USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 5
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Russia
19 MAIDEN NAME
OF MOTHER
C. B.L.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
annie Rosenberg
(Address) 239 Chestnut Et Choiseeu
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE .the burial or transit . permit was issued: alpu C. Jereanu ( Signature of Agent of Board of Health or other) Cancer 2/05/62
(Official Designation) - U
(Date of Issue of Permit)
ON5-59-92 5686
CHELSEA 27-5€
PLACE OF DEATH Suffolk County ) Winthrop (City or Town) Mayflower Nursing Home No.
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.
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
Louis Goodman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 239 Chestnut ( Usual place of abode)
Length of stay: In place of death.
6
years ...
7
months
... days. In place of residence
years.
.. months. ....... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Feb
14
1962
(Year)
(Month)
(Day)
4 I HEREBY
July
S
1955
to.
Feb 14
19.62
CERTIFY
That I attended deceased from
I last saw hiwalive on
Feb. 14, 1962, death is said to
have occurred on the date stated above, at
10:30A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Pyelonephritis, bilateral
Due To (b) .....
INTERVAL
BETWEEN
ONSET ANO
DEATH
Zyrs
30
PHYSICIAN - IMPORTANT f(Was deceased a { U. S. War Veteran, hi { if so specify WAR)
St.
Chelsea
(If nonresident, give city or town and State)
Russia
21
Informant
Place of Burial or Cremation
Jeb 15
19/62
PARENTS
2 FULL NAME
te Chapter 137, ·1954. requires lens to print or e cause or of death on tificates, and De 48, Acts of quires Physi- print or type ·xder signature.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF TOWN
131450
537 ERI
. ..
.
6
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of theFEB 1 51962 AM 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.
X PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
MELERE 3-8-62
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
21
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Nathan
H
(First Name)
(Middle Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
58 Campbell, Avenue
(Usual place of abode)
St.
Revere. ..... Mass.
Length of stay:
In place of death ..
......... years
months.
28
days. In place of residence.
16
.years
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced Evelyn Cook
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
AGE
48
Years .....
.. Months.
.. Days
If under 24 hours
Hours ...........
Minutes
13 Usual
Occupation :
Proprietor
14 Industry
or Business :
Hardware Store
15 Social Security No.
034-10-6441
16 BIRTHPLACE (City)
(State or country)
Leominster
17 NAME OF
FATHER
Morris Feldman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Ida Finkel
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Mrs. Evelyn Feldman
Informant
(Address)
58 Campbell ive., Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Dalish Sirianni
(Signature of Agent of Board of Health or other)
Health Officer
LA Dach. 16, 1962
(Date of Issue of Permit)
Y
1
(Month)
(Day)
That I attended deceased from
4 I HEREBY CERTIFY
January 1956
to ..
Feb. 15
1962
I last saw himalive on
Feb 14
1952 death is said to
have occurred on the date stated above, at 1:45 A.m.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cancer
of
Brain
.......
ONSET AND
DEATH
6yrs.
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
None.
CONDITIONS
No
Was autopsy performed?
What test confirmed diagnosis Clinical- Pathological.
NO
5 Was disease or injury in any way related to occupation of deceased? If so, specify Charles Liberman (Signed) M. D CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE) (Address) WINTHROP MASS Date 2/15/ 1962
PARENTS
Chevra Tillum of Boston
Everett
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL February 18 162 19
7 NAME OF
FUNERAL DIRECTOR
Paul .... R ....... Levine
ADDRESS470 Harvard St. .. Brookline
16, 19 62
( Registrar)
-928145
M R-301A 1
II TRUCTIONS FOR HIL CERTIFICATE
1 giving 'S OF DEATH
d not enter m: than one ale for each (ª (b) and (c)
is loes not mean nie of dying, & heart failure, ni etc. It means lis se, or compli- ns which caused
na ons, if any, ic gave rise to oui cause (a), tin the under- ng cause last.
Co itions contrib- t death but not dh the terminal so ondition given
ot - Chapter 137, : 1954. requires /si ans to print or e he cause or se of death on thertificates, and apt. 48, Acts of 9, .quires Physi- ns , print or type ne der signature.
Received and filed
V
No.
Winthrop Community Hospital
Feldman
[ (Was deceased a
U. S. War Veteran,
( Last Name)
lif so specify WAR) Nc
(If nonresident, give city or town and State)
3 DATE OF
DEATH
Feb.
15
1962
(Year)
To be filed for burial permit with Board of Health or its Agent.
(Official Designation)
(Kind of work done during most of working life)
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.
RECEIVED
OF TOWN
11.12 1
-1-15
Ni !!
ERK
5
6
INTH
FEB 1 61962 AM
M R-301A 1
-
PLACE OF DEATH
Suffolk (County)
CINSE PE
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Lulu Belle Nott
(First Name)
(Middle Name)
(Last Name)
[ (Was deceased a
{U. S. War Veteran,
NO.
