Town of Winthrop : Record of Deaths 1961, Part 8

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 8


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


R-301A 1


JCTIONS OR CERTIFICATE


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


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


is, if any, ve rise to ause (a), he under- luse last.


ions contrib- eath but not the terminal dition given


Chapter 137, 54. requires 3 to print or cause or death on ificates, and 8, Acts of tires Physi- rint or type r signature.


59-925686


PLACE OF DEATH


Suffolk (County)


PENSEPEY


Winthrop (City or Town)


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.


35


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


2 FULL NAME


Herbert .... Newell .... Ridgway.


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


(a) Residence. No.


(Usual place of abode)


81 Washington Avenue


St.


(If nonresident, give city or town and State)


Length of stay : In place of death. 6.3years .. ............ months. ......... days. In place of residence. 63years ... months ............ .. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


February


16


19.67


(Month)


(Day)


(Year)


4 I


HEREBY CERTIFY, That I attended deceased from


1961


Jun To: 6, tojeb.


16


I last saw h./.jalive on


F20


16


19.61, death is said to


have occurred on the date stated above, at


10: 15-17 m.


INTERVAL BETWEEN ONSET AND DEATH 48 kg


(b) Due To Coronary artery diseñse


Due To


(c)


arteriosclerosis


Generalized


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?


What test confirmed diagnosis ?


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


(Signed)


ed) Inepli Greenel


M. D.


OF MOTHER


Harriet Eliza Cross


JOSÉph GREGORIE


(PRINT OR TYPE SIGNATURE)


(Address) 194 Washinton ore - Date.


2/17


6 Mount Auburn Cemetery Cambridge, Mass. Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


February 18 ,1961


19


alfred B. March


ADDRESS


....


Received and filed


FEB 17 1961


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, " diyorede CeceliaClarke


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 83 Years.


0


.Months


2 Days


If under 24 hours


Hours.


.Minutes


13 Usual


retired inventor of beach


Occupation :


(Kind of work done during most of working life)


14 Industry


amusement devices


or Business :


15 Social Security No.


029-01-3553-A


16 BIRTHPLACE (City)


(State or country)


Massachusetts


17 NAME OF


FATHER


Charles Lowell Ridgway


18 BIRTHPLACE OF


FATHER (City)


Boston


(State or country)


Massachusetts


19 MAIDEN NAME


20 BIRTHPLACE OF


MOTHER (City)


Cambridge


(State or country)


Massachusetts


Mrs. Herbert N. Ridgway


Informant


(Address)


95 Gordon St. Apt. 9. Brighton


Mass ...


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


10


Feb, 17, 1961


(Official Designation)


(Date of Issue of Permit)


1 V


Registered No.


PHYSICIAN - IMPORTANT


[(Was deceased a


{ U. S. War Veteran,


{if so specify WAR)


NO.


No. 81 Washington Avenue


7 NAME OF


FUNERAL DIRECTOR


174 Winthrop St. Winthrop,


PARENTS


Boston


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Broncho Pneumonia


(a)


IJarmenial


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


5


ROPA


RULES OF PRACTICE FEB 171961 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.


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.


R-305 1


PLACE OF DEATH


Suffolk


(County)


Revere


(City or Town)


No. 38 NorthAvenue


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


Revere


(City or town making return)


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


2 FULL NAME


Felice .... Bomarsi


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


(a) Residence. No.


393 Main


St.


Winthrop Mass


(If nonresident, give city or town and State)


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


...........


.months .............. days. In place of residence.LO ..... years ....


.. months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


Male


10 COLOR


White


11 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Married


lla If married, widowed, er diviseMalo


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


AGE ..... 7. 1 Years. 14


Months.


11Days


If under 24 hours


Hours.


Minutes


14 Usual


Occupation :


Contractor


(Kind of work done during most of working life)


15 Industry


or Business :


Building


· 16 Social Security No.


17 BIRTHPLACE (City)


(State or country)


Italy


18 NAME OF


FATHER


Erineo Bomarsi


19 BIRTHPLACE OF


Rome


FATHER (City)


(State or country)


Italy


20 MAIDEN NAME


OF MOTHER


Maria Carnesi


21 BIRTHPLACE OF


Rome


MOTHER (City)


(State or country)


Italy


22 Mrs ..... Rita Bomarsi


Informant


(Address)


393 Main St Winthrop


A TRUE COPY.


ATTEST:


Regfatica On or, Toun where death occurred)


February 23, 1961


19


1


VEV


(Usual place of abode)


(Month)


(Day)


5 Accident, suicide, or homicide (specify)


(Specify type of place)


Manner of


Nature of


Injury


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


Where did


Injury occur ?


(City or town and State)


3 DATE OF


DEATH


February


21,


1961


Year)


4 I 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


Date and hour of injury 19


If accidental, was injury causally related to the death ?


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


Injury


(How did injury occur ? )


While at work?


Was autopsy performed ?


