Town of Winthrop : Record of Deaths 1963, Part 19

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 19


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).


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4/6


63


Date


19


Woodlawn Crem.


6


Everett, Mass.


DATE OF BURIAL


April


9.


19


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


174 Winthrop St. Winthrop


ADDRESS


Received and filed


MAY 10 1963


19


( Registrar of City or Town where deceased resided )


PARENTS


MOTHER (City)


( State or country)


Mrs. James Stavros


InformantB ..... N ..... Road Gloucester, Mass


( Address )


A TRUE COPY


ATTEST :


( Registrar of City or Town where death occurred)


DATE FILED


April


19 03


X


ORM R-302


WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD


Due To (b) 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 Due To (c)


50M1-9-59-926111


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


NO


What test confirmed diagnosis ?


Physcial Exam


No


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


If so. specify


( Signed )


W.M.Poland


M. D.


Place of Burial or Cremation


(City or Town) 63


21


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


( write the word)


MARRIED


WIDOWED


or DIVORCED


Widowed


8:30P


have occurred on the date stated above, at .. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Arteriosclerosis general


(a)


INTERVAL BETWEEN ONSET AND DEATH over


19


(Kennedy)


( Was deceased a


U. S. War Veteran.


(if so specify WAR


NO


( If nonresident, give city or town and State)


April


Ella Margaret Graff


Registered No. .


N.Y.


SPACE FOR ADDITIONAL INFORMATION


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


R-305 1


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) . the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided


PLACE OF DEATH


Egsex (County)


Danvers


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


MEDICAL EXAMINER'S CERTIFICATE OF DEATH


Denvers


(City or town making return)


Registered No. .......


§ (If death occurred in a hospital or institution, No. Danvers State Hospital, Hathorne


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


2 FULL NAME Margaret MacCarthy (Shea)


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


66 Summitt Avenue


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.


1


months.


s .. ].9 .... days. In place of residence ............. years ..........


.... months .............. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


15,


1963


(Month) (Day)


(Year)


female


white


12a If married, widowed, or divorced


HUSBAND of


(Giye maiden name of wife in full)


(or) WIFE of


John T. Mccarthy


(Husband's name in full)


13 DATE OF BIRTH


14


AGE87


Years .


0


Months.


6


Days


If under 24 hours


.. Hours


Minutes


15 Usual


Occupation:


Unable to work


(Kind of work done during most of working life)


16 Industry or Business :


17 Social Security No.


024-09-9797


18 BIRTHPLACE (City)


....


(State or country)


So. Wales, England


19 NAME OF


FATHER


Patrick Shea


20 BIRTHPLACE OF


FATHER (City)


(State or country)


Unknown


England


21 MAIDEN NAME


OF MOTHER


Margaret Dacey


Unknown


22 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


23


Informant


(Address)


Hathorne, Mass


A TRUE COPY


ATTEST:


........


I (Registrar of Chy or Town where death occurred)


DATE FILED


April 17,


63


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


10 COLOR


11 CITIZEN


OF U.S.


YES


NO


12 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


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.) Arteriosclerosis, fracture left


hip , before adm. to hospital


5 Accident, suicide, or homicide (specify)


accident


Date and hour of injury


F.b. 15,


19.


63


If accidental, was injury causally related to the death?


no


Where did


Winthrop


Injury occur ?


(City or town and State)


Did injury occur in or about home, on farm, in industrial place, or in


public place ?


Com. Hospital


(Specify type of place)


Manner of


F 11 to floor


Injury


(How did injury occur?)


Nature of


Fract. left hip


Injury


While at work?


no


Was autopsy performed? n.O.


6 Was disease or injury in any way related to occupation of deceased ?... n.c If so, specifR .l.ph ..... ..... Foss


(Signed)


Ralph E Foss


M. D.


(Address)


Peabody,


Mass


Date ....


4/15 1963


Winthrop Cemetery, Winthrop 7 Place of Burial or Cremation. (City or Town)


DATE OF BURIAL


April 18,


1963


8 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS


Winthrop,


Mass


Received and filed


MAY-10-1963


19.


