USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 43
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19. WAS AUTOPSY PERFORMED! NO
20%. ACCIDENT SUICIDE HOMICIDE
20b. DESCRIBE HOW INJURY OCCURRED. (Enter nature of injury in Part I or Part II of item 18)
20c. TIME MONTH, DAY, YBAR MOU'ES OF
INJURY 8-15.62 M.
WHILE AT
WORK
AT WORK
NOT WHILE
20e. PLACE OF INJURY (e.g., in or about bome hurt, factory, street, office bldg., etc.)
201. CITY OR TOWNSHIP COUNTY STATE
her him
aline on
19
Death occurredhat .....
m on the date stated above; and to the best of my knowledge from the courses stated.
221. SIGNATURE
(Degree or title)
22b. ADDRESS Forlangtrowy nc.
22c. DATE SIGNED 8-16-22
23a. BURIAL, CREMA·
THE POINT (Specify)
Removal
23b. DATE
8-16-62
23c. NAME OF CEMETERY OR CREMATORY
Removed to Ft. Bragg, N. C.
23d. LOCATION (City, town, or county) Fayeteville, N.C.
[State)
24. DATE REC'D BY LOCAL
REG.
25. REGISTRAR'S SIGNATURE
26. FUNERAL DIRECTOR
Wilson e Harrington
ADDRESS Hamlet, N.C.
X
=
1
-
l items must be complete and accurate.
be undertaker, or erson acting ~ ach, is responsi- ble for filing the ompleted certifi- ite with registrar of the district where death occurred.
he physician last in attendance is required to state he cause of death nd sign the medi- cal certification.
If there was no doctor in attend- ance, medical cer- tification to be completed by local Health Officer, (or Coroner, if in- quert su held).
US-9A
FORM & Rev. 1-54 17 1962
MEDICAL CERTIFICATION
-
1
20d. INJURY OCCURRED
21. I attended the deceased fre
2500-15.67
19
10
19. . and last sow
INTERVAL BETWEEN ONSET AND DEATH 1
1
= tb
8.16.62
A
..
215
20
bis in a local 1 ard and will be manently bled. O on
> Type or write legibly. Use black ink.
---
IF UNDER 24 HRS.
L STATE
Vass.
La Place of Residence
TON
1
ERK
0
THROR
DEC 1 /1962 AM
ORM R-301
fils for burial permit oard of Health gits Agent. IN 'RUCTIONS FOR IC. CERTIFICATE
II. OR TYPE S OR CAUSES DEATH d not enter me than one a e for each (I. (b) and (c)
s, does not meon de of dying. heart failure. W, etc. It means diese, or compli- which caused
A
(a) Pulmonary adoma
Dne Tu (1)) ... Myocardial infarct
Due To
(C)
Coronary heart disease
OTHER
SIGNIFICANT
Diabetes Mellitus
Was autopsy perturmed?
yes
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased; If w, specify
ChiClan
M. 1).
Charles L. Clay, M. D.
(Print or Type Name)
(Address) Ass's. Dir., Mass. Gen'l. Heep. .Date
Oct. 18 62
19.
6 Meretzer
Woburn
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Oct. 21.
"62
7 NAME OF
FUNERAL DIRECTOR
Arnold Golov
ADDRESS 1668 Beacon St Brookline
Receivedhandled
OCT 23 1962
19
Charles i Mackie
( Regi. tr.1 )
A TRUE COPY ATTEST:
PARENTS
IN BIRTHPI WITH
Russia
14 MAIDI\ \ANI
Julia C BL
20 BIRIMPLAC! O)
MOIBIER (!))
Russia
21 Informant
Selma Goldoff
( Address)
21 Sturgis St Winthrop
I
HEREBY CERTIFY that a satisfactory standard certificate of death
W
hled with me NKFORE the burial or transit permit was issued:
30,93
1
(Signature of Aacht of Board of Health or other) Oct 21.1967
(Official Designation)
(Date of Issue of Permit)
1
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City of Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT
216
i wn making this return)
STANDARD CERTIFICATE OF DEATH
10/88
pital our institution.
tree: ahid number )
PHYSICIAN -- IMPORTANT 1
2 FULL NAME.
Mark M. Goldoff
(If deceased is a married, widowed or divorced woman, give also manden Hatte )
21 Sturgis Street (a) Residence. NNo ... (U'sual place of almale)
Length of stay : In place of death .... .. year. .. months ..
