USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 40
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
INTERVAL BETWEEN ONSET AND DEATH
2days
19 ..
to ..
Sept.
29,
(Was deceased a
U. S. War Veteran,
No
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
8
:1
NOV 1 61962 AM
FORM R-301
e led for burial permit It Board of Health · r its Agent. ISTRUCTIONS FOR ET:AL CERTIFICATE
PINT OR TYPE LE OR CAUSES F DEATH
lo not enter ore than one use for each ola). (b) and (c)
Is does not meon e mode of dying. cias heart failure, tinio, etc. It means e isease, or compli- tu:s which caused
(sditions, If any, sich gave rise to ove cause (c). sting the under. log cause last.
Conditions contrib- i te death but not ind to the terminal sie condition given
420 80 X70
M.C. C 7- 1962
i 2-62-932382
PLACE OF DEATH
SUFFOLK (County) ROXBURY (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF - TOWN
(City or Town making this toturn)
STANDARD
CERTIFICATE OF DEATH
Registered No.
Path occurred in a hospital or institution, JE WISH MEMORIAL HOSPITALath No
2 FULL NAME. CLARA GREENBERG
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 DOLPHIN AVE. WINTHROP
(a)
Residence. No ..
(Usual place ol abode)
Length of stay : In place of death .......... years ......... months ....
6 days. In place of residence 3 year ........ months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
OCTOBER
4
196 2
(Month)
(Day)
(Year)
- 4 I HEREBY CERTIFY . That I attended deceased from 9-28 , 1962. 10. 10 - 4
I last saw h.Chlive on 10 -4 19.6 Death is said to
have occurred on the date stated above, at 10:0 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Acute Pulmonary GDEMA
Due Ta
(b)
ARTERIOSCLEROTIC HEART
DISEASE
(c)
OTHER
SIGNIFICANT
CONDITIONS
DIABETES MELLITUS years
Was autopsy performed?
NO
What test confirmed chagnosis ?
CLINICAL
S Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signature Dannal CHOLa) M. D. SAMUEL HASSIN (Print or Type Name) (Address) eund May Hot Date 10.4. 1962
Knights OF LIBERTY 6 Place of llurial or Cremation
WOBURN
(City or Town)
DATE OF BURIAL OCT. 5 19.62
7 NAME OF
BENJAMIN BIRNBACH
FUNERAL DIRECTOR
ADDRESS
1668 BeACONST. Brookline
OCT 9 1962
Received anch filed
Charles it mackie
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
WhiTE
10 SINGLE
MARRIED
(write the word)
WIDOWED
DIVORCED
UNKNOWN
11 If married, widowed, or divorced
HUSBAND) of
(G."e maiden name of wife in full)
ABRAHAM GreenBerg
(or) WIFE -
(Husband's name in full)
12
AGE. 77 Years.
Months
Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation ..
House wife
( Kind of work done during most working life)
14 Industrv
or Business :.
AT HOME
IS Social Security No.
16 BIRTHPLACE (City) ( State of country ) Russia.
17 NAME OF
FATHER
CBL
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA.
19 MAIDEN NAME
OF MOTHER
CBL
20 BIRTHPLACE OF
MOTHER (City).
RUSSIA
(State or country)
HARRY FishMAN
21 Informant
(Address)
19 Beverly Rd. WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued: Ruc Man (Signature of Agent of Board of Health or other)
1313211
10-5-62
....
(Registrar)|| (Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
LU.Br
-
NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(If nonresident, give city or town and State)
Female
19 6.2
(a)
INTERVAL BETWEEN ONSET AND DEATH Hours
PARENTS
WTOUG LO
-
RECEIVED
OF
TOWA
il i'
OFF
LERK
IM
DEC : 71962 PM
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
STANDARD
CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital or institution, St. I give its NAME instead of street and number)
2 FULL NAME ... Isabelle ... E ....... Greenlaw.(Raymond)
(If deceased is a married, widowed or divorced woman, give also madlen name.)
