Town of Winthrop : Record of Deaths 1940, Part 21

Author: Winthrop (Mass.)
Publication date: 1940
Publisher:
Number of Pages: 494


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 21


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 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70


Statement of Occupation .- Precise statement of occupation is very Important, 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 occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husl- ness, report the usual oeenpatlon prior to retirement. Children not galnfully employed may he returned as at school or at home. For a woman whosc only occupation was that of home housework, write housework. For a person engaged In domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


R-302


PLACE OF DEATH


(County)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BOSTON


(City or town making return)


Registered No


2215


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


(If U. S. War Veteran, specify WAR)


(a) Residence. No ......


(Usual place of abode)


Length of stay: In hospital or institution.


(Specify whether)


....


years


months


days.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX 1 Fem


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


(write the word)


18 DATE OF


DEATH.


march


7


(Month)


(Day)


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive.


years 7 IF STILLBORN, enter that fact here.


AGE 81 Years .. Months. Days


If less than 1 day Hours Minutes


Usual 9 Occupation:


Industry


10 or Business:


at home


II Social Security No.


12 BIRTHPLACE (City)


(State or country)


Russia


13 NAME OF


FATHER


Jacob helson


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Sarah


-


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


Relation, if any


Informant.


(Address)


17 Jacob score )


A TRUE COPY.


ATTEST:


Jaques Q. Brunhe


(Registrar of city or town where death occurred)


DATE FILED


3/9/40


19


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of.


Of autopsy


What test confirmed diagnosis ?


20 Was disease or Injury in any way related to eccupation of deceased ?


If so, specify


B.a. Udelson


(Signed)


(Address)


3/7/199


M. D. 40


21 PLACE OF BURIAL.


CREMATION OR REMOVAL


Chelsea Woburn


DATE OF BURIAL


3/4/40


40


(Cemetery) (City or Town) 19


......


22 NAME OF


FUNERAL DIRECTOR


m. Staneteky


ADDRESS


Received and filed


19


(Registrar of City or Town where deceased resided)


50m-10-'39. No. 8427-f


Suffolk


1


(City or Town)


Hebrew aged Home


No.


Rebecca


Livre


2 FULL NAME


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


361 Shirley St


St.


Winthrop


(If nonresident, give city or town and state)


1940 ( Year)


19 | HEREBY CERTIFY ..


That I attended deceased from


3/7/40


3/1/60


19


.,


to ....... 19


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


3 /7/ 194 P death is said


to have occurred on the date stated above, at ............


Immediate cause of death.


Pneumonia


Duration


....... 3/4/40


Due to


myocarditis


Due to


arterio seturi


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


PARENTS


more


www sue Wtswsta Itstucq Ty another City of town at the time 6. Sec. 12, G. L.)


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46,


(


2


7


IN THR


APR121040 MM


R-302


PLACE OF DEATH


ESSanty)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Danvers


(City or town making return) 63


Registered No.


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


2 FULL NAME


(HELA E a married traged or divorced woman, give also maiden name.)


(a) Residence. No ...


(Usual place of abode)


Length of stay: In hospital or institution ....


(Specify whether)


56 Sagemore


AVE.


years


months


days. 18


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


18 DATE OF


DEATH


Mar. 8, 1940.


(Month)


(Day)


(Year)


IS I HEREBY CERTIFY


red.


That I attended deceased from


.? , 19


to.


19


.....


I last saw


alive on


to have occurred on the date stated above, at.


.m.


Duration


Immediate cause of death


generali zou


Chr.Lvocusto.


3726


8


AGE


85


Months.


Days


If less than 1 day


Hours


Minutes


Usual


9 Occupation:


Painter(retired)


Industry 10 or Business:


II Social Security No ..


12 BIRTHPLACE (City)


Cannot be learned


(State or country)


LOSGOR


13 NAME OF


FATHER


valter S. Dunn


PARENTS


14 BIRTHPLACE OF


FATHER (City)


Halifax


(State or country)


N. 8.


15 MAIDEN NAME


OF MOTHER


Jane FlIna


16 BIRTHPLACE OF


MOTHER (City)


Dublin


(State or country)


'Ireland


(Address)


Date


5/32/40


21 PLACE OF BURIAL,


CREMATION , OR REMOVAL. .. \,


(Cemeteryn


(City or Town)


DATE OF BURIAL


3.199 /40


19.


