Town of Winthrop : Record of Deaths 1961, Part 37

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 37


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


M. D


PAUL


C. BARSAM


(PRINT OR TYPE SIGNATURE)


(Address)


MASS. MEN. HOSP Date


July 3061


Vilkomer Cemetery melrose


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Benjamin. F. Solomon


ADDRESS


420 Harvard St Brookline


July 6.


19 61


19


21


Informant


31 Visst Boulevard Rd Newton Care


1


[ ( Was deceased a


U. S. War Veteran.


lif so specify WAR)


W.W.I


WINTHROP


MASS.


( If nonresident, give city or town and State)


MÉMORIAL HOSP.


No.


R-301A 1


PARENTS


18 BIRTHPLACE OF


FATIIER (City)


(State or country)


CORONARY HEART DISEASE.


4


A TRUE COPY ATTIST. Charles it Mackie Wat Registrar


- = CEIVED


TOWA


IF


MLERK


3


3


6


HROB


OCT 2 51961 AM


X


PLACE OF DEATH


SUFFOLK (County BOSTON (City or Town)


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


OUT- OF - TOWN To be filed for burial permit with Board of Health or its Agent. 85


Registered No.


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


PHYSICIAN - IMPORTANT


WILLIAM HENRY WALPOLE


2 FULL NAME


( Middle Name)


( Last Name)


( First Name)


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


119 RIVER STREET- RD


WINTHROP.MASS


( If nonresident, give city or town and State)


Length of stay: In place of death.


years.


months


9 days. In place of residene


50


years ..


months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


MALE


9 COLOR


WHITE


10 SINGLE


MARRIED


(write the word)


WIDOWED


of DIVORCED TAPRIES


4 1 HEREBY


CERTIFY


.


That I attended deceased from


JUNE ..... 26


161, 1


to ..


JULY


7


61


I last saw h. I.Mlive on


JULY 7


16I, death is said to


have occurred on the date stated above, at ..... 2 ..... 3 7 A .... 111.


INTERVAL


(or) WIFE of


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) ROUTE RENAL FAILURE


BETWEEN


ONSET AND


DEATH


GDAUS


Due To


(b) LOWER NEPHRIN NEPHRESIS


Due To


(c)


OTHER


SIGNIFICANT ACUTE MECKLES


CONDITIONS


DIVERTICULUNS


Was autopsy performed?


VIES


What test confirmed diagnosis?


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


(Signed)


FRANKLIN E BALLHÄR


M. D


( Address)


1180 BIENCON ST


Date ..


7/7/6/19


WINTHROP


a


Place of Burial or Cremation


(City or Town)


WINTHROP


DATE OF BURIAL


JULY 10


19.41


21


Informant


7 NAME OF


FUNERAL


DIRECTOR Maurice N Ruby


ADDRESS


WINTHROP


JUL 11 1961


19


( Registrar)


PARENTS


17 NAME OF


FATHER


JOHN F WALPOLE


18 BIRTHPLACE OF


FATHIER (City)


MILFORD


(State or country)


MASS


19 MAIDEN NAME


OF MOTHER


MARY A GERMAN


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


MASS


BENTHAL 1/4 RIVEN RD WINTHROP.


HALPOLE


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)


2803


7-7-61


(Official Designation)


(Date of Issue of Permit)


V.B.


- 8145


R-301A 1


CTIONS R IRTIFICATE


ving DEATH enter an one or each ) and (c)


not mean of dying, ul failure, . It means or compli- ch caused


, if any, e rise to use (a). e under- se last. C . ns contrib- th but not ie terminal ition given


Chapter 137, 54. requires i to print or hcause or death on ficates, and 8, Acts of hires Physi- rint or type Ir signature.


125 1961


No. FAULKNER HOSPITAL


0


I ( Was deceased a I' S War Veteran,


(if so specify WAR)


NO


10a If married, widowed


HUSBAND of


BERTHA C


O'HARA


0


(Give maiden name of wife in full)


( Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE 76 Years


Months.


Days


lí under 24 hours


llours ....


