USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 16
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
(Official Designation)
(Date of Issue of Permit)
4-60-928145
IM R-301A 1
INTRUCTIONS FOR HL CERTIFICATE
giving IS, OF DEATH d not enter De than one ale for each (1, (b) and (c)
idoes not mean 1de of dying, heart failure, n etc. It means diase, or compli- w: which caused 1.
ntions, if any, gave rise to cause (a), 01 to the under- cause last.
Cditions contrib- death but not ecto the terminal secondition given
1C
V =:- Chapter 137, tof 1954. requires ycians to print or pe the cause or u.s of death on af certificates, and la er 48, Acts of 5ª requires Physi- in to print or type n'under signature.
(Signed)
JOSEPH GREGORIE
(PRINT OR TYPE SIGNATURE)
€
6 Winthrop .. inthrop
No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
M. D
(Address)
194 Warns net Bate
2/25-1962
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
myocardial Heart DISE
(a)
Due To
(b)
arteriosclerosis gen,
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
25
196 2
3 DATE OF
april
DEATH
(if so specify WAR)
(a) Residence. No.
(U'sual place of abode)
2
No.
INSEPETI
Registered No.
10 SINGLE
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Cotrain
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF
1 13
CIK:
WIN
MA
nr.
APR 2 61962 AM
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.
11 R-301A 1
RUCTIONS FOR C. CERTIFICATE
giving $ OF DEATH donot enter wer than one se for each a (b) and (c)
igloes not mean wie of dying, heart failure, etc. It means se, or compli- which caused
gions, if any, gave rise to cause (a), the under- cause last.
titions contrib- death but not o the terminal condition given
Chapter 137, 1954. requires ins to print or ne cause or of death on ertificates, and 48, Acts of quires Physi- print or type ider signature. C
-6-59-925686
PLACE OF DEATH
Suffolk .. (County)
PETIT
Winthrop (City or Town)
No. 26 Centre St.
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
81
t
S(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
2 FULL NAME
Mary G. Cushing
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 26 Centre Street St.
(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 ... 3 ..... years.
.. months.
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEBied
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Joseph Cushing
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE2.8.
Years.
Months.
Days
If under 24 hours
.. Hours ........
Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Own Home
15 Social Security No.
East Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
George G. Brennan
18 BIRTHPLACE OF
St. John
FATHER (City)
(State or country)
N. B.
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
CHARLES LIBERMAN
(PRINT OR TYPE SIGNATURE)
(Address)
WINTHROP,
......
Date ..
4/30/1962
6
Holy Cross
Malden, Mass
Place of Burial or Cremation
DATE OF BURIAL
May ...... 2.,
196.2.
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Moley
Winthrop Mass
ADDRESS
Received and filed MAY 1 -1962 19
(Registrar)
PARENTS
Доверили
I. D.
OF MOTHER
Mary L. McDonald
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country)
Mass
21 Joseph Cushing
Informant
(Address)
26 Centre St, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kalkle o Pereanne (Signature of Agent of Board of Health or other) Health Gebucht 5/1/62
(Official Designation)
(Date of Issue of Permit) /
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
April 29 1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
June
60
to
April 29
19.
62
I last saw he Yalive on
April
29, 1962 death is said to
have occurred on the date stated above, at
5:45 P.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Coronary Occlusion acute
INTERVAL BETWEEN ONSET AND DEATH 6hrs.
Due To
Hypertension
3yrs
(c)
Arterioselevutic Heart
3yrs
DISEASE
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed ?
No
What test confirmed diagnosis ?
Clinical
(City or Town)
To be filed for burial permit with Board of Health or its Agent.
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, {if so specify WAR) No
That I attended deceased from
- (b)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
1
10
C.
HROP
MAY 1 1962 PM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following les 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.
FORM R-301
il for burial permit oard of Health its Agent. UTRUCTIONS FOR OL CERTIFICATE
Ir OR TYPE SOR CAUSES O DEATH
not enter de than one die for each . (b) and (c)
it does not mean de of dying, heart failure, N. etc. It means ase, or compli- which caused
ations, if any, di gave rise to cause (a), ug the under- cause last.
