USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 39
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
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
3 DATE OF DEATH (a) (b) Due To (c) 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
50M - 10-61-931673
PLACE OF DEATH
Suffolk (County)
I
Revere
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
450
Revere
(City or Town making this return)
Registered No.
192
S(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
Mary L. Lynch a/k/a Minnie Lynch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
171 Revere
Winthrop
(Usual place of abode)
21
48
(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
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
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
85,
7
Months ..
2
.Days
If under 24 hours
Hours ....
Minutes
13 Usual
Accountant (retired)
Occupation :
(Kind of work done during most working life)
14 Industry
Office Work
or Business :
15 Social Security No.
028-07-4884
16 BIRTHPLACE (City) New York City
(State or country)
New York
17 NAME OF
FATHER
William J. Lynch
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary L. Smith
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
New York
Laura Broussard
2I Informant
(Address)
171 Revere St., Winthrop
A TRUE COPY
ATTEST:
DATE FILED
(Registrar of City or Town where deceased resided)
2.9,
1962
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY , That I attended deceased from
Oct.
8
.62
19
to.
Oct. 29
19.
62
I last saw
hexalive on
Oct ..
29
19.
62death is said to
have occurred on the date stated above, at
8 P.
... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Uremia
INTERVAL BETWEEN ONSET AND DEATH
48hr
Due To
Carcinoma of rectum
3yrs.
Was autopsy performed?
no
What test confirmed diagnosis ?
Clinical signs
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed)
James F. Burns
M. D.
537 Broadway
70/30/
,62
St. Joseph Cemetery, Boston 6
Place of Burial or Cremation
(City or Town)
November 2,
62
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed 19
ist
( Registrar of City or Town where death occurred)
November 1,
.. 19.
62
2 FULL NAME
No .....
Grover Manor Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR
St
October
(Address)
Everett
Dat
AGE
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE. DATE OF DISCHARGE. RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
:
5
NOV -81962 AM
RM R-304
PLACE OF DELIVERY No.
Suffolk (County )
1 Winthrop (City of Town)
Winthrop Community Hospital
Ruggiero, Stillborn Male
2 NAME OF FETUS (if given)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH )
To be filed for burial permit with Board of Health or its Agent.
193
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVERY
10
31
1962
( Year)
( Month)
(Day)
7 IF MULTIPLE BIRTH, BORN :
1st.
.2nd 3rd
4 SEX
Male M.Female .. . Undetermined.
5 COLOR (if
determined)
wh
6 THIS BIRTH (Check one)
Single X Twin
Triplet
MOTHER adeline albanese
PRESENT NAME
adeline Ruggiero
9
RESIDENCE, NO.
962 Bennington
CITY OR TOWN Gaat Boaton
STATE
STREET Maso
10 COLOR OR
RACE.
11 AGE AT TIME OF
THIS DELIVERY
34 (Years)
12 PLACE OF
BIRTH
East Boston Masa (City or Town! (State or country )
18 PLACE OF
BIRTH
Boston
(City or Town
Mars
(State or country)
13 OCCUPATION
20 PREVIOUS DELIVERIES TO MOTHER ( Do not include this fetus) 3
(a) How many children are
now living?
3
(b) How many children were born alive but are now dead ? more
(c) How many previous fetal deaths of ANY gestation age ?
21 LENGTH OF
PREGNANCY
283/4
.completed
weeks
22 WEIGHT OF FETUS
Lb.
Oz.
(or
Gramıs )
23 WHEN DID FETUS DIE? Before V Labor
During Labor
or Delivery
Unknown
I HEREBY CERTIFY that this delivery occurred on the date stated above at 10% .m., and product of conception was not a live birth.
Signature of Attending Physician or Medical Examiner : @ Thomas Stoffer.
M.D.
