Town of Winthrop : Record of Deaths 1963, Part 21

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 21


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


CONDI


1958; angina Pectoris


Was autopsy performed?


What test confirmed diagnosis ?


Ecq


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


If so, specify


NO


(Signature)


4. B. herenfiets


M. D.


H.B. Greenfield


747 Shirley S( Print or Type Name) WinthropMas


(Address)


Date.


5-21


1963


6 Winthrop


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May 24.


.19.63


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


Winthrop Mass.


ADDRESS


Received and filed


MAY 23 1963


19


I


Winthrop .... (City or Town)


No .......


Town .... Hall ..... Winthrop


PHYSICIAN - IMPORTANT


(Was deceased a


no


U. S. War Veteran,


if so specify WAR).


St


(If nonresident, give city or town and State)


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


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


tions, if ony, gove rise to couse (0), & the under- couse last.


iditions contrib- › deoth but not to the terminal condition given


PIN


42-932382


(Registrar )| (Official Designation)/ .


BIRTH CENTI do FILE LIST. REMENT


PARENTS


031-09-9236


Myocardial infarction


ORM R-301


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


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 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-301


for burial permit bard of Health its Agent. RUCTIONS FOR . CERTIFICATE


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


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


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


ditions contrib- death but not 'o the terminal condition given


22-932382


A TRUE COPY ATTEST:


:


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


Female 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


74 Years.


Months ...


.. Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :.


HouseWORK


(Kind of work done during most working life)


14 Industry


or Business :


OWN Home


15 Social Security No ....


028-05-9768


16 BIRTHPLACE (City)


(State or country )


CANADA


17 NAME OF


FATHER


Joseph Hale


18 BIRTHPLACE OF


FATHER (City)


(State or country)


CANADA


19 MAIDEN NAME


OF MOTHER


MARY Shermany


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


CANADA


Rita Heil


21 Informant


(Address)


67 Wordsworth St. E. Boston


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


26.0.


(Signature of Agent of Board of Health or other) June 1, 1963


(Date of Issue of Permit)


1


Winthrop


(City or Town)


Winthrop Community Hospital


S(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.)


67 Wordsworth Street


East Boston,


Mass.


(a) Residence. No ....


(Usual place of abode)


(If nonresident, give city or town and State)


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


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


3 DATE OF


DEATH


MAY


31-


1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY


, That I attended deceased from


3


1963


I last saw h& ... alive on


MAY


31


to ...


MAY


1963


death is said to


have occurred on the date stated above, at


..... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Cerebro vascular accident


INTERVAL BETWEEN ONSET AND DEATH 2 weeks


17yrs


Due To (c)


OTHER


Theft leg amputate que le


CONDITIONS


arterial thrombosis 1961


Was autopsy performed?


110


What test confirmed diagnosis ?


Clinical


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


If so, specify


110


(Signature)


Charles meloni MD


M. D.


CHARLES MELONI


(Print or Type Name)


(Address)


305 Haurest EBosto Date.


NA4.31,63


Holy Cross 6


Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


June


3


1963


7 NAME OF


. DIRECT


TRelleRICK J. MAGRATH


ADDRESS


EAST Boston


Received and filed


JUN 5 1963


19


CENSE PETITS


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


CERTIFICATE OF DEATH


Registered No.


C


No ..


Piston 6-6-63


X PLACE OF DEATH


Suffolk -


(County)


(City or Town making this return)


Mary Hale


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


No


St


4


(Registrar) | (Official Designation)


X


PARENTS


(b) Due ToGeneral arteriosclerosis


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


RECEIVED 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.


OF TOW


17 12


(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 Labsent from home when the certificate of death is needed.


1000


1330


CO


5


6


(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.


WINTHROP


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


JUN : 51963 9Nement of Occupation .- Precise statement of occupation is very impor- Yant, 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.


FORM R-301


d for burial permit Board of Health its Agent. STRUCTIONS FOR AL CERTIFICATE


IT OR TYPE OR CAUSES F DEATH


not enter re than one se for each ). (b) and (c)


does mot medm sode of dying, s heart failure. a, etc. It means ease, or compli- which comsed


litions, if amy, & gove rise to e comse (a), ng the under- cause last.


onditions contrib- to death but mot to the terminal condition given


153.8 47. X7/


8 - 1983


1-62-932382


PLACE OF DEATH


X LUT Suffolk (County) East Besten (City or Town)


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


CERTIFICATE OF DEATH


Registered No. 1


f(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,


il so specify WARI


No


(a) Residence. No. 37 Mermaid Ave.


