USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 24
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Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51
(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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