USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 17
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Registered No.
f(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Johanna Drew
( First Name)
( Middle Name)
( Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence No. 96 Nahant Avenue
(Usual place of abode)
St.
Winthrop, Massachusetts
( If nonresident, give city or town and State)
Length of stay: In place of death
years .
months. 9 days. In place of residence
10. years.
....... months.
.......
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
11
1962
(Month)
(1)3y)
(Year)
Female
9 COLOR
White
10 CITIZEN
OF U.S.
YESİ
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
4I HEREBY CERTIF
April2
1902
to ..
X.
April
11
That
ttended deceased Irom
62
19
Mast saw Helalive on
April .... 11
1962, death is said to
have occurred on the date stated above, at.
1:15 ..... Pm.
lla If married, widowed, or divorced
HUSIAN1) of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
13
AGE 2.5 ..... Years
.. Months.
.. Days
If under 24 hours
Hours ............. .Minutes
14 Usual
Occupation :
Betired
(Kind of work done during most of working life)
15 Industry
Interior Decorating
OTHER
SIGNIFICANT
CONDITIONS
Hiatus hernia
Pneumonitis
Several days or Business:
years
Was autopsy performed?
no
What test confirmed diagnosis?
clinical
S Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Charles L. Clay, M. D.
(Frint or Type Name)
Aco's. Die., Masa Con %. Now.April 11,62
(Address)
6 Holy ..... Cross ..... Cemetery. ...... Malden
Place of Burtal or Cremation
(City or Town)
DATE OF BURIAL April 14 19.62
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop Mass
APR 16 1962
.19
Received and filed
Charles & Mackie,
Registrar)
PARENTS
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Newfoundland
20 MAIDEN NAME
OF MOTHER
Mary Ann Powers
21 BIRTHPLACE OF
MOTHER (City)
(State of country)
Newfoundland
22 John G. Edwards
Informant
(Address)
96 Mahant Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
ICTIONS R ERTIFICATE
ving 1? DEATH ni enter an one epr each () and (c)
la mot mean of dying. ut failure. €. It means stor compli- vich caused
or if any, R: rise to se (a), · under- ase last.
ditos contrib- di'k but not o e terminal ontion riven
: Chapter 137, { 54 requires igt to print or t cause or death on :e ficates, and r 8, Acts of gires Physi- Fint or type o mir signature.
rectent 5% only
El Ink. 2 1 1962
-
Due To (b)
INTERVAL BETWEEN ONSET AND DEATH 5 mos
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Arteriosclerotis heart
(a)
disease
Due To (c)
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Newfoundland
18 NAME OF
FATHER
Lawrence Drew
M. D.
1
86
No.
MASSACHUSETTS GENERAL HOSPITAL
f ( Was deceased a {C. S. War Veteran.
{if so specify WAR) No
8 SEX
A TRUE COPY ATTEST:
Charles it Mackie City Registrar
RECEIVED
TOWA
11 12. 1
1.1-10
CLERK
8
6
THỊ
MAY 211962 AM
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. 042215
Registered No.
f(If death occurred in a hospital or institution.
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Mrs. Dorothy
Brass
(First Name)
(Middle Name)
(Last Name)
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
11 Sea Foam Ave .,
St.
Winthrop, Mass
(a) Residence. No.
(Usual place nf abode)
Length of stay: In place of death.
........ years ..
months.
25
.days. In place of residence
40
.years
........ months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
Ila If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Harry Brass
(Husband's name in full)
12 DATE OF BIRTH
DEATH
2 day
13
AGE .. 5.3 ... Years.
.Months ...
.. Days
If under 24 hours
.. Hours.
Minutes
Due To
(b)
sclerotic heart disease
Due To
(c)
Diabetes
OTHER
SIGNIFICANT
CONDITIONS
Nephrosis
2 years
16 Social Security No.
None
London
17 BIRTHPLACE (City)
(State or country)
England
18 NAME OF
FATHER
Joseph E. Katziff
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
20 MAIDEN NAME
OF MOTHER
Celia H. Meisel
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
22
Harry Brass
Informant
(Address)
11 Sea Foam Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
19161.