22 NAME OF


FUNERAL DIRECTOR John 12


D'in Ley


ADDRESS


winthrop


19


(Registrar of City or Town where deceased resided)


waves city of sonra lu case the deceased resided in another city of town at the time


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


50m-10-'39. No. 8427-f


17


Informant.


(Address)


Relation, if any


A TRUE COPY.


ATTEST:


(Registrar of city or town Where ceath occurred)


DATE FILED 3/25/40


Other conditions


(Include pregnancy within 3 months of deathi)


PHYSICIAN


Major findings :


Of operations


Of autopsy


Date of.


Underline the cause to which death should be charged sta- tistically.


What test confirmed diagnosis ?


clinical


20 Was disease or Injury In any way related to occupation of deceased ? If so, specify.


(Signed)


Myer Asekoff


M. D.


Due to


Due to


Mar.


40


death is said


(Husband's name in full)


6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.


.years


5a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(If U. S. War Veteran, specify WAR)


St.


ii (If Woodresident,' give city or town and state)


Received and filed.


.19


1


No. Danvers State Hospital


TOWA


1


3


5


HP


APR121940 AM


..


- .


R-302


PLACE OF DEATH


Essex (County)


Danvers


(City or Town)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Dunvers


(City or town making return)


Registered No.


1 (If death occurred in a hospital or institution, St.


2 FULL NAME


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


(a) Residence. No ..


235 ... Court Road


. .St.


years


months


days


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


female


4 COLOR OR RACE 5 SINGLE


MARRIED


white


WIDOWED


or DIVORCED


widowed


5a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


GeorgeHart


(Husband's name in full)


6 Age of husband or wife if alive.


7 IF STILLBORN, enter that fact here.


8


76


AGE


Years


Months.


Days


......


If less than 1 day


Hours


Minutes


Usual


9 Occupation:


Cannot be learned


Industry 10 or Business:


Il Social Security NALHut be learned


12 BIRTHPLACE (City)


Boothbay, Mains


(State or country)


13 NAME OF


FATHER


edwin Anderson


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Kaine


15 MAIDEN NAME


OF MOTHER


Vesta Webber


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


Maine


17 Informant (Address)


A TRUE COPY.


ATTEST:


(Registrar, of city or town where death occurred) 3/12/40


DATE FILED


19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH.


March 11, 1940.


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY. That I attended deceased from .


I last saw b


.. alive on.


40


death is said


to have occurred on the date stated above, at.


1.852


m.


Immediate, cause, of death ........ "


Duration 2 VYS Generalized arteriosclerosis 3yrs Bronchopneumonia


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


Of autopsy


What test confirmed diagnosis ?.


20 Was disease or Injury In any way related to occupation of deceased ? no


If so, specify.


(Signed)


Malvin Goodman


. M. D.


(Address)


Date.


3/119 40


21 PLACE OF BURIAL,


BEMATION OR REMOVAL


(City or Town)


DATE OF BURIAL


3/13/10


19


22 NAME OF


FUNERAL DIRECTOR


Charius R. Bennison


ADDRESS


Winthrop


Received and filed.


afar 12 -H.J


19


(Registrar of City or Town where deceased resided)


50m-10-'39. No. 8427-f


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


1


No .. DanversState ... Hospital


.....


.........


give its NAME instead of street and number)


(If U. S.


War Veteran,


specify WAR)


"(H honest


Ifheit Live city or town and state)


(Usual place of abode)


Length of stay: In hospital or institution.


(Specify whether)


(write the word)


years


PARENTS


K. Mochillipc


Relation, if any


Date of.


Underline the cause to which death should be charged sta- tistically.


....


19


..........


19.


.40


1


We svira tu tost tuc ucctastu festued in another city of town at the time


6 5


YROPN


ASS


APR121940 %1


1 R-305


after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time


25m-10-'39. No. 8427-g


PARENTS


14 BIRTHPLACE OF FATHER (City)/


(State or country) Russia


15 MAIDEN NAME OF MOTHER Sarah (cannot be learned)


16 BIRTHPLACE OF MOTHER (City) Russia


(State or country)


17 Anin-law


Relation, if any


Informant.


(Address)


alme


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


Mar 18.


19


MEDICAL CERTIFICATE OF DEATH


18 DATE OF DEATH. March 14, 1940 (Month)


(Day)


(Year)


19 | 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.)


Broncho pneumonia


fractured leg. under


investigation


20 Accident, suicide, or homicide (specify)


Date of occurrence .. Where did Injury occur?


(City or town and State)


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


Manner of


Injury


Nature of Injury


While at work ?


