Town of Winthrop : Record of Deaths 1961, Part 5

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 5


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).


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(a) Residence. No.


(Usual place of abode)


Length of stay:


In place of death.


.. years


.months.


days. In place of residence.


1.1.f@rs


.months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


January 25, 1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY,


That I attended deceased from


Oct 14


19


to


25


JAN 25


61


I last saw h Chalive on


1/25/61


19


death is said to


have occurred on the date stated above, at


10 45 Am.


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


ACUTE PULMONARY EDEMA


INTERVAL


11 IF STILLBORN, enter that fact here.


BETWEEN


ONSET AND


DEATH


3 HRS.


Years


.Months.


.Days


If under 24 hours


Hours.


Minutes


Due To


(b)


MYOCARDIAL DISEASE


3 YRS.


Due To


(c)


ARTERIOSCLEROTIC HEART


DIS. WIN CONGESTIVE FAILURE


3YRS


OTHER


SIGNIFICANT


CONDITIONS


NONE


Was autopsy performed?


No


What test confirmed diagnosis?


CLINICAL


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


(Signed)


Myson n. King


M. D


MYRON N. KING M.D


222 PLPRINT OR TYPE SIGNATURE)


(Address)


WINTHROP MAS Date


1/25 1961


HolyCross


Malden


6


Place of Burial or Cremation


(City or Town) January 27


19 61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS Winthrop .... Mass


Received and filed


JAN 2-6-1961


...... 19


(Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City) (State or country) Ireland


19 MAIDEN NAME


OF MOTHER


Susan Sheekey


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


21 Fred Culkeen


Informant (Address) 28 Schofield Dr .. Newton


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: gulphs serienne (Signature of Agent of Board of Health or other)


1/26/6/


(Official Designation)


(Date of Issue of Hermit)


RUCTIONS FOR CERTIFICATE


giving OF DEATH


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


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


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


itions contrib- death but not the terminal ondition given


- Chapter 137, 1954, requires ans to print or he cause or of death on ertificates, and : 48. Acts of equires Physi- o print or type nder signature.


11.C


0-928145


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DMareded


10a If married, widoreda dicuikeen


HUSBAND of


(Give maiden name of wife in full)


12


AGE 63


13 Usual


Occupation :


Retired


(Kind of work done during most of working life)


14 Industry


or Business : ...


Sales lady


Raymonds


15 Social Security No.


011-24-6846


16 BIRTHPLACE (City)


(State or country)


Mass


Winthrop.


17 NAME OF


FATHER


Patrick Sheerin


DATE OF BURIAL


210 Main Street


No ..


(First Name)


(Middle Name)


(Last Name)


St.


( If nonresident, give city or town and State)


1 R-301A 1


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER.


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


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


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(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.


M R-301A 1


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No.


15 Siren Street


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.


20


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Mary (Haggerston) Lougee


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


15 Siren Street


St.


(If nonresident, give city or town and State)


Length of stay: In place of death


years ..


......


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


9.1


.. years


Omonths .... 28.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


January 25, 1961


(Month)


(Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCEWidow


10a If married, widowed, or divorced


HUSBAND of


Edwin Lougee


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


=


12


.... 91 Years.


0


Months .... 28 .. 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


Winthrop


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


Alexander Haggerston


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass


Watertown


19 MAIDEN NAME


OF MOTHER


Louisa Tewksbury


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass


Winthrop


(Address) Winthrop 52, Mass


6 Winthrop


Winthrop


Place of Burial or Cremation


(Cjty or Town)


DATE OF BURIAL


Jan. 28


19


61


7 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


Winthrop Mass


ADDRESS


Received and filed JAN-3-0-4961 19


(Registrar)


PARENTS


21 Eva Murray


Informant


(Address)


90 Terrace Ave. Winthrop


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


Signature of Agent of Board of Health or other)


4,0


1/27/6/


(Official Designation) (Date of Issue of Permit)


V.A.V


STRUCTIONS FOR AL CERTIFICATE


in giving E OF DEATH not enter re than one se for each ), (b) and (c)


does not mean ode of dying, s heart failure, , etc. It means ase, or compli- which caused


tions, if any, gave rise to cause (a), the under- 8


cause last.


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Hypertrophic arthritis


12 yrs


Was autopsy performed ?


no


What test confirmed diagnosis ?


Clinical & laboratory


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


, M. Traunstein, Jr., M. D.


(Signed)


M. D.


M. Traunstein, Jr., M. D.


(PRINT OR, TYPE SIGNATURE)


73 Bartlett Rd


Date.