(Usual place ol abode)


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


"{ .. months .......... days. In place of residence .. O.years. ......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


April


22


1963


(Month)


(Day)


(Year)


I HEREBY CERTIFY , That I attended deceased Irom 19. ,50 63 Cet. 19 ..


I last saw he blive on


April


22 1) 63


death is said to


have occurred on the date stated above, at


5:30 P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Carcinoma


of Colon


Due


(b)


with generalized


Due To


carcinomatosis, especially


(c)


to liver


OTHER


SIGNIFICANT


CONDITIONS


None.


Was autopsy performed ?


No


What test confirmed diagnosi


Operative-Pathological.


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


(Signature)


Charter Liberman.


CHARLES LIBERMAN


(Print or Type Name)


(Address) WINTHROP, DASS Date.


4/23/1963


6 Tiferath Israel of Winthrop EverETT


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


April 23


1963


7 NAME OF


FUNERAL DIRECTOR


Arnold Golov


ADDRESS 1668 Beacon ST. Brockline


Recepred and filed


APR 2.4 1963


Charles it Mackie


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


widowerl


11 If married, widowed, or divorced HUSBAND ol


(Give maiden name of wile in full)


(or) WIFE of


Joseph Kalish


(Husband's name in full)


12


AGF 62 Years.


.Months.


.. Days


If under 24 hours


Hours ........ Minutes


13 l'sual


Occupation :


Housewife


( Kind of work done during most working life)


14 Industry


or Business :


AT Home


15 Social Security No ..


None


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


Levi Golden


18 BIRTHPLACE OF


FATIIER (City) ..


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


CNBL


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


Russia


Ave. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death hled with me BEFORE the bug l or 'transit permit was issued:


Signature of Agent of Board of Healthor other) /


16338


11/13/63


(Date of Issue of Permit)


V.


A TRUE COPY ATTEST:


......


St Winthrop


(If nonresident, give city or town and State)


2 FULL NAME


Eva (Golden) Kalish


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


(City or Town making this return)


1


Princeton Shelby Nursing Home


103


PARENTS


Myer Press, 35 Mermaid


21 Informant


( Address)


(Registrar)|| (Official Designation)


-


4


to ...


April 22


INTERVAL BETWEEN ONSET AND DEATH 6yrs.


RECEIVED


TOWN


0


OFFICE


NIN


GLERK


W


ROP. MASS.


JULI 8 1963 AM


City Registrer


Charles H. Mackie


AUF) ONLY ATTESTI


X 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)


04828


Registered No.


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


2 FULL NAME


JOSEPH BRENDEN SHEA


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


(a) Residence. No.


35 SIREN ST


(Usual place ol abode)


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


.years.


2


months.


......


days. In place of residence 33 years.


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May


4


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


an


19


to ...


63


May 4


19.63


I last saw hondlive on


may


05, 1963, death is said to


have occurred on the date stated above, at


5A m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


CEREBRO VASCULAR ACCIDENT


INTERVAL BETWEEN ONSET AND DEATH 3 mos


Due


ARTERIO SCLEROSIS


(b)


Due To (c)


OTHER


DIABETES MELLITUS YOU


SIGNIFICANT


CONDITIONS


DUODENAL ULCER JO


Was autopsy performed ?


No


What test confirmed diagnosis ?


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


No


(Signature)


Johnadams fr R


M. D.


1JOHY


ADAMS


(Print or Type Name) (Address) 704 HUNTINGTON AtDate.


5/4


19.


63


6 NEW CALVERY


BOSTON


Place of Burial or Cremayon


(City or Town)


DATE OF BURIAL MAY 1 16 3


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY.


ADDRESS WINTHROP,


Received and fled


MAY 8 1963


Charles ? Mackie ( 6)}]


11/11/19631


( Registrar )|| (Official Designation)


(Date of lsue of Permit)


V.I.V


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


MALE


9 COLOR


WHITE


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


WIDOWED


11 If married, widowed, or divorced


HUSBAND of CATHERINE


HURLEY


(Give maiden name of wile in fun)


(or) WIFE of ...


( Husband's name in full)


12


AGE. 76 Years.


Months.


.... Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


MANAGER


( Kind of work done during most working lile)


14 Industry


or Business:


FIRST NAT STORES


15 Social Security No 028-05-3878


IRELAND


16 BIRTHPLACE (City)


(State or country )


17 NAME OF


FATHER


MICHAEL SHEA.


