USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 27
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7/18
1961
6 Holy Cross
Malden
Place of Burial or Cremation
DATE OF BURIAL
(City or Town)
July 20"
19
61
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit, was issued: Marble C. fereannet (Signature of Agent of Board of Health or othery
Health Officer
7/19/61
(Official Designation)
(Date of Issue of Permit)
V.B
STRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH
not enter re than one se for each ), (b) and (c)
does not meon ode of dying, s heart failure, , etc. It means cose, or compli- which caused
itions, if any, gove rise to · couse (o), g the under- cause lost.
nditions contrib- o deoth 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 equires Physi- › print or type nder signature. 14.C.
-11-59-926662
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
JULY
18
1961
(Month)
(Day)
(Year)
4 I
HEREBY CERTIFY,
That I attended deceased from
may
26
., 19 44
to
JULY 18
19.
61
I last saw h. Lalive on
JULY 18
19 61, death is said to
have occurred on the date stated above, at
11-Am.
INTERVAL
BETWEEN
ONSET AND
DEATH
3 mg
13 mg
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
ARTHRITIS
5YRS.
Was autopsy performed?
No
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased O If so, specify
X
M R-301A -
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
142 Pleasant Street WinthropConvalescent
Mary E Meehan
(Welch)
(a) Residence. No.
(Usual place of abode)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE CARCINOMA of COLOR (a) ... GAD GENERAL CARCINOMA Due To (b)
ARTERIOSCLERITIC HEART DO.
M. D.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING JUL 2 01961 A1
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.
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
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
137
Michael Joseph Murphy
PHYSICIAN - IMPORTANT
f(Was deceased a U. S. War Veteran,
(If deceased is a married, widowed or divorced woman, give also malden name.) 40 Bowdoin St.
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death. 0 .years. 0 months. 17
.days. In place of residence .years. months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE MARRIED WIDOWED or AIVORCEL
(write the word) Wedrica
10a If married, widowerMiery C. Crowley HUSBAND of
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE ... 72
10 yr 'ears Months. 14 Days
If under 24 hours Hours. Minutes
13 Usual Occupation : Retired
Chauffeur
(Kind of work done during most of working life)
14 Industry or Business : Standard Oil Co
15 Social Security No. 109.03-1320
16 BIRTHPLACE (City) (State or country) Wisconsin
17 NAME OF
FATHER
Michael & Murphy
18 BIRTHPLACE OF FATHER (City) (State or country)
Ireland
19 MAIDEN NAME OF MOTHER
Helena V Kamen
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
William Musklene
21 Informant (Address) Hi Doudouist Henlord
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : ralph S. Sirianni (Signature of Agent or Board of Health or other)
7/ 21/6/
4.0
(Official Designation)
(Date of Issue of Yermit)
1 V.BJ
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ), (b) and (c)
does not meon ode of dying, s heart foilure, a, etc. It means eose, or compli- which caused
itions, if ony, gove rise to couse (a), g the under- cause last.
nditions contrib- o dcoth but not to the terminol condition given
- Chapter 137, 1954. requires ans to print or he cause or of death on ertificates, and : 48. Acts of equires Physi- print or type der signature. I.C.
6 Holy -6.2020
Place of Burfal or Cremation DATE OF BURIAL
July 22
Schreef Placequando
7 NAME OF FUNERAL DIRECTORES 12 ADDRESS 147 Was Thro St Weathered
Received and filed
19
JUL 2 1 1961
(Registrar)
10yr.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Cerebral
17
Hemorrhageldays
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? MI If so, specify
(Signed) M. D.
(Ad
(PRINT OR TYPE SIGNATURE) John F. Collins Podle 21 July, 61
PARENTS
St.
Winthrop- Mass
(If nonresident, give city or town and State)
35
3 DATE OF
DEATH
July 20
1961
(Month)
(Day)
(Year)
4 I HEREB July 3 CERTIFY
19. "61 to July
-That I attended deceased from 19 20 6/
I last saw h ....... alive on vuly 19 19. 6% death is said to have occurred on the date stated above, at the $ 5 00m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Arteriosclevotic Heart Disease
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Generalized
Arteriosclerosis
×
RM R-301A 1
To be filed for burial permit with Board of Health or its Agent.
No.
(City or Town) Winthrop Community Hospital
S(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
2 FULL NAME.
-11-59-926662
Halden (City or Town) 1961
(if so specify WAR)
(Giye maiden name of wife in full)
0
7
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICEJUL 2 11961 M
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.
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.
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
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) 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 deccased
50M-9-59-926111
PLACE OF DEATH
Middlesex
(County ) Cambridge
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
(City or Town making this return)
Registered No.
138
Guardian Hospital 85 Otis St., Camb.
§ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Violet Thomas
2 FULL NAME
(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,
St
Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months.
10
6
days. In place of residence:
years ......
... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
20,
1961
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
( Month)
(Day)
(Year)
July 14,
CERTIFY,
61
er
I last saw h ...... alive on
19
death is said to
have occurred on the date stated above, at
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Recurrent Subdural Hematona
(a)
(b) Due To Cerebral Atrophy
5 yrs.
13 Usual
Occupation :
Home
14 Industry
or Business :
Housewife
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
17 NAME OF FATHER
N.B.L.
c.
18 BIRTHPLACE OF
FATHER (City)
(State or country )
C.N.B.L.
5 Was disease or injury in any way related to occupation of deceased ?
If so. specify
Francis L. Smith, M.D.
(Signed)
85 Otis St. Camb.
Date.
19
winthrop Cemetery 6
Winthrop,
(City or Town)
DATE OF BURIAL 19
7 NAME OF
FUNERAL DIRECTOR
Maurice W. Kirby
ADDRESS
210 Winthrop St., Winthrop, Mass
.. .
ATTEST :
61
19
(Registrar of City or Town where death occurred)
July 20
61
DATE FILED
19
( Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
C.N.B.L.
C.N.B.L.
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Veteranes Bureau
21
Informant
.Winthrop, ... Mase.
( Address )
A TRUE COPY COPY Tehnice ly COL,
Received and filed
That
I attended
July 20,
deceased from
61
19
10a If married, widowed. or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
C.N.B.L.
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE 4.
Years.
-
Months .....
Days
If under 24 hours
Hours ....
.Minutes
(Kind of work done during most of working life)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
NO
What test confirmed diagnosis ?
Operation
July 20 61
(Address )
Place of Burial or Cremation
July 29,
61
M. D.
1
(City or Town)
No ....
26 Beacon St., Winthrop
(a) Residence. No .. ( Usual place of abode)
19
to .......
July 19,
61
9:35 A.
m.
I HEREBY
Widowed
XI
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
RUD
AUG 91961 AM
PLACE OF DEATH
SUFFOLK
- T .. .
....
(County)
Winthrop (City of Town)
Winthrop Community Hospital No.
[(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,
NO
if so specify WAR)
HE. Boston
(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
July
(Month)
21
1961 (Year)
4 I HEREBY CERTIFY,
July di
1961, to
That I attended deceased from
di
196
19 61, death is said to
I last saw ha) .... alive on
July di
have occurred on the date stated above, at
P
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Prematurity
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Atalectasis of hunge
Was autopsy performed ?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
., M. D.
A. Paul DERHAGOTHESE NATURE)
(Address) SECHRY AV. CHELSEA Date July di 1961
6. 1. 1SE Nedictlern, West Roxbury Place of Burial or Cremation (City or Town)
DATE OF BURIAL
July 24
WillAnn F. Walsh
7 NAME OF FUNERAL DIRECTOR
ADDRESS 20 /KgJUL 25 Gosphthong
Received and filed
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
White
10 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCED Quela
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
14 Hours.
.Minutes
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
17 NAME OF
FATHER
NEEnged. Buches
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston
MASS
19 MAIDEN NAME OF MOTHER
HackErt ChildRed HackEtt
East PepperELL
MASS
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
George Buchey
IVALOR Rd BASE BOSTON
21
Informant c
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued: Kalku e. Percannes (Signature of Agent of Board of Health or other) Theatthe Officer 7/22/61
(Official Designation)
(Date of Issue of Permit)
X
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH
not enter re than one se for each ), (b) and (c)
does not mean ode of dying, s heart failure, , etc. It means ease, or compli- which caused
itions, if any, gave rise to cause (a), g the under- cause last.
nditions contrib- o death but not to the terminal condition given
- Chapter 137, 1954. requires ans to print or the cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
-11-59-926662
19%-8
PENSE PETIT
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.
139
Baby Girl Bushey
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
.St.
1 VALOR
(Day)
PARENTS
M R-301A -
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.
CE OF
OF
MIN
(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, Out also deaths from disease resulting from injury or infection related to occu- Dation, 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.
JULI 2 51961
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 - Atts had been given up or changed, or if the deceased had retired from business, Heport 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.
,
X
ORM R-304
PLACE OF DELIVERY No.
Suffolk (County )
1 Winthrop (City or Town)
Winthrop Community Hospital
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
140
( If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVERY
July 24, 1961 Month )
( Day)
(Year)
4 SEX
X
Male. .. Female ... . Undetermined
5 COLOR (if
determined )
6 THIS BIRTH (Check one) SingleA Twin Triplet
7 IF MULTIPLE BIRTH, BORN : .2nd .3rd. 1st. .
FATHER
MOTHER
14 MAIDEN NAME Mary Doheney
PRESENT NAME Mary Titus
9 RESIDENCE, NO. CITY OR TOWN
88 Holyoke St., Malden
STATE
STREET
Mass.