{if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No,
30 Pleasant Park Road (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
1.4 ... days.
In place of residence 13 years
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
February
18
1962
DEATH
(Month)
(Day)
(Year)
Female
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
FEBRUARY 6, 1962, to.
That I attended deceased from
FEBRUARY 18
19.6 .....
I last saw handalive on
FEBRUARY 18 , 1962
death is said to
have occurred on the date stated above, at
m.
1:15 P
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) ACUTE CORONARY INSUFFICIENCY
INTERVAL BETWEEN ONSET AND DEATH 36 HRS
5YRS
Due TO ACUTÉ IMYOCARDIAL INSUFFICIENTE (c)
WITH PULMONARY EDEMA
I WEEK
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis?
EKG- KRAY
5 Was disease or injury in any way related to occupation of deceased? If so, specify
No
(Signed)
Dorothy Chemy appleton
M. D
DOROTHY Cheney APPLETON
6
Winthrop Cemetery Winthrop ,Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL
February .... 21 ,1962
19
7 NAME OF
FUNERAL DIRECTOR
Calfred D Marile
ADDRESS
174 Winthrop St. Winthrop, Mass.
Received and filed FEB 20 1962 19
(Registrar)
PARENTS
17 NAME OF
FATHER
George Dyer
18 BIRTHPLACE OF FATHER (City) (State or country) Maine
19 MAIDEN NAME
OF MOTHER
Isabel Webster
20 BIRTHPLACE OF
MOTHER (City)
Winthrop
(State or country)
Massachusetts
21 Informant
Mrs. Omar T. Johnson
(Address) 30 Pleasant Park Road, Winthor
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Tereau es
(Signature of Agent of Board of Health or othery
Reavete Arecie
2/20/62
(Official Designation)
(Date of Issue of Permit)
VBV
ITRUCTIONS FOR IL CERTIFICATE
1 giving S OF DEATH d not enter K: than one ale for each a (b) and (c)
is loes not mean mle of dying, a heart failure, ni etc. It means lis se, or compli- 1& which caused
id.ons, if any, io gave rise to ' cause (a), 'in the under- ig cause last.
"o, itions contrib- t death but not the terminal ondition given
ot - Chapter 137, 1954. requires Hians to print or he cause or of death on ch ertificates, and pt: 48. Acts of ¿quires Physi- print or type le der signature. C
-
1
6-1.928145
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles Eugene Nott
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Years.
12
AGE 73
5
Months.
4
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupationretired Telephone Operator
(Kind of work done during most of working life)
14 Industry
N. E. Tel &Tel Co.
or Business :
15 Social Security No.
011-05-0510
Winthrop
16 BIRTHPLACE (City)
(State or country)
Massachusetts
(PRINT OR TYPE SIGNATURE)
(Address) 197 Woodside Aut Date .. FEB 19 1962
WINTHROP, MAS
se
No.
WinthropCommunity Hospital
MEDICAL CERTIFICATE OF DEATH
months.
.days.
8 SEX
10 SINGLE
(write the word)
Widowed
Due To
(b) ARTERIOSCLEROTIC HEART DISEASE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
B.E.C.EI.V.G.D
OF TOWA
OFFICE O
CLERK
MINT
FEB 2 01962 AM
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.
PLACE OF DEATH
X Suffolk (County)
LINSE PETIT
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
23
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. Winthrop Convalescent Home
PHYSICIAN - IMPORTANT
2 FULL NAME
Ada .... BlancheWrightson
(First Name)
(Middle Name)
(Last Name)
[(Was deceased a U. S. War Veteran,
[if so specify WAR) NO.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
11 Nahant Avenue
.St.
(If nonresident, give city or town and State)
months ..
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Sydney John Wrightson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Years
12
AGE83
7
Months.
1.6 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupationretired Fur Seamstress
(Kind of work done during most of working life)
14 Industry
or Business :
retail Dept.Store
15 Social Security No.
032-20-0065
London
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
Arthur Smith
18 BIRTHPLACE OF
FATHER (City)
London
(Signed)
th Transfer
M. D
(State or country)
England
M. Traunstein, Jr., M. D.
(Address)
73 Bartlett Rd.
Feb. 20,10
62
Date
Winthrop 52, Mass
Winthrop Cemetery, Winthrop, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 20,1962
19
7 NAME OF
FUNERAL DIRECTOR
Celfred B Money
ADDRESS
174 Winthrop St Winthrop,
Received and filed FEB 20 1962 19
(Registrar)
Q PARENTS
19 MAIDEN NAME
OF MOTHER
Mirriam Smith
20 BIRTHPLACE OF
.