D. Thomas Staffier, MD (PRINT OR TYPE SIGNATURE) Breed ST E.B. .Date 10/3/1962
Address
I.HEREBY CERTIFY that a satisfactory certificate of fetal death was. fbed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)- Health Office
11/1/12
(Date of Issue of Permit )
(Official Designation
A TRUE COPY ATTEST:
25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE PhocomeLIA (Fetal Deformities) (a)
Due To (b) Due To (c)
OTHER SIGNIFICANT CONDITIONS
Topenia of pregnancy
26 Woodlawn Place of Burial or Cremation
Svesert
novi
(City or Town) 1962
DATE OF BURIAL
27 NAME OF
Ernest Plaggiano 147 Winthrop St Winthrop
ADDRESS
NOV 1 1952
19
Received and filed
(Registrar )
14
MAIDEN NAME
15
RESIDENCE, NO.
CITY OR TOWN
Boston
962 Bermington
STATE
STREET man
16 COLOR OR
RACE
W
17 AGE AT TIME OF
THIS DELIVERY
34(Years)
Plumber.
19 INFORMANT
Nicholas Ruggiero
24 AUTOPSY
Yes ..
No
Gal or maternal dition causing eil death (do i use such 'ens as stillbirth prematurity.) F'al and/or ma- 2 al conditions Thy, which gave de to above Mse (a), stating / underlying rise last.
ditions of fetus mother which y have contrib- ed to fetal th, but, in so as is known, 'e not related cause given (a).
||5M -6-60-928241
8 FULL NAME
FATHER Nicholas Ruggiero
St.
3
In giving AUSE OF CAL DEATH o not enter pre than one use for each of (a), (b) and (c)
FETAL DEATH
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.
TO!
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, ... shall not be permitted except.
ERKE
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiratori, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretaryof stateor Aquired by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
PLACE OF DEATH -
SUFFOLK (Cont) ) BOSTON, MASS (City of Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permier. /4- with Board of Health or its Agent.
49053
[(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and numher)
No.
MASSACHUSETTS GENERAL HOSPITAL
..
2 FULL NAME
Angela Maddaloni (DiVita)
( If deceased is a married. „ dowed or divorced woman, give also maiden name.)
(if so specify WAR)
(a) Residence. No.
23 ... Trident Avenue
sWinthrop, Massachusetts
( Visual place of abode )
,
(If nonresident, give city nr town and State)
length of stay: In place of death .....
.. years .............. months.
1
.days. In place of residence.
......
years
.. month«
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
September 14
1962
DEATH
(Month)
(Day)
(Year)
I HEREBY
CERTIFY
O
September fzeased
62
19
I last saw H.Lalive on
September 14,62
death is said to
have occurred on the date stated above, at ............
2.1-20pm
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebral hemorrhage
Due To
Cerebral arterial
(b)
Schlerosis
......
? yrs
Due To (c)
OTHER
SIGNIFICANT
Hypertension
unknown
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?
clinical
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
.....
(PRINT OR TYPE SIGNATURE)
(Address) Date Sept. 14,62
6
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL S.e.p.t ...... 18., 19. 62
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed SEP 1-8-1962 Charles A.M
19
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED Widow
WIDOWEDN
of DIVORCED
10a If married, widowed, or divorced
HUSBAND of
John Maddaloni
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
72 Years
10
Months.
18
Days
If under 24 hours
.. Hours.
.... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
at home
15 Social Security No. 019-18-0997
16 BIRTHPLACE (City) (State or country) Italy
17 NAME OF
FATHER
Carmen DiVita
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Anna Palazzolo
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Vincent DiVita
21
Informant
(Address)
56 Park Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death . was filed with me BEFORE thy burial or transit permit was issued:
....
(Signature of Agent of board of Health or other
62023
9-17-62
(Date of Issue of Permit)
(Official Designanon)
-
NR-301A 1
STICTIONS OR ALCERTIFICATE
In iving EIF DEATH at enter re han one nfor each ). b) and (c)
c's not mean & of dying, s cart failure. , Ic. It means es, or compli- hick caused
34 20
Uss, if any, 1 ive rise to (a). E'ke under- ause last.
mions contrib- Death but not I the terminal udition given
.Chapter 137. 54, requires s to print or cause or death on rificates, and 48. Acts of quires Physi- print or type er signature.
