USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 48
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St
Winthrop, Mass
(Usual place of abode)
(If nonresident, give city of town and State)
Length of stay: In place of death 0 years 1 months 16 days. In place of residence ...
.. years ...
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Nale
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEDMarried
DIVORCED
UNKNOWN
11 If married, widowed, or divorced
--
have occurred on the date stated above, at 4:15Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Renal Failure secondary to Ronal
Due To
(b)
.............
Encuryan resection
(c) .......
Post-op simoid resection
for
OTHER SIGNIFICANT CONDITIONS Diverticulitis - MOR
Was autopsy performed?
Yes
What test confirmed diagnosis ? Autopsy & ... Jab .finding
5 Was disease or injury in any way related to occupation of deceased ? If so, specify « ... ) .............
(Signature)
J. Peter mareth
M. D.
J.Feter ... Mcal] :....... U.D.
(Print or Type Name)
.........
(Address)
.VAH .. B.catom, Masa ....... Date ..... Nov .... 21.19 ...... 62
6 Mt. Pleasant Com, Arlington, Mass .... Place of Burial or Cremation (City or Town)
DATE OF BURIAL ........... 11-24-62 19
7 NAME OF
FUNERAL DIRECTOR
Morris Kirby F F.
ADDRESS
....................
210 Winthrop St., Winthrop, Masa
Received and filed NOV 27 1962 59
Charles H, Mackse
(Registrar)
PARENTSO
17 NAME OF
FATHER
Joseph S. Gabm
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Masa
Charlestom,
19 MAIDEN NAME
OF MOTHER
Catherine Sullivan
20 BIRTHPLACE OF
MOTHER (City).
E .... Cambridge,
(State or country)
21 Informant
V .. A .... Hoap .... Racorda ... 150 ... Sonth
(Address)
Huntington Ave., Boston, Mass.
-
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health or other)
13900 11/2/62
(Official Designatio
Date of Issue of of Permit)
fs burial permit od of Health itiAgent. RI TIONS
ERTIFICATE
(. TYPE OI CAUSES DATH ne enter tin one er each @ and (c)
dos not mean de of dying, art failure, @ It means stor compli- ach caused
ios if any, gis rise to ese (). 1: under- @ se last.
dias contrib- ath but not o ie terminal casition given
L 1
104
1 1 - 1963
21
1962
(Month)
(Day)
VA
(Year)
4 I HEREBY CERTIFY, at. 5
19 62 to ....
That
attended deceased from
21
19 .62
death is said to
HUSBAND of
Margaret ..... Carthy.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
daya
AGE.
65 Years
8
Months.
8 Days
If under 24 hours
.. Hours ........ Minutes
13 Usual
Occupation :.
Rotired clerk
(Kind of work done during most working life)
4 Industry or Business :.
15 Social Security No ..
012 07 4261
16 BIRTHPLACE (City)
(State or country)
Scmorville
Due To Status post-on Tur of Bladder 15 days
INTERVAL BETWEEN ONSET AND DEATH
States post-op abdchimal
4 day
240
STANDARD CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
No ....
PHYSICIAN ... IMPORTANT
S
(Was deceased a
U. S. War Veteran,
if so specify WAR) ..
(a) Residence. No .....
3 DATE OF
DEATH
(write the word)
-----
1
OM R-301
-
A TRUE COPY ATTEST:
nardes it mackie City Registrar
OF TOP
11
9
0
THR
FEB 1 1963 AM
FIM R-302
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
X
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
472
Revere
(City or Town making this return)
I
Revere
(City or Town)
No
Grover Manor Hospital
[(If death occurred in a hospital or institution, . [ give its NAME instead of street and number)
Margaret McLeod
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
4 Pleasant
Winthrop, Mass.
(Usual place of abode)
Length of stay: In place of death ......
.years
.months.
16lays. In place of residence
51
.. years.
........ months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
14,
1962
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY, That I attended deceased from
Feb.
28
62
19.
to.
Dec. 14
19
62
I last saw lflalive on
Dec. 14
19 ... 62death is said to
have occurred on the date stated above, at
8:00P .m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Uremia
(a)
Due ToCerebral Vascular Accident (b)
1year
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?
Clinical Signs
5 Was disease or injury in any way related to occupation of deceased ? ... If so, specify
(Signed)
James F. Burns
M. D.
(Address)
Everett, Mass.
