Town of Winthrop : Record of Deaths 1963, Part 18

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 18


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54


FATHER


Frank Arnoldson


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Waltham


(State or country)


Massachusetts


19 MAIDEN NAME


OF MOTHER


Doris 0'Neil


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


South Hadley


Massachusetts


Records at the


21 Informant


Wrentham State School


( Address)


Wrentham, Massachusetts


A TRUE COPY


ATTEST :


(Registrar of City or Town where death occurred)


DATE FILED


April 3, 1963


.19


(Registrar of City or Town where deceased resided)


1


. .


-


:


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


March


31


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


March


31


41


March 31


83


I last saw


er


.alive on


March 31


63


19


.. , death is said to


have occurred on the date stated above, at


3:40 p


nı.


INTERVAL BETWEEN ONSET AND


Due To


(b)


Pulmonary abscess


(L.U.L. )


(? I.B.C.)


Due To Circulatory Malformations congenita (c)


OTHER


SIGNIFICANT


CONDITIONS


Cyanosis


Was autopsy performed?


Yes


What test confirmed diagnosis ?


Clinical & Autopsy


No


5 Was disease or injury in any way related to occupation of deceased ? If so, specify


(Signed)


Wiggin L. Merrill


M. D.


(Address)


Wrentham, Mass.


Date ...


Apr.1


63


19


Mt. Auburn Crematory, Cambridge, Mass. 6


l'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 3,


19


63


7 NAME OF


FUNERAL DIRECTOR


Short & Williamson, Inc.


ADDRESS 52 Trapelo Road, Belmont, Mass.


Received and filed


MAY 2.9 1963


19


50M - 10-61-931673


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


PLACE OF DEATH


Norfolk


Wrentham


(City or Town making this return)


(Was deceased a


U. S. War Veteran,


No


( if so specify WAR,. Winthrop, Massachusetts


19


to ....


19.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Bronchopneumonia (Left)


(a)


months


(Give maiden name of wife in full)


If under 24 hours


.Hours ........ Minutes


Day?


Boston


. .


:


(County)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


..


6


20


THROP.


MAY 2 91963 AM


{


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


No. .................................


.......


....... ...................


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


WN


To be filed for burial permit with Board of Health or its Agent.


85


(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


( If deceased is a married, widowed or divorced woman, give also maiden name.)


58 Birch Road, ...


... Winthrop., .. Massachusetts


(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


3 DATE OF


DEATH


April


1.


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That


attended deceased from


March 22, 19 63


to ....


April


1


1963


wdast saw h.O.lalive onA.p.r.i.l ...... ]


19 ... 6 .. 3, death is said to


have occurred on the date stated above, at


7.50am


INTERVAL BETWEEN ONSET AND DEATH


12 DATE OF BIRTH


3 days 13


55


AGE .........


Years .............. Months ............ Days


If under 24 hours


... Hours .............. Minutes


Due To


(bHemorrhagic Diathesis


1 mo


Due To Idiopathic Thrombocyto-


(c) penic Purpura


OTHER


SIGNIFICANT


Obesity


CONDITIONS


....


Was autopsy performed?


Yes


17 BIRTHPLACE (City)


(State or country)


NewYork, ......


What test confirmed diagnosis?


Aut; op.s.y.,


S Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


M. D.


Charles.L ... Clay,. M. D.


(l'rint or Type Narne)


(Address)


Ass's. Die. Hans Con'%, Keep, DaApril 1, 19 63


PARENTS


6 Staro Konstandine(Lebanon) W.Roxbury


Place of Burial or Cremation


DATE OF BURIAL


April ... 2,


.19 63


7 NAME OF


FUNERAL DIRECTOR


Benjamin F.Solomon


ADDRESS


120 Harvard Street, Brookline


Recelyed and fled


APR ........ 2 ... 1953


-19


(Signature & Agent of Board of Health or other)


6006/22


50-1-63


A TRUE COPY ATTESTI


18 NAME OF


FATHER


Joshua H.Gordon


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


20 MAIDEN NAME


OF MOTHER


Clara R.Dinn


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Germany


22


$% Barry I. Tulin


Informant


(Address)


58 Birch Road, Winthrop, Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:


(Official Designation)


(Date of Issue of Permit)


T


NSTRUCTIONS FOR CAL CERTIFICATE


In giving SE OF DEATH do not enter ore than one use for each a), (b) and (e)


's does mat mean mode of dying, as heart failure. sia, etc. It means isease, or campli- s which caused .


ditions, if any, ich gave rise to ve cause (a). ing the under- cause last. M C.


