Town of Winthrop : Record of Deaths 1963, Part 33

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 33


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


005 20


9


WINTHRO


[ R-301


rial permit Health ent. ONS


IFICATE


TYPE AUSES TH ter one each nd (e)


ot mean dying, failure, It means compli- caused


if any, rise to : (a), under- last.


contrib- but not terminal on given


PLACE OF DEATH


SUFFOLK (County)


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


CERTIFICATE OF DEATH


Registered No.


161


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


2 FULL NAM


GEORGE A HUNTER


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


(a)


Residence.


235 WASHINGTON AVE


St WINTHROP.


(City or town and State)


Length of stay: In place of death 44 years months.


days. In place of residence 4 years.


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Aug 26,


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from 19 19 to.


I last saw h ...... alive on 19 ....... , death is said to


have occurred on the date stated above, at 9:15Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Death presumably due


INTERVAL


BETWEEN


ONSET AND


DEATH


Due


(b)


Tto natural causes, probably


Due


(c)


acute coronary occlusion on


basis of history.


OTHER SIGNIFICANT CONDITIONS Winthrop Board of Health


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


element M. D.


CHARLES LIBERMAN


(Address)


WINTHROP,MASS Date ..


8/27/1963


WINTHROP


WINTHROP.


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


AUG 29


1943


7 NAME OF


FUNERAL DIRECTOR


MAURICE W. KIRBY


ADDRESS


WINTHROP , MASS


Received and filed


AUG 2 9 1963


19


(Registrar)


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


DIVORCED


(write the word)


MALE


WHITE


11 If married, widowed, or divorced


HUSBAND of MARY A


TRAINOR


(or) WIFE of.


(Husband's name in full)


12


AGE 6.6 Years Months


.Days


If under 24 hours


.. Hours ... . . Minutes


13 Usual


Occupation :


CLERK


(Kind of work done during most of working life)


14 Industry


or Business :


OFFICE


15 Social Security No 012-05-3079


10


16 BIRTHPLACE (City) ..


(State or country )


NB CANADA


17 NAME OF


FATHER


JOHN HUNTER


PARENTS


18 BIRTHPLACE OF


FATHER (City) ..


MONGTON


(State of country) MENETE NB CANADA.


19 MAIDEN NAME


OF MOTHER


WILLIAMS


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


MINSTON


N.B. CANADA


21 Info


MRS HARY HUNTER


(Address)


235 WASHINGTON AVE WINTHROP


I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued: Ralph 16 Serianni (Signature of Agent of Board of Health or other) Health officer august 29, 1963


(Official Designation)


(Date of Issue of Permit)


N.B.


3404


1


WINTHROP (City or Town)


235 WASHINGTON AVE


(City or Town making this return)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO


(Usual place of abode)


MARRIED


(Give maiden name of wife in full)


MONCTON!


(Print or Type Name)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


FF


0


ORGANIZATION AND OUTFIT


18


1


6


RULES OF PRACTICE AUG 2 91963 AM


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.


ERK


SERVICE NUMBER


OF TOMA


R-301


rial permit Health ent.


ONS


IFICATE


TYPE AUSES TH ter one each nd (c)


ot mean dying, failure. It means compli- caused


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


contrib- but not terminal on given


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. 162


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


2 FULL NAME JOSEPHINE L GRADY (O DONNELL


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


(a)


Residence.


040 WASHINGTON AVE


(Usual place of abode)


(City or town and State)


Length of stay: In place of death ......... .years .... month 50 days. In place of residence 25 years. months ... ... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED


DIVORCED


UNKNOWN WIDOWED.


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


EDMUND @ GRADY


(or) WIFE of ..


12 AGE 76 Years


Months ..


Days


13 Usual


HOME MANE


(Kind of work done during most of iworking life)


14 Industry


or Business :


HOME


15 Social Security No 017-26-4604


16 BIRTHPLACE (City)


EAST BOSTON


(State or country )


MASS


17 NAME OF


FATHER


JOHN, JO DONNELL


18 BIRTHPLACE OF


FATHER (City).


EAST BOSTIN


(State or country)


19 MAIDEN NAME


OF MOTHER


MARGARET PETERS


20 BIRTHPLACE OF MOTHER (City) (State or country)


PE.I.


. WINTHROP


WINTHROP.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


AUG 30.


19 63


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS WINTHROP, MASS


Received and hled


AUG 2 9 1963


19


( Registrar )


A TRUE COPY ATTEST:


(Day)


4 IHEREBY CERTIFY , That I attended deceased from


1962, toug27


19.63


I last saw he palive on Cinq 25


196 3 death is said to


have occurred on the date stated above, at 1:50pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Myocardial heart Niceare


Due


(b)


ThronecValvular Hear Ds


400


Due


(c)


arteriosclerosis gem


ANEURYSM


OTHER SIGNIFICANT abdominal Gorta aneurysm CONDITIONS Ca & colon


1 gr


W'as autopsy performed ?


