USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 26
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STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under thegofluence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery) ." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner Indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain basal gangkali (found dead in bed)."
"Heart disease, presumably coronary sclerosis. (Sudden death.)".
(
155
MIN
OF TO
CLERK
RECEIVED
X
PLACE OF DEATH
Suffolk (County )
Winthrop (City or Town) , No. 142 Pleasant St.
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
1.02/
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT f(Was deceased a { U. S. War Veteran, { if so specify WAR)
2 FULL NAME Helena ........ ... Harvey.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(L'sual place of abode)
30 Waldemar Ave St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.. years .. 2
months days. In place of residence.5.0 .years. months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July12 1961
(Month) (Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDSingle
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 77 Years.
Months.
Days
If under 24 hours
Hours.
.......
.Minutes
13 Usual
Occupation :
At Home
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
Waltham
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Charles J. Harvey
18 BIRTHPLACE OF
FATHER (City)
Waltham
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Ellen L. Lanagan
20 BIRTHPLACE OF
MOTHER (City)
Waltham
(State or country)
Mass
21 Margaret Wilson
Informant
(Address)
30 Waldemar Ave., Winthrop
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O' Maley
Winthrop Mass
ADDRESS
Received and filed JUL-14-1961 19
(Registrar)
PARENTS
(Signed)
M. D.
John Collins MD (PRINT OR TYPE SIGNATURE) 27 Bennington Street July 13, 19 61
(Address)
6
Winthrop Cemetery
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
July 15
19.61
(City or Town)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: ValkRS Jescanne (Signature of Agewych Heard of Health or other) July 14-1961
(Official Designation)
(Date of Issue of Permit)
TVP.
TRUCTIONS FOR L CERTIFICATE
n giving OF DEATH not enter e than one se for each , (b) and (c)
does not mean de of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not to the terminal condition given
- Chapter 137, 1954. requires ans to print or he cause or of death on ertificates, and · 48, Acts of ¿quires Physi- ) print or type idensignature. L.
-6-59-925686
PERSONAL AND STATISTICAL PARTICULARS
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cerebral. Hemorrhage
6 days
Due
(b)
Hypertension
Several rears
Due To (c)
OTHER
SIGNIFICANT Generalized arteriosclerosis
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?
clinical
5 Was disease or ipjury in any way related to occupation of deceased? no If so, specify lohn 7- Coccus met
death is said to
have occurred on the date stated above, at 7:15 P Mig.
INTERVAL
BETWEEN
ONSET AND
DEATH
4 I HEREBY
CERTIFY,
That I attended deceased from
196.1
July 1,
to.
July ... 12
I last saw h.elalive on
July 7,
1961
To be filed for burial permit with Board of Health or its Agent.
Registered No.
:32
M R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following · les of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(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 instruction on face side of standard certificate of death. JUL 1 4199
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 basmess, 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.
6
P
5
11. 12. 1
TOWĄ
CL
RECEIVED
X 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.
133
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Michael J .Moynihan
(First Name)
(Middle Name)
(Last Name)
[ (Was deceased a U. S. War Veteran,
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
45 Atlantic Street
.St.
(If nonresident, give city or town and State)
Length of stay: In place of death. years .. months. days. In place of residence 35 years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
12
1961
(Month)
(Day)
1
(Year)
4 I HEREBY CERTIFY
July 5
19.61, to
July
17
That I attended deceased from
1961
I last saw h.j.xtalive on
July
11
19 ... 6.2 .. , death is said to
have occurred on the date stated above, at 5:00 A.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
5YRS
10a If married
HUSBAND of
sedan Alexander
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE9.3
Years
Months.
Days
If under 24 hours Hours ..... Minutes
Due To
(b)
GENERALIZED ARTERIOSCLEROSIS 10YRS.
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
HYPERTROPHIC ARTHRITIS
4YES:
Was autopsy performed?
