Town of Winthrop : Record of Deaths 1963, Part 25

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 25


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


OF TOWN


OFFICE O


7 12.1


10.


NIK


CLERK :N


4


(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.


WI


6.5


HR


(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.


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- JUL [1 11963 AMtant, 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 I PLACE OF DEATH


SUFFOLK .........


(County)


BOSTON


(City or Town)


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


GUT


OF - TO21 ....


(City or Town making this return)


Registered No.


05222


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


2 FULL NAME


Baby Girl .Başch


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


(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.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Single


11 1f married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


HOURS. Years.


Months ...........


Days


If under 24 hours


Hours


20 Iinutes


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


or Business :.


15 Social Security No.


MONTHS16 BIRTHPLACE (City)


Boston


(State or country)


17 NAME OF


FATHER


C.N.B.L.


18 BIRTHPLACE OF


FATHER (City) ..


(State or country)


C.N.B.L.


19 MAIDEN NAME


OF MOTHER


Ann P. Basch


Winthrop,


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Mass,


21 Informant


Ann P. Basch


(Address)


210 Shore Drive, Winthrop, Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Richard Forman QW. (Signature of Agent of Board of Health or other)


16585


5-15-63


(Official Designation) (Date of Issue of Permit)


A TRUE COPY ATTEST:


1963


(Day)


(Year)


4 I HEREBY


May 10,


63


19


RTIFY


That Heattended deceased from


May 10,"


63


veI last saw heralive


May .... 10,


1963, death is said to


have occurred on the date stated above, at ...... 2 :102 ... m.


DEATH WAS CAUSED BY :. IMMEDIATE CAUSE


(a) .PREMATURITY.


I I/3


Due To (b)


Due To (c)


PULMONARY ANECTASIS


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


Yes


What test confirmed diagnosis ? Autopsy


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


If so, specify ....


(Signature)


M. D.


Charles L. Clay, M.D." (Print or Type Name) (Address) Ass'ti Dinvy Meser Gen'h. Hep .... .DatMay10, 1963


Gethsemane Cemetery Boston, Mass.


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


May


15.


19


63


7 NAME OF


Eastman Funeral Service Inc.


FUNERAL DIRECTOR


ADDRESS


896 Beacon St., Boston, Mass.


Received and filed


MAY 1 7 1963


19


Charles it Mackie


(Registrar )|


.......


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


210 Shore Drive


St


Winthrop,


Mass ..


DEATH


DECLINED BY MEDICAL EXAMINER


R-301


urial permit f Health ;ent. ONS


IFICATE


TYPE AUSES TH ter one each nd (c) ot mean dying, failure, It means compli- caused


/ any, rise to (a). under- last.


contrib- but not terminal riven


16 35 1963 ctent only k. 2382


May .... 10,


(Month)


to ...


INTERVAL


BETWEEN


ONSET AND


DEATH


PARENTS


X


NOMASSACHUSETTS.GENERAL .. HOSPITAL


A TRUE COPY ATTEST:


Williamh Kane. City, Registrar


TO:


KLERK


6


YROR


JUL 251963 PM


1


301


I


BOSTON


(City or Town)


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


122 OUT - OF - TATOTT To be filed for burial permit with Board of Health or its Agent.


Registered No.


05236


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Ruby H. Walton


(Berry)


(First Name)


(Middle Name)


(Last Name)


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


61 Washington Avenue


(a) Residence. No.


(Usual place of abode)


1


months.


26


days.


In place of residence.


40 years


.months.


......


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 CITIZEN


OF U.S.


YES


NO


II SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


4 I HEREBY CERTIFY,


Mar.c.h ..... 18 .. ,


.19 ... 6.3. ... May 14, ....


.. 1.96.3


That weattended deceased from


le last


h.a.Blive


May 14,


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


have occurred on the date stated above, at


5:27P ... m.


INTERVAL BETWEEN ONSET ANO DEATH


12 DATE OF BIRTH


Dec. 11 1669


AGE


73


Years ...


5


.Months.


3


.. Days


If under 24 hours


....


