Town of Winthrop : Record of Deaths 1963, Part 7

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 7


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


(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 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.


RM R-301


or burial permit rd of Health s Agent. UCTIONS FOR CERTIFICATE


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


es nat mean af dying, heart failure, etc. It means ,or campli- which caused


ns, if any, ave rise ta cause (a), the under- ause last.


tians contrib- leath but nat the terminal nditian given C.


2-932382


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


white


10 SINGLE


(write the word)


single


MARRIED


WIDOWED


DIVORCED


UNKNOWN


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE.8.5. Years ......... Months .... 2.4 Days


If under 24 hours


.Hours ... .... Minutes


13 Usual


retired Bldg.Supt.


Occupation :


(Kind of work done during most working life)


14 Industry or Businessommercialapartments


15 Social Security No .......


010-03-1223 1793


16 BIRTHPLACE (City)


(State or country)


England


17 NAME OF


FATHER


Edward Richards


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Margaret Jones


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Wales


Alfred O. Richards


Informant


( Address)


24 Quincey Ave, Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 4


(Signature of Agent of Board of Health or other) (~e)) .


Fel. 19. 1963


(Registrar)|| (Official Designation)


(Date of Issue of Permit)


TV


1


inthrop (City or Town)


No.


Robert Owen Richards


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.


29


S(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,


(if so specify WAR).


NO.


(a) Residence. No .. 24 Quincey Avenue


S


(If nonresident, give city or town and State)


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


February


16


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


JANUARY 27 1963


to ...


FEBRUARY 16


63


I last saw hagalive on


FEBRUARY 15, 1963, death is said to


have occurred on the date stated above, at 2:45 Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) ACUTE CEREBRAL HEMORRHAGE


INTERVAL BETWEEN ONSET AND DEATH


8 DAYS


5 YEARS


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? No


If so, specify


(Signature)


Dorothy Cheney appleton


M. D.


DOROTHY Cheney APPLETON


(Print or Type Name)


(Address) 197Woodside


ViniTHACO BADE Date 2/18


1963


Winthrop Cemetery, Winthrop


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL February 19, 1963


..... 12


7 NAME OF


FUNERAL DIRECTOR


alfred -B. March


ADDRESS


174 Winthrop St


Winthrop


Received and filed


FEB 19 1963


19


PLACE OF DEATH


Suffolk (County)


2 FULL NAME


24 Quincey Avenue


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


(Usual place of abode)


Length of stay: In place of death years 2 months days. In place of residence 39


male


Due To


(b)


ARTERIOSCLEROSIS


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


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 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.


ORM R-301


I


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.


30


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


PHYSICIAN - IMPORTANT


2 FULL NAME. MARY EMMA ( Armstrong) TAYLOR


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


10


Surfside Avenue


St


Winthrop


(a) Residence. No ..


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death.


4years ......... months .......... days. In place of residence4.Q.


.. years .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


FEBRUARY


16.


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


19


to.


19


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


have occurred on the date stated above, at


....


1'30 P.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Death due to natural


Due To


Causes , presumably due


(b)


Due To.


arteriosclerotic heart


OTHER


disease


SIGNIFICANT


CONDITIONS


Winthrop Boardy Healthy


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


LIBERMAN


(Address)


(Print or Type Name) Winthrop Mass Date


2/17/1963


6


Holy Cross


Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


February


1.9 ....


1963


7 NAME OF


FUNERAL DIRECTOR


FRANK H. CARR


ADDRESS


79 EIm


St., Charlestown


Received and filed


FEB 18-1963


19


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED Married


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


FRANK L. TAYLOR


(Husband's name in full)


12


AGE92


Years


Months.


.Days


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


or Business :


At Home


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Nova Scotia


17 NAME OF


FATHER


Robert Armstrong


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Nova Scotia


19 MAIDEN NAME


OF MOTHER


unknown


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Nova Scotia


Mrs. Esther Sanborn


21 Informant


(Address)


32 Francis St., Belmont


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


(Signature of Agent of Board of Health or other)


7.1.18.1967


(Registrar )|| (Official Designation)


(Date of Issue of Permit)


1 X


A TRUE COPY ATTEST:


62-932382


PLACE OF DEATH


Suffolk (County)


No


10 Surfside Ave., Winthrop


(City or Town making this return)


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


OR TYPE OR CAUSES DEATH not enter than one : for each (b) and (c)


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


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


litions contrib- death but not o the terminal ondition given


M. D. PARENTS


(c) ....


INTERVAL


BETWEEN


ONSET AND


DEATH


If under 24 hours


Hours ......


.Minutes


Housewe


Chester


(write the word)


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER.


RULES OF PRACTICE FEB 1 81963 AM of the


The fulfillment of the purpose of these laws calls for the observance 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 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.


1


ORM R-301


for burial permit ard of Health ts Agent. TRUCTIONS FOR CERTIFICATE


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


does not mean de of dying, heart failure, etc. It means ase, or compli- which caused


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


ditions contrib- death but not to the terminal condition given


PLACE OF DEATH


JUFFOLK (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.


31


No MAY FLOWER NURSING HOME 39 GROVERS ALE ( If death occurred in a hospital or institution.


St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME ... S


JULIA J (BARRY) SULLIVAN


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


(Was deceased a


U. S. War Veteran,


if so specify WAR).


NO


(a)


Residence. No. 47 SUNNYSIDE AVE


(Usual place of abode)


St


WINTHROP.


(City or town and State)


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


days. In place of residence 40 years.


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY , That I attended deceased from


Nov.


