USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 46
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6 CE ,
RULES OF PRACTICE DEC 1 1961 AM
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.
2
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.
IM R-301A 1
PLACE OF DEATH
Suffolk (County)
Boston (City or Town)
JOSEPH D WARD SECRETARY OF TH" ".MON WEALTH DANISION OF VI IL. STATISTIC:
STANDARD
CERTIFICATE OF DEATH
Registered No.
{ {If death occurred in a hospital or institution, St. I give its NAME instead of street and number) PHYSICIAN - IMPORTANT [ (Was deceased d YU :. S. War Veteran. (if to specify WAR)
2 FULL NAME Joseph P FLANERY, Si. ( First Name) ( Mlichlic Name) ( Last Name) (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence No. 25. Taylor
Winthrop, Mass.
(If nonresident, que city of town and State)
length of stay :
In place of death
years.
months
8
.. days.
In place of residence
45 year
months .. ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
1310
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEDTidowed
or HIVORCED
:Oa If married, widowed, or divorced
HUSBAND of .
Margaret McDonald
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 64 Years.
6 ..... Months ..
.29 ... Days
If under 24 hours
.Hours ..........
... Minutes
:3 Ustra!
Occupation :
Chauffeur (Retired)
(Kind of work done during most of working hie)
14 Industry
or Business :
Boston Sand & Gravel Corp
15 Social Security No.
010-22-8548
16 BIRTHPLACE (City)
(State or country)
Latertarm
17 NAME OF
FATHER
Owen W. Flannery
18 BIRTIIPLACE OF
FATHER (City)
(S:ate or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Margaret Perron-
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Veterans Administration Records
Intormant
(Address)150 S. Huntington A-3 Boston Moss. I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: namaratil
Signature of Agent of Board of Health or other> 4034 10/16/61
(Official Designation)
(Date of Issue of Permit)
1 VR
ITRUCTIONS FOR IL CERTIFICATE
1 giving £ OF DEATH I not enter : than one te for each 1 (b) and (e)
idoes not mean ide of dying. heat fui.ure. l' etc. It means isse, or compli- Wwhich caused
ions, ij cny,
cause (a). the under. cause last.
ditions contrib- death but not to the terminal condition given
Cha' ler 137, f 1954. requires lars lo prin: : the world of death on erlsficates. and 1.r 48, Acts of require l'ha si - e primi or aspe nurt signature
1.
7 NAME OF
C.
FUNERAL. DIRECTOR
Q Malloy Fureral Hora
ADDRESS 79 Atlantic St ... Winthrop, Loss.
Received And filed
OCT 17 1961
.. 19
........ 1 1-
(Reg.strar)
PARENTS
( Address) VAH Boston, Lasse Date Oct. IL 19.61
6
MAnthrop Cemetery
Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL October 17 61
19.
I .. TE.VAL
DETWEEN
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Hepatic failure 7 days with
( a)
cirrhosis ( Themachromatosis ) .
ONSET AND DEATH Tours
Due l'v
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis? '"tony & clinica]
S Was disease or injury in any Way related to occupation of deceased? If so, specify
(Signed)
HENRY T. OKNA (PRINT OR TYPE SIGNATURE,
---
To be filed for buria! permit with Board of Health cris Mient
No. Veterans Administration Hospital
.
( L'sual place of abode )
3 DATE OF
DEATII
Octcher
(Month)
(Day)
(Year)
4I HEREBY CERTIFY.
Oct ... 6
19
61, to.
October 11
That i attended deceased from
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX, death is said tol have occurred on the date stated above, at 11:25 .... A.m.
(write the word)
Ferrins
00-928145
A TRUE COPY ATTEST: Charles In. Takie Oty Registrar
TOM
OF
11 12.1
CLERK
6
JAN 2 1962 AM
IM R-301A 1
STRUCTIONS FOR AL CERTIFICATE
in giving E OF DEATH not enter "e than one se for cach , (b) and (c)
does not mean de of dying, heart failure. , etc. It means ase, or compli- which caused
tions, if any gave rise to cause (a). the under. cause last.
ditions contrib. death but not to the terminal condition given
45
: :- Chapter 137. of 1954. requires :ians to print or the cause or of death on certificates, and e: 48, Acts of requires Physi- to print or type under signature. n.C. Directon use only
CK Ink.