.Minutes


13 Usual


WHOLESALE PAPER. MER


Occupation :


(Kind of work done during most of working hfe)


14 Industry


or Business :


PRINTING PAPER


15 Social Security No.


MILFORD


16 BIRTHIPLACE (City)


(State or country)


MASS


MILFORD


(a) Residence. No. ( L'sual place of abode)


3 DATE OF


DEATH


JULY 7


1.9.6.1


(Month)


(Day)


(Year)


(PRINT OR TYPE SIGNATURE)


A TRUE COPY ATTUSE: Cruris à Martie City Regerar


TO:


0


6


THROP.


OCT 251961 AM


A R-301A


1


PLACE OF DEATH


Suffolk (County) Boston (City or Town)


The Commonwealth of Massarmiarts, UIT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


-


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


Revere


St.


Winthrop,


Mass.


(If nonresident, fivy 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


8, 1961


(Bay)


(Year)


(Month)/


4 I HEREBY CERTIFY


That I attended deceased from


July 6, 1961, 0


July


8


1961


I last saw him alive on July 8


19 61, death is said to


have occurred on the date stated above, at


3:15 A.m.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) PREMATURITY


Subarachnoid hemorrhage


Due To


(b)


UNKNOWN


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?...


YES


What test confirmed diagnosis ?...


Autopsy


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


(Signed).


319 tonawet and Date 7/896


6 Winthrop Cemetery


Place of Burial or Cremation (City or Town)


DATE OF BURIAL July ..... 10. 19.61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


Winthrop, Mass


ADDRESS


JUL 12 1961


.19 Charles A. of Ina (Referir"


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


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


Years.


Months


1


. Days


If under 24 hours


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)


Massachusetts


17 NAME OF


FATHER


Daniel Joseph Duggan


18 BIRTHPLACE OF


Chelsea'


FATHER (City)


(State or country)


Massachusetts


19 MAIDEN NAME


OF MOTHER


Margaret Flannery


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Winthrop Mass.


21 Boston-Lying- In- Hospital


Informant


(Address)


221 Longwood Ave. 1


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


(Signature of Agent of Board of Health or other)


2815


7 10 61


(Official Designation)


(Date of Issue of Permit)


-THIS IS A VENT RECORD. e only APPROVED ink or black riter ribbon.


RUCTIONS FOR . CERTIFICATE giving OF DEATH


not enter than one for each (b) and (c)


does not meon le of dying. heart failure, etc. It means se. or compli- which caused 0,5


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


tions contrib .. death but not the terminal ondition given


Chapter 137, 954, requires s to print or cause or f death on tificates. \P. 46, 95 9 & .P. 114 45, AP. 38 : 6.)


25 1961


IO-58.923686


Boston-Lying-In-Hospital


FRANK Baby "Duggan 2 FULL NAME


( M'as deceased a U. S. War Veteran,


if so specify WVAR)


(a) Residence. No. 286


(Usual place of abode)


To be filed for burial permit with Board of Health 6 or Its Agent. 06502


PARENTS


, M. D.


Winthrop


Boston


A TRUE COPY ATTESTE Chris it Mackie Gry Registrar


HECEIVED


TOWA


F


. 1


3


ILERK


3


-


C.


65


VTHROP


OCT 2 51961 AM


X


SUFFOLK


(County)


BOSTON


(City or Town)


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


OUT - OF - TOWN To be filed for burial permit with Board of Health? or its Agent.


06591


CHILDREN'S HOSPITAL MEDICAL CENTER. {(If death occurred in a hospital or institution, No.


MICHELLE


WOOD


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


30 PLUMMER AVE.


WINTHROP, MASSACHUSETTS


St.


(If nonresident, give city or town and State)


Length of stay: In place of death


years


1


1


months. days. In place of residence years.


.months.


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


JULY


12


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY


That


Attended deceased from


61


JUNE


11


61


19


er


JULY 12


61


I last saw h ........ alive on


19


... , death is said to


have occurred on the date stated above, at


m.


INTERVAL


BETWEEN


ONSET AND


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


YES


What test confirmed diagnosis?


