Town of Winthrop : Record of Deaths 1963, Part 28

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 28


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


(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.


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.


137


(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


No


(a) Residence. No ..


18 Cottage Ave


St


(If nonresident, give city or town and State)


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


1.Gays. In place of residence .. 20years.


... months ...


... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


July


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


Match, 1962


to ..


July


15


63


I last saw h.CYalive on 14, 1963, death is said to


have occurred on the date stated above, at 6:10A. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Career of Pancreas


Due To


(b)


Due To (c)


OTHER


Status post hysterectomy ctos,


CONDITIONS


Was autopsy performed ?


Yes


What test confirmed diagnosis? Clinical, surgical.


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


(Signature)


M. D. CHARLES LIBERMAN


(Print or Type Name)


(Address)


WINTHROP


Date.


7/15/1963


.S.t ...... Patricks, .... Lowell ...... Mas.s.


0


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 17, 1963


19


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS


Winthrop, Mass.


Received and filed


JUL 15 1963


19


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


(write the word)


WIDOWERSingle


DIVORCED


UNKNOWN


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


(or) WIFE of.


(Husband's name in full)


12


AG 45


Years.


Months ...


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


SchoolTeacher


(Kind of work done during most working life)


14 Industry


or Business :.


Education


15 Social Security No.


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


Mass


PARENTS


17 NAME OF FATHER John ODonnell


18 BIRTHPLACE OF


FATHER (City) ..


Holyoke


(State or country)


Mass


19 MAIDEN NAME


OF MOTHER


Anastasia Downing


20 BIRTHPLACE OF


MOTHER (City)


Lowell


(State or country)


Mass


21 Informant


Esther O'Donnell


(Address)


18 Cottage Ave,, Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 5. Siria


(Signature of Agent of Board of Health or other) (NP) Health Officer July 15, 1963


(Date of Issue of Permit)


THE.V


1


I permit ealth


ATE


E ES


c)


sean ling, sare eans spli- used


y, to


trib- not inal iven


-301


(City or Town making this return)


Winthrop Community Hospital No.


2 FULL NAME. Kathleen D. O'Donnell


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


(Usual place of abode)


15


1963


That I attended deceased from


INTERVAL BETWEEN ONSET AND DEATH 6 anos


A TRUE COPY ATTEST:


(Registrar) (Official Designation)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


[THROP


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice: JUL 20103 MI


(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.


DIA


1


WINTHROP


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


138


2 FULL NAME


Alfred H. Queenan.


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


47 Loring Rd.


Winthrop


St.


(If nonresident, give city or town and State)


Length of stay: In place of death


1


.. years.


4


months


3


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


months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED Widowed


WIDOWED


or DIVORCED


4 I HEREBY CERTIFY, That I attended deceased from


Sept. 1956


65


to


14416


19.


I last saw h ..... Yafive on


July 16/ 1963, death is said to


have occurred on the date stated above, at


11:15Pm.


INTERVAL


BETWEEN


ONSET ANO


11 IF STILLBORN, enter that fact here.


(Husband's name in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Cerebral Hemorrhage ....


Due To typertension and cerebral (b)


Arteriosclerosis,


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


None.


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 ....


(Signed)


Charles Liberman, M.


I. D.


CHARLES LIBERMAN


(PRINT OR TYPE SIGNATURE)


(Address) WINTHROP, MASS Date.


1/16/1963


Cambridge Catholic Cambridge


Piace of Burial or Cremation DATE OF BURIAL


July Igy or Town) 19


1.63


7 NAME OF


FUNERAL


Frederick J. Magrath 325 Chelsea St. East Boston. ADDRESS


Received and filed JUL 18 1963


(Registrar)


PARENTS


18 BIRTHPLACE OF


East Boston,


FATHER (City)


(State or country)


Mass.


19 MAIDEN NAME


OF MOTHER


Catherine Mccarthy


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Philadelphia


Penn.


21 Mildred Queenan.


Informant


(Address)


47 Loring Rd. Winthrop


I IIEREBY 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) (3)


Health Officer


July 13, 1963


(Official Designation)


(Date of Issue of Permit)


1 x+ V


S


ICATE


ATH


r ne ch (c) mean dying, ailure, means om pli- caused


any, e to (a), der- last.


ontrib- ut not rminal given


r 137. quires int or le or h on s, and cts of Physi- r type ature.


