USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 25
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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 )
Janes S. Drorbaugh
M. D.
James E. Dror bough
(Print or Type Name)
(Address)
221 Luyword que
.. Date ..
6.26 0219
6 ST. MICHAEL - BOSTON
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL JUNE 30, 1.62
7 NAME OF
FUNERAL DIRECTOR ANDREWS TREED, IM.
ADDRESS
231 BELMONT ST, BELMONT
Received and filed
JUL J TYOL
19
Charies : Mackie
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATII
JUNE
26,
(Day)
1962
(Year)
( Month)
(a) Residence. No ...
(Usual place of abode)
PHYSICIAN - IMPORTANT
JaWas deceased a U. S. War Veteran, af to specify WARY.
Winthrop
VASS
months days.
INTERVAL BETWEEN ONSET AND DEATH
21 Informant
(Address)
'A TRUE COPY ATTEST,
Charles & m. Kg
Chy Registrar
RECEIVED
TOW.
OF
11.12. A
10
OFF
Mi
CLERK
6
THROP
AUG =91962 AM
PLACE OF DEATH
X OUT - OF - TOWN
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Ilealth or its Agent. 125
Registered No.
[(If death occurred in a hospital or institution,
No.
Veterans Administratich Hospital
give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME-
James
H
HOLLAND
( First Name)
( Middle Name )
( Last Name)
{if so specify WAR)
- ( If deceased isa married. widowed or divorced woman, give also maiden name.) -
(a) Residence. No.
( l'sual place of abode)
Dead on arrival
Length of stay: In place of death . years .... months
... days.
In place of residence.
Life
months .... ... ... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 CITIZEN
OF U.S.
YES
11 SINGLE MARRIED WIDOWED DIVORCEf) UNKNOWN
lla If married, widowed, or divorceBarry
HUSHIAND of
Jane
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
7-22-97
13
AGE
64 Years
11
Months
4
.Days
If under 24 hours
Hours. ....... Minutes
14 Usual
Occupation :
Master
(Kind of work done during most of working life)
15 Industry
or Business: Burton Soryel Deli
16 Social Security No.
Besten,
17 IIIRTIIPLACE (City)
(State or country)
Massachusetts
18 NAME OF FATHIER James Holland
19 HIRTfIPLACE OF FATHER (City) (State or country) Treland
20 MAIDEN NAME OF MOTHER
Con !:
21 BIRTIIPLACE OF MOTHIER (City) (State or country)
Informant (Address) 22 V.A. Hospital Records, 150 South Huntington Ave.,Besten Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: R.K.Gorman
(Signature of Agent of Board of Health or other)
A0.7.8.3.8
6-27-62
I (Official' Designation)
(Date of Issue of Permit)
RUCTIONS FOR IC. CERTIFICATE
giving OF DEATH S d not enter : than one ale for each ( (b) and (c)
istoes not mean nic of dying, I heart failure. m etc. It means filsc, or compli- u which caused
wcions, if any, icl gave rise ta cause (a). the under- in couse last.
atitions contrib- death but nat do the termine! condition River
420.1 4 Ve :. Chapter 137 toof 1954 requefes y cians to print or os the cause or u:s of death on ar certificates, and a er 48, Acts of St requires Physi- ut to print or type n under signature.
Ji 9 1962 IC.
I 61-930213
A TRUE COPY ATTEST:
PARENTS
6 Winthrop Cemetery Winthrop, Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
6-29-62 .19
7 NAME OF
FUNERAL
DIRECTOR
O' Malay F.H.
ADDRESS 79 Atlantic St., Winthrop, Mass
Record and filed Charles 2 Machen 19
( Registrar )
26
1962
(Day)
(Year)
4 1
HERERY CERTIFY,
That I attended deceased from
19 to 19
I fast saw h ........ afive on
19 ...
......... , death is said to
have occurred on the date stated above, at
8:30 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) CORONARY THROMBOSIS
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
N.L.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? IV. If so, specify
(Signed) Jotun P Icon.
M. D.
JOHN P. TREANONUTR MD
(Print or Type Name)
(Address) Svalon Hearth Digt Date June 26 1962
OM R-301 1
Suffolk
(County)
Boston
(C'ity or Town)
STANDARD CERTIFICATE OF DEATH
..
[ ( Was deceased a
U. S. War Veteran. WW 2
1 Sargent Terrace
XXX
Winthrop, Mass.
tlf nonresident, give city or town and State)
3 DATE OF
DEATH
(Give maiden name of wife in full)
A TRUE COPY ATTEST: Charles it Mackie City Registrar
RECEIVED
OF TOWA
OFFICE
KLERK
5
6
VTHR
ni
AUG = 91962 AM
X I
PLACE OF DEATH
SUFFOLK (County)
WINTHROP
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
Registered No.
