDOWEDWidowed


or DIVORCED


4 I HEREBY CERTIFY,


That I attended deceased from


Oct


1951


to ..........


30 June


19


61


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


John Fortunat Brosseau


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Cerebral Vascular Incident


(a)


Due To


(b)


Generalized Arteriosclerosis 10mg


Due To (c)


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? MO ... If so, specify Arthur @ Murray, M. D


(Signed)


Arthur


C


Murray


(Address).


(PRINT OR TYPE SIGNATURE) Winthrop, Mass Date 20 June 1961


6 Woodlawn Cemetery


Everett


Place of Burial or Cremation


(City er InEn.


DATE OF BURIAL


July 3


1961


7 NAME OF


FUNERAL DIRECTOR


Alfred .... B ...... Marsh


ADDRESS


174 Winthrop St. Winthrop


Received and filed Bely 5. 1961


(Registrar)


PARENTS


17 NAME OF


FATHER


Alfred B. Thompson


18 BIRTHPLACE OF


FATHER (City)


St. Johns New Brunswick


(State or country)


Canada


19 MAIDEN NAME


OF MOTHER


Helen Mccarthy


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Mrs. Helene Black


Informant


(Address)


43-A Nahant Avenue, Winthrop


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) Y


Thealite Oly cet


6/90161


(Official Designation)


(Date of Issue of Permit)


3 DATE OF


DEATH


June


30


1961


(Month)


(Day)


(Year)


I last saw hey ... alive on


10 June


1961, death is said to


have occurred on the date stated above, at 12:30 p.m.


INTERVAL


BETWEEN


11 IF STILLBORN, enter that fact here.


ONSET AND


DEATH


12


5 days


AGE


8.7Years.


6Months ..


20 Days


If under 24 hours


Hours ...........


Minutes


13 Usual


Occupation :


housework ....


(Kind of work done during most of working life)


14 Industry


or Business :


housewife


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


St. Johns, New


Bruns.


WICK


Canada


Registered No.


[if so specify WAR)


No


(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


RU $ OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians willicettify toGuch deaths only as those of persons to whom they have given belidide care during a 'last illness from disease un- related to any form of injury. .




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