USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 46
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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
X
PLACE OF DEATH
Suffolk
(County)
1
inthrop
(City or Town)
Winthrop Community Hospital No
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Bessie ELIZABETH
Winston
(If deceased is a married, widowed or divorced woman, give also maiden name.)
105 Sagamore Avenue
(a) Residence. No.
(Usual place of abode)
25 Min
Length of stay: In place of death .......... years .......... months .......... days. In place of residence ........
44,
ears ..
......
.. months .......
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
(write the word)
FEMALE WHITE
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. 70 Years
.Months .. ....
Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation :
SEC
(Kind of work done during most working life)
14 Industry
or Business :.
PILE DRIVING
15 Social Security No ...
LAST BESTEN
16 BIRTHPLACE (City)
LIST BESTUN
(State or country ) XI HS)
17 NAME OF
FATHER
MICHAEL WINSTON
18 BIRTHPLACE OF
FATHER (City)
IRELAND
(State or country)
19 MAIDEN NAME
OF MOTHER
MARY MITCHELL
20 BIRTHPLACE OF
MOTHER (City)
IRELAND
(State or country)
21 Informant
JAMES WINSTON
(Address)
105 SAGAMORE AVE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burial or transit permit was issued: Tackle CIpriamus of. (Signature of Agent'of Board of Health or other)
12/20/62
(Date of Issue of Permit)
i
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
DEC 21
196.2
7 NAME OF
FUNERAL DIRECTOR
MAURICE IV KIRBY
ADDRESS
WINTHROP
Received and filed BEC 20 1962 .19
1962 (Year)
4 I HEREBY CERTIFY
That I attended deceased from
1950 Dec. 18 1962
I last saw hexlive on
Dec, 18
, 1962, death is said to
have occurred on the date stated above, at 3:05 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Hypertensive-Coronary
(a)
INTERVAL BETWEEN ONSET AND DEATH
10yrs.
Due To
(b)
Due To Cardiac Decompensation
(c)
4wks
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? Mn If so, specify
(Signature)
Charles Liberman
M. D.
CHARLES
LIBERMAN
(Address)
(Print or Type Name)
WINTHROP MAS Date 12/18/1962
6 .
HOLY CROSS
MALDEN
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
Registered No.
231
dor burial permit Bird of Health s Agent. STJCTIONS OR MICERTIFICATE
TOR TYPE R CAUSES EATH ot enter n:han one Is for each b) and (e)
Des not mean o of dying, fieart failure, 1:tc. It means a:, or compli- Which caused
ins, if any, hlave rise to cause (a), the under- ause last.
Ntions contrib- oleath but not the terminal ndition given
PARENTS
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop, Mass.
NO
St
(If nonresident, give city or town and State)
3 DATE OF
DEATH
Dec.
(Month)
8 (Day)
Artery Heart Disease
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
SINGLE
(Registrar) || (Official Designation)
-2-932382
RM R-301
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
..
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
0
HR
RULES OF PRACTICE The fulfillment of the puppes6 .2.0.1962 ff se laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
X PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No. 82 Plummer Ave.
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.
Registered No.
232
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [ (Was deceased a ¿ U. S. War Veteran,
[if so specify WAR)
(1f deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No.
( L'sual place of abode)
82 Plummer Ave.
St
(1f nonresident, give city or town and State)
Length of stay :
In place of death.
14 years.
months.
days. In place of residence 4
years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December 19, 1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19.
62
to Leac 19
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Firam Crowell
(Husband's name in full)
I1 IF STILLBORN, enter that fact here.
12
12/10/20
AGE
81
Years ....
.Months ....
Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
Retired) y
(Kind of work done during most of working life)
14 Industry
or Business :
...
FestRy Cook Restaurant
15 Social Security No.
018-18-5063A
16 BIRTHPLACE (City).
(State or country)
Prince Edward Island
17 NAME OF
FATHER
Joseph Kennedy
18 BIRTHPLACE OF FATHER (City) (State or country) Newfoundland
19 MAIDEN NAME OF MOTHER Jane Kennedy !!
20 BIRTHPLACE OF MOTHER (City) (State or country) Newfoundland
21 Informant (Address)
82 Plummer 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 teriaque Z
. (Signature of Agent of Board of Health or othef) ' Heatet Altice
12/20 112
(Date of Issue of Permit)
(Official Designation)
... .
MR-301A 1
TICTIONS IR L ERTIFICATE
living F DEATH @ enter dian one eor each ,) and (c)
&s not mean of dying, art failure, c. It means or compli- ich caused
s, if any, ve rise to tuse (a), he under- use last.
ons contrib- ath but not cthe terminal edition given
C
Chapter 137, 954. requires Ens to print or e cause or of death on ertificates, and e 48, Acts of Iquires Physi- t print or type vier signature.