Date
12/14/ ,62
19.
Winthrop Cemetery, Winthrop 6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
December 18, 62
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass.
Received and filed
JAN 15 1963
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
Single
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of.
(Husband's name in full)
12
69
AGE
Years
Months ..
Dayz
If under 24 hours
Hours ......
.Minutes
13 L'sual
Secretary
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
Ludlow Valve
15 Social Security No ....
032-05-1423A
16 BIRTHPLACE (City)
Boston
(State or country)
Mass.
17 NAME OF FATHER George McLeod
PARENTS
18 BIRTHPLACE OF
FATHER (City).
North Sydney
(State or country) Cape Breton, N. S.
19 MAIDEN NAME
OF MOTHER
Mary A. McArthur
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Ireland
Charlotte McLeod
21 Informant
( Address)
4 Pleasant St., Winthrop
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
December 18,
19 62
THIS IS A PERMANENT RECORD
WRITE PLAINLY, WIIN UNPADINU LIIVA
50M - 10-61-931673
2 FULL NAME.
CERTIFICATE OF DEATH
Registered No.
241
(Was deceased a
U. S. War Veteran,
if so specify WAR,
St
(If nonresident, give city or town and State)
(Give maiden name of wife in full)
INTERVAL
BETWEEN
ONSET AND
DEATH
2days
1 2 E
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE. DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
6
JAN 1 51963
F IM R-302 1
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
4.73
Revere
(City or Town making this return)
Registered No.
2242
S(If death occurred in a hospital or institution, XX \ give its NAME instead of street and number)
Mary G. Fanning (Sullivan)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
(if so specify WAR,
31 River Road
Winthrop, Mass.
(a) Residence. No ...
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months.
10
lay's. In place of residence 40
.. years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED LA
DIVORCEDWidowed
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
William F Fanning
(Husband's name in full)
12
AGE
82Years
Months .......
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most working life)
14 Industry
Own Home
or Business:
15 Social Security No ..
Boston
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
John Sullivan
18 BIRTHPLACE OF
FATHER (City).
Boston
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Esther Roe
20 BIRTHPLACE OF
MOTHER (City).
Boston
(State or country)
Mass.
21 Informant
(Address)
31 River Road, Winthrop
A TRUE COPY
ATTEST:
(Registrar of City of Town where death occurred)
DATE FILED
December 18,
1962
(Registrar of City or Town where deceased resided)
3wks.
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?
Clinical Signs
5 Was disease or injury in any way related to occupation of deceased ?no If so, specify
(Signed)
James F. Burns
M. D.
(Address)
Everett, Mass.
Date.
12/15/,62
Holy Cross
Malden
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December 18, 162
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass.
Received and filed JAN 15 1963 19
50M - 10-61-931673
(a) THIS IS A PERMANENT RECORD WRITE PLAINLY, WITH UNFADING DLALA INA 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)
n. C.
PLACE OF DEATH
December
15,
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
Dec. 5
19
to.
62
Dec. 15
19
62
I last saw he.Malive on
D.e.c .......
15.
162, death is said to
have occurred on the date stated above, at
8:00P .J.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Uremia
INTERVAL
BETWEEN
ONSET AND
DEATH
2days
3 DATE OF
DEATH
That I_attended deceased from
Due ToCerebral vascular accident (b)
PARENTS
Florence Caspole
Grover Manor Hospital No ..
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
TO:
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
-
6
JAN 1 51963 AM
X
PLACE OF DEATH
Norfolk
(County)
Quincy
(City or Town)
Quincy City Hospital
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Quincy
(City or town making return)
Registered No.
1029
243
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
Joseph F. Dever, Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
44 Wilshire Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .....
.......
.. months ..
1
days. In place of residence.
1
.years ..........
... months .............. days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Male
10 COLOR
White
11 CITIZEN
OF U.S.
YES
NO
12 SINGLE MARRIED XTX WIDOWED DIVORCED UNKNOWN
12a If married, widowed, or divorced
HUSBAND of
Holen G. Fuller
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH
14
AGE ...
38
Years.
.......... Months .............. Days
If under 24 hours
.Hours
Minutes
15 Usual
Occupation :
Insurance Agent
(Kind of work done during most of working life)
16 Industry
or Business:
Life Insurance
17 Social Security No.
Boston
18 BIRTHPLACE (City)
(State or country)
Mass.
