USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 47
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by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States In any war In which It has heen engaged. such recital shall appear upon the permit. The board of health. or its agent. upon receipt of such ststement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit Is so given and the physician certifying the cause of death shall thereafter furnish for registration any other nece+ sary information which can be obtained as to the deceased. or as to the manuer or cause of the death, which the clerk or registrar way require .- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the hoard of health or its agent appointed to Issue such permits, or if there is no such hoard, from the clerk of the town where the body is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of ouly such persons ss are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body iles and take charge of the same; . .. - General Laws, Chap. 38, Sec. 6.
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 deatha only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physlolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury, have died without recent medical attemlance or whose phyef- cian is ahsent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly on in- directly 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 diseasa resulting from injury or Infeotlon ralated to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death meana the disease, or complication which causes death. not the moile of ilylug, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name the disease caualug death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important compliestion of the principal cause.
Statement of Ocoupatlon .-- Precise statement of occupation ia very im- portant, so that the relative healthfulness of various pursuits can be known. Make some eutry in this section for every person aged 10 years or over. If the occupation had been given up or changed ou account of the disease causing death, report the usual occupation prior to illness. If the deceased hsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at hoine. For a woman whose only occupatiou 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.
SPACE FOR ADDITIONAL INFORMATION
ERCE SUS
CERTIFICATE OF DEATH GEORGIA DEPARTMENT OF PUBLIC HEALTH
State Pile No.
L. R. Filo No.
2. Usual Residence of Deceased
(a) Stat
MASS.
(b) County
City of
WINTHROP
(c) Town ...
(If Outside City or Town Limite, Write Rural)
(d) R.F.D. and Box No.
75 CREST AVENUE
Nº : 59
Citizen of
(.) Foreign Country?
NO
Yes
If Yes. Name
or No / Country
If Veteran Name War
Social Security Number
MEDICAL CERTIFICATION .....
Date of
APRIL
5
19
43
Time
6:00
P. M.
(Nour : Minute)
24. I hereby certify that I attended the deceased who died on the above date. I last saw DID NOT SEE HIM ALIVE
H. Alive on 19
Duration
Primary Cause of Death
COMPLETE CARBONIZATION OF
BODY
(Please Underiine the Cause to Which This Death Should De Charged)
Contributory Causeo
(Including Any Pregnancy Within Three Months of Death)
NONE
Operation
Date of Operation
Diagnosis : Clinical. Lab .. X-Ray (Check)
Was Autopsy Performed : NO
25. If death was due to external violence please answer the following questions :
(a) Accident, Suicido
ACCIDENT
Date of APRIL 5,1943 (b) Occurrence.
Place of SAPELOE ISLAND PLANTATION, MCINTOSH, GEORGIA
(c) Accident
(City)
(County)
(@tate)
Where : Homo, Farm, BEACH OF ISLAND
While at Work
YES
Means of AIRPLANE ACCIDENT
(.) Injury.
Homes M. Wiola
Physician's THOMAS M. WINSTON, CAPTAIN, M.C.
26. Own Signature STATION HOSPITAL, ARMY AIR BASE,
Date Siqued
Physician's HUNTER FIELD, SAVANNAH, GA.
APRIL 7, 1943
P. U. Address
narie m. Olsen Cortinasto Carefully Before Olgning)
Marital
S) M.
6. Status (circle)
W. D.
Months
Days
If less than 24 brs. Hrs. Min.
Birth
Place
MASS.
Year
SOLDIER
TED STATES ARMY AIR FORDE
ALIEN A. DEERVAN UNKNOWN
UNKNOWN
TINKNOWN
PERSONNEL ETIES
dress UNITED STATES ARMY
REYOVAL
(a) Dato 4/8/4-3
SAPR'S IST
Militia
Dist. No.
09900
DE ISLAND PLANTATION
Outelde City er Town Limits, Write Rural)
p. or itution
In This
Community
RVAN,
JOSEPH
T.
ONAL AND STATISTICAL PARTICULARS
5. Raco
WHITE
23. Death
Homicide (Specify).
(d) Industry, Public Place
TOSH
R-302
1
PLACE OF DEATH
(County)
Boston (City or Town)
No. Mass General Hospital
St. ( If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
39Fairview St
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
2
mont16
days.
in this community
yrs. 2
mos.
6 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
5a If married, widowed, or divorced HUSBAND of
( Give maiden name of wife in full)
(or) WIFE of
Gertrude W Howley
(Husband's name in full)
6 Age of husband or wife if alive
51
years
7 IF STILLBORN, enter that fact here.
AGE
8 61 Years Months Days
If less than 1 day Hours Minutes
Usual
9 Occupation :
Trunk maker
10 or Business :
industry
Leather factory
11 Social Security No. ...
012-07-8415
12 BIRTHPLACE (City)
(State or country)
Charlestown
13 NAME OF
FATHER
James McFague
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Charle stown
15 MAIDEN NAME
OF MOTHER
Mary Quinn
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Charle stown
17
Informant.