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


(Signed)


M. D


F3 PROSENT ERGER


(PRINT OR TYPE SIGNATURE)


(Address)3.00LONGTTOODAVEDa. JULY 12 9 6]


WinkranCemetery Winthrop 6


I'lace of Burial or Crerdition


(City or Town)


7 NAME OF


FUNERAL DIRECTOR


Ernest P. Cosaima


147 Winthrop I. Salon


ADDRESS


Charles Raised med filed JUL 14-1961 19 Va H. Machine istrar)


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


I ments


day


If under 24 hours


AGE


Years.


Months.


.. Days


Ilour s ............ .Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


16 BIRTIIPLACE (City)


(State or country)


Winthrop


1155


17 NAME OF


FATHER


Frederick Wood


18 BIRTHPLACE OF


FATIIER (City)


(State or country)


Vermont


19 MAIDEN NAME OF MOTHER


Mary O'Byrne


20 BIRTIIPLACE OF


MOTHER (City)


(State or country)


Vermon


-


Frederick Wood


1 HEREBY CERTIFY that a satisfactory standard certificate of death was Gled with me BEFORE the burial of transit permit was issued: acquisire iMano


(Signature of Agent of Board of Health or other)


2882


(Date of Issue uf Permit)


(Official Designation)


X


R-301A 1


CTIONS R ERTIFICATE


ving F DEATH enter an one or each ) and (c)


not mean of dying. art failure, c. It means or compli- ich caused


if any, e rise to use (a), e under- ise last.


ns contrib. th but not he terminal ition sign 59.3


Chapter 137, 54. requires Es to print or cause or death on ificates, and 8. Acts of ires Physi- rint or type 'r signature.


25 1961


028145


PLACE OF DEATH


2 FULL NAME


St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT [ ( Was deceased a U. S War Veteran.


(if so specify WAR)


(a) Residence. No.


HOSPITAL of abode)


JULY


12


19


4:40 A


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


MULTIPLE CONGENITAL ANOMALIES DEATH


(a)


PARENTS


Middlebury


Brandon


DATE OF BURIAL July 13 1001 21 Informant (Address) 20 Plummer Avenue


Registered No.


A TRUE COPY ATTEST: Charles St Mackie (a Registrar


- ICEVED


OF


TOWA


-1


#3 ERK


6


H


OCT 2 51961 AM


C


X


PLACE OF DEATH


Suffolk


(County ) Chelsea


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


Chelsea


(City or Town making this return) S


344


Registered No.


[ {If death occurred in a hospital or institution,


.. St.


1


give its NAME instead of street and number)


2 FULL NAME John Albert Wright


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


U. S. War Veteran,


(if so specify WAR,


(a)


Residence.


No.


100a Summit Ave.


1


siinthrop Mass.


( Usual place of abode)


hospital


( If nonresident, give city or town and State)


Length of stay: In place of death.


Gears ....


Q.months ....... ]days. In place of residence ...


3.5%.


......... months .......... doy s.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


July 15.1961


( Month ) (Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


July 6, 19 61


to ..


July .... 15.


19 ... 61


I last saw haddlive on


July .... 15


161 .. , death is said to


have occurred on the date stated above, at


12:304.


INTERVAL


BETWEEN


ONSET AND


DEATH


(a) Perforated duodenal ulcer


Due To with peritonitis


(b)


Due To


Arteriosclerotic heart


(c)


disease-congestive heart failure


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?


yes


What test confirmed diagnosis ?


autopsy


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


If so, specify


16 BIRTHPLACE (City)


(State or country)


Boston, Mass.


17 NAME OF


FATHER


James F.Wright


18 BIRTHPLACE OF


FATHER (City)


...


Boston, Mass.


(State or country)


19 MAIDEN NAME zabeth Magee OF MOTHER


20 BIRTHPLACE OF


MOTHER (City) Ireland


( State or country)


Soldiers' Home Record


(Address Office , Chelsea, Mass.


A TRUE COPY


FUNERAL DIRECTOR Winthrop, Mass.


ADDRESS


Received and filed


OCT-10-1961


19


( Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


Male


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCEDMarried


10a If married, widowed, or divorced


HUSBAND of


Irene .. Doherty


( 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


...


