Town of Winthrop : Record of Deaths 1963, Part 48

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 48


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


12


87


AGE


ears


11


Months.


Dayz


1f under 24 hours


Hours ........ Minutes


Due To


Mechanical Obstruction of


(b)


duodenum


months


Due To


(c)


Arteriosclerotic Heard Dis


OTHER


SIGNIFICANT


CONDITIONS


Gen. Arteriosclerosis


yrs


cu


Was autopsy performed?


What test confirmed diagnosis ?


Clin. & Lab.


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


(Signed)


Willard M. Hausman


M. D. Willard M. Hausman


(Address)


Hathorne, Mass.


Date.


8/30/ 1 63


Mt. Auburn Cemetery, Cambridge, 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


Sept. 3,


12.63


7 NAME OF


FUNERAL DIRECTOR


bilson Funeral Home


ADDRESS


Received and hled


Sept. 5, 1963. 19 ATTEST :


(Registrar of City or Town where deceased resided)


DEC. 13,1963


8 SEX


female


9 COLOR


white


10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN


(write the word)


single


11 1f married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry or Business :


15 Social Security No .. unknown


16 BIRTHPLACE (City)


(Stale or country)


Mass


17 NAME OF


FATHER


Arthur F. Teel


18 BIRTHPLACE OF


Charlestown


FATHER (City) ..


(State or country)


Mass .


19 MAIDEN NAME


OF MOTHER


Marcella Canney


20 BIRTHPLACE OF


Charlestown, MOTHER (City) ..... Mg.99: (State or country)


Mary E. Sheehan


21 Informant


( Address)


Danvers, Mass.


A TRUE COPY Tracy I . Flagg


Health Agora 1963 DATE FILED


19


1


1


THIS IS A PERMANENT RECORD


13


50M1 . 10-61. 931673


(a) Residence. No ..


(Usual place of abode)


11 1


.. , to ......


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Gastroenteritis - Acute


(a)


1


retired attendant nurse


Charlestown


PARENTS


Somerville, Mass.


No ..


SPACE FOR ADDITIONAL INFORMATION


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


RECEIVED


LERK


101


OF


VTHROP MASS.


1.10


DEC 1 31963 AM


X


R-302


PLACE OF DEATH


(County)


ERTAFEJ. AVILTEM


COPY OF CERTIFICATE OF DEATH


Registered No.


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


2 FULL NAME


Kathleen Walters (Kathleen Barry)


S


(Was deceased a


(if so specify WAR, 244


UNDINE 61 Udine Avenue, Winthrop, Mass .S.


(a) Residence. No.


(Usual place of abode)


18


(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.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


married


11 If married, widowed, or divorced


HUSBAND of


Stephenmai napig")


(or) WIFE of


Y'ears


1,1


250


xfonths.


Days


If under 24 hours


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


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


or Business:


15 Social Security No ..


unknown


newton


16 BIRTHPLACE (City) ....... MA.g.S ..... (State or country)


17 NAME OF


FATHER


Michael Barry


PARENTS


18 BIRTHPLACE OF unknown


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Norah Delenhanty


20 BIRTHPLACE OF


unknown


MOTHER (City).


(State or country)


Ireland


Mary E. Sheehan


21 Informant


(Address)


Danvers, Mass.


A TRUE COPY


ATTEST:


Tracy I. Flagg.


Healtheingreifty SEoptheredeath 1963


DATE FILED


19


(Registrar of City or Town where deceased resided) Dec. 13,1963


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


Denvers


(City or Town making this return)


1


Danvers


(City or Town)


Renvers State Hospital, Hathorne


No.


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


7 NAME OF


FUNERAL DIRECTOR


Maurice W. Kirby


Winthrop, Mass.


ADDRESS


Received and filed-


September 5, 1963


19


Grupy. Toomany


month


Due To (b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis ?


Clin. & Lab.


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


(Signed)


Willord M. Hausman


Willard M. Hausman


M. D.


(Address)


He thorne, Mass.


0/2/63


Date.


Winthrop Cemetery Winthrop, Mass.


6


Place of Burial or Cremation


September 4, 1963"


19


DATE OF BURIAL


50M . 10.61-931673


DEATH


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY, That I attended deceased from


August 15 62


September 2


to.


19


63


I last saw h ..... alive on


September 2 1963 d


is said to


have occurred on the date stated above, at


3:30p


.ın.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Hodgkins' Disease (Granulo


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


(Husband's name in full)


12


AGE


64


Housewife


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


September 2, 1963


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


SPACE FOR ADDITIONAL INFORMATION


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


CLERK


RECEIVED


ASS.


