USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 4
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
1-
PLACE OF DEATH
Suffolk (County)
CINSELPETIT
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
15
Registered No.
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Belinda Yvonne Waldron {}
(First Name)
(Middle Name)
(Last Name)
(if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
133 Cliff Avenue
(Usual place of abode)
.. St
(If nonresident, give city or town and State)
Length of stay: In place of death.
18years ..
.. months.
.days. In place of residence.
18
.. years.
months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
5
1962
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY
That I attended deceased from
to ...
19.62
....
VEC 15
19:5 4
FEB
5
I last saw h&RRalive on
FEB
5
19.2
death is said to
have occurred on the date stated above, at ...
1:30 P
m.
(or) WIFE of
Harold .... Evans
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
6.0Years ..
.9.
Months.
.10.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
housework
(Kind of work done during most of working life)
14 Industry
or Business :
own .... home.
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
New York
17 NAME OF
FATHER
Charles Henry Waldron
18 BIRTHPLACE OF
FATHER (City)
Utica
(State or country)
New York
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
New York City
(State or country)
New York
21 Mrs. Wallace L. Fabyan
Informant
(Address)
133 Cliff Ave. Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass teriaund
(Signature of Agent of Board of Health or other)
×17 /62
(Official Designation)
(Date of Issue of Permit)
X
8 SEX
9 COLOR
female
white
10 SINGLE
(write the word)
MARRIED divorced
WIDOWED
or DIVORCED
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CORONARY OCCLUSION
(a)
..
INTERVAL
BETWEEN
ONSET AND
DEATH
16 hrs
2YRS.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
No
What test confirmed diagnosis?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? Na If so, specify
(Signed)
Myroun King
M. D.
MYRON N. KING M.9
(PRINT OR TYPE SIGNATURE)
6
HolyHood Cemetery. Brookline
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 8,1962
19
7 NAME OF
FUNERAL DIRECTOK
alfred B March
ADDRESS
174WinthropSt ....... Winthrop .....
Received and filed
FEB * 1962
.19
(Registrar)
PARENTS
50-928145
X
No. 133 Cliff Avenue
PHYSICIAN - IMPORTANT
[ (Was deceased a
U. S. War Veteran,
T
Nolan
(Address) 222 PLEASANT ST
Date.
2/7
62
OF MOTHER
Florence Victoria
NewYork City
ite
Due To
(b)
GENERAL ARTERIOSCLEROSIS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
caused
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
11:
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.
FELL =1/1032 PM
(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.
RM R-301 1
STRUCTIONS FOR DAL CERTIFICATE
In giving UE OF DEATH
) not enter øre than one E se for each ). (b) and (c)
does not mean ode of dying, s heart failure, , etc. It means ease, or compli- which caused
tions, if any, it gave rise to cause (a), Og the under- cause last.
sditions contrib- .death but not to the terminal condition given
N.e :- Chapter 137, ft of 1954 requires gicians to print or P
the cause or us of death on certificates, and ter 48, Acts of requires Physi- u to print or type under signature.
C.
PLACE OF DEATH
X SUFFOLK. (County) WINTHROP (City or Town) No. 10 UNDINE AVE
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME LEWIS P MURPHY (First Name) (Middle Name) (Last Name)
f (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.)
10 UNDINE AVE
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
9
years.
months.
days. In place of residence.
9 years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February
7,
1962
(Month)
(Day)
(Year)
That I attended deceased from
to ..
.Feb
7
19 .... 62
I last saw h ........ alive on
Feb.
5
196.2
death is said to
have occurred on the date stated above, at
p.m.
2:50
INTERVAL BETWEEN ONSET AND
DEATH
1 yr.
2 yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Carcinoma of pharynx
3 yrs
Was autopsy performed?
no.
What test confirmed diagnosis?
Clinical & laboratory
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
no
(Signed)
In. Transfer
M. Traunstein, Jr. , M.D.
PARENTS
6
ST MARY
DORCHESTER.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL FEB 10 1962
7 NAME OF
FUNERAL DIRECTOR
MAURICE 4 KIRBY
ADDRESS
WINTHROP
Received and filed
FEB 8 1962
19
(Registrar)
A TRUE COPY ATTEST:
8 SEX
9 COLOR
10 CITIZEN
OF U.S.
YES NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
11a If married, widowed, or divorced
HUSBAND of
MARY
FARRELL
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
13
AGE 77 Years.
Months.
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :
PRESS MAN.
(Kind of work done during most of working life)
15 Industry
or Business :
NEWS PAPER
16 Social Security No.
628-07-7788
ST JOHN
17 BIRTHPLACE (City)
(State or country)
N. PI
18 NAME OF
FATHER
JOHN
19 BIRTHPLACE OF
FATHER (City)
ST JOHN
M. D.
(State or country)
N .B.
20 MAIDEN NAME
OF MOTHER
MARY COLLINS.
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
N B.
