Town of Winthrop : Record of Deaths 1961, Part 28

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 28


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


ditions contrib- death but not o the terminal condition given


::- Chapter 137, of 1954. requires cians to print or the cause or ; of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 28,


6


19


PARENTS


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Halble E fireande x (Signature of Agent of Board of Health or other) Theable Officer


. 7/26/65


(Official Designation)


(Date of Issue of Permit)


X


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWEMarried


or DIVORCED


10a If married, widowed, or divorced Ondina Nunes HUSBAND of (Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


E hr


4 days'3


Occupation :


machine operator


(Kind of work done during most of working life)


14 Industry


5 days or Business:


Commercial Filters Corp.


Was autopsy performed?


Noclinical & X-ray


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased ?- If so, specify


No


(Signed)


Louis E Schuif/a OMP.


M. D


Louis E Schwartz (PRINT OR TYPE SIGNATURE)


(Address19 Bennington st" Date 7-25-61 19


F. Boston


Woodlawn Everett


Registered No.


141


S(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)


PHYSICIAN - IMPORTANT [(Was deceased a


St.


East Boston


Mass


(If nonresident, give city or town and State)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OF


78 12 3


GLERK.


OFFI


3


MIN


1 (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.


WI


6.


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.


(3) Medical Examiners will investigate and certify to all deaths supposably THROP. 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 JUL 271961 PMThose 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-304


1


(City or Town) PLACE OF DELIVERY Suffolka (County )


2 NAME OF FETUS (if given )


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.


1.42


(If death occurred in a hospital or institution, give its NAME instead of street and number)


3 DATE OF


DELIVERY


Month )


(D)


(Year )


4 SEX


Male ... .. Female


Undetermined


5 COLOR (if


determined)


6 THIS BIRTH (Check one)


Single Twin


Triplet


7 IF MULTIPLE BIRTH, BORN :


1st.


2nd


3rd.


FATHER


8 FULL NAME Leo Marshall


14 MAIDEN NAME


MOTHER Victoria Marshall


PRESENT NAME


Victoria Marshall


9


RESIDENCE, NO.


CITY OR TOW


Earl Bolin


STAT


15


RESIDENCE, NO.


CITY OR TOWN


EurBol STAT


10 COLOR


RACE


11 AGE AT TIME OF THIS DELIVERY (Years)


22


12 PLACE OF BIRTH Bustin


mass


(City or Town)


( State or country ,


13 OCCUPATION Truckbliver


19 INFORMANT


Victoria Marshall


20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus) 2 normal


(a) How many children are now living? 2


(b) How many children were born alive but are now dead ? None


(c) How many previous fetal deaths of ANY gestation age ?


21 LENGTH OF PREGNANCY 32


.completed


weeks


(or


FETUS 14 Oz. Grams


23 WHEN DID FETUS DIE? Before Labor


24 AUTOPSY


Yes


No


25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Died in Utero


Due To (b) Ery Thro BlasTosis DeTalks Blood Due To (c) Rho


OTHER SIGNIFICANT CONDITIONS


26 Holy Cross Cemetery Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL July 29,


27 NAME OF FUNERAL DIRECTOR Vincent kopino


ADDRESS


9 Chelsea St., East Boston, Mass.


Received and filed


JUL 28 1961


19.


(Registrar )


A TRUE COPY ATTEST :


I HEREBY CERTIFY that this delivery occurred on the date stated


above at m., and product of conception was not a live birth.


Signature of Attending Physician or Medical Examiner : Louis ESduffa M. D.


Louis E Schrifta (PRINT OR TYPE SIGNATURE) 19 Bennington: Address Date Jul 27 19 6/


I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued :


Talkh E: Sirianni ( Signature of/Agent of B a fond of Health or other) 7/2$61


H: O


(Official Designation )


(Date of Issue of Permit)


BROMell


Prescott


STREET


16 COLOR


RACE


17 AGE AT TIME OF 2 2 Years) THIS DELIVERY


BIRTH


Lynn (City /Town )


Mees


(State or country )


In giving CAUSE OF TAL DEATH do not enter nore than one ause 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, ny, which gave se to above ise (a), stating underlying se last.


nditions of fetus mother which y have contrib- ed to fetal th, but, in so as is known, re not related cause given (a).