MOI


1 12 1


MIN


HROP


OF


IM


DEC (1) 31963 AM


X 1


PLACE OF DEATH


Essox (County)


Danvers


(City or Town)


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


(City or Town making this return)


Registered No. .


[(If death occurred in a hospital or institution, Denvers State Hospital, Mathonnest. ( give its NAME instead of street and number) No ...


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


St.


(If nonresident, give city or town and State)


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


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


femal o


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)


John Lendrigan


(or) WIFE of.


(Husband's name in full)


12


AGE


1


Months


3


Dayz


If under 24 hours


Hours .....


.. Minutes


13 Usual


Occupation :


unable to work


(Kind of work done during most working life)


14 Industry or Business :


15 Social Security No.


(State or country)


Newfoundland, Canada


17 NAME OF


FATHER


James w. Scott


18 BIRTHPLACE OF


FATHER (City)


(State or country)


"Newfoundland, Canda


19 MAIDEN NAME OF MOTHERMargaret Stup


20 BIRTHPLACE OF


unknown


MOTHER (City) (State or country) Nowroundland, Candda


Hlavy L. Shechan


21 Informant


(Address)


Unver :. Haus.


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


rectobar 30 19 63


50M - 10-61-931673


2 FULL NAME Annabella -andrigan Winthrop, Mass. (a) Residence. No .. (Usual place of abode) Length of stay: In place of death. Years .. 2months 22 MEDICAL CERTIFICATE OF DEATH 3 DATE OF October 24, 1963 DEATH (Month) (Day) (Year) AJ HEREBY CERTIFC:+ 3502 242 to I last saw h.S.alive on October 2 00 63 have occurred on the date stated above, at 10:50pm. DEATH WAS CAUSED BY: IMMEDIATE CAUSE Bronchial Pneumonia (a) Due To (b) Due To (c) OTHER Arteriosclerotic Ht. dis. 110 5 Was disease or injury in any way related to occupation of deceased ? If so, specify_ tillard . Haussan (Address) Date Holy Cross Cem. Nal den, dass. 6 Place of Burial or Cremation October 23, 1963 DATE OF BURIAL 19. 7 NAME OF Frederick J. Magrath Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Mathorne, Mass, 10/24/63 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


That I attended deceased from


July 22, 19


6.1


19 63


INTERVAL BETWEEN ONSET AND DEATH.


SIGNIFICANTGeneralized Arteriosclerosis NiMEHPLACE (City) CONDITIONS


Was autopsy performned?


A. & Laboratory


What test confirmed diagnosis ?


(Signed) Willard 1. Hausmar M. D.


FUNERAL DIRECTOR East Boston, Mass.


ADDRESS


Octo:


Received and filed DEC. 13, 1963


(Registrar of City or Town where deceased resided)


R-302


PARENTS


(Was deceased a U. S. War Veteran, if so specify WAR,. 245


SPACE FOR ADDITIONAL INFORMATION


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


ERK


RECEIVED


:MOL


2. ZUBY


MIN


1


F


WINTHROP MASS.


DEC (1) 31963 AM


-


>


PLACE OF DEATH


Essex


(County)


Danvers


(City or Town)


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


(City or Town making this return)


Registered No.


246


[(If death occurred in a hospital or institution,


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


2 FULL NAME. Henry A. Corinha, Sr.


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


242 Lincoln St., Winthrop, Mass


(Usual place of abode)


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


months ...


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


Oct. 25, 1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That I_attended deceased from


Sept. 20


19


63


Oct. 25


19


63


I last saw h.


..... dive on


October 25, 19. death is said to


have occurred on the date stated above, at


3:25 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Coronary Occulsion


INTERVAL


BETWEEN


ONSET AND


Days


Due To Anterior Myocardial inf (b)


3dys


OTHER


Arteriosclerotic ht. dis


.yrs


SIGNIFICANT


CONDITIONSGen. Arteriosclerosis


yrs


Was autopsy performed?


Clinical & Lab.


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


(Signed)


Willard M. Hausman


Willard M, Hausman


M. I).


(Address)


Hathorne , MasS .


10/25/63


Winthrop Cemetery Winthrop, 6


Mass


Place of Burial or Cremation


October 29, 1953own)


19


Arthur J. d'Haley


ADDRESS Winthrop, Mass.


