Town of Winthrop : Record of Deaths 1961, Part 24

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 24


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


(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.


et write in pace -- Mar- reserved for ING and ING.


TE OF DEATH


CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE


TOWN OR CITY CLERK'S NO.


5


STATE FILE NO.


1. NAME OF


DECEASED


Theresa


D. INIROLE)


Clara


C. (LAET)


Kichle


2. DATE


OF


DEATH


Feb 3, 1361


3. PLACE OF DEATH


A. COUNTY


Rockingham


4. USUAL RESIDENCE AUNESE DECEASED LIVED. IF IMETITUTION' RESIDENCE


STATE


Vass


D. COUNTY


Winthrop


.. CITY


OR


TOWN


Plaistow


C. LENGTH OF


STAY (IN THIS PLACE)


one year


C. CITY INIVE ACTUAL TOWN OF RELICENCE. NOT MAILINN ADORESE).


OR


TOWN


Winthrop, Mass


0. FULL NAME OF (IF NOT IN HOSPITAL OR INSTITUTION. LIVE ETSEET AOBREEE OR LSCATIONI D. STREET I1F PUBAL. GIVE LOCATINM)


HOSPITAL OR


INSTITUTION


Pine Street


ADDRESS


Summit AvB


E IS RESIDENCE


ON FARMY


YES


NO PX


.. SEX


Female


S. COLOR OR RACE 7.


white


MARRIED


NEVER MARRICO


DIVOR CED


WIOOWTO


NAME OF HUSBAND OR WIFE IMAIDEN NAME 19 WIFE)


Harry L. Kishle


.. DATE OF BIRTH


10. AGE UIN TEAMS


LA


62


IF UNSER I YEAR MONTHS RAVE


IF UNDED 14 NAS


NOURE


11A. USUAL OCCUPATION 1.º F .


INDUSTRY


Housewife


110. KIND OF BUSINESS OR


Home


12. BIRTHPLACE ICITY OF TOWN. STATE


OR FOREIGN COUNTRY)


Ireland


13. CITIZEN OF WHAT


COUNTRY?


14. FATHER'S NAME Lapham


1 S. WAS OKCEASED EVER IN U.S. ARMEO FORCES? 17. SOC SEC. NO.


(VES. NO. SD UMKNOWN) |{IF TES. GIVE MAD ON DATEE OF EENVLES


532-03-3875


ISA. INFORMANT


Harry L. Kiehle


1 ... ADDRESS


Plaistow, T.H.


19. CAUSE OF DEATH IENTER ONLY ONE CAUSE PED LINE FOR (A), IDI. ANN ICH


PART I DEATH WAS CAUSEO SY;


IMMEDIATE CAUSE IA) __


Acute Coronary occlusion


INTERVAL SETWEEN ONSET AND DEATH Instant


CONDITIONE IF ANY. WHICH NAVE NICE TO ADOVE CAUSE TAI. STATINN THE UNDER. LYING CAUCE LAST. DUE TO (CI_


DUE TO (91


Coronary artery disease


6 months


PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH SUT NOT RELATED TO THE TERMINAL DISEASE CONOITION GIVEN IN PART HAI


20. WAS AUTOPSY PERFORMED?


NO


21A. ACCIOENT


SUICIOE HOMICIOE


21C. TIME


OF


INJURY


MONTH DAY T CAD - M


21F CITY. TOWN OR LOCATION COUNTY


STATE


10


22. I attended the deceased from


Death occured at .


. .


5:3.7 .... D. im on the date stated above; and to the best of my knowledge, from the causes stated.


23A SIGNATURE


R.W. Tower


MD


11DEUMmer St Haverhill


23C. DATE SIGNED


2/3/61


İSTATO


24A BURIAL CREMATION


ENTOMOMENT


REMOVAL


24. DATE


CREMATORY


24 C. NAME OF CEMETERY OR


Winthrop Cemetery


24D. LOCATION ICITT. TOWN, Ce CONWITT!