15M-6-60-928241


Winthrop Community Hospital Baby Girl Marshall


St.


/27/61


O Prescott AV


STREET


22 WEIGHT OF


Lb.


During Labor or Delivery Unknown


OF TO


OFFI


MIN


CLERK


CA


0


*


WII


6


FETAL DEATH


EXTRACT'S OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS.OF 1960. JUL 2/71961 PM 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


ORM R-302


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


.


A TRUE COPY


ATTEST :


(Registrar of City of Town where death occurred)


August 1,


19.


61


( Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


Married


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


Gordon W. Graham


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL


BETWEEN


ONSET AND


DEATH


11 IF STILLBORN, enter that fact here.


12


AG


.Years


69


1


Months.


26 Days


If under 24 hours


.Hours ......


.. Minutes


13 Usual


Occupation :


Housewife


( Kind of work done during most of working life)


14 Industry


or Business :


Own home


15 Social Security No.


Boston.


16 BIRTHPLACE (City)


(State or country )


Mass


Arteriosclerosis


2years


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country )


Holland


19 MAIDEN NAME


OF MOTHER


Katherine Nold


20 BIRTHPLACE OF


Pittsburgh,


MOTHER (City)


( State or country)


Penn.


Winthrop


DATE OF BURIAL


August 2,


61


19


7 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS


Winthrop, Mass.


Received and filed


AUG 10-1961


.. 19.


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


Revere


(City or Town making this return)


1


PLACE OF DEATH


Suffolk (County)


Revere (City or Town )


No .... Grover .... Manor .... Hospital


§ (If death occurred in a hospital or institution,


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


2 FULL NAME


Gertrude E. Graham (Steinauer)


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


Ilılı Hermon


S


Winthrop, Mass.


(If nonresident, give city or town and State)


Length of stay: In place of death .......... years .......... month ... Q


„days. In place of residence 40 years. .. months .......... days.


MEDICAL CERTIFICATE OF DEATH


(a)


Residence.


No ..


( Usual place of abode)


3 DATE OF


DEATH


July


31,


(Month)


(Day)


4 I HEREBY CERTIFY.


June .... 15.


19


have occurred on the date stated above, at


(a)


Brain Tumor


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


NO.


(Signed )


George A. Haines


16 Raymond St.,


( Address )Everett


S


Winthrop


Place of Burial or Cremation


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)


What test confirmed diagnosis ?


X-Ray


1961


(Year)


That I attended deceased from


61


to .... Jul.y ...... 31


19 .. 61 ..


I last saw Me.Malive on


July31


1961


death is said to


3:00A


m.


Due To (b) 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)


50M-9-59-926111


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


If so, specify


No


M. D.


.Date.


July 31 . 67


(City or Town)


21 Gordon W. Graham


Informant


( Address)


Ihh Hermon St., Winthrop


143


Registered No.


( Was deceased a


U. S. War Veteran.


if so specify WAR


DATE FILED


0.


X U.B.V


3mos,


NAME O


FATHER


Charles Steinauer


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT/ SERVICE NUMBER


AUG. 1.0.1961 AM


FORM R-302


EATH


The Commonwealth of Massachusetts JOSEPH D. WARD


ARIZONA STATE DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS


STATE FILE NO.


4363


CERTIFICATE OF DEATH


REGISTRAR'S NO.


8.08


1. PLACE OF DEATH


A. COUNTY


Pima


B. LENGTH OF STAY


IN THIS TOWN


6 wks


IN ARIZONA


6 wks


2. USUAL RESIDENCE


A. STATE


Mass.


(WHERE DECEASED LIVED. IF INSTITUTION: RESIDENCE BEFORE ADMISSION) B. COUNTY


C. CITY


OR


TOWN


Tucson


IN CITY LIMITS


O OUTSIDE CITY LIMITS


C. CITY


OR


TOWN Winthrop


IN CITY LIMITS


OUTSIDE CITY LIMITS


D. FULL NAME OF


HOSPITAL OR


INSTITUTION


(IF NOT IN HOSPITAL OR INSTITUTION. GIVE STREET ADDRESS OF 1948 E Hedfick


D. STREET (IF RURAL, GIVE LOCATION) E. IS RESIDENCE ON A FARMI ADDRESS


-


YES O NO O


3. NAME OF


DECEASED


(TYPE OR PRINT)


(FIRST)


Helen


B.