January26, 61


61


I last saw h.C.


eralive on


January 25, 1961


death is said to


have occurred on the date stated above, at


9:20 p. m.


INTERVAL


BETWEEN


ONSET AND


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Arteriosclerotic and hypertensive DEATH


heart disease


8 yr


Due ToGeneralized arteriosclerosis (b)


10 yrs


(write the word)


4 I HEREBY CERTIFY,


That I attended deceased from


.. January ...... 7 , , 152


to


January 25,


19.


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


(a) Residence. No.


(Usual place of abode)


50


-11-59-926662


W.c.


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


editions contrib- death but not to the terminal condition given


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE TOW


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


0


C.


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.


15M-6-60-928241


INSET PLACE OF DELIVERY No. Winthrop Community Hospital


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)


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


Registered No. 21


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


3 DATE OF DELIVERY


1 26


61'


(Month )


(Day )


(Year)


4 SEX


Male .. .. Female .. Undetermined


5 COLOR (if


determined) .Al.


6 THIS BIRTH (Check one) Single/. Twin . Triplet


7 IF MULTIPLE BIRTH, BORN : 1 st. .2nd. .3rd


FATHER


MOTHER


MAIDEN NAME Antonetta Camiolo PRESENT NAMEAntonetta Foti


9 RESIDENCE, NO.164 Cottage STREET


CITY OR TOWN East Boston


STATE Mass


15 RESIDENCE, NO. 164 Cottage. CITY OR TOWNEast Boston STATE


STREET Mass.


10 COLOR OR


RACE.


White


11 AGE AT TIME OF THIS DELIVERY 38 (Years)


16 COLORIRRite RACE


17 AGE AT TIME OF2 8 THIS DELIVERY


(Years)


12 PLACE OF


BIRTH


Boston (City or Town )


Mass


18 PLACE OF BIRTH Boston (City or Town)


Mass


(State or country )


Pressman


19 INFORMANT Mother


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


(a) How many children are now living ? 3


(b) How many children were born alive ut are now dead ?


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


0


21 LENGTH OF PREGNANCY 26 .completed weeks


22 WEIGHT OF FETUS 2 Lb. 4 Oz


23 WHEN DID FETUS DIE? Before Labor During Labor or Delivery X


24 AUTOPSY


Yes .


No


X


25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Premature scarring of placenta Due To (b) Premature seperation and Due To (c) bleeding causing insufficien blood supply to fetus OTHER SIGNIFIC CONDITIONS


26 HOLY CROSS Place of Burial or Cremation


DATE OF BURIAL JAN. 27,


MALDEN (City or Town) 19

27 NAME OF


FUNERAL DIRECTOR//PIETROKVAZZA ADDRESS / HENRY ST, EAST BOSTON


Received and filed


JAN 26 1961


.19.


A TRUE COPY ATTEST :


I HEREBY CERTIFY that this delivery occurred on the date stated above at


9. 55 nAMAnd product of conception was not a live birth.


Signature of Attending Physician or Medical Examiner : G. M. Caplan M.D.


A "PRAT Hapkan NATURE)


Address East Boston


Date 1/26/961


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


Malkh E. Seriaum (Signature of Agent of Board of Health or other )


4.0. 1/26/6/ (Official Designation ; (Date of Issue of Permit)


X


In giving CAUSE OF TAL DEATH do not enter more 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. ) al and/or ma- nal conditions, ny, which gave ;e to above se (a), stating · underlying ise last.


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


5 +5


1


ORM R-304 X Suffolk Winthrop (City or Town )


2 NAME OF FETUS


(if given )


Baby Boy Foti


St.


Registrar


Grams )


Unknown


(or


(State or country )


13 OCCUPATION


8 FULL NAME Ralph Foti


OF TOW


OFFICE DA


11 12 1


10


FETAL DEATH


10


18


HROP.


EXTRACTS OF CERTAIN SECTIONS OF AS AMENDED OR ADDED BY CHAPTER 48.


ACTS OF 1960.


Section 2A. "Examination of Jobb 161961 turns 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.


RM R-303 A 1


N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS 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


PLACE OF DEATH


SUFFOLK (County) WINTHRO.P. (City or Town)


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


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


Registered No.


22


[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. Winthrop Police Haatrs.


2 FULL NAME


HAROLDE. ..... FRENCH


(First Name)


(Middle Name)


(Last Name)


U. S. War Veteran,


(if so specify WAR)


NO


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


183 Winthrop St.


St.


Winthrop, Mass


(a) Residence. No.


( Usual place of abode)


Length of stay :


In place of death


.years.


months.


1


days .


In place of residence


69


.years


-


.. months ..


-


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


January


28.


