Town of Winthrop : Record of Deaths 1961, Part 1

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 1


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.


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



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X SUFFOLK (County)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


To be filed for burial permit with Board of Health or its Agent.


Registered No.


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


PHYSICIAN - IMPORTANT


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


(If deceased is a married, widowed or divorced woman/ give also maiden name.) 164 SOMERSET AVE WINTHROPST.


(a) Residence.


(Usual place of abode)


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


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


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


JAI 2 1961 (Year)


(Month)


(Day)


8 SEX


FEMALE


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED WIDOWED


or DIVORCED


4 I


HEREBY


CERTIFY,


That I attended deceased from


JAN


52, 10


.. , to.


JAN 2


6/


I last saw HERlive on


JAN


2


19 61, death is said to


have occurred on the date stated above, at


2SEP


.. m.


INTERVAL


BETWEEN


ONSET AND


DEATH


5DAYS


AGE


LOUIS


' (Give maiden name of wife in full)


KRAMER


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12 80 Years 4 Months. 4 Days


If under 24 hours


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


13 Usual


Occupation :


HOUSEWIFE


(Kind of work done during most of working life)


14 Industry


or Business :


OWN


HOME


15 Social Security No. NONE


16 BIRTHPLACE (City)


(State or country)


GERMANY


17 NAME OF


FATHER


HERMAN TEICHMEIER


18 BIRTHPLACE OF


FATHER (City) (State or country)


GERMANY


19 MAIDEN NAME OF MOTHER MARIE HASE


20 BIRTHPLACE OF MOTHER (City) (State or country)


GERMANY


21 Informant ALFRED W. TEICHMEIER (Address) I OAK KNOLL RD. METHUEN


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 Officina


Jan 2, 1961


.... (Official Designation) (Date of Issue of/Permit)


INSTRUCTIONS FOR EDICAL CERTIFICATE


In giving USE OF DEATH do not enter more than one cause for each f (a), (b) and (c)


This does not mean , mode of dying, h as heart failure, henia, etc. It means , disease, or compli- ions which caused ath.


Conditions, if any, which gave rise to above cause (a), itating the under- lying cause last.


Conditions contrib- ing to death but not ated to the terminal ease condition given (a).


Tote :- Chapter 137. ts of 1954. requires ysicians to print or e the cause or ses of death on Ith certificates, and apter 48, Acts of 9, requires Physi- ns to print or type ne under signature.


50H-11-59-926662


PLACE OF DEATH


FORM R-301A 1 WINTHROP (City or Town) ·LACIÓAM WINTHROP COMMUNITY HOSPTIAL


No.


2 FULL NAME.


FRIEDA (TEICHMEIER) KRAMER


10a If married, widowed, or divorced HUSBAND of


(or) WIFE of


DEATH WAS CAUSED BY: IMME IATE CAUSE


LOBAR PNEUMONIALEFT


(a)


...


Due To (b)


CEREBRAL VASCULAR ACCT


3 DAYS


Due To ARTERIO-SCLEROTIC S HYPER (c)


TENSIVE HEART DIS E CONG


OTHER


FAILURE


SIGNIFICANT


CONDITIONS


CARCINOMA OF UTERUS


Was autopsy performed?


IVO


What test confirmed diagnosis ?


CLINICAL+ Yen


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


(Signed) MYRON N. KING M.D


M. D.


(PRINT OR TYPE SIGNATURE)


(Address) 222 PLEASANT WINTER


5 Date.


1/2/06/


6 BELLEVUE CEMETERY LAWRENCE Place of Burial or Cremation (City or Town)


DATE OF BURIAL JAN. 5.


1961 19


7 NAME OF FUNERAL DIRECTOR


J. B. EMMERT + SONS


ADDRESS 93 E. HAVERHILL ST. LAWRENCE


Received and filed


(Registrar)


8 YRS.


24RS.


PARENTSS


CERTIFICATE OF DEATH


(If nonresident, give city or town and State)


MEDICAL CERTIFICATE OF DEATH


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER 1


i


6


THROP


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the obserata 31961 AM


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.


X


Middlesex


Everetty


(City or Town)


Whidden Memorial Hospital


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


Everett


(City or Town making this return)


2


Registered No. .....


f (If death occurred in a hospital or institution.