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


Due To


OEsophageal and Gastric Varites


Due To


"Nutritional Cirrhosis


OTHER


SIGNIFICANCoronary Heart Disease


CONDITIONS


years


16 Social Security No.


018-16-4495


rest Medway


17 BIRTHPLACE (City)


(State or country)


Massachusetts


18 NAME OF


FATHER


Charles Berry


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Unable to obtain


(Signed)


M. D.


Cheries L. Cl., M. D.


(Print or Type Name)


(Address)


Ass's, Dir., Mose Gon'%. Hosp. Date.


5/15/ .19.63 19


6 Winthrop


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Liay


17


19 ...


53


7 NAME OF


FUNERAL


DIRECTOR


Howard S Reynolds


ADDRESS Winthrop, L'ass


I HEREBY CERTIFY that a satisfactory standard certificate of death


was filed with me BEFORE the burial or transit @ermit was Issued:


Carolyn Ware


Received pod Bied


1 ... 19 Charles it Mackie


(Signature of Agent of Board of Health or other)


16598


5-16-65


(Official Designation)


(Date of Issue of Permit)


T


A TRUE COPY ATTEST:


3


-


any, se to (a), nder- last. contrib- but not erminal given


137. requires print or ause or cath on ates, and Acts of s Physi- t or type ignature.


1963 ten aly k.


PLACE OF DEATH


SUFFOLK


(County)


No.


Massachusetts General Hospital BAKER MEMORIAL


...........


[(Was deceased a U. S. War Veteran,


{if so specify WAR)


Xx


Winthrop, Massachusetts


(If nonresident, give city or town and State)


3 DATE OFMay 14,


DEATH ..


1963


(Month)


(Day)


(Year)


lla If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Frank E nalton


(Husband's name in full)


5 days3


14 Usual


Occupation :


Clerk


(Kind of work done during most of working life)


years 15 Industry


Cemetery Office


or Business :


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


@c.@low


PARENTS


20 MAIDEN NAME


OF MOTHER


Lillie Mac Intosh


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Unable to obtain:


22


Marguerite Walton


Informant


(Address)


Washington avC. winthrop, la


MAY 21 1963


(Registrar)


NS


FICATE


EATH er one ach d (c) mean dying, failure, means compli- caused


Length of stay: In place of death.


years ..


19


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)Gastrointestinal Hemorrhage


years


A TRUE COPY ATTEST:


--


Williamal Kane. City Registrar


1


X


PLACE OF DEATH


Suffolk (County) Boston


(City or Town)


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


OUT OF TOWN


(City or Town making this return)


STANDARD


CERTIFICATE OF DEATH


Registered No.


05382


)


[(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)


No


(a) Residence. No.


(Usual place of abode)


293 BowDown St. Winthrop,


Massachusetts


(City or town and State)


Length of stay: In place of death years months/ 4 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


DIVORCEDMARRIELL


11 If married, widowed, or divorced


HUSBAND of ..


Rocc"


DiNODIA


(Husband's name In full)


12


AGE/


76


Years


Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Housework


Occupation :


(Kind of work done during most of iworking life)


14 Industry


or Business :


OWN Home


15 Social Security No CNBI


16 BIRTHPLACE (City).


(State or country )


BOSTON, MASS.


17 NAME OF


FATHER


DANIEL RING


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Boston


mass.


19 MAIDEN NAME


OF MOTHER


Catherine Flaherty


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


MASS.


Boston


21 Informant


Robert Di Nubla


243 Bowdoin St. Winthrop


I HEREBY CERTIFY that a satisfactory standard certifcate of death filed with me BEFORE the burial or transit permit was issued: 7.P. Graça B 01280 (Signature of Agent of Board of Health or other) may 21,1963


Received and


MAY 23 1963' Charles it mackie


......


(Day)


(Year)


4 IHEREBY CERTIFY, That I attended deceased from


May 6


19 63


, to May


20


1963


I last saw heralive on


May


20


1963, death is said to


have occurred on the date stated above, at


4:10 pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Pneumonia LabAR


Due To


Intestinal Obstruction


(b)


Due To


Diverticulitis, sigmoid Colon


(c)


OTHER


SIGNIFICANT


CONDITIONS


Pulmonary Tuberculosis


20 yrs


Was autopsy performed ?