1 21-62
(Date of Issue of Permit)
7 V.1
A TRUE COPY ATTEST
(Registrar)
PARENTS
Beegarabian cemetery Everett
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April 27
9
62
7 NAME OF
FUNERAL DIRECTOR
...
Arnold Golov
ADDRESS
1.668 Beacon St. Brookline
Received and gfiled
APR 27 1962
........ 19.
Charles & Macky
(Print of Type, Name)
4/24 10 62
(Address ...
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
Robert H. Dailin
NO
(Signed)
M. D. Robert H Dailey
New England Center Hogy Date.
2 years
14 Usual
Occupation :
Housewife
15 years
(Kind of work done during most of working life)
15 Industry
or Business :
A.t ..... Home.
Was autopsy performed?
NO
What test confirmed diagnosis?
April 24
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
March
30
19.
62
62
April 24
I last saw h.
.Flive on
April
24
19.
to ..
19.62
death is said to
have occurred on the date stated above, at
.P.m.
INTERVAL
BETWEEN
ONSET AND
4.45
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Congestive failure
3 DATE OF
DEATH
TRUCTIONS FOR IL CERTIFICATE
n giving LE OF DEATH
not enter 'e than one Ise for each , (b) and (c)
daes mat mean ode of dying, heart failure, , etc. It means ase, or campli- which caused
ations, if any, gave rise ta cause (a), le the under. cause last.
Ciditions contrib- death but mat ala the terminal wcanditian given 260
Ne :- Chapter 137, Jof 1954 requires yicians to print or p the cause or w:s of death on I certificatea, and 1 ter 48. Acta of s requires Physi- :to print or type under aignature. 711. C.
IN 8 1962
MI-61-930213
RM R-301 1
No.
New England Center Hospital
[(Was deceased a U. S. War Veteran,
(If nonresident, give city or town and State)
(Official Designation)
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
RECEIVED
TOW
OF
CLERK
OFI
65
THRORN
JUN -81962 AM
---
TH
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. 04523
88
Registered No. [(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
( First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4Q Myrtle Avenue
Winthrop, Massachusetts
(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
3 DATE OF
May
3
1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That PAttended deceased from
62
19.
.April29
162
May
3
Mast saw h.e.Mlive on
May
3
19 ... 6.2, death is said to
have occurred on the date stated above, at 5:45p
......... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Pulmonary edema
(a)
INTERVAL
BETWEEN
ONSET ANO
DEATH
1 Day
Due To
(b)
Myocardial infarction
unk
mos
Due To
(c)
Coronary arteriosclerosis mos
OTHER
SIGNIFICANT
Colloid Goiter
Unk
CONDITIONS
yrs
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)
collar
M. D.
Charles L. Cley, M. D.
(Print or Type Name)
(Address)
Ass's. Dir., Mass. Gon'1. Horp.
teMay.3 ,62
BETH ISRAEL
6
EVERETT
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL 5-4 1962
7 NAME OF
FUNERAL DIRECTOR
TORF CHAPELS
ADDRESS CHELSEA
MAY 8 1962
"Chances & Mack19
(Registrar)
TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
FEMALE WHITE
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
lla If married, windows 10 MON
KUPERSLAK
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
18.82
13
AGE80
..........
Years.
.Months ...........
.Days
If under 24 hours
.Hours.
Minutes
14 Usual
Occupation :
....
(Kind of work done during most of working life)
-
15 Industry
or Business :
OWN HOME
16 Social Security No. ....
014-18-7779 A
17 BIRTHPLACE (City)
(State or country)
RUSSIA
18 NAME OF
FATHER
HERSHEL GARBER
19 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
20 MAIDEN NAME
OF MOTHER
C. D.L
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
22 MATHEW COOPER
Informant
(Address)
40 MYRTLE QUE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
2685
5-4-62
(Official Designation)
(Date of Issue of Permit)
1
!
es not mean of dying, heart failure, etc. It means :, or compli- which caused
ans, if any, have rise to cause (a), the under- ause last.
mioms contrib- o cath but not & the terminal dition given 120.1 81 C
&- Chapter 137 1954 requires fans to print or he caust or e of death on hertificates, and ot. 48, Acts of , quires Physi- 1, print or type e ader signature. 1.0. Directen WE use only .. CK Ink. IN 8 1962
31-930213
PLACE OF DEATH
MASSACHUSETTS GENERAL HOSPITAL
No.