Received and filed


Oct. 30,


03


19


DEC. 13, 1963


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


mal e


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


marrrid


11 If married, widowed,


HUSBAND of


KdeHleen Feenoy


(or) WIFE of.


(Husband's name in full)


12


AGE.


70Years


2,


Months.


27 Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


or Business :


15 Social Security No.


023-09-9916


16 BIRTHPLACE (City)


(State or country)


nathrop


17 NAME OF


FATHER


Anthony Cor inha


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass.


Boston,


19 MAIDEN NAME


OF MOTHER


Elizabeth Feenan


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass.


Boston,


Freely Toomey


21 Informant


(Address)


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


October


30


محـ


No. (a) Residence. No. DEATH (a) arction Due To (c) DATE OF BURIAL 7 NAME OF FUNERAL DIRECTOR 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 What test confirmed diagnosis?


SOM - 10-61.931673


.


R-302


-


Danvers, State hosp. Hathorne


no


(Was deceased a


U. S. War Veteran,


(if so specify WAR


(If nonresident, give city or town and State)


(write the word)


(Give maiden name of wife in full)


1


PARENTS


to ...


SPACE FOR ADDITIONAL INFORMATION


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


LERK


. 20


OF


THROP MASS.


N


DEC [31963 AM


PLACE OF DEATH


1


(County) Donors


(City or Town)


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


(City or town making return)


Registered No.


247


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


2 FULL NAME.


Einard Potain B


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


(a) Residence. No. ....


6 Pauling St.


sWinthrop, Mass.


(Usual place of abode)"


(If nonresident, give city or town and State)


Length of stay: In place of death .... ] .. 6.years .......... months ........ ]}days. In place of residence ...... years ............. months .............. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


9 SEX


male


10 COLOR


white


11 CITIZEN


OF U.S.


YES


NO


12 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


4I 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.) Heart Disease presumably


12a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


13 DATE OF BIRTH


14


AGE ..


.... Years ....


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


Days


If under 24 hours


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


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 ?


Manner of


Injury


(How did injury occur?)


Nature of


Injury


no


While at work?


Was autopsy performed?


6 Was disease or injury in any way related to occupation of deceased ? If so, specify Dougald C. Jacuillivray


(Signed)


Nugold, C. achillivray, M. D.


(Address)


10 Berry St.


Dat 0/29/ 19 63


7


23 (CaDol Down) LiQSS . Informant


(Address)


DATE OF BURIAL november 4, 19 ......


& NAME OF


FUNERAL DIRECTOR


WM ............ Crosby,Inc.


ADDRESS


December


13;


1963


Received and filed


.....


november-5, 1963


(Registrar of City or Town where deceased resided)


A TRUE COPY.


.


ATTEST :


(Registrar of Chy Or Town where death occurred)


DATE FILED


1963


...


5


the time of death should be transmitted on Form K. 505 to the clerk of the city of town in which the deceased resluca as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


25M ·3-61-930213


PARENTS


18 BIRTHPLACE (City)


(State or country)


Edward Lotvin B.


19 NAME OF


FATHER


unknown


20 BIRTHPLACE OF


unkavon


FATHER (City)


(State or country)


Many Zodoru


21 MAIDEN NAME


OF MOTHER


unknown


22 BIRTHPLACE OF


unknown


MOTHER (City)


(State or country) , E. Sheeben


15 Usual


Occupation :


(Kind of work done during most of working life)


16 Industry


or Business :


17 Social Security No.


verdient.


119h. WWII


coronary thrombosis


sudden death(or) WIFE of


5 Accident, suicide, or homicide (specify)


no


(Month)


3 DATE OF


DEATH


October 28, 1963


(Day)


(Year)


[(Was deceased a


U. S. War Veteran,


(if so specify WAR)


No Danvers State liosp.


(Specify type of place)


SPACE FOR ADDITIONAL INFORMATION


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


RECEIVED


. OLENK


MIN


WINTHROP MASS.


C


DEC 1 31963 AM


-


PLACE OF DEATH


OUT - OF - TOWN The Commonwealth of Massachusetts KEVIN H. WHITE SUFFOLK (County) SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS BOSTON STANDARD (City or Town) CERTIFICATE OF DEATH


(City or Town making this return) 248


11140


LEMUEL SHATTUCK HOSPITAL


f(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 :): divorced woman, give also maiden name.)


(a) Residence. No .. 16 PAINE ST.