1
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City " Town)
Thr Commmmmmwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
235
To be filed for burial permit with Board of Health or its Agent.
Registered No. 10056
(If death occurred in a hospital or institution, St } give its NAME instead of street and number) PHYSICIAN -- IMPORTANT
2 FULL NAME .
Rose Corwin
(First Name)
(Middle Name)
(Last Name)
(ff deceased is a married, widowed or divorced woman, give also maiden name.)
36 Perkins Street
Winthrop, Massach setts
(if nonresident, give city or town and State)
Length of stay:
fn place of death ......
years ..
..
months ...... .... d! 1
In place of residence +0
.years.
months ....
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
October 23, 1961
DEATH
(Month)
(Day)
(Year)
4I HEREBY CERTIF
That > attended deceased from
19 ...
October 23
. 19.
61
October 23,
to ..
we last saw HO.Lalive on
October 23, 1961, death is said to
have occurred on the date stated above, at
8:05 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUCE
(a) rupture of abd. aneurysm
....
ONISET AND
CZATH
1
hr.
1)1 To
(b)
atherosclerotic abd costic
Due To
aneurysm
(d) atherosclerosis, severe.
OTHER
SIGNIFICANT
generalized.
CONDITIONS
hypertensive heart di
8
Was autopsy performed?
Y.O.S
What test confirmed diagnosis?
.. Autopsy
S Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D
Charles h ... Cl ....... D.
(PRINT OR TYPE SIGNATURE)
(Address) A.s.s't ... DIF ...
Nt. Lebanon, Workmen's Circle, W. Fox 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
October 25,
19
67
7 NAME OF
FUNERAL DIRECTOR
Arnold Golov
ADDRESS
1668 Beacon St. Brookline
Received and filed OCT 26 1961. --- 19
Charles & Track
"gistrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEMarried
10a Ii married, widowed, or divorced
HUSBAND of
(Give m .; Jen name of wife in full)
Samuel Corwin
(or) WIFE of
(Husband's name in fuil)
11 IF STILLBORN, enter that fact here.
12
81
Years ..........
.Months.
... Days
If under 24 hours
.Hours .............. Minutes
13 Usual
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
At Homo
15 Social Security No.
None
16 BIRTHI'LACE (City)
(State or country)
Hungary
17 NAME OF
FATHER
Joseph Ober
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Hungary
19 MAIDEN NAME
OF MOTHER
Celia (CBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Hungary
21 Samuel Corwin
Informant
........
(Address)
So Perkins St. Winthrop
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)
:1184
10-25-61
(Date of Issue of Permit)
! (Official Designation)
[ ( Was deceased a U. S. War Veteran. (if so specify WAR) No
(a) Residence. No. ( l'sual place of abode)
CERTIFICATE OF DEATH
Massachusetts General Hospital BAKER MEMORIAL
No.
0-928145
PARENTS
15-yr:
Occupation :
yrs
61
A TRUE COTY ATTEST:
Charles ,. Meskie
RECEIVED
TUK
LERK
إم)
..
THROP.
JAN 2 1962 AM
M R-305 1
7 25M-4-59-925100 as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at Nature of Injury
PLACE OF DEATH
Suffallmy
Chelsea)
No. "Chelsea Naval Hospital
.......
§(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
[(Was deceased a
U. S. War Veteran, UMI &II.
[if so specify WAR)
(a) Residence. No. 1.770 Cliff Ave. (Usual place of abod
......... Sł. (If hontes the town and State)
Length of stay: In place of death. .years. .......... .months. 15.days. In place of residence ............. years. months 1.5 ..... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Oct 24, 1961
(Year)
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.)
Blunt force injury of head with" fracture .... of ....... skul .......... guboura.]
hematomas and cerebral laceration
5 Accident, suicide, or homicide (specify) ...
Accident
Date and hour of injun or about 10/8/61
If accidental, was injury causally related to the death ?
