Town of Winthrop : Record of Deaths 1963, Part 34

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 34


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).


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If so, specify


Michael J.Baccari,


M.D.


(Signature)


michael & Bass


M. D.


July 179 63


PARENTS


(Address)


(Print or Type Name)


VAH Boston, Mass.


Woodlawn Cem. Everett, Mass. 6 Place of llurial or Cremation (City or Town)


DATE OF BURIAL


7-20-63


19.


7 NAME OF


FUNERAL DIRECTOR


Brown F.H.


11 Pembroke St., Medford, Mass.


ADDRESS


belliam & Kane.


JUL-2 4.1963 ..


63


11 If married, widowed, HUSBAND of


(or) WIFE of.


(Husband's name in full)


12


AGE.70


0


Months


7


ars ..


Days


1f under 24 hours


Hours . Minutes


13 Usual


Occupation.


(Kind of work done during most of working life)


14 Industry


or Business ..


1


15 Social Security No.


013-22-7527


16 BIRTHPLACE (City).


(State or country )


17 NAME OF


FATHER


Lars


18 BIRTHPLACE OF


FATHER (City). ...


(State or country)


.. Norway


19 MAIDEN NAME


OF MOTHER


Henrietta Von Schoppe


20 BIRTHPLACE OF


MOTHER (City).


(State or country )


21 Informant


V.A. Hospital Records 150 S. Huntington Ave. Boston, Mass


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burialfr transit peryen was issued: aqueline Dasole ris: Signature of Agent of Board of Health or other)


112491


7/19/03


(Date of Issue of Permit )


( Registrar) | (Acial Designation)


THUISPADV ITTPIT.


R-301


1 permit ealth


ATE


PE SES


C 2 (c) mean ying. ilure. mpli- used


y, 10 er- st. strib- t mot minal given


i ed Opy


7/ 1963 $3


1


(City or Town)


Veterans Administration Hospital


No


Registered No.


f(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


-


( Was deceased a


U. S. War Veteran,


WW 1


if so specify WARI


Winthrop, Mass


.. St


1 10 Length of stay : In place of death .......... years.


17


1963


3 DATE OF


DEATH


July


That I attended deceased from


(Give maiden name of wife in full)


liver


2 mos


Plumber, retired


Nova Scotia


Nova Scotia


( Address)


A TRUE COPY ATTEST:


Williaml. Kane. City Registrar


TU


5


0


THROP


SEP 2 31963 AM


1


X


PLACE OF DEATH


Suffolk


(County)


Boston


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


OUT - OF


167 TOWN


(City or Town making this return)


07593


Registered No.


[(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.)


12 Sewall Ave.


Ist


Winthrop, Mass'


(City or town and State)


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


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


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


white


0 SINGLE


MARRIED MATT


WIDOWED


DIVORCED


UNKNOWN


aord)


--


11 If married, widowed,.


HUSBAND of


Maude Phillips


(Give maiden name of wife in full)


(ot) WIFE of.


(Husband's name In full)


12


AGE .. 67. Years.11


.Months .. 28


.Days


If under 24 hours


Hours.


.. Minutes


13 Usual


Occupation


Ret. Grill Man


(Kind of work done during most of working life)


14 Industry


of Business


023 10 3896


15 Social Security No ...


Swampscott


16 BIRTHPLACE (City)


(State or country}


Mass.


17 NAME OF


FATHER


George


18 BIRTHPLACE OF


France


FATHER (City).


(State or country)


19 MAIDEN NAME


OF MOTHER


Whorf


20 BIRTHPLACE OF


MOTHER (City) ...


(State or country)


Massachusetts


West Lawn Cem. Lowell, Mass. 6


Place of Ilurial or Cremation


(City of Town)


DATE OF BURIAL


July .... 27 ..


1963


19.


7 NAME OF


FUNERAL DIRECTOR


Reynolds F.H.


