USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 50
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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
tt'inty)
BOSTON
(City of Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
251
To be filed for burial permit with Board of Health or its 10504
Registered No.
V. T. .. rx. Evite
2 FULL NAME Evelyn. Cohen ( First Nan:c) (Middle Name) ( Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence
370 Shirley St., Winthrop, Mass. ( U'sual 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 2 years.
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WHITEI)
10a If married, widowed, or divorcey
HUSBAND of
HERMAN COLED
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Hl IF STILLBORN, enter that fact here.
6
days
12
ACEGO
Years
.Months ..........
.. Days
If under 24 hours
Hours.
.Minutes
13 Usual
House wife
Occupation :
(Kind of work done during most of working hic;
14 industry
or Business :
OUIN ROME
6 days, Social Security No.
16 BIRTIIPLACE (City)
(State or country)
CHCI50A, KIHSS
17 NAME OF
FATHER
HirSh KAUFMAN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
OF MOTHER
ANN- (C.B.L)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
Herbert w. Cole
(Address)
23NOBLest West NEWTON
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bytial or transit permit was issued: Dorato (Signature of Agent ol Board of Health nr other)
4368
11/6/21
I (Official Designation)
(Date of Issue of Permit)
-
INSTRUCTIONS FOR DICAL CERTIFICATE
In giving USE OF DEATH do not enter more than one cause for each (a), (b) and (c)
his does not meon mode of dying, us heart failure. enia, etc. It means discose, or compli- ms which coused
raditions, if any, which gove rose to ove couse (a). sling the under. ing cause lost.
Conditions contrib- : to deoth but not ed to the terminal se condition given 1).
33,0,
Note :. Chapter 137. ts of 1954. requires ysicians to print or ie the cat.sc or uses of death on ath certificatex, and apter 48, Acts of 69. Fromnies Physi- ns to print or type me under signature
ral Director ase use only LACK Ink. JAN 30 1962
-6-60-928145
PARENTS
CHEVRAH TORAH 6 I'lace of Burial or Cremation
Everett
(City or Town)
DATE OF BURIAL NOV 7 1961 21 Informant
7 NAME OF
FUNERAL DIRECTOR
TORF FUNCHAL Service
ADDRESS CHE IseA
8 19.61
Roseijed And filedNO .... Chiari
Nov.
5.1961
(Month)
(Day)
(Year)
HEREBY CERTIFY, That We attended deceased from
Oct, 31 1.61 ..... to ... Nov. 5,
19 .. 61
We last saw h .. O.nlive on Nov, 5, 19619 , death is said to
have occurred on the date stated above, at P .m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Subarachnoid Hermorrhage
INTERVAL
BETWEEN
ONSET AND
DEATH
Due Tolunturn of Aneurysm of "Right Internal Carotid Art -! Due Toary (c)
OTHER SIGNIFICANT CONDITIONS
Lobar Pneumonia
Was autopsy perormed?
Yes
What test confirmed diagnosis?
Autopsy
S Was disease or injury in any way related to occupation of deceased?
If so, specify
C.f.Cham
(Signed)
M. D
Charles L .. Cley ... M. D.
(PRINT OR TYPE SIGNANOV. 5, 1961 (Address) Ass's. Dir., Mass. Gon'l. Hosp. Date. 19
No.
Massachusetts General Hospital BAKER MEMORIAL
STANDARD CERTIFICATE OF DEATH
[(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 specily WAR) No
( Registrar)
3 DATE OF
DEATH
ORM R-301A 1
A TRUE COPY ATTEST:
it mackie ( . Po trar
JAN 3 01362 AM
PLACE OF DEATH
SUFFOK (CountyBOSTON
)RM R-301A 1 BETH ISRAEL (City or Town) HOSPITAL BOSTON.
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 liealth or its Agent. 10583
Registered No. S(If death occurred in a hospital or institution, St. } give its NAME instead of street and numher)
PHYSICIAN - IMPORTANT {( Was deceased a
{U. S. War Veteran.
{if so specify WAR) no
WINTHROP, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death .. years. months. 14 days. In place of residence
... . .. years ........
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
MARRIED
WIDOWED
or DIVORCEDmarried
10a If married, widowed, or divorced
Sadie Cohen
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
69
AGF ...
Years.
.Months ..
.Days
If under 24 hours
.Ilours ..
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No. .
013-28-6175
16 BIRTIIPLACE (City)
(State or country)
Russia
17 NAME OF
FATIIER
George Kaplow
18 BIRTHPLACE OF FATHER (City) (State or country) Russia
19 MAIDEN NAME
OF MOTHER
Sarah
(unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
21 Sadie Kaplow
Informant ....