Ville. FR 24-
(a) Residence. No. 555 Shirley Street
(Usual place of abode)
st. Winthrop, .... Mass
I.ength of stay : In place of death .......... year ........... months .......... days. In place of residence
11
years
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DENTHI
October
6.
1962
(Month)
(Day)
(Year)
4IHEREBY CERTIFY , That PAttended deceased from September .... 27 62 .. ..... October ..... 6. 1952
last saw Eralive on October.b ...........
. 1962 death is send to
have occurred on the date stated above. at11 :. 45p.m.
INTERVAL BETWEEN ONSET AND DEATH
? MO
CARCINOMA of CERVIX
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)
Cellan
M. D.
Charles L. Clay, M. D.
(Print or Type Name)
(Address) Ass's. Dir., Mass. Gen'l. Hosp. Dat Oct. 6 1º 62
Winthrop Cemetery, Winthrop
6
....
Place of Burial or Cremation
(City or Town)
DATE OF NURIAL
October 10,
19.
62
7 NAME OF
FUNERAL DIRECTORErnest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received aml filed
OCT 11 1962
... 19.
Charles it Mackie
....
(Registrar)|
PERSONAL AND STATISTICAL PARTICULARS
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWEDmarried
DIVORCED
UNKNOWN
11 If married, selowed, or divorced HUSHAND of (Give maiden name of wife in full)
(or) WIFE of
Arthur w. Greenlaw
( Husband's name in full)
12
41
2
Month,
15
Vrare
IJ l'sont
(x cupation .
Singer-Pianist
Thing of work done during most working life)
14 Indus !! v
or Business
Entertainment
15 Social Security No.
018-18-5983
Malden
16 BIRTHPLACE (City)
(State or country )
Massachusetts
17 NAME OF
FATHER
John J. Raymond
PARENTS
18 BIRTHPLACE OF
FATHER (City) ..
Boston
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Florence May Greenlaw
20 BIRTIIPLACE OF
MOTHER (City)
(State or country )
New Brunswick
-
21 Informant
Arthur W. Greenlaw
( Address)
555 Shirley St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death Ned with me BEFORE the burial or transit permit was issued [ 2. mc na
(Signature of Agent of Board of Health or other)
1313277
10-10-62
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTESTI
DRM R-301
edfor burlal permit Fard of Health ", Agent. MIUCTIONS FOR CA CERTIFICATE
N OR TYPE EDR CAUSES DEATH Iciot enter o than one IN: for each s (b) and (c)
s'oes not mean mle of dying. I heart failure. ti etc. It means 'is se, or compli- Is which caused
wioms, if any, 1 (b)
ic gave rise to cause (a), ti the under. nj cause last.
C ditions contrib. death but mot l'o the terminal condition given
52 (7/
0 7- 1962 in Director se ve only ACK Ink.
-62-932302
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF - TOWNDO
(City or Town making this return)
(City of Town)
MASSACHUSETTS GENERAL HOSPITAL
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
if so specify WARI
( write the word)
If under 24 hours
Hours ... . Minutes
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
METASTATIC CARCINOMA
(a)
IO Yrs
(If notresident, give city of town and State)
V
A TRUE COPY. ATTEST:
Charles it Mackie
City Registrar
RECEIVED
TOWA
OF
11 12 .
OFF
...
CLERK
6
MASS
THROP
DEC =71962 PM
PLACE OF DEATH
Suffolk (County)
Boston
.... (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
OUT - OF -TOWN To be filed for burial permit with Board of Health - or its Agent.
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
Kalmên
( First Name)
(Middle Name)
H Disler
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 379 Shirley
Street
St.
Winthrop
Mass
( If nonresident, give city of town and State)
Length of stay: In place of death
...
years.
. ... . months
15 days. In place of residence
15
years
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
White
10 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCEMARRIED
4 I HEREBY CERTIFY.
Sept
23
19 .. 6.2 . to .........
Oct
8
...
That I attended deceased from
1962
I last saw himalive on
Oct
8
962, death is said to
have occurred on the date stated above, at 8:20 Am.
INTERVAL
DETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
....