ST JOHN
22 MAS MARY FARRELL MURPHY Informant (Address) 10 UNDINE 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)
< / p , 4, 2
(Date of Issue of Permit)
(Official Designation)
4
PERSONAL AND STATISTICAL PARTICULARS
MALE WHITE
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Arteriosclerotic & hypertensive
heart disease
Due TGeneralized arteriosclerosis
(b)
4 I HEREBY
March 17,
19
CERTIFY,
.6260
(Print gr Type Name)
73 Bartlett Winthrop-52, ..... Mass .Date ..
Feb. 8,
19
62
(Address) .
61-930213
(a) Residence. No. (Usual place of abode)
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 sypposa611962 AM 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.
X
Mildlosox
(County) Cambridge
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
205
(City or Town)
No. En route to Cambrid . Cite dosp.
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
Albert Geffin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 7 fantle Avenue (Usual place of abode)
..........
St.
-vi nonresid (If honresident, 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
3 DATE OF
DEATH
February 12, 1962
(Month)
(Day) (Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Arteriosclerotic Heart Disease with hypertension and auricular fibrillat WIFE of
9 SEX
10 COLOR
11 CITIZEN
OF U.S.
YES
NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
i.ale
white
12a If married, widowed, or divorced,
HUSBAND of
Rose Kissen
(Give maiden name of wife in full)
Sudden Death.
13 DATE OF BIRTH
14
AGE ..
Months .............. Days
If under 24 hours
Hours
Minutes
Date and hour of injury
19
If accidental, was injury causally related to the death?
Where did
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place ?
Manner of
(Specify type of place)
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
.. Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased? If so, specify Davil G. Dow
(Address)
Daten ......
19 ....
7 Place Fol|Burial A CremanoAZ CC .. (CityCor. Town)
23
Informant
1000 Serpin
(Address)
DATE OF BURIAL 19 ....
rob. 13,
8 NAME OF
FUNERAL DIRECTOR
Forr Funeral service
ADDRESS
Chelsea, . 00%.
19
Received and filed MAR 5 1962
(Registrar of City or Town where deceased resided)
PARENTS
20 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
21 MAIDEN NAME
OF MOTHER
Cannot be learned
22 BIRTHPLACE OF
MOTHER (City)
(State or country)
A TRUE COPY.)
IATTEST!
Viamar 2 200 Damar.
(Registrar of City or Town where death occurred)
DATE FILED
Feb. 13
62
X
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at
25M-3-61-930213
PLACE OF DEATH
IM R-305 1
THIS IS A PERMANENT HANNAGU DLALA TYPEWRITER RIBBON -
the time of death should be transmitted on Form R-305 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.)
(Husband's name in full)
5 Accident, suicide, or homicide (specify)
15 Usual
Occupation :
Stitchor
(Kind of work done during most of working life)
16 Industry
or Business :
Ipholsterirs
17 Social Security No.
002-00-5455
18 BIRTHPLACE (City)
(State or country)
Russia
19 NAME OF
FATHER
Isaac Coffin
(Signed) Dania . De ... M. D.
....
[(Was deceased a {U. S. War Veteran, {if so specify WAR)
2 FULL NAME.
OF TOW
-
OFF
WERK
00
6
THROP
SPACE FOR ADDITIONAL INFORMATION
MAR :51962 AM
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
IM R-301A 1
ISTRUCTIONS FOR DIAL CERTIFICATE
n giving JE OF DEATH ( not enter me than one Ise for each (), (b) and (c)
us does not meon de of dying, heart foilure, , etc. It meons Case, or compli- which coused
ations, if ony, -
gave rise to cause ( 0 ) . ifk the under- couse lost.
C'ditions contrib- deoth but not cato the terminol secondition given
Nc :- Chapter 137, :auf 1954. requires yrians to print or pe the cause or us of death on atcertificates, and ajer 48, Acts of 59 requires Physi- an: o print or type minder signature.
1. C .
1
1- 0-928145
X PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Frank
A ..
Kelly
[(Was deceased a
U. S. War Veteran,
I
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
102 Pleasant St
(Usual place of abode)
St
Winthrop
Length of stay: In place of death.
.years ..
1
months.
10 days.
In place of residence.
.years ..
months ..
........
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February 13,
1962
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY,
That I attended deceased from
Jan 2 , .... ...... ,
19. to ...
I last saw hl.Malive on
Feb. 12,
19.
62
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE67
Years.
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Tunnel Employee retired
(Kind of work done during most of working life)
14 Industry
or Business :
3 years Social Security No.
Boston
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
Arsenius Kelly
18 BIRTHPLACE OF
FATHER (City)
East Boston
M. D
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Helen C. Healey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Informant
Irs, Regina R. Kelly
(Address) 102 Pleasant St, Winthrop
I HEREBY, CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Talere C. Junianimais
(Signature of Agent of Board of Health or other)
1
dealtin
2/14/62
(Date of Issue of Permit)
(Official Designation)
PARENTS
6Mt. Calvary, Mattapan
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Feb. 15 196.2
7 NAME OF
FUNERAL
DIRECTOR
Stephen C. Higgins
ADDRESS
2 Neponset Ave., Dorchester
Received and filed
FEB 14.1962
19.