Where did
Injury occur ?
Winthrop Mass
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place ?
Manner of
Injury
.......
Accidental fall .... to ... pavement
How did injury occur ? )
While at work ?
... Was autopsy performed?
yes
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Michael A.Luongo
M. D.
(Address) Boston , Mass. 10/24/61
Place Amlian @ lownationat 1. Cem. it Nyer, Va DATE OF BURIAL 19
8 NAME OF Oct. 30, 1961 FUNERAL DIRECTOR William E.McGin
ADDRESS 167-Maple
Received and filed DEC 1- 101
19
(Registrar of City or Town where deceased resided)
9 SEX
10 COLOR
11 SINGLE
MARRIED
WIDOWED
or DIVORCED,
(write the word)
Single
Tfa ITharried, widowed, of
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
If under 24 hours
AGB3
... Years .....
5
Months .......
.Days
Hours ....
.Minutes
14 Usual
Occupation :
WHOiwork done during most of working life)
15 Industry
or Business :
......
retired
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
Haverhill, Mass.
Michael Buckley
19 BIRTHPLACE OF
FATHER (City) (State or country)
20 MAIDEN NAME
Haverhill, Mass.
OF MOTHER
Julia Creene
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Peabody , Mass.
22 Informant (Address) Mary Buckley
A TRUE COPY.
28 Forost St. Danvers, Muss.
ATTEST:
(Registrar of City of Town where death occurred)
DATE FILED
Oct. 25, 1961
19
236
(City or town making return)
Registered No. 52%
2 FULL NAME (INQuase Pista ma HGKIR Ved or divorced woman, give also maiden name.)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Chelsea
SIVILU ULALN LITEWKIIEK KIBBUN -
THIS IS A PERMANENT RECORD
PARENTS
of divorced
6
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DEC.121961 ... AM
DATE OF DISCHARGE RANK, RATING
......
ORGANIZATION AND OUTFIT
SERVICE NUMBER
ORM R-301A
ditians, ifany. ich gave rise to cause lai, ing the under. & cause last
conditions contrib. to death but not to the terminal candition given
Chapte- 13 :. : 1954. Finquire ans to print o. the sause or of death . 1. certificates, and 1 4%. A.Is of eusies Plivel. " print at type nier signature M.C.
12-1000
-11-59-926662
PLACE OF DEATH
Suffolk (County)
JOSEPH D. WARD 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)
I HYSICIAN -- IMPORTANT [(W'a deceased a U. S. War Veteran. no
(if so specify WAR)
St. .Winthrop, Mass.
(If nonresident, give city or town and State)
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
CCT
30
1961
(Month)
(Day)
(Year)
8 SEX
fomale
9 COLOR
white
10 SINGLE
MARRIED
(write the word)
WIDOWED
of DIVORCEDWidowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William Brown
(liusband's name in full)
11 IF STILLBORN, enter that fact here.
12
ACE.
90
Years.
Months ..... ..
Days
if under 24 hours
Hours ..........
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
of Business :
15 Social Security No. ..... none
16 BIRTHPLACE (City)
(State or country)
Hass.
17 NAME OF
FATHER
Harris Feyser
18 BIRTHPLACE OF
.
FATHIFR (City)
(State or country)
Pcland
19 MAIDEN NAME
OF MOTHER
Caroline "olson
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
Hass
Boston,
21 Informant Leslie Bro:m.
(Address)
26 Novada St. 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 y
4250
10/31/6/
(Official Designation)
(Date of Issue of Permit)
237
To be filed ier burial permit with Board of Health or its Agent
1
Boston (City or Town)
No. . Neponset View Hospital
2 FULL NAME ..
Annie C.Brown
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 26 Nevada Street,
(Usual place of abode)
Length of stay: In place of death.
3
.years ..
months .............. days. In place of residence .............. years.