Cuditions contrib- a death but not ato the terminal un condition given M.C.
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
82
2 FULL NAME.
Story
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Frank
S.
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
110
(a)
Residence. No.
(Usual place of abode)
Length of stay: In place of death ..
.... months. 1 days. In place of residenceyears monthsdays.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
WV
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
marriedh.
11 If married, widowed, or divorced HUSBAND of margaret M. Keough
(or) WIFE
(Husband's name in full)
12
AGE
90 Years.
4
Months 16 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Optometrist
(Kind of work done during most working life)
14 Industry or Business :
15 Social Security No ..
16 BIRTHPLACE (City)
Milestone, NIH.
(State or country)
17 NAME OF
FATHER
Wir.
H. Story
18 BIRTHPLACE OF
FATHER (City)
(State or country)
embrown
19 MAIDEN NAME
OF MOTHER
Sarah Newell
20 BIRTHPLACE OF MOTHER (City) (State or country)
Iiim. H. Story
21 Informant (Address) 19 Francia 1ª -L'in throp, masa.
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) Theater active
4/30/12
(Date of Issue of Permit)
TVIV
A TRUE COPY ATTEST:
30
(Month)
(Day)
1962 (Year)
4 IHEREBY CERTIFY Dec 4 1938 to
Dei /30 19
19. odeath is said to
have occurred on the date stated above, at
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Congestive heart failure
(a)
Due To
arterio sclerotic heartdis
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed ?
NO
What test confirmed diagnosis ?
Examination
5 Was disease or injury in any way related to occupation of deceased ? If so, specify NO
(Signature) Harald 3 Buenfeld M. D. Harold 3. Greenfield 417 Shi Printers int or Tupe Name) (Address) Winthrop when Date.
4-30 1962
Butter Carnetery Dearing, N. H.
6 Place of Turial or Cremation (City (or Town)
DATE OF BURIAL
May
.3
1962
7 NAME OF
FUNERAL DIRECTOR
PWwoodbury
ADDRESS Hillsboro N.H.
Received and filed
APR 3.0 1962
19
-
(City or Town making this return)
1
Winthrop (City or Town)
Winthrop Community Hospital
No ...
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
19 Frances St.
.St Winthrop, Mass.
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
That I attended deceased
from
I last saw h .! . dive on 4 .
140 A
.m.
INTERVAL BETWEEN ONSET AND DEATH
4yrs.
....... ......
-62-932382
(Registrar) (Official Designation)
PARENTS
(Give maiden name of wife in full)
19
S(If death occurred in a hospital or institution,
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un - related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil. dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
RECEIVED
TOWY
OF
11 12 1
CL
OFFICE
in
MIN
ERK
5
6
IRO2.
APR :3 01962 PM
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts OF - TOWN KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No.
To be filed Ior burial permit with Board of Health or ita Agent. 83 03179
f(If death occurred in a hospital or institution, St. Į 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.90 Putnam Street
( U'sual place of abode)
Winthrop, Massachusetts
(If nonresident, give city of town and State)
Length of stay: In place of death
years
months 26 days.
In place of residence? 4 year
.months .....
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
26
1962
(Month)
f Day)
(Year1
4 1 HERENY CERTIFY,
March 1
19
62 .March 26
19
death is said to
have occurred on the date stated above, at 7:20 .... p.m.
INTERVAL BETWEEN ONSET AND DEATH
12 DATE OF BIRTH
JUNE 12, 1880
Af;Ea.
Years.
Months.
.. Days
If under 24 hours Hours ............ .Minutes
Due To
(b)
Bleeding duodenal ulcer
Unknown
15 days, ['sua!
Occupation :
STEAM FITTER
(Kind of work done during most of working life)
OTHER
SIGNIFICANT
Arteriosclerotic Unknown yrs of Business:
CONDITIONS
cardio-vascular disease
Was autopsy performed?
no
What test confirmed diagnosis?
clinical
17 BIRTHPLACE (City)
(State or country)
N. S.
18 NAME OF
FATHER THOMIS LINGLEY
19 BIRTHPLACE OF
FATHER (City)
(State or country)
NS.
HALIFAX
Charles L. Clay, M. D.
