USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 47
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A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- te n, shall. if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two. and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physiciani will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated 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 Examingre 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 occupation. the sudden deaths of persons not disabled by recognized disease, and those of. persons found dead.
DEC 2 61962 AM
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 import- ant, 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. Children 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
......
--
(If deceased is a married, widowed or divorced woman, give also maiden name.) 4) Upland Rd (a) Residence. No ...... (Usual place of abode)
........ months ......... days. In place of residence. 45years.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
male / white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
1
married
11 If married, widowed, of divorced
HUSBAND of
Florence Di pesa
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE ... Kears.
Months.
...... Days
If under 24 hours
Hours ......
.Minutes
13 Usual
Occupation :..
Retired
(Kind of work done during most working life)
14 Industry
or Business :.
J'aios
15 Social Security No ...
021- 09-0103
16 BIRTHPLACE (City)
(State or country )
17 NAME OF
FATHER
Ciriaco Lirica
18 BIRTHPLACE OF
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Cannot Wie Jeanned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Staty
Holy Cross Com. malden 6 Place of Burjal/or Cremation, (City or Town)
DATE OF BURIAL
December 27 1962
"Bounfiglio, Paul
ADDRESS
Received and filed DEC 2.6. 1962 19
(Registrar)||
TOLLE CODY ATTEST.
1962 (Year)
(Month)
(Day)
That I attended deceased from
1963
I last saw him.alive on
Dec. 23, 1962, death is said to
have occurred on the date stated above, at 10: 56 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Cerebrovascular Hemorrhage
Due
(b)
Cerebral Arteriosclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Nove
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 z
(Signature)
Chatten
CHARLES
LIBERMAN
(Addres
(Print or Type Name) WINTHROP, MASS Date 12/23/1962
PARENTS
Mrs Florence Giaila
21 Informant
( Address)
41 Upland Ord Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Halkh ceteriacar (Signature of Agent of Board of Health or other) Paleta Officia 12/26/62
(Official Designation)
(Date of Issue of Permit)
2 -932382
PLACE OF DEATH
X Suffolk (County) 1 Winthrop (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
WINTHROP
(City or Town making this return)
STANDARD CERTIFICATE OF DEATH
Registered No.
236
Winthrop Community Hosp. No ....
2 FULL NAME
Gabriel
Giarla
PHYSICIAN - IMPORTANT
1
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
St
(If nonresident, give city or town and State)
months
days.
Length of stay : In place of death .......... years.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
DEC.
73
YTOR TYPE ER CAUSES F EATH o t enter re han one usfor each ),b) and (c)
R's not mean no of dying, sheart failure, a tc. It means sel, or compli- Which caused
dit is, if any, hive rise to e ause (a), ngthe under- Pause last.
onions contrib- to eath but not the terminal sdition given
ERM R-301
edor burial permit Bard of Health r ; Agent. ISTICTIONS OR ALCERTIFICATE
§(If death occurred in a hospital or institution, e its NAM treet and number)
4 I HEREBY CERTIFY
Dec. 20 1962
to .......
DEC. 23
INTERVAL BETWEEN ONSET AND DEATH 3 days.
7 NAME OF
FUNERAL DIRECTOR
128 Revere St Revere
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
i.
.. ....
6
ההי
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance ofDEC 2 61962 PM
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 SUFFOLK (County) WINTHROP (City or Town) 2.34 COURT RD
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
237
[(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
JOSEPH WN NOLAN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
234 COURT RD
St.
(Usual place of abode)
Length of stay : In place of death.
4 5years.
ars ...
months. ...... days. In place of residence 43 years. months .... ...... .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December 23
(Month)
(Day)
1962
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
19
I last saw h .. ..... alive on
19 ..........
., death is said to
have occurred on the date stated above, at
1:15 A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Natural Causes
INTERVAL BETWEEN ONSET AND DEATH
Presumably Coronary Occlusion
(b)
....
Sudden
Due
Arteriosclerotic Heart Disease
(c)
...
10 yrs.