.Was there an autopsy ?


21 Was disease or lajury to any way related to occupation of deceased ?.


If so, specify


(Signed) 6. 2. O.Leary


(Address).


est Med Exam Date 3-14 1940


.. M. D.


22 ayudatti aduno- Statura Place of Burial, Cremation or Removal. City or Town)


DATE OF BURIAL


19


23 NAME OF


I. b. Stantteky


FUNERAL DIRECTOR


ADDRESS


Bootnumber


Received and filed


19


(Registrar of City of Town where deceased resided)


1


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


36 Handside are


St.


Winthrop. mars


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution ..


(Specify whether)


years


months


days.


(If nonresident, give city or town and state)


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


or DIVORCED wordower


(write the word) .


male white


widowed, or divorced Sarah Rembaum


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of ...


(Husband's name in full)


6 Age of husband or wife if alive.


Years


7 IF STILLBORN, enter that fact here.


AGE


8 80 Years Months Days


li less than 1 day


Hours


Minutes


Usual 9 Occupation:


notion Peddler


Industry


10 or Business:


11 Social Security No. nonel


12 BIRTHPLACE (City)


(State or country)


turcia


13 NAME OF


FATHER


Joseph Chenofsky


PLACE OF DEATH


(County) Boston


(City or Town) 126 Kelsyth Road


No


utfolk


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH


(City or town making return)


Registered No.


2457


(If death occurred in a hospital or institution,


give its NAME instead of street and number)


(If U. S. War Veteran, specify WAR).


61


2 FULL NAME


Serael Gehenafter


51. 1


- .


19


(Specify type of place)


march19,


..........


10


'0


11


1


APR121940 MM


R-302


1


PLACE OF DEATH


ST (County) [ K BOSTON Peter Bent Brigham Hapi No ...


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BUSIUN (City or town making return) 2744


Registered No


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


(11 U. S. War Veteran, specify WAR) Winthrop mass


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution.


years


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX Fem


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


(write the word)


18 DATE OF


DEATH.


March 22 1940


(Month)


(Year)


(Day)


That I attended/ deceased from


5a If married, widowed, or divorced HUSBAND of


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive. Yecrs


7 IF STILLBORN, enter that fact here.


ÅGE ..


Months


.Days


If less than 1 day


Hours.


Minutes


Usual


9 Occupation:


at home


Industry 10 or Business:


11 Social Security No ...


12 BIRTHPLACE (City)


(State or country)


EBoston


13 NAME OF


FATHER


James a Burns


14 BIRTHPLACE OF


FATHER (CHY)


(State or country)


Boston mass


15 MAIDEN NAME


OF MOTHER


anna Glynn


16 BIRTHPLACE OF MOTHER (City) Boston (State or country)


17


Informant


(Address)


Relation, if any


A TRUE COPY


ATTEST:


James Q.Burke


(Registrar of gity or town where death occurred)


DATE FILED 3/2.6/40


19


Major findings :


Of operations


Of autopsy


Cympline ext lung


What test confirmed diagnosis ?. autopay


20 Was disease or Injury In any way related to occupation of deceased? Who If so, specify.


(Signed)


WB Osgood


M. D.


(Address)


Date 3/22/1940


21 PLACE OF BURIAL.


CREMATION OR REMOVAL(!Y


HolyCaso


DATE OF BURIAL


3/25/40


19


22 NAME OF


FUNERAL DIRECTOR


ADDRESS


Maraton


Received and filed


19


(Registrar of City or Town where deceased resided)


50m-10-'39. No. 8427-f


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


2 FULL NAME


Mary a. mcCann


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


20 Woodside PR.


St.


months


days.


(If nonresident, give lity or town and state)


In this community/Oyrs.


mos.


days.


63


119 I HEREBY CERTIFY. Ca 29 1940 3/22/40 19


h .. Aalive on ....


3/22/2019.


death is said


to have occurred on the date stated above, at .... 33300m


Duration Immediate cause of death. Hodgkins disease


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


Walken


(Cemetery)/


(City or Town)


PARENTS


3 60 Years


TOWA


12 1


7


6


5


HROP.


M


APR121940 M1


M R-302


PLACE OF DEATH


SUFFOLK BOCounty


(City or Town)


No. New England Hosp for W & C


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


ISTON [ City or town making return)


Registered No 3034


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


-


2 FULL NAME


3 SEX


F


5a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


7 IF STILLBORN, enter that fact here.


Usual


9 Occupation:


Industry


10 or Business:


11 Social Security No.


13 NAME OF


FATHER


15 MAIDEN NAME


OF MOTHER


PARENTS


17


Informant.