PERSONAL AND STATISTICAL PARTICULARS
VIHEREBY CERTIFY, That I attended deceased irom
Aprimary
195%, to CT 20
1961
I last saw herlive on
OCT 30
1961
death is said to
have occurred on the date stated above, at
5:00 P. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
L
€ 1.
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
W'as autopsy performed ?
What test confirmed diagnosis ?
5 W'as disease or injury in any way related to occupation of deceased? ¿... If so, specify
(Signed)
(Address) Novinky
mi Pare 10/30 10c.j
6
David Vicur Choulim (Lebanon) W.Roxbury Piace of Burial or Cremation (City or Town) DATE OF BURIAL November 1, 19 67
7 NAME OF
FUNERAL DIRECTOR ..
Benjamin F Solomon
120 Harvard Stress
Bico-line.
ADDRESS
....
C
19
(Registrar)
T
V.B
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter more than one ause for cach a). (b) and (c)
is does nul meda mode of dying. us heart failure. sid, etc. It means iseuse, or compli- s which caused
1 .. . EU.VAL ELTWEEN CI:SET AND DEATH
-111.21 CM. 1).
(PRINS OR TYPE SIGNATURE)
Che Commonwealth of Massachusetts
PARENTS
Poston
A TNUL CUCK ATTEST: Charles it . I . Kie City Registrar
OF TOW
1: 12
1)
ULERK
6
HROP
JAN 2| 1962 AM
238
To be fled for burial permit with Board of Health or its Agent.
10500
Registered No.
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[Was deceased a {C. S. War Veteran. lif so specify WAR)
( If deceased is a married, widowed or un ed woman, give als maiden name. )
(a) Kesidence No. 4.55 Shirley
st.
Winthrop, Massachusetts (If nonresident, give ally o- town and State)
30 years.
.. months. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
white
10 SINGLE MARRIED TRAINED or DIVORCED
(write the word)
(Month) (Lay)
4I HEREBY CERTIFY. That _ attended deceased from November 3, 1961, 10+ 02 19 6 Wf last saw ho MMlive on Nor MO- 6, 1961, death is said to have occurred on the date stated above, at 1:35 cm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Extension of leute
Inferior-Myocardial
(0),
Due To (c) .cuto Inforior Myccardi .. ]
3day.
OTHER
Infarction
SIGNIFICA CONDITIONS COMOMENT ENCOPY CHIC.
W'as autopsy performed?
1.0
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
M. D
Cherles L. Ci ... . D. (PRINT OR TYPE SIGNATURE)
(Address) Asset. Dir., Na s. Com'1. 1.327. Dave .... 1967
Holy Grov 6
Place of Burial or Cremation
DATE OF BURIAL
7 NAME OF
DIRECT
ADDRESS
Recife is the NOV 8 1961 7 .... 19
(City or Town) 1068) 21 Informant (Address),
I HEREBY CERTIFY that a satisfactory standard certificate of death was fild with me BEFORE the burial or transit permit was issued:
4361
// (Signature of Agent of Board of Health or mber) 11/6/6/
(Official Designation)
(Date of Issue of Permit)
If under 24 hours Hours .. ...... .. Minutes
Occupation :
(Kind of work done aring most of working life)
014 Industry
or Business :
15 Social Security No.
AG BIRTIIPLACE (City) (State or country)
17 NAME OF
FATHER
18 BIRTHPLACE OF FATHER (City) : (State or country)
Germany
19 MAIDEN NAME OF MOTHER
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ireland
1-928145
PLACE OF DEATH!
SUFFOLK
(County) COSTON
(City or Town)
JOSEPH D. WARD :"CI ITALY OF THE COMMONWEALTH LIV.SION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Mcasachusolis Gowww. Mar Stal OUTER MEMORIAL
No.
2 FULL NAME: Mary S. Hanlc. ( First Name)
Name)
(Last Name)
( ['sual place of abode)
Length of stay. In place of drain . years. months .days. in place of residence
3 DATE OF DEATH NOVEMBER 6, 1962
Married
102 If m! rried, widowed, or divorced HUSBAND of
Mr. , (Give maiden name of file in fat)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that iact here.
12 - ... Years .... 7 Months ........... .Days
T.