6 Holy Cross
Walder, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December 22, 62
19
7 NAME OF
FUNERAL
DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop, Mass
Received and filed
DEC 20 1962 19
(Registrar)
PARENTS
(Address) 19 Benny Gan
Date Fece 19/200
M. D
(Signed)
Louis Schraffall
(PRINT OR TYPE SIGNATURE)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
clinical eram
5 Was disease or injury in any way related to occupation of deceased? ..... If so, specify
Due To
(b)
alitario Salevatic Heart Dist
Due To (c) Arteriosclerosis
I last saw heLalive on
Dec. 18
1962, death is said to
have occurred on the date stated above, at 12:4 5pm.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ONSET AND
DEATH
10a If married, widowed, or divorced
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
(a)
Bronchopneumon
FINSE PIT
2 FULL NAME Julia M. Crowell (First Name) ( Middle Name) (Last Name)
owell
-
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
RULES OF PRACTICE DEC 2 01962 PM
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.
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.
FRAM R-301
der burial permit Bod of Health Agent. TICTIONS R IL ERTIFICATE
TR TYPE ( CAUSES L:ATH n enter elan one seor each ,) and (c)
ds not mean of dying, art failure, F , c. It means 20or compli- ich caused
es, if any, ve rise to IMse (a), nhe under- use last.
ne ons contrib- ofath but not Isthe terminal dition given
IC.
-932382
A TRUE COPY
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED married
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
ichael D. McGrath
(Husband's name in full)
12
AGE55
Years
Months
23
Days
If under 24 hours
.Hours ......... Minutes
13 Usual
Housewife
Occupation
(Kind of work done during most working life)
14 Industry
Business :
at home
15 Social Security No.0.29-10-6933
16 BIRTHPLACE (City).
Cohasset.
(State or country)
dass
17 NAME OF
FATHER
John J. Shea
18 BIRTHPLACE OF
Connecticut
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Catherine Greeley
20 BIRTHPLACE OF
MOTHER (City)
(State or country) Ireland
21 Informant
Michael D. McGrath
(Address)
35 Lincoln St.
inthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Hakke E. Periannis 1.
(Signature of Agent of Board of Health or other)
Thatcle Effacer
12/31/62
(Date of Issue of Permit)
1
Winthrop (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
Registered No.
233
[(If death occurred in a hospital or institution,
St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Laura M. Shea) McGrath
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a U. S. War Veteran, (if so specify WAR).
(a) Residence. No ....
35 Lincoln St.,
(Usual place of abode)
1 hour 30 min.
Length of stay: In place of death .......... years .......... months ....
St.
Winthrop Mass.
(If nonresident, give city or town and State)
... days. In place of residence .......... years .......... months ......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEL
19
1962
DEATH
(Year)
(Month)
(I)ay)
4 I HEREBY CERTIFY , That I attended deceased from
1/12
1962
106 2
to ..
12/14
I last saw hekalive on
12/16/6, 19, death is said to
have occurred on the date stated above, at farm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE CEREBRAL HEMORRHAGE (a)
INTERVAL BETWEEN ONSET AND DEATH
Due To
E LEFT HEMIPLEGIA
(b)
Due To HYPERTEN SIVE HEART DIS. (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 /16 If so, specify
(Signature)
M. D.
MYRON N. KINGRID
(Address)
222 PLEA (Print or Type Name)
1
2/19 1962
6 winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Dec. 22,
19.62
7 NAME OF
FUNERAL DIRECTOR
Crnest :. Cacciano
ADDRESS
147 winthrop St., inthrop
Received and filed DEC 2-+-1962 ......... .19.
No Winthror Community Hospital
PLACE OF DEATH
Suffolk (County)
1YR.
PARENTS
(Registrar)|| (Official Designation)
(write the word)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un. related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
DEC 211962 AM
DRM R-301
ilefor burial permit Bird of Health of.s Agent. INS: UCTIONS FOR ICA CERTIFICATE
IN OR TYPE SER CAUSES OFDEATH do ot enter og than one au for each (a) (b) and (c)
is Des not mean me of dying, as heart failure, nia etc. It means line, or compli- s which caused
ndims, if any, ichgave rise to ve cause (a), tin the under- ng cause last.
Casitions contrib- hideath but not the terminal d se ndition given )
X PLACE OF DEATH 1
Suffolk (County)
Winthrop (City or Town)
87-6-1
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
Registered No. 234
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(W'as deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No ..