(Address) To Trident Ave., Winthrop, Mass.
V HEREBY CERTIFY that's satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was imurd: deve à lu valliquan
(Signature of Agent of Board of Health or other)
A20936 Nov8, 1968
(Official Designation)
(Date of Issue of Permit)
V.B.V
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter nore than one ause for each (a), (b) and (c)
is does not mean mode of dying, as heart failure, sid, etc. It means liscase, or compli- Is which caused
nditions, if any. ich gave rise to we cause (a). ling the under. ng cause last.
Conditions contrib- to death but not d to the terminal condition ,given e
163.6
ote: - Chapter 137. s of 1954. requires 'sicians to print or the cause or ses of death on th certificates, and hpter 48, Acts of , requires Phys :- is to print or type ne under signature. 74.0
AN 30 1962
-6-60-928145
PARENTS
01
Jewish Deed Holders, Everett.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
November 9, 19 61
7 NAME OF
FUNERAL DIRECTOR
Benjamin F.Solomon
420 Harvard Street, Brookline.
ADDRESS
olives/and filed
NOV 9 1961
19
& Lack Registra) (Registrar)
(Year)
+ 1
HEREBY CERTIFY.
19
to ..........
10,23
....
01
That 1,attended deceased from
4
11, 9+01, death is said to
have occurred on the date stated above, at m. INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
SEPTICEMIA !!
.......
Due To
(0)
ca of comon with left colectony
Due To (c) Wound infection
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis?
Operation
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D
YASHAR
(PRINT OF PIPE SIGNATURE)
( Address) BILO
61
I last saw hesualive on
November 8,1961
DEATH
(Month)
No. SAMUEL ( First Name) (Middle Name) (Last Name) (If deceased is a married, widowed or divorced woman, give also maiden name.) St. 18 TRIDENT AVE.
KAPLOW
2 FULL NAME
(a) Residence. No. ( Usual place of aboute)
3 DATE OF
19/20101
(Day)
10 SINGLE
(write the word)
...
Grocer (mtired)
( Ca-Cancer of Collon)
Date.
A TRUS COPT ATTEST.
.
JAN 3 01362 MM
X
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
Massachusetts General Hospital
BAKER MEMORIAL
f(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[ ( Was deccased a U. S. War Veteran. lif so specify WAR)
WWI
2 FULL NAME Harry Mc Grath Jr. ( First Name) (Middle Name) (last Name) (If deceased is a married, widowed or divorced woman, give also maiden name )
34 Enfield Rd.
Winthrop,
Massachusetts
(If nonresident, give city nr town and State)
Length of stay: In place of death. .years .. . ... months. days. In place of residence years
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
3 DATE OF November 14, 1961 DEATII (Month) (D)ay)
(Year)
8 SEX
M
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED Married
or DIVORCED
# I HEREBY
ERTIF
That WF attended deceased
November 10, 61
to
November 14
19
10a If married, widowed, or divorced
HUSBAND of
Virginia.Ingersoll
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
AGE.
Years ....
40 11 Months 5 Days
If under 24 hours Ilours. .Minutes
13 Usual
Occupation :
Insurance Agent
(Kind of work done during mnost of working life)
14 Industry
or Business :
Bigby-McGrath
15 Social Security No. ...
017-16-2576
16 BIRTHPLACE (City)
Somerville, -Mags ..-
(State or country)
17 NAME OF
FATHER
Harry A. McGrath Sr.
18 BIRTHPLACE OF
FATHIER (City)
(State or country)
Somerville
19 MAIDEN NAME
OF MOTHER
Julia Coakley
20 BIRTHPLACE OF MOTHER (City) (State or country)
Somerville .... Mass.
21 Harry A. McGrath Sr.
Informant
(Address)
16 Rengley Ridge, Winchester
THEREBY CERTIFY that a
.Ausfactory, standard certificate of death
was/ filed with me BEFORE the burial og (transit permit was issued;
Sedmad V callallen
(Signature of Agent of Board of Health or other)
AZ1082
Nov 14, 1961
! (Official Designation)
(Date of Issue of Permit)
×
ORM R-301A 1
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter nore than one ause for each (a). (b) and (e)
is does not mean mode of dying. as heart failure. nia, etc. It means lisease, or campli- Is which caused
ditions, if any, ich gave rise to Dve cause (a). Ring the under- s& cause last.