(Registrar)
8 SEX
M
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorcede ina R. Travers HUSBAND of
death is said to
have occurred on the date stated above, at
7.35 Am.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cirphous of Liver
Due To
(b) Cirrhosis of Liver
Due To (c)
OTHER
SIGNIFICANT
Diabetes ... Mellitus
CONDITIONS
Was autopsy performed? ... ·No Clinical Findings
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
No
(Signed) John F. ..... Collins, M.D. (PRINT OR TYPE SIGNATURE)'
(Address) Revere ..... Mass .. Date. Feb. 13,19 .62
New York
To be filed for burial permit with Board of Health or its Agent.
No. Winthrop Community Hospital
(First Name)
( Middle Name)
(Last Name)
[if so specify WAR)
(If nonresident, give city or town and State)
62
Feb. 13.
19
62
3 Mos
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE September 6 ,1918
DATE OF DISCHARGE.
December 11, 1918
RANK, RATING ... Private
ORGANIZATION AND OUTFIT.I.st .Co, Boston C . C.
ARMY
SERVICE NUMBER 4903214
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.
RECEIVED
TOWN
OF
0 301330
1/ 12 1
10.
MIN
CLERK
*
5
6
CHRO
FEB 1 41962 PM
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
WAILL PLAINLI, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
P
PLACE OF DEATH
Middlesex (County )
Everett
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
EVERETT
(City or Town making this return)
19
Registered No.
S (If death occurred in a hospital or institution. St. ¿ give its NAME instead of street and number)
2 FULL NAME. George E. Mahoney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 105 Circuit Road ( Usual place of abode)
Winthrop, Mass.
( If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months ....
3.days. In place of residence.
30
.. years.
....... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
13,
1962
(Month)
(Day)
( Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED Widowed
or DIVORCED
4 I HEREBY CERTIFY,
from Jan. 1 62
19
to ..
im February 1319.62
death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET ANO DEATH
(or) WIFE of ..
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
80
-
12
AGE
Years.
-
Months .......... Days
If under 24 hours
....
.. Hours ........ Minutes
13 Usual
Occupation :
Dentist
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security
No.
None
16 BIRTHPLACE (City)
(State or country )
Mass.
East Boston
17 NAME OF FATHER Edward Mahoney
18 BIRTHPLACE OF FATHER (City) (State or country ) Ireland
19 MAIDEN NAME OF MOTHER Frances A. Walsh
20 BIRTHPLACE OF
MOTHER (City)
East Boston
( State or country)
Mass.
21 Mary G. Mahoney
Informant (Address) 105- Circuit Ros, Winthrop, Mass
A TRUE COPY
ATTEST :
.( Registrar of City or Town where death occurred)
February 16,
62
19
( Registrar of City or Town where deceased resided)
PARENTS
John F. Collins
M. D.
( Address)
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL February 16, 62
19
7 NAME OF
O'Maley Funeral Home
FUNERAL DIRECTOR
ADDRESS Winthrop, Mass.
Received and filed
MAR 7
1962
62
19
10a If married, widowed, or divorced HUSBAND of Anna F. Croak
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic Heart
Disease
Due ToGeneralized (b) Arteriosclerosis
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ? N. Clinical finding's What test confirmed diagnosis ?
NO
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
( Signed}
Benningto st.
Keveres 'Mass. .. , Feb.14,62
.. Date.
50M-9-59-926111
(a) 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 Due To (c)
1
No.
Woodlawn Manor Nursing Home
( Was deceased a
U. S. War Veteran.
(if so specify WAR,
No
(write the word )
That I attended
February 13,19
deceased
62
I last saw live on 9:35 pm.
1 year
DATE FILED
T !!
1-1
6
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
MAR - 71962 AM
M R-301A 1
NI TRUCTIONS FOR IIL CERTIFICATE
h giving OF DEATH dinot enter ne than one a e for each (i, (b) and (c)
udoes not mean de of dying, heart failure, etc. It means liise, or compli- u which caused
neions, if any, ic gave rise to cause (a), the under- cause last. 1.C. Colitions contrib- death but not do the terminal se ondition given
-
-
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Arteriosclerosis.
10 yrs.
Was autopsy performed ?
NO
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased? No. If so, specify ....
(Signed)
M. D. CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE) (Address) WINTHROP Dat 2/14/ 1962
6 BethJacob
Noturn
(City or Town)
DATE OF BURIAL
7 NAME OF FUNERAL DIRECTORY os Funeral Device Snc ADDRESS Ochelsea
Received and filed FEB 15-1962 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
10a If married, widowed, or divorced Many Krivits ky
HUSBAND of
(Give maiden name of wife in fully
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
96
Year Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Vailor
(Kind of work done during most of working life)
14 Industry
or Business :
Tailoring
15 Social Security No.
031-07-7847
16 BIRTHPLACE (City)
(State or country)
C
Russia
17 NAME OF
FATHER
abraham - Goodman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
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.