1
dass In place of residence
19
PERSONAL AND STAINIKA PARTICULARS
3 DATE OF
DENTI
October
18
(Month)
(1).15)
(Year)
OdtI. F 18" " 62R 1 1} \October 18.
62
we1 last saw lı
.
October 18
14
Teath ( s,and) ...
1 .
11 It married widowed os d. ..
IHUSBAND Di
Selma Baker
have occurred on the date stated above, at
4:00p.m.
INTERVAL
BETWEEN
(or) WIFE of
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ONSET AND
DEATH
Unk Min v 62
11.1
1
u.der :4 tour.
Vintite.
1 Wk
Mfg. Ladies Dress
Unk Yrs*
Retired
013-05-8728
-
Boston Mass.
17 NAME OI
1 AIHIK
Benjamin Goldoff
Married
182Male
White
wn and State, 1
MEDICAL CERTIFICATE OF DEATH
1962
Winthrop, Massachusetts :
1:
No
MASSACHUSETTS GENERAL HOSPITAL No
-62-932382
1Cx I Directon . use only ACK Ink. 28 1962
ntions, if ony, gove rise to cause (a). is the under. a couse lost.
Coditions contrib- , death but not e. to the terminal s condition given 1
- City, Logiotram "
TOP
i
ERK
6
HR
DEC 2 81962 AM
DRM R-301
et or burial permit Bird of Health Es Agent. NSIUCTIONS FOR CA CERTIFICATE
NOR TYPE E)R CAUSES FDEATH o ot enter ol than one u for each a)(b) and (e)
s oes mat mean 'e af dying, a heart failure. ic etc. It means is se, or compli- s which caused
doms, if any, cigave rise ta vi cause (a). in the under. a cause last.
alitlans contrib. I death but not do the terminal e ondition given
-
D. Thomas Saffier
(Signature)
M. 1).
O.Thomas STAFFIER MA
(Address)
2/BARESSTER
Date
001.20 10) 62
Winthrop Cemetery, Winthrop 6 Place of l'urial or Cremation (City or Town)
DATE OF BURIAL
October 22,
.19.62
7 NAME OF
Ernest P. Caggiano
FUNERAL DIRECTOR
ADDRESS
147 Winthrop St., Winthrop
Received and Wed
O.C.T 23 1962
Charles if Mackie
( Registrar)
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
female
y COLOR
white
10 SINGLE
( write the word)
MARRIED
WIDOWED
widowed
DIVORCED
It If manuel, widowed, or divorced
11USBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frank Ferrara
(Husband's name in full)
12
Months
li under 24 hour-
Hours
Minutes
Occupation
housewife
chind of work done during most working life?
14 Indu .***
or Business
at home
15 Social Secunty No
16 BIRHILPLACE. (CH))
+essina
taly
17 NAMI. OF
Joseph Velardo
PARENTS
1× BIRTHPLACI. OF
Messina
(state or country )
Italy
19 MAIDEN NAMI.
OF MOTHER
?
20 BIRTHPLACE OF
MOTHER tCity) ..
(state of country )
Italy
21 Informant
Rita. Donahue
(Address)
2.) Breed St., E. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
134℃ ;-
10-22-62
(Official Designation) (Date of Issue of Permit)
1X
-
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
OUI
217 ....
(City or Town making this return) 10236
Registered No.
f(if death occurred in a hospital or institution, .St. I give its NAME instead of street and number)
2 FULL NAME
Maria Ferrara (Velardo)
(If deceased is a married, widowed of divorced woman, give also maiden name. )
Ja Was deceased a U. S. War Veteran. Li wo specify WARI. no
147 Winthrop (a) Residence. No.
(U'snal place of almonde)
Length of stay : In place of death
ve.Ir.
... .. month .........
davs. In place of residence
sear .
months
das ..
MEDICAL. CERTIFICATE OF DEATH
3 DATE OF
DEATII
OCTOBER 19
(Month)
( Day)
1962
(Year)
4 |HEREBYCERTIF
1 attended deceased
I last saw HERalive of
OCTOBER 18, 1962, death
have occurred on the date stated alxive, at 8 204 .