19 62 to Fele


17


63


I last saw hetalive on


Feb 15, 1969, death is said to


have occurred on the date stated above, at 7110An


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Myocardial Heart


Disease


Due To


(b) arteriosclerosis


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


Diabetes Mellitus


6 hours


Was autopsy performed ?


What test confirmed diagnosis ?


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


If so, speerfy


ature spe regar M. D.


Joseph GREGORIE


(Print of Type Name) (Address) 9+ Washinghaare Date ?.


2/18 63 19


6 WINTHROP


WINTHROP.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


FEB


20


1963


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS


WINTHROP


Received and filed


FEB 19 1963


19


( Registrar )|


8 SEX


9 COLOR


10 SINGLE


(write the word)


MARRIED


WIDOWED


DIVORCED


UNKNOWN KLIDUMED


FEMALE


WHITE


11 If married, widowed, or divorced HUSBAND of


(or) WIFE of


(Give maiden name of wife in full)


CORNELIUS SULLIVAN


(Husband's name in full)


12


AGE. 77 Years.


.. Months.


Days


If under 24 hours


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


13 Usual


HOME MAKTER


(Kind of work done during most of 1working life)


14 Industry


or Business :.


HUME


15 Social Security No. NONE


16 BIRTHPLACE (City)


(State or country )


17 NAME OF


FATHER


JOHN SULLIVAN BURRY


18 BIRTHPLACE OF


FATHER (City)


(State or country)


IRELAND


0


PARENTS


21 Informant


JOSEPH F SULLIVAIL


( Address)


47 SUNNYSIDE AVE WINTHROP


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


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


Health Officer


Feb . 19, 1963


(Official Designation)


(Date of Issue of Permit)


62-933404


A TRUE COPY ATTEST:


17


1963


PERSONAL AND STATISTICAL PARTICULARS


Occupation:


IRELAND


19 MAIDEN NAME


OF MOTHER


UNKNOWN )


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


IRELAND


(City or Town making this return)


1


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


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 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.


ORM R-301


1


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.


32


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


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


Mccluskey (Dunnigan)


(a)


Residence. No.


18 James Ave.,


(Usual place of abode)


Length of stay: In place of death .......... years ......... months ... 16days. In place of residence ..


years .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


February


18


1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY, That I attended deceased from


Jan,


1962, to


Feb 15


63


I last saw hexalive on


Feb. 18


., 19 63 death is said to


have occurred on the date stated above, at.


10:10 Pm.


INTERVAL BETWEEN ONSET AND DEATH


(a) Hypertensive and Arlexion


3yrs.


(b)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


No


What test confirmed diagnosis? Clinical


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


(Signature)


M. D. CHARLES LIBERMAN


(Print of Type Name)


(Addre


Winthrop, Mass Date 2/18/1963


6


St. Patrick's


Lowell


Place es Dutral of cremation


(City or l'own)


DATE OF BURIAL


Feb. 21


, 53


7 NAME OF


FUNERAL DIRECTOR


Maurice W. Kirby


ADDRESS


Winthrop


Received and filed


FEB 19 1963


19


(Registrar)


8 SEX


9 COLOR


White


MARRIED


WIDOWED Widowed


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Frank A. Mccluskey


(Husoand's name in full)


12


AGE,8 1


.Years


Months.


Days


If under 24 hours


Hours .......


Minutes


13 Usual


Occupation :


Domestic


( Kind of work done during most working life)


14 Industry


or Business :


15 Social Security No.


027-29-4881


16 BIRTHPLACE (City)


(State or country )


Mass.


17 NAME OF


FATHER


Francis Dunnigan


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Treland


19 MAIDEN NAME


OF MOTHER


Mary McArdle


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Informant


Mary Mccluskey


( Address)


18 James Ave., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Maich VerLa (Signature of Agent of Board of Health or other) ( NO)


Health Office


Feb. 19 1963


(Official Designation) (Date of Issue of Permit)


TV


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


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


oes not mean e of dying, heart failure, etc. It 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


62-932382


A TRUE COPY ATTEST:


PHYSICIAN - IMPORTANT


(Was deceased a U. S. War Veteran, if so specify WAR) no


Winthrop Mass


St


(If nonresident, give city or town and State)


38


10 SINGLE


(write the word)


Female


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Due Selerotic Heart Disease


House 1


North Chelmsford


No.


Winthrop Community Hospital


(City or Town making this return)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE. July 15, 1942


DATE OF DISCHARGE Feb. 24, 1945


RANK, RATING MOLM Second Class


ORGANIZATION AND OUTFIT


US Navy


SERVICE NUMBER.


140-40-83


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 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.


FED 250003 AN


ORM R-301


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


OR TYPE OR CAUSES DEATH


ot enter than one for each (b) and (c)


oes not mean e of dying, heart failure, etc. It 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 C.


PLACE OF DEATH


Suffolk (County) Winthrop


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


STANDARD CERTIFICATE OF DEATH


Registered No. 34


[(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.)


47 Washington Avenue


... 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


Feb.


22


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


19. to .....


19


I last saw h ...... alive on


19 ........ , death is said to


have occurred on the date stated above, at


........


5 ..... m.


INTERVAL BETWEEN ONSET AND DEATH


(a)


Due Tonatural causes, probably (b)


acute coronary occlusion on


Due


(c)


Basis of history


OTHER SIGNIFICANT CONDITIONS


Winthrop Boarding 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


CHARLES


LIBERMAN


(Address)


(Print of Type, Name) WINTHROP MASS Date:


e: 2/22/1963


6


Forest Hills Crematory.,


Poston


Place of Burial or Cremation


(City or Town)


February 25, 1963


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Benjamin F. Solomon


ADDRESS


420 Horvard Street, Brookline


Received and filed


FEB 25 1963


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE




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