USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 17
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(State or country)
17 NAME OF
FATHER
Timothy Glennon
PARENTS
18 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Anna Kelly
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Boston
New Calvary Cem. Boston
6
Place of Burial or Cremation
(City or Town)
April 29,
63
19.
50M - 10-61-931673
No
2 FULL NAME ..
DEATH
....
Due To
(b)
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
(Address)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Copies of returns of deaths which occurred in your city or town in ease the deceased resided in another eity or town
Was autopsy performed?
What test confirmed diagnosis ?
3 DATE OF
April 24, 1963
(Month)
(Day)
(Year)
4 LHEREBY CERTIFY . That I attended deceased from
April 23, 53
April
24
to ...
I last saw h.
Etve on
April 24
OSdeath is said to
5:10p
have occurred on the date stated above, at
... n.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a)
Metastatic Cancer of Breast
right side
1962
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
James L. Crooker
M. D.
386 Broadway
Somerville
.Date ...
Apr.24,63
ADDRESS
54 Roxbury St. Roxbury
Received and filed
MAY 2 - 1963
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
ATTEST:
DATE FILED
(Registrar of City or Town where death occurred)
Apr. 26,
1.63
19.
X
No
(Was deceased a
U. S. War Veteran,
if so specify WAR,
winthrop, Mass.
St
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
I
Registered No.
Leo F. Finneran (son)
21 Informant
(Address)
11 Sanborn Ave. ".Roxbury
P.E.Murray Funeral Service
74.
Nursing Home
19
b3
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
6
THROP
MAY 2 1963 AM
4
52 Jencola I Wentheil Comment of file) (If death occurred in a hospital or institution, No ... At. \ give its NAME instead of street and number) PHYSICIAN - IMPORTANT James E Phillips
2 FULL NAME
(If degeased is a married, widowed or divorced woman, give also maiden name.)
61 Vinal SV.
Revere 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 .......... days. In place of residence .......... years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
anale
9 COLOR
chiti
10 SINGEL
MAARRIEW
(write the word)
DEATH
(Month)
24,
(Day)
1969
(Year)
4 I HEREBY CERTIFY , That, I attended deceased from
mar
11
19 ....
13 to 02/0-2/ 24
19.6.3
I last saw havalive on
apul94
19 6 death is said to
HUSBAND of
have occurred on the date stated above, at
9 p
... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Pulmonary Edema
(a)
Due To
(b)
Cerebral Thrombosis
3/21/69
Due To Acute Cardiac Desempenation
(c)
....
OTHER
SIGNIFICANT
CONDITIONS
Pernicious anemia
1958
Was autopsy performed?
me
What test confirmed diagnosis ?
Clinical exam.
5 Was disease or injury in any way related to occupation of deceased ? 21.4 If so, specify
(Signature)
M. D.
Louis E Schraffa M.D
(Print or Type Name)
(Address) 14 Kennung Lin WE Bak Date CePer Day 1969
HOLY CROSS CEMETERY MALDEN
6
Place of Burial or Cremation
APRIL 29
19.63
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
R JOSEPH A LANGONE I
ADDRESS 58 MERRAMAC ST BOSTON
Received and filed
MAY 2 - 1963
19
.......
( Registrar
A TRUE COPY ATTEST:
PLACE OF DEATH
X Suffolk / (County) Winthrop (City or Town) 1
TEVERE E7-1-9
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
79 .........
(City or Town making this return)
STANDARD CERTIFICATE OF DEATH
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Na
DIVORCED
UNKNOWN
11 If married, widowed, JULIA
r_divorced CERCHIONE
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE 82 Years.
Months.
.. Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation :
INDUSTRY Letue
(Kind of work done during most working life)
14 Industryalice
or Business:
LNduSTRY-
15 Social Security No
013-03-6017
16 BIRTHPLACE (City)
(State or country )
BOSTON MASS
17 NAME OF
FATHER
FRANK PHILLIPS
18 BIRTHPLACE OF
FATHER (City) ..
MEDWAY MASS
(State or country)
19 MAIDEN NAME
OF MOTHER
SARAH GANON
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
JULIA PHILLIPS WIFE
21 Informant
(Address)
DI VINAL ST REVERE MASS
wa
.sfactory/ standard certificate of death burial sobransit perpig was issued: Barwann (B)
Health Officer
/i/Agent di Board & Health or other) 4/26/62 ...
wal Designath
(Date of Issue of Perunit)
₹ 2-932382
Sehr
ORM R-301
for burial permit ard of Health its Agent. RUCTIONS FOR CERTIFICATE
-
-
OR TYPE OR CAUSES DEATH
not enter than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means ase, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last. 4
ditions contrib- death but not to the terminal condition given
34 70
IRELAND
PARENTS
X
3 DATE OF
abril
INTERVAL BETWEEN ONSET AND DEATH 4/27/63
11a/ 11/19
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
(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 absent from home when the certificate of death is needed. PAY 2 1963 AM
(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.