RM R-301A 1
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH not enter re than one se for each b. (b) and (c)
does not mean de of dying. heart failure. elc. It means Case, or compli- which caused
ions, if any. gave rise to
the under. cause last.
-ditions contrib- death but not do the terminal condition given
36.1
:. Chapter 137. f 1954. requires ians to print or the cause or of death on ertincates, and r 48, Acts of acquires Physi- To print or type niler si nature w. C. Directon use only K Ink.
PARENTS
TVB
Charles . til
OF TOW
11 12 1
OFF
NII
is
CLERK
6 5
MAS
THROP
JAN 2|1962 AM
X
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
(b) 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 deceased
PLACE OF DEATH
Essex (County)
Lynn
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lynn
(City or Town making this return)
239
94 Franklin Street No. Leonora B. Madden ( Boardman)
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and numher)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... 86 Plummer Ave.
St.
Winthrop
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death 8 years ...
months.
.days. In place of residence.
8. years
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widow
4 I HEREBY CERTIFY,
That I attended deceased from
July
19 ..
50,
to
December ...... ]
19 ...
61
I last saw h.e.lalive on
Nov.28/1961 19 ..
...... , death is said to
have occurred on the date stated above, at 6.30 p.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cerebrovascular ..... accident ..
INTERVAL BETWEEN ONSET AND DEATH 4 mo.
11 IF STILLBORN, enter that fact here.
12
AGE.90 ... 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 ..... none
16 BIRTHPLACE (City)
(State or country)
Manne
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?........... no If so, specify
(Signed)William Berenson
M. D.
(Address).
32 So. Common St. Lynn 12/1/61
Vernon Grove Cem. Milford, Mass 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December 5 .19.
6
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS.
Winthrop, Mass
Received and filed.
DECEMBER
8, 1961
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Mai ne
19 MAIDEN NAME
OF MOTHER
c/n/b/1
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine.
21
Informant.
Arthur J. O'Maley
(Address) 79 Atlantic St Winthrop
A TRUE COPY ATTEST: (Registrar of City or Town where death occurred)
DATE FILED
December 4,1961
.19.
7
3 DATE OF
DEATH
December 1, 1961
(Month)
(Day)
(Year)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Edward .... A.
(Husband's name in full)
Due To
Hypertensive heart disease
6 yrs
25M-8-56-918227
)RM R-302 1
MARGIN RESERVED FOR BINDING
17 NAME OF
FATHER
Boardman
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
RECEIVED
TOWA
78 12. 1
140
CLERK
3
5
6
HROB MASS
DEC : 81961 AM
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
42 Sunnyside 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.
20
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Lawrence
(First Name)
(Middle Name)
J. Ryan Sr.
[(Was deceased a
U. S. War Veteran,
(Last Name)
(if so specify WAR)
170
(If deceased is a married, widowed or divorced woman, give also maiden name.)
42 " Sunnyside
(a) Residence. No. (Usual place of abode)
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
December 4
1961
(Month)
(Day)
(Year)
4
HEREBY CERTIFY,
19.
to ...
I last saw h ........ alive on
19.K ....... , death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET ANO DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE (a)
Due
(b)
Death apparently due to natural causes,
Due (c) presumably acute
OTHERS SIGNIFICAronary occlusion CONDITIONS plicated by known Was auppfarbetes, What t Winthrop Board of Health
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Sig
Chantes Liberman
CHARLES LIBERMANI MID
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop, mass Date
12/4/ 1961
6 Holy Cross Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December 9, 19 67
7 NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath
ADDRESS
325 Chelsea St. E. oston
Received and filed
....... 19.
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED married
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
Aed Riley
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
71
Years.
Months.
.. Days
If under 24 hours Hours. Minutes
13 Usual
Occupation :
Stevedore
(Kind of work done during most of working life)
14 Industry
or Business :
Retired
15 Social Security No.
022-10-8604
Montreal
16 BIRTHPLACE (City)
(State or country)
Canada
17 NAME OF
FATHER
Patrick Ryan
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