T


:


.


1


PARENTS


Unknown


Mary E Sheehan


25M - 3-61-930213


(City or Town)


f(Was deceased a


U. S. War Veteran,


if so specify WAR)


No


SPACE FOR ADDITIONAL INFORMATION


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


RM R-304


PLACE OF DELIVERY No.


SUFFOLK (County )


Winthrop


(City or Town)


Winthrop Community Hospital


1


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


3 DATE OF


DELIVERY


May


2


1963


(Month )


(Day)


(Year)


4 SEX


Male ...... Female X Undetermined ..


5 COLOR (if


determined)


W.


6 THIS BIRTH (Check one)


Single L . Twin ....


Triplet


7 IF MULTIPLE BIRTH, BORN :


1st ..


.. 2nd


3rd


FATHER


8


FULL


NAME


Raymond, Otter


14


MAIDEN NAME


Cynthia. Herbert


PRESENT NAME


Cynthia Otter


9


RESIDENCE, NO.


142 Fauline St.


STREET


CITY OR TOWN


T


inthron


STATE


... Mas.s.


15


RESIDENCE, NO.


CITY OR TOWN


inthrop


STATE.


Mass


10 COLOR OR ,


RACE


hit.e .. ..


11 AGE AT TIME OF


THIS DELIVERY


27 (Years)


16 COLOR OR


RACE .. .


Y hitel


17 AGE AT TIME OF


THIS DELIVERY


21


(Years)


12 PLACE OF


BIRTH


McGregor


mexas.


(State or country)


(City or Town)


18 PLACE OF BIRTH in-hrop, (City or Town)


Mass


(State or country)


13


OCCUPATION


Mechanic


20 PREVIOUS DELIVERIES TO MOTHER


(Do not include this fetus)


1


(a) How many children are


now living?


1


(b) How many children were


born alive


dead?


but are now None


(c) How many previous fetal deaths of ANY gestation age? None


21 LENGTH OF


PREGNANCY


completed weeks


28


22 Weight Lb. 2 Oz. 13


OF FETUS


(or


23 WHEN DID FETUS DIE? X Before Labor


During Labor


or Delivery


Unknown


24 AUTOPSY Yes No


X


25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Premature rupture of membranes


Due To (b) Due To (c)


OTHER SIGNIFICANT CONDITIONS


26


Winthrop Com


Winthrop


(City or Town)


Place of Burial or Cremation


16-3


DATE OF BURIAL


3,


27 NAME OF


FUNERAL DIRECTOR Ichard C. Kirby Inc.


ADDRESS


917 Bennington St JE. Boston


Received and filed


MAY 3 - 1963


19


( Registrar)


MOTHER


..


In giving AUSE OF AL DEATH not enter re than one use for each f (a), (b) and (c)


/ or maternal, ition causing 1 death (do use such s as stillbirth rematurity.) l and/or ma- al conditions, y, which gave : to above e (a), stating underlying e last.


litions of fetus hother which have contrib- dd to fetal b, but, in so as is known. not related ause given a ).


(PRINT OR TYPE NAME)


Address


73 Bartlett Rd.,


Winthrop, Mass.


Date May 2 1963


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


G Levianni (B)


( Signature of Agent of Board of Health or other )


Health officer


(Official Destination)


May 3. 1963 (Date of Issue of Permit )


· X


A TRUE COPY ATTEST :


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


Registered No.


93


1


2 NAME OF FETUS


(if given)


Faby Girl Otter


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)


St.


142 Pauline St.


„STREET


19 INFORMANT Raymond


Otter


Grams)


I HEREBY CERTIFY that this delivery occurred on the date stated above at10;16pm., and product of conception was not a live birth.


Signature of Attending Physician or Medical Examiner : M. Traunstein 1


M.D.


10M-6-62-933404


FETAL DEATH


EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.


Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, .. . shall not be permitted except ..


Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.


Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."


Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.


