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