M
4
N WINTHROP COMMU (1) Y HOSP.
[(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).
WWII
(a) Residence. No ..
66 TRENTON
S. EAST BOSTON MASS
(If nonresident, give city or town and State)
..... years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April 26 1963
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I
Decis, 1956, to April 26
attended deceased from
1963
I last saw h.amalive on
April 26
19.02, death is said to
have occurred on the date stated above, at
6 F.m.
INTERVAL BETWEEN ONSET AND DEATH
12 days
Due To
(b)
arteriosclerosis
Due To
(c)
....
Diabetes mellitus
OTHER SIGNIFICANT Coronary thrombosis CONDITIONS
12 days
16 BIRTHPLACE (City)
(State or country )
PORTUGAL
Was autopsy performed ?
What test confirmed diagnosis? autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify ... NO.A.
M. D.
(Signature) H. B. Green field 447 Ch(Printer Ty Name)
(Address) Winthrop Mass Date.
4.26 1963
HOLY CROSS MALDEN
Place of burial or Cremation
(City or Town)
DATE OF BURIAL APRIL 29 19.
7 NAME OF
DIPIETROLAVAZZA
ADDRE // HENRY ST,EAST BOSTON
Received and filed APR 30 1963 19
....
Signature of Agent of Board of Health or other)
Health officer
april 291963
(Date of Issue of Permit)
62-932382
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX MALE
9 COLOR
WHITE
10 SINGLE
MARRIED
(write the word)
WIDOWED
DIVORCEDSINGLE
UNKNOWN
11 lf married, widowed, or divorced HUSBAND of
(or) WIFE of.
(Husband's name in full)
12 AGE 65 Ye
Months .........
.. Days
If under 24 hours
Hours ... .... Minutes
13 Usual
LONGSHOREMAN
(Kind of work done during most working life)
15-20us
Social Security 013-05-5838
17 NAME OF
FATI
MANUEL ALMEIDA
18 BIRTHPLACE OF FATHER (City) (State or country)
PORTUGAL
19 MAIDEN NAME
OF MOT
AUGUSTA GRACE
20 BIRTHPLACE OF MOTHER (City) (State or country) PORTUGAL
21 Informan FRANCISCO MARTINS
63 (Address) 2/ EUTAW STREET EAST BOSTON MASS.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Pacplo E. Sirianni (B)
1 ×
1 for burial permit oard of Health its Agent. TRUCTIONS FOR IL CERTIFICATE
T OR TYPE . OR CAUSES DEATH not enter re than one se for each ). (b) and (c)
does not mean ode of dying, s heart failure, a, etc. It means ease, or compli- which caused
itions, if any, h gave rise to e cause (a), g the under- cause last.
nditions contrib- to death but not to the terminal condition given
PLACE OF DEATH
SUFFOLK (County) WINTHROP (City or Town)
LENSE V
"The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
(City or Town making this return)
STANDARD CERTIFICATE OF DEATH
Registered No.
80
POSSIDONIO B. ALMEIDA
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Histor
0
(a)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral thrombosis
(Give maiden name of wife in full)
15-20 yo
14 Industry
or Business
SUGAR REFINERY
PARENTS
(Registrar)|| (Official Designation)
(Usual place of abode)
Length of stay: In place of death ........ years ........ month.days. In place of residence
1
FORM R-301
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE .. SEPT. 2, 1942
DATE OF DISCHARGE SEPT. 29 1944
RANK, RATING PRIVATE
ORGANIZATION AND OUTFIT US ARMY ENLISTED RESERVE COR
SERVICE NUMBER 3/166020
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 disabledjby/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 frpin disease resulting from injury or infection related to occu- pation, the sudden deaths of person's 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.
THROP"
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 steven er ys fruitthe deceased had retired from business, tion had been given up or changed person aged 10 years or over. If the occupa- 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
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
1
PLACE OF DEATH
Suffolk (County)
-OVIETE
COPY OF CERTIFICATE OF DEATH
Registered No.