Cerebro - Vascular accident
Due To
(b)
Arterio sclerotic cerebro-
Due To
Vascular disease
(c)
OTHER
SIGNIFICANT
CONDITIONS
osteoarthritis
Was autopsy performed?
no
What test confirmed diagnosis?
I Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
Stephen Buline
M. D
(State or country)
Stephen Bulova
(PRINT OR TYPE SIGNATURE)
(Address)
330 Brookline Ave
Date.
Oct. 8
1962
Boston
TIFERETH ISRAEL IF WINTHROP
EVERETT
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
OCT.
10
62
7 NAME OF
FUNERAL DIRECTOR
MORRIS W. BREZNAIL
ADDRESS 470 HARVARD ST. BROOKLINE OCT 10 1962
Received and filed Charles of Mackie (Registrar)
PARENTS
16 BIRTHPLACE (City)
(State of country)
RUSSIA
17 NAME OF
FATHER
UNKNOWN
18 BIRTHPLACE OF
FATHER (City)
RUSSIA
19 MAIDEN NAME
OF MOTHER
UNKnowy
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
21
Informant
LENA DISLER
(Address) 329 Shirley St. WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was me BEFORE the burial or transit permit was issued: 2. michan
(Signature of Agent of Board of Health or other)
B13248
10 -9-62
(Official Designation) (Date of Issue of Permit)
50-928145
Kalman Disker
HSTUCTIONS FOR CI CERTIFICATE I giving SIOF DEATH
la ot enter or, than one u for each a. (b) and (c)
does not mean we af dying. a heart failure, is etc. It means isse, or campli- which caused
doms, if any, cigave rise ta ce cause (a). in the under- & cause last.
o'itians contrib. I death but nat () the terminal ondition given . I.C.
534
1 1954. requires tians to print or the cause of of death on Icertificates, and Ir 48. Acts of ,requires Physl- h.o print or type inder signature.
7-1962
No.
Beth Israel Hospital
2 FULL NAME
{U. S. War Veteran.
( Last Name)
(if so specify WAR)
no
( l'sual place of abode)
Oct.
8
1462
(Year)
(Month)
(Day)
10a If married, widowed, or divorced
HUSBAND of LENA
ROMM
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH
15 days
82 Years.
12
AGE
...... Months .........
... Days
If under 24 hours
........
... Hours .............. Minutes
13 Usual
Occupation :
CARPENTER
(Kind of work done during most of working life)
14 Industry
or Business :
RETIRED
15 Social Security No. ......
UNKNOWN
yrs.
R R-301A 1
3 DATE OF
DEATH
f( Was deceased a
A TRUE COPY ATTEST?
Charles H Mackie City Registrar
TOW;
12
OFFI
LERK
2
HROP
DEC =1/1962 PM
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
Due To (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 Due To (c)
50M - 10-61-931673
X J PLACE OF DEATH
Essen
(County)
Danvors
(City or Town)
Banvers State Hospital, Hathorne,
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
Frank Nigro
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
Cif so specify WAR
374 Pleasent
Winthrop,
Ness.
(a)
Residence. No.
(Usual place of abode)
29
Length of stay: In place of death .......... years .......... months
lays. In place of residence .......... years .......... months ......
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
1962
(Month)
(Day)
(Year)
AIHEREBY CERTIFY,
Oct. 5
That ,I attended deceased from
I last saw h ...
.ahve on
NOV. 4.
52
death is said to
, 19 ....
have occurred on the date stated above, at
7:15p.
INTERVAL BETWEEN ONSET AND
(or) WIFE of
(Husband's name in full)
12
88
5
26
AGE ..
Years
Months.
Dayz
Ii under 24 hours
Hours .. .... Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry or Business :
15 Social Security No.
Not determined
Naples
16 BIRTHPLACE (City)
(State or country)
Itel:
17 NAME OF
FATHER
Not Determined
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Not Determined
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Mary E.
Sheehan
2] Informant
(Address)
His thorne, ass.
