Town of Winthrop : Record of Deaths 1963, Part 17

Author: Winthrop (Mass.)
Publication date: 1963
Publisher:
Number of Pages: 574


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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