MOTHER (City)
London
(State or country)
England
21
Informant
(Address)
11 Nanant Avenue, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass. Tavoli C. tercanne. (Signature of Agent of Board of Health or other)
Health Biele 2/20/62
.... (Official Designation) 1
11
(Date of Issue of Permit)
X
-
M R-301A 1
I TRUCTIONS FOR KIL CERTIFICATE
1 giving S OF DEATH
d not enter ne: than one ale for each a (b) and (c)
is 'oes not mean m.le of dying, a heart failure, ni, etc. It means 'is se, or compli- is which caused
id ons, if any, icigave rise to ve cause (a), tin the under- ngicause last.
Cositions contrib- Lideath but not the terminal ondition given
ot - Chapter 137, $ 1954. requires 'si ans to print or che cause or Ser of death on th ertificates, and Ipt 48, Acts of , quires Physi- is print or type ne :der signature.
6-4 928145
February
18
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19 .... 62
Jan ...... 132 .... , 19.62. to
Feb ..
18
I last saw heralive on
Feb ...... 18 ...
19
6.2., death is said to
have occurred on the date stated above, at
.5 .: 10 ..... p .... m.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Arteriosclerotic & hypertensive
heart disease
5 yrs
Due To
(b)
Generalized arteriosclerosis
7 yrs
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis Clinical & laboratory
5 Was disease or injury in any way related to occupation of deceased? no. If so, specify TRAUNSTEIN JR., MI D.
6
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
... years.
4.
.months.
.days. In place of residence. 4 ... years
3 DATE OF
DEATH
Married
-
1
Registered No.
Reginald .J ....... Wrightson
(PRINT OR TYPE SIGNATURE),
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER RECEIVED
OF TOWN
17 12. 1
OFFICE
NINI
CLERK
5
6
ITH
FEB 2 01962 AM
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.
PLACE OF DEATH
X SUFFOLK (County)
Chelsea
38-62
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH 10 4 HIGHLAND AVE.
Registered No.
f(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)
(a) Residence. No. IL CLARK AVE. CHELSEA (L'sual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay : In place of death .. . .. .. . years ....
months. os days. In place of residence.
.......... years ..
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Feb
19
1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19 to. 19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of A. PAUL THOMPSON
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 66 Years.
Months.
Days
If under 24 hours
.Hours ......
.Minutes
13 Usual
Occupation :
CLERK
(Kind of work done during most of working life)
14 Industry
or Business: INTERNAL REVENUE SERVICE
15 Social Security No/ 07-14-1000
16 BIRTHPLACE (City) CHELSEA
(State or country)
MASS
17 NAME OF
FATHER
WEBSTER L. HOBART
18 BIRTHPLACE OF
FATHER (City)
CHELSEA
(State or country)
MASS
19 MAIDEN NAME
M. D.
OF MOTHER
AMELIA G. LESLIE
20 BIRTHPLACE OF
MOTHER (City)
PICTOU
(State or country)
N.S.
21 JOAN LESLIE POLLARD
(Address)
ILCLARK NVE CHELSEA
7 NAME OF
RECT
Wendell Mr. Dykeman
ADDRESS 23 Gary One Phella
Received and filed 19
FEB-19-1962
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED OITOMED
I last saw h ........ alive on
have occurred on the date stated above, at
8:30 A.m.
19
death is said to
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a)
Death apparently due to acute
Re coronary occlusion, due to (b) arteriosclerotic. heart
To disease. Diabetes mellitus (c) a known significant condition. OTHER SIGNIFICANT For Winthrop Board of CONDITIONS
Was autopsy performed?
? Chiartes Liberum, Mivel
What test confirmed diagnosis . ...
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE) (Address) Winthrop Less Date 2/19/1962
6 W000LAWN
E V E R ETT. (City or Town)
Place of Burial or Cremation
DATE OF BURIAL FEB. 21,
062
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death way filed with me BEFORE the burial or_transit permit was issued: Fabric Teriaund (Signature of Agent of Board of Health or other) Health Officer 2/19/62
(Official Designation) 4 6
(Date of Issue of Permit)
X
1
A'RUCTIONS FOR C. CERTIFICATE
. giving S OF DEATH dinot enter c. than one ale for each a (b) and (c)
is'oes not mean mle of dying, a heart failure, etc. It means use, or compli- s which caused
dions, if any, ichgave rise to ve cause (a), in the under- nig cause last.
Coritions contrib- Lıdeath but not d the terminal ndition given )
Chapter 137, af 954. requires wis to print or · cause or f death on citificates, and ter 48, Acts of squires Physi- teprint or type uler signature.
IM -59-925686 1
M R-301A 1
WINTHROP (City or Town)
No. MOUNTS CONVALESCENT HOME ,
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME MARION L. (HOBART) THOMPSON (If deceased is a married, widowed or divorced woman, give also maiden name.)
SPACE FOR ADDITIONAL INFORMATION
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