Winthrop, Mass


IF ENTOMBED


24E. PLACE OF BURIAL


INAME OF CENETESY)


LOCATION ICITT. TOWN. COUNTY) ISTATEI


DATE


25. FUNERAL DIRECTOR'S SIGNATUR


Maurice . Kirby


zio winthrop st


Winthrop, Kass


DATE REC'D BY TOWN OR CITY CLERK


2/3/81


CLERK'S OWN SIGNATURE


Pauline H. Keczer


CLERK OF


Plaistow


A nine copy, Altest:


Clerk of


Flaistow


Dated.


2/17


61


C.O. 18648-10-57-95M


sc


AGE


OCUPATION


ATHPLACE


TIZENSHIP


VETERAN


SE OF DEATH nl. C.


DIAGNOSIS


MEDICAL CERTIFICATION


Primary anemia


215. DESCRIBE HOW INJURY OCCURRED IENTER DATUDE OF INJUST IN PART I OD PART II OF ITEM ID.)


21D. INJURY OCCURRED


WHILE AT


NOT WHILE


WORK


AT WORK


271/61


211. PLACE OF INJURY IC. ... ID OR ABOUT NOME. FARN. FACTORY. STREET. OFFICE BLOG., ETC.


2/3/61


and last saw


TheT_alive on .2/1/61


(DEGBLE OR TITLE)


COUNTERSIGNED - AGENT (CITY MO. OF HEALTH) DATE


IRATI


ITEARI


ITYPE OR PRINT)


ISTITUTION


ESIOENCE


SEX


1,20


CE OF DEATH


DEFORE ADMISSION.)


15. MOTHER'S MAIDEN NAME


1


RECEIVED


OF TO!


..


1011.


CLERK


6


THỊ


JUL 201961 AM


121


NON RESIDENT


odTICS


CERTIFICATE OF DEATH FLORIDA


STATE FILE


261-008779


BIRTH NO.


1. PLACE OF DEATH «. COUNTY St. Lucie


CODE NO.


66-025


a. STATE


Massachusetts


Suffolk


8. CITY. TOWN, OR LOCATION Ft. Pierce


e. IS PLACE OF DEATH


INSIDE CITY LIMITS?


YES DA


NO


c. CITY. TOWN. OR LOCATION Winthrop


e. IS RESIDENCE INSIDE CITY LIMITS? YES 1,1 NO


d. NAME OF


HOSPITAL OR


(If not in hospital, give etrect address) INSTITUTIONN't . Pierce Mem. Hosp.


€. LENGTH OF STAY IN 18 3 dys.


d. STREET ADDRESS


RF


ON A FARMI YES


NO


3. NAME DF DECEASED (Type or print)


FYrat GEORGE


Middle EDWARD


Last NOWELL


4. DATE


OF


DEATH


Feb.


13


Dag


Year


5. SEX M


6. COLOR OR RACE W


7. MARRIED


NEVER MARRIED


8. DATE OF BIRTH


Sept. 19,1895


9


AGE (In pare


last birthday)


65


Months Deya


Hours


Min.


100. KIND OF BUSINESS OR INDUSTRY


Auto (G. E.)


11. BIRTHPLACE (State or foreign country) Farmingdale, Maine


12. CITIZEN OF WHAT COUNTRY? U.S.A.


13. FATHER'S NAME Bert Novell


14. MOTHER'S MAIDEN NAME


Esther Z. Green


15. WAS DECEASED EVER IN U. S. ARMED FORCES? (Ya. no, or unknown) Les


(If yes, give wor or datse of service) WW # I


16. SOCIAL SECURITY NO. 17. INFORMANT'S SIGNATURE Address 023-16-9592


Muss Malelf Howell. Winthrop, Massachusetts (


18. CAUSE OF DEATH [Enter only one cause per line for (a), (b), and (e).) PART L. DEATN WAS CAUSED BY: IMMEDIATE CAUSE do Menasicilia Carcinoma - Junga & hear


PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART I(a)


MEDICAL CERTIFICATION


20a. (Probably) ACCIDENT


SUICIDE


HOMICIDE


20c. TIME OF INJURY


Hour a. m. p. m.