What test confirmed diagnosis? CLINICALY LABORATORY
5 Was disease or injury in any way related to occupation of deceased? If so, specify
NO.
(Signed) M. Traunstein fr. M. D M.TRAUNSTEIN JR. M.D (PRINT OR' TYPE SIGNATURE) (Address) 73 BARTLETT RO, Date. July 12, 1961
PARENTS
17 NAME OF
FATHER
Timothy Moynihan
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Ellen Lynch
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
Mary Moynihan
21
Informant
(Address)
45 Atlantic St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of, transit permit was issued: Lackh E Virianne
(Signature of Agent of Board of-Health or other)
4.O
July 14-1961
(Official Designation)
(Date of Issue of Permit)
TVB
TRUCTIONS FOR L CERTIFICATE
giving , OF DEATH
not enter e than one e for each , (b) and (c)
does not mean de of dying, heart failure, ,etc. It means ase, 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, f 1954. requires :ians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type ander signature.
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL July15 1961
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop, Mass.
Received and filed JUL-14-1961 19
(Registrar)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDi dowed
or DIVORCED
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
ARTERIOSCLEROTic HEART
DISEASE
13 Usual
Occupation :
Retired Clerk
(Kind of work done during most of working life)
14 Industry
or Business :
Am. Agriculture Corp
15 Social Security No.
032-01-4873
Boston
16 BIRTHPLACE (City) (State or country) Mass
NO
WINTHROP MAST
Holy Cross
Malden Mass
-
0-928145
M R-301A 1
To be filed for burial permit with Board of Health or its Agent.
No. 45 Atlantic St.
(a) Residence. No.
(Usual place of abode)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un. related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(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. TILL: 1 44961 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.
UFF
TOW
LASS.
E
X
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. Mayflower Rest Home
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 134
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Henry H Mc Laughlin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
130 Grovers Ave
St.
(If nonresident. give city or town and State)
Length of stay: In place of death ........ ... years.
.6
months
days. In place of residence.
38years
. months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
13
1961
(Month)
(Day)
(Year)
4 I
HEKEBY
CERTIFY,
19
to.
19
I last saw h ... alive on
19 ............ , death is said to
have occurred on the date stated above, at
7:05 A.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
Arteriosclerotic Heart Disease yrs
(b)
Due
(c)
Generalized Arteriosclerosis
OTHER
SIGNIFICANT
CONDITIONS
Prostatism
yrs
Was autopsy performed?
No
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
Arthur C. Murray M.D.
(PRINT OR TYPE SIGNATURE) (Winthrop Board of Health 13 July 61
6
Winthrop
Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL July ..... 15 ..... 1961 19
7 NAME OF
FUNERAL DIRECTOR
Ernest P Caggiano
ADDRESS 147WinthropSt Winthrop
Received and filed 19.
JUL-14-1961
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
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 ..
83
.Years.
8
Months
Days
If under 24 hours
Hours .............. Minutes
13 Usual
Occupation :
Retired Gardener
(Kind of work done during most of working life)
14 Industry
or Business :
Landscaping
15 Social Security No.
022-16-7610
New York
16 BIRTHPLACE (City)
(State or country)
New York
17 NAME OF FATHER Henry E Mc Laughlin
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
I reland
Amy.BMcLaughlin
21 Informant (Address) 64. Vinal Ane Somerville
I HEREBY CERTIFY tbat a satisfactory standard certificate of death was filed with me BEFORE the burial or' transit permit was issued: Ralph E
(Signature of Agent of Board of Health or other)
HO
July 14 1961
(Official Designation)
(Date of Issue of Permit)/
V.B.
A 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.
litions contrib- death but not o the terminal ondition given
Chapter 137, 1954. requires .ns to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature. 11.0.