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CoronARY Thrombosis
(a)
INTERVAL BETWEEN ONSET AND DEATH 4 days
YRS
Due To (c)
OTHER
CA - LEFT BREAST
SIGNIFICANT
CONDITIONS
METASTASA TI SPINE.
2 YRS.
Was autopsy performned ?
No
What test confirmed diagnosis?
E . K . G .
5 Was disease or injury in any way related to occupation of deceased? /Yv If so, specify
6 yrs
Due To
CORONARY HEART DISEASE
(b)
PLACE OF DEATH
Suffolk (County)
No. 29 ... Breed
PHYSICIAN - IMPORTANT
winthrop
...
if( mmesilent, give city of town and State)
Messina
81 x70 ¿C . -
28 1962
62-932362
Oct 15
62
OCTOBER 19
, 19 62
0
THE.
DEC 2 81962 AM
FORM R-301
fid for burial permit thioard of Health its Agent. ITRUCTIONS FOR OILL CERTIFICATE
RIT OR TYPE UL OR CAUSES (' DEATH , not enter fre than one c se for each 1). (b) and (c)
Ch does mot meon lode of dying. A's heart failure. hes. etc. It means Nease, or compli- ou which caused
'o'itions, if omy, oAh gave rise to be couse 101. long the under. yi' cause last.
unditions contrib. ato death but not It to the terminol a condition given
wirdiction leclinea by Medical kaminer
420 81 C C 28 1960
PLACE OF DEATH
Suffolk (County )
Boston
(C'ity or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - T 218
(City or Town making this return)
10382
Registered No.
fli death occurred in a ho- jutal or institution, St. / give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
. Mas deceased a 10. S. War Vrtetan, it so specify WARI
WWI
Winth.dp, Mass.
(It noutestent, give city of town and State)
1 ....
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
25
1962 ( Year)
October 25. 162 .
have occurred on the date stated above, at 5:30 P.m. DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a) Congestive heart failure second
to arteriosclerotic heart disease. (1)
Unk.
Dne 1u («) .
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
No
Clinicis. findings
What test confirmed diagnosis?
5 Was disease or mijury in any way related to occupation of deceased? . If w, specify .
M. 1)
Arthur Lea
(Aildress)
(Print or Type Name) VAH, .... Boston, Massate.
19-25-1 62
wirth
6 Hly Coase
Maldon, Masst (City of Town)
. Place of Burial ur C'remation
DATE OF BURIAL
October 29
19
7 NAME OF
FUNERAL DIRECTOR
Arthur j. O'Maloy 79 Atlantic St. inthrop, Mass.
ADDRESS
OCT 20 1362
Received and filed
Charles it Frackie
6.01.28 196-2-
(Date of Issue of Permit)
A TRUE RUE COPY
OPY ATTEST: EST:
PERSONAL AND STATISTICAL PARTICULARS
Male
White
10 SINGLE
MARRIED
(write the word)
Married
DIVORCIO
Elizabeth Dearie
HUSBAND of
(Givr maiden name of wife in full)
(or) Will of
( Husband's namr in full)
ry
671 rar-
Month.
li under 24 hour-
Occupation
Ret. Rigger
( kind of work done during most working life)
14 Indu -***
U.S. Naval Shipyard
15 Maial Scounty No 018 12 3792
16 BIRSTIRI ACE CityI
St. Johns
Newfoundland
17 NAMI O)]
-
James Cahill
IN BIR THIPI ACE DI
Newfoundland
OF MOTHER
Mary Squires
20 BIRTHPLACE OF MOBIL.R (City ) (state of mintry }
England
21 Intormant
( Address)
VA Hospital Records, 150 S. Huntington Ave., Boston 30 Mass.
HEREBY CERTIFY/ that a satisfactory standard certificate of death was filed with me BEFORE the burial of trandit permit was issued:
(Signature of Agent of Boardof Health or other)
(Registrar )|| (Official Designation)
2-62-932382
2 FULL. NAME.
Edward J. CAHILL
(If deceased is a married, widowed or divorced woman, give also maden name. I
78 Atlantic
(a) Residence. No.