.St .. WINTHROP


(C'ity or town and State)


Length of stay: In place of death .......... yea; s. months. 30days. In place of residence. years. months .. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


Male


8 SEX


9 COLOR


White


Xxxxxxxx


10 SINGLE


(write the word)


MARRIED


WIDOWED


DIVORCEDCarried


UNKNOWNS


11 If married,


widowed, or divorced


HUSBAND of


Patricia Cummings


(Give maiden name of wife in full)


(or) WIFE of


( Husband's name in full)


12


AGF ... 29Years.


Months


Days


If under 24 hours


Hours


Minutes


13 l'sual


Electrician


Occupation


( Kind of work done during most of working life)


14 Industrv or Business.


15 Social Security No


021-26-9448


16 BIRTHPLACE (City) ...


New York


(State or country )


17 NAME OF


FATHER


Emanuel Di Novo


PARENTS


18 BIRTHPLACE OF


New York


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Elizabeth Gero


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


New Hampshire


21 Informant


William Leahy


(Address)


5 Mystic St. Charlesuuml


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


.


Janinagia


1911/17


(Signature of Agent of Board of Health of other)


(Date of Inye of Permiy) 11/17/62


1 ×


A TRUE COPY ATTEST:


NON.


14


1963


(Month)


(1)ay)


1


(Year)


4 1 HEREBY CERTIFY , That 1 attended deceased from


Nov. 17, 1963


Non


19.


14


:3


to ..


....


I last saw hralive or.


NEUER


19 ...


. death is said to


have occurred on the date stated above, at


10:50 P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


CARCINO MATOSIS


INTERVAL BETWEEN ONSET AND DEATH


(a)


8 mod


Due To CARCINOMA OF ADRENAL


(b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


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


(Signature)


Pliku Q. Phanmin


., M. D.


ELIHU A. CHANNIN


(Print or Type Name)


(Address) LEMUEL SHATTUCK Bogate Nov. 141963


Woodlawn Ceme. Everett


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Nov. 18.1963


19.


7 NAME OF


FUNERAL DIRECTOR


Joseph F .Hurphy


322 Bunker Hill St.Charlestown


ADDRESS


Received and filed


NOV 1 9 1963


19


....


Wieland. Kane


10 1964 2-934553


RM R-301


or burial permit rd of Health s Agent. CTIONS OR CERTIFICATE


R TYPE CAUSES EATH t enter han one for each b) and (c)


s not mean of dying. earl voiture. Ic. It means or compli- kich caused


s, if any, ve rise to Iuse (a), the under- amse last.


ions contrib- cath but not the terminal dition given


195 57


Registered No.


No ...


BARTOLO


DiNovo


(Was deceased a


U. S. War Veteran,


(if so specify WARY


Korean


(Usual place of abode)


.......


(Registrar) | (Official Designation)


3 DATE OF


DEATH


A TRUE COPY. ATTEST RECEIVED


( Vance. 1940


TOWA


1 LERN


6 5


INTHRORN


JAN 1 01964 AM


FORM R-301 15 kids for burial permit oard of Health its Agent. TRUCTIONS FOR L CERTIFICATE


2-3 Vatting BK,-15 UNDERhills. R CLAY


TOR TYPE OR CAUSES DEATH not enter e than one e for each . (b) and (c)


does mat mean de of dying, heart failure. , etc. It means ase, or compli- which caused


tions, if any, teve rise 10 camse (a). & the under. conse last.


ditions contrib- death but not to the terminal condition given


500 88.69 120


Director e use only ACK 10 1964 62-933404


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


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


(City or Town making this return) 249


STANDARD CERTIFICATE OF DEATH


Registered No.


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


2 FULL NAME Florence ... M ...... Ingalls


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


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


1.0


(a) Residence. No ..


L1.Washington Avenue


(Usual place of abode)


St


Winthrop,Mass


(City or town and State)


days. In place of residence 10 years. months ....... ... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


Thi bo


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


11 If married, widowed, or divorced


HUSBAND of


Faro "(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12


10


If under 24 hours


Hours ....... "linutes


13 Usual


Occupation :


surse


( Kind of work done during most of ;working life)


14 Industry


or Business :.


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Calcio Lainc


Was autopsy performed?


Yes) ASSOC. WITH FOREIGN 17 NAME OF


What test confirmed diagnosis? Autopsy ). BODY


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


If so, specify


(Signature)


M. D.


Charles L. Clay M. D. (Print or Type Name) (Address) Ass's .. Din, Moss. Gon'1, Hosp ...... Date .. Nov .. 14 ..... 19 .. 6.3.