6-59-92 5686
Arthur @. Murrayl
M. D.
OF MOTHER
Margaret Thompson
19 MAIDEN NAME
PARENTS
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT [(Was deceased a { U. S. War Veteran, lif so specify WAR)
(Usual place of abode)
That I attended deceased from
Single
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Natural Causes
20
yrs
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 certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease us related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those'd persons who, though disabled by recognized disease unrelated to any form injury, have died 'without recent medical attendance or whose physician 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.
JUL 1 41961 AM
OFF
OF
TOW
.
SS.
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.
t
PLACE OF DEATH
Suffolk. (County)
Winthrop (City or Town) 40 Cutler
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.
Registered No. §(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
no.
U. S. War Veteran,
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
40 Cutler
(Usual place of abode)
Length of stay :
In place of death ..
20
months.
days. In place of residence.
25
.. years
months ........
.days.
MEDICAL CERTIFICATE OF DEATH BLACK INK
PERSONAL AND STATISTICAL PARTICULARS
8 SEX female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
(write the word)
or DIVORCED married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Jacob Mover
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No. ..... .none
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Myer' Abramhoff
18 BIRTHPLACE OF
FATHER (City) (State or country) Russia
19 MAIDEN NAME
OF MOTHER
Mollie
(unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country) Russia
Jacob Nover
21 Informant (Address) 40 Cutler Street, winthrop, Lass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
4.0
(Signature of Agent of Board of Health or other)
am
tily 17, 1961
(Official Designation)
(Date of Issue of Permit)
KI.B.
TRUCTIONS FOR L 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 ondition given
:- Chapter 137, 1954. requires ians to print or the cause or death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
. C.
0-928145
-
-
Due To (c)
OTHER
SIGNIFICANT
CONDIT
Rheumatoid Arthritis
Parkinson's Syndrome
15 yrs. 15 yrs,
no
Was autopsy performed?
What test confirmed diagnosis Clinical
5 Was disease or injury in any way related to occupation of deceased? ho If so, specify
(Signed)
Charles Liberay
M. D
Liberman
also .... print ... nameCharles
(PRINT OR TYPE SIGNATURE)
(Address)
.283 Shore ... Drive., .... Date.July 17, 19 61
¿Jorkmens Circle(Lebanon) West Roxbury Place of Burial or Cremation (City or Town)
DATE OF BURIAL
July .... 18m. 19 61
7 NAME OF
FUNERAL DIRECTOR
Benjamin F.Solomon
ADDRESS
120 Harvard Street, Brookline.
Received and filed 1111 17 1067 19
(Registrar)
PARENTS
2 FULL NAME
Mary Mover
(First Name)
(Middle Name)
(Last Name)
St.
(If nonresident, give city or town and State)
3 DATE OF
DEATH
July 17, 1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
October 1940
to July
17
That I attended deceased from
1961
I last saw hệ.Y .. alive on
July 16.
1961
.. , death is said to
have occurred on the date stated above, at
7:45 A,m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebral Hemorrhage
Due To
(b)
Cerebral Arteriosclerosis
INTERVAL BETWEEN ONSET AND DEATH 6 days
5 grs.
77
Odessa,
135
No.
M R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF
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 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.
6
HROP
JUL 1 71961 PM
PLACE OF DEATH
Suffolk
Winthrop (City or Town)
CERTIFICATE OF DEATH
Registered No.
136
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) No.
Home
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
(if so specify WAR)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
46 Washington Ave.
St.
20
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years.
.. months.
7
days. In place of residence
.. years.
months ..
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Widow
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Michael Meehan
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
88
8
22
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
Chelsea
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
John Welch
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Unable to obtain
19 MAIDEN NAME
OF MOTHER
Annie
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to obtain
21 William Welch
Informant
(Address)
30 Red Barn Rd. Wayland
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop, ..... Mass
Received and filed
JUL 20 1961
19
(Registrar)
PARENTS
(Signed)
MYRONO N. KING
(PRINT OR TYPE SIGNATURE)
(Address) LIVPLEASANT SI.
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