'anditions contrib- to death but not I to the terminal e canditiont given


296 ote :- Chapters. s of 1954 Quires micians to print or e the cause or ses of death on th certificates, and pter 48, Acts of ), requires Physi- as to print or type le under signature AY 14 1963 pal Directen lise use only JACK Ink.


13.61-930213


ORM R-301 1


....


....


Registered No.


3665-


2 FULL NAME Holon W Tulin, (First Name) (Middle Name) (Last Name)


8 SEX


female


white


9 COLOR


10 CITIZEN


OF U.S.


YES 19


NO


11 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


lla If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Mischa Tulin


14 Usual


Occupation :


Piano Teacher


(Kind of work done during most of working life)


8 YES


15 Industry


or Business:


unk yrs


16 Social Security No.


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Intraperitoneal Hemorrhage


Charles it mackie


(Registrir)


(City or Town)


(a) Residence. No. (Usual place of abode)


Massachusetts General Hospital BAKER MEMORIAL


A TRUE COPY ATTEST:


Charles it Mackie City Registrar


6


THROW


MAY 2 41963 AM


FORM R-301


d for buriaf permit Board of HenIth its Agent. STRUCTIONS FOR AL CERTIFICATE


T OR TYPE : OR CAUSES DEATH not enter re than one se for each ), (b) and (c)


does not mean ode of dying, I heart failure. 1, etc. It means ease, or compli. which caused


itions, if any, gave rise to : cause (a). If the under- cause last.


editions contrib. o death but not to the terminal condition given nº C.


Directon use only CK Ink. l{ 14 1963 62-932382


PLACE OF DEATH


SUFFOLK


(County)


I


BOSTON


(City or Town)


Ofe Gantmonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


(City or Town making this return)


03750


Registered No.


S(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)


2 FULL NAME


Albert ... L ... Day.


(If deceased is a married, Widowed or divorced woman, give afso maiden name.)


64 Lincoln Street


Winthrop, Mass.


St.


(a) Residence. No ..... (Usuaf 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 Male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


married


4 I HEREBY CERTIF


March


28


19


63


to


inthat Je attended deceased, from V


19


11 lf married, widowe HUSBAND of Elgia Mackay


(or) WIFE of.


(Husband's name in full)


2 AGE. 82 Years. .Months ......... .Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Railroad worker


( Kind of work done during most working life)


14 Industry


or Business:


Railroad


un'k yrs Social Security No ...


16 BIRTHPLACE (City) ... (State or country) New Hampshire


PARENTS


17 NAME OF


FATHER


Information Unavailable


18 BIRTHPLACE OF


FATHER (City)


(State nr country)


Information Unamailable


19 MAIDEN NAME


OF MOTHER


Information Unavailable


20 BIRTIfPLACE OF


MOTHER (City)


(State or country)


Information Undwilable


Elgie M. Day


21 Informant


( Address)


64 Lincoln St. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was aled with me BEFORE the buriaf or transit permit was issued: Jacqueline Daral (Signature of Agent of Board of Health or other)


16 00 8


4/3/63


(Official Designation) (Date of 1 ue of Permit) TX


A TRUE COPY ATTEST:


INTERVAL BETWEEN ONSET ANO DEATH unk yr


Due To (b)


Due To (c)


OTHIER


Cor Pulmonale


SIGNIFICANT


CONDITIONS


Was autopsy performed?


Yes


What test confirmed diagnosis ?


Autopsy


5 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signature)


@hillary


M. D.


Charler.L."ClayphiPor Type Namey


Apr. 2 63


...........