1961


(Month)


(Day)


(Year)


9 SEX


Male


10 COLOR


White


(write the word)


11 SINGLE


MARRIED


SINGLE


WIDOWED


or DIVORCED MARRIED


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.) Coronary occlusion; Acutemyocardial ..... infarction


lla If married, widowed or divoted Dempsey


HUSBAND of


(or) WIFE of


(Husband's name in full)


12 IF STILLBORN, enter that fact here.


13


A(, 69


Years ...


Months.


-


Days


If under 24 hours


Hours


Minutes


14 Usual


Occupation':


Costable


(Kind of work done during most of working life)


15 Industry


or Business :


......


Town of Winthrop


16 Social Security No.


028-09-7472


17. BIRTHPLACE (City)


....


Winthrop


(State or country)


Mass.


18 NAME OF FATHER Ora French


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Wok wen


not Known


20 MAIDEN NAME Mary J. Sawyer OF MOTHER


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass


Boston


Mrs. Anna French


22


Informant


(Address)


183 Wintrop 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: Ralph E. Nicianna


(Signature of Agens of Board of Health or other)


yam30/61


(Official Designation) "(Date of Issue of Permit)


(Registrar)


PARENTS


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


If so, Specif


(Signed) ....... Michael A. Luongo, NO.


(Print or Type Signature) (Address) Boston, Mass Date Jan. 29,61


7


Winthrop, Cemetary,


Winthrop


Place of Burial, or Cremation.


(City or Towns


DATE OF BURIAL Feb. 1. 1961 19


8 NAME OF


FUNERAL DIRECTOR


Maurice W. Kirby


ADDRESS 210 Winthrop St. Winthrop, Mas


Received and filed


JAN 30-1961


19


PHYSICIAN - IMPORTANT


[(Was deceased a


(If nonresident, give city or town and State)


(Give maiden name of wifeIn full)


5 Accident, suicide, or homicide (specify)


Date and hour of injury


19


IF ACCIDENTAL, was injury causally related to the death? Where did Injury occur ? (City or town and State)


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


Manner of (Specify type of place)


Injury


(How did injury occur?)


Nature of


Injury


While at work?


Was autopsy performed?


No


§§ 44-48.


HO laHA end of


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


...


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the obsestance 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 unrelated 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 poison) 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


Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."


If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"


PLACE OF DEATH


Suffolk (County)


INSTITUTIO


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.


23


Winthrop Community Hospital


No.


2 FULL NAME


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


50 Bates Avenue


St.


(If nonresident, give city or town and State)


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


months.


4


.days. In place of residence


60


.years ..


months.


......


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


/


24


1961


(Year)


(Month)


(Day)


That I attended deceased from


61


I last saw h, ALalive on


1/29


16/


death is said to


have occurred on the date stated above, at


6.30Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


BRONCHO-PNEUMONIA


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


3 DAYS


11 IF STILLBORN, enter that fact here.


88


12


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.


Dorchester


16 BIRTHPLACE (City) (State or country) Mass


17 NAME OF


FATHER


John Hurley


18 BIRTHPLACE OF


Frederickton


FATHER (City)


(State or country)


New Brunswick


19 MAIDEN NAME


OF MOTHER


Mary McGrath


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Frederickton


New Brunswick


Helan A. Sullivan


21


Informant


(Address)


50 Bates Ave., Winthrop


I HEREBY CERTIFY tbat a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Malkh E Percanne (Signature o/ Agent gi Board of Health or other)


1


/


38/6/


Received and filed JAN 30 1961


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDEtowed


(write the word)


10a If married, widowed, or divorced


HUSBAND of


Edward F. Sullivan


(or) WIFE of


(Husband's name in full)


Due To


·ARTERIO-SCLEROTIC


(b)


HEART DISEASE


jogar


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


0


What test confirmed diagnosis ?


0


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


(Signed)


twee D' Regan


M. D.


FRED O' PEGAN AMID


(PRINT OR TYPE SIGNATURE)


(Address) 113 PLEASANTST


Date. 1/29 1961


6 Winthrop Cemetery Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL February ..... 1 19.61


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


Arthur J. O'Maley


Winthrop Mass


40.


(Official Designation)


(Date of Issue of Permity


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, z, etc. It means lease, 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- o print or type der signature.


8-11-59-926662


M R-301A 1


Mary C ( Hurley) Sullivan


[(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)


(a) Residence. No.


(Usual place of abode)


4 I HEREBY CERTIFY,


Deci


19.60


to


1/29


PARENTS


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


SPACE FOR ADDITIONAL INFORMATION -


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER YTHROP


JAN .3.01961-PM


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.




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