C 3- 1962
-59-925686
Registered No
PHYSICIAN - IMPORTANT
[(Was deceased a
{ U. S. War Veteran,
sept.
13
19
....
INTERVAL
BETWEEN
ONSET AND
DEATH
18hrs
PARENTS
(Signed)
@@@la
M. D.
A TRUE COPY ATTEST: Charles i Mackie City Registrar
RECEIVED
TOW
OF
LERK
1
6
VINTHROP
DEC 3 1962 AM
ORM R-301
for burisì permit hard of Health ts Agent. ERUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH
not enter than one : for each (b) and (c)
loes not mean le of dying, heart failure, etc. It means se, or compli- which caused
lons, if any, gave rise to cause (a). the under- cause last.
titions contrib- death but not · the terminal Condition given 20.1 0.81 ×70
C 3- 1962 Directon I use only CK Ink.
12-932382
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 - TOS
(City or Town making this return) 09135
---
--
2 FULL NAME
Jessie, McLaren
(MacDonald.)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ........
3 Willis Avenue
St
Winthrop, Mass
(Usual place of abode)
Length of stay: In place of death .......... years ..
1.months .....
days. In place of residence ..
.8.
.years .......... months ....
........ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
September
17
19.62
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That Iattended deceased from
August 13, 1962, to September 17, 1962
wd last saw Helalive on
.September ..... 1.719 62death is said to
have occurred on the date stated above, at .10 .:. 5.0am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial Infarct, Acute
(a) Posterior
Due To Coronary
Atherosclerosis
(b) and Thrombosis, Rt Branch
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Acute .... Pericarditis
unk
Was autopsy performed? .. y.e.s.
What test confirmed diagnosis ? .. autopsy ...
(Signature)
.Charles Ur Clay M.D. Print or Type Name) (Address) Ase't Din, Maser Gon' Hosp ... Date Sept . 17, 62
Woodlawn Cemetery, Everett .... Place of Burial or Cremation (City or Town)
DATE OF BURIAL
September 20th
19.62
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby, Inc
ADDRESS 917 Bennington St.,E.Boston
Received and filed
SEP 21 1962
.19
Charles iv, Ma chania)
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Widowed
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Alexander McLaren
INTERVAL
BETWEEN
(or) WIFE of
12
ONSET AND
DEATH
2 wks
AGE.
80Years
2
Months.
9
.Days
If under 24 hours
.. Hours .....
.Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most working life)
14 Industry
or Business :
At home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Roderick MacDonald
18 BIRTHPLACE OF
FATHER (City)
Nova Scotia
(State or country )
Canada
19 MAIDEN NAME
OF MOTHER
Jessie MacDonald )OK)
20 BIRTHPLACE OF
Nova Scotia
MOTHER (City).
(State or country)
Canada
Mrs.Jesse Cann-daughter
3 Willis Avenue,
Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued: Harman
(Signature of Agent of Boerd of Health or other) 12971 9-19-62
(Official Designation) (Date of Issue of Permit)
· V
Registered No.
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
No.MASSACHUSETTS.GENERAL HOSPITAL M.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No
(If nonresident, give city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
(Husband's name in full)
2 wks
Provincetown
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
@@@low
M. D.
PARENTS
A TRUE COPY ATTEST: Charles & Mackie City Registrar
OF TO!
1/ 12.
JERK
6
DEC 3 1962 AM
R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
es not mean : af dying, heart failure, etc. It means e, or compli- which caused
ms, if any, ave rise ta cause (a), the under- cause last.
itions contrib- death but not the terminal dition given
70 31. C.