$686


PLACE OF DEATH


SUFFOLK


(County)


No.


Mayflower Nursing Home


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


{(Was deceased a


NO


{ U. S. War Veteran,


[if so specify WAR)


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


3 DATE OF


DEATH


July


16


1963


(Month)


(Day)


(Year)


10a If married, widowed, or diANNA B. Burns ..


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


12


AGE ..


Years.


Months ...


.Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Shipfitter


(Kind of work done during most of working life)


14 Industry


or Business :


Retired


B. Naval Yard


15 Social Security No.


C.N. B. L.


16 BIRTHPLACE (City)


(State or country)


East Boston


Mass.


17 NAME OF


FATHER


John Queenan


DEATH


IWR.


77


4yrs


6


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


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


HRUR


JUL 1 81963 FH


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.


JUL 1 81003 EM


R-301


permit alth


CATE


PE SES


e h (c)


mean lying, sluTe, neans mpli- aused


ny, 10 a), ter- ast.


ntrib- ! no! minal given


Was autopsy performed ?


What test confirmed diagnos!


Clinical, Surgical Pathdag


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


No


(Signature)


Charles


Libe man,


M. D.


CHARLES LIBERMAN


(Print or Type Name)


(Address WINTHROP MASS Date.


7/19/1963


6


WINTHROP


NINTHRCI?


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


JULY 20


1965


7 NAME OF


FUNERAL DIRECTOR


MAURICE UN TIPBY


ADDRESS


WINTHROP.


JUL 19 1963


19


( Registrar )


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


WHITE


10 SINGLE


MARRIED


WIDOWED


DIVORCED


(write the word)


MARRIED


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


GALLANTE 19


(or) WIFE of


JOHNY.


(Husband's name in full)


12


41


. Months ..


.Days


Occupation :


(Kind of work done during most of iworking life)


14 Industry


or Business :.


CITY OF BOSTON,


15 Social Security No.


16 BIRTHPLACE (City)


(State or country }


MASS.


17 NAME OF


FATHER SALVATORE BATTAGLIA.


18 BIRTHPLACE OF


FATHER (City) .....


ITALY


(State or country)


19 MAIDEN NAME


OF MOTHER FRANCES, FISSICHELLA


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


ITALY


21 Informant


JOHN J GALLAHER


(Address)


37 CLIFF AVE WINTHROP.


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


(Signature of Agent of Board of Health or other)


Health Officer


July 19.1963


(Official Designation) (Date of Issue of Permit)"


4


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


(City or Town making this return)


BAY VIEW NURSING HOME STURGES 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.


HELEN DI BATTAGLIA) GALLAGHER


(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


37 CLIFF AVE


(Usual place of abode)


St WINTHROP


(City or town and State)


Length of stay: In place of death ........ years ......... months Ce days. In place of residence.


8


years.


months


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


July


17


1963


(Month)


(Đay)


(Year)


4 I HEREBY CERTIFY> That I attended deceased, from


Sept


1961


to ..


1414


19.,


1963


17


I last saw /He.Talive on


July 17, 1963, death is said to


have occurred on the date stated above, at


11:15 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Cancer of Beast


INTERVAL


BETWEEN


ONSET AND


DEATH


2/2 yrs


Due To (b)


Due To (c)


OTHER


Carcinomatosis to


SIGNIFICANT


CONDITIONS


Lung


NO


1/2 yrs


BOSTON


PARENTS


Received and filed


John allach


1


Registered No.


139


(a) · Residence. No ..


FEMALE


If under 24 hours


Hours


Minutes


13 Usual


SOCIAL WORKER


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.


JUL 101003 7:


R-301


1


PLACE OF DEATH


Suffolk Four (County) Winthropp (City or Town)/


REVERZ 89-5-8


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. 140


rial permit Health nt. IS


ICATE


YPE USES 1


ne ch (c)


mean dying, failure, means compli- caused


any, e to (a), der- last. contrib- ut not erminal given


-


Due


(c)


arteriosCLERutic heart disease


OTHER


SIGNIFICANT


CONDITIONS


CARDIAC FAILURE


1 day


Was autopsy performed?