ADDRESS


I HEREBY CERTIFY that a satisfactory standard certificate of death 180 Winthrop St., Winthrop, Mass' wasfiled with my BEFORE (the burial or transit permit was issued;


Leonauf. Kace.


3


JUL 32 1958


(Registrar)


A TRUE COPY ATTEST:


Wic 1


with mural thrombosis


Due TRt Chronio .pyelonephritis (c)


yrs


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.


D. OBrien M.D.


(Print or Type Name)


(Address) ... VAR Boston, Mass Date July 251963


PARENTS


V.A. Hospital Records 150 S.


21 Informant


Huntington Ave., Boston, Mass.


(Address)


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


18835-


7/26/63


(Official Designation) (Date of Issue of Permit)


553


ial permit Health t.


CATE


PE JSES


r he ch (e) mean dying, ailure. means ompli- caused


any, 10 (a). der- last. ontrib- ut not rminal given .


20


1


(City or Town)


Veterans Administration Hospital


No


George A. _ WOOD


(a) Residence. No.


(Usual place of abode)


24.


1963


3 DATE OF


DEATH


K July


(Month)


(1)ay)


(Year)


A LHEREBY CERTIF 63 July 24


to


That


attended deceased


63


19


XXXXXXXX death is said to


have occurred on the date stated above, at 2: 00P .m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL BETWEEN ONSET AND DEATH


(a) Recent ... infarction .. Rt ... cerebellum 4day


Due To Septal myocardial infarction (b)


July 16 19.


( Was deceased a


U. S. War Veteran,


WW I


(if so specify WAR).


.days. In place of residence. 23


STANDARD CERTIFICATE OF DEATH


R-301


A TRUE COPY ATTEST:


William). Kance


City Registrar OF TOW.


11.12


FFICE


CLERK


MIN


5


WII


MA


OCT 31963 PM


1


R-302


No ...


( Usual place of abode)


( Month)


8/13


19


630.


I last saw


h.


(b)


(c)


OTHER


SIGNIFICANT


CONDITIONS


6


Holy .... Cross


Copies of returns of deaths which occurred in your city of town in case the deceased resided mit another city of town


Due To


Brain tumor


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.)


3 DATE OF


DEATH


August 14, 1963


(Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


( write the word)


MARRIED


WIDOWED


or DIVORCED


Married


4 I HEREBY CERTIFY.


That I attended deceased from


8/14


19


63


19.


63 death is said to


have occurred on the date stated above, at


11:40P


... m.


INTERVAL


BETWEEN


ONSET AND


DEATH


24 hrs


11 IF STILLBORN, enter that fact here.


12


AGI


32


Years ...


-


.Months ....


...... Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation:


Reg ....... Nurse


(Kind of work done during most of working life)


14 Industry


or Business :


Nursing


15 Social Security No.


029-24-8220


16 BIRTHPLACE (City)


(State or country)


Winthrop,


Mass


17 NAME OF


FATHER


George H. Ostman


18 BIRTHPLACE OF


FATHER (City)


Winthrop,


(State or country )


Mass,


19 MAIDEN NAME


OF MOTHER


Bridie Feeney


20 BIRTHPLACE OF


MOTHER (City)


( State or country )


Ireland


21


Informant


Bridie Ostman


( Address )


100 Marshall St. ,Winthrop


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O' Maley


ADDRESS Winthrop, Mass


A TRUE COPY


ATTEST :


Client Y. Lilym


( Registrar of City or Town where death occurred )


Received and filed


XXXXXXXXXX 19


SEP 16 1963


DATE FILED


August 19,


63


19.


....


TVAV


1


Lynn


(City or Town)


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


Lynn


(City or Town making this return)


168 ...


S (If death occurred in a hospital or institution,


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


2 FULL NAME


Claire Caruso


(Ostman)


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


(a) Residence. No ...


100 Marshall


St


Winthrop


( If nonresident, give city or town and State)


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


.. months.