No


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


(Signed)


Michael .... A ...... Luongo


M. D.


(Address)


B.o.s.t.on


Date 2/21 1961


Winthrop Cemetery, Winthrop


7 ..... Place of Burial, of Cremation. (City or Town)


DATE OF BURIAL February 24, 19.61


& NAME OF


FUNERAL DIRECTOR


Ernest P. Caggiano


ADDRESS 147 Winthrop St., Winthrop


Received and filed


MAR 8 .1961.19.61


(Registrar of City or Town where deceased resided)


{(Was deceased a


¿ U. S. War Veteran,


[if so specify WAR)


No


Registered No.


Rome


PARENTS


M.C.


.....


SPACE FOR ADDITIONAL INFORMATION


MAR-1981AH


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


PLACE OF DEATH


SUFFOLK (County) WINTHROP (City or Town) 95 LOPING RD No.


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.


((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)


No


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


(a) Residence. No.


95 LORING PO


(Usual place of abode)


.St.


.......... ......... (If nonresident, give city or town and State)


20


Length of stay: In place of death ,20 years. ........... months ... ...... .days. In place of residence. .years .... ....... ... months .......... .. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


February 22 ..... 1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


February .... 8 ......


167


to ...


February 22


61


I last saw h.


Imlive on


February 22,


19.


death is said to


have occurred on the date stated above, at


9:10 a. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


....


Carcinomatosis


Due To Primary carcinoma in right


(b)


lung


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


none


Was autopsy performed ? .... no.


What test confirmed diagnosis ?


X-ray of lung


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


(Signed)


John F. Collins, M.D.


(PRINT OR TYPE SIGNATURE)


(Address) 32 Bennington St. Date :..


Feb. 24, 161


6


WINTHROP


WINTHROP


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


FEB


27


19.61


7 NAME OF


FUNERAL DIRECTOR


MADRICE W KIRBY


ADDRESS .... WINTHROP


Received and filed FEB 27-1961 19


(Registrar)


8 SEX


MALE


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED MAPPIES


10a If married, widomed, or divorced


HUSBAND of


JENE


Nore


('Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


Months.


Days


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation :


MOTORMAN <8


(Kind of work done during most of working life)


14 Industry


or Business :


M. T. H.


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


MASS


17 NAME OF


FATHER


JOHN NORRIS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


N. H.


19 MAIDEN NAME


OF MOTHER


ANNE RILEY


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


N H.


21


Informant


MRS IRENE NORRIS


(Address) OBLORING RD WINTHROP


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


16.0


Mel. 24. 1961


(Official Designation)


(Date of Issue of Permit)


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, 954. requires is to print or cause or of death on tificates, and 48, Acts of uires Physi- print or type er signature.


1.1-59-926662


R-301A 1


2 FULL NAME


JOHN MG. NORRIS


PERSONAL AND STATISTICAL PARTICULARS


INTERVAL


BETWEEN


ONSET AND


12


DEATH


1 month AGE 79


1 year


LYNN


PARENTS


M. D.


61


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. 171101


(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 FACT 1961 PM 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.


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No. 914 Shirley 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.


38


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


2 FULL NAME


Wiggo Christian Williams



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


(a) Residence. No.


914 Shirley Street


St.


(If nonresident, give city or town and State)


(Usual place of abode)


Length of stay: In place of death


6.5.years .............. months ...........


days. In place of residence


6.5 years.


months ...


......


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


February


24


1961


(Month)


(Day)


(Year)


4 I


HEREBY


CERTIF


nav


1956, 10


That/ I attended deceased from


24


61


I last saw ha Vialive on


7.0


.. , 19 (a), death is said to


have occurred on the date stated above, at


7:30 A.m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Cerebral Hemorrhage


(a)


Arteriosclerosis


(b) ......


cerebral


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis? Clinica/


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


(Signed)


(ilegales herencia, M. D.


CHARLE.


LIBERMAN.


(PRINT OR TYPE SIGNATURE) (Address) 414/ Kropmuss Date 2/28/1961


6


Winthrop Cemetery


Winthrop, Mass,


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


February 28, 1961


alfred B. Manili


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


174 Winthrop St. Winthrop,


Received and filed


MAR 11901


19.


(Registrar)


PARENTS


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED widowed


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


Laura Christafsen


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ... 9.5 ... Years.


0 Months.


3


Days


If under 24 hours


Hours ...


.Minutes


13 Usual


retired oiler


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business


Deer Island Pumping Station


15 Social Security No.


none


Q510


16 BIRTHPLACE (City)


(State or country)


Norway


17 NAME OF


FATHER


John Knudsen


18 BIRTHPLACE OF


Oslo


FATHER (City)


(State or country)


Norway


19 MAIDEN NAME


OF MOTHER


unknown


20 BIRTHPLACE OF


Os10


MOTHER (City)


(State or country)


Norway


Informant


(Address)


George T. Williams


914 Shirley St. Winthrop


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


Mass.


