USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 8
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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 Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.