Mrs .... G MoFaguo
( Address)
39 Fairview St
Winthrop
A TRUE COPY.
cis
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
April ... 14 ... 1942
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Apr ..... 11, .... 19.42.
(Month)
(Day)
( Year)
19 | HEREBY CERTIFY,
Feb ... 5.42 .. , 19 ...
to ......
Apr ..... 11/42
19
That i attended deceased from
I last saw h.j.m ........ alive on ....
Apr ..... 1.1 .42 ....
19
death Is sald to
have occurred on the date stated above, at ...... 1.1.47.p.
Immediate cause of death
Pneumonia, lobar
m
Duration
r
72 hrs ....
Due to.
Carcinoma of stomach
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician r
Major findings :
Of operations.
Exploratory .... laparotomy.
jejunostomy.
.Date of ..
.Apr .... 4/42
Of autopsy
What test confirmed dlagnosis ?.
20 Was disease or Injury In any way related to oooupation of deceased ?
if so, specify
(Signed)
J .... Gorrell
M. D.
(Address)
Boston
Date.4 .11. 48
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
Winthrop Cem. Winthrop
(Cemetery)
Apr ..... 14/.42
19
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
W P Carley
ADDRESS
Allston .. Mass
Received and filed JUL 28 1943
19
(Registrar of City or Town where deccased resided)
50m (e)-1-41-4667
Copies of . ... vi tuwu at the time of death should be made forthwith and transmitted on Form Rt-302 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
F
ufoik
The Commontocaith of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
3264
Arthur Leo MeFague
(If U. S.
war Veteran,
specify WAR)
7 mos
Underline the cause to which death should be charged sta- tistically.
Relation, if any
wife
DATE OF BURIAL
R-3Q2
1
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
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.
5760
S (If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME.
George Otis Colby
(If deceased is a married, widowed or divorced woman, give also maiden name.)
33 Court road
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution .. Hospital
(Before death)
....
years
months
2 days.
In this community
yrs.
mos.
11 days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Josie Potter
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
69
years
7 IF STILLBORN, enter that fact here.
8
68
AGE
Years
3
Months
14
Days
If less than 1 day
....
.. Hours.
Minutes
Usual
Linotype Operator
9 Occupation :
Industry
10 or Business :
News paper
11 Social Security No ...
02.3-09-68.05
12 BIRTHPLACE (City)
(State or country)
.. Newburyport Mass.
13 NAME OF
FATHER
Daniel T. Colby
14 BIRTHPLACE OF
West Newbury
FATHER (City)
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Sarah Thomson
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Relation, if any
17
Informant
(Address)
A TRUE COPY.
ATTEST :
(Registrar of city or town' where death occurred)
June 15
1943
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
10
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, May 30
19
43
June 10
19
to
43
we
+ last saw h ....
im ..... alive on ..
June 10
19.4.3, death Is said to
have occurred on the date stated above, at
11.55
a
n.
Duration
Immediate cause of death
Primary carcinoma of liver
4 mos
Due to.
Due to.
Other conditions.
Chr. nephritis
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis?
Autopsy
no
If so, speolfy
(Signed)
H.
W. Benjamin
Boston
M, D.
Date.
6-10
19
43
(Address)
21 PLACE OF BURIAL,
Belleville
CREMATION OR REMOVAL
(Cemetery)
(City or Town)
June
13
19
43
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
H. S. Reynolds
Winthrop, Mass.
Received and filed JUL 1 2 1943 19
(Registrar of City or Town where deceased realded)
r
Featured In sonu lu wuitu the deceased resided. (See Chap. 48, Sec. 12, G. L.) PARENTS
50m (e)-1-41-4667
.,4
DATE FILED
Ł
No.
Peter Bent Brigham Hospital
(If U. S.
War Veteran,
speolfy WAR)
(a) Residence. No.
(Usual place of abode)
(Specify whether)
we
That
+ attended deceased from
Physician
r
Of autopsy
20 Was disease or injury In any way related to ocoupatlon of deceased ?.
Newburyport, Mass
-302
SUFFOLK
-
1
PLACE OF DEATH
(City or Town)
No.
Little Sisters of Poor Hospital St.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Vito Frederick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
293 Bowdoin St.
St.
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution
(Before death)
1
years 6
months
4 days.
In this community
1
yrs.