.Hours ........ Minutes


13 Usual


Occupation :


Investigator


( Kind of work done during most of working life)


14 Industry


or Business :


not known


15 Social Security No. 010-09-7629


PARENTS


(Signed )


Klaus G.M.Reverdy


M. D.


Soldiers' HomeHosp. 7/15/61


Milton Cem., Milton, Mass. 6


Place of Burial or Cremation- July 18,1961 19


Town)


DATE OF BURIAL


7 NAME OF Arthur J.O' Maley


50M-9-59-926111


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


THIS IS A PERMANENT RECORD


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 .


C


RM R-302


1


(City or Town)


No Soldiers' Home Hospital


CERTIFICATE OF DEATH


(Registrar of City or Town where death occurred)


DATE FILED


July 15,1961


19


V.B.


21 Informant


ATTEST :


The Joseph aTerrell


( Was deceased a


WWWI


( write the word)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


76


11


23


TOW


ERIT


6


HROP.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


Aug. 7,1918 OCT - 91961 AM


DATE OF DISCHARGE


Apr.30,1919


Private


RANK, RATING


ORGANIZATION AND OUTFIT


U.S.Marine Corp.


SERVICE NUMBER


136803


PLACE OF DEATH


Suffolk (County)


East Boston (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


OUT - OF - TOWN To be filed for burial permit with Board of Health O or its Agent 07062


Registered No.


St. } give its NAME instead of street and number) No. Princeton-Shelby Nursing Home


2 FULL NAME


Frances Yvonne Lanou Dasch


(First Name)


( Middle Name)


(Last Name)


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


f ( Was deceased a ¿U' S. War Veteran.


lif so specify WAR)


(a) Residence. No. 44 Cottage Park Road


St


Winthrop, Mass


( L'sual place of abode)


Length of stay:


In place of death.


years ...


5 months.


days


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


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


July


24


1967


(Month)


(D)ay)


(Year)


4I HEREBY CERTIFY


NOV


4


19.49,


to.


JULY 24


.That I attended deceased from


1961


I last saw h. Clive on


JULY


24


, 19. 61, death is said to


have occurred on the date stated above, at


2:40 Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


GENERAL CAROHEMATOSIS


WITH-PARAPLEGIA


Die To.


(b)


TIMETASTASIS TO SPINE


Due To


(c)


ADENO CARCINOMA RT. BREAST


OTHER SIGNIFICANT CONDITIONS NONE


Was autopsy performed?


Ne


What test confirmed diagnosis? OPERATION + CLINICAL


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


(Signed)


.. , M. D


MYROOS N. KING (J.D)


(PRINT OR TYPE SIGNATURE)


(Address) 222 PLEASANT ST Date JULY 26 1961


6 Winthrop Cemetery, Winthrop, Mas. Place of Burial or Cremation (City or Town)


DATE OF BURIAL July 27,1961 19


7 NAME OF


FUNERAL DIRECTOR


alfred B. Weiss


ADDRESS


174 Winthrop St. Winthrop,


Received and filed /JUL2- 1961 Macke 19


(Registrar)


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


widowed


MARRIED


WIDOWED


of DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


Eugene Carl Dasch


(or) WIFE of


(Husband's name in full)


II IF STILLBORN, enter that fact here.


12


AGE


67 Years 6


Months.


29 Days


If under 24 hours


Hours.


.......


.Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Winthrop Community Hospital


15 Social Security No.


023-18-3889


16 BIRTHPLACE (City)


Burlington


(State or country)


Vermont


Q PARENTS


17 NAME OF


FATHER


Frank S. Lanou


18 BIRTHPLACE OF


FATIIER (City)


St. Jacques


(State or country)


Juebec


19 MAIDEN NAME


OF MOTHER


Emilie Rousseau


20 BIRTIIPLACE OF


.


MOTHER (City)


Burlington


(State or country)


Vermont


I


Informant


Jugene Carl Dasch, Jr.