Gertrude Cooper
OK
{ ( Was deceased a U. S. War Veteran,
(if so specify WAR)
NO
(a) Residence. No.
.....
( Usual place of abode)
NCERTIFICATE
Itgiving EOF DEATH ot enter othan one for each b) and (c)
STUCTIONS
HI R-301 1
PARENTS
HOUSEWIFE
unk
A TRUE COPY ATTEST:
Charles it. Mackie City Registrar
RECEVEZ
TO !!
OF
1-
Gi
LERK
.11 .:
8
6
WINTH
JUN -81962 AM
FORM R-301
fid for burial permit Hoard of Health its Agent. STRUCTIONS FOR I AL CERTIFICATE
UIT OR TYPE LE OR CAUSES F DEATH
1 not enter re than one cise for each ). (b) and (c)
does not mean lode of dying. s heart failure. ta, etc. It means ¡cose, or compli- which caused
alitions, if any. ak gave rise to e camse (o), in the under- comse last.
-
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
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
(Signature)
DeClan
M. D.
Cherias.L ... Clay .. M. D ..
(Print or Type Name)
(Address)Aus'in Dire Mana Gen'%, Hosp. Date May 3 1962
6
Winthrop
Winthrop
l'lace of Burial or Cremation
(City or Town)
62
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop, Mass
Received and filed
MAY 8 1962
Charles H Mackie
............. 19.
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
Harried
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
John H! nale
(Husband's name in full)
12
AGE
V'ears
23
If under 24 hours
.Ilours ........ Minutes
13 Usual
Occupation :
( Kind of work done during most working life)
14 Industry
or Business :.
Own home
15 Social Security No ..
021-16-9898
16 BIRTHPLACE (City) .... Sidney
(State or country)
Australia
17 NAME OF
FATHER
Thomas Aitken
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Sarah Walker
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Australia
21 Informant
John H Hale
( Address)
101 Sumit Ave. Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
7684
5 4 . 6 3
(Date of Issue of Permit)
12-62-932382
PLACE OF DEATH
SUFFOLK
.........
(County)
BOSTON
(City or Town)
NOMASSACHUSETTS GENERAL.HOSPITAL
.....................
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME.
Annie Hale
(Aitken)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
101 Summit Avenue
St
Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months ..
7 days. In place of residence.
35,
... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
3
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
April 26 , 162
.......
to .....
May ....... 3
19.
.62.
I last saw h.e.Klive on
May3
2 death is said to
have occurred on the date stated above, at
12: 20a
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
INTERCEREBRAL HEMORRHAGE
INTERVAL BETWEEN ONSET AND DEATH I wk
Due To
HYPERTENSION
YRS
(b)
(Usual place of abode)
......
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN89
(City or Town making this return)
Registered No.
PHYSICIAN - IMPORTANT
5
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
(write the word)
(Give maiden name of wife in full)
(or) WIFE of
71
9
Months.
Days
Housewife
unditions contrib- glo deoth but not in to the terminal condition given
331. 10
I Director No use only MACK Ink. IN 8. 1962
1
(Registrar)|| (Official Designation)
TX
May
7
That weattended deceased from
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
TO!
CLERK
C.
6
THROT
JUN -81962 AM
OIM R-301A -
I TRUCTIONS FOR IL CERTIFICATE
I giving OF DEATH
JE d not enter Tue than one de for each (b) and (c)
does not mean de of dying. heart failure, etc. It means ase, or compli- which caused
ions, if any, gave rise to on cause (a), fy the under- inA cause last.
C ditions contrib- death but not edo the terminal secondition given
765 86
To: :- Chapter 137, tf 1954, requires Ycians to print or 'e the cause or 18. of death on it certificates, and mjer 48, Acts of 9 requirea Physi- nto print or type Bunder signature. M.C.
IN 8 1962
PLACE OF DEATH
Suffolk (County) Boston (City or Town)
Beth Israel
The Commonwealth of Massachusetts - JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS 1
STANDARD
CERTIFICATE OF DEATH Hospital
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
( First Name)
(Middle Name) (Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
283
Mains St
St.
Winthrop, Mass
( If nonresident, give city or town and State)
Length of stay: In place of death
years.
months 15 days. In place of residence.
