Town of Winthrop : Record of Deaths 1961, Part 30

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 30


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


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 import- ant, 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. Children 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.


SPACE FOR ADDITIONAL INFORMATION


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


R-301A 1


RUCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each (b) and (c)


Does not mean e of dying, heart failure, etc. It means e, or compli- which caused


os, if any, ave rise to cause (a), the under- cause last.


tions contrib- death but not the terminal ndition given


Chapter 137, 1954. requires ans to print or ne cause or of death on ertificates, and 48, Acts of quires Physi- print or type der signature. C


( 928145


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No. 133 Cliff Avenue


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. 1.52


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Wallace ..... Linwood .... Fabvan


(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.)


(a) Residence. No.


133 Cliff Avenue


(Usual place of abode)


St.


(If nonresident, give city or town and State)


Length of stay: In place of death 17 years


.months.


days. In place of residence ..... 7 ... years.


months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


(write the word)


MARRIED married


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY,


AUG11


19:


54


That I attended deceased from


to ..


AUG 16


I last saw h.#Malive on


/14


1961


death is said to


have occurred on the date stated above, at


135Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


CARCINOMA OF PANCREAS


WITH OBSTRUCTIVE JAUNDICE


(b)


HYPERTENSIVE HEART +


2YRS


Due To


VASCULAR DISEASE


(c)


POLYCYTHEMIA


3YRS


OTHER


SIGNIFICANT


OSTEO ARTHRITIS


CONDITIONS


DIABETES MELLITUS -SECONDARY S NO


Was autopsy performed ??


What test confirmed diagnosis? CHIICALS X-RAY


5 Was disease or injury in any way related to occupation of deceased? No. If so, specify


(Signed)


Myron n. Kruz


M. D


MYRON N. KINGAND


(Address)


2) PLEASANT SỐ


Date.


8/16


19.61


WINTHROP MASS


6


Winthrop Cemetery,


Winthrop, Mass


.


MOTHER (City)


Savoy


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


August 18,1961


19


7 NAME OF


FUNERAL DIRECTOR


Leefeel 13 March


ADDRESS


174 Winthrop St. Winthrop, Dass.


Received and filed


AUG 17-1961


19


(Registrar)


PARENTS


11 IF STILLBORN, enter that fact here.


12


AGE


64


4 Months ... ... Days


If under 24 hours


Hours ...........


.. Minutes


13 Usual


Occupation :


Glass contractor


14 Industry


or Business :


own business


15 Social Security No.


012-05-0240


Pittsfield


16 BIRTHPLACE (City)


(State or country)


Massachusetts


17 NAME OF


FATHER


Daniel F. Fabyan


18 BIRTHPLACE OF


FATHER (City)


Buxton


(State or country)


Maine


19 MAIDEN NAME


OF MOTHER


Mildred Horton


20 BIRTHPLACE OF


(State or country)


Massaachusetts


21 Informant Mrs Wallace ........ .... Fabvan


(Address)


133 Cliff Ave, Winthrop, Mass


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


[ (Signature of Agent of Board of Health or other)


8/09/61


(Official Designation)


(Date of Issue of Permit)


3 DATE OF


DEATH


August


16


1961


(Month)


(Day)


(Year)


male


white


10a If married, widowed, or divo


Ru diyorcedaldron


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


INTERVAL


BETWEEN


ONSET AND


DEATH


8 mo.


(Kind of work done during most of working life)


SYRS-


(PRINT OR TYPE_SIGNATURE)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE. RANK, RATING ....


ORGANIZATION AND OUTFIT.


SERVICE NUMBER.


6


THROP.


AUG 1 '71961 AM


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.


X


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No.


19 Myrtle Ave.


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.


153


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


2 FULL NAME


Ellen .... Barron


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


(a) Residence. No. 19 Myrtle Ave


St.


(If nonresident. give city or town and State)


Length of stay: In place of death


.. years.


months


days. In place of residence 5.0


.. years


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


August 21 1961


DEATH


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY


That I attended deceased from


to


@mail


19


61


Lili q.


21


61


I last saw helalive on


(aug.


11, 1961, death is said to


have occurred on the date stated above, at


11:30 A.m.


INTERVAL


BETWEEN


ONSET AND


DEATH


11 IF STILLBORN, enter that fact here.


Byrs


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 :


Own Home


15 Social Security No.


16 BIRTHPLACE (City) (State or country) Ireland


17 NAME OF


FATHER


Edward O' Brien


18 BIRTHPLACE OF


FATHER (City) (State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Ellen Carroll


20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland


21 Helen Barron


Informant (Address) 19 Myrtle Ave., Winthrop, Mas


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


Winthrop Mass


ADDRESS


Received and filed AUG 23 1961 19 ...


(Registrar)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIEI)


WIDOWED


or DIVORT Blowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Thomas E, Barron


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Arterios clerotic Heart


(b)


Disease.


C.x


Due To (c)


OTHER SIGNIFICANT CONDITIONS Cardiac Decompensation


Cardiac Decompensation


6 mos.


Was autopsy performed?


What test confirmed diagnosis ?clinical


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


(Signed)


Sitecan M. D.