Month, Das, Year


20d. INJURY OCCURRED WHILE AT WORK


NOT WNILE AT WORK


20c. PLACE OF INJURY (e. g., in or about home. farm, factors, street, effice bidg., etc.)


20/. CITY. TOWN. OR LOCATION


COUNTY


STATE


21. 1 attandad tha decoasad from


2-13-6/ and last saw alive on 2-13-6.


22€. SIGNATURE


(Degree of title)


MO


22c. DATE SIGNED


23a. BURIAL, CREMATION, REMOVAL (Specify) Removal


236. DATE 2-15-61


23c. NAME OF CEMETERY OR CREMATORY


23d. LOCATION (City, town. of county)


(State)


24. FANERAL DIRECTOR 'S SIGNATURE


Everett Middlesex Mass. 26. REGISTRAN'S SIGNATURE


Thillow Fod


AgPois N. 7th St Et. Pierce Fla 2-15-61


25. DATE RECD. BY LOCAL REG.


Auna here Devisandre


V.B.


5


erd when preparly oxacuted


pleloly with per-


black Ink er Ispewriter


Fueeral director west file Ibe cer- tifleete tilh 1ha


rogioire? Fitbin 72 Moore af- 187 death er befera soking any d102001- lise of bedy.


1992


All Llene ere le be respiele & Accorste.


Y.8.6612 Ice - 1956


Woodlawn Crematory y


226. ADDRESS Fr Pierca Dla 2-15-61


19. WAS AUTOPSY PERFORMED! YES NO


200. DESCRIBE NOW INJURY OCCURRED. (Enter nature of injury in Part 1 or Part 11 of item 18.)


INTERVAL BETWEEN ONSET ANO DEATN Granita


Conditions, if any, which gare riss fo above couse (a), atoting the under- Iging cause last.


DUE TO (b)


DUE TO (e)


Month


1961


10a. USUAL OCCUPATION (Give kind of work done during most of working life, even if retired) Mechanic


IF UNDER 1 YEAR IF UNDER 24 HRS.


WIDOWED DIVORCED


5 Faun Bar Ave.


REGISTRAR'S NO. 42


2. USUAL RESIDENCE ( Where deceased lived. I/ institution: Residence before admission) b. COUNTY


2-10=61. 10


Death occurred at 23 80 Em on the date stated above; and to the best of my knowledge, from the causes stated.


.: CEVED


IF TOW


LINK


61


6


THROP


JUL 2 01961 AM


-


-


-


122


'61-008360


STATE FILE NO.


REGISTRAR'S NO.


1, PLACE OF DEATH


CODE NO. 62-163


0. STATE


8. COUNTY


Suffolk


8. CITY, TOWN. OR LOCATION


St. Petersburg


e. IS PLACE OF DEATH


INSIDE CITY LIMITS?


YES D


NO


e. CITY. TOWN, OR LOCATION


Winthrop


€. 15 RESIDENCE


INSIDE CITY LIMITS?


YES A


NO


d. NAME OF


HOSPITAL OR


INSTITUTION


(If not in hospital, rive street address) Mound Park Hospital


". LENGTH OF


STAY IN 18


3 mos.


d. STREET ADDRESS


2 Burrill Terrace


RR-20


ON A FARM?


YES


3. NAME OF


DECEALED


(Type or print)


First Ruth


Middle Dyer


Lost Woods


4. DATE


OF


DEATH


February 18, 1961


5. SEX Female


6. COLOR OR RACE


White


7.


MARRIED


NEVER MARRIED


C. DATE OF BIRTH


9. AGE (In wars


test birthday)


Menthe


Mis.


10a. USUAL OCCUPATION (Gior kind of work done during most of working life, even if retired) Housewife


100. KIND OF BUSINESS OR INDUSTRY At Home


11. BIRTHPLACE (State of foreign country) Winthrop, Massachusetts


12. CITIZEN OF WHAT COUNTRY?


U.S.A.


13. FATHER'S NAME


14. MOTHER'S MAIDEN NAME


Isabelle Webster


15. WAS DECEASED EVER IN U. S. ARMED FORCES?


16. SOCIAL SECURITY NO. 17. INFORMANT'S SIGNATURE


charles Foods.


