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