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