Charles Liberman


(PRINT OR TYPE SIGNATURE) (Address) Winthrop Mass Date. 8/21/106/


6


Holy Cross Cemetery ........ Malden Mass Place of Burial or Cremation Town) DATE OF BURIAL August 24 19.61


PARENTS


I HEREBY CERTIFY that a satisfactory standard certificate of death was Tiled with me BEFORE the burial or transit permit was issued: Kalfle C. Sercanal (Signature of Ageny of Board of Health or other Health Office 8/23/61


(Official Designation)


(Date of Issue of Permit)


RUCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each (b) and (c)


Does not mean e of dying, heart failure, etc. It means e, or compli- which caused


os, if any, gave rise to cause (a), the under- cause last.


itions contrib- death but not the terminal ndition given


Chapter 137, 954. requires is to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.


-59-925686


I R-301A 1


Registered No.


PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, {if so specify WAR)


(Usual place of abode)


12


89


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


10


ḷERK


5


THROP


RULES OF PRACTICE AUG 2 31961 AM


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 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 bad 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.


R-301A 1


-


winthrop .. (City or Town)


Chelsea 9-7-61 1-


6


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


153


ROSSINE MACK (NcGeoch)


2 FULL NAME.


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


(a) Residence. No .......


157 Park St.


St.


Chelsea, Mass.


(Usual place of abode)


Length of stay: In place of death.


2


.. years.


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


(If nonresident, give city or town and State)


18.


.. years


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


1


9 COLOR


Remale white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Harry B. Mack


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


5 YRS AGE .. 89Years .. 7.


... Months.


3 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. --


16 BIRTHPLACE (City)


Patterson


(State or country)


New Jersey


Me Geoch


17 NAME OF


FATHER


John McGPoch


18 BIRTHPLACE OF


Scotland


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Rossine Fitzsimmons


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


s.c.o.t.land


6 St. Philips Cen. ( Crompton K. I Place of Burial or Cremation (City or Town)


DATE OF BURIAL August25, 1961


7 NAME OF


Edmund J. Carafa


FUNERAL DIRECTOR


ADDRESS


389 Washington Ave., Chel.


Received and filed.


AUG 24 1961


19


(Registrar)


5YRS


Due To (c)


OTHER


SIGNIFICANT


CHRONIC NEPHRITIS


CONDITIONS


1YR


Was autopsy performed?


What test confirmed diagnosis?


CLINICAL


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify ..


(Signed)


(Address)


447 Broodrios


.. Date .....


18-22196


100M- 11-55-916145


UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)


oes not mean of dying, heart failure, tc. It means > e, or compli- which caused


ns, if any, ave rise to cause (a), the under- ause last.


ions contrib- icath but not the terminal ndition given


Chapter 137, 1954, requires is to print or cause or death on rtificates.


·f


PLACE OF DEATH


Suffolk (County)


Mc. Convalescent Home No ...


S (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)


3 DATE OF


AUGUST


22


DEATH


1961


(Year)


(Month)


(Day)


4 I HEREBY CERTIFY,


That I attended deceased from


JUNE 4


19.


yes,


to AUG 22


41


I last saw heralive on


AUG22,


19.41, death is said to


have occurred on the date stated above, at


8 4%


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


ARTERIOSCLEROTIC


HEART DISEASE


INTERVAL BETWEEN ONSET AND DEATH


Due To


GENERALIZED


(1)


ARTERIOSCLEROSIS


NO


PARENTS


21


Informant.


11,20 Frank Cartas


(Address) /CO Ciney Que L'inthings


I' HEREBY CERTIFY that a, satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Tackle C. Serianu (Signature of Agent of Board of Health or other)


Health Officer


8/24/6)


(Official Designation )


(Date of Issue of Permit>


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


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46. Sec. 9.


A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- te n, shall. if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be. a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health. or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the


death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap, 632, Sec. 4, Acts of 1945.


No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.


Chap. 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


(1) Attending physicians will ceftify to such deaths only as those of persons to whom they have given bedside care.during a last illness from disease unrelated to any form of injury.


(2) Board of Health physiciane will certify to such deathsonly 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 notably deaths daused 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 occupation, 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 import- ant, 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. Children 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.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING ....


ORGANIZATION AND OUTFIT


SERVICE NUMBER


......


x PLACE OF DEATH


Suffolk (County)


Winthrop. (City or Town)


Mount's Convalescent Home No. 104 Highland Ave


[(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, lif so specify WAR)


2 FULL NAME


Ellen E .Hurley


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


83 Loring Road


St.


(If nonresident, give city or town and State) 50 .years. months .. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


August 26, 1961


(Month)


(Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWER i


or DIVORCEAngle


4 I HEREBY CERTIFY ,


aug. 14


1961


to.


Leing : 26


I last saw h.Y. alive on


Cenci


5/1


19 61


death is said to


have occurred on the date stated above, at


1:00Am.


INTERVAL BETWEEN ONSET AND DEATH


3 yrs.


12


AGE96


Years ..


......


Months


Days


If under 24 hours


Hours.


.. Minutes


13 Usual


Retired Milliner


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Millinery


None


15 Social Security No.


Boston


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


Jeremiah Hurley


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Annie Barret


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Informant (Address) .... Charles Blais 83 Loring Road Winthrop


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


ADDRESS Winthrop., ...... Mass.


Received and filed AUG 29-1961 19


(Registrar)


PARENTS


(Signed) Charles .... Liberman (PRINT OR TYPE SIGNATURE)


Winthrop Board of Health


5-26- 196-1


Holy Cross


Malden, Mass


6


Place of Burial or Cremation




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