Conditions . contrib- la death but mat ad to the terminal le canditian given
331
ote - Chapter 137. % of 1954, requires esun 10 print or de the cause or ses of death on Ith cellhcales, and pter 48. Acts of W. requires Physi- is to print or type The under signature.
val Directon ise use only CACK Ink. AN 30 1962
ADDRESS Cambridge, Mass
NOV 16 1961 Readingles It macher
19
(Registrar)
PARENTS
Winthrop Cem ..
S
Winthrop. Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Nov ..... 17,
19 ... 61
7 NAME OF
FUNERAL DIRECTORChas .... B ...... Wat.son
M. D.
( Address ) Ass't. Dir., Muss. Gen'l. Hesp. November149 61
4 days 12
Due To (0)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) Charles L. Clay, M. D. (PRINT OR TYPE SIGNATURE)
The Commonwealth of Massachusetts L 1 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 01 its Agent
10292
Registered No.
No.
(a) Residence. No. ( l'sual place of abode)
months ......
.. days.
MEDICAL CERTIFICATE OF DEATH
We last saw h. 1live on ... N.o.vember ....... 11 19 .... 61 death is said to have occurred on the date stated above, at .1: 1.5 ........ m. INTERVAL BETWEEN ONSET AND DEATH.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Intracerebral Hemmorrhage
(a)
16-60-928145
5
A TRUE COPY ATTEST:
r
JAN 3 0 1962 MM
FORM R-301
INSTRUCTIONS FOR DICAL CERTIFICATE
In giving USE OF DEATH do not enter more than one cause for each (a). (b) and (c)
his does not mean mode of dying. as heart failure. rnia, etc. It means disease, or compli- ns which caused
inditions, if any. rich gave rise to ove cause (a). iling the under- ing cause lass.
Conditions contrib- to death but not ed to the terminal se condition Rivey 1).
Note :- Chapter 137. cts of 1954 requires hysicians to print or pe the cause or uses of death on ath certificates, and hapter 48, Acts of 159, requires Physi. ans to print or type me under signature
AN 30 1962 ( 3.61-930213
X PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial po .. with Board of Her. 4 or its Apeny-art
11080
New England Deaconess Hospital
[(If death occurred in a hospital or institution.
St. { give its NAME instead of street and number)
PHYSICIAN -- IMPORTANT
Mr. Robert Allen
2 FULL NAME
( First Name) ( Middle Name) ( Last Name) ( If deceased is a married, widowed or divorced woman, give also maiden name.)
39 Circuit Road
Winthrop, Mass.
( If nonresident, give city or town and State)
Length of stay:
In place of death
years
12
.months
days.
In place of residence
2
years ......
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
lla If married, widowed, or divorced
HUSBAND) of
Margaret Kilen
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
13
AGE 74
Years.
7 Months 3
.. Days
If under 24 hours
Hours ...........
.Minutes
14 Usual
Occupation :
Meat Dealer
(Kind of work done during most of working life)
15 Industry
or Ilusiness :
Market
/16 Social Security No.
022-05-2565
Boness
17 BIRTHPLACE (City)
(State or country)
Scotland
18 NAME OF
FATHER
James Allen
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
20 MAIDEN NAME
OF MOTHER
Elizabeth Hamilton
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
22 Informant (Address) 20 Circuit Id. Winthrop, Paci.
I HEREBY CERTIFY that a satisfactory standard certificate of death was find with me BEFORE the burial or transit permit was issued:
ADDRESS
Received and filed NOV 27 1961 .. 19 ham, il Mache
(Signature of Agent of Board of Health or other) A+612 11/22/6
(Date of Issue of Permit)
A TRUE COPY ATTEST:
PARENTS
Memorial Park. 6
St. Petersburg .... Fla.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Nov.
25
1961
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds Winthrop, Mass
196 1
(Month)
(Day)
(Year)
CERTIFY.
That I attended deceased from
4IHEREBY
November
19.
61
to
November 21
1961
61
19
death is said to
have occurred on the date stated above, at
12:45 A.
m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) MYOCARDIAL INFARCTION
DEATH 12 day
D)UP To (b) ARTERIOSCLEROTICHEART DISEASE Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
DIABETES MELLITUS
18 year
Was autopsy performed?
yes
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
Effortenuan
(Signed) J.O. PARTAMIAN
M. D.
(Print or Type Name) (Address) N.E. Deaconess Hospitable 11/21/1961
(if so specify WAR)
[ ( Was deceased a
3U. S. War Veteran,
No
(a) Residence No. . ( l'sual place of abode )
3 DATE OF
DEATH
November
21
I last saw h ....... alive on
November
20
(Give manlen name of wife in full)
E Jean Chambers
(Registrar) (Official Designation)
Registered No.