What test confirmed diagnosis ?


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


(Signature) andre Catino, M. D. ANDREW CATINO M.D. (Print or Type Name) (Address) 603BROADWAY Date Lub 18 963


Revere Holy Cross Malder 6


Place of Burialof Cremation (City or Town)


DATE OF BURIAL


july 19


1963


7 NAME OF


FUNERAL DIRECTOR


Iamminis Sements


224 North st Boston


ADDRESS


..


JUL 18 1963


Received and filed 19


8 SEX


Familie


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


Widowed


11 1f married, widowed, or divorced HUSBAND of


(or) WIFE of.


achille Mauceri


(Husband's name in full)


12


83 Years.


Months.


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation


House Wife


(Kind of work done during most of working life)


14 Industry


or Business.


OWN home


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Lorenzo Pusti


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy.


19 MAIDEN NAME


OF MOTHER


Giuseppina Malica


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Joseph Maucerison


(Address)


79 Pitcairn st Revere


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


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


( N+3 )


July 18, 1963


(Date of Issue of Permit)


- X


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


(Month)


(Day)


(Year)


4 2


HEREBY CERTIFY,


July 13. 1962


to nal


17


That I attended deceased from 19.63


last say h.Cgalive on


have occurred on the date stated above, at .. 10 P. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


CARdiAC DeCOMPENSATION


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


2day


Due To (b)


2.0


ly 17-1963


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


Corrandina Mauceri


2 FULL NAME


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


79 Pitcairn


(a) Residence. No ..


(Usual place of abode)


10


.months.


days. In place of residence.


3 years.


.months.


... days.


Ridere Mars


.St.


(City or town and State)


s NA


[(If death occurred in a hospital or institution,


May Flower Nursing Hangi No


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(write the word)


196 3 death is said to


/Give maiden name of, wife in full)


PARENTS


21 Informant


( Registrar)| (Official Designation)


53


-


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


1


6


19


ROP


JUL 1 81963 Při


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.


R-301


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.


141


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


Beatrice Macfarland


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


(a)


Residence. No.


46 Harbor View Ave. Winthrop


St


(Usual place of abode)


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


2days. 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 Widowed


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE o


Edwin Curtis Macfarland


(Husband's name in full)


12


AGE .. 68Years ... 6 ..


.Months .... 1.2Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Hotel .... Clerk


(Kind of work done during most working life)


14 Industry


or Business :


Hotel Services


15 Social Security No 030 03 5630


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


17 NAME OF


FATHER


Stephen E. Simmons


18 BIRTHPLACE OF


FATHER (City)


Framingham, Mass.


(State or country)


19 MAIDEN NAME


OF MOTHER


Minnie E. Spofford


20 BIRTHPLACE OF


MOTHER (City)


Unknown Wayland


(State or country)


Mass.


21 Informant


Edwin.E. Macfarland Ison)


( Address)


46 Harbor View Ave. Winthrop, Mass


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


(Signature of Agent of Board of Health or other)


Werethe officer


Julia 19, 1963


( NP3 )


(Official Designation)


(Date of Issue of Permit)


-


V


rial permit Health nt. NS FICATE


YPE USES H


er one ach d (c)


t mean dying, failure, means compli- caused


any, se to (a), inder- last.


(c)


RHEUMATIC HEART DISEASE


50YRS


OTHER


SIGNIFICANT


CONDITIONS


NONE


Was autopsy performed?


No


What test confirmed diagnosis? EKG.X-RAY


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


(Signature)


Dorthy Cheney appleton


M. D.


DOROTHY CHENEY APPLETON


(Print or Type Name)


(Address)


197 Woodside AVE Date


7/18


19 63


WINTHROP, MAJS


6


.Woodlawn .... Crematory


Everett Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July22 1963


19


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


ADDRESS


174 Winthrop St. Winthrop


Received and filed


JUL 19 1963


19


(Registrar)


A TRUE COPY ATTEST:


382


PLACE OF DEATH


Suffolk (County)


No .. Winthrop Community Hospital


2 FULL NAME


3 DATE OF


DEATH


JULY


18


1963


(Month) (Day)


(Year)


41HEREBY CERTIFY , That I attended deceased from JULY 16 63 to. JULY 18 19 63




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