Town of Winthrop : Record of Deaths 1961, Part 50

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 50


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very 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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