No.
A TRUD COPY ATTEST:
Ciro Pochtrar
JAN 3 01002 .4
X
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commamuralth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
01259
To be filed for burial permit with Board of llealth or its Apent.
11227
Registered No.
[(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) PHYSICIAN - IMPORTANT
~
( First Name)
(Middle Name)
( Last /Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.) 11 Emerson Rd., Winthrop, Mass.
(a) Residence No.
( ('sual place of abode)
Si
( If nonresident, give city or town and State)
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Nov. 22, 1961
DEATHI
(Month)
(Day)
(Year)
8 SEX
FENIALE
9 COLOR
WHITE
MARRIED
WIDOWED or DIVORCED
ANOVERBY FGEIT I NYOV .Th:22 attendedceased from
19 ..
to ..
19
Wq last saw h.
OFlive on N.o.v ......... 22 ....... 196 19.
death is said to
have occurred on the date stated above, at
m.
(or) WIFE of
JOSEPH
NOLAN
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AG
72
Months.
.. Days
If under 24 hours
Hours ............
Minutes
i)ue in
(i) Acute Cholecystitis
4 d.
13 Usual
Occupation :
SALES CLERIT
(Kind of work done during most of working life)
14 Industry
or Business :
DEPARTMENT STORE
15 Social Security No.
016-18-3242
BOSTON
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
WILLIAM I MCDERMOTT.
18 BIRTHPLACE OF
BOSTON
FATHER (City)
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
DORA SHEEHAN
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS
BOSTON
l'lace of Burial or Cremation
(City or Town)
7 NAME OF
FUNERAL
DIRECTOR
MAURICE W KIRBY
ADDRESS
WINTHROP
NOV 28 1961 19.
cei Charles 21 Machus
( Registrar)
PARENTS
6
HOLY CROSS
MALDEN
DATE OF BURIAL
Nov 27
1961
21
Informant MRS MARIE WOLF
(Address)
LIEMERSON DU WINTHROP.
I HEREBY CERTIFY That a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 19. Rogertous
(Signature of Agent of Board of Health or other)
4637
11/54/6/
(Official Designation)
(Date of Issue of/Permit)
V . KL
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter more than one suse for each a), (b) and (c)
is does mot medn mode of dying, as heart failure. sia, etc. It means isease, or compli- which caused $
iditions, if amy, ch gove rise to ve couse (a). ing the under- i cause last.
Conditions contrib- to deoth but mot I to the terminal : condition given
5
ute - Chapter 137. s of 1954. requires sicians to print or the cause or ,es of death un h certihcates, and pter 48. Acts of . requires Physi- % 10 pri it or type he undier signature
al Director se use only ACX Ink. IIN 30 1962 16-60-928145
No. SARAH
(MCDERMOTT
[ ( Was deceased a U. S. War Veteran,
(if so specify WAR) N.O.
Length of stay: In place of death. .years .months 2 days. In place of residence 40 years.
10a If married, widowed, or divorced
HUSBAND of
(Give Maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Acute Pancreatitis
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
Cholelithiasis
mos.
Was autopsy performed?
Yes
Autopsy
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
@@@ca.
M. D.
Charles L. Clay, M. D. 19 (PRINT OR TYPE SIGNATFOR. 22, 196 (Address) Ass't. Dir., Mass. Gen'i. Hosp. Date
OTHER
SIGNIFICANT
CONDITIONS
PERSONAL AND STATISTICAL PARTICULARS
10 SINGLE
(write the word)
Massachusetts General Hospital BAKER MEMORIAL
ORM R-301A 1
A TRUE COPY ATTEST: Chris & Mackie
IAN 3 01052 14
X PLACE OF DEATH
Suffolk (County)
Roslindale (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
To be filed for burial promit 4 9 with Board of Health or its 11226
No. Recuperative Centre, 1245 Centre St. (give its NAME. instead of street and number)
2 FULL NAME. THOMAS J
SHEA -
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 190 Somerset Avenue
(Usual place of abode)
(If nonresident, give 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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
IO SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Single
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
HI IF STILLBORN, enter that fact here.