19 (Address)es'r. Dr., Mass. Can't. Hosp." Winthrop Cemetery Winthrop 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL April 4


1963


7 NAME OF


FUNERAL DIRECTOR


Ernest P. Cation


ADDRESS 147 Windhoy St. Wasthe.


SAPR 4 1963 19


Received and ffed


Charles it mackie


(Registrar)|


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


no


3 DATE OF


DEATH


April


2


1963


(Month)


(f)ay)


(Year)


We I last saw Himlive on


.April


2


19 ... 63death is said to


0


(Give maiden name of wife in full)


have occurred on the date stated above, at 4:30a.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Pulmonary Emphysema


NMASSACHUSETTS GENERAL HOSPITAL


434.1 82 × 20


A TRUE COPY ATTEST: Charles it Mackie


City Registrar


TO:


6


THROP


MAY 1 41963 AM


1


1


Boston


(City or Town)


KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


(City or Town making this return) 03749


Registered No.


[(If death occurred in a hospital or institution,


.St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME.


Baby Boy Dunne


(If deceased is a married, widowed or divorced woman, give also maiden name.)


914A Shirley


Winthrop


(a) Residence. No ...


(Usual place of abode)


Length of stay: In place of death.


20 hrs ..


.. months


days.


45 min In place of residence ......... years .......... months .......... clays.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


White


10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN


(write the word)


Single


11 If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of ..


(Husband's name in full)


12


AGE .......... Years ..........


.. Months ...... ..


.Days


11 under 24 hours


20 Hours 45 Minutes


13 Usual


Occupation :


( Kind of work done during most of working life)


14 Industry


or Business:


15 Social Security No. .


none


16 WIRTHPLACE (City)


(State or country)


mars


17 NAME OF


FATHER


Robert Dunne


18 MIRTHPLACE OF


FATHER (City)


(State or country)


Boston


Mais


19 MAIDEN NAME


OF MOTHER


Sharon Knox


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Mars


21 Informant


Robert Dunne


(Address)


914 A Shirley St Hanteras


I HEKEBY CERTIFY that a satisfactory standard certificate of death was/filed with me BEFORE the burial or transit permit was issued: Jacqueline Durata


(Signature of Agent of Board of Health or other)


16009


11/3/63


·1.


(Registrar)|| (Official Designation)


(Date of Issue of Permit)


X


A TRUE COPY ATTEST:


PARENTS


Winthrop 6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Afx 4


43


7 NAME OF


Eineittlaggiano 147 Wertherof St Winthrop.


ADDRESS


APR - 4 1963


Received and Tiled Charles A Mackie


16-62-933404


PLACE OF DEATH


Suffolk


FORM R-301


filed for burial permit h Board of Health or its Agent. INSTRUCTIONS FOR DICAL CERTIFICATE


RINT OR TYPE ISE OR CAUSES OF DEATH do not enter more than one cause for each (a). (b) and (c)


`Ais does not mean mode of dying, k as heart failure. enis, etc. It means disease, or compli- ons which caused


onditions, if any, ·hich gave rise la bove cause (a). using the under. 'ing cause last.


Conditions contrib- { to death but not ed to the terminal use condition given


6 2 776 135


(Print or Type Name) (Address) 3.00rLongwood .... A.v.@Date.4 ..... 2-6.3 .. 14


M. D.


(Signature)


5 Was disease or injury in any way related to occupation of deceased? If so, specify


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


What test confirmed diagnosis ?


INTERVAL


BETWEEN


ONSET AND


DEATH


22


Due To


Prematurity


(b)


3 DATE OF


DEATH


April 2 1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY, That .I attended deceased from 63 to April 2 19 63


April 1


19


I last saw himive on ... A pr.il ..... 2.


16.3. death is said to


have occurred on the date stated above, a5.2.1.5 ..... a ... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


RespIRAtóRy


Distress


(City or town and State)


... St


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


The Children's Hospital Med. Ctr.


(County)


Due To (c)


Wanttori


Y 14 1963


A TRUR COPY ATTEST: Charles it Mackie City Registrar


1


6


THROP


MAY 1 41963 AM


FORM R-301


d for burial permit Board of Health · its Agent. STRUCTIONS FOR AL 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), af the under. cause last. 211 C


nditions contrib- o death but not to the terminal condition given


20.1 81 170 Director i use only CK Ink. Y 14 1963 62-932382


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


(City or Town making this return) 03820


NIMASSACHUSETTS GENERAL HOSPITAL.