ORM R-301


for burial permit oard of Health its Agent. TRUCTIONS FOR L CERTIFICATE


OR 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), & the under- cause last.


sditions contrib- death but not to the terminal condition given


PLACE OF DEATH


Suffolk (County)


WUL


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


2 FULL NAME Ellen .... M ........ Skehan


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


(a)


Residence. No.


35 Enfield Road


(Usual place of abode)


St


(If nonresident, give city or town and State)


Length of stay : In place of death.3 .. 5.years.


months ......... days. In place of residence 35 ears.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWEDN


DIVORCE Widowed


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


Thomas E. Skehan


(Give maiden name of wife in full)


(or) WIFE


of


(Husband's name in full)


12


87


AGE


Years.


.Months ...


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Housewife


Occupation :


(Kind of work done during most working life)


14 Industry


or Business:


Own Home


15 Social Security No ....


16 BIRTHPLACE (City)


(State or country )


East .... Boston


Mass


17 NAME OF


FATHER


Dennis Harrington


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary Mccarthy


20 BIRTHPLACE OF MOTHER (City ) .. (State or country) Ireland


Robert W. Skehan


21 Informant


(Address)


35 Enfield Rd., 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 May 3, 1963


(Date of Issue of Permit)


T


A TRUE COPY ATTEST:


:


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May 2 1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That I attended deceased from


19 .. , to ..


19


I last saw h ...... alive on 19 ... death is said to


have occurred on the date stated above, at


6:30 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Death presumably due to


INTERVAL


BETWEEN


ONSET AND


DEATH


Due Tonatural causes, probably (b)


a cerebro vascular


(c)


occlusion on basis of history


OTHEROF


arteriosclerosis and hypertension


CONDITIONS


SIGNIFICANT


Winthrop Board of Health


Was autopsy performed?


Charles Liberan Mim


What test confirmed diagnosis ?


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


(Signature)


Charles


Lettera


M. D.


CHARLES


LIBERMAN


(Address)


(Print or Type Name)


WINTHROP MASS Date


5/3/


19 63


Holy Cross


Malden


6 Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May 6,


19. 63


7 NAME OF


FUNERAL DIRECTOR


Arthur J O'Maley


ADDRESS


Winthrop Mass MAY 3- 1963


Received and filed 19


....


(Registrar)|| (Official Designation)(


62-932382


-


Winthrop


(City or Town)


No ...


35Enfield Road


(City or Town making this return)


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


... months .......... days.


(write the word)


PARENTS


.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


MAY 3 1963 PM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


X


Suffolk


150slow 6-6-63


LIBERTATE


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


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


No


(a) Residence. No ..


136 Trenton Street,


(Usual place of abode)


st.East .... Boston , Ma.s.s ..


(If nonresident, give Lity 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


3 DATE OF


DEATH


May


3


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


May 20


191962


to ...


14 ay


3


That I attended deceased from


19 63


I last saw h. malive on


inclu 2


19% ... ), death is said to


have occurred on the date stated above, at GCT, Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Lolar Pneumonia.


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Cerebral Hemmelige


Was autopsy performed ?


NO


What test confirmed diagnosis ?


Clinical


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


If so, specify


(Signature)


M. D. Charles T. Ferrerd


(Address)


(Print or Type Name) 154 (JEjun, 182 11 Date.


5/3


19 4.3


6


Woodlawn Cemetery


Everett.


(City or Town)


DATE OF BURIAL


19 ..... 6.3


7 NAME OF


FUNERAL DIRECTOR


Vincent Rapino


ADDRESS


9 Chelsea St. East Boston Mass


Received and filed


MAY 6 -1963


19


8 SEX


male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


widowed


11 If married, widowed, or divorced HUSBAND of


Maria Panarinto


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE


Years


.....


.Months.