3.0 years
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May 4 1962
(Month) (Day)
(Year)
4 1
HEREBY CERTIFY.
That I attended deceased from
april 20, 1962 to ......... May
4 1962
I last saw h.c.balive on
May 4, 1962 death is said to
2:10 p.m.
have occurred on the date stated above, at ......... INTERVAL BETWEEN ONSET AND TREATH
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
YES
.
What test confirmed diagnosis? AUTOPST -
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed) Edward 2 Roble M. D
Edward J Rolde
(PRINT OR TYPE SIGNATURE)
(Address)
330 Breakline AveDate.
May 41962
Boston
Mt. Pleasant 6 Place of Burial or Cremation
Arlington Mass
(City or Town)
DATE OF BURIAL May ..... 7. 19 .. 6.2
7 NAME OF
FUNERAL DIRECTOR Arthur J. O'Maley Winthrop, Mass
ADDRESS
Receinfo and' filed C MAY 8 19.62 19 ·
Charles à Mache
( Registrar)
PARENTS
17 NAME OF
FATHER
James Lodarry
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Eva Buckley
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Mary J McGarry
Informant
(Address)
283 Main St., Winthrop
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)
08 327 NT
May 4,1462
(Official Designation)
(Date of Issue of Permit)
10 SINGLE
(write the word)
MARRIED
WIDOWERMarried
or DIVORCE!
10a If married, widowed, or divorced
HUSBAND of
Mary J. McPhail
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
63 Years
Months ............
.. Days
If under 24 hours
.......
Hours .............. Minutes
13 Usual
Occupation :
Clerk
(Kind of work done during most of working life)
14 Industry
or Business :
Registry Motor Vehicles
15 Social Security No.
16 BIRTHPLACE (City)
Arlington
(State or country)
Nass
90.
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent. [ .
Registered No.
Joseph Joseph P. McGarry
Mc garry
((Was deceased a
U. S. War Veteran.
(if so specify WAR) .. No
(a) Residence. No. (L'sual place of abode)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(2) BILATERAL PULMONARY INFART
8 SEX
Male
9 COLOR
White
No.
A TRUE COPY ATTEST:
Charles it. Mackie City Registrar
OF TOWN
17.
JERK
5
5
INTHRO
JUN - 81962 AM
CIM R-301 1
I TRUCTIONS FOR UL CERTIFICATE
1 giving OF DEATH
not enter me than one de for each 1. (b) and (e)
does not mean de af dying, heart failure. etc. It means ase, or compli- which caused
ions, if any, gave rise la cause (a). ri: the under- cause last.
ditions contrib- death but not a the terminal condition given
465, 86
T: : - Chapter 137, tbf 1954 requires ycians to print or e the cause or ill of death on it certificates, and Ler 48. Acts of requires Physl- ato print or type Munder signature. MI, C.
18 1962
( 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
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent.
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Walter
D
( Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
27 Vine Ave
St.
(If nonresident, give city or town and State)
months.
......
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Nale
9 COLOR
White
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divorced .
Lar aret Reid
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
11/6/85
13
76
AGE
Years.
5
23
Months ...
......... Days
If under 24 hours
Hours ............
.Minutes
14 Usual
Occupation .
Derut" Collector
(Kind of work done during most of working life)
15 Industry
or Business :
State Income Tax
16 Social Security No.
None
East Boston
Was autopsy performed?
No
What test confirmed diagnosis?
S Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D.
Alfred TARICCO
(Print or Type Name)
5/5
19 62
6 Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
May
8
19
6
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop, Mass
Received and filed
MAY .......... 9.1962
Chances & Mack
19
(Registrar)
PARENTS
18 NAME OF
FATHER
John Ramsey
19 BIRTHPLACE OF
FATHER ."(City)'
täteor dountry-)
> Canada
20 MAIDEN NAME OF MOTHER 's Jane Gregg
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
22 Margaret R Ransey
Informant
(Address) 21 Vine Ave. withrop, Mass.
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)
17/0 6 N.T.
5/7/62
(Official Designation) (Date of Issue of Permit) TVIV
A TRUE COPY A COPY ATTES TEST:
1962
3 DATE OF
DEATH
....
