Town of Winthrop : Record of Deaths 1963, Part 2

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 2


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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(City or Town)


January 13,


63


19


7 NAME OF


FUNERAL DIRECTOR


Torf Funeral Home


Chelsea, Mass.


ADDRESS


Received and filed


FEB 6 1963


19


( Registrar of City or Town where deceased resided )


A TRUE COPY


ATTEST :


( Registrar of City or Town where death occurred )


DATE FILED


January17,


.6.3


JX


10a If married. widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Julius Hollis


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGESLL


v


Months.


24 Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Not Determined


15 Social Security No.


BIRTHPLACE (City


(State or country)


Russia


17 NAME OF


FATHER


Morris Mason


18 BIRTHPLACE OF


FATHER (City)


(State or countryRussia


19 MAIDEN NAME


OF MOTHER


Bertha Shirley


( Signed )


Chiara N: MUSTAFA, M.D.


( Address )


Ha thorne, Mess.


1/15/


M. D.


63


Date.


19


20 BIRTHPLACE OF


MOTHER (City Russia


(State or country}


Mary F. Spechen


21


Informant


( Address )


Hathorne, More.


.


1


(County )


Danvers


(City or Town)


CERTIFICATE OF DEATH


Registered No.


§ (If death occurred in a hospital or institution,


2 FULL NAME


( Was deceased a


U. S. War Veteran.


(if so specify WAR,


8 SEX


19 63


63


2:50p,


INTERVAL


BETWEEN


ONSET AND


DEATH


Sales Clerk


DATE OF BURIAL


TH


FEB -61963 AM


SPACE FOR ADDITIONAL INFORMATION


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


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


X


PLACE OF DEATH


Fsaax (County )


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


Donvers


(City or Town making this return)


6


No Denvery State Hospital, Hathorne St.


2 FULL NAME


Gertrude Fay


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


(a) Residence. No .... 120 Circuit Road


........


Length of stay: In place of death.


11 years 2 months 9


days. In place of residence .......... years .......... months .......... days.


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Jonuarv


12.


1963


(Month)


(Day)


(Year)


8 SEX


female


9 COLOR


white


10 SINGLE


( write the word)


MARRIED


WIDOWED


or DIVORCED married


4 I HEREBY CERTIFY,


That I attended deceased from


April 30, 1967


to ...


January 12


1963


I last saw


f.K.alive on !


Jon. 12.


53


., death is said to


have occurred on the date stated above, a de : 00p .. m.


INTERVAL


BETWEEN


ONSET AND


DEATH


Due Arteriosclerotic heart disease (b)


Due General Arteriosclerosis (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis ?


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


tilard M


ausman


(Signed )


Willard M


alsman


M. D.


( Address )


Hathorne, Mass.


Date.


1/15/


63


19


Winthrop Cemetery, 6 Place of Burial or Cremation


winthrop


(State or country)


Unknown


21


Mary L


Sheehan


Informant


( Address )


Hethome, Mars.


7 NAME OF


FUNERAL DIRECTOR


C'Maley Einerel Home


ADDRESS Winthrop Mas


Received and filed


FEB 6 1963


19


( Registrar of City or Town where deceased resided )


A TRUE COPY


ATTEST :


( Registrar of City or Town where death occurred )


DATE FILED


January 17,


.19 ..


63


V.I.V


1


Danvers


(City or Town)


Registered No.


S (If death occurred in a hospital or institution,


( Was deceased a


U. S. War Veteran.


(if so specify WAR,


& Winthrop


Mass.


( Usual place of abode )


(If nonresident, give city or town and State)


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


James .... Fay


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGES3


.. Years3


6


Days


Months.


If under 24 hours


.Hours .....


.. Minutes


13 Usual


Occupation:


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


Not Determined


Dorchester


16 BIRTHPLACE (City)


(State or country)


ress.


17 NAME OF


FATHER


Meeney


18 BIRTHPLACE OF


Boston


FATHER (City)


(State or country )


Mass.


19 MAIDEN NAME


OF MOTHER


Elizabeth (Unknown)


20 BIRTHPLACE OF


MOTHER (City)


Unknown


DATE OF BURIAL


(City or Town)


January 15,


163


PARENTS


50M-9-59-926111


C


MEDICAL CERTIFICATE OF DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Pneumonia


(a)


ET!