1


days. In place of residence


years.


.months.


........ days.


32


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Nicholas W. Caruso


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Cardiac failure


mos


PARENTS


( Signed )


Sidney Paly


M. D.


( Address )


Swampscott.


Date


8/16


. 19 63


Mal.den


Place of Burial or Cremation ( City or Town)


DATE OF BURIAL Aug ........ 17,


19


63


50M-9-59-926111


PLACE OF DEATH


Essex


(County)


Registered No.


Lynn Hospital


( Registrar of City or Town where deceased resided )


no


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


If so, specify


Was autopsy performed?


What test confirmed diagnosis ?


.x-ray.


281 Humphrey St.


Due To


Hydrocephalus


Ło.,


8/1/1


( Was deceased a


U. S. War Veteran.


if so specify WAR,


TON


ông Hả Đường, ha,


.LEIK


WINTHROP


6


SPACE FOR ADDITIONAL INFORMATION


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


SEP 1 61963 AM


M R-302


1


PLACE OF DEATH


Middlesex (County) Cambridge


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


169


Cambridge


(City or Town making this return)


Registered No.


1208


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


Ralph James Paone


2 FULL NAME


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


38 Paine St.


St


(if so specify WAR, "inthrop, Mass.


(a)


Residence. No ..


(Usual place of abode)


22


21


(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


August 16, 1963


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


July


63


19 ..


That I attended deceased from


16


19


53


I last saw h.


Lative on


19


19.


to.


Aus.


16,


O death is said to


have occurred on the date stated above, at


10:30a.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Peritonitis


INTERVAL BETWEEN ONSET AND DEATH 2wks.


Due To


Ca. Stomach


(b)


Due To (c)


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


(Signed)


Albert S. Murphy


M. D.


(Address)


Boston, Mass.


Date


8-16. 63


winthrop Com.


Winthrop, Mass.


Place of Burial or Cremation


Au ;. 19


19.


FUNERAL DIRECTOR


ADDRESS


210 Winthrop St. Winthrop


Received and filed


SEP 11 1963


19


(Registrar of City or Town where deceased residled)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


Whi to


10 SINGLE


(write the word)


MARRIED


WIDOWED Married


DIVORCED


UNKNOWN


11 If married, widored orfdiyorfed Venti


HUSBAND of


(or) WIFE of.


(Husband's name in full)


12


57


AGE


Years


Months .......


.. Days


If under 24 hours


.Hours ........ Minutes


13 Usual


Occupation :.


(Kind of work done during most working life)


14 Industry


Sunshine Biscuit


or Business:


012-10-1638


15 Social Security No.


16 BIRTHPLACE (City) ....... 33%


(State or country)


17 NAME OF


FATHER


Cosmo Paone


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


(c.n.b.l.) Albano


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Italy


Mrs. Ralph Paone


21 Informant


(Address)


38 Paino St. inthrop


A TRUE COPY


ATTEST :


(Registrar of City or Town where death occurred)


DATE FILED


Aug . 19,


19 6


TVK


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town


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


50M - 10.61-931673


C.


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


(City or Town)


Mount Auburn Hospital


No ..


7 NAME OF


Maurice ... Kirby


(City or Town)


63


DATE OF BURIAL


PARENTS


Salesman


6mos.


(Give maiden name of wife in full)


(a)


Aus,


(Was deceased a


U. S. War Veteran,


no


SPACE FOR ADDITIONAL INFORMATION


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


ROP MASS


SEP 11 11963 AM


R-301


rial permit E Health ent. ONS


IFICATE


TYPE AUSES TH ter one each nd (c)


ot mean dying, failure. It means compli- caused


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


contrib- but not terminal on given


PLACE OF DEATH


Suffolk (County)


SENSE


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)


120


S(If death occurred in a hospital or institution, No


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Albertine Cecelia (Bolm) Drake


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


(a) Residence. No ..