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


Berenice A (Nickerson) Goodwin


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


15 Willow Ave.


Winthrop,


Mass.


(If nonresident, give city or town and State)


Length of stay: In place of death.


........ years ....


.months


7


13


days. In place of residence ..


... years.


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


January 5, 1961


1051


(Day)


( Year)


ented deceased from


I last saw


her


Jän. 5


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


have occurred on the date stated above, at


8:55 Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


11 IF STILLBORN, enter that fact here.


12


78


3


18


If under 24 hours


Hours ...


Minutes


13 Usual


Occupation :


Teacher (retired)


( Kind of work done during most of working life)


14 Industry


or Business :


Public School


15 Social Security No. None


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


James Nickerson


18 BIRTHPLACE OF


FATHER (City)


Nova Scotia


(State or country )


19 MAIDEN NAME


OF MOTHER


Adelia Garron


Nova Scotia


21 Etta G. English


Informant


( Address)


Winthrop


A TRUE COPY


ATTEST :


(Registrar of City or Town where death occurred) .


DATE FILED


January 10,


19


1


( Registrar of City or Town where deceased resided )


PARENTS


50M-9-59-926111


No ..


2 FULL NAME


(a)


Residence. No ..


( Usual place of abode)


DEATH


(Month)


CE


4


Sept.


19


to ..


(b)


(c)


OTHER


SIGNIFICANT


CONDITIONS


What test confirmed diagnosis ?


( Address)


6


DATE OF BURIAL


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


No


PLACE OF DEATH


FORM R-302


WRITE PLAINLY WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - r


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 MARGIN RESERVED FOR BINDING THIS IS A PERMANENT RECORD


John F. Williams


( Signed )


Everett


1=6


M. D.


Date. 196.1.


Woodlawn Crematory Everett Place of Burial or CreuJanuary 9, (City or Town)


19


Howard S Reynolds


7 NAME OF FUNERAL DIRECTOR Winthrop, Mass.


ADDRESS


Received and filed FEB 13 1961 19 .....


9 COLOR


8 SEX


Female


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Widow


10a If married. widowed, or divorced


HUSBAND of


( Give maiden name of wife in full)


(or) WIFE of.


Benjamin F. Goodwin


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Carcinoma of Pancreas


(a)


Due To


Secondary Carcinoma


of Liver


Due To Acute Dilation Heart


Was autopsy performed ?


Clinical Findings


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


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


.


1


( Was deceased a


U. S. War Veteran.


if so specify WAR,


1


19


AGE


Years.


Months.


.. Days


TOW


F


11 12 1


OLE


OFFIC


10


RH


MIN


*


mmmmm


3


WII


RO


FED 1 31961 MM


SPACE FOR ADDITIONAL INFORMATION


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


X PLACE OF DEATH


PuisTor


7.61


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


To be filed for burial permit with Board of Health or its Agent.


3


Registered No.


[(If death occurred in a hospital or institution,


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


2 FULL NAME


Mary A. Murray


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


25 White St.


St.


(If nonresident, give city or town and State)


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


3


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


............. years.


months ....


......


... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


January


6,


1961


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


une


59


San 6


19.61


I last saw himalive on


Ja


6


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


have occurred on the date stated above, at


gioi p. m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Cerebro vascular


Hemorrhage


Due To


arteriosclerosis


(b)


generalized


Due To


Senility


(c)


yp


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


(Signed).


Joseph Gregorie


., M. D.


194 Wash iPRINTOn TARESIGNATURE) 1/7 61


(Address)


Date


19


6 Holy Cross


Malden


Place of Burial or Cremation


Jan.


9


(City or Town)


61


19


7 NAME OF


FUNERAL DIRECTOR


Frederick J. Magrath


ADDRESS


East ..... Boston


Received and filed JAN 10-1961 19


(Registrar) #


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


94


12


AGE


Years.


Months.


.Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


housework


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


14 Industry


or Business :


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


NovaScotia


17 NAME OF


FATHER


Andrew


Cameron


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Nova Scotia


19 MAIDEN NAME


OF MOTHER


Elizabeth Morrison


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


James K. Murray


"Nova Scotia


21


Informant


(Address)


280 Revere St. 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)


emma 8, 1461


(Official Designation)


(Date of Issue of Permit)


Y


FORM R-301A 1


3.515


INSTRUCTIONS FOR EDICAL CERTIFICATE


In giving USE OF DEATH do not enter more than one cause for each f (a), (b) and (c)


This does not mean mode of dying, h as heart failure, henia, etc. It means disease, or compli- ions which caused th.