6


SPACE FOR ADDITIONAL INFORMATION


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


F.E.B .... G1963.AM


X


PLACE OF DEATH


Suffolk (County)


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


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


-


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


(a) Residence. No ...


155River Rd.


(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


male


9 COLOR


white


10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN


(write the word)


married


11 If married, widowed, or divorcediriam Hambro HUSBAND of


(or) WIFE of.


(Husband's name in full)


12


AGE.68 .. Years.


.. Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Accountant


(retired)


(Kind of work done during most working life)


14 Industry or Business:


15 Social Security No 020-14-4355"


Framingham,


16 BIRTHPLACE (City) (State or country) Mass.


17 NAME OF


FATHER


Edward Slattery


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Massachusett:


19 MAIDEN NAME


OF MOTHER


Mary Sahey


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Boston,


Mass.


6 Hand in Hand,


West Roxbury


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL January 13, 19 63


7 NAME OF


FUNERAL DIRECTOR


Benjamin F.Solomon


ADDRESS


420 Harvard Street, Brookline.


Received and filed


JAN- 14-1968


19.


(Registrar)


A TRUE COPY ATTEST: ATTEST:


1963


(Month)


12-


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


Nov


1952


to ........


JAN 12


19 63


I last saw hungalive on


JAN


11, 1963


death is said to


have occurred on the date stated above, at 3:23 A.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Cerebral Hemorrhage


Due To/


(b) Cerebral Arteriosclerosis


lup.


Due To (c)


OTHER


Pulmonary Emphysema


SIGNIFICANT


15yrs. CONDITIONS Coronary Artery Ytt, Disease Ux.


Was autopsy performed?


What test confirmed diagnosis?


Clinical


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


(Signature)


M. D.


CHARLES LIBER MAN


...


(Address)


WINTHROP, MASS Date Juni. 12 1963


(Print or Type Name)


PARENTS


21 Informant


Miriam Slattery


(Address)


155 River 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: Delft S. Lerama


-(Signature of Agent of Board of Health or other) 4222.12, 1963


(Date of Issue of Permit)


1


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.


ditions contrib- death but not to the terminal condition given


62-932382


1


Winthrop


(City or Town)


No


Winthrop Community Hospital


Martin F Slattery


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


St


Winthrop, Mass.


3 DATE OF


DEATH


TAN


INTERVAL BETWEEN ONSET AND DEATH 18 /rs.


(Give maiden name of wife in full)


(Official Designation)


(City or Town making this return)


ORM R-301


SPACE FOR ADDITIONAL INFORMATION


11- 26 - 1917


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


9-30-1921


RANK, RATING


JAN 1 41963 AM Vermars 1ST Class Fun!


ORGANIZATION AND OUTFIT


R.S. Navy


SERVICE NUMBER.


NONE


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 deathly only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


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


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


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


ORM R-302


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


PLACE OF DEATH


Essex (County)


1


Danvers


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD


SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


CERTIFICATE OF DEATH


Registered No.


8


Danvers State Hospital, Hathorne St. ( give its NAME instead of street and number) No


2 FULL NAME


Frank P. Hallett


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


U. S. War Veteran.


if so specify WAR


58 Otis


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 ...


5 months 12 days. In place of residence years months days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


January


18.


1963


(Month)


(Day)


( Year)


4 I HEREBY CERTIFY,


That I attended deceased from


August 6,


62


19.


to ..


January 18,


19.6.3


I last saw h.whalive on


January 18,, 163,


h is said to


8:450


INTERVAL BETWEEN ONSET AND DEATH


(b) Due Torteriosclerotic heart disease


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?no


What test confirmed diagnosis ?


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


Willard


Hausman


(Signed) illard


housman


M. D.


Hathorne , Mass.


Date


1/22/


1963


6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


January 23,


.1963


19


21


Informant


( Address)


Ho thorne fass:


7 NAME OF


Alfred B Marsh


FUNERAL DIRECTOR


ADDRESS Winthrop ...


Moga.


Received and filcd


FEB 6 1963


19


ATTEST :


(Registrar of City'or Town where death occurred )


DATE FILED


January 25,


63


19


( Registrar of City or Town where deceased resided )


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


married


10a If married, widowed, or divorced


Unknown


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE7.8


Years.