15 Pailey Road
(Usual place of abode)
St Somerville
(If nonresident, give city or town and State)
months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
white
10 SINGLE
MARRIED
WIDOWEDWidow
DIVORCED
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
VINI
(or) WIFE of ..
Guiseppe
(Husband's name in full)
12
AGE 62 Years 5 Months - Days
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :
ATGMCH
(Kind of work done during most working life)
14 Industry or Business :
15 Social Security No ...
NONE
16 BIRTHPLACE (City)
ITALY
(State or country )
17 NAME OF
FATHER
DAIO FRSSO - LOTTI
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
Marianna PadriNi
20 BIRTHPLACE OF MOTHER (City) (State or country) ITALY
Mrs Julia Divi
21 Informant
(Address)
126 Saratoga ST. E. BOSTON
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)
i
(Official Designation) 66
(Date of Issue of Permit)
1
A TRUE COPY ATTEST: ATTE.
22
1962
(Month)
(Day)
(Year)
19 4 I HEREBY CERTIFY, That I attended deceased from 219 19. .. , to ..
I last saw h.a.f.alive on
2.21, 1950
death is said to
have occurred on the date stated above, at
115 am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bronchopheumenin
INTERVAL BETWEEN ONSET AND DEATH
24 hours
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Cardiac Hyff Tropfing (teog) YRS-
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signature)
1John D Fatorella
(Address)
305 Chelsea il
Date.
12/00 196.2).
6 Holy Cross Malden
Place of Burial or Cremation Dec- 24/- 1962
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR/
ARTHUR S. PORcellA
ADDRESS 876 Winthrop Ave, Pure
Received and filed DEC 26-1962 19
(Registrar)
82-932382
Winthrop Community Hospital
( LOTTI)
2 FULL NAME Eva Lotti Dini
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Length of stay: In place of death .......... years .......... months
3
days. In place of residence 22 years.
3 DATE OF
DEATH
12
........
١٤٢٠١٠٢٠٢٠
M. D.
(Print or Type Name)
(City or Town)
PARENTS
(write the word)
(a)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
6
1.11 teths only as those of persons
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 to whom they have given bedside care during bas iness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa. tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
=
PLACE OF DEATH
SUFFOLK (County)
WINTHROP (City or Town) 24 FORREST. Non
The Commonwealth of Massachusetts EDWARD J. CRONIN 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.
235
ST.
$(If death occurred in a hospital or institution., St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
NO
St
(If nonresident, give city or town and State)
.months. ....... .days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
10a lf married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
3
AGE
Years ...
4
.. Months.
.Days®
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
NONE
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No ..
16 BIRTHPLACE (City).
(State or country)
17 NAME OF FATHER
18 BIRTHPLACE OF
faure
FATHER (City). (State or country)
Tema
19 MAIDEN NAME OF MOTHER
Mildred & haul.
20 BIRTHPLACE OF MOTHER (City) (State or country)
Trading
if Pensou.
21 Informant. (Address) 24 FORREST ST.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Kalplid Semana (Signature of Agent of Board of Health or other)
16.0. Sec. 24,1962
(Official Designation )
(Date of Issue of Dermit)
X
MEDICAL CERTIFICATE OF DEATH
3 DATE OF December
22
1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
I last saw h ........ alive on
19
..... , death is said to
have occurred on the date stated above, at
4:50 %.
.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL BETWEEN ONSET AND DEATH
3 yrs
Due To (Congenital) (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? no clinical
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? No If so, specif .............
Arthur C.
murray 23 Dec 1962
M/ D.
Winthrop Board of Health
.Date
0 WINTHROP.
6 Place of Burial or Cremation
DATE OF BURIAL DEC 24 122
7 NAME OF Maurice It 1 July
ADDRESS WINTHROP.
Received and filed.
DEC 26 1962 .. 19.
(Registrar)
PARENTS
100M-11-55.916145
STICTIONS OR ALIERTIFICATE
In iving E F DEATH xt enter re man one isefor each ), ) and (c)
es not mean of dying, Part failure, IS c. It means sces or compli- hich caused
lies, if any, ve rise to muse (a). he under- use last.
h
c
n 7
n ons contrib- to cath but not the terminal € Lidition given .
te Chapter 137, of 954, requires lis to print or P cause or death on S f rtificates.
MR-301A 1
2 FULL NAME
James a Mille
(h/deceased is a married, widowed or divorced woman, give also maiden name.)
24 Horas St (a) Residence. No ... (Usual place of abode)
Length of stay: In place of death. ... years. months. Zdays. In place of residence. 2 years
Registered No.
SINGLE
19.
to
19.
Due To
Cerebral Palsy
(b)
(City or Town)
ROBERT MILLS
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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