No


What test confirmed diagnosis ?


operation-5-7-63


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


(Signature)


Causale 7 minton. 8


M. D.


Russell F. Minton, JI


(Address)


(Print or Type Name)


Beth Israel Hosp. Date 5-20 1963


New CALVARY


Boston


Place of Burial or Cremayon


MAY 22


,63


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Frederick J. MAGRATH


EAST BOSTON


ADDRESS


PARENTS


A TRUE COPY ATTEST:


(Registrar)|| (Official Designation)


(Date of IQue of Permit)


Xi €


-


urial permit of Health gent. ONS


IFICATE


TYPE AUSES TH ter one each nd (c) of mean dying, failure, It means compli- caused


y any, rise to (a). under- last.


contrib- but not terminal on given


54


1963


Lo4


3 DATE OF


DEATH


(Month)


MAY


20


1963


(write the word)


(Give maiden name of wife in full)


(or) WIFE of


INTERVAL


BETWEEN


ONSET AND


DEATH


10 days


14 days


7


(City or Town)


123


BETH ISRAEL HOSPITAL No MARY DiNUBLA


R-301


A TRUE COPY ATTEST:


Williamf. Kane. City, Registrar


,


PLACE OF DEATH


Suffolk


(County)


-


Boston


(City or Town)


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


CERTIFICATE OF DEATH


124


OUT - OF -TOWN OWN


(City or Town making this return)


Registered No.


05261


[(If death occurred in a hospital or institution,


No


St. { give its NAME instead of StEss! Anf PHYSICIAN - IMP number)


2 FULL NAME


M. Augustus L. Norris


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


(a) Residence. No.


37 Bay View Ave.


St.


Winthrop, Mass.


(City or town and State)


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


O days. In place of residence6 ..... years ....... months ......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWEMMarried


DIVORCED


UNKNOWN


11 lf married,


Ruth Gilbert


HUSBAND of


(Give maiden name of wife in fuil)


(or) WIFE of.


(Husband's name in fuli)


12


AGE 57 ... Years.


Months ....


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Welder


(Kind of work done during most of iworking life)


14 Industry


or Business :.


U ...... S ...... Arsenal


15 Social Security No .. 012-14-4423


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


17 NAME OF FATHER Augustus W. Norris


18 BIRTHPLACE OF


FATHER (City).


Halifax


(State or country)


Nova Scotia


19 MAIDEN NAME


OF MOTHER


Ellen G. Lane


20 BIRTHPLACE OF


MOTHER (Clty)


East Boston


Mass


(State or country)


21 Informant


Ruth Norris


(Addres


37 Bay View Ave.


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


(Signature of Agent of Board of Health or other)


67500


Anna 1/453


(Official Designation) ( Date of Issue of Fermit)


THEV 1


S


CATE


PE JSES 1


r ne ch (e) mean dying, allure, means ampli- caused


ERy. e la (a). der- last . ontrib. ut sat rminal given


Was autopsy performed?


Yes.


What test confirmed diagnosis ?


AUTOPSY.


S Was disease or injury in any way related to occupation of deceased? NO If so, specify - (Signature) C.K. GORMAN. M. D. 51stmay 1963 PARENTS


(Print or Type Name)


(Address N.E. DEACONESS 800? Date


6 Winthrop Cemetery Winthrop


Place of Buria! or Cremation


(City or Town)


DATE OF BURIAL June 3,


19 .63


7 NAME OF


FUNERAL DIRECTOR


ArthurJ .0' Maley


.. ...


ADDRESS


Winthrop, Mass


Received and filed


JUN


4 .... 1963


.19


Marcel, Manning


ASSY


A TRUE COPY ATTEST:


May 31, 1963


(Month)


(Day)


(Year)


4I HERENY CERTIFY


May 25,


19


to ..


63


May 31,


19.


63


I last saw h. imlive on


May .... 31,


have occurred on the date stated above, at


1:30 .... P.n.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


CORONARY ARTERY OCCLUSION.


19.63


death is said to


INTERVAL


BETWEEN


ONSET AND


DEATH


I WR.


(a)


Due To ARTERIOSCLEROTIC HEART DIREASE (b)


2mo


1YRS


OTHER


SIGNIFICANT


CONDITIONS


DIABETES MELLITUS.


(c) ......


-


61 170


963


R-301


al permit Health t.