Days


79


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Retired


14 Industry


or Business :


****


15 Social Security No .. 0:31-10-4755


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Rosario Recca


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Rosa Lentini


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


21 Informant


Angelo Recca (son)


(Address)


136 Trenton St., 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 : Ralph to Serianni (Signature, of Agent of Board of Health or other) Health officer Darauf 6- 1963


(Date of Issue of permit)


X


.


does not meon de of dying, heart foilure, etc. It meons ase, or compli- which coused


ions, if ony, gove rise to couse (0), the under- couse lost.


ditions contrib- death but not to the terminal condition given


PLACE OF DEATH


(County) Winthrop


(City or Town)


May flower Nursing Home No


2 FULL NAME


Juneppe


Recca


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


3


2 2-932382


(Registrar) | (Official Designation)


A TRUE COPY ATTEST:


.


:


PARENTS


Place of Burial or Cremation


May 6.


. OVIETEN


(City or Town making this return)


1


ORM R-301


for burial permit oard of Health its Agent. TRUCTIONS FOR CERTIFICATE


OR TYPE OR CAUSES DEATH not enter e than one e for each (b) and (c)


PERSONAL AND STATISTICAL PARTICULARS


INTERVAL BETWEEN ONSET AND DEATH 5 days


(Kind of work done during most working life)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY: SERVICE


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


MAY-61963 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.


.


1


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No ..


40 Shirley Street


S(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)


N.O.


(a) Residence. No.


40 Shirley Street


St


(Usual place of abode)


Length of stay: In place of deat. 30.year _. ....... months. LIdays. In place of residence61.years ....... Conths .. ]]days.


(If nonresident, give city or town and State)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May


11


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


6-17


61


5-11-


to ...


.6.3.


I last saw hhlive on


May 10


16.3., death is said to


have occurred on the date stated above, at .6 :. 2.5a ... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) .... acute ..... myocardial ..... infartim ..


Due Toarteriosclerotic heart (b) disease.


3yrs


Due To


generalized


(c) arteriosclerosis


5yrs


8 SEX


9 COLOR


White


10 SINGLE


„(write the word)


MARRIEDMarried


WIDOWED


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of Myrtle .... May ..... Ackerman.


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE ... 67Years ..... 5 Months .. ]] Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :


Foreman


(Kind of work done during most working life)


14 Industry


or BusiwinthropWater Department


15 Social Security No ......


010-09-8907


Winthrop


16 BIRTHPLACE (City)


(State or country)


Massachusetts


17 NAME OF FATHER Robert Cobb


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Prince Edward Island


(State or country)


Canada


19 MAIDEN NAME


OF MOTHER


Alma Coliette Floyd


20 BIRTHPLACE OF


MOTHER (City)


Winthrop


(State or country)


Massachusetts


21 Informant


Mrs ....... Louis R. Cobb


(Address)


40 Shirley St. Winthrop


Mas HEREBY CERTIFY that a satisfactory standard certificate of death Was Thiled with me BEFORE the burial or transit permit was issued: Eceph 6. Alivianon (3)


Signature of Agent of Board of Health or other) Health office


Day 13-6 3


(Official Designation) (


(Date of Issue of Permit)


T


A TRUE COPY ATTEST:


52-932382


FORM R-301


I 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.


ditions contrib- death but not to the terminal condition given


Was autopsy performed?


no


What test confirmed diagnosis ?clinical & lab


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


(Signature)


Mr. Traunstein


M. D.


M. Traunstein, Jr., M.D.


(Print or Type Name)


(Address)


73 Bartlett Rd ....... Date ...


5-11


196.3


Winthrop, Mass .


6.


Winthrop Cemetery Winthrop Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May 14,1963


7 NAME OF


FUNERAL DIRECTOR


alfred B. March


ADDRESS


174 Winthrop St. Winthrop,


Received and filed


MAY 13 1963


19


(Registrar) |


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


(City or Town making this return) ....


Registered No.


2 FULL NAME


Louis Russell Cobb


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


PERSONAL AND STATISTICAL PARTICULARS


Male


INTERVAL


BETWEEN


ONSET AND


DEATH


12 hr


OTHER


SIGNIFICANT


CONDITIONS


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 : MAY 1. 21052 PM


(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.




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