Town of Winthrop : Record of Deaths 1963, Part 20

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 20


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


(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.


RM R-301


OR TYPE R CAUSES EATH t enter han one for each b) and (c)


s not mean of dying, eart failure, tc. It means or compli- hich caused


s, if any, ve rise to ause (a), the under- ause last.


ions contrib- eath but not the terminal dition given I.C.


PLACE OF DEATH


Suffolk


(County)


Winthrop


(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. ( give its NAME instead of street and number)


2 FULL NAME.


Florence May Gingrich( Benson )


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


(a) Residence. No.


49 Waldemar Avenue


Winthrop, Massachusetts


(If nonresident, give city or town and State)


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


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


.5€ rs .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May


15


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


2:30 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Death due to natural causes


INTERVAL


BETWEEN


ONSET AND


DEATH


Due To


(b)


presumably coronary occlusion


(c)


Due Toon


basis of history.


Winthrop Board of Health


OTHER


SIGNIFICANT


CONDITIONS


Charles Libermais, Mal


Was autopsy performed ?


What test confirmed diagnosis ?


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


If so, specify


(Signature)


Charles


Liberar, M. D.


CHARLES


LIBERMAN.


(Print or Type Name)


(Address)


Wirttrap, he45Date.


5/16/1963


Woodlawn Cemetery, Everett, Mass


6


I'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


May 18, 1963


19.


7 NAME OF


FUNERAL DIRECTOR


alfred B.Marsle


ADDRESS


174 winthrop St. Winthrop


Received and filed


MAY 17 1963


19


( Registrar)


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


widowed


female


white


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


John Edward Gingrich


(Husband's name in full)


12


AGE .. 7.O.Years.


Months ..


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Office mamager


(Kind of work done during most working life)


14 Industry


or Business :


Boston Y W .C .4.


15 Social Security No ..


025-26-0168


16 BIRTHPLACE (City)


(State or country)


Massachusetts


17 NAME OF


FATHER


Edgar Nicol Benson


PARENTS


18 BIRTHPLACE OF


Boston


FATHER (City)


(State or country)


Massachusetts


19 MAIDEN NAME


OF MOTHER


Mary Flora Gorman


20 BIRTHPLACE OF


MOTHER (City).


Boston


(State or country)


Massachusetts


21 Informant


(Address)


Harry N. Benson


290 Elm St. Walpole, Mass.


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


.......


(Signature of Agent of Board of Health or other)


Wealth officer


May 17,1963


(Official Designation) (Date of Issue of Permit)


T VIVI


A TRUE COPY ATTEST:


6 932382


1


or burial permit d of Health Agent. ICTIONS


OR CERTIFICATE


No.


49 Waldemar Avenue


(City or Town making this return)


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


(Usual place of abode)


PERSONAL AND STATISTICAL PARTICULARS


Boston


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE:


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


500


THROP


RULES OF PRACTICE U HAT 1 71503 Th


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.


RM R-301


or burial permit rd of Health s Agent. UCTIONS FOR CERTIFICATE


OR TYPE R CAUSES DEATH


ot enter than one for each (b) and (c)


es not mean of dying, heart failure, etc. It means e, or compli- which caused


s, if any, ave rise to cause (a), the under- cause last.


itions contrib- death but not the terminal ndition given


PLACE OF DEATH


SUFFOLK


(County)


NSE


1


WINTHROP


(City or Town)


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


2 FULL NAME. JOHN FRANCIS GALLAGHER


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


(a)


Residence. No ....


109


Pleasant Street


St


Winthrop


(Usual place of abode)


Length of stay: In place of death629 years months.


.. days. In place of residence ..... Myears .......... months .......... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


SINGLE


11 If married, widowed, or divorced HUSBAND of


(or) WIFE of.


(Husband's name in full)


12


74


AGE.


Years


Months ..


.. Days


If under 24 hours


Hours .....


Minutes


13 Usual


Occupation :


Photo-Engraver


(ret.)


(Kind of work done during most working life)


14 Industry


or Business :


Donovan & Sullivan Co.