No


010-30-9687


Address


Winthrop, Massachusetts


16. CAUSE OF DEATH [Enter only one cause per line for (0), (b), and (c).)


PART I. DEATH WAS CAUSED BY:


IMMEDIATE CAUSE (=)


mayo candil infantion


INTERVAL BETWEEN


ONSET AND DEATH


1 wach


Conditions, if any, which gars ring to


DUE TO (6) astiosche ti teaux disque


stating the kader- lying cause last.


DUE TO (c)


PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART I(a)


19. WAS AUTOPSY


PERFORMED?


YES


NO


200. DESCRIBE HOW INJURY OCCURRED. (Enter nature of injury in Part I or Part II of item 18.)


ACCIDENT


SUICIDE


0


HOMICIDE


20c. TIME OF INJURY


Hour Month, Day, Yeur


20/. CITY. TOWN, OR LOCATION COUNTY STATE


204. INJURY OCCURRED WHILE AT WORK


C NOT WHILE AT WORK


23 Jan CL, to 18 Feb 61


and last saw Mer


4:08 Am on the date stated above; and to the best of my knowledge, from the causes stated.


224. HONATURE


(Deskre or titis) Bank &. Price MO


220. ADDRESS


& Et.


500. 7745. South


22c, DATE SIGNED 18 Feb 61


23g. DURIAL, CREMATION. REMOVAL (Specify)


230. DATE


23c. NAME OF CEMETERY OR CREMATORY


234. LOCATION (City, town. or county)


(State)


Removal Feb.19,1961


Winthrop Cemetery


Winthrop Massachusetts


26. REGISTRAR'S SIGNATURE


24 FUNERAL DIRECTOR 'S SIGNATURE JOHN ARBRES RHODES, INC. |25. DATE RECD. BY LOCAL REG. DampSt. Petersburg, Fla. 2-19-61


Emily B. Ener


.


1


78


MEDICAL CERTIFICATION


n Y


any


-


200


12


NON RESIDENT


CERTIFICATE OF DEATH FLORIDA


2. USUAL RESIDENCE ( Where desmond lived. If institution; Residence bufera admission)


Pinellas


Massachusetts


Month


Day


Year


W UNDER 1 YEAR 7 UNDER & HAS.


WIDOWED


DIVORCED


December 8, 1894


George W. Dyer


(If you, give ver an dele af service)


20c. PLACE OF INJURY (c. g., in or about home,


farm, factory, street, office bidg., etc.)


21. I attended the deceased from Death occurred at


.


V.B.J


ter


P


C


1


1


JUL 2 01361 AM


X


SUFFOLK


(County)


BOSTON


(City or Town)


The Commonwealth of fanmarquartOUT - OF - TOWN 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. 04702


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 so specify WAR)


NO.


(a) Residence. No.


12.Elliot


( Usual place of abode)


St.


Winthrop, Massachusetts


(If nonresident, give city or town and State)


Length of stay: In place of death.


.. years.


months.


1 days.


In place of residence 42 years


months


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


(wrue the word)


MARRIED Widowed


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


Jessie Flora MacArthur


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name la full)


Il IF STILLBORN, enter that fact here.


12


AGE ..


94 Years


8 Months 23


.Days


If under 24 hours


Hours ......_ Minutes


Due To


(5)


Ureteral Obstruction


Due TBilateral


(c)


Carcinoma of Prostate


OTHER


SIGNIFICAN Pulmonary Edema


CONDITIONS


Mins


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


........


@@@com


M. D


(Signed)


Charles L. Clay, M. D.


(PRINT OR TYPE SIGNATURE)


(Address)


Asa't. Dir. Mass. Gen'l. Heap. Date.