(U'snal place of alde)
Length of stay: In place of death ..... .. years
-lil .. .. In place of residence 35.e. ver-
( Month )
That
VATouded deceased,
tram11
JIHEREBY CERTIF
1
October 25
62
Minutes
PARENTS
62
I
Veterans Administration Hospital
6
DEC 2 81962 AM
PLACE OF DEATH
Buffal (County)
Duminica Plan 180 0
Lemuel Shattuck AUSPICAF
The Commomuralth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
219 To be 'ed ini burial permit w th Board r: 1!ca'il
Registered No. 10416
felf death occurred in a hospital of msnitution, $1. I give it. NAME instead of street and number) I HYSICIAN - IMPORTANT
: FULL NAME
GILLIS
LELUIS
: 1Wa deceased a 1 & War Veteran. H -o -peuty WAR)
( First Name ) 21 tlf dagred is a married, widowed of divorced woman, gove also maiden name, 235 Leaveit Park Rd ,
(a) Residence No ( l'sual pour of shode )
Length of stay In place of death
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
utover 25
DEATII
(Month)
(D)av)
(Year)
II HEREBY CERTIFY
9/20
That I attended deceased from 10/25
. 19. ₺
I last raw h .. .... alive on
05 /25/
, 19. E & death is said to
have occurred on the date stated above, at 3:55Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
BLEEDING ESOPHAGEAL VARICES
Due To
(b)
CHENNEC'S CIRRHOSIS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
YES
What test confirmed diagnosis?
S Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Robert J. Lindeman
ROBERT J. LINDEMAN
(I'rint or Type Name)
(Address )
SHATTUCK HOSP.
Date.
12/25
19 02
WINTHROP
MINIAPPLY
(City ar Town)
6 Place of Burial or Cremation
DATE OF BURIAL
GET 27
19 6
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS WINTHROP
Received and filed
OCT 29 1962
7.19
Charles it mackie
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
OF t's.
FEMALE WHITE
YES & NOC
lla li married, widowed, or divorced BUSBAND of EVERETT
Lyng minden name of wife m full)
LEWIS
( Husband' - name in full)
13
"Years
. .. D)3) .
If under 24 hours
Hours
Minutes
14 1'%pal
I Kind of work done during most of working hie)
15 Industry
or Business
HOTEL
16 Social Security No.
17 BIRTIJI'LACE (City)
(State of country )
HINTHINT
1X NAME OF
FATHER
FREDERICK A GILLIS
14 BIRTHPLACE OF
FATHER (City)
CHST BESTEN
(State of country )
MASS
20 MAIDEN NAME DF MOTHER
21 BIRTHPLACE OF
MOTHER (City )
(State of country )
FAST BESTEN
22
Informant
HALTEN LEKIS
(Address) { / HERRCRY ST RYN THEUPP
1 HEREBY CERTIFY that a satisfactory standard certificate of death way hled with me JEFORE the hunal of transit permit was issued: K.
( Signature of Agent of Board of Health or other>
-
LB 1 35 CL
11/3€/62
(Date of Issue of Permit)
OIM R-301 1
NI TRUCTIONS FOR DEL CERTIFICATE
n giving JE OF DEATH i not enter ne than one case for each ( . (b) and (c)
si dors not mean lade of dying. heart failure. 1. etc. It means d'ase, or compli- , which caused
ations, if any. i gave rise to a cause (a). Is the under. cause lust.
Coditions contrib. death but not to the terminal s condition given
te :- Chapter 137. of 1954 requires sicians to print or the of es off death on h certificates, and ptet 48. Acta of , requirea Physi- s to print or type e under signature. M.C.
C 28 1962
J-61-930213
( Registrar) (Official Designation)
PARENTS
13yks
INTERVAL (Or) \\ ]] E Hi BETWEEN ONSET AND DEATH D' DATE OF BIRTH Nov 26
month-
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
In place of residence 4/5:
month- 35 /1.
OF DEATH
M. D.
... - COPY ATTEST: Charles H. Mackie City Registrar
- -
DEC 2 81962 AM
FIRM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK UR USE APPKUVEU DLALA 1 1EDWALLLA AINDA - 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 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
PLACE OF DEATH
Middlesex (County)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Everett
(City or Town making this return)
1
Everett
(City or Town)
Whidden Memorial Hospital No ..
§(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
Joseph H. De Foe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran, WW I
(if so specify WAR,
Winthrop, Mass.