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
FRANK P. CARUCCIO
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.) VOT 13KT/ 4 1
(a) Residence. No 76 INGLESIDE AVENUE
St
WINTHROP
(Usual place of abode)
20
years .. months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
White
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
July 3,
19
62
July 3,
19
62
I last saw himalive on
July 3,
19.62 death is said to
have occurred on the date stated above, at
5:25p.m.
INTERVAL BETWEEN ONSET AND
(or) WIFE of.
(Husband's name in full)
Hour12
AGE.69 Years.
.8
Months.
20 Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :.
Presser
(Kind of work done during most working life)
14 Industry
or Business :
Clothing
15 Social Security No.
011-01-1253
16 BIRTHPLACE (City)
(State or country )
Italy
17 NAME OF
FATHER
Michael Caruccio
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Angela DiCreto
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Italy
21 Informant
Mrs. Angelina Caruccio
(Address)
76 Ingleside Ave., 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)
7/5/62
(Date of Issue of Permit)
A TRUE COPY ATTEST:
years
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
EKG
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
NO
(Signature)
M. D. Joseph Gregoriel M. D. Winthrop, Mas's. yge Name)
July 31962
(Address)
Date.
6
Winthrop Cemetery,
Winthrop
Place of l'urial or Cremation
(City or Town)
DATE OF BURIAL
July 6,
19.62
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed
JUL 5 - 1962
19
11 If married, widowed, or_diyorced
HUSBAND of
Angelina Capaldo
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Coronary occlusion
(a)
3 DATE OF
July 3, 1962
DEATH
(Month)
(Day)
(Year)
HEREBY CERTIF
That I attended deceased from
to
€>2-932382
DRM R-301
le for burial permit Fard of Health ats Agent. IS IUCTIONS FOR CA CERTIFICATE
¡OR TYPE ER CAUSES DEATH dot enter u1 than one u' for each (b) and (c)
Des not mean ne of dying, & heart failure, itetc. It means flie, or compli- which caused
Lions, if any, Igave rise to e cause (a), nthe under- & cause last.
o: itions contrib- l death but not the terminal ondition given
--
WINTHROP COMMUNITY HOSPITAL No
(Was deceased a
U. S. War Veteran,
if so specify WAR).
NO
(If nonresident, give city or town and State)
Length of stay : In place of death ......... years .......... months .......... days. In place of residence.
(Registrar) |f (Official Designation)
Due Coronary artery disease
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
NECESSI
SERVICE NUMBER
RULES OF PRACTICE
LEKK
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 forth pf i. 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 aupposably due to injury. These include not only deaths caused directly or in fectky by 1982 PM traumatism (including resulting septicemia), and by the action of chemich (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin 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.
ORM R-301
Fol for burial permit :board of Health its Agent.
IN RUCTIONS FOR ICCERTIFICATE
giving IS OF DEATH dinot enter ne than one ale for each (= (b) and (c)
is does not mean nie of dying, heart foilure, m etc. It means di ise, or compli- ns which caused
mioms. if ony. ie gove rise to ou cause (a). the under- cause lost.
Ciditions contrib- death but not do the terminal secondition given 1
17
Nie :- Chapter 137. c of 1954 requires hiciandto print or F the / cause or 0:s of death on 11 certificates, and heter 48. Acts of s requires Physi- a: to print or type r: under signature.
li 9 1962
V11-61-931825
PLACE OF DEATH
SUFFOLK (County)
Trà
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS (City of Town making this return)
COPY OF CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital or institution.
.St. { give its NAME instead of street and number) No ...
PHYSICIAN - IMPORTANT
) (Was deceased a U. S. War Veteran. Cif so specify WAR ...
(a)
Residence. No ....
18 ... CLIFF.AVE WINTHROP MASS.s
(If nonresident. give city or town and State)
Length of stay: In place of death .......... year ........... months ....... days, In place of residence
years months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
7
4
1962
(Year)
(Month)
(Day)
& IHEREBY CERTIFY , That I attended deceased from
N
... .. 19 ....
62. to 7-4
10
62
I last saw l
ERve on
7- 4
, 19.62 death is said to
have occurred on the dute stated above. at
8;40RM
INTERVAL BETWEEN ONSET AND DEATH
DEATH RES SETATORYMFATLURCAUSE Vesperatory Failure (a)
FULUMNORY HYALINE-
(b)) icilinanon HexaunMEMBRANE SYNDROMARS
2DAYS
13 l'oral
Occupation ....
NOŅE
t Kind of work done during most working life)
14 Indus ***
or Business.
NONE
15 Social Security No
Boston, .8.55.
16 BIRTHPLACE (City1.
istne or country 1
17 NAME OF FATHER KENNETH C. QUIST
18 BIRTHPLACE OF
FATHER (City) ...