15 RESIDENCE, NO. CITY OR TOWN
88 Holyoke St., Malden
.STREET
STATE Mass.
10 COLOR OR
RACE
White
11 AGE AT TIME OF THIS DELIVERY 42 (Years)
16 COLOR A RACE White
17 AGE AT TIME OF THIS DELIVERY 42 (Years)
12 PLACE U
BIRTH
Nova Scotia
(City or Town )
(State or country )
18 PLACE OF BIRTH Revere, Mass. (City or Town !
(State or country )
13 OCCUPATION Crane Operator
19 INFORMANT
Victor Titus
20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus
7
21 LENGTH OF PREGNANCY full teomleted weeks
22 WEIGHT OF FETUS
Lb.
Oz.
23 WHEN DID FETUS. MIE? X Before Labor
During Labor or Delivery . . Unknown.
25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Gord around nrck
Due To (b) Card wound real Due To (c) coRd aRound NECK
OTHER SIGNIFICANT CONDITIONS
none
26 Woodlawn Place of Burial or Cremation
Everett
DATE OF BURIAL
July 25
19
27 NAME OF FUNERAL DIRECTOR
ADDRESS
Howard S Reynolds Winthrop, Mass
Received and filed
July 24, 1961
Registrar 1
A TRUE COPY ATTEST :
I HEREBY CERTIFY that this delivery occurred on the date stated above at 12 . 2 1. . amdmroduct of conception was not a live birth.
Signature of Attending Physician or Medical Examiner :
M.D.
Maurice Traunstein Jr. (PRINT OR TYPE SIGNATURE)
Addres73 Bartlett Rd, Winthrop Mass
Date 7/24.161
I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued:
Ralph E Sirianni (Signature of agun Board of Health or other )
40 (Officart Designation )
July 24, 1961
Date of Issue of Permit) X
In giving CAUSE OF ETAL DEATH do not enter more than one cause for each of (a), (b) and (c)
tal or maternal dition causing al death (do t use such ms as stillbirth prematurity.) tal and/or ma- nal conditions, any, which gave se to above ise (a), stating · underlying ise last.
nditions of fetus mother which y have contrib- ed to fetal ith, but, in so as is known, re not related cause given (a).
|5M-6-60-928241
Baby Boy Titus
St.
2 NAME OF FETUS (if given)
W
(a) How many children are
now living ?
7
(b) How many children were born alive burg are now dead?
(c) How many previous fetal deaths of ANY gestation age ? 0
24 AUTOPSY Yes No
5
(or Grams
Asphyxia
(City or Town) 61
8 FULL NAME Victor Titus
FETAL DEATH
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS, OF 1960.
Section 2A,, "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, . . . shall not be permitted except .. . ".
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
X Suffolkinty) Winthropown
Boston
C 17:2-8
CINSE PETIT
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.
NoWinthrop Community Hospital
2 FULL NAME .Calisto
( First Name)
(Middle Name)
(Last Name)
Ramos
U. S. War Veteran,
{if so specify WAR) no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
190 London St.
(L'sual place of abode)
Length of stay: In place of death .........
years.
.months.
4
days.
In place of residence ..
... years ..
... months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July.
25
1961
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY, That I attended deceased from
July 21
19 .. 6.1, to ..
July ..... 25
19.6.1.
I last saw Tr ........ alive onuly
25, 161, death is said to
have occurred on the date stated above, at 6 75 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
..... Acute ..... pulmonary ..... edema
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
66
AGE
Years
Months ...
Days
If under 24 hours
Hours ........... .Minutes
Due To
(b)
Congestive heart failure
Due To
(c)
Bilat. viral pneumonitis
OTHER SIGNIFICANT CONDITIONS
15 Social Security No.
024-07-24.95
16 BIRTHPLACE (City)
.....
Portugal
(State or country)
17 NAME OF
FATHER
Michael Ramos
18 BIRTHPLACE OF FATHER (City) (State or country) Portugal
19 MAIDEN NAME
OF MOTHER
Elizabeth (unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country) Portugal
21 Informant (Address) Ondina Ramos (wife) 190 London St. Last Boston Mass
7 NAME OF
FUNERAL DIRECTOR
Vincent. Rapino
ADDRESS
9 Chelsea St., East, Boston, Mass.
Received and filed
JUL 27 1961
.19
(Registrar)
50-928145
PLACE OF DEATH
M R-301A 1
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
lions, if any, gave rise to cause (a), : the under- cause last.
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