[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)


Alice Davies Howland(GilbertMIAN - IMPORTANT Alice Howland ) Altrex@; }berxxHowlandxxxxxxxxdeceased a (If deceased is a married, widowed or divorced woman, give also maiden name.)


U. S. War Veteran, (if so specify WAR) ....


33 Bellvoew Avenue


St


Winthrop, Mass.


(a) Residence. No ......


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death ......... years ......... months.


3 days. In place of residencef.Z .. years. ....... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


April


2


1963


(Month)


(D)ay)


(Year)


IHET


March 29


19


wel last saw if. .. alive on


April


2


19 63


death is said to


have occurred on the date stated above, at 10 :. 352 .n.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL BETWEEN ONSET AND DEATH


12


? HRS


AGE ... 82years ..... 3.


.Months.


7 Days


If under 24 hours


.. Hours .......


Minutes


Due To


ACUTE MYOCARDIAL INFARCTION


(b)


(c)


DISEASE"


OTHER


SIGNIFICANT


CONDITIONS


DISEASE


HYPERTENSIVE HEART


? YRS


.16 BIRTIIPLACE (City)


(State or country)


Massachusetts


Was autopsy performed?


.....


Yes


What test confirmed diagnosis ?


...... Autopsy.


5 Was disease or injury in any way related to occupation of deceased? Ií so, specify .....


(Signature)


M. D.


Chartest:"Cho(pmiPor Type Name)


(Address)Ana's"Dir., Muss. Gen"1. Hosp. .. Date.Apr. 2 1963


Winthrop Cemetery Winthrop, Mass. 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL April 5 1963 ... 19 ....


7 NAME OF


FUNERAL DIRECTOR


alfred To Mark


ADDRESS ........


174 Winthrop St. Winthrop,


APR 9 1903 19 ...........


Received apy


Charles it Mackie


(Registrar)


A TRUE COPY ATTEST:


8 SEX


9 COLOR


white


(write the word) MARRIED widowed WIDOWED DIVORCED UNKNOWN


female


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE


George Howland


(Husband's name in full)


13 Usual


housewife


Occupation :


L DAYS


(Kind of work done during most working life)


14 Industry


or Business:


own home


2 YRS


15 Social Security No .....


015-16-9440-E


Chelsea


17 NAME OF


FATIIER


Samuel Barry Gilbert


PARENTS


18 BIRTHPLACE OF FATHER (City). (State or country) England


19 MAIDEN NAME


OF MOTHER


Mary Ann Fraser


20 BIRTHPLACE OF MOTHER (City) .. (State or country) Nova Scotia


21 Informant


Mrs. Max LeRoy Rorick


(Address)


33 Bellevue Ave. Winthrop


TEREBY CERTIFY that a satisfactory standard certificate of death ME hed with me BEFORE the burial or transit pesegit was issued: Jacqueline Dorate (Signature of Agent of Board of Health or other)


1684 4 4/5/63


(Official Designation)


(Date of I ue of Permit)


.


to


FORTIF April


Je attpided deceasede; fsom


19


(a)


CARDIC RUPTURE


Due To


ARTERIOSCLEROTIC HEART


10 SINGLE


2 FULL NAME


1


Registered No.


A TRUE COPY ATTEST: Charles it mackie City Registrar


MAY 1 41963 AM


1


FORM R-301


ed for burial permit Board of Health or its Agent. NSTRUCTIONS FOR CAL CERTIFICATE


NT OR TYPE E OR CAUSES F DEATH o not enter ore than one use for each ), (b) and (c)


does not mean mode of dying, as heart failure, ia, etc. It means sease, or compli- which caused


ditions, if any, ch gave rise to De cause (a), ing the under. ' cause last. 711 onditions contrib- to death but not ' to the terminal condition given .


330 20


al Director No use only I.CK Ink. MY 14 1963 62-932382


PLACE OF DEATH


SUFFOLK


(County)


1


BOSTON


(City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


Registered No.


