USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 16
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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.
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RM R-303
1
SUFFOLK (County)
WINTHROP
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Registered No.
No. 390 Winthrop St., Winthrop
[(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
DONALD
MCDOUGALL
[(Was deceased a
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
390 Winthrop Street,
Winthrop, Massachusetts
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In place of death.
30
.. years.
.. months ..............
days. In place of residence.
30
.. months ....
.davs.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
20,
1963
9 SEX
Liale
10 COLOR
White
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word) Single
(Month)
(Day)
(Year)
4 I 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.) PORTAL CIRRHOSIS OF LIVER
(77)
5 Accident, suicide, or homicide (specify)
Date and hour of injury 19.
IF ACCIDENTAL, was injury causally related to the death?
Where did Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or
public place ?
(Specify type of place)
Manner of
Injury
(How did injury occur ?)
Nature of
Injury
While at work?
Was autopsy performed 120
tion of deca
(Signed)
Michael A. Luongo
...... D.
(Address)
Date
19
22
Elizabeth Bradford
7 .oodlawn
Everett
Place of Burial or Cremation.
(City or Town)
DATE OF BURIAL
April 19 22. 53
8 NAME OF
FUNERAL DIRECTOR
Howard S Mevnolds
ADDRESS 'inthron, lass
Received and filed
APR 22 1963
19
....
A TRUE COPY ATTEST:
(Registrar)
(Official Designationy
(Date of Issue of l'ermit) Tolv
...
If under 24 hours Hours .. Minutes
14 Usual
Occupation :
.....
(Kind of work done during most of working life)
Repairs
15 Industry 0 Business :
......... ........
024-12-1243
K Social Security No.
17 BIRTHPLACE (City) (state of country)
Last Boston Lass
18 NAME OF FATHER William LcDougall
19 BIRTHPLACE OF FATHER (City) (State or country) Lass
East Boston
20 MAIDEN NAME OF MOTHER Kary hammerer
21 BIRTHPLACE OF MOTHER (City) (State or country)
Boston
Informant
(Address)
ت
Surfside " inthron, lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Crepho E. fizianna (a) .
(Signature .of Agent of Board of Health or other)
He a itt, Officer
Gujarat .2.2, 1963
. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. ...
§§ 44-48.
100M - 3-62-932695
PLACE OF DEATH
led for burial permit Board of Health r its Agent.
Un LIFE INE CAUSE OR CAUSES OF DEATH ON DEATH CERTIFICATES.
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of of Death. See reverse side for additional Information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
12 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 AGE. Years
50
12
Months ..... ........ Days
PARENTS
or injury in
..... , M. D.
Boston ( Print or Typo Name)
(City or Town making this return)
U. S. War Veteran,
if so specify WAR)
St
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 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 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 poison) , 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.
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
FORM R-301
ed for burial permit Board of Health r its Agent. NSTRUCTIONS FOR CAL CERTIFICATE
NT OR TYPE E OR CAUSES OF DEATH
do not enter ore than one use for each (a), (b) and (c)
is does not meon mode of dying, as heart foilure, nia, etc. It meons discose, or compli- as which caused .
nditions, if ony, ich gove rise to ove couse (o), ling the under- ng cause last.
Conditions contrib- to death but not 'd to the terminal le condition given . ).
1
medical exam
6
HOLY CROSS
MALDEN
Place of/Burial or Cremation
(City or Town)
DATE OF BURIAL
APPIL
24
19.63
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS
WINTHROP
Received and filed
APR 23 1963
19
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
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. WILFRED & JOHNSON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No
26 BEACON ST
(Usual place of abode)
Length of stay: In place of death 5 years months
days. In place of residence 485 2.years
.. months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
WIDOWED
DIVORCED
(write the word)
MALE
WHITE
DIVORCED
11 If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(Husband's name in full)
13 Usual
LABORER
(RETIRED)
(Kind of work done during most of iworking life)
14 Industry
or Business :.
TOWN OF WINTHROP.
15 Social Security No ....
16 BIRTHPLACE (City). FAST BOSTON
(State or country )
MISS
17 NAME OF
FATHER
ERICK W JOHNSON
18 BIRTHPLACE OF
FATHER (City) ..