OTHER
SIGNIFICANT
CONDITIONS
none
Was autopsy performed?
no
What test confirmed diagnosis? post-mortem judgement
5 Was disease or injury in any way related to occupation of deceased ? no. If so, specify
(Signed) Led Arthur C. Murray . D. Arthur C. Murray
(PRINT ORITYPE SIGNATY Winthrop Board of He Date 24 Dec 1.62
6
WINTHROP
Place of Burial or Cremation
DATE OF BURIAL
DEC 26
19.62
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS WINTHROP
Received and filed VEC.261962 19
(Registrar)
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED MARRIED
10a If married, widowed, or divorced
HUSBAND of
RUTH H FCPA
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 44 Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
-
AIR LINES
(Kind of work done during most of working life)
14 Industry
or Business :
FREIGHT DISPATCHER
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
EAST BOSTON
17 NAME OF
FATHER
JOSEPH W MILAN
18 BIRTHPLACE OF
BOSTON
FATHER (City)
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
JARAH MCDERMOTT
20 BIRTHPLACE OF
BOSTON
MOTHER (City)
(State or country)
MASS
-
21 RUTH H NOLAN
Informant
(Address)
234 COURT RD WINTHANK
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E Sercan (Signature of Agent of Board of Health or other)
R.O.
Dec. 24.1962
(Date of Issue of Permit)
11-59-926662
PLACE OF DEATH
FR-301A 1
NS UCTIONS FOR CACERTIFICATE giving S OF DEATH dot enter than one u for each a (b) and (c)
is es not mean 1º of dying, heart failure, tinetc. It means ine, or compli- IS which caused .
clons, if any, iclgave rise to a cause (a), in the under- 7 cause last.
- itions contrib- death but not the terminal ondition given I.C.
Chapter 137, o 954. requires ns to print or e cause or sof death on tificates, and 48, Acts of quires Physi- print or type der signature.
t
WINTHROP
(City or Town)
PARENTS
guldişwi
OVIPYEM
To be filed for burial permit with Board of Health or its Agent.
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran, [if so specify WAR) NO
...... (If nonresident, give city or town and State)
PERSONAL AND STATISTICAL PARTICULARS
(Official Designation)
AVVIL
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 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.
6
INTHROR
DEC 2 61962 AM
DRM R-301 ×
les or burial permit Bird of Health or s Agent. NS UCTIONS FOR CA CERTIFICATE
NJOR TYPE EUR CAUSES PDEATH la ot enter or than one uj for each a)(b) and (c)
sies not mean mi: of dying, as heart failure, idetc. It means iste, or compli- s which caused
dimms, if any, chave rise to ve cause (a), in the under- I cause last.
on tions contrib- Etdeath out not the terminal ndition given
752. 29 JIN 22 1963
Directen siuse only AK Ink.
2.2-932382
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
STANDARD
CERTIFICATE OF DEATH
Registered No.
{(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME.
Brian E. Riggs
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 Sunset Road
St
Winthrop, Massachusetts
(a) Residence. No ...
(Usual place of abode)
(If nonresident, g.ve city or town and State)
Length of stay: In place of deathyears months/ days. In place of residence 2 years / month 27 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October 27,
(Month)
(Day)
(Year)
4IHEREBY CERTIFY, That
Sept. 26 .62
to.
o'ct
27
19
OZdeath is said to
have occurred on the date stated above, at
12:58am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
BRONCHOPNEUMONIA BILATERAL
(a)
Due To
BRAIN ABSCESS
(b)
Due To (c)
OTHER
HYDROCEPHALUS
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)
M. D
Charles L. Clay, M. D.
(Print or Type Name) (Address) Aus't. Dir., Mass. Gen'l. Hosp. DateOCT.27.19 62
6 WINTHROP
WINTHROP
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL OCT 30 9.62
7 NAME OF
FUNERAL DIRECTOR
MAURICE W. KIRBY
ADDRESS
WINTHROP
For.31 1962
Received and filed 4 .. 19 Charles it Mackie
(Registrar)
PERSONAL AND STATISTICA PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
io SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
SINGLE
11 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
INTERVAL
BETWEEN
DNSET AND
(or) WIFE of.
DEATH
12
? DAS AGE 2 Years / Month: 271)
(Husband's nan.e ir full)
If ioder 24 hours
11.1 .
Minutes
13 Voud'
I+ Yrs.
Occupatinn :..
NONE
i Kind of work done de ng most ort iny ifc)
14 Industry
or Business :
15 Social Security No .....
WINTHROP.