St
(a) Residence. No.
56 Court Ed.,
(Usual place of abode)
28
days. In place of residence.
17
ears.
.......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
2.
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIF
Y,, That I attended deceased from
Oct. 5.
19.
to.
62
Nov. 2,
19.
62
death is said to
I last saw
Lalive on
November 2, 1,62
1 m
have occurred on the date stated above, at 3:30 A.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Acute Pulmonary Edema
10-5-62
Due To
Chronic Myocarditis
1961
(b)
Due To Acute Dilatation Heart 11-2-62 (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
Clinical Findings
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signed)
John F. Williams
M. D.
(Address)
596 Broadway ,
Everett, Mass.
Date.
11-2-62
19
Holy Cross Cemetery , Malden, Mass
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
November 5,
19.
62
7 NAME OF
FUNERAL DIRECTOR
Madeline G. Casey
ADDRESS
295 Wash. Ave. , Chelsea
Received and filed
DIG 12 LOL
62
19
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Married
11 If married, widowed, or divorced
HUSBAND of
Mary B. (Casey ) DeFoe
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
AGE69 Years ..
Months ......
.. Day
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :..
Engineer
(Kind of work done during most working life)
14 Industry
or Business :
Retired
15 Social Security No.
016-16-9251
westboro
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
George De Foe
18 BIRTHPLACE OF
FATHER (City)
Natick
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Alice Comiskey
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
21 Informant
Mrs. Mary B. De Foe
(Address)
56 Court Rd.Winthrop?
Mass.
A TRUE COPY nulanos.
ATTEST:
^(Registrar of City or Town where death occurred)
DATE FILED
November 5,
19. 62
$
PARENTS
Westboro
50M - 10.61-931673
m.c.
(Registrar of City or Town where deceased resided)
CERTIFICATE OF DEATH
Registered No.
220
2 FULL NAME
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months.
....
(a)
SPACE FOR ADDITIONAL INFORMATION Prior Service July 18,1918-Sept. 17, 1918
DATE OF ENTERING MILITARY SERVICE. Cct. 23, 1918 (2nd enlistment)
DATE OF DISCHARGE
Dec. 10, 1918
RANK, RATING
Act. Sgt.
ORGANIZATION AND OUTFIT
S.A.T.C. Tufts College, Mass
SERVICE NUMBER 593035
RECEIVED
TO
11.72
9
1.
THROP.
DEC 121962 AM .
DRM R-302
Suffolk (County)
COVILTEM
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
COPY OF CERTIFICATE OF DEATH
Registered No. ....
60
221
NoChetroa Memorial Hospital
Edward J. Shcehan
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
83 Chester Ave.
/
Winthrop, Mass.
(a)
Residence. No.
(Usual place of abode)
8
8
St
(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
DEATH
1TO1.23.1962
(Month)
(D)ay)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
Mo.v.16, 19.62 ., to.Nov.23
19 ... 62 ....
I last sawum alive onNov,23
15.2., death is said to
have occurred on the date stated above, at. 400 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
12
AGE ..... .
.. Y'ears.
.. Months.
Day3
If under 24 hours
Hours.
Minutes
Due Massive pulmonary embolus (b)
Due To
Post operative Nov. 16,1902
()Angular carcinoma sigmoid ?mos.
SIGNComplete obstruction of
sigmoid Nov.16/62
Was autopsy performed? What test confirmed diagnosis ?
5 Was disease or injury in any way slated to occupation of deceased?
If so, specify
autopsy
(Signed) M. D.
(Addressharles M.StearnsDate. 19
116 Hawthorn St. Nov.26 62
Chelsea, 999 city ofTown)
Hogyichof Walden, Mass. DATE OF BURIAL 19
NOV.27,1962
FUNERAL DIRECTOJohn G. clsh
ADDRESS 18 Broadway, Chelsea , Mass.