5/13/


.19 ... 6.1


Glenwoodl Cemetery Everett, Mass Place of Burial or Cremation (City of Town)


DATE OF BURIAL May 16 1961 .. 19


7 NAME OF


FUNERAL DIRECTOR


alfred 3. Mars


ADDRESS


174 Winthrop St Winthrop,


MAY 1.9 1961 Charles H. Mack


(Registrar)


. PARENTS


17 NAME OF


FATHER


James Bruce


18 BIRTHPLACE OF


Dundee


FATHER (City)


(State or country)


Scotland


19 MAIDEN NAME


OF MOTHER


Margaret Cunningham


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Dundee


Scotland


Mrs. Minnie B. Parsons


21


Informant


(Address)


12 Elliot St.Winthrop


I HEREBY CERTIFY that a satisfactory standard certifcate of death


was filed with


me BEFORE the burial or transit permit was issued:


Mass.


Daniel J. McNamara.


(Signature of Agent of Board al Heal


2105


(Official Designation)


(Date of Issue of Permit)


-V. B.


ICTIONS OR CERTIFICATE


lving P DEATH


t enter han one for each b) and (c)


's not mean of dying, cort failure, ic. It means or compli- rich , caused .


s, if any, De rise is INSC (a), he under- use last.


ons contrib- ath but not the terminal dition given


177


Chapter 137, 954. requires is to print or : cause or i death on tificates, and 48, Acts of quires Physi- print or type der signature. n.c. Nrector se caly


€ 28145


PLACE OF DEATH


No.


Mosaachusetts General Hospital BAKER MEMORIAL


2 FULL NAME


Robert Bruce


(First Name)


(Middle Name)


(Last Name)


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


3 DATE OF


DEATH


Month)


1.96.1


(Year)


4 I HEREBY CERTIFY


That TEattended deceased


May


61


May


12,


19


19


61


Plast saw h .. 1 MMlive on


May ... 12,


......


death is said to


have occurred on the date stated above, at ........:. 5.3P .... m.


INTERVAL


BETWEEN


ONSET ANO


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Pyelonephritis, Chronic,


DEATH 6 wks.


13 Usual


Occupation :


retired educator


(Kind of work done during most of working life!


14 Industry


or Business :


Northeastern University


15 Social Security No. ...


021-26-7034


16 BIRTHPLACE (City)


(State or country)


Scotland


Dundee


(a)


....


Active, Bilateral


19 61


6 wks


unk


wks


6


R-3014 1


21


TOW


.L


1 in


6


JUL 141961 PM


City Registrar


A. FRET COPY ATTEST: Charles it Mackie


X


PLACE OF DEATH


Suffolk


(County)


Boston, Mass


(City or Town)


Howland Nursing Home.


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,


(Middle Name) (Last Name) (if so specify WAR)


( If deceased is a married, widowed or divorced woman, give also maiden name.) 197 Pauline St., Winthrop, Mass.


(a) Residence. No.


(Usual place of abode)


(If nonresident, give city or town and State)


.. months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEmarried


10a If married, widowed, or divorced


HUSBAND of


EdNA BELL.


(Give maiden name of wife In full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Arteriosclerotic Heart dis


· DEATH


(a)


ONSET AND


yrs.


Due To


(5) Coronary Occlusion, acute


Due To (c)


OTHER


Malnutrition


5


yrs.


Was autopsy performed?


none


clinical


What test confirmed diagnosis?


no


5 Was disease or injury in any way related to occupation of deceased? IVso, specify ~.


"Charles Liberan


(Signed)


Charles Liberman


(Address)


(PRINT OR TYPE SIGNATURE) Winthrop, Mass


5 16 62


St. Mary's


Newburyport, Ma


6 Place of Burial or Cremation (City or Town)


DATE OF BURIAL


May 18, 1961


19


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS


Winthrop, Mass.


MAY 31 1961 2 .19


Kamar les 4. Mach nantes


(Registrar)


LO PARENTS


17 NAME OF


FATHER


William Kenney


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Newburyport,


Mass.


19 MAIDEN NAME


OF MOTHER


Johanna Ready


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Newfoundland


21 Elizabeth Farrington


Informant


(Address)


901 Hillside Ave., Painfield


I HEREBY CERTIFY that a satisfactory standard certificate of death was freq with me BEFORE the burial or transit permit was Lesucd: Jacqueline Dorato


(Signawife of Agent of Board of Health or other)


2122


5/19/6/


I (Official Designation)


(Date of Issue of Permit)


T .I.B


UCTIONS OR CERTIFICATE


iving OF DEATH


t enter. han one for each b) and (c)


of dying. cort failure, c. It means or compli- bich caused


s. i/ cn7. De rise to Iuse (), he under. imse lass.