(MIDDLE)


Grant


c.


(LAST)


Cammall


-


4. SEX


female


white


GA. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED (SPEGIFT) wodowea


6B. NAME OF SPOUSE


- - -


9B. KIND OF BUSI- NESS OR INDUSTRY home


10. BIRTHPLACE (STATE


OR FOREIGN COUNTRY)


Mass.


11. CITIZEN OF WHAT


COUNTRY?


U.S.A.


12. WAS DECEASED EVER IN U. S. ARMED FORCES7 | 13. SOCIAL SECURITY (TSS, NO. OR UNKNOWN) no (IP TES, WAR OR DATES OF SERVICE)


unkRown


14A. FATHER'S NAME


unknown


148. BIRTHPLACE


(STATE OR COUNTRY)


15A. MOTHER'S MAIDEN NAME


unknown


15B. BIRTHPLACE -


16. INFORMANT'S SIGNATURE


mitte


ADDRESS P.ODPREY 1115


17. DATE


OF


DEATH


(MONTH) May


(DẠY)


(TEAR) 1901


18. CAUSE OF DEATH ENTER ONLY ONS CAUSE PSR LINE FOR (A). (B), (C).


1. DISEASE OR CONDITION DIRECTLY LEADING TO DEATHt (A)


.


Cerebral /frenter's)


INTERVAL BETWEEN ONSET AND DEATH


ITHIS DOES NOT MEAN THE NODE OF DYING, SUCH AS HEART FAILURE. ASTHENIA. ETC. IT MEANS THE DISEASE. INJURY. OR COMPLICATION WHICH CAUSED DEATH.


ANTECEDENT CAUSES MORBID CONDITIONS, IF ANY, GIVING RIBE TO THE ABOVE CAUSE (A) STATINO THE UN. DERLYING CAUSE LAST. DUE TO (C)


DUE TO (B) Cert. SEGerais


geters


11. OTHER SIGNIFICANT CONDITIONS CONDITIONS CONTRIBUTING TO THE DEATH BUT NOT RELATING TO THE DISEASE OR CONDITION CAUSING DEATH.


PLACE DISSASE CONTRACTED. 19A. DATE OF OPERATION


19B. MAJOR FINDINGS OF OPERATION


20. AUTOPSY? YES


0 NO


21. 1 HEREBY CERTIFY THAT I ATTENDED THE DECEASED FROM.


ALIVE ON 22A. SIGNATURE


AND THAT DEATH OCCURRED AT (DEGREE OR TITLE)


22B. ADDRESS


22C. DATE SIGNED


23A. ACCIDENT


SUICIDE


HOMICIDE


NATURAL CAUSE


(SPECIFY)


AL CE


23D. TIME (MONTH) OF


(DAY)


(THAN) ( HOUR )


23F. HOW DID INJURY OCCUR?


INJURY


M


24A. CORONER'S SIGNATURE


24B. ADDRESS


24C. DATE SIGNED


25A. BURIAL O CREMATION O REMOVAL D


258. DATE May 9/61


25C. NAME OF CEMETERY OR CREMATORY Evergreen Crematorium


25D. LOCATION (CITY, TOWN,.OR COUNTT) (STATE) Tucson, Arizona


27B. AD


AND REGISTRAR


26A. DATE REC -LOCAL REG. -10-6


27A. FUNERAL DIRECTOR'S SIGNATURE err Mortuary & Rieu


AT EMBALMER'S SIGNATURE


288. EMBALMER'S 226 FERT NO


JON


Received and filed


19


(Registrar of City or Town where death occurred )


27,1961


( Registrar of City or Town where deceased resided )


DATE FILED


Not Be tes l


19


U


NON- RESIDENT


A.


7. DATE OF BIRTH DAY


NONTH YEAR Jan. 28 1881


8. AGE (IN TEARS| IF UNDER 1 YEAR LAST BIRTHDAT) NONTNS DAYS 80


IF UNDER 24 HRS HOURS


NIN.


-


9A. USUAL OCCUPATION (GIVE KIND OF WORK DURING MOST OF LIFE SVEN IF RETIRED) housewife


(STATE OR COUNTRY)


MEDICAL CERTIFICATION


10


C /THAT I LAST SAW THE DECEASED


&M. FROM THE CAUSES AND ON THE DATE STATED ABOVE.