Conditions, if any, which gave rise to bove cause (a), tating the under- lying cause last.


Conditions contrib- ng to death but not ited to the terminal case condition given (a).


ote :- Chapter 137, s of 1954. requires sicians to print or e the cause or ses of death on th certificates, and ipter 48, Acts of 9, requires Physi- has to print or type ne under signature.


50M-11-59-926662


Suffolk


(County)


Winthrop


CERTIFICATE OF DEATH


(City or Town)


Mount's Convalescent Home


No.


PHYSICIAN - IMPORTANT


[(Was deceased a


no


U. S. War Veteran,


(if so specify WAR)


(a) Residence.


No.


(Usual place of abode)


East Boston


MARRIED.


WIDOWEWidowed


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


James F. Murray


INTERVAL


BETWEEN


ONSET AND


DEATH


1 dag


own home


PARENTS


DATE OF BURIAL


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 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.


X PLACE OF DEATH


Suffolk (County)


CONSEDITING


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


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


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


46 Washington Ave.


St.


Winthrop


(If nonresident, give city or town and State)


Length of stay : In place of death .. .


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


14 days. In place of residence.


.......


.years.


... months


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


an.


7


1961


(Month)


(Day)


(Year)


4ş I


HEREBY


CERTIFY


That I attended deceased from


mar


1950 to Jan, 1


1900


1 last saw h.C.lalive on


Jan


3


19 ..


.. , death is said to


have occurred on the date stated above, at


10-12. P ..


.. m.


INTERVAL


BETWEEN


ONSET AND


DEATH


weeks


Due To Carcinoma


(b) Gall Bladder


Due To


(c)


OTHER


arteriosclerosis


SIGNIFICANT CONDITIONS general


1900


Was autopsy performed?


no


What test confirmed diagnosis ?


operation


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


(Signed) popple fre igone M. D. 194 Washurtto ane (PRINT OR TYPE SIGNATURE) Joseph GREGORIA Date 1-9


1960


6 Winthrop Cemetery, Winthrop


(City or Town)


Place of Burial or Cremation


DATE OF BURIAL


Jan. 10


60


19


7 NAME OF


FUNERAL DIRECTOR


ErnestP ...... Caggiano


ADDRESS


147 Winthrop St. Winthrop


Received and filed


JAN 10-1961


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIEDwidowed


WIDOWEIN


or DIVORCEI)


10a If married, widowed, or divorced


HUSBAND of


Edgar D." Waterman


(Husband's name in full)


11 1F STILLBORN, enter that fact here.


87


12


AGE


Years.


Months ..


Days


If under 24 hours


Hours.


.......... Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business :


at home


15 Social Security No.


16 BIRTHPLACE (City) (State or country)


Cape Breton


Canada


17 NAME OF


FATHER


Henry Bennett


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Cape Breton


Canada


19 MAIDEN NAME


OF MOTHER


?


Young


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Canada


Cape Breton


Mrs Doris Gillis


(Address) 330 Selby St. Montreal, Que.


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


(Signature of Agent of Board of Health or other) Jan 7, 1961


(Official Designation)


(Date of Issue of Permit)


NSTRUCTIONS FOR CAL CERTIFICATE


In giving SE OF DEATH lo not enter ore than one use for each a), (b) and (c)


s does not mean mode of dying, as heart failure, ia, etc. It means sease, or compli- which caused


ditions, if any, :h gave rise to le cause (a), ing the under- cause last.


onditions contrib- to death but not to the terminal condition given


: :- Chapter 137, of 1954, requires cians to print or the cause or s of death on certificates, and er 48, Acts of requires Physi- to print or type under signature. Mit ..


6.6600


-


Winthrop (City or


No.


...


46 Washington Ave


The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


To be filed for burial permit with Board of Health or its Agent.


2 FULL NAME


Selena Waterman (Bennett)


(a) Residence. No. (Usual place of abode)


to ...