May
(Month)
(Day)
(Year)
4 I HEREBY
April 7
19.
CERTIFY
May L
May L
62
19
I last saw
alive on
19
death is said to
have occurred on the date stated above, at .
6:25
Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
, Respiratory failure
.....
Due To
Pulmonary Embolism !
(b)
Due To
(c)
OTHER SIGNIFICANT CONDITIONS
....
INTERVAL BETWEEN ONSET AND DEATH
7726
Ramsey
PHYSICIAN - IMPORTANT
[ ( Was deceased a
U. S. War Veteran.
{if so specify WAR)
Winthrop, Massachusetts
(a) Residence. No.
(L'sual place of abode)
Length of stay: In place of death.
years.
months
days.
In place of residence.
5.9years
28
............
Registered No.
New England Center Hospital
No.
( First Name)
( Address)
N.E.C.H.
Date,
17 BIRTHPLACE (City)
(State or country) ],'ass
That I
attended deceased
A TRUE COPY ATTEST:
Charles it. Mackie City Registrar
1
ERK
10
6
THROP
JUN - 81952 AM
IM R-301 1
RUCTIONS FOR CERTIFICATE
I giving OF DEATH
ot enter than one u for each (b) and (c)
Des not mean ne of dying. heart failure, etc. It means se. or campli- which caused
ons, if any. gave rise to cause (a). the under- cause last.
tions contrib- Adeath but nat the terminal ndition given
451 85
:- Chapter 137, 1954 requires ans to print or he cause or e of death on bertificates, and Pr 48, Acts of Requires Physi- so print or type ender signature. I.C.
Director ·use only :K Ink. 11 8 1962
31-930213
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.
04866
Messechu f(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number) No. General Hospital BAKER MEMORIAL ....
William Benker
2 FULL NAME
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No.
16 Egleton Park
(Usual place of abode)
Winthrop, Massachusetts
( If nonresident, give city or town and State)
Length of stay: In place of death
years.
months
1 .days. In place of residence 15 years ............ months. ... days.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
6,
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That Heattended deceased from
May
6 , ..... 162 , . May
19
62
welast saw Åm.alive on ... Ma .. y.
.6 ..
19 .... 62, death is said to
have occurred on the date stated above, at ....
3:55P.m.
INTERVAL BETWEEN ONSET AND DEATH
(a) Ruptured Aortic Aneurysm
Due To (b)
3hrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
17 BIRTHPLACE (City)
(State or country)
Mass.
Boston
What test confirmed diagnosis?
Clinical
S Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Chillay
TS
M. D.
Charles. L. Clay, M.D. (Print 'or Type Name)
(Address) Ass's. Diz., Mess. Gon']. Hosp. Date. 19
PARENTS
Winthrop Cemetery, Winthrop 6 Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
May 9,
19.62
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed
MAY 9 1962
19
Charles & Ma
Registrar)
A TRUE COPY ATTEST:
8 SEX
male
9 COLOR
white
10 CITIZEN
OF U.S.
YES K
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
11a lí married, widowed, or divorced
HUSBAND of
Rose M ..... Sabino
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
Sept. 28, 1900
13
61
AGE.
Years.
7
Months.
8
Days
If under 24 hours
.. Hours.
Minutes
14 Usual
Occupation :
Testman
(Kind of work done during most of working life)
15 Industry
or Business :
Telephone Co.
16 Social Security No. ....
011-05-0690
18 NAME OF
FATHER
Jacob John Benker
19 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass.
20 MAIDEN NAME
OF MOTHER
Mary E. McNamara
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Mrs. Rose M. Benker
22
Informant
(Address)
16 Egleton Pk. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: xl 9 M Mamarajd
.....
(feature of Agent of Board of Health of other)
7132 Note: 5/8/62
(Official Designation) N , y (Date of Issue of Permit)
Registered No.
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
{if so specify WAR)
WW II
MEDICAL CERTIFICATE OF DEATH
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Boston
A TRUE COPY ALLEST: Charles it. Mackie City Registrar
TOW;
CLERK
6
INTHROT
JUN - 81962 AM
PLACE OF DEATH
Suffolk (County)
1
Winthrop
(City or Town)
No ....
10.4.Highland Ave.
1
Thomas Murnane
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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