(Address) An Cottage Park Road Winthro


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the . burial or transit permit was issued: 1


„.a.s.s ..


alianreal


(Signature of Agent of Board of Health or other)


3049


7/26/61


(Official Designation) (Date of Issue of Permit)


V.B


T


ICTIONS OR CERTIFICATE


iving F DEATH


t enter han one for each b) and (c)


's not mean of dying, cart failure. c. It means , or compli- hich caused


s, if any, ve rise to uuse (a), he under- ause last.


ions contrib- ath but not the terminal dition given m.C


Chapter 137. 954. requires ns to print or e


cause or of death on tificates, and 48, Acts of quires Physi- print or type er signature.


25 1961


928145


R-301A 1


CERTIFICATE OF DEATH


[(If death occurred in a hospital or institution,


PHYSICIAN - IMPORTANT


(If nonresident, give city or town and State)


MEDICAL CERTIFICATE OF DEATH


1400


admitting clerk


JUS ATTLIT:


8 martie Ln. Bepetrar


TOWA


CLERK


3


C.


6


הנ


OCT 251961 AM


X


M R-303 A


1


(County) BOSTON


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


OUT - OF - TOWN To be filed for burial permis with Board of Health 90 or itz


Registered No.


[(If death occurred in a hospital or institution,


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


No.


PHYSICIAN - IMPORTANT


2 FULL NAME


FREDERICK R.


HARTY


f (Was deceased a {U. S. War Veteran,


( First Name)


(Middle Name)


(Last Name)


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


158 Highland Avenue


Winthrop, Mass.


(a) Residence. No.


(Usual place of abode)


St.


(If nonresident, give city or town and State)


Length of stay: In place of death ...


years ...


months.


.days.


In place of residence


25 years.


months ..


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


August


2.


1961


(Month)


(Day)


(Year)


9 SEX


Male


10 COLOR


White


MARRIED


WIDOWED M


or DIVORCEyarried


4I HEREBY CERTIFY that I have investigated the death of the person above. named and that the CAUSE AND MANNER thereof are as follows : (If an injury was involved, state fully.) Pulmonary embolus following fracture of femur; Parkinsonit.i.


!la If r


Margaret M. Caffrey


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


AGO


Years.


.Months ..


Days


If under 24 hours


Hours


Minutes


14 Usual


Occupation :


Retired.


Investment ..... Broke


(Kind of work done during most of working life)


15 Industry


or Bu iness:


Stocks & Bonds


16 Social Security No.


033-26-0792


Bo.s.t.on


17 PIRTIIPLACE (City)


(State or country)


Mass


18 NAME OF


FATHER


James Harty


19 BIRTHPLACE OF


FATHER (City)


Petersham


(State or country)


Mass


20 MAIDEN NAME


OF MOTHER


Rose Fitzgerald


21 BIRTHPLACE OF


Easthampton


MOTHER (City)


(State or country)


Mass


22


Informant


Margaret . M. Harty


(Address) 158 Fachland Ave. Winthrop I HEARBY CERTIFY that a satisfactory standard certificate of death bles with me BEFORE the burial of topay permy was issued; was


(Signature of Agent of Board of Health or other)


918877


(Official Designation)


(Date of Ing of Permite/


TX


A TENMANENT REGVAD, Every Item of


of Death. See reverse side for additional information. See also Chap. 33, 5§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly cl csi jed under the International Classification of Causes information should be carefully supplied, MEDICAL EXAM INERS should state CAUSE AND MANNER OF


If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.


50M-6-60-928145


10


CI 5 1961


PLACE OF DEATH


SUFFOLK


Was autopsy performed ?


Ycs.


6 Was disease or injury in any way related to orcupaxion ofdeceased ?


If so, specify


(Signed)


Michael A. Luongo/M.D.


BostUhr Type Signature)


8/3


61


(Address) Date


7


Cedar Grove Cem


Boston Mass


Place of Burial, or Cremation.


(City or Town)


DATE OF BURIAL


August 7


1967


8 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


ADDRESS


Winthrop, Macc


Received and filed


AUG S 1001


( Registrar)


PARENTS


-


5 Accident, suicide, or homicide (specify) ... Ccicont.


Date and hour of injury


19


61


IF ACCIDENTAL, was injury causally related to the death?