;- Chapter 137, 1954. requires ans to print er the cause. of death o ertificates.und r 48, Acts of equires Physi- o print or type nder signature X7
3-62
PLACE OF DEATH
SUFFOLK
(County)
BOSTON (City or Town)
No.
ST. Elydleth Arg
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
MAS
CATHERINE
V.
Walsh
(Middle Name)
(Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death.
......
.years.
.. months.
14
.days. In place of residence.
7
.years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Thomas J. Walsh
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
58
2
Months.
.Days
6
If under 24 hours
.Hours ...
.Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
At ..... home
15 Social Security No.
None
Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
William H. Cuddy
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Margaret T. Fitzgerald
20 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass.
21
Informant
Mr. Thomas J. Walsh-hus
(Address)
98 Grand View Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued: R farma (Signature of Agent of Board of Health or other)
9-19-62
(Date of Issue of Permit)
- V.R.V
(Registrar)
PARENTS
Old Calvary Cemetery Boston
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
September 21st
19
62
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby, Inc.
ADDR $917 Bennington St. E.Boston
Received and flea SEP 201962 Charles & In :1142976 ..... Il (Official Designation)
0-928145
!
To be filed for burial permit with Board of Health Agent. 195
Registered No.
0019
PHYSICIAN - IMPORTANT
( Cuddy Was deceased a
U. S. War Veteran,
{if so specify WAR)
No
Winthrop
St.
(If nonresident, give city or town and State)
3 DATE OF
DEATH
9
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw ha ...... alive on 19 .. death is said to
............;
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
LYMPHATIC METASTASE To LUNA
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
(b)
CARCINOMA OF BRENT
Due To
(c)
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)
willing F. Poste
M. D
WILLIAM F. BOYLE
(PRINT OR TYPE SIGNATURE)
(Address) ST ELIZAer This Hose Date. 9-18- 19 02
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN
(First Name)
62
have occurred on the date stated above, at
5:30 Am.
AGE
Years ..
A TRUE COPY ATTEST:
Charles H. Mackie City Registrar
TO.
OF
1
ERK
3
YTHR!
DEC 3 1962 AM
1 1-301A 1
RI TIONS
RTIFICATE
Iving ( DEATH le enter an one for each 1) and (e)
not mean de of dying, art failure. c. It means Bor compli- mich caused
as. if any, que rise to use (a). ie under- use last.
.oms contrib- ath but not The terminal dition given
586. Chapter 13 954. requer ns to print e
eausd or of death on tificates, and 48. Acts of quires Physi- print or type der signature.
: 7- 1962
PLACE OF DEATH
Suffolk (County) Brighton (Cintor Town) St. ELizAREthis Hospital No.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN 07
To be filed for burial permit with Board of Health or its Agent. 09579
Registered No.
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
f( Was deceased a
{U. S. War Veteran,
WW1
(if so specify WAR) .
Winthrop
(a) Residence. No. (L'sual place of abode)
Length of stay: In place of death
years
.. months
15 days. In place of residence
37
years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
3 DATE OF
DEATH
Sept.
28
1962
( Month)
(D)ay)
(Year)
4I HEREBY
9-13
CERTIFY.
1962, to
That
A attended deceased from
4.28
1962
... I last saw h/ hlive on 5 28 19 6 2 death is said to
DEATH WAS DAUSED BY; IMMEDIATE CAUSE
Bile Peritonitis & ABD. HaseEss
Due To
(b)
Common Duct Stone
Due To (c)
Acute + Chronic Pancreatitis
SIGNIFICANT CONDITIONS
Post Op. Cholecystectomy
YES.
Was autopsy performed?
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
NO
(Signed)
PAUL F. CONDON MID.
( Address) St. Cliz Hos)
Date
9.28 962
6
woodlawn Crematory Everett, Lass
Place of Burial or Cremation (Clty or Town)
DATE OF BURIAL
Oct. 1
1952
7 NAME OF
FUNERAL
DIRECTOR
Howard S Reynolds
winthrop, Lass
ADDRESS ....