New England Deaconess Hospital


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


No


(Usual place of abode)


(write the word)


3 DATE OF


DEATH


That 1 attended deceased from


(Registrar)|


A TRUE COPY ATTEST:


William& Kasse: City REBRESF


Of=TOW


ERKERK ET? NTHROR NA'S


1.


6


JUL 2/51963 PM


JUL 251963 PM


-302


PLACE OF DEATH


Suffolk (County)


Chelsea (City or Town)


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


125


Chelsea


(City of Town making this return)


Registered No.


3.46


[(If death occurred in a hospital or institution,


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


2 FULL NAME ...


Mary ...... Douglas


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


(Was deceased a


U. S. War Veteran,


if so specify WAR


(a) Residence. No ...


(Usual place of abode Loring Road


.........


S


Anthrop Hass


(If nonresident, give city of 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


(write the word)


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


Single


Female


White


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.88


Months ..... 7 ... Days


If under 24 hours


Hours ........ Minutes


Arterioselerotie heart


Due To


(b)


disease


1 mo.


Due To


(c)


Arteriosclerosis


OTHER


SIGNIFICANT


CONDITIONS


"Lobar pneumonia


2 wks


Was autopsy performed ?


.no


What test confirmed diagnosis ?


x-ray & clinical


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


(Signed)


CharlesJ.Ferrera


M. D.


(Address)


154 Bennington St. 6/14/63


Fast Boston, Mass.


6


Winthrop, Mass


(City of


DATE OF BURIAL


June ...... 17. 1963


19


7 NAME OF


FUNERAL DIRECTOR Howard .... S.Reynolds


ADDRESS


Winthrop,Mass.


Received and filed


AUG 5 1963


19


(Registrar of City or Town where deceased resided)


21 Informant


Margery ..... Fenton


(Address)


39 Lovejoy Rd., Andover, Mass.


A TRUE COPY


Joseph a. Tyrrell


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


June 16,1963


TUBI .19


1


17 NAME OF FATHER Alexander Douglas


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Scotland


19 MAIDEN NAME


OF MOTHER


Margaret Alexander


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Scotland


50M · 10-61-931673


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


1


(Month)


4 I HEREBY CERTIFY, That I attended deceased from


May 1


1963 ...


to ........... June 14


death is said to


I last saw h .. palive on


June 14


19.6.3


have occurred on the date stated above, 4 p


.111.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL


BETWEEN


ONSET AND


DEATH


(a)


13 Usual


Occupation :


Bookkeeper


(Kind of work done during most working life)


14 Industry


or Business :.


Publishing Co.


15 Social Security No .. 013-07-8487.


16 BIRTHPLACE (City)


(State or country)


Boston, Mass.


PARENTS


3 DATE OF


DEATH


June 14, 1963


(Day)


(Year)


No.Chelsea Memorial Hospital


SPACE FOR ADDITIONAL INFORMATION


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


1:


6


HRAD


AUG | 51963 AM


×


R-302


PLACE OF DEATH


Essex Gloucester


(County )


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


126


Gloucester


(City or Town making this return)


Registered No. .


No.


Addison Gilbert Hospital


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


2 FULL NAME.


Mabel Sophia Doleman


( If deceased is a married, widowed or divorced woman, give also maiden name.) U. S. War Veteran. if so specify WAR,


126 Court Road


St inthrop


...... S.S.


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


( If nonresident, give city or town and State)


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


3


.days. In place of residence.O.


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


June


28


1963


3.


(Day)


(Year)


8 SEX


Female


9 COLOR


White


MARRIED


WIDOWED


Married


4 I HEREBY CERTIFY,


That I attended deceased


from


April 50 June 28


19.


to ...


June 28


63


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


INTERVAL


BETWEEN


ONSET AND


DEATH


(or) WIFE of ..


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


Years ..


0


MonthsO


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housewife


( Kind of work done during most of working life)


14 Industry


or Business :


Own Home


15 Social Security No. 10-05-8370B


lockeport, N. S.


16 BIRTHPLACE (City)


(State or country)


Canada"


17 NAME OF George H. hiltz


18 BIRTHPLACE OF


Lockeport, N.S.


FATHER (City)


(State or country )


Canada


19 MAIDEN NAME


OF MOTHERAGE Letilia Crowell


20 BIRTHPLACE OF


MOTHER (City )


(State or country )


Nova scotia


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July


1,


19


7 NAME OF


FUNERAL DIRECTOR


Arthur J. OMaley


ADDRESS


inthro,


Mass .