ONS CONtrib- ath but mot the termine! dition riven


420.1


: Chapter 137. 954. requires lis to print or t: cause or f death on pilficates, and 148. Acts of nulres Phys !- orint or type her signature. 1


1.


11.C.


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


OUT - OF - TO To be filed for burial permit with Board of Health or ite Agent 124


STANDARD CERTIFICATE OF DEATH


Registered No.


04741


55 Burroughs St., J. P. John W. Kenney


2 FULL NAME


(First Name)


May 15, 1961


(Month)


(Day)


(Year)


December, 19


HEREBY CERTIFY.


That


May 15, 1961


.....


to ...


May


55


I last saw h.


1m


ive on death is said to 11:00 mp have occurred on the date stated above, at INTERVAL (or) WIFE of


BETWEEN


(Husband's name in full)


U IF STILLBORN, enter that fact here.


12


AGE


Years ..


Months ............. Days


If under 24 hours Hours Minutes


Retired Circulation Mgr.


(Kind of work done during most of working life)


14 Industry


or Business :


Newspaper.


15 Social Security No. .......


Newburyport ss.


16 BIRTHPLACE (City)


(State or country)


73


· 3 dayy Usua! Occupation :


SIGNIFICAN I


CONDITI('.'


14,


191961


3 DATE OF


DEATH


Length of stay: In place of death .......... .years. 1months ............ days. In place of residence. 10 years.


No.


R-301A 1


X 28145


A TRUE COPY ATTI JOLY ATTEST


Charte At Wardies


City Reun trar


L


3


6 "


HROP.


JUL 1 71961 AM


PLACE OF DEATH


SUFFOLK


(County)


BOSTON, MASS .......... (City or Town)


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


PUT - OF - TOWN


To be filed for burial permit with Board of Health or its Agent. 125


85005


[(If death occurred in a hospital or institution,


St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


Mrs .... Margaret .... Cawthorne


(First Name)


(Middle Name)


(Last Name)


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


(if so specify WAR)


70


(a) Residence. No.


49 Waldemar Ave


XSt.


Winthrop, Mass.


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death ..


.years ..


months ...


3


days. In piace of residence


40 years.


-


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE


9 COLOR


WHITE


10 SINGLE (write the word)


MARRIED


WIDOWED WIDOWED


or DIVORCE1)


NY HEREBY CERTIFY


May 21


19


to ..


61


May


24


19


61


.


(Give maiden paine of wife in full)


(or) WIFE of


WILLIAM CAWTHORNE


(Husband's name in full)


11 IF STILLBORN, enter thet fact here.


12


AGF 64 Years-


Months .....___ Days


If under 24 hours


.. Hours


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


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


HOME


OTHER


SIGNIFICANT Acute ... Myocardial ... Infarction 5 dy's 15 Social Security No.


NOT KNOWN


CONDITIONS


Diabetes Mellitus


Was autopsy performed?


What test confirmed diagnosis?


Yes


Autopsy


No


(Signed)


Sauca Knee


M. D


(State or country)


MASS,


DR


.SAUL .. A ..... ROSENBERG


(PRINT OR TYPE SIGNATURE)


PETER BENT BRIGHAM HOSP. .. Date May 24


.19 .. 63.


6


HOLY CROSS


MALDEN MASS


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


MAY 27,


61


7 NAME OF


FUNERAL DIRECTOR


MAURICE W. KIRBY


ADDRESS


....


210 WINTHROP ST. WINTHROP


Andeiyed and Bled


harke grenache19.