A TRUE COPY
ATTEST:
00 Toonly
(Registrar of City or Town where death occurred)
DATE FILED
November 7,
.19.62
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
white
10 SINGLE MARRIED WIDOWED DIVORCED widowed
Il If married, widowed, or Merry Ann Muntz HUSBAND of
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic heart disease
(a)
OTHER
SIGNIFICANT
CONDITIONS
Terminal Pneumonia
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
Willard M. "ausman
(Signed)
M. D. Willard M. Hausman, M. D.
(Address)
Hp thorne, Mass.
11-5-
62
Date
19
Winthrop Cemetery, Winthrop
6
Place of Burial or Cremation
(City or Town)
November 7,
62
DATE OF BURIAL
19.
7 NAME OF
FUNERAL DIRECTOR
Frnest l'. Caggiano
Winthrop, Mass.
ADDRESS
Received and filed DE3 0- 1952 19
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or Town making this return)
202
Registered No.
No ...
2 FULL NAME
St
(If nonresident, give city or town and State)
(write the word)
mais
19
62
Nov. 4,
to ...
19
62
malo
None
PARENTS.
n.C.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
F TOM.
DEC 3 1962 AM
, the time of death should be transmitted on Forin 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.)
PLACE OF DEATH
Essox
(County} Danvors
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
(City or Town)
No. Scribner Nursing Home
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Anthony George Silva
[(Was deceased a {U. S. War Veteran,
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if so specify WAR)
(a) Residence. No.
CorinhaPerch
St.
Vil Kanalen give cith & Sown and State)
(Usual place of abode)
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
Novobor 7, 1962
(Month) (Day) (Year)
9 SEX
male
10 COLOR
white
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED idousd
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are (If an injury was involved, state fully.) pos"Coronary thrombosis no
lla If married, widowed, ar divorced
HUSBAND of
My Corinha
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE .... 8.2. Years ....
.. Months.
Days
If under 24 hours
Hours ...........
.Minutes
5 Accident, suicide, or homicide (specify)
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
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased ?
If so, specify Ralph E. Foss
(Signed)
Fos.s.
Ralph ....
M. D.
(Address)
Peabody Mass
Dat
11-8-19.62
Holy Cross Cemetery, Malden
7 Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL
November 10,
19
62
Informant
(Address)
maicott st., Danv-
8 NAME OF
FUNERAL DIRECTOR Whlyert ..... Mc Donald ,Jr.
ADDRESS
18 Hawthorne Blvd. Salem
Received and filed 19
A TRUE COPY
ATTEST :
Comelit. Toomey
(Registrar of City or Town where death occurred) Nov. 9.
DATE FILED
(Registrar of City or Town where deceased resided)
PARENTS
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Portugal
20 MAIDEN NAME
OF MOTHER
Frances Rock
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portugal
22 Anthony J. Silva (Son)
Beverly
17 BIRTHPLACE (City)
(State or country)
Mess
18 NAME OF FATHER
Antoine Silva
15 Industry
or Business :
Carpenter-City of Winthrop
16 Social Security No.
026-11-8772
(Specify type of place)
25M-4.59-925100
1 2-305 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city of town at
19
62
14 Usual
Occupation :
Carpenter
(Kind of work done during most of working life)
recent medical attention, sudden
death
TO
1
1
ERK
NTHRORM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
DE-C-3 -1962 AM
SERVICE NUMBER
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
To be filed for burial permit with Board of Health or its Agent.
204
Winthrop Community Hospital [(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No.
2 FULL NAME William J. Epps (First Name) (Middle Name) (Last Name)
(If deceased is a married. widowed or divorced woman, give also maiden name.)
63 Crest Avenue
.St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months .. . 1 .. 5 .. days.
In place of residence.3.2 .... years ..
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
. Tamper 12, 1962
DEATH
(Year)
(Month)
(Day)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDWidowed
or DIVORCED
4 I HEREBY CERTIFY, That I attended deceased from
1962, to nove
12
1962
I last saw h.l.kralive on
nc v.