Received and filed


JUL 17 1963


.. 19


DATE FILED,


(Registrar of City or Town where death occurren)


.


14/ 03


( Registrar of City or Town where deceased resided )


PARENTS


( Signed )


C. Bruce Brown


( Address )


M. D.


Rockoort, Hass.


Date.


6/23


19


,03


inthrop 6


inthrop, Mass.


21 John Soloman


Informam ( Address+


A TRUE COPY


Fred


ATTEST :


Digrauz


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.)


50M-9-59-926111


Due To (c)


OTHER


Aplastic anemia


1 mo.


SIGNIFICANT


CONDITIONS


NO


Was autopsy performed ?


What test confirmed diagnosis ?Ificar


NO


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


5 dys


10a If married, widowed. or giyersed Edgar Doleman


HUSBAND of


(Give maiden name of wife in full)


I last saw


er


...... alive on


, ..... , 19 ...


death is said to


4:55P


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Cerebral vascular thrombosis


(a)


Due


Arteriosclerosis


(b)


1


(City or Town)


( Was deceased a


10 SINGLE


( write the word)


(Month)


1963


SPACE FOR ADDITIONAL INFORMATION


THEOR


DATE OF ENTERING MILITARY SERVICE


JUL 1 71963 AH


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


R-302


Copies of returns of deaths which occurred in your city of town in case the deceased resided in another city of town Due To (c) 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


50M - 10-61.931673


PLACE OF DEATH


Suffolk


(County)


Revere


(City or Town)


No


Harry Clinton Beless


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


338 Pleasant


(a) Residence. No ..


(Usual place of abode)


14


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


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Married


11 If married, widowed denceKendall Farrand HUSBAND of


(or) WIFE of.


(Husband's name in full)


80


1


12


AGE


Years


Months ..


15


.Days


If under 24 hours


Hours .......


Minutes


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


Hospital supplies


or Business :


012-03-1968


15 Social Security No ....


Heegham


16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF


FATHER


John Henry Beless


18 BIRTHPLACE OF


Needham


FATHER (City)


(State or country)


Mass.


19 MAIDEN NAME


OF MOTHER


Mary Lee


20 BIRTHPLACE OF


MOTHER (City)


(State or country )


Mass.


Brookline


Theadore L. Beless


21 Informant


(Address)


338 Pleasant St., Winthrop


A TRUE COPY


ATTEST:


DATE FILED


(Registrar of City of Town where death occurred)


July


2,


1963


T VED


...


Due To (b)


OTHER


SIGNIFICANT


CONDITIONS


No


Was autopsy performed?


Clinical, Pathological


What test confirmed diagnosis ?


no ......


(Signed)


M. I).


(Address)


Winthrop


6/30


63


Date


19


Winthrop Cemetery 6


Winthrop


Place of Burial or Cremation


July


2,


(City or Town)


63


19


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


174 inthrop St., Winthrop


ADDRESS


Received and filed


JUL 12 1963


19 ..


(Registrar of City or Town where deceased resided)


PARENTS }


127


Revere


(City or Town making this return)


Registered No.


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


(Was deceased a


U. S. War Veteran,


NO


(if so specify WAR,


Winthrop


.. St ...


(If nonresident, give city or town and State)


30


3 DATE OF


DEATH


June


29.


1963


(Month)


(Day)


(Year)


August


19


to.


June


29


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


9: 15A .


have occurred on the date stated above, at


111.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Cancer of Breast


(a)


INTERVAL BETWEEN ONSET AND DEATH


19


63,


death is said to


Y


CERTIFY


"Juflet I meyded deceased (fran


Male


(Give maiden name of wife in full)


Retired salesman


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


If so, specify


Charles Liberman


DATE OF BURIAL


Ocean View Manor


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


1


2 FULL NAME.


SPACE FOR ADDITIONAL INFORMATION


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


1


JUL 1 21963 AMI


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


128


(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


Roslyn May Paro (Doane)


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


587 Pleasant Street


St


(If nonresident, give city or town and State)


Length of stay: In place of death ...


3


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


days. In place of residence 25 years 7 months 0 days.




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.