(State or country)
EAST BOSTON.
MASS
19 MAIDEN NAME
OF MOTHER
ALICE L SCOTT.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
BOSTON
MASS
21 Informant FREDERICK LAIDLAW (Address) 141 COTTAGE PARD WINTHROP
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)
Health Officer
April -25, 19613
X VIA V
A TRUE COPY ATTEST:
5-62-933404
( Registrar)| (Official Designation)
(Date of Issue of Permit)
1
PLACE OF DEATH
SUFFOLK (County)
WINTHROP. (City or Town)
No.
26 BEACON ST WINTHROP.
WINTHROP MASS
St
(City or town and State)
3 DATE OF
DEATH
APRIL
(Month)
(Day)
That I attended deceased from
4 IHEREBY CERTIF
APRIL 241959
to APRIL 21
19.
63
I last saw himalive on
APRIL
1
19.1.3death is said to
have occurred on the date stated above, at
(a)
Due To z
ARTERIO- SELCRITIC
HEERE
PHEN
4YES
Due To
(c)
GENERAL ARTERIOSCLEROSIS
4YRS.
OTHER SIGNIFICANT CONDITIONS
3 PREVIOUS INFARCTION
4 YRS
No
Was autopsy performed?
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased If so, specify
(Signature)
Ingrown. King
M. D.
MYRININ KING !
(Print or Type Name)
222 PLEASANT ST. Date APRIL 23 ,63
(Address)
WINTHROP MISS
PARENTS
INTERVAL BETWEEN ONSET AND (or) WIFE of 12 3 DEATH 15 MIN AGE Years .. .. . Months. ...... Days
If under 24 hours
Hours
.Minutes
Occupation :.
(b)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE MYOCARDIAL
FARETION
21
1963
(Year)
(Was deceased a
U. S. War Veteran,
if so specify WARKU W 2
(City or Town making this return,
IDERTATEL AVILTEM
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE MARCH 21 1941
DATE OF DISCHARGE OCT 4 1943
RANK, RATING CPL,
ORGANIZATION AND OUTFIT ARMY =150
SERVICE NUMBER. 31032389 T !!!
1
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 mrecognized disease unrelated to any form of injury, have died without fecent modicall 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.
ORM R-301
for burial permit oard of Health its Agent. TRUCTIONS FOR L CERTIFICATE
TOR TYPE OR CAUSES DEATH not enter e than one e for each , (b) and (c)
does not mean de of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), g the under- cause last.
ditions contrib- o death but not to the terminal condition given
11C.
12-932382
X 1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
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
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
27 Vine Avenue
Winthrop, Mass. St
(Usual place of abode)
Length of stay: In place of death .......... years .......... monthk .....
.. days. In place of residence ..
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
.. nite
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
.. idoy
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Maisey
(Husband's name in full)
12
77
10
Months ..
.....
... Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most working life)
14 Industry
or Business :
Oun home
15 Social Security No ....
None
16 BIRTHPLACE (City) (State or country ) Scotland
17 NAME OF
FATHER
John Reid
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country) cotlaud
19 MAIDEN NAME
OF MOTHER
Jannett Dain
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Scotland
21 Informant
Join R.Reid
( Address) 1025 Co . Onybelth Ave. Moston,
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) Zenith, officer april 23, 1963
(Official Designation)
(Date of Issue of Permit)
2 V.S.V
A TRUE COPY ATTEST:
21
1963
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY, That I attended deceased from 4/20 1963 to ... 4/2/ 19 ,63
I last saw helalive on
4/21
196
death is said to
have occurred on the date stated above, at
11 05 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Due To
GENERAL ARTERIOSCLEROSIS
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
SENILE PSYCHOSIS
CLINICAL & LEG
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signature)
.....
M. D). MYRON N.KING
(Address) .
222 PLEASANT
4/21
1965
. inthron
Winthrop
6
Place of Burial or Cremation
April 27,
19
7 NAME OF
FUNERAL DIRECTOR
Howard & Remolds
Lars
ADDRESS
Received and filed
APR 2-3 1963
19
(Registrar)
,50
.years ...
... months.
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
APRIL
ACUTE MYOCARDIAL INFARCT
INTERVAL BETWEEN ONSET AND DEATH 11 days
5YRS.