25 Sargent Street


(Usual place of abode)


St


(If nonresident, give city or town and State)


Length of stay: In place of death ... 4 .. years.


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


4 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)


Widowed


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of .... MillardLlewellynDrake


(Husband's name in full)


12


82


2


6 hp


AGE.S.IYears


2


Months.


21


Days


If under 24 hours


Hours .....


Minutes


13 Usual


Occupation :


Housewerk


(Kind of work done during most working life)


14 Industry


or Business OWN At Home


15 Social Security No ....


022-10-64.88


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


17 NAME OF


FATHER


Leon Bohm


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Germany ......... (Europe)


19 MAIDEN NAME


OF MOTHER


Louise A. Favier


20 BIRTHPLACE OF


MOTHER (City).


(State or country )


Weshington, D. C .......


Winthrop, Cemetery


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


September 3,


19.63


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


alfred 75. March


ADDRESS 174 Winthrop St. winthrop.


Received and filed


SEP 3 1963


19


(Registrar)


A TRUE COPY ATTEST:


Sagst.


1


1963


(Year)


(Month)


(Day)


4 IHEREBY CERTIFY, That I attended deceased from


aug31, 1962


to 01


Senti


I last saw \he falive on


Levy 31


1963, death is said to


have occurred on the date stated above, at


0.00Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Cerebro Vascular hemorrhag


INTERVAL BETWEEN ONSET AND DEATH


Due


(b)


arteriosclerosis gen.


....


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 ? " ..... If so, specify


(Signature)


....


M. D. Joseph GREGORIE


(Print or Type, Name)


(Address)


My Washing tone and Date


9/2


19


60


PARENTS


Millard ... L. Drake


(son)


21 Informant


(Address)


415 horti Clay Street


Hinsdale, Illinois


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


(Signature of Agent of Board of Health or other)


Health Officer


Vept 3,196V


(Official Designation) (Date of Usue of Permit)


TUB


2382


I


Registered No.


25 Sargent Street, Winthrop


(Was deceased a U. S. War Veteran, (if so specify WAR)


3 DATE OF


DEATH


SE


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


6


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 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 certificata 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.


I R-302


1


PLACE OF DEATH


Middlesex (County) Cambridge


(City or Town)


No ...


Holy Ghost Hospital


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


Barbara Bowman


2 FULL NAME


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


3 Paine Street


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of death.


5 years 6


.. months


16


35


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


September 4, 1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY, Feb. 19 ..... ,>19


58 Sept.


That I


attended deceased from


03


I last saw


& live on


Sept. 320.


63


death is said to have occurred on the date stated above, at 1:50A,


DEATH WAS CAUSED BY: IMMEDIATE CAUSE Acute diffuse peritonitis (a) (runtured gallbladder)


INTERVAL BETWEEN ONSET AND DEATH


Due To Pulmonary congestion & edema


Due To (c) ....


extensively involving the partetal, temporal and


SIGNIFICANT Occipital lobes. CONDITIONS art. scl.& Hypertensive heart BIRTHPLACE (City)


disease


yes


Was autopsy performed ?


What test confirmed diagnosis ?


17 NAME OF


FATHER


Peter ?. Bowman


18 BIRTHPLACE OF


Queboc


FATHER (City)


(State or country)


Canada


19 MAIDEN NAME


OF MOTHER


Delia B. Robinson


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Froland


Ellen F. Bowman


21 Informant


(Address)


8 Paino St. Winthrop


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred) Sept. 5, 6


19


VB


.


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Single


11 If married, widowed, or divorced


HUSBAND of


(or) WIFE


(Husband's name in full)


12


AGE


Years


Months.


Day3


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :.


(Kind of work done during most working life)


14 Industry


or Business:


Shoe


15 Social Security No.


rone


(State or country)


Canada


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


If so, specify


(Signed)


John F. Lee


M. D.


(Address)


Holy Ghost Hosp, 0-4


63


Winthrop Cem.


winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


19


7 NAME OF


FUNERAL DIRECTOR


Anthony J. O'Maley


ADDRESS .....