(Print or Type Name)
( Address) Ass't. Dir., Mess. Con'l. Honp. . Date. March 26 62
WINTHROP
WINTHROP
6
l'lace of Burial or Cremation
(City or Town)
DATE OF BURIAL
MARCH 30
1962
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS WINTHROP
MAR 2 9 1962
.19
Recetyed And filed ...
Charles H. macha
( Registrar)
8 SEX
9 COLOR
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
MALE
WHITE
fla If married, widowed, pr divorced
HUSHAND of
DELLA (FHY)
(Give (maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Bronchopneumonia
10 days,
SI
15 Industry
HEATING 4 VENTILATING
16 Social Security No.
022-07-5440
HALIFAX
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Ch@low
M. D.
PARENTS
20 MAIDEN NAME
OF MOTHER
EMMA EASTWOOD
21 BIRTIIPLACE OF
MOTHER (City)
HALIFAX
(State or country)
22 MAS DELLA LINGLEY
Infor mant
(Address)
90 PUTNAM ST WINTHROP.
I HEREBY CERTIFY that a satisfactory standard certificate of death was Hig with me BEFORE the burial or transit pemmit was issued: N OTrasavons ja
Signature of Agent of Board of Health or other)
6500
/ 3/28/62
(Official Designation) (Date of Issue of Permit)
SUCTIONS FOR CERTIFICATE
giving EOF DEATH
ot enter nthan one for each b) and (c)
es mat mean af dying, Heart failure. File. It means e', or campli- hich caused
sms, if any. ave rise ta ause (a). the under- ause last.
·ians contrib- eath but not the terminal dition given
154.
te. Chapter 137. @ 1954 requires inns to print or le cause or fol death on rtificates, and t 48. Acts of quires Physi- print or type der signature.
I )Irecten . se only W 21 1962
2 FULL NAME
Richmond Lingley
( First Name)
( Middle Name)
( last Name)
MASSACHUSETTS GENERAL HOSPITAL
No.
F1 R-301 1
Due To
(c)
Adenocarcinoma of rectum
years
That Pattended deceased Lerin
62
Y last saw himive on
March ..... 26.
19.62
A TRUE COPY ATTEST: Charles it Mackie City Registrar
RECEIVED
OF TOWN
71 12 1
9-
LERK
5
THROP
MAY 2 11962 AM
DRM R-302
3 DATE OF
DEATH
(b)
(c)
6
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
OTHER
SIGNIFICANT
CONDITIONS
April 5,1962
( Month)
(Day)
( Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY
CERTIFY,
That I attended deceased from
I last saw h ...... alive on
19
death is said to
have occurred on the date stated above, at
.m.
INTERVAL BETWEEN ONSET AND DEATH
(or) WIFE of .... Date of birthsbaprile 31962
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
2
Months.
Days
If under 24 hours
Hours ......
.Minutes
Due To
Birth injury to brain
$4 hrs
13 Usual
Occupation :
none
(Kind of work done during most of working life)
Due To
Prematurity
34 hrs.
14 Industry or Business :
15 Social Security No.
16 BIRTHPLACE (City)
( State or country )
.Chelsea, Masso
17 NAME OF
FATHER
Romeo H.Barrera
18 BIRTHPLACE OF FATHER (City)Phillipine Islands (State or country)
19 MAIDEN NAMErleen F.Hennessy OF MOTHER
20 BIRTHPLACE OF
MOTHER (City Everett.,Mass.
( State or country)
Romeo H.Barrera (father )
DATE OF BURIAL
7 NAME OF R.C.Kirby, Inc. FUNERAL PREVERnington St . , Boston , Mass TRUE COPY
People G. Tyrell.
ATTEST :
Registrar of City or Town where death occurred )
DATE FILED
April 9,1962
19
( Registrar of City or Town where deceased resided)
50M-9-59-926111
PLACE OF DEATH
Suffolk
(County ) Chelsea
CENSE PFT
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
206
Registered No.
[ (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
Hernandez Barrera
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
501 Shirley
Winthropif Masgify
AR ..
St ..