1 2, 196 2, death is said to
have occurred on the date stated above, at
1:31 p.m.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ....
9.0 Years.
Months.
Days
Hours .............
.Minutes
13 Usual
Betired Guard
Occupation :
(Kind of work done during most of working life)
14 Industry
Revere Sugar Refinery
or Business :
15 Social Security No.
022 - 03 - 0547A
Chelsea
16 BIRTHPLACE (City) (State or country) Massachusetts
17 NAME OF
FATHER
Charles H. Epps
18 BIRTHPLACE OF
FATHER (City)
Kent
M. D
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Maria McGuinness
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Informant Emily Enps
(Address) 03 Crest. Ave., winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Halkla C Serianni
(Signature of Agent of Board of Health/or other)
11/1/62
(Date of Issue of Permit)
(Official Designation)
50-928145 0-928145
R-301A 1
SUCTIONS FOR A CERTIFICATE
hgiving EOF DEATH
oot enter or than one us for each )(b) and (c)
es not mean te? of dying, us heart failure, aetc. It means see, or compli- which caused
lims, if any, have rise to e cause (a), x the under- cause last.
ositions contrib- t.death but not the terminal ondition given
(- Chapter 137, 1954, requires ans to print or the cause or of death on certificates, and r 48, Acts of ,equires Physi- Bo print or type nder signature.
Old Calvary Cemetery
6
Place of Burial or Cremation
(City or Town)
Boston
DATE OF BURIAL
11-15-62
19
7 NAME OF
FUNERAL
DIRECTOR
Arthur J. O'Malev
ADDRESS
79 Atlantic St., Winthrop
Received and filed . .. v
19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify
NO
(Signed)
JOSEPH GREGORIE
(PRINT OR TYPE SIGNATURE)
(Address)
194 Wash my Fox Date.
11/19
196 2
Was autopsy performed?
What test confirmed diagnosis?
INTERVAL BETWEEN ONSET AND DEATH
315CL52
Due To
(b)
arteriosclerosis
Due To
generalized
(c)
amaurosis
OTHER
SIGNIFICANT
CONDITIONS
bilateral
yn
10a If married, widowed, or divorced
HUSBAND of
.....
ignes Ready
(Give maiden name of wife in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Myocardial Hour
PHYSICIAN - IMPORTANT
[ (Was deceased a { U. S. War Veteran,
[if so specify WAR)
(a) Residence. No. (Usual place of abode)
Registered No.
I VRV
If under 24 hours
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 : -
RECEIVED
(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.
OF TOY
12 1
MIN
6
5
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. Malle 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.
NOV 1 41962 PM
1
1
FIRM R-302
& WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK LIFEWALLDA AAUUVA
THIS IS A PERMANENT RECORD
50M .10.61-931673
PLACE OF DEATH
Middlesex (County) Cambridge
(City or Town)
Cambridge City Hospital No ..
f(If death occurred in a hospital or institution, .St. Į give its NAME instead of street and number)
Etta C. Patchell
(Shea)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
79 Highland Ave.
St
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years.
1
months.
9
20
days. In place of residence. ..... years .......... months .......... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
"hite
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
vidowod
11 If married, widowed, or divorced HUSBAND of Roborten Puterel2)
(or) WIFE of.
(Husband's name in full)
12
85
AGE
Years
.Months ............ Dayz
Housewife
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
nono
15 Social Security No.
Cardiff So."eles
10-15mg6 BIRTHPLACE (City)
England
(State or country)
17 NAME OF
FATHER
Patrick O'Shea
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Margaret Dacey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
Marie L. Coulter
21 Informant
(Address)
79 Highland Ave.
Winthrop
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Nov. 14,
.19 62
(Registrar of City or Town where deceased resided)
PARENTS
(Address) 475 Comm. Ave .. Date.
11-12 , 62
Winthrop Com. Winthrop, Mass.
Place of Burial or Cremation
(City or Town)
Nov. 15th
62
19.
Arthur J. O'Maley
ADDRESS
Winthrop, Mass.
Received and filed
DEC 6 - 1962
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.