6


Fine Grove Falmouth Foreside


Place of Burial or Cremation


(City or Town) 11C


DATE OF BURIAL


Nov. 16


19 63


7 NAME OF


Ernest 2 Casciano


ADDRESS 147 Winthrop St Winthrop


decoryed and filed


DEC -5- 196


PARENTS


FATHER


Taknown


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Unkno .. n


19 MAIDEN NAME


OF MOTHER


Uninorn


20 BIRTHPLACE OF


MOTHER (City) ...


(State or country)


Unknown


21 Informant


Samle Commer


(Address)


1- Underhill St, Winthrop


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


/ SSignature of Agent of Board of Health or other)


BY1073


11-17-03


(Date of Issue of Permit)


T V. B


A TRUE COPY ATTEST:


1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY , That Wattended deceased from November ..... 10 19.63 ...... to. November ... 14, 19.63 last saw leralive on November 14, 19.63 death is said to have occurred on the date stated above, at .10 .: 10p .. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE UREMIA


(a)


Due TOPYONEPHROSIS


(b)


YEARS


Due Ta (c)


OTHER BOWEL FISTULAR MULTIPLE ANT


SIGNIFICANT CONDITIONS SIGMOID VESICAL SINUS (YRS)


INTERVAL, BETWEEN ONSET AND DEATH 1 WK


AGE .. -.


Years


Months.


Days


19


9 COLOR


3 DATE OF


DEATH


November


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


MEDICAL CERTIFICATE OF DEATH


No. MASSACHUSETTS GENERAL HOSPITAL


(Registrar)|| (Official Designation)


.


A TRUE COPY ATTENT


Wieland Name. Cây Registrar


RECEIVED


OF TOWN -


OFFICE


71 1.


CLERK


6 5


ROP


JAN 1 01964 AM


ORM R-301


for burial permit ard of Health its Agent. RUCTIONS FOR CERTIFICATE


OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (e)


oes not mean e of dying, heart failure, etc. Il means se, or compli- which caused


ons, if any, gave rise to cause (a), the under. cause last.


itions contrib. death but not the terminal ondition given


Medical Examiner Declined


420.1 81 8 70


10 1964


62-934553


PLACE OF DEATH


Suffolk


(County)


Boston


(City or Town)


Veterans Administration Hospital


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) 250 11500


2 FULL NAME


Patrick


F.


Molloy


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


(a)


Residence. No.


33


Bayview Ave.


XX


Winthrop,


Mass.


(C'ity or town and State)


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


(write the word)


Married


It If married, widowed, or divorced


HUSBAND of


Harriet .... Boyd


(or) WIFE of.


(Husband's name in full)


12


AGE69 ... Years.


.8


Months19


Days


If under 24 hours


Hours ....... )linutes


13 Usual


Occupation.


Oiler, retired


( Kind of work done during most of working life)


14 Industry


minut


es


or Business ..


OTHER


Arteriosclerotic aneurysm


SIGNIFICANT


CONDITIONS


abdominal aorta


Was autopsy performed?


Yes


What test confirmed diagnosis ?


Autopsy


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


If so, specify


M. D.


....


........


(Print or Type Name)


VAH Boston, Mass.


... Date.


Nov.15 ,63


Winthrop Cem., Winthrop, Mass. .


6


Place of Burial or Cremation


(City or Town)


November 18


19.


63


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Morris Kirby


ADDRESS


Winthrop, Mass.


Received and hled


NOV 2-0 1963


19.


William . Kane


A TRUE COPY ATTESTI


17 NAME OF


FATHER


Domenick Molloy


PARENTS


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary Murphy


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Informant


V. A. Hospital Records, 150 S.


(Address)


Huntington Ave ., Boston, Mass.


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


212.


19295


11/15/63


(Date of Iagde of Yermit) T V.B.


3 DATE OF


DEATH


November


14


1963


(Month)


(Day)


VA


(Year)


4 I HEREBY CERTIFY , That I attended deceased XO XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX LIKIYAXXXIX on November 14 , 163, death is said to have occurred on the date stated above, at .1:45P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Massive recent anteroseptal


(a)


myocardial infarction


INTERVAL


BETWEEN


ONSET AND


DEATH


hrs.


Due


T


(b)


Old ..... postero-septal .... infarction


Due To


Acute right coronary thrombo-


(c)


15 Social Security No .... 033-34-8724.


mos-yirg6 BIRTHPLACE (City) .... LOwell


(State or country )


Mass


(Signature)


Richard ... Lucey


(Address)


X OUT - OF - TOWN


1


Registered No.


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


1 (Was deceased a




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