IZ YRS6 BIRTHPLACE (City) (State or country )
MASS
17 NAME OF
FATHER
EDWARD I RICOS
$ BIRTHPLACE OF
FATHER (City)
BOSTON
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
JUDITH REESE
20 BIRTIIPLACE OF
MOTHER (City).
BOSTON
(State or country)
MANS
21 Informant
EDWARD I RIGE!
(Address)
41 SUNSET RD WINTHROP.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bu: ia, or transit permit was issued: Damata
(Signature of Agent of Board of Health or other)
B13530
10 mag-62
(Official Designation) (Date of Issue of Permit)
TOWN
KEVIN H WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITA .. STATISTICS
BUT _ ~~
(City or " wn maki .. th's return).
(City or Town)
NOMASSACHUSETTS GENERAL HOSPITAL
PHYSICIAN - IMPORTANT .
) Was deces to a
U. S. W
. eteran,
if so spe. . y WARI.
NO
Yeattended deceased from
,62
I last saw
hamalive on
Oct. 27
1962
PARENTS
A TRUE COPY ATTEST: Charles it Mackie City Registrar
1
JAN 2 2 1963 AM
FOIM R-301
d f burial permit oal of Health it Agent. TR:TIONS R L ERTIFICATE
TR TYPE € CAUSES LATH 4 enter rejian one se or each . ) and (e)
do not mean od of dying, port failure. , c. It means a or compli- ich caused
ises, if any, De rise to IMse (a), r ke under- use last.
nd'ons contrib- oftath but not Lathe terminal edition given
15.0° 85
IN 22 1963
X
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
No
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18 Wadsworth Ave
St
(Was deceased a
U. S. War Veteran,
(if so specify WARY
Winthrop
No
(a) Residence. No ..
(Usual place of abode)
0
Length of stay : In place of death .......... years .......
.. months ..
44
days. In place of residence 35
(If nonresident, give city or town and State)
....... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
IO SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Widowed
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of
Patrick & Carroll
(Husband's name in full)
12
AGE. & ZYears.
Months .. .....
Days
If under 24 hours
Hours ........ Minutes
13 Usuai
Occupation :
(Kind of work dour dit arz most working life)
14 Industry
or Business:
at Home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Seremnak Reardon
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
"Catherine Mc Carthy
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Ireland
John Carroll
2 I Informant
(Address)
44 W. Eagle St East Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death Aled with me BEFORE the burial or transit permit was issued: R.K. Yor
(Signature of Agent of Board of Health or other)
31360
11-2-62
(Official Designation) (Date of Issue of Permit)
-
--
3 DATE OF
October
31
1962
DEATH
(Month)
(Day)
(Year)
9-11 7- 82
BY CERTIF
LO" That I attended deceased
19
62
62
death is said to
have occurred on the date stated above, at
.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Pulmonary embolus
(a)
Due To
Blood clot, site unknown
(b)
unk
Due To (e)
OTHER
Generalized arterio-
SIGNIFICANTSCLerosis ..... with
CONDITIONS chronic brain syndrome
yrs
Was autopsy performed?
Phys. Exam.
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of decear
If so, specify
Donald . Baran, mp
(Signature)
DONALD P. BARKER M.) ........ ,
GLENSIDEPHOSPRENAme 10-31-62
(Address)
.Plain Mass ....
.Date ..
......
.........
Calvary
Brochaton Maso
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Hov 3
19.
62
7 NAME OF
FUNERAL DIRECTOR
Ernest Plaggrans
. ....
ADDRESS
147 Winthrop St Wintherof
Received and filed
NOV 6 1962
₹19
Charles it mackie
....
(Registrar)|
The Commonwealth of Massachusetts
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF
239
(City or Town making this return)
STANDARD CERTIFICATE OF DEATH
Registered No.
GLENSIDE HOSPITAL
CARROLL, Mary A. (nee
Reardon )
PHYSICIAN - IMPORTANT
I last saw G ..... alive on
19
12. 30P.
INTERVAL
BETWEEN
ONSET AND
DEATH
4 hr
(Give maiden name of wife in full)
PARENTS
-932382
1
7
JAN 2 21963 AM
0
X 1
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
QUI
....
(City or Town making this return) 1108
Veterana ....... Administration Hospitalt. ( give its NAME instead of street and number)
2 FULL NAME.
Joseph-Harold .... GAHM
(If deceased is a married, widowed or divorced woman, give also maiden name.)
-
929 Shirley
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