[(If death occurred in a hospital or institution, .St. Į 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.)


9 Eliot Street


Winthrop, Mass.


S


Says. In place of residence years months days. 3


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


MALE


9 COLOR


WHITE


10 SINGLE


MARRIED


WIDOWED MARRIED


DIVORCEE


UNKNOWN


11 If married, widowed, or divorced HUSBAND of


EDITH GRACE


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12 52


... Years.


4.


23


Days


If under 24 hours


Hours ........


Minutes


13 Usual


Occupation:


MACHINIST


14 Industry or Business :..


PORTSMOUTH NAVY YARD


15 Social Security No ...


029-05-6333


16 BIRTHPLACE (City)


(State or country)


SOMERVILLE


MASS


17 NAME OF


FATHER


JOHN A REYNOLDS


18 BIRTHPLACE OF


FATHER (City)


STONHAM


(State or country)


MASS


19 MAIDEN NAME


OF MOTHER


ANNIE G CRONIN


20 BIRTIIPLACE OF


MOTHER (City)


EAST ORANGE


(State or country)


NEW JERSEY


EDITH REYNOLDS (WIFE)


21 Informant ( Address) G ELLIOT ST. WINTHROP MASS


I HEREBY CERTIFY that a satisfactory standard certificate of death wes fled with me BEFORE the burial or transit permit was issued: Raymond Rugeram/ (Signature of Agent of Board of Health or other)


16033 11/4/13


(Date of Tosue of Permit)


T


A TRUE COPY ATTEST:


PARENTS


ST PATRICK'S STONEHAM


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


FRANCIS H, BROWN


ADDRESS 34 BOW ST SOMERVILLE


Keceixed and filed


APR &1 1963


.... .................... .... .... Charles it Mackie


...........


2


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That wenttended deceased from March "22 19. 63 ... , to ....... April 2 19 63


wel last saw H ...... alive on April 2 163 .. , death is said to


have occurred on the date stated above, at


12: 18pm.


INTEIIVAL BETWEEN ONSET AND


DEATH WAS CAUSED BY: IMMEDIATE CAUSE Subrachnoid Hemorrhage


Due To Aneurysm of Anterior (Communicating Artery


Yrs


Due To (c)


OTHER SIGNIFICANTHypertensive Heart CONDITIONS Disease


Yrs


Was autopsy performed?


What test confirmed diagnosis ?


AUTOPSY


5 Was disease or injury in any way related to occupation of deceased ? If so, specify


......


(Signature)


M. D.


.Charles.L ... Clay,. M. D. (Print or Type Name) (Address) Ass't .. Dir., Mass .. Gan.I .. Hosp ....... Date.Apr ....... 2 ..... 163


6 Place of Burial or Cremation APRIL 5 .19.63


....


(City or Town making this return)


03784


NOMASSACHUSETTS GENERAL HOSPITAL


John L Reynolds


(Was deceased a


U. S. War Veteran,


(if so specify WAR) ...


NONE


(a)


Residence. No ..


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death .... years ......... months


3 DATE OF


DEATH


April


(write the word)


..... (Registrar)| (Official Designation)


( Kind of work done during most working life)


A TRUE COPY ATTEST: Charles it. Mackie City Registrar


i ?


6


MAY 1 41963 AM


1


FORM R-301


led for burial permit Board of Health or its Agent. INSTRUCTIONS FOR ICAL CERTIFICATE


INT OR TYPE SE OR CAUSES OF DEATH do not enter more than one suse for each (a), (b) and (e)


is does not mean mode of dying, as heart failure. nia, etc. It means disease, or compli- s which caused


nditions, if any, ich gave rise to ove cause (a), lling the under. ing cause last.


Conditions contrib- · to death but nat 'd to the terminal se condition given ·).


19.9 07 /


IY 14 1963


PLACE OF DEATH


Suffolk


......


...... (County)


Boston


(City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD


CERTIFICATE OF DEATH


((If death occurred in a hospital or institution,


SK( 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.)


St


Winthrop, Mass.