(State or country)
DEDHAM MASS
19 MAIDEN NAME
OF MOTHER
JEANNE E.BARRIEAU
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
CHELSEA, MASS
Winthrop Cemetery -Winthrop, Mass. 6
Place of llurial or Cremation
Kity of Town)
· DATE OF BURIAL
TURY S
62
7 NAME OF
FUNERAL DIRECTOR
FRANCIS E. KENNEY + SONS
ADDRESS 1445 RIVER St. HYDE PARK MASS
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
R.K .Gorman
(Signature ol Agent ol Board of Health or other)
107955
7-5-62
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
& SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWFD
DIVORCED
UNKNOWN
( write
SINGLE
11 If married. widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of.
( Husband's name in full)
12
AGE
Vear-
Month-
2
Day.
li under 24 hour-
Hour-
Minutes
Due To
(c)
Causacon Sentie
C/S
OTHER
SIGNIFICANT
CONDITIONS
Was antopsy performed ?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify
(Signed
(Address)
A. D.
(Print or Type Name)
.. ])ate
7/5 /62
PARENTS
21 Foformant
( Address )
MR.KENNETH QUIST
18 CLIFF AVE
WINTHROP MASS
Received and filed
JUL 11 1962
Charles 21 mackie
( Registrar of City or Town where deceased restled)
OUT - OF TOWN
1
BOSTON MASS (City or Town)
ST ..... MARGARET, S HOSPITAL
2 FULL NAME.
BABY GIRL QUIST.
(If deceased is a married. widowed or divorced wontan, give also maiden name.)
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
NONE
X
A TRUE COPY ATTEST:
Charles it mackie
City Registrar
TOW
UFF
CLERK
6
HODÍ
AUG = 91962 AM
DRM R-301
for burial permit Bird of Health ns Agent. NTRUCTIONS FOR CA CERTIFICATE
NOR TYPE EOR CAUSES FDEATH
not enter athan one u for each a (b) and (e)
aes not mean l'e of dying, a heart failure, etc. It means isse, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
alitians contrib- death but not dothe terminal anditian given C.
X PLACE OF DEATH 1
Suffolk (County)
Winthrop (City or Town)
Che Commonwealth of zhassathusetis KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN ~ IMPORTANT
2 FULL NAME
AbrahamYorks
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
26 Bates Ave.
(Usual place of abode)
St
(If nonresident, give city or town and State)
Length of stay: In place of death ... .. Qyears .......... months .......... days. In place of residencel.Q .. years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
JULY
DEATH
(Month)
(Day)
10
1962
(Year)
4 IHEREBY CERTIFY , That I, attended deceased from
7/7
19.6
to ..
7/1
192
I last saw h| live on
7/4
19.6, death is said to
have occurred on the date stated above, at
8.30 Pm.
INTERVAL
BETWEEN
ONSET ANO
DEATH
(a) ARTERIOSCLERITIC & HYPERTENSIV CARDIO VASCULAR DISEASE
Due To
(b)
CHRONIC GLOMERULONEPHRITIS
SYRJ.
Due To (c)
OTHER
HYPOCHROMIC SECONDARY
ANEMIA
2YRS
Was autopsy performed?
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signature)
myrin-n. 15mg
M. D.
MYRIAD N. KING M.D
(Print or Type Name)
(Address) 122 PLEASANT ST
> Date.
7/10 1962
"INTHALD DIDN'T
6Ohel Jacob Cemetery - Woburn
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 11
1962
7 NAME OF
FUNERAL DIRECTOR
Arnold Golov
ADDRESS
1668 Beacon St. Brookline
Received and filed
July
11, 19 6.2
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Widowed
11 If married, widowed, or divorced
HUSBAND of
Rosc ..... Kapulsky
(Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
12
2YRS
AGE.
8.6Years ...
. . Months.
Days
13 Usual
Occupation :
Master Plumber
(Kind of work done during most working life)
14 Industry
or Business :
Self Employed
15 Social Security No 021-28-3191
16 BIRTHPLACE (City) ....
(State or country)
Russia
17 NAME OF
FATHER
Yachin Yorks
18 BIRTHPLACE OF
FATHER (City)
Russ.i.a.
(State or country)
19 MAIDEN NAME
OF MOTHER
Sarah
(UNKNOWN)
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
.....
21 Informant (Address) 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)
7/11/62
(Date of Issue of Permit)
1 VVB
.62-932382
A TRUE COPY ATTEST:
PARENTS
Ida Katz - 26 Bates Ave.
(Registrar) || (Official Designation)
(City or Town making this return)
No .... 26 Bates Avenue, Winthrop
(Was deceased a U. S. War Veteran, if so specify WAR)
No
If under 24 hours
Hours ... . .. Minutes
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
SIGNIFICANT
CONDITIONS
CIRRIASIS OF LIVER.