H F Reinhard


(Address)


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


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


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible


(State or country)


Mass


50m-10-'39. No. 8427-f


4 COLOR OR RACE: 5 SINGLE


MARRIED


W


WIDOWED


or DIVORCED


(write the word)


Widowed


(Give maiden name of wife in full)


Louis .... T .... Howard


(Husband's name in full)


6 Age of husband or wife if alive .Years!


8 ÅGE .. .6.9 .... Yoars Months. Days


If less than 1 day


Hours


Minutes


a.t .... home


12 BIRTHPLACE (City)


Boston


(State or country)


Mass


Ferdinand A Reinhard


14 BIRTHPLACE OF


FATHER (City)


Boston


Julia Wood


16 BIRTHPLACE OF


MOTHER (City)


Halifax


(State or country)


Nova Scotia


Relation, if any Brother


A TRUE COPY.


ATTEST:


James Q. Bunke


Registrar


/(Registrar of city or town where death occurred)


DATE FILED


4/3/40


.. 19.


18 DATE OF


DEATH


March 30 1940


(Month)


(Year)


(Day)


That I attended deceased from


I last saw h .. O.r ..... alive on.


3/30/40


to have occurred on the date stated above, at.


19 ...


., death is said


Duration


Immediate cause of death ..


Metastatic carcinoma


to liver


Due to Carcinoma of left breast


Due to


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Left mastectomy


carcinoma


Date of.Jan. 1937


Of autopsy


What test confirmed diagnosis ?


20 Was disease or lajury In any way related to occupation of deceased ?


If so, specify.


(Signed)


L B.Crowell


(Address) N E Hosp for W & C


Da3/30/4019


, M. D.


21 PLACE OF BURIAL,


CREMATION OR REMOVAL


South Church Cem. Andover


(Cemetery)


(City or Town)


DATE OF BURIAL


22 NAME OF


FUNERAL DIRECTOR


C R Bennison


ADDRESS


Winthrop


Received and fled


apr 2 ml


19


(Registrar of City or Town where deceased resided)


(If U. S.


War Veteran,


specify WAR)


63


75 Somerset Avenue


St.


Winthrop


(a) Residence. No ...


(Usual place of abode)


Length of stay : In hospital or institution.


years


months


days.


(If nonresident, give city or town and state)


In this community5 yrs.


nos.


5


days.


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


19 | HEREBY CERTIFY.


3/26/40


19


to ..


3 /30/40


19


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


4/2/40


19


1


Alice Howard


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


TOM !!!


11 12


9


in


8


6


HROF


APR121940 M


<


A R-302


3 SEX


male


(or) WIFE of


8


AGE


Usual


9 Occupation:


Industry


10 or Business:


16 BIRTHPLACE OF


PARENTS


MOTHER (City)


(State or country)


17


Informant.


(Address)


50m-10-'39. No. 8427-f


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible


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


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


(State or country)


4 COLOR OR RACE 5 SINGLE


white


(write the word)


MARRIED


WIDOWED


or DIVORCED


separated


5a If married, widowed, or divorced HUSBAND of


(Give maiden baigje bof wife in)( 1 3


(Husband's name in full)


6 Age of husband or wife if alive


7 IF STILLBORN, enter that fact here.


Months. Days


If less than I day Hours .. .Minutes


11 Social Security No ......... ne


12 BIRTHPLACE (City)


(State or country)


Russia


13 NAME OF


FATHER


Morris Buddelof


14 BIRTHPLACE OF


FATHER (City)


...


15 MAIDEN NAME


OF MOTHER


Rosie ----


Cannot NO ICETEA


Relation, if any


Muckhilips(


A TRUE COPY.


-


ATTEST:


(Registrar'of city or town where death occurred)


DATE FILED 4/9/40


19


.............


.St.


(If Homesiatht, give' city or town and state)


(Specify whether)


years


months


dayg.


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


April 1, 1940


(Month)


(Day)


(Year)


19 I HEREBY CERTIFY.


That I attended deceased from


I last saw h ......... malive on .............. }}} ?............... , 19.


.... ,


death is said


to have occurred on the date stated above 10. 05 TO


om.


Immediate cause of death


Lobar ... pnoumonia ......


...


Duration 3/11/40


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of.