(City or town and State)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


4


1963


(Month)


(Day)


VA


(Year)


4IHERENY CERTIFY , That Vattended deceased


Mar ...... 16


19 ..


63 ... ..... Apr .... 4.


19


63


from


XXXXXXXXXXXX ...... , death isaid to


have occurred on the date stated above, at .. 4:30A. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Colitis


Due To


Fatty nutritional ..... cirrhosis


yY's.


Due To


(c)


Megaloblastic anemia


unik


OTHER


SIGNIFICANT


CONDITIONS


Pneumonia


wka.


Was autopsy performed ?


Yes


What test confirined diagnosis ?


Autopsy.


5 Was disease or ygury in any way related to occupation of deceased ? If so, specify 2. Huile_


(Address)


(Print or Type Name)


VAH, Boston, Mass.


DateApr ..... 4 ...


........ 63


6


Winthrop Cem., Winthrop,


Mass.


l'lace of llurial or Cremation


(City or Town)


DATE OF BURIAL


April


6


63


FUNERAL DIRECTOR


Kirby Funeral Home


ADDRESS 210 Winthrop St., Winthrop, Mass


Koupived) and filed


APR 9 1963


Charles it. Mackie


.......


(Registrar)|| (Official Designation)


(Date of Issue of Permit)


TVIV


A TRUE COPY ATTEST:


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Married


11 1f married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


BruceNelson


(Husband's name in full)


12


AGE ..


53.Years .... 3


Months.


25 Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :.


Housewife


(Kind of work done during most of tworking life)


14 Industry


or Business :.


15 Social Security No ...


525.28.4310


16 BIRTHPLACE (City)


(State or country)


Colorado


17 NAME OF


FATHER


Hamer H. Jones


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Miss.


Rich Hill


19 MAIDEN NAME


OF MOTHER


Elta Howe


20 BIRTHPLACE OF


MOTHER (City)


Nacon


(State or country)


Miss


21 Informant


V. A. Hospital Records, 150.S.


(Address)


Huntington Ave. , Boston, Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bugiel or transit permit was issued: Raymond Rogersand (Signature of Agent of Board of Health of other) #1816057 4/5/63


₱-62-933404


X


1


x Veterans Administration Hospital


(City or Town making this return)


Registered No.


033813


Elta J. Nelson (Maiden name: Jones)


(Was deceased a


U. S. War Veteran, WIFII


if so specify WAR) ...


(a) Residence. No.


46


Moore


(Usual place of abode)


Length of stay: In place of death years monthly days. In place of residence 17 years.


.months ......


.. days.


PERSONAL AND STATISTICAL PARTICULARS


INTERVAL


BETWEEN


ONSET AND


DEATH


unik.


(b)


(Signature


M. D.


S. Miller


7 NAME OF


Agular


A TRUE COPY ATTEST: Charles it Mackie City Registrar


MAY 1 41933 AM


X


PLACE OF DEATH


Essex (County )


1


Gloucester


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Gloucester


(City or Town making this return)


Hillcrest Nursing Home No


S (If death occurred in a hospital or institution,


.St. { give its NAME instead of street and number)


2 FULL NAME.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


31 Villa Avenue


st Winthrop, Mass.


(a)


Residence. No


( Usual place of abode)


Length of stay: In place of death .......... years .......... months.


$7


days. In place of residence


45


.... years .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


6,


1963


DEATH


( Month )


(Day)


(Year)


from


4 I HEREBY CERTIFY, Aug. 15 62


19


That I attended deceased


April 6,


63


er


I last saw


.alive on


April 1,


1963


death is said to


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of ..


Harry Graff


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


5 yrs . AGE Years


12


91


6


Months.


28


.. Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Housewife


( Kind of work done during most of working life)


14 Industry


or Business :


Home


15 Social Security No.


New York


none


16 BIRTHPLACE (City)


(State or country )


N.Y.


17 NAME


Edward G. Kennedy


FATHER


18 BIRTHPLACE OF


St. John


FATHER (City)


(State or country )


N.B.


19 MAIDEN NAMEMargaret Jane Greene OF MOTHER


20 BIRTHPLACE OF


New York


( Address )


Gloucester, Mass




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