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 froin 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.
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
50M ·10-61-931673
X
PLACE OF DEATH
Norfolk (County)
TLM
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
Braintree
(City or Town making this return)
120
John Scott Nursing Home
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
Lillian Frances (Hatch) Walcott
(If deceased is a married, widowed or divorced woman, give also maiden name.)
10 Orlando Avenue
St
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months ......
14
19
lays. In place of residence.
Years
... months
.days.
MEDICAL CERTIFICATE OF DEATH
11
62
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY,
That I attended deceased from
6 .- 28
16.2
t.o.
7/11
.62
I last saw he. Llive on
7/5
19 .... 62death is said to
have occurred on the date stated above, at
10 p.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Massive Myocardial Infarcti
(b) Arteriosclerotic Heart
Disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
No
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? N.O If so, specify
(Signed)
Vincent Pattavina
M. D.
Professional Center
(Address
So. Braintree, Mass.
.Date ...
7/12 62
Riverside Cemetery Sagus
6
Place of Burial or Cremation
July 14,
62
19
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS
174 Winthrop St., Winthrop
Received and filed JUL .16 1952 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEDWidowed
DIVORCED
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
(Give maiden nam
Truman G. Walcott")
(or) WIFE of
(Husband's name in full)
12
MI
4
+
esGE ..
84 ears.
8
Months.
Dayz
If under 24 hours
Hours ...
.Minutes
13 Usual
Occupation:
At Home
(Kind of work done during most working life)
14 Industry
At Home
or Business :
15 Social Security No.
015-20-4866
16 BIRTHPLACE (City)
(State or country )
Mass
17 NAME OF
FATHER
Alton J. Hatch
18 BIRTHPLACE OF
FATHER (City)
Chelsea
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Annie E. Williams
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Chelsea
21 Informant
Mr. Walter H. Packard
4gApackard Drive, Braintree
A TRUE COPY
Care R. Johnson & ..
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
JUL 12 1962
19 ...
1
Braintree (City or Town)
COPY OF CERTIFICATE OF DEATH
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR
Winthrop
No
(a)
Residence. No.
(Usual place of abode)
No ...
2 FULL NAME
3 DATE OF
DEATH
7
(write the word)
INTERVAL
BETWEEN
ONSET AND
DEATH
Years
Chelsea
PARENTS
C
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
X
PLACE OF DEATH
SUFFOLK Winthrop "(County) BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or Town making this return)
Registered No.
130
Winthrop Community Hospital
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
No.
2 FULL NAME
FLORENCE
PRATT
(First Name)
(Middle Name)
(Last Name)
[(Was deceased a
U. S. War Veteran,
lif so specify WAR)
(If deceased is a married. widowed or divorced woman, give also maiden name.) 31 Villa Avenue, Winthrop St.
(a) Residence. No.
(Usual place of abode)
Length of stay:
In place of death.
years.
months.
14
.days.
In place of residence.
46
years
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
13, 1962
9 SEX
10 COLOR
white
11 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word ) Widowed
12 If married, widowed, or divorced HUSBAND of
(or) WIFE of
Same
(Give maiden name of wife in full) S Pratt
(Husband's name in full)
13 DATE OF BIRTH May 20, 1877
5 Accident, suicide, or homicide (specify)
Date and hour of injury
6/27
62
19.
Yes.
IF ACCIDENTAL, was injury causally related to the death ?
Where did
Winthrop, Mass.
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or public place ? Home ..
Manner of
Fall tal Frogre
Injury
(How did injury occur ?)
Nature of
Fracture of femur.
Injury
While at work?
Was autorsy performed?
NO.
6 Was disease or injury in any way related to upation of here. sed ?
(Signed). Michael W.
(Print or Type Name)
Boston
Date 7/13 62
(Address) mit auburn 7
Camb Maso
(City or Town)
DATE OF BURIAL
July
16
62 19
8 NAME OF FUNERAL DIRECTO Enesto Gaggiano ADDRES 147 WinterofSt Natury JUL 16 1952 Received and filed 19
A TRUE COPY ATTEST:
(Registrar)
PARENTS
20 BIRTHPLACE OF FATHER (City) (State or country)
21 MAIDEN NAME OF MOTHER Unknown
22 BIRTHPLACE OF MOTHER (City) (State or country)
7
William B Pratt
23
Informant
(Address)
3/ 11/19 aug Withmy
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with/me BEFORE the burial or transit permit was issued: Halkle (
(Signature of Agent of Board of Health or other)
Healthe Office (Official Designation)
(Date of Issue of Permit)
Y V.BY
NILATA
DRACH
OD MDE THE CATICE OD CALICEC AL
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 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. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
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