NO


What test confrined diagnosis ?


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


ature) seple Pregaque M. D.


Joseph GREGORIE


(Print or Type Name)


(Address) 94 Washington Cel Date 8/29 1963


PARENTS


21 Informant


CHARLES J O'DONNELL


(Address) 146 MT VERNON RD MELROSE


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE.the burial or transit permit was issued: Piept 6 Sirianni (B) (Signature of Agent of Board of Health or other) Health officer Clignot 29,463


(Official Designation)


(Date of Issue of Permit)


3404


I


NO MAYFLOWER NURSING HOME 39 GROVERS


(City or Town making this return)


AVE


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


NO


St


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


aug


27


1963


(Year)


(Monthp


INTERVAL BETWEEN ONSET ANO DEATH


(Husband's name in full)


If under 24 hours


.. Hours. . .... Minutes


Occupation :


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OF TOWA .. 4.2.


0


OFF


NEW


Ti ERK


RULES OF PRACTICE


6 5


The fulfillment of the purpose of these laws calls for the observar following rules of practice:


Câncer


(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 if hode01963 PM persons who, though disabled by recognized disease unrelated to any form 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


rial permit Health ent. NS FICATE


'YPE USES H er one ach d (c)


t mean dying, failure, t means compli- caused


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


contrib- but not terminal n given . .


PLACE OF DEATH


Suffolk 1 .


(County)


Winthrop


(City or Town) 10/5 No.


Winthrop Community


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. 163


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


2 FULL NAME


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


9 Johnson Ave,


St


(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


3 DATE OF


DEATH


(Month)


(Day)


1963


(Year)


4 IHEREBY CERTIFX,


That I attended deceased from


19 63, to Live 79


19.


63


I last saw hexalive on


129 1969 death is said to


have occurred on the date stated above, at 1100


.. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Coronaryocclusion


INTERVAL BETWEEN ONSET AND DEATH 30 mm


1)ue To


(b)


arteriosclerosis


Due To


Gjen.


(c)


OTHER


SIGNIFICANT


CONDITIONS


None


Was autopsy performed?


What test confirmed diagnosis ?


....


(Signature) M. D. CIÓPapa GREGORIO (Print or Type Name)


(Address)


Winthrop Winthrop Mass


6


1Place of Turial or Cremation


(City or Town)


DATE OF BURIAL


Sept 3


63


19


7 NAME OF


FUNERAL DIRECTOR


Ernest P Caggiano


ADDRE


947 Winthrop St, Winthrop


Received and filed


SEP 3 1963


19


(Registrar)


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Widowed


Female


11 1f married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in fuli)


Joseph nusto


(or) WIFE of.


(Husband's name in full)


12


,82


10


5


AGE


Years


Months.


Days


13 Usual


Housewife


Occupation :


(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 )


Italy


17 NAME OF


FATHER


Unknown


FINZio


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Unknown


20 BIRTHPLACE OF MOTHER (City) (State or country) Italy


Mrs Albert Mangini


2I Informant


( Address)


96 Plummer Ave. winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Taipht divenne (0)


(Signature of Agent of Board of Health or other)


Health Offrir


9/1/63


(Official Designation) (Date of Issue of Permit)


382


1


Fortuna


MusTo (FINIZIO)


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


No


(a)


Residence. No ..


(Usual place of abode)


10


2.9


(a)


if under 24 hours


Hours ........ Minutes


PARENTS


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


If so, specify


Date


8/32


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


11.12.


CRK


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 iHness 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 diseaseamselated to any form of injury, have died without recent medical attendantE pr whose GAYsician 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.


PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


No 129 Strandway


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.


164


S(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.)


(a) Residence. No.


129 Strandway


Winthrop


St


(City or town and State)


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


18


years


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


August


30.


1.9.6.3


(Month) (Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


4/27/


192-9, to De una, 30


19


63


I last saw hjimalive on


Quy 380


1963, death is said to


have occurred on the date stated above, at 3:24pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Coronary Occlusion


(b) arteriosclerosis


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


NO


What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased 10 If so, specify


(Signature)


Deple stregaque


M. D.


Joseph GREGORIE


(Address)


194 Washington. 15 Date.


(Print or Type Name) 8/30 63


6


Holy Cross


Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIA


September 3,


,63


7 NAME OF


FUNERAL DIRECTOR Richard C . Kirby Inc.


ADDRESS


917 Bennington St.E.Boston


Received and filed


SEP 3 1963


19


(Registrar )


8 SEX


M


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWEDMarried


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


Edith G. Gillogly


(or) WIFE of


(Husband's name in full)


12


AGE.70


5min


.Years.


Months.


.Days


If under 24 hours


Hours.


.Minutes


13 Usual


Occupation :


Taxi ..