19 NAME OF
FATHER
Joseph F. Dever
20 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Boston
21 MAIDEN NAME
OF MOTHER
Marion G. Clifford
22 BIRTHPLACE OF
MOTHER (City)
(State or country)
N'ass.
23 Mrs. Joseph F. Dever, Jr.
Informant
(Address)
" Wilshire St., winthrop,
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
.......................... ..........
19
(Registrar of City or Town where deceased resided)
PARENTS
M. D.
(Address)
Hilton, lass.
Date 12/27 19 62
7 Winthrop Cemetery, Winthrop, L'ass.
Place of Burial or Cremation.
(City or Town)
62
Dec. 31,
19
8 NAME OF
FUNERAL DIRECTOR
Maurice W. Kirby
ADDRESS ...... Winthrop, Nass.
Received and filed JAN 16-1963 Deo-28,5 19. 62
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at THIS IS A
No.
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
Died suddenly.
5 Accident, suicide, or homicide (specify)
Where did
Injury occur ?
(City or town and State)
public place ?
Manner of
(Specify type of place)
Injury
(How did injury occur ?)
Nature of
Injury
(Signed)
Frederic Tudor
DATE OF BURIAL
25M-3-61-930213
as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
the time of death should be transmitted on Form R.305 to the clerk of the city or town in which the deceased resided
If accidental, was injury causally related to the death?
December
27.
1962
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Presumably coronary occlusion.
Date and hour of injury
19
Did injury occur in or about home, on farm, in industrial place, or in
While at work ?
.Was autopsy performed ?
No
6 Was disease or injury in any way related to occupation of deceased ? If so, specify
Boston
1 -305 1
[(Was deceased a
{U. S. War Veteran,
T.V.2
[if so specify WAR)
Winthrop, Mass.
TON
6
SPACE FOR ADDITIONAL INFORMATION JAN 1 61963 AM
DATE OF ENTERING MILITARY SERVICE
September 9, 1942
DATE OF DISCHARGE
October 23, 1945
RANK, RATING
T /Sgt.
11067643
ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
suffolk (County )
Boston
(City or Town)
The Commonwealth of MassarquasiIs KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
244
To be filed for burial permit with Board of Health or its Agent.
Registered No.
The Children's Hospital Medical Ctr. (If death occurred in a hospital or institution. No.
Steven Mark Coler
2 FULL NAME
. (First Name) f Middle Name ) ( Last Name) ( If deceased is a married, widowed or divorced woman, give also maiden name.)
100 Circuit Rd.
Winthrop
(a) Residence. No. ( \'sual place of abode )
( If nonresident, give city or town and State)
Length of Stay
In place of death
year.
months
dass.
place of residence14
year
.months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX MALE
9 COLOR
White
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
13
AGE 14 Y
Years.
Months
.Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
STUDENT
(Kind of work done during most of working life)
15 Industry
or Business:
STUDENT
16 Social Security No.
NONE
17 BIRTHPLACE (City)
(State or country)
WINTHROP
18 NAME OF
FATHER
NORMAN S. COLOR
19 MIRTIIPLACE OF
FATIIER (City)
NEW YORK N.Y.
20 MAIDEN NAME
OF MOTHER
JEANNE Goloboy
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
(Address) Joi CIRCUIT Rd., WINTHROP
Jacqueline
HEREBY CERTIFY that a satisfactory andard certificate of death filed with me BEFORE the burial or Mansit permit was, issued: Varato
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
1
UCONS
CU'IFICATE
O DEATH ofiter thi one beach Chind (c)
esot mean / dying. hat failure. e It means er compli- uk caused
i/ amy, rise to (a). under- e last. his contrib- d4 h but not De terminal tion given
-
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
Yes.
What test confirmed diagnosis?
Bone Marrow
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
( Signed) DINAH KÜHNER M. D. (State or country)
Koh
(Address) 300 .... Longwood.A.V.Gate .... 11-29-62
PARENTS
SHARON MEMORIAL PARK.
SHARON.
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
NOU
30
62
22
Informant
NORMAN S. CO/ER
7 NAME OF
FUNERAL DIRECTOR MORRIS DO BREZNIAK
ADDRESS
470 HARVARD ST. BROOKLINE
Received und filed
DEC 4 1962
1 .. 19
Charles à Mackie
(Registrar)
1 -301
Chapter 137. 954 Wquires s to print or cause I drath lon atificates, and
e 48. [Acta ol quires Physi- print or type der signature.