Was autopsy performed?
No
What test confirmed diagnosis ?
(Print or Type Name)
(City or Town) 62
DATE OF BURIAL
No
inthrop Community Hospital
Marcaret (Reid)
Ramsey
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
(or) WIFE of
AGE.
Years
5
Walter D
(City or Town making this return)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE APR 2 31963 AM
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.
ORM R-301
for burial permit oard of Health its Agent. TRUCTIONS FOR L CERTIFICATE
T OR TYPE OR CAUSES DEATH
not enter e than one se for each , (b) and (c)
does not mean ode of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), g the under- cause last.
nditions contrib- o death but not to the terminal condition given M.C.
PLACE OF DEATH
Suffolk
(County)
inthrop
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
[(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.
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death ..
..... years ......
.... months ..
.. days. In place of residence.Z.years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
acril
23,
1963
(Month)
(Day)
(Year)
IHEREBY CERTIFY, That I attended deceased from
July 2, 19 56
to
April
23.
196.3
I last saw h.e. Flive Apr ... 22 1963, death is said to
have occurred on the date stated above, at
2:09 am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
BETWEEN ONSET AND DEATH
(a)
Due To
Arteriosclerotic and
(b) hypertensive .... heart disease
Due To
Generalized arterio-
(c) .... sclerosis
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ? Clinical & labora-
5 Was disease or injury in any way related to occupation of deceased ? NO If so, specify.
(Signature) Mr. Traunstein fr. M. D. M. Traunstein, Jr( M. D. (Print or Type Name) (Address) 73 Bartlett Rd. Winthrop 52, Mass. Apr. 23, 63
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April 25 1963
19.
7 NAME OF
FUNERAL DIRECTO
alfred & Marsh
ADDRESS
174 Winthrop St. Winthrop, Mass
Received and filed APR 24 1963 19
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
widowed
11 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
AlbertFELeon Ayer (Husband's name in full)
12
Massive cerebral .... hemorrhage18hrs AGE7.8 Years ..... 2 ... Months .....
Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation :
housework
(Kind of work done during most working life)
14 Industry
10 yrs . or Business:
own home
15 Social Security No .. Boston
16 BIRTHPLACE (City)
(State or country )
Massachusetts
17 NAME OF
FATHER
Stephen Fopiano
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
unable to ascertaine
20 BIRTHPLACE OF
MOTHER (City)
"
(State or country)
=
21 Informant
John L. Ayer
( Address)
176 Woodside Avenue
I HEREBY CERTIFY that a satisfactory standard certificate of death wwas filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
Shaft offrei
Cipal 24 1963
(Date of Issue of Permit)
V
1
No .......
inthron Com unity Hos ital
Madeline
(Fopiano) ;
2 FULL NAME.
Louise
Aver
(If deceased is a married, widowed or divorced woman, give also maiden name.)
176 Woodside Avenue
St.
winthrop Hass
(If nonresident, give city or town and State)
52-932382
A TRUE COPY ATTEST:
( Registrar ) | (Official Designation)
(City or Town making this return)
I
Mt. Calvery Cemetery
Boston, Mass
PARENTS
Genoa
8 yrs
4
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 (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.
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
, resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, See. 12, G. L.) at the time of death should be transmitted on Form R-302 to the elerk of the eity or town in which the deceased
PLACE OF DEATH
Middlesex
(County)
Cambridge
(City or Town)
Guardian Hospital
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF QUIL CERTIFICATE OF DEATH
Cambridge
(City or Town making this return)
584- 178
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
Mary Finneran
(If deceased is a married, widowed or divorced woman, give also maiden name.)
46 Washington Ave.
(a) Residence. No ..
(Usual place of abode)
1
Length of stay: In place of death .......... years .......... months ..
days. In place of residence .......... years .......... months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED
UNKNOWN
Widowed
11 If married, widowed, or divorced
HUSBAND of
(or) WIFE of.
Joseph
(Give maiden name of wife in full)
Finneran
(Husband's name in full)
12
AGE
Years.
.. Months.
.Dayz
If under 24 hours
.....
.Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
Nursing Home
or Business:
15 Social Security No ....
Boston
16 BIRTHPLACE (City)
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