Of autopsy


What test confirmed diagnosis ?........... 3.2.2 .....


20 Was disease or Injury In any way related to occupatloo of deceased ?


no


If so, specify.


(Signed)


Nyer Aschot2


M. D.


.


(Address)


Date


19


4/5/40


21 PLACE OF BURIAL, . .. .


CREMATION OR REMOVAL


INVeTust deWARCemetery)


Avereily or Town)


DATE OF BURIAL


19


22 NAME OF


4/2/20


FUNERAL DIRECTOR Manuel .. Stano taky.


ADDRESS


Received and filed.


19


..........


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


D anders


(City or town making return)


Registered No


67


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


PLACE OF DEATH


Essex (County)


No ...... Danvers State Hospital


2 FULL NAME


Nathan But


(If deceased is a married, wasto Go


566 Shirley


Favorced woman, give also maiden name.)


(If U. S.


War Veteran,


specify WAR)


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or institution ..


47


years


··· p ......................... , 19 ..... 40 .


PHYSICIAN


Underline the cause to which death should be charged sta- tistically.


(Registrar of City or Town where deceased resided)


CFFI


0


...


769


ROP.


ASS.


MAY-21960 K1


R-302


PLACE OF DEATH


Suffolk (County)


Chelsea (City or Town)


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Chelsea


(City or town making return)


Registered No ..


63


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


2 FULL NAME


Charles ......... Hinckley


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


203 MainSt


St.


Winthrop, Mass


Length of stay: In hospital or institution.


(Specify whether)


years


months


days1.7


In this community


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


(Day)


DEATH


anp11-3,1940


(Year)


19 I HEREBY CERTIFY.


That I attended deceased from


Har ...... 16 .~ 19 ..... 400.


A.pr ...... 2.9.


.....


19


40


I last saw h ....... A.olive on .. 3.y., 19 ....... 4 death is said to have occurred on the date stated above, at ...... 5 .;. 1.7.40. Immediate cause of death .. Duration Unemia.


2 das


Due to


Arterio-sclerotic kidney


disease


Due to


Generalized ... arterio ..


sclerosia.


?


Other conditions


(Include pregnancy within 3 months of death)


PHYSICIAN


Major findings :


Of operations


nono


Underline the cause to which death


Of autopsy


none


should be charged sta-


What test confirmed diagnosis ?


Yes .... JIP.N.


....


tistically.


20 Was disease or Injury In any way related to occupation of deceased ?


If so, specify


Isadoro Kaplan


(Signed)


(Address)


Soldiers Home


Dato


M. D.


49


40


21 PLACE OF BURIAL, CREMATION OR REMOVAL. WinthropCem.Winthro] (Cemetery) DATE OF BURIAL Apr. 5, 1920°r Town) .19 .... FUNERAL DIRECTOR Albert F. Douglass


22 NAME OF


ATTEST:


(Registrar of city 'or towe'shere death pccursed)


Apr.


194Received and filed


Apr. 0, 1940"


19


(Registrar of City or Town where deceased resided)


wwwwitu ju your city of town in case the deceased resided in another city or town at the time


3 SEX


Male


white


5a If married, widowed, or divorced


HUSBAND of


(Give Mardel


(or) WIFE of


6 Age of husband or wife if alive


63


8


AGE


68Ye


7 Months.


.8 Days


Industry


Il Social Security No.


none


12 BIRTHPLACE (City)


Boston


(State or country)


13 NAME OF


FATHER


Charles A.


14 BIRTHPLACE OF


FATHER (City)


Wellfleet


PARENTS


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17


Hospital Records


Informant.


(Address)


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


of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible


(State or country)


Mass


50m-10-'39. No. 8427-f


4 COLOR OR RACE 5 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


married


(Husband's name in full)


.. years 7 IF STILLBORN, enter that fact here.


If less than I day


Hours


Minutes


Usual


9 Occupation:


Retired.Fireman


10 or Business:


(City of Chelsea)


15 MAIDEN NAME


OF MOTHER


Clare Anderson


East Boston


Mass"


Relation, if any


A TRUE COPY.


ADDRESS


Chelsea, Mass.


DATE FILED


1


No Soldiers !.... Home ... Hospital


(If U. S.


War Veteran,


specify WAR)


Spanish


(a) Residence. No ...


(Usual place of abode)


Hospital


(If nonresident, give city or town and state)


.Date of.


7


M R-301 A! Suffolk (County) Whichit


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD


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


Registered No .. 69




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