Received and filed DE0,1411962
(Registrar of City or Town where deceased resided)
PARENTS
Ireland
21 Informant
(Address) Margaret Sheehan
83 Chester Ave. ,Winthrop.
Masso
A TRUE CODE Peuple a. Tyrrell ATTESTT
November"
( Registrar of 26, 196" where death occurred)
DAIL FILEU
19
(a) OTHER 6 7 NAME OF Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town 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 CONDITIONS
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK LIFEWKIILK KIDDUN - THIS IS A PERMANENT RECORD
50M - 10-61-931673
× 1 PLACE OF DEATH
Chelsea (City or Town)
§(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
V/W2
if so specify WAR,
(write the word)
MARRIED
WIDOWED
DIVORCEDMarried
UNKNOWN
11 lf married, widowed,
margaret Carolan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
sudden: sol
Occupation :
I of work done during most working life)
14 Industry
or Business :..
15 Social SecurityNational Guard
16 BIRTHPLACE (City) (State or country)
17 NAME OF
FATHER
Boston, friss.
18 BIRTHPLACEiChael Sheehan FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Ireland
20 BIRTHPLACEPALia Deasey MOTHER (City) .. (State or country)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(chp soaking this return)
SPACE FOR ADDITIONAL INFORMATION.
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
HRUP.
DEC 1 41962 PM
MR-301A 1
PLACE OF DEATH
X SUFFOLK (County) WINTHROP (City or Town)
175 SHIRLEY
ST
§(If death occurred in a hospital or institution.,
St. { give its NAME instead of street and number)
AIMEE E. (PUTNAM) PAYNE
2 FULL NAME
(If deceased is a married, widowed or divorced woman, giye also maiden name.)
-
(Was deceased a
U. S. War Veteran,
if so specify WAR).
NO
175 SHIPLEY ST St
(a) Residence.
No.
(Usual place of abode)
Length of stay: In place of death 79 years
months. days. In place of residence 14 years. months. ........... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED WIDOWED
10a If married, widowed, or divorced
HUSBAND of ....
(Give maiden name of wife in full)
(or) WIFE of.
JOHN _ PAYNE
(Husband's' name in full)
11 IF STILLBORN, enter that fact here.
12
79
If under 24 hours
Hours ........ Minutes
13 Usual
HOME MAKER
(Kind of work done during most of working life)
14 Industry
Our HOME
or Business
15 Social Security No ..
NONE
16 BIRTHPLACE (City)
(State or country)
MASS
17 NAME OF
FATHER
JOHN P PUTNAM
18 BIRTHPLACE OF
FATHER (City).
Win THROP
(State or country)
DA55
19 MAIDEN NAME
OF MOTHER
MARGARET TAYLOR
20 BIRTHPLACE OF
MOTHER (City)
YARMOUTH
(State or country)
MASS.
21 Informant
MRS VIRGINIA MIO REGUGH.
(Address)
175 SHIRLEY ST WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued :
(Signature of Agent of Board of Healthy or other)
Health Milicer
12/5/62
(Official Designation9
(Date of Issue of Permit)
TICTIONS JR CERTIFICATE
n iving F DEATH at enter e han one xfor each ,) and (c)
pes not mean of dying, eart failure, c. It means ,or compli- hich caused
tis, if any, ive rise to ausc (a), the under- ause last.
sions contrib- o'cath but not the terminal adition given
Chapter 137, :1954, requires ens to print or e cause or of death on rtificates.
100M. 11-55.916145
6
WINTHROP
WINTHROP
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
DEC 6
1963
7 NAME OF FUNERAL DIRECTOR MAURICE W. KIRBY
ADDRESS WINTHROP.
Received and filed. DEC 5-1962 19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? Ne If so, specify ..
(Signed)
M. D.
(Address).
WINTHROP, MASS Date.
12/4/1962
3yrs
SIGNIFICANT
CONDITIONS
Thoracoplasty left. 12yrs
Was autopsy performed ?.
What test confirmed diagnosis? Clini
12 yrs
Due To (c)
Due
Arterial Hypertension
(h)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cerebral Hemorrhage
to.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent.
Registered No. 222
PHYSICIAN - IMPORTANT
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December 3 1962.
DEATH
(Month)
(Day)
1
(Year)
4 I HEREBY CERTIFY That I attended deceased from July 19 50 December 3 1962
I last saw heralive on
December3, 1962, death is said to
have occurred on the date stated ahove, at 3:25 Pm.
INTERVAL BETWEEN ONSET ANO DEATH 4.8hrs Years. .. Months. .. Days®
Occupation :
WINTHROP
OTHER
Pulmonary Tuberculosis
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased. furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as required by section one, where same was contracted. the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
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