238. PLACE OF INJURY (E.G., IN OR ABOUT HOME,


FARM, FACTORY, STREET, OFFICE BLDG., ETC.)


23C. (CITY OR TOWN) (COUNTY) (STATE)


NOT WHILE


23E. INJURY OCCURRED


WHILE AT


WORK DI


AT WORK


26B, REGISTRAR'S SIGNATURE


FORM VS-2 REV. 8-8-60 -. 25


H


PUNCHED VERIFIED


BIRTH NO.


Suffolk


B. COLOR OR RACE


SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


ORM R-302


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


n. C.


PLACE OF DEATH


Essex


(County )


1


Danvers


(City or Town)


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


Danvers


(City or Town making this return)


Registered No. 145


S (If death occurred in a hospital or institution, Danvers State Hospital, Hathorne st. ( give its NAME instead of street and number) No ...


2 FULL NAME Charles .... Flanagan


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


( Was deceased a


U. S. War Veteran,


(if so specify WAR, ...... no.


(a) Residence. No. 86 Plumner Avenue St. Winthrop Mass.


( Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death ._..... years ....... months.


1.Says. In place of residence .......... years .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July


25


(Day)


1961


( Month)


(Year)


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEDWidowed


4 I HEREBY CERTIFY,


That I attended


deceased


from


April. 6,


19:59


to ...


July .... 25.


19


61


I last saw


h. 1.Mive on


July.25,


19 ... 61death is said to


have occurred on the date stated above, at 5:508am.


INTERVAL


BETWEEN


ONSET AND


DEATH


(or) WIFE of.


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) .Generalized ... Arteriosclerosis


years


11 IF STILLBORN. enter that fact here.


12


AG


78


Years.


8


.Months.


.. 1.6.Days


If under 24 hours


.Hours ........


Minutes


13 Usual


Occupation :


Retired .... Fireman


(Kind of work done during most of working life)


14 Industry or Business :


15 Social Security No.


none


16 BIRTHPLACE (City)


(State or country)


M998.


17 NAME OF


FATHER


Patrick Managan


18 BIRTHPLACE OF


Unknown


FATHER (City)


(State or country )


Ireland


19 MAIDEN NAME OF MOTHER Elizabeth Martin


20 BIRTHPLACE OF


Unknown


Holy Cross Cemetery, Malden, Mass 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


July 27,


1967


21 Informant ( Address )


Mary E. She ehan


Hathorne, Mass.


7 NAME OF FUNERAL DIRECTOR Arthur J. O'Maley


ADDRESS Winthrop ...... Mas.s.


Received and filed AUG 15-1961 19


( Registrar of City or Town where deceased resided )


PARENTS


50M-9-59-926111


Due To (b) 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)


OTHER


? Cancer Intestinal


SIGNIFICANT


CONDITIONS


tract


Was autopsy performed ?


no


What test confirmed diagnosis ? clinical & Laborato


5 Was disease or injury in any way related to occupation of deceased ? If so, specify


( Signed )


Andrew Nichols III


M. D.


(Address) Hathorne, Mass. Date


7-25-1967


MOTHER (City)


(State or country )


Ireland


A TRUE COPY


Jemily. Tooming


ATTEST :


(Registrar of City or Town where death occurred )


DATE FILED


July 31,1:


67


Boston


10a If married, widowed, or divorced


HUSBAND of


Lillian G. Fraser


(Give maiden name of wife in full)


RECEIVED


TOW


OF


GLEA


1410


MIN


5.


AUG 1 5 1961


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


ORM R-302


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


m.C.


PLACE OF DEATH


Essex (County )


Denvers (City or Town)


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


Danvers


(City or Town making this return)


Registered No.


If death occurred in a hospital or institution, give its NAME instead of street and number)


2 FULL NAME


William F. Crowley


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


43 Loring Rd.


x Winthrop, Mass.


(a) Residence. No ....


( Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death .......... years.


.. months.


18


days. In place of residence .......... years. .months .......... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


( write the word)


( Month)


(Day)


( Year)


4 I HEREBY CERTIFY.


That I attended deceased from


July 1l .