.3 ... Months.1.7Days


If under 24 hours


Hours


Minutes


13 Usual


Occupation:


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


022-05-6726


Everett


16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF


FATHER


warren


Hallett


PARENTS


18 BIRTHPLACE OF Cape Cod


FATHER (City)


(State or country) Mass.


19 MAIDEN NAME


OF MOTHER


Nellie Burse


20 BIRTHPLACE OF


Salem,


MOTHER (City)


Mass.


(State or country)


Mary


Sheehan


Winthrop Cemetery Winthrop


50M-9-59-926111


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


C


A TRUE COPY .


Danvers


(City or Town making this return)


S (If death occurred in a hospital or institution,


( Was deceased a


(write the word)


have occurred on the date stated above, at


m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


General Arteriosclerosis


(a)


Fruit & Produce (Wholesale)


111


FEB - 61963 AM


SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


ORM R-301


for burial permit ard of Health ts Agent. TRUCTIONS FOR L CERTIFICATE


TOR TYPE OR CAUSES DEATH


not enter e than one e for each , (b) and (c)


does not mean de of dying, heart failure, ,etc. It means ase, or compli- which caused


ions, if any, gave rise to cause (a), the under- cause last.


ditions contrib. death but not to the terminal condition given


1


62-933404


1


PLACE OF DEATH


SUFFOLK (County) WINTHROP (City or Town)


+ OVIETEM


ERTAT


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. 9


f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT


DOROTHEA (TAUCHEN) SAFFORD 2 FULL NAME.


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


(a) Residence. No ..


94 LOCUST ST


(Usual place of abode)


st.


WINTHROP


(City or town and State)


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


months .. days. In place of residence 44 ye 4years


.. months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


DIVORCED


(write the word)


2


DIVONED


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Acute left ventricular


(a)


dilatation


INTERVAL BETWEEN ONSET AND DEATH


minut


(b)myocardial heart disease


yrs.


DuRheumatic heart disease


yrs.


14 Industry


or Business :


BEVERAGE CO.


15 Social Security No. 010-03-0444


16 BIRTHPLACE (City)


(State or country )


MASS


17 NAME OF FATHER JAMES TAUCHEN


18 BIRTHPLACE OF


FATHER (City)


(State or country)


AUSTRIA


19 MAIDEN NAME


OF MOTHER


ANNA M LISKA.


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


MASS


SOUTH BOSTON


21 Informant


MAS ANNA M. TAUCHEN


(Address)


44 LOCUST ST. 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) Mac , 21


(Official Designation) FIN CK


(Date of Issue of Permit)


K PM V


TRUE CO COPY ATTEST:


(Year)


4 IHEREBY CERTIFY , That I attended deceased from


58


to.


January 18


19


63


June


19.


I last saw heRlive on


Jan. 18,


19 ... 63death is said to


have occurred on the date stated above, at


1:08 pm.


12


44 Years


Months.


.Days


If under 24 hours


.Hours ........ Minutes


13 Usual


Occupation :


CLERK


(Kind of work done during most of tworking life)


OTHER SIGNIFICANT CONDITIONS


pneumonitis, hepato- megaly with jaundice


4-5 days


Was autopsy performed?


What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ? NO If so, specify


(Signature) Josiple Arelaxil M. D. Joseph Gregorie, M.D. (Print or Type Name)


(Address)


194 Washington


.Date.Jan.18.163


Winthrop, Mass WINTHROP


6


WINTHROP


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


JAN


21


1963


7 NAME OF


FUNERAL DIRECTOR


MAURICE W. KIRBY


ADDRESS


WINTHROP


Received and filed


JAN 2 1 1963


19


( Registrar)


FEMALE


WHITE


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


3 DATE OF


DEATH


January 18,1963


(Month)


(Day)


WINTHROP COM. HOSP No ...


SOUTH BOSTON


PARENTS


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


165


THROP


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 ofpersons! to whom they have given bedside care during a last ilmess from disease ufi! 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.


---


RM R-302


Egger


ISNO


(County )


1


Denvers


(City or Town)


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


Danvers


10


Danvers State Hospital, Hathorno St.


Michael Eruzione


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


( Was deceased a


U. S. War Veteran.


if so specify WAR,


No


(a) Residence. No ..


271 Bowdoin


St.


Winthrop,


Mass


( Usual place of abode)


(If nonresident, give city or town and State)


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


months


1.1.days. In place of residence .......... years .....