Winthrop, Mass.


Received and filed OCT 4 1963 19


50M - 10-61. 931673


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


171


Cambridge


(City or Town making this return)


Registered No.


1293


(Was deceased a


U. S. War Veteran,


no


(if so specify WAR


winthrop, Mass.


St


(If nonresident, give city or town and State)


(Give maiden name of wife in full)


88


Stitcher - Retired


old Forebral infarcts


left


19


PARENTS


Sept. 7,


63


DATE FILED


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


19


SPACE FOR ADDITIONAL INFORMATION


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


RECEIVED


TOWA


OF


11 12 1


OFFIC


in.


MIN


in


İLERK


WI


6


"5


ASS


HRO


OCT 41963 AM


303 urial permit of Health gent.


Injury of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, §§ 44-48. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes Nature of Injury If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.


PLACE OF DEATH


SUFFOLK


1


(County) WINTHROP


(City or Town)


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


(City or Town making this return) ....


MEDICAL EXAMINER'S CERTIFICATE OF DEATH


Registered No.


122


[(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) No.


MILDRED


HOWE


(First Name)


(Middle Name)


(Last Name)


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


16 Court Road, Winthrop


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of deathyears months .... days. In place of residence


55 je


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


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


September


7,


1963


(Month)


(Day)


(Year)


FEMALE


10 COLOR


WHITE


11 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN WIDOWED (write the word)


12 If married, widowed, or divorced HUSBAND of


(or) WIFE of CHARLES


(Give maiden name of wife in full) HOWE


(Husband's name in full)


5 Accident, suicide, or homicide (specify) Date and hour of injury 19


IF ACCIDENTAL, was injury causally related to the death? Where did Injury occur ?


(City or town and State)


Did injury occur in or about home, on farm, in industrial place, or In public place ?


(Specify type of place)


Manner of


.....


(How did injury occur ?)


While at work ? Was zutopsy performed. ... ... No


6 Was disease or injury in any wayunted to og qua ion of deceased ?


(Signed Stanach Michael A. Trong6, M.D.


M. D.


Boston ( Print or Type Kame)


Date 9/7 63


7 WINTHROP Place of Burial or Cremation. (City or Town)


DATE OF BURIAL SENT 10 1963


8 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS WINTHROP


Received and filed


SEP 9 1963


19


A TRUE COPY ATTEST:


(Registrar)


PARENTS


19 BIRTHPLACE OF


FATHER (City)


(State or country)


MASS


20 MAIDEN NAME


OF MOTHER


ANNA BOYCE


21 BIRTHPLACE OF MOTHER (City) (State or country) MASS


22 Informant (Address)


MPS NANCU EVANS


ZIL COURT RD WINTHROP,


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Paph G Serianni (8)


(Signature of Agent of Board of Health or other) Health Officer Sept 9,19613 (Official Designation) (Date of Issue of Permit)


TV .....


13 45v .Years ..... Months ...... ......


If under 24 hours Hours Minutes


14 Usual


Occupation :


NOME KERER.


(Kind of work done during most of working life)


15 Industry on Business :


HOME


NINE


N Social Security \No.


FAST BOSTON


17 BIRTHPLACE (City) (tate of country) MASS


18 NAME OF FATHER DAVID J MAHUNY


RANDOLPH.


CAMBRIDGE


(Address)


WINTHROP


100M - 3-62-932695


PHYSICIAN - IMPORTANT


(Was deceased a U. S. War Veteran, if so specify WAR)


St


(If nonresident, give city or town and State)


16 Court Road, Winthrop


2 FULL NAME


4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Arteriosclerotic heart disease. (77).


9 SEX


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


i RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER SET - 91953 KM


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 unrelated 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 poison) , thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


STATEMENT OF CAUSE OF DEATH


Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."




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