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Carcinomatosis


( weeks)


(Ging maiden name of wife in full)


(or) WIFE of


PARENTS


(Address)


RM R-301A 1


5.24.60


MIX


31-6-59-925686


21


Informant


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


TO:


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 inrelated 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 certily 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 erinfection 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-301A 1


INSTRUCTIONS FOR DICAL CERTIFICATE


In giving JSE OF DEATH do not enter more than one cause for each (a), (b) and (c)


his does not mean mode of dying, as heart failure, nia, etc. It means disease, or compli- ns which caused h.


unditions, if any, sich gave rise to ove cause (a), iting the under- ing cause last.


Conditions contrib- 3 to death but not ed to the terminal se condition given 1)


te :- Chapter 137, of 1954. requires icians to print or the cause or es of death on 1 certificates, and ter 48, Acts of requires Physi- ; to print or type : under signature.


OM-11-59-926662


PLACE OF DEATH


SUFFOLK (County) WINTHROP (City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


5


WINTHROP COMMUNITY HOSPITAL, {If death occurred in a hospital or institution. No.


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


PHYSICIAN - IMPORTANT


[(Was deceased a


U. S. War Veteran,


[if so specify WAR)


No


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


AVENUE


St.


(If nonresident, give city or town and State)


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


months 2 3 days. In place of residence.


22 years.


......


.. months.


......


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


JAN


8


1961


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY,


JAN


19


51


to


JAN


8


19.6


I last saw h. FRalive on


1/8


19 61, death is said to


have occurred on the date stated above, at


352 pm


INTERVAL


BETWEEN


ONSET AND


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Cachal vascular accident


(a)


DEATH 3 who


3 YRS.


Due To


general arteriosclerosis


(c)


AURICULAR FIBRILLATION -MYOCARDIAL.


OTHER


SIGNIFICANT


POST LEFT Thigh amputation"


CONDITIONS


DIABETES MELLITUS MILD


LYRS.


iYR.


Was autopsy performed ?


What test confirmed diagnosis ?


CLINICAL.


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


(Signed)


MYRON


Dr. KING MD


(PRINT OR TYPE SIGNATURE) (Address) wwwPleasantST ... Date ... 1/8 /06/


ANSHA SFARD'


Place of Burial or Cremator


DATE OF BURIAL JAN 9


7. NAME OF


FUNERAL DIRECTORS


Louie Hymaning


ADDRESS


Received and filed ItaClark


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


FEMALE WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED LL iDOWD.


10a If married, widowed, or divorced HUSBAND of


(or) WIFE of


JOSEPH


(Give maiden name of wife in full)


B: COHEN


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


74 years.


2


Months.


16 Days


If under 24 hours


Hours.


.Minutes


13 Usual


Occupation :


HOUSEWIFE


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


14 Industry


or Business :


AT HOME


15 Social Security No. NINE


16 BIRTHPLACE (City)


(State or country)


RUSSIA


17 NAME OF


FATHER


KiVA BRENNER


18 BIRTHPLACE OF


FATHER (City)


(State or country)


RUSSIA


19 MAIDEN NAME


M. D.


OF MOTHER


EVA COHEN


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russin


21 Informant


(Address) A PARKVIEW BLVD. GRANSTIX ROL


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE The burial 6r transit permit was issued: 1


(Signature of Agent of Board of Health or other)


De.O. Jan 9, 1961


(Official Designation)


(Date of Issue of Permit)


To be filed for burial permit with Board of Health or its Agent.


FANNIE (BRENNER) COHEN 2 FULL NAME


(a) Residence. No.


200 WOODSIDE


(Usual place of abode)


That I attended deceased from


67


Due


(b)


Hypertensive q artenco valentes


Heart ois à congesture future


5YRS.


No


6


DANVERS


(City or Town)


1961


19


PARENTS


William ECHEN SEN


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF. DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


TOWA


RULES OF PRACTICE


JE OF


ERIT


The fulfillment of the purpose of these laws calls for the observance ofthe following rules of practice : L'O


(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. - Those of 5 MASS


(2) Board of Health physicians will certify to such deaths only as persons who, though disabled by recognized disease unrelated to an injury, have died without recent medical attendance or whose soy yo absent from home when the certificate of death is needed.




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