15 Social Security No ....


16 BIRTHPLACE (City)


(State or country )


Irerand


17 NAME OF


FATHER


Daniel Gallagher


18 BIRTHPLACE OF


FATHER (City)


Donegal


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary Bradley


Derry


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Informant


Miss E. Veronica Gallagher


(Address)


100 Pleasant St. Winthrop


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


(Signature of Agent of Board of Health or other)


Legitti offer


Thay ir0. 19 63


(Date of Issue of Permit)


2-932382


A TRUE COPY ATTEST:


INTERVAL BETWEEN ONSET AND DEATH


Due Tonatural causes, probably


(b)


acute coronary occlusion


Due To


(c)


on basis of history


Wirtherap Board of Health


OTHER SIGNIFICANT CONDITIONS Charles Liberman In


Was autopsy performed?


What test confirmed diagnosis ?


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


If so, specify


(Signature)


Clicples


... M. D.


CHARLES LIBERMAN


(Print or Type Name)


(Address) WINTHROP, MASS Date


5/17/1963


6


Holy Cross


Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May


21,


19.63


7 NAME OF


FUNERAL DIRECTOR


FRANK H. CARP


ADDRESS


79 Elm


St. Charlestown


Received and filed


MAY 20 1963


19


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


MAY


17


1963


(Year)


(Month)


(Day)


4 IHEREBY CERTIFY , That I attended deceased from


19


to ..


19


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


19 ........ , death is said to


(Give maiden name of wife in full)


have occurred on the date stated above, at


9:05Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) Death presumably due to


No


109 Pleasant St. ,Winthrop


(City or Town making this return)


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


No


(If nonresident, give city or town and State)


(Registrar) || (Official Designation)


Don


PARENTS


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


YTHEOR


MAY 201963 AM


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.


RM R-301


1


Winthrop


(City or Town)


No.


283


Court Road


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


No


2 FULL NAME


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


283 Court


Road


Winthrop


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of death.


19


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Married


11 If married, widowed, or divorced HUSBAND of .. Emma .. K .Kinsella


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


2-7-1911


12


AGE ... 52 Years.3.


Months.14 ..... Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :


Retired-Civil Engineer


(Kind of work done during most working life)


14 Industry or Business :


15 Social Security No ...


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


William W.K.Campbell


Boston


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass


19 MAIDEN NAME


OF MOTHER


Elizabeth J.Crowley


20 BIRTHPLACE OF


MOTHER (City)


Boston


(State or country)


Mass.


21 Informant Mrs .EMMA ... K.Campbell ( Address) 283 Court Rd., WINTHROP Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 6.


(Signature of Agent of Board of Health or other) (Nes) ....


Health Officer )ha, 13.1963


(Date of Issue of Permit)


A TRUE COPY ATTEST:


PARENT!


6


WINTHROP CEMETERY


WINTHROP


I'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


MAY


24


1963


7 NAME OF


FUNERAL DIRECTOR


ARTHUR PORCELLA


ADDRESS


BEACHMENT, MASS.


Received and filed


MAY 23 1963


19


8 SEX


3 DATE OF


DEATH


MAY 21 1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


MAY 1,


1963


to ...


MAY 21,


196.3


I last saw hfMalive on


MAY 20,


19.63, death is said to


have occurred on the date stated above, at 3:10 Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) CORONARY THROMBOSIS


INTERVAL BETWEEN ONSET AND DEATH


Due To.


ARTERIOSCLEROSIS


2 YRS


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


PREVIOUS ATTACK


4YRS


Was autopsy performed?


NO


What test confirmed diagnosis ?


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


YES


(Signature)


a. n. Carlan


M. D.


1. N. CAPLAN UD


(Print or Type Name)


(Addre 186PRINCETONST EAST BOSTON MAY 2 1963


PLACE OF DEATH


Suffolk


(County)


J. OVIETEM-


LIBERTATE


WINTHROP


(City or Town making this return)


or burial permit rd of Health Agent. ICTIONS


OR CERTIFICATE


OR TYPE R CAUSES EATH


t enter han one for each b) and (c)


es not mean of dying, eart failure, tc. It means , or compli- kich caused


as, if any, ve rise to ause (a), the under- ause last.


ions contrib- eath but not the terminal dition given M.C.


2-932382


Warren M. Campbell


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


St


(If nonresident, give city or town and State)


(Registrar ) || (Official Designation)


Revere


(b)


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) 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-301


r burial permit 'd of Health Agent. CTIONS OR ERTIFICATE


R TYPE CAUSES CATH t enter han one or each ) and (c)


s not mean of dying, eart failure, c. It means or compli- ich caused


s, if any, ve rise to ause (a), he under- use last.


ions contrib- cath but not the terminal dition given IR.