12 1963
AMAI.
J DATE OF
NOV. 29 1962
DEATH
( Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
NOV ....... 28
19.62.
to
NOV.
29
196 2
I last saw himlive on
NOV ....
.29
19 .. 6.2, death is said to
have occurred on the date stated above, at 12: 10 pm
INTERVAL
BETWEEN
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Cicute
ONSET AND
(a)
Leukemia
DEATH
1/2 year
. St.
23 hrs. 40 min.
St. \ give its NAME instead of street and number) PHYSICIAN - IMPORTANT [ { Was deceased a il'. S. War Veteran. lif so specify WAR) No
14/6
RUSSIA
1 (Print or Type Name)
A TRUE COPY ATTEST; .
FEB 11 |963 PM
X
PLACE OF DEATH
Suffolk (County)
Boston
(City of Town)
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD T CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital or institution,
4. I give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL, NAME
Edward
J.
Cox
(If deceased is a married. widowed or divorced woman, give also maiden name )
16 Wilshire
Sı.
Winthrop, Mass.
(a) Residence. No ..
(Usual place of abode)
Length of stay: In place of death.
years
month & 23
days. In place of residence
14.
ar‹
months
davs.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
( write the word)
Married
If It married, widowed, or divorced
HUSBAND of
Sarah Bradeen
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
12
Acı 62
Years
0
Month.
4
11115
If under 24 hour
Hours
Minutes
13 l'qual
(kcupation
Lineman
(kind of work done during most of working life)
14 Indu ****
or Business
WESTERN UNION
15 Social Security No
010-07-0223
Newton
16 BIRTHPLACE (City)
( State or country )
Mass.
17 NAME OF
FATHER
Joseph Cox
18 BIRTHPLACE OF
FATHER (City)
(State or country )
Ireland
19 MAIDEN NAME.
OF MOTHER
Julia McDonell
20 BIRTHPLACE OF
MOTHIER (City).
(State or country)
Ireland
21 Inlormant
V.A. Hospital Records, 150 S.
(. Valdres)
Huntington Ave. ,Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued: De. R. Garman
( SignbuGre of Agent of Board of Health or other)
12-6-62
3/4/42
(Official Designation)
(Date of Issue of Permit)
fofurial permit ard f Health ts ;ent.
RUIOMS FR
. CITIFICATE
& TYPE Of CAUSES DATH noenter lin one e Er each and ( c )
not mean of dying. vi failure.
or compli. ch caused
i.if any, e rise to use (a). e under. use last.
Moms contrib- Sath but not the terminal Ifition given
163 50 X 7/ 12 1863
6 Winthrop Cemetery Winthrop, Mass. l'lace of llurial or Cremation (City of Town)
DATE OF NURIAL
December 7
62
7 NAME OF
FUNERAL DIRECTOR
Morris Kirby
210 Winthrop St
Winthrop, Mass.
ADDRESS
DEC 7 1962
12
Received and fled
Charles & Mackie
( Registrar )
VA
(Year)
That
1
attended deceased from
4 IHEREBY CERTIFY.
Nov. 11
19
62
in
Dec. 4
. 19
62
have occurred on the date stated above, at 2:00P.In.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Carcinoma of left lung with
metastases to lymph nodes
Due
(b)
INTERVAL BETWEEN ONSET AND DEATH
7 Mths
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)
Roger Daniela
, M. D.
Roger Daniels
(Print or Type Name)
(Address)
VAH,Boston, Mass ....
12-4- ..... 62
PARENTS
245
(City or Town making this return)
(Was deceased a l'. S. War Veteran, Cif so specify WARI WWII
{( it\ or town and State)
3 DATE OF
DEATH
December
4
1962
(Month)
(D)a))
XXXXXXX . death is said to
(a)
OIM R-301
I
Veterans Administration Hospital
·
-
FEB 1 11063 PM
SUFFOLK
(County)
BOSTON
(City or Town)
New England Center Hospital
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH 1 DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
246
(City or Town making this return)
97
TOWN
...
Registered No. ((If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
IMrs Ethel R Sullivan Kelly) 2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name. )
(a) Residence. No ..