18 BIRTHPLACE OF


FATHER (City)


IRELAND


(State or country)


19 MAIDEN NAME


OF MOTHER


MARY FLAYHIVE


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


IRELAND.


21 Informant


MISS, MARY R. SHEA


( Address)


35 SIREN ST WINTHROP MASS


I HEREBY CERTIFY that a satisfactory standard certifcate of death was hled with me BEFORE the burial or transit permit was issued: 1


1


1,2-932382


PLACE OF DEATH


d for burial permit loard of Health its Agent. TRUCTIONS FOR IL CERTIFICATE


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


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


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


sditions contrib- , death but mot to the terminal condition given


331


1. 9-1963


1


BOSTON


(City or Town)


BARKER HILL HED, CENTRE N


St


(Was deceased a


U. S. War Veteran,


il so specily WARY


No


WINTHROP


(Il nonresident, give city or town and State)


----


(a)


FORM R-301


PARENTS


(Signature of Agent of Board of Health or other)


BOSTON


That I attended deceased from


A TRUE COPY ATTEST:


Charles It. Mackie City Registrar


KERK


..


0


THROP


JUL - 91963 AM


ORM R-301


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


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


does mat mean de of dying, heart failure, etc. It means ase, or campli- which caused


tions, if any, rave rise to cause (a), : the under- cause last.


ditians contrib- death but mat to the terminal condition given


260 63


I Director luse only i.K Ink. 9- 1963


·2-932382


PLACE OF DEATH


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


2 FULL NAME.


Loretta Thompson


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


PHYSICIAN - IMPORTANT


-


(Was deceased a


U. S. War Veteran,


if so specify WARY


No


(a)


Residence. No.


142 Pleasant St.


.. St


Winthrop


Mass.


(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


9 COLOR


Female White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOW


Vilaved


4 I HEREBY CERTIFY,


That He attended deceased from


19


April 24


63


May 5,


to,


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


May .... 5,


19.


63 death is said to


have occurred on the date stated above, at 6 ... am ......... m.


(or) WIFE


(Givy maiden name of wife in full)


HENRY U. THOMPSON


(Husband's name in full)


12


AGE/


75 Years.


Months.


.. Days


lf under 24 hours


Hours .. .... Minutes


13 Usual


Occupation :


Housework


(Kind of work done during most working life)


14 Industry


or Business :


OWN Home


15 Social Security No CNBL


16 BIRTHPLACE (City) SQUANTUM


(State or country)


MASS


17 NAME OF


FATHER


Joshua C. Small


18 BIRTHPLACE OF


FATHER (City).


(State or country)


MAINE


19 MAIDEN NAME


OF MOTHER


CLARA TRACEY


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


News BRUNSWick


21 Informant


Avis CLARK


(Address) 10 HAVRe St. East Boston


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


(Signature of Agent of Board of Health or other)


606752


5-6-63


(Date of Issue of Permit)


A TRUE COPY ATTESTI


5 Yrs


Due To


(c)


Thyroid


OTHER


Diabetes Mellitus


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)


M. D.


.Charles .. L .... Clay ... M. Da.


(Print or Type Name)


(Address) Aan's Dir .. Maas Gon'l. Hosp.


... Date


May 5, 63


Winthrop Winthrop


Place of Burial « Cremation


(City or Town)


DATE OF BURIAL


MAY 7


63


7 NAME OF


FUNERAL DIRECTOR RedeRICK J. MAGRATH


ADDRESS East Boston


MAY _8 1953


Received an hled


Charles A. Mackie


19.


11 If married, widowed, or divorced HUSBAND of


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Myxodma


INTERVAL


BETWEEN


ONSET AND


DEATH


5 Yrs


(a)


X SUFFOLKOF- TOWN


(City or Town making this return)


04866


NMASSACHUSETTS GENERAL HOSPITAL


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


3 DATE OF


DEATH


May ... 5,


(Month)


(Day)


(Year)


1963


(write the word)


Due To


Idiopathic atrophy of


(b)


unk


Yrg


.....


PARENTS


(Registrar)|| (Official Designation)


A TRUE COPY ATTENT: Charles H. Fre ckie


JUL -91963 AM


ORM R-302


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


m


Medical Examiner Waivere The Commonwealth of Massachusetts Jurisdiction


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


Revere


(City or Town making this return)


COPY OF


Registered No.


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


Agnes Hodgkins (Finlayson)


2 FULL NAME


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


115 a Summit Ave.


St


Winthrop


(a)


Residence. No ..