81
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME .... Walter .... A ... Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a WWI
U. S. War Veteran,
if so specify WAR,
(a) Residence. No 14 Townsend
(Usual place of abode)
St.Winthrop Mass
(If nonresident, give city or town and State)
Length of s
hospital -year] months 20 days. In place of residence.
.... years ...... months ... ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April ..... 26. 1963
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from ale
Mar .................
63
to ..... A.pr1126
63
I last saw
Imlive on pri1-2.6
3 .. , death is said to
have occurred on the date stated above, 9 :30p
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL
BETWEEN
ONSET AND
DEATH
(a) Carcinoma of prostato with
Due Tyfidespread metastasis to (b) lungs and bones
yrs.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? no What test confirmed diagno clinical & labs findings
....
5 W'as disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) Sefik Abdulhayoglu M. D).
(Address) Soldiers' Home Apr. 96, 63
6 Winthrop Cen. , Winthrop, Mass. Place of Burial or Cremation (City or Town)
DATE OF BURIAL April .... 30, 19.63 19.
7 NAME OF
FUNERAL DIRECTORM.H. McKenna
ADDRESS Somerville, Mass.
Received and filed 19
(Registrar of City or Town where deceased resided)
8 SEX
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED
UNKNOWN
Widowed
11 If married, widowed, or divorced
HUSBAND of Nellie .... E.Conway
(Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
12
AGE.72. Years .. 2 ..
Months .. .
.Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation:Retired-Fire ... Capt
(Kind of work done during nfost working life)
14 Industry
or Business:
Fire Dept.
15 Social Security No ...
018-20-0822
16 BIRTHPLACE (City)
(State or country)
Somerville, lass.
17 NAME OF
FATHER
William H.
PARENTSD
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER Minnie F.Wile
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Massachusetts
21 Informant
Hospital Records
(Address)
Soldiers' Home Hospital
A TRUE COPY
ATTEST:
Souple a Tyrrell
DATE FILED
(Registrar of City or Town where death occurred) April 26,1963 .. 19
V.A.
I
Chelsea
(City or Town)
LIBERTATE
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
Chelsea
(City or Town making this return)
No Soldiers' Home Hospital
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
n
P
50M · 10-61-931673
PERSONAL AND STATISTICAL PARTICULARS
..................
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
5/26/18
DATE OF DISCHARGE
7/3/19
RANK, RATING
Sgt.
U.S.A.Motor Truck Co. 473 Motor Supply Train 4
ORGANIZATION AND OUTFIT.
....
...
U
SERVICE NUMBER
319 1918
MAY - 81963 AM
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
(a) Residence. No ..
4 Elm.Wood Court
(Usual place of abode)
Length of stay: Inapatal ..
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April 30, 1963
(Month)
(Year)
I last saw be alive on April 30
16.3",
have occurred on the date stated above, a 1.40p.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Ulcerative colitis .Long.
OTHER
SIGNIFICANT
CONDITIONS
(Address) Soldiers !.... Home ........ Da5 1/63
Chelsea , Mass.
6.Calvary Gem. ,Portland,Mo
I'lace of Burial or Creniation
(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
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town
Was autopsy performed? ........ 0
What test confirmed diagnosis ?
"x-ray-surgical
50M - 10-61-931673
PLACE OF DEATH
Suffolk (County)
-OYILTEM
COPY OF CERTIFICATE OF DEATH
245-
82
Registered No.
§(If death occurred in a hospital or institution,
..... St. ? give its NAME instead of street and number)
2 FULL NAME ..... PaulVincent Farr
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR,
/St Winthrop, Mass
(If nonresident, give city or town and State)
.. days.
..... years ... ] ... month2.8 ... days. In place of residence ........ years ....... months ....
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCEDA
UNKNOWN1 dowed
11 If married, widowed, or divorced
(or) WIFE of.
(Husband's name in full)
12
yrs.
AGE.73. .. Years. 1.O.
.Months
1
.Days
If under 24 hours
Hours ...
.Minutes
13 L'sual
Occupation :.
Kitchen Man
(Kind of work done during most working life)
14 Industry
or Business :
Restaurant Work
15 Social Security
004-01-81.80
16 BIRTHPLACE (City)
(State or country)
Portland, Me.