63 Thornton Park
(Usual place of abode)
Length of stay: In place of death ......... years ..... months. 2 days. In place of residence ..
. years .. months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF . L.
DEATH
7
4
(Month)
(Day)
(Year)
4IHEREBY CERTIFY,
That I attended deceased, from
19
I last saw K ...... alive on
., death 1, sitti to
have occurred on the date stated above. at
11.
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Due To (c)
OTHER
SIGNIFICANT & Lung Atelectaris
CONDITIONS
Was autopsy performed ?
NO
What test confirmed diagnosis? EXAMINATION ONLY
5 Was disease or injury in any way related to occupation of deceased? ! If so, specify
(Signature)
arvan 12. Schaut
M. D.
ALVAN R. SCHWARTZ
(Print or Type Name)
(Address)
NECH, BOSTON
Date
12/7/1962
6
Winthrop Cemetery, Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 10,
19.6.2
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Cacciano
147 Winthrop St., Winthrop
ADDRESS
DEC 11 1962
19
Received and filed
Charles & mackie
( Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
fe ... le
9 COLOR
white
10 SINGLE
( write the word)
MARRIED
WIDOWED
married
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name ol wife in full)
(or) WIFE of
Francis J. Sullivan
( Husband's name in full)
12
AGE47
7 yrs
Years
11
Months
Days
If under 24 hours
Hours ........ Minutes
13 l'sual
(k cupation ..
Housewife
( kind of work done during most working life)
14 Industry
or Business:
at home
15 Social Security No. .
16 MIRTIPLACE (City). winthrop
(State or country )
wass
17 NAME OF
FATHER
John L. helly
18 MIRTIIPLACE OF
FATHER (City).
Boston
(State or country )
Hass.
19 MAIDEN NAME
OF MOTHER
Ethel Doyle
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Pennsylvania
21 Informant
Francis J. Sullivan
( Address)
63 Thornton Pk., winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or Dansit permit was issued: 20522/12801 9563104 (Signature of Agent of Board of Health or other) Dec.9 1962
(Official Designation) (Date of Issue of Permit).
-
forarial permit erdf Health sent. UCONS FOR CLO IFICATE
O TYPE RIAUSES ETH oEnter thi one fi each (band (c)
emot mean elf dying, kat failure. el Il means ew compli- pak caused
if amy, rise to gie (a), under- ale last.
Los contrib. Ath but not e terminal tion given
78
12 1963
....
932382
PLACE OF DEATH
No.
PHYSICIAN - IMPORTANT
-
(Was deceased a
U. S. War Veteran, no
Cif so specify WARI.
SI
( If nonresident, give city of town and State)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Amyotrophic Lateral Sclerosis
ORI R-301
PARENTS
A TRUE COPY ATTEST: Entries A. Mackie
......
FEB 111063 PM
OM R-301
đ burial permit od of Health inAgent. TROTIONS
.CITIFICATE
TYPE OI CAUSES DATH neenter : tin one er each and (c)
las not mean of dying, Ist failure, . It means stor compli- wch caused
io, if any, the rise to use (a). e under. ise last.
fins contrib- with but not > o he terminal oItion given
5 57 7/ 1.9.1963 cto
use only
K Ink.
PLACE OF DEATH
SUFFOLK
(County)
I
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
12139
f(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME.
MILDRED I EVANS
(Oldrede)
(If deceased is a married. widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
S
(Was deceased a
U. S. War Veteran.
(if so specify WAR)
20 Enfield Rd.
st.Winthrop, Massachusetts
(a)
Residence. No ..
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months.
44 .. days. In place of residence.
60
years.
9
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
IO SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Married
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
Herold J Evans
(Husband's name in full)
12
2! hrs AGED
Years.
CY
.Months ..
0 Days
If under 24 hours
Hours ......
.. Minutes
13 l'sual
Housewife
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
Can home
15 Social Security No ...
trop
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Sau Eldredge
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
China
19 MAIDEN NAME
OF MOTHER
Hattie Brown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Hs. SS.
Boston
21 Informant
Harold J Evans
(Address)20 Enfield Rd. Winthrop, Lass
I HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE the burial or transit permit was issued:
O Rageman Ka
(Signature of Agent of Board of Health or other)
1314229
12-13-62
(Official Designation) (Date of Issue of Permit)
(Registrar)
3 DATE OF
DEATH
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