61


August 1


to ...


19


61


death is said to


have occurred on the date stated above, at


INTERVAL BETWEEN ONSET AND DEATH


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


72


Years


6


13


If under 24 hours


.....


.. Hours .......


Minutes


13 Usual


Occupation:


Retired Engineer


( Kind of work done during most of working life)


14 Industry or Business : 011-18-0818


15 Social Security No.


Boston


16 BIRTHPLACE (City)


(State or country)


Mass.


OTHER Diabetes Mellitus


What test confirmed diagnosis ?


Clinical & Laborato


5 Was disease or injury in any way related to occupation of deceased ? If so. specify


( Signed )


Andrew Nichols III


M. D.


( Address )


Hathorne, Mags. 8-1-


61


19.


Winthrop Cemetery, 6


Winthrop, Mass.


( City or Town)


DATE OF BURIAL


August 3,


61


19


21


Informant


( Address )


Hathorne, Mag.s.


7 NAME OF FUNERAL DIRECTOR


Richard C. Kirby, Inc


ADDRESS E. Boston, Mass.


ATTEST :


( Registrar of City or Town where death occurred)


DATE FILED August 4,51


1


(a) (b) 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)


50M-9-59-926111


3 DATE OF


DEATH


« resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)


SIGNIFICANT


CONDITIONS


Due To


Generalized Arteriosclerosis


years


years


17 NAME OF


FATHER


William Crowley


PARENT'S


18 BIRTHPLACE OF


Boston


FATHER (City)


(State or country )


Mass.


19 MAIDEN NAME


OF MOTHER


Mary E. Clinton


20 BIRTHPLACE OF


MOTHER (City)


Boston


Mass:


(State of country)


Mary L. Sheehan


A TRUE COPY


Josep J. Toomey


Received and filed AUG 15-1981 19


( Registrar of City or Town where deceased resided)


10a If married, widowed, or divgertrude Walsh


HUSBAND of


(Give maiden name of wife in full)


I last saw


Malive on


August 1


19


4:108


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Cerebral Hemorrhage


weeks


MEDICAL CERTIFICATE OF DEATH


August


1.


1961


1


No


Danvers State Hospital , Hathorn


( Was deceased a


U. S. War Veteran,


W.W. I


(if so specify WAR


married


61


Months.


Davs


Was autopsy performed ?


no


Place of Burial or Cremation


RECEIVED


TOWA


71 12 3


CLERK


1-1-10


S


5


WI


-


THR


AUG 151961 AM


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


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.


Mi


2 FULL NAME


Marion


Agnes


Shea


[(Was deceased a


U. S. War Veteran,


{if so specify WAR)


NO


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


5 Sagamore Ave.


St.


Winthrop, Mass.


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of death .............. years. ......... months. 11


50


-


days.


In place of residence


.years.


.. months ..


- days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE-


9 COLOR


WHITE


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


SINGLE


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 7 7 Years.


Months.


.Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


OFFICE


CLEARKT


(Kind of work done during most of working life)


14 Industry


or Business :


COURT HOUSE


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


M.15


17 NAME OF


JEREMIAH A SHEA


18 BIRTHPLACE OF


FATHER (City)


(State or country)


IRELAND


19 MAIDEN NAME


OF MOTHER


MARY A (SHEA)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


MASS


21 HENRY V MULLEN


Informant


(Address) / OSWAKEFIELD ST READING


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS


HINTHIPOP


Received and filed


AUG 3 - 1961


19.


(Registrar)


11 DAYS


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


GENERAL ARTERIOSCLEROSIS


3 YRS.


Was autopsy performed?


No .


What test confirmed diagnosis ?


X-Ray- operation.


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


(Signed)


, M. D.


MYRON IN. KINGM.D


(PRINT OR TYPE SIGNATURE)


Date. (Address) 222 PLEASANT SI 8/1/6/


6


CALVARY


LA INI


BOSTON


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


AVG


4


1961


PARENTS


I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or, transit permit was issued: Ralph 6. Percannex Signature of Agent of Board of Health or other) Thealth Officie 8/5/61


| (Official Designation)


(Date of Issue of Permit)


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, 1, 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 he cause or of death on ertificates, and 48, Acts of equires Physi- print or type nder signature. 1. C.




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