Rec Sandales of mackie
OCT 2 1962
( Registrar)
PARENTS
21 Any Addison
Informant) } ...... r
(Address) I Carrent Ste winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
ww fled with mecBEFORE the burial_or transit permit was issued:
Danuta
(Signature of Agent of Board of Health or other)
13134
10 - 1 - 62
(Official Designation)
(Date of Issue of Permit) .
1
...
12
67
AGE
Years.
11
.Months ...
1 5Days
If under 24 hours
... Hours .............. Minutes
13 Usual
Occupation :
Frinter
(Kind of work done during most of working life)
14 Industry
or Business :
Publications
15 Social Security No.
010-97-9332
Chapin
16 BIRTHPLACE (City)
(State or country)
Io: 3
17 NAME OF
FATHER
John Addison
18 BIRTHPLACE OF
Unable to obtain
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Dora Dillingham
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at 8 12 Am. INTERVAL BETWEEN ONSET AND 11 IF STILLBORN, enter that faet here.
E. ADDison
2 FULL NAME
DALLAS ( First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
EI SARGEAnt
St.
( If nonresident, give cily or town and State)
Married
10a If married, widowed, or divorced
HUSBAND of
Any Ball
-
Pau Candan M. D
PRINT OR TYPE SIGNATURE)
Unable to obtain
-928145
L TOUT COPY ATTESTA Charles à Im
r
RECEIVED
TOW
1
OFFI
KLERK
1
6 3
'THROP
DEC #71962 PM
1
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
n. c.
PLACE OF DEATH
Middlesex
(County)
Waltham
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
.L'altham
(City or Town making this return)
198
CERTIFICATE OF DEATH
Registered No.
529
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
No. 21 Brigham Road
Agnes
T.
Murphy
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
NaTio ist.
-4 28 Tafts Avenue
Winthrop,
if so specify WAR,
(a) Residence. No
(Usual place of abode)
2
Şt ...
50
(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
3 DATE OF September 29, 1962
DEATH
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY , That I attended deceased from March 16 62
19
62
I last saw
if. Lalive on
Sept.
28
62
death is said to
have occurred on the date stated above, at
10:102.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) .Cerebral Thrombosis
Due To
recurrent
Due To
Arteriosclerosis
(c)
...
generalized
?
OTHER
Cardiomegaly
Was autopsy performedlone phritis ..
What test confirmed diagnosis ?
2wks
5 Was disease or injury in any way relateto occur ation of deceased? If so, specify Clinical
(Signed) M. D.
(Address)
Joseph J. Caravoglio
634 Moody St. Wal.
19.
Sept. 29,62
6 ... p
Placed Bilar or clean tery
1.(Cil, tripwh)
DATE OF BURIAL
October 3, 1962 .... 19 .. (Address) Mary Ellsworth 59 Mayall Road, waltham
7 NAME OF
FUNERAL DIRECTOR
Bemand ......... Mullin
ADDRESS
16 Prospect St. Waltham
Received and filed
NOV 15 1902
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
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 .... ..... Years.
.Months ..
Day3
If under 24 hours
Hours ......
Minutes
13 Uchel
Occupation :
S(Kinhof work done deringentost mocking life)
14 Industry
or Business :
15 Social Security NoVariety Store
16 BIRTHPLACE (City)
(State or country)
New Foundland, N. B.
canada
17 NAME OF
FATHER
18 BIRTHPLACE op monthly Murphy
FATHER (City).
(State or country)
cannot be learned
19 MAIDEN NAME
OF MOTHER
Canada
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
cannot be learned
11
21 Informant
A TRUE COPY Jillian JOLanagan
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
October 4, 1962
.. 19 ...
1
(City or Town)
The Commonwealth of Massachusetts
PARENTS
50M - 10-61-931673
(b) 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 CONDITIONS
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.