(Registrar)


PARENTS


17 NAME OF


FATHER


DANIAL W. HART


18 BIRTHPLACE OF


FATHER (City)


BOSTON


19 MAIDEN NAME


OF MOTHER


CATHERINE MORAN


20 BIRTHPLACE OF


CHELSEA


MOTHER (City)


(State or country)


MASS


MRS. VIRGINA WILDER


48 WALDEMER AVE. WINTHROP.


21 Informant


I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was inmed: Daniel J .McNamara. (Signature of Agent of Board of Health or other)


2267


5 25 61


(Official Designation) (Date of Issue of Permit)


1 V.B


TRUCTIONS FOR IL CERTIFICATE


n giving E OF DEATH


not enter re than one se for each , (b) and (c)


does not mean ode of dying, heart failure. , etc. It means ese, or compli- which caused


tions, if any, gave rise to casse (.), the under- cause last.


ditions \contrib- death but not to the terminal condbio/ given


·:· Chapter 137, f 1954. requires 'isns to print or the cause of of death on certificates, and ler 48, Acts of requires Physi- 1:0 print or type Finder signature. 1.19%


M.C.


10-928145


-


Due To


Arteriosclerosis with


(5)


Thrombosis of right


Due To


(c)


Coronary Artery


10a If married, widowed, or divorced


HUSBAND of


death is said to


6:50 AM


have occurred on the date stated above, at


m.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Severe ... Generalized


3 DATE OF


DEATH


May.


24.


.19.61


(Month)


(Day)


(Year)


That


attended deceased


Piast saw h ..... Elive on


May


21


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


Registered No.


PETER BENT BRIGHAM HOSPITAL


No.


M R-301A -


EAST BOSTON


16 BIRTHPLACE (City)


(State or country)


MASS.


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


If so, specify


HOUSE WIFE


A TRUE GOLY ATTEST: Cheries it InaKie Give Me mirar


- - CE IEC


1


THROP.


JUL 171961 AM


X


FORM R-302


WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD


C.


PLACE OF DEATH


Middlesex (County ) Tewksbury, Mass. (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


TEWKSBURY HOSPITAL


( City or Town making this return)


Registered No.


1.26


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


2 FULL NAME.


Irvine Ross


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


( Was deceased a


U. S. War Veteran,


No


(if so specify WAR,


(a) Residence. No.


( Usual place of abode)


0


.year


10


.months.


3


.days. In place of residence.


.years ...


.... months.


........ days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


June 5,


1961


( Month)


(Day)


(Year)


8 SEX


Male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


or-DIVORCED


( write the word)


Married


4 I HEREBY CERTIFY.


Aug. 2,


60


That I attended deceased from


June 5,


61


19


I last saw h.anilive on


June 4.


61


19


death Is said to


have occurred on the date stated above, at


1:45a.


m.


10a If married, widowed, or divorcetary Barry


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of ...


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


67


12


AGE


Years ..


3


Months.


15


„.Days


If under 24 hours


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


13 Usual


Occupation:


Retired Business Man


(Kind of work done during most of working life)


14 Industry


or Business :


Tow boatoperator


15 Social Security No.


011-05-6603


Fact DOSton


16 BIRTHPLACE (City)


(State or country)


Messochusetts


OTHER


SIGNIFICANT


Pulmonary


CONDITIONS


Emphysema


NO


XRays- EKG


No


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


If so, specify


(Signed )


M. Mully Yavarow


M. D.


( Address )


TEWKSBURY HOSPITAL


Date


June 5. 61


Woodlawn Cemetery, 6 Place of Burial or Cremation (City or Town)


Everett


DATE OF BURIAL June 8,


19 61


7 NAME OF FUNERAL DIRECTOR Ernest P. Caggiano


ADDRESS


147 Winthropost


Winthrop


21-1001


Received and filed


Supr:


PARENTS .


17 NAME OF


FATHER


Joseph Ross


18 BIRTHPLACE OF Nova Scotia


FATHER (City)


(State or country )


Canada


19 MAIDEN NAME


OF MOTHER


Sarah Smith


20 BIRTHPLACE OF


MOTHER (City)


( State or country )


Nova Scotia


Canada


Hospital Recores


21 Informant ( Address)


A TRUE COPY


Gupt.


ATTEST :


Registrar of City of Town where death occurred)


June 5/ 1961


DATE FILED


19


I Rowie+w


50M-9-59-926111


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 (c)




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