(Usual place of abode)


1


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


MEDICAL CERTIFICATE OF DEATH


May


15,


1963


(Month)


(Day)


(Year)


4.1 HEREBY CER


TIFY,


That I attended deceased from


viay


V


te ...


May 15


63


death is said to


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


10:45A


have occurred on the date stated above, at


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Uremia


Due To


Cerebral thrombosis


lwk.


3yrs .


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Widowed


11 If married, widowed, or divorced


HUSBAND of


Ralph (Giromigen namesof wife in full)


INTERVAL BETWEEN ONSET AND (or) WIFE of DEATH 12 hours . 86 1


14


Months


Days


If under 24 hours


Hours


Minutes


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


At home


or Business :


15 Social Security No2017


16 BIRTHPLACE (CiNew Brunswick, Canada (State or country)


17 NAME OF


FATHER


Murdock Finlayson


18 BIRTHPLACE OF


FATHER (City)


(State or country)


New Brunswick, Canada


19 MAIDEN NAME


OF MOTHER


Adeline Petley


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


"New Brunswick, Canada


Robert Hodgkins


21 Informant


(Address)


40 Taylor St., Winthrop


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


May


20,


063


DATE FILER


(Registrar of City or Town where deceased resided)


SOM - 10.61.931673


C.


PLACE OF DEATH'S


Suffolk


(County)


I


Revere


(City or Town)


Grover Manor


No ..


3 DATE OF DEATH (a) (b) 6 · 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 CONDITIONS


No


Was autopsy performed ?


Clinical signs


What test confirmed diagnosis ?


No


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


M. D.


5/15


63


(Address) ...... Everett.


Date


19


Winthrop Cemetery


Winthrop


I'lace of Burial or Cremation


May


18,


63


19.


DATE OF BURIAL


7 NAME OF


Ernest P. Caggiano


FUNERAL DIRECTOR


ADDRESS


147 Winthrop St. ,Win hrop


Received and filed


JUN 14 1963


19.


PERSONAL AND STATISTICAL PARTICULARS


(Husband's name in full)


AGE


Years


Housewife


OTHER


Left hemiplegia


SIGNIFICANT


Due To


Hypertensive heart


disease


(c)


19


.. ,


19


(If nonresident, give city or town and State)


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


.days. In place of residence.


40


(Was deceased a


U. S. War Veteran,


(if so specify WAR


T V. ....


PARENTS


(Signed)


537 Broadway


TAFEL OVIETEM


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


JUN 1 41063 AM


ORM R-302


WRITE PLAINI.Y, 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


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


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


1


PLACE OF DEATH


Middlesex


(County)


OVIETEM


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


COPY OF CERTIFICATE OF DEATH


Registered No.


f(If death occurred in a hospital or institution,


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


2 FULL NAME .....


ANNA L. CANAVAN


(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 ........


43 Hutchinson


(Usual place of abode)


.St ..... Winthrop.


Massachusetts


(If nonresident, give city or town and State)


Length of stay: In place of death.


5 years .6 months 15 days. In place of residence ...


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Single


4 I HEREBY CERTIFY , That I attended deceased from


163


Me ... 22.


...... ,


1963, to.


May22


I last saw hGaalive on


Hay 22


19 ... 633death is said to


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


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL BETWEEN ONSET AND DEATH ?


12


AGE 74 Years.


7 Months.


2


Days


If under 24 hours


Hours .......


Minutes


Due To


(b)


Arteriosclorotic ..... Heart


Due To


(c)


........ Generalized Arteriosclerosis


14 Industry


or Business :


15 Social Security No ...


Cannot Icarn


Boston


16 BIRTHPLACE (City)


(State or country)


Marsachusetts


Was autopsy performed ?


no


What test confirmed diagnosis ?


clinical


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


(Signed)


M. D.


W.


Hanna


19 MAIDEN NAME


OF MOTHER


Emma L. Dubberley


20 BIRTHPLACE OF


Nova Scotia


MOTHER (City)


(State or country)


Canada


Holy Cross Cemetery


L'alden


....


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL May 25 19. 63


Waltham 54, Massachusetts


7 NAME OF


FUNERAL DIRECTOR


OMlilley .... Funderal .... Home


ADDRESS Winthrop, Leseschusetts


A TRUE COPY


ATTEST:


James J.


Carroll


(Registrar of City or Town where death occurred)


DATE FILED


May .... 27


16.3


.......


(Registrar of City or Town where deceased resided)


PARENTS




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