Injury occur ?


Where did


Plymouth, Noss.


(City or town and State)


Did injury occur in or about. home, on farm, in industrial place, or in


public place ?


Hospital ..


Manner of


Fall


irem chair.


Injury


(How did injury occur ?)


Nature of


Injury


While at work?


(Specify type of place)


M. D.


§§ 44-48.


MASSACHUSETTS GENERAL HOSPITAL


{if so . specify WAR)


WW#1


11 SINGLE


(write the word)


A TRUE COPY ATTEST Frank It. Mackie Cty kesim


TO


IF


-


1.110


isin


19-


M:"1


CLERK


6 5


THROP


OCT 2 5 1961 AM


X


R-301A


I


BOSTON


(City or Town)


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


OUT OF TOWN To be filed for burial permit with Board of Health or its Agent. 02182


Registered No.


f(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


Annie Grinnell


(First Name)


( Middle Name)


( Last Name)


f ( Was deceased a U. S. War Veteran. no


{if so specily WAR)


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


(a) Residence. No.26 Emerson Road


(L'sual place of abode)


St.


Winthrop, Massachusetts ..


( If nonresident, give city of town and State)


Length of stay: In place of death.


years ..


months


1. days


In place ol residence


.60years ..


.. months ..


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX F


9 COLOR


W


10 SINGLE


MARRIED)


WIDOWED


or, DIVORCESingle


4I HEREBY CERTIFY,


August 7


1901


to ..


August


19


10a If married, widowed, or divorced


HUSBAND ol


(Give maiden name of wile in full)


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Pulmonary Edema


Due To,


(b)


Myocardial Infarction


Due To


Old with recent extension


(c)


Coronary Heart Disease


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


yes


What test confirmed diagnosis?


autopsy.


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


If so, specify


(Signed)


M. D


Charles L. Clay, M. D.


(PRINT OR TYPE SIGNATURE)


(Address) Ass's. Dle., Moss Gon'L Mars, Date August 7, 61


6


Fairview ..... Cemetery.


Jefferson, ... L


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


August


10


19


61


7 NAME OF


FUNERAL DIRECTOR


Richard .... Hall., ......... D ..


ADDRESS


Waldoboro, Laine


.....


Received Mind filed


Charles It Mackie .. 19


(Registrar)


( PARENTS


18 BIRTIIPLACE OF


FATIIER (City)


(State or country)


Appleton, Maine


19 MAIDEN NAME


OF MOTHIER


Lucinda Grinnell


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Appleton, Maine


21 Edward Grinnell


Informant


(Address)


RED Appleton Meiner


I HEREBY CERTITY that a/MItisfactoty/standard certificate of death


was flied with me BEFORE/


burial//tranche mit was issued:


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


A18468


Chuy 8,190-1


(Official Designation)


(Date of Issue of Permit)


CTIONS OR ERTIFICATE


iving F DEATH t enter han one for each ) and (e)


s not mean of dying, at failure, c. It means or compli- ich caused


s, if any, ve rise to use (a). se under- use last.


ans contrib- ath but not he terminal dition given


420.1


: Chapter 137, 954. requires lis to print or . cause or f death on ificates, and 148, Acts of tuires Physi- orint or type 1 er signature. IC. Irector se only Ink. 1 25 1961


× 28145


PLACE OF DEATH


·SUFFOLK 1 ..


(Month)


(D)ay)


(Year)


That weattended deceased from


61


Welast saw h ... eafive on


August 7


19 [1] death is said to


have occurred on the date stated above, at


9:25 Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


2 day


s 12


AGE ..... 68.Years.


Q Months.


.6 .... Days


11 IF STILLBORN, enter that fact here.


If under 24 hours


.Hours.


.Minutes


3 days13 Usual


Occupation :


Stenographer


3 yrs


(Kind of work done during most of working lile)


24 yVIG14 Industry


or Business :


Various Industries


15 Social Security No.


no


16 BIRTHPLACE (City) Appletor, Maine (State or country)


17 NAME OF


FATHER


George Grinnell




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