12
AGE 72 Years
Months
. .... Days
If under 24 hours
Hours
Minutes
13 L'sual
Occupation :
Telephone Pioneer
(Kind of work done during most of working life)
14 Industry
or Business:
N.E.Telephone
15 Social Security No.
011-07-8592
Bast Boston
16 BIRTIIPLACE (City).
(State or country)
Mass
17 NAME OF
FATHER
Patrick Shea
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHIER
Mary O'Brien
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Ireland
21
Informant
Mrs. Mildred Shea
(Address)
190 Somerset Ave,, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death. was filed with my BEVORFythe bunal or transit perimit was Beurd. Requerton .
(Signature of Agent of Board of Health or other) 4636
(Registrar)
YEARS
Due To (c)
OTIIER
DIABETES MELLITUS
CONDITIONS
4 YEARS
Was autopsy performed? NO What test confirmed diagnosis? ELECTRO CARDIOGRAMS
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
, M. D.
(Addre ) 422 Beacon & Boston ate 11-22
19 61
6
Holy Cross Cemetery, Malden Place of Burial or Cremation (City or Town) DATE OF BURIAL November 27th 19 61
SOM-9.96-917973
7 NAME OF DIRECTOR Richard C. Kirby, Inc. ADDRESS 917 Bennington St. ,E. Boston
NOV 28 1961 19
Reg Dell And filed
N 30 1962
3 DATE OF
NOVEMBER 22
DEATH
(Month)
(Day)
1461 (Year)
4 I HEREBY CERTIFY
That I attended deceased from
NOV 1
19
61 to NOV 21
1961
I last saw h/M alive on
NOV. 21. 1961
is said to
have occurred on the date stated above, at
555
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CARDIAC - MYOCARDIAL
INFARCTION
INTERVAL
BETWEEN
ONSET AND
DEATH
(a)
ORM R-301A 1
INSTRUCTIONS 1
FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter more than one ause for each [a), (b) and (c)
his does not meon mode of dying. as heart failure. 110. etc. It mrons fiscase. or compli- 5
which coused 420 ditions, " ony. h
cousť (a) ing the under- last.
unditions contrib- to death but not I to the terminal . condition given -
e :- Chapter 1 ... of 1954, requires "clans to print or the Cause or s of death on certiucates.
PARENTS
Registered No.
J(If death occurred in a hospital or institution,
PHYSICIAN -
IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
1
St ..
Winthrop
(Official Designation)
(Date of Issue of Permit)
11/24/6/
X
Due (b) · CORONARY ARTERIOSCLEROSIS
A TRUE COPY ATTEST: Charis & Mackie ( Ty Decotrar
IAN 3 01962 44
--
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
250 1
To to fied for oursal permit with board of Itealth 11. April 11705
Registered No.
[(If death occurred in a hospital or instrution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME .
Ellen Mitchell
( First Name)
(Middle Name)
( ... Hyland)
( Last Name)
lif so specify WAR)
( If deceased is a married. widowed or divorced woman, give also maiden name.) 11 Moore Street
(a) Residence. No. ( L'sual place of abode)
( If nonresident, xive city of town and State)
Length of stay: In place of death.
. .
years ............ months
2
60
days. In place of residence
years.
months .... ..... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
December
5
1961
DEATH
(Month)
(Day)
(Year)
female
9 COLOR
white
10 CITIZEN
OF U.S.
11 SINGLE
MARRIED
YES NO
DIVORCETY UNKNOWN
11a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Thomas Mitcheff
Give ,ryaiden nany wife in full)
(Husband's name in full)
12 DATE OF BIRTH
June
15 1871
13
AGESO
6
Months ..
Dave
Hours ............ Minute.
Years
14 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
15 Industry
or Business :
at home
16 Social Security No.
none
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)
Charles L. Cles. .....
Ass'ı. Dir., Luna. Ces'i. tame)
Date.
Dec 5 19.51
6 Winthrop Cemetery
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December 9
1961 .19
7 NAME OF
FUNERAL DIRECTOR
William J. Killion
ADDRESS
1 Sprague St Revere, Mass
Received and filed
DEC 12 1961
.19
Charles 21 Mackie
(Registrar)
PARENTS
20 MAIDEN NAME
OF MOTHER
unable to learn
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
11
22 Helen Furey
Infor.nant
(Address)
97 Francis Street Lo ton
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)
4850
15
18/6.
(Date of Issue of Dermit)
KRV
STRUCTIONS FOR CAL CERTIFICATE
In giving E OF DEATH o not enter 're than one se for each ), (b) and (c)
does not meon odo of dying, s heart failure. 1. etc. It means rase, or rompli which roused
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