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Jenuary


22,


1953


( Month)


(Day)


(Year)


9 COLOR


8 SEX


male


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED Widowed


4 I HEREBY CERTIFY,


deceased


January 11


53


19. to ...


I last saw h ...... alive on


January


22,


, 19.


death is said to


53


have occurred on the date stated above, at 9:10p. .. m.


INTERVAL BETWEEN ONSET AND DEATH


years


Due To (b) ...


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Bronchopneumonia


days


Was autopsy performed? no clinical & Laborate


What test confirmed diagnosis ?


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


(Signed) Iflera de frusman ausman


M. D.


( Address) Hathorne, Mess. Date. 19


1/22/


63


Holy Cross Cemetery, Malden, 6


Tings.


Place of Burial or Cremation


(City or Town)


January 26,


63


19


7 NAME OF


FUNERAL DIRECTOR


Vincent Rapino


F. Pastor,


Mass.


ADDRESS


Received and filed


FEB 6 ...... 1963


19


( Registrar of City or Town where deceased resided)


PARENT


ry 18 BIRTHPLACE OF


FATHER (City)


(State or country )


Italy


19 MAIDEN NAME


OF MOTHER


Meric, maiden name unk


20 BIRTHPLACE OF


Unknown


MOTHER (City)


( State or country)


Italy


21


Informant


.... J.p.thorne ......... p.s.s.


( Address )


A TRUE COPY


ATTEST :


( Registrar of City or Town where death occurred)


-


DATE FILED


January ..... 25,


19 63


50M-9-59-926111


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


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


. C.


X PLACE OF DEATH


No ..


(City or Town making this return)


Registered No.


§ (If death occurred in a hospital or institution,


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ....... 7.Years.


7


Months.


8


Days


If under 24 hours


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


13 Usual


Occupation:


Leundry Worker


(Kind of work done during most of working life)


14 Industry or Business :


15 Social Security No.


029-10-7001


raples


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Vincent Eruzione


Unknown


Stcehen


DATE OF BURIAL


That I attended


January 22


from


63


19


10a If married, widowed, or


Concetta Crissi


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


DEATH WAS CAUSED BY : IMMEDIATE CAUSE Arteriosclerotic heart disease (a)


2 FULL NAME


i!


SPACE FOR ADDITIONAL INFORMATION .... F.E.B. -. 61963. AM DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


X


Suffolk


(County) Winthrop


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


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


11


(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)


(a) Residence.


No.


(Usual place of abode)


5


Length of stay: In place of death


years.


. months


days. In place of residence .......... years.


.. months.


. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


JANI


.


DEATH


(Month) (Day)


23


1963


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Novi


1958,


Jan 23.


,


19.63


I last saw h &Yalive on


Jan. 21,, 1963, death is said to


have occurred on the date stated above, at


5:30 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Arterioselevatic Heart


Disease,


INTERVAL BETWEEN ONSET AND DEATH 5yrs


Due


Hypertensive Heart


5 yrs


Due To (c)


OTHER


Cerebro Arteriosclerosis


5 yrs


CONDITIONS


and Epilepsy


Was autopsy performed ?


NO


What test confirmed diagnosis ?


Clinical


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify ... . Charles Liberman (Signed) M. D. (Address) Winthropmass


Date. 1/23/ 1963


6


winthrop


linthrop.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


19


7 NAME OF


FUNERAL DIRECTOR


Howard S Reynolds


ADDRESS winthrop, lass.


Received and filed


JAN 25 1963


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widow


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Edgar B Brown


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


79


AGE


Years


6


Months.


10


Days


If under 24 hours


... Hours .....


Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business:


At home


15 Social Security No.


003-14-3316


16 BIRTHPLACE (City.)


(State or country)


Laine


17 NAME OF


FATHER


Charles F Noyes


18 BIRTHPLACE OF


FATHER (City)


Jefferson


(State or country )


Maine


19 MAIDEN NAME


OF MOTHER


Josephine Howe Clary


20 BIRTHPLACE OF


MOTHER (City)


Unable to obtain


(State or country ) -


21 Ralph Roach


Informant


(Address)


6 Grant Rd. Lynfield, Dass


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issucd : taiph, E siberian. .. (Signature of Agent of Board of Health or other) 1.03)




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