PLACE OF DEATH


Suffolk


(County)


Winthrop (City or Town)


No ..


39 Grovers Ave


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


(City or Town making this return)


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


2 FULL NAME


Daniel J. Geary


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


(if so specify WAR)


(a)


Residence. No ..


66 Winthrop Shore Drive


(Usual place of abode)


St


(If nonresident, give city or town and State)


Length of stay: In place of death2 years.


.years .......... months.


......


.days. In place of residence.O.


years.


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


:


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


(write the word)


Malele


White


10 SINGLE


MARRIED


WIDOWED


DIVORCEIMarried


UNKNOWN


11 If married, widowed, or divorsed


HUSBAND of


Mary F.


Geary ( Reardon


(or) WIFE of ..


(Husband's name in full)


12


AG8.5


Years.


Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Accountant


(Kind of work done during most working life)


14 Industry


or Business :


N.E.News Co


, 15 Social Security No ..


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


John Geary


-


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Boston


Mass


19 MAIDEN NAME


OF MOTHER


Mary Burns


20 BIRTHPLACE OF


MOTHER (City)


Boston,


Mass


(State or country)


Mary F. Geary


21 Informant


( Address)


66 Winthrop Shore Drive


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 Fever


77201 23,196 3


(Official Designation) (Date of Issue of Permit)


A TRUE COPY ATTEST:


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That I attended deceased fron


60


to 2 css


21


1963


I last saw h.4.palive on


196, death is said to


have occurred on the date stated above, at 5.15 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


myocardial Hear Disease


Due To


(b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Sendity


Was autopsy performed?


72


What test confirmed diagnosis ?


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


If so, specify


(Signature)


mente Lazone


M. D.


JGraph Gregario


(Print or Type Name) que /22 961


(Address)


194 Washington Date


6 .New Calvary


Boston ........ Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May 24,


19.


63


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


ADDRESS


Winthrop Mass.


Received and filed


MAY 23 1963


19.


(Registrar)


62932382


I


Registered No.


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


no


3 DATE OF


DEATH


May21 1963


INTERVAL BETWEEN ONSET AND DEATH


(Give maiden name of wife in full)


PARENTS


.


·


Boston


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) 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 bad 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.


PLACE OF DEATH


Suffolk ... (County)


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


(City or Town making this return)


Registered No.


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


2 FULL NAME.


Amelia.M ..... Thibeau


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


(a) Residence. No ....


144 Main Street


(Usual place of abode)


Length of stay: In place of death. 2.5years ...


... months .. days. In place of resideno 25.) ..... months ... .. days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Widowed


11 If married, widowed, or divorced HUSBAND of


(or) WIFE


of


(Give maiden name of wife in full)


Clifford Thibeau


(Husband's name in full)


12


AGE


56.


10 Months: 28


.Days


If under 24 hours


Hours ... ... Minutes


13 Usual


Occupa


Senior .Clerk


(Kind of work done during most working life)


14 Industry


or Business:


Winthrop Water Dep't


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Lowell, Mass


17 NAME OF


FATHER


John Stempien Stymping


18 BIRTHPLACE OF


FATHER (City) ..... Cannet ... be learned


(State or country)


Austria


19 MAIDEN NAME


OF MOTHER


ANNIE


You' aka


Cannot be learned


20 BIRTHPLACE OF MOTHER (City) .... Cannot be learned (State or country)


Austria


21 Informant


(Address)


Robert Thibeau


144 Main St., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: d'aple 16 Serianni (a)


(Signature of, Agent of Board of Health or other)


Heaith Gifeur


Muy 2 3, 1963


(Date of Issue of Permit)


A TRUE COPY ATTEST:


:


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May21 1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


non


58


19


That I attended deceased from


to ...


May


14


1903


I last saw Ha ... alive on


May


14


63


19.


death is said to


have occurred on the date stated above, at


3:40Pm


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Myocardial infarction


INTERVAL BETWEEN ONSET AND DEATH


(a)


Due To


coronary arteries derosis


(b)


Due To (c)


OTHER


SIGNIFICANT




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