( 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
( Was deceased a
U. S. War Veteran,
(a) Residence. No. ( Usual place of abode)
19
to
19
10a If married, widowed, or divorced HUSBAND of ( Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Was autopsy performed?
What test confirmed diagnosis ?
yes
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed )
D.W. Bailey, Lt.MC USN
M. D.
USNH, Chelsea, Mess .4/5/62
.Date. 19
( Address) Holy Cross, Malden, Mass.
Place of Burial or Cremation
April 9,1962own)
19
PARENTS
21
Informant
(Address )
501 shirley st. ,winthrop
ADDRESS
Received and filed
MAY 18 1962
19
X
1
(City or Town)
U.S.Naval Hospital
No ..
2
WRITE FLAINLI, WIIN UNPAVING DIACA INK UK USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
(a)
Respiratory arrest
RECEIVED
TOWA
OF
11 12
1
1110
2
MIN
CLERK
מול
6
MAY 1 81962 AM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
PLACE OF DEATH
Suffolk (County)
...
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
85
(City or Town making this return) 03629
Stewart Mrs. Eleanor S. Aiken (nee Patrick) 2 FULL, NAME
(II deceased is a married, widowed or divorced woman, give also maiden name.)
61 Orlando Avenue
S
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.
17
days. In place of residence .. 65ears. months ... ... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
(write the word)
widowed
female white
DIVORCED
UNKNOWN
11 If married, widowed. or divorced
HUSBAND ol
(Give maiden name of wife in lull)
(or) WIFE of
Harry .... Wallace Aiken
(Husband's name in full)
12
AGE.
85 Years O
Months
II under 24 hours
Hours ..
Minutes
13 l'sual
Occupation :
housewife
( Kind of work done during most working life)
14 Industry
or Business:
own home
15 Social Security No.
010-18-8377-D
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
William Patrick
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Annie Fenerty
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Nova Scotia
21 Informant
Harry .... W ...... Aiken
(Address)
17 Revolutionary Rd. Lex.
I HEREBY CERTIFY that a satisfactory standard certificate of death Mads Ned with me BEFORE the burial or transit permit was issued:
ADDRESS
174 Winthrop St .Winthrop
Received And filed
APR 11.1962
19
Charles H Machu
(Signature of Agent of Board of Health or other) 6764
17-11-6.2
(Date of Isaue of Permit)
T
MAIS Y.
1
Boston
(City or Town)
No. New England Deaconess Hospital
f(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)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATII
April
7
1962
(Month)
(Day)
(Year)
4 IHERENY CERTIFY
March 21
19.62
April 7
19.62
I last saw
h ... Calive on
er
to ..
April 7,
1.62
death is said to
have occurred on the date stated above. at6: 30 P.m.
INTERVAL BETWEEN ONSET AND DEATH
(a)
Due To
Carcinoma of Colon
- (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
W'as autopsy performed?
yes
What test confirmed diagnosis?
5 W'as disease or injury in any way related to occupation of deceased ? Lo If so, specify
(Signature)
Jisgun Fischer
M. D.
Jurgen
Fischer
(Addr
(Print or Tipe Name) N.E. Deaconess Lag .Dat 4-8 1962
Winthrop Cemetery Winthrop, Masg
6
Place of Ilurial or Cremation
(City or Town)
DATE OF BURIAL
April 1, 1962
7 NAME OF
FUNERAL DIRECTOR
alfred 3. March
2 1 1962
:- - 932382
ORM R-301
for burial permit rd of Health s Agent. SIUCTIONS FOR CERTIFICATE
FOR TYPE FOR CAUSES DEATH Sot enter than one for each (b) and (c)
es mot mean s: of dying, Iheart failure. desc. It means , or compli- which caused
Ans, if any, ave rise to cause (a), the under- ramse last.
ations contrib- oleath but not the terminal edition given
53.8
PARENTS
(Registrar) || (Official Designation)
Registered No.
.........
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Metastase
That I attended deceased from
3 yrs
Cambridge
A TRUE COPY ATTEST: Charles it Mackie City Registrar
RECEIVED
TOW:
OF
11.12
LER
19.
2. :
8
6
HiLD
MAY 211962 AM
R-301 -
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
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent. 03765
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.