HO.


2-28 3/1/61


(Signature of Agent of Board of Health or other)


(Official Designation)


(Date of Issue of Pormit)


ICTIONS OR CERTIFICATE


iving F DEATH


t enter han one for each ) and (c)


s not mean of dying, part failure, c. It means or compli- tich caused


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


ons contrib- ath but not the terminal dition given


hapter 137, 54. requires to print or cause or death on ficates, and 8, Acts of ires Physi- int or type r signature.


59-925686


R-301A 1


Registered No.


PHYSICIAN - IMPORTANT


[(Was deceased a


{ U. S. War Veteran,


{ if so specify WAR)


NO ..


HUSBAND of


INTERVAL


BETWEEN


ONSET AND


DEATH


3 days


5yrs


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


......


MAR - 1196T'TA


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.


IM R-303 A


1


Suffolk (County)


Boston (City of Town)


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


OUT - OF - TOWN


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


Registered No.


1:1860


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


2 FULL NAME


KENNETH


KELLY


( First Name)


(Middle Name)


( Last Name)


PHYSICIAN - IMPORTANT


( (Was deceased a


...


{ U. S. War Veteran,


{if so specify WAR)


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


(a) Residence. No.


30 Atlantic Street


St.


Winthrop, Mass.


( L'sual place of abode)


2


23


5


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


3 DATE OF DEATH ........ February 21 1961


(Month)


(D)ay)


(Year)


9 SEX


Kale


10 COLOR


White


11 SINGLE


(write the word)


MARRIED Single


WIDOWED


or DIVORCED


4 I 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 in jury of head with .....


bilateral subdural hematomagand


cerebral ..... contusion.


12 IF STILLBORN, enter that fact here.


23


5


9


If under 24 hours


1.3


AGE


Years


Months.


.Days


....


Hours ...........


Minutes


IF ACCIDENTAL, was injury causally related to the death? Yes


Where did


Injury occur ?


Boston , ...... Ma.s.s ...


(City or town and State)


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


public place ?


Public highway


(Specify type of place)


Manner of


Pedestrian struck by motor


Injury


....


(How did injury occur ?)


16 Social Security No.


Winthrop


17 BIRTHPLACE (City)


Car(State of country)


Mass


18 NAME OF


FATHER


William K Kelly


19 BIRTHPLACE OF


East Boston


FATHER (City)


(State or country)


Mass


20 MAIDEN NAME


OF MOTHER


Althea W Pratt


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass


Sommerville


(Print or Type Signature)


(Address) Boston ..... Mass ...


Date


2 .- 22.


19.6.1


7 Winthrop


Winthrop


Place of Burial, or Cremation.


(City or Town)


Feb. 24


19.


61


DATE OF BURIAL


8 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


ADDRESS


....


Winthrop Kass


Received and filed FED 19


(Registrar)


PARENTS


(Sign


Thehall thango


M. D.


............


Michael.


Luongo ......... D.,


SOM-6-50-928145


₹ 22 1961


PLACE OF DEATH


War Veteran, G.I .. Chap. 46, Section 10, requires physicians to insert a recital to that effect. If deceased was a U. S. of Death. See reverse side for additional Information. See also Chap. 38, $$ 6, 20; Chap. 46, 55 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. MEDICAI. EXAMINERS should state CAUSE AND MANNER OF 11 44-48. M.c. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Nature of Injury


lla If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


5 Accident, suicide, or homicide (specify)


Accident


Date and hour of injury


2-19.


19.61


14 l'sual


Occupation :


Soldier


(Kind of work done during most of working life)


15 Industry


U S Army


or Business:


031-28-4831


William K Kelly


22


Informant


(Address)


105 Chestnut St. N Reading


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


(Signature of Agent of Board of Health or other)


936


2/23/61


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


39


While at work ?


.Was autopsy performed NO


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


If so, pecan


(If nonresident, give city or town and State)


A THUẾ COLY ATTRT:


RECEIVED


TOW


0


DOMA


MAR 2 21961 AM


X


PLACE OF DEATH


Middlesex


(County) Cambridge


(City or Town)


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


40


Cambridge


(City or Town making this return)


Registered No.


320


Guardian Hospital 85 Otis St Coulddeath occurred in a hospital or institution. No.


-give its NAME instead of street and number)


2 FULL NAME


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


9 Atlantic St.


St


Winthrop, Mass.


(a) Residence.


No ..


( Usual place of abode )


(If nonresident, give city or town and State)


Length of stay:


In place of death .......... years .......... months.


dag .. In place of residence .......... years


10


.months ......


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


March 3, 1961


( Month)


(Day)


( Year)


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Married


4 I HEREBY CERTIFY.


Feb .... 11. 19


61


Mar. 3.


That I attended deceased from


I last saw h ...... allvelon


March 3, 19 Q death is said to


have occurred on the date stated above, at


2:307.


INTERVAL BETWEEN ONSET AND DEATH




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