OWNER-OPERATOR


(Kind of work done during most of fworking life)


14 Industry


or Business:


Owner Taxi Business


029-22-2942


15 Social Security No ....


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


17 NAME OF


FATHER


Florence J. Sullivan


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary T. Flanagan


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 InformantMrs. Edith G. Sullivan


129 Strandway Winthrop


(Address)


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Lueph 6 Seriavina (3)


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


Health 07


8/31/63


(Official Designation


(Date ofIssue of Permit)


1


permit :alth


ATE


PE SES


(c) mean ying, ilure, seans mpli- used


y 10 a), er- st.


strib- t not minal given


PARENTS


Cornelius J. Sullivan


(Was deceased a


U. S. War Veteran,


if so specify WAR)


W.W.2


(Usual place of abode)


(Give maiden name of wife in full)


INTERVAL BETWEEN ONSET ANO DEATH


L


-301


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE Aug 27 1942


DATE OF DISCHARGE.


Oct 21 1943


RANK, RATING Chief


ORGANIZATION AND OUTFIT


U.S. Coast Guard. Reserve


....


SERVICE NUMBER


3005-529


TOW


T:


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 newP 2 1963 BH (3) Medical Examiners will investigate and certifto ad 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


PLACE OF DEATH


Suffolk


(County)


Boston


(City or Town)


Veterans Administration Hospital


No


2 FULL NAME


John S. ROBERTS


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


59 Crest Avenue


Winthrop, Mass.


(City or town and State)


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


-days. In place of residence 50 years months days.


¢


MEDICAL CERTIFICATE OF DEATH


3' DATE OF


July


9,


1963


DEATH


(Month)


(Day) VA


(Year)


LHEREBY CERTIFY


That I attended deceased from


July 9,


19


63


to. July 9, 53


XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX death is said to


have occurred on the date stated above, at


7:45 P


... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Pulmonary edema and congestion


(a)


INTERVAL BETWEEN ONSET AND DEATH hrs


Due To Aortic stenosis and mitral (b)


insufficiency, rheumatic


Due TLeft ventricular hypertrophy (c)


yra.


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


What test confirined diagnosis ?


Autopay


(Sixnamnre)


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


If so, specify


Michael 2 Baccari


M. D.


Michael ... J ....... Baccari


.... VAH Boston, (Print or Mus8. Name)


(Address)


.Date.


July10 .. 63


Winthrop Cem., Winthrop, Mass. 6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 12


,63


19


7 NAME OF


FUNERAL DIRECTOR


Maurice Kirby


ADDRESS


210 Winthrop St. Winthrop, Mass.


JUL 1 5 1963


Received and flex William& Kane


I HEREBY CERTIFY that a satisfactory standard certifcate of death was filed Th me BEFORE the burial or transit permit was issued: il. mac & Co or aber)


317380


7-11-63


(Date of Issue of Permit)


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Married


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


(or) WIFE of.


(Husband's name in full)


12


AGI62


.. Years ..


2


Months10.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation


Shipfitter (Retired)


(Kind of work done during most of working life)


14 Industry


or Business.


SHIP YARD


15 Social Security No ....


16 BIRTHPLACE (City)


(State or country )


Chelsea


Mass


17 NAME OF


FATHER


Charles Roberts


18 BIRTHPLACE OF


FATHER (City)


UNKNOWN


(State or country)


19 MAIDEN NAME


OF MOTHER


SARAH ADDISON


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


UNKNOWN


21 Informant


Veterans Administration Records


150 So. Hunt. Ave., Boston, Mass


0 75 1963


4553


arisl permit f Health ent. INS


FICATE


YPE USES H ter one ach nd (e)


t mean dying, failure, t means compli- caused


any. ise to (a). under- last.


contrib. but not terminal · given


aminer ion 6


PARENTS


.......


(Registrar)|| (Official Designation)


165.


The Commonwealth of MassachusetJT - OF - TOWN KEVIN H. WHITE (City or Town making this return) SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD Registered No. 07107 CERTIFICATE OF DEATH


[(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,


WW I


if so specify WAR).


(a) Residence. No.


(Usual place of abode)


yra.


Dorothy O'Leary


A TRUE COPY ATTEST:


Williaml. Kane. City Registrar


TOM


INTHROP


SEP 2 31963 AM


PLACE OF DEATH


Suffolk (County)


Boston


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


166


OUT - OF - TOWN


(City or Town making this return)


7411


Frederick Anders ANDERSON


2 FULL NAME


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


1069 Shirley


(a) Residence. No.


(Usual place of abode)


(('ity or town and State)


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


Married


(Month)


(D)ay)


(Year)


4 I HEREBY CERTIFY


June 7. 19 .... 63


to.


July 17


19


TILLDeath is said to


have occurred on the date stated above, at 4: 10 A.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Metastatio malignant melanoma


(a)


INTERVAL BETWEEN ONSET AND DEATH 6 mos


Due To


(b)


Metastasis to heart, brain, lungs adrenals


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


What test confirmed diagnosis ?


Autopsy


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




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