17 NAME OF
FATHER
John F. Marr
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Delia M.Curran
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Maine
21 Informandospital Record Office
(Address)
Soldiers' Home Hospital
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
May 1,1963
19
(Registrar of City or Town where deceased resided)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
Chelsea
(City or Town making this return)
1
Chelsea
(City or Town)
BERT
No .... Soldiers Home Hospital
Received and filed 19
19
DATE OF BURIAL
May 3,1963
19
7 NAME OF
FUNERAL DIRECTOR Male.y ..... Funeral ..... Homo
ADDRESS 79 Atlantic St. , Winthrop, MaggRUE COPY
Couple a. Tyrrell
(write the word)
4 I HEREBY CERTIFY , That I attended deceased from May 3 62 to April 30
death is said to
Due Tostanding ileostomy;
(b)
extensive ... colon resections;
Due To
abdominoperineal resection yrs
(c)
163
HUSBAND of
Nellio Keller
(Give maiden name of wife in full)
INTERVAL BETWEEN ONSET AND DEATH
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) Charles.D.Komos M. D.
PARENTS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
7/25/18
DATE OF DISCHARGE
1/21/19
....
RANK, RATING
Private l/c Co.B
...
ORGANIZATION AND OUTFIT
34th M. G .B .N.
SERVICE NUMBER
MAY-21933 AM
Injury If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. Pof 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 Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF 1544-43. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every itent of Injury
50M-9-61-931348
NY 14 1963
PLACE OF DEAT
Suffolk (County)
Boston ........ (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF TOWI93
(City or Town making this return ;
03386 Registered No.
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) No. 27 Park Drive.
2 FULL NAME
JOSEPH
A
FRA SER
[( Was deceased a
PHYSICIAN - IMPORTANT
(First Name)
( Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
27 .... Park ... Drive
St
( If nonresident, give city or town and State)
( Usual place of abode)
Length of stay :
In place of death
years.
.months ..
days. In place of residence 10
.years
months .........
.. days.
MEDICAL CERTIFICATE OF DEATII
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OFOn or about March 19 1963 DEATH
(Month)
(1)ıy)
(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.) Asteriosclerotic heart disease.
9 SI:X
10 COLOR
MALE
A MITE
11 SINGLE Y (write the word )
MARRIED
WIDOWED
DIVORCED
UNKNOWN
DIVORCED
2
12 If inarried, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH
AGE: 56 Years.
.Days
If under 24 hours .. Hours ......... .Minutes
15 Usual
Occupation
SPOOKER
(Kind Iwork done during most of working life)
100L
17 Social Security No.
UR BIRTIIPLACE (City)
(State or country)
MASS
My NAME OF
FATHER
JOSEPH FRASER.
20 BIRTHPLACE OF
FATHER (City)
EAST BOSTON
(State or couotry)
MAS5
21 MAIDEN NAME
OF MOTHER
MARY BOWIE
22 BIRTHPLACE OF
MOTHER (City)
EAST BOSTON
(State or country) MASS
23 Informant JAMES FRASER
(Address) 105 PINE RIDGE RD READING
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with pro BEFORE the burial or transit permit was issued:
Signature of Agent of Board of Health or other)
805923 ......
3-05-63
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST: (Registrar)
PARENTS
M. 1).
Michael A .Liongo,M.D. (Print or Tape Nanic)
(Address) .... Boston, Mass. Date 3 24 163
WINTHROP. (City or Town)
Place of Ilurial, or Cremation.
DATE OF BURIAL MARCH 24 1923
8 NAME OF FUNERAL DIRECTOR MAURICE I MIRBY
ADDRESS MINTHAUP
MAR 27 183
1
ORM R-303
iled for burial permit h Board of Health or its Agent. 24B
OR TYPE THE CAUSE OR CAUSES OF DEATH ON DEATH CERTIFICATES. -
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 publie place ?
(Specify type of place)
Manoer of
(Ilow did injury occur ?)
Nature of
While at work ? . Was awyrysy performed?
6 Was discans or injury in any way related to necuration of deceased?
F
EAST BOSTON
..............
1
16 Influstry.
Business:
.Months ..........
U. S. War Veteran,
{if so specify WAR)
WWII
5-11
A TRUE COPY ATTEST: Charles it Mackie City Kezistrar
6
HRO
MAY 1 41963 AM
1
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
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.)
1
Wrentham
(City or Town)
The Wrentham State School No.
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Registered No.
35
§(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Suzanne Arnoldson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No.
45 Perkins Street
(Usual place of abode)
St
(If nonresident, give city or town and State)
Length of stay: In place of death ......... years ......
... months.
22
11
27
days. In place of residence .......... years .......... months .......... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWED Single
DIVORCED
UNKNOWN
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of.
(Husband's name in full)
12
AGF32
Years.
9
.Months.
12
Patient at the
Wrentham State School
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
None
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
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