6 mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
Rita Pizzi
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve 7.2 years
7 IF STILLBORN, enter that fact here.
8
AGE
8.3. Years
Months
Days
If less than 1 day Hours. Minutes
Usual
9 Occupation :
Tailor
Industry
10 or Business :
Retired
11 Social Security No .......
none
12 BIRTHPLACE (City)
(State or country )
Italy
13 NAME OF
FATHER
Unknown
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
15 MAIDEN NAME
OF MOTHER
Unknown
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
17 Chet Frederick (
Relation, If any ... s.on
Informant
(Address)
A TRUE COPY.
Francia X 4ans
ATTEST :
(Registrar of city or town where death ogcurred)
DATE FILED June 18 19 43
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
12
1943
(Month)
(Day)
That I attended deceased from
19 | HEREBY CERTIFY,
m.
J.une .... 9 ....... 19.4.3.
to
June .... 12 .. , 19.43 ..
I last saw h .... im ..... alive on.
June 11
19.43, death Is sald to
have occurred on the date stated above, at.
4
a .
Immediate oause of death
Cerebral ... hemorrhage
2 .das ..
r
Due to
Arteriosclerosis
few yrs.
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
r
Major findings :
Of operations
Underline the cause to which death
Date of
should be charged sta- tistically.
What test confirmed dlagnosis?
20 Was disease or injury In any way related to occupation of deceased ?
(Signed)
M. D.
(Address)
222 Bowdoin St.
Date
6-12 19 43
21 PLACE OF BURIAL,
Winthrop Cem.Winthrop, Mass.
CREMATION OR REMOVAL
(Cemetery)
(City or Town)
DATE OF BURIAL
June 15
19 43
22 NAME OF
FUNERAL DIRECTOR
Kirby Bros.
ADDRESS
Winthrop, Mass.
Reoelved and filed
JUL .1 2 .... 1943.
19
(Registrar of Clty or Town where deceased resided)
X
50m (e)-1-41-4667
2 FULL NAME
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
TON
(City or town making return)
Registered No.
5821
(If U. S.
War Veteran,
speolfy WAR)
Winthrop,
Mass.
(Specify whether)
(Year)
Duration
Of autopsy
If so, specify
E.H.L. Harnett
i
₹-302
Middlesex4
(County) Cambridge
(City or Town) Cambridge City Hospital No.
The Commonborralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
(City or stomp making return) 14.00
Registered No.
1008
S (If death occurred in a hospital or institution, > give its NAME instead of street and number)
Moriarty
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 67 Wilshire St.
(a) Residence. No.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or institution ..
(Before deatlı)
(Specify whether)
yeara
months
days.
In this community
yTS.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F.
4 COLOR OR RACE
5 SINGLE
(write the word)
Sing16
5a If married, widowed, or divoroed
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.
Stillborn
8 AGE Years Months. .Days
If less than 1 day .Hours Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No ...
Cambridge
12 BIRTHPLACE (City)
(State or country)
John Moriarty
13 NAME OF
FATHER
Boston
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Marion Peuton
15 MAIDEN NAME
OF MOTHER
Boston
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mother
17
Informant
(Address)
Mother
(
A TRUE COPY.
ATTEST :
June 22, 1943
(Registrar of city or town where death occurred)
DATE FILED
Frederick H. Burke
19
18 DATE OF
DEATH
June 19, 1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, June 19
That I attended deceased from
to
June
19
44.3
1 last saw h ..... er .... aliv3 ...
19
death is said to
have occurred on the date stated above, at m.
Duration
Immediate cause of death Stillborn
Due to.
Toxacmia of pregnancy
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
r
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta- tistically ..
Of autopsy.
What test confirmed diagnosis?
20 Was disease or Injury In any way related to oooupation of deceased ?
(Signed)
MA88.
(Address)
475 Commonwealth Ve 6/19 43
21 PLACE OF BURIALTOP CEM. Winthrop
CREMATION OR REMOVAL
tomater>1, 1943(City of Town)
DATE OF BURIAL
19
22 NAME OF
John Fo Haley
FUNERAL DIRECTORintitrop Mign.
ADDRESS
June 23, 1943
Reoelved and filed
JUL 1 3 1943
19
(Registrar of City or Town where deceased resided)
Y
r
1
1
PLACE OF DEATH
50m (e)-1-41-4667
If so, speolfy.
Frederick J Lynch
M. D.
Relation, if any
St.
(if U. S.
War Veteran,
specify WAR)
Winthrope
Mass.
MARRIED
WIDOWED
or DIVORCED
2-302
Essex (County)
Danvers
(City or Town)
Danvers State Hospital, Hathorne, Masg . (If death occurred in a hospital or institution, No.
give its NAME instead of street and number)
2 FULL NAME
Eskel Rossing
(If deeeased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
80 Shirley
St.
Winthrop,
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : in hospital or institution.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE| 5 SINGLE
(write the word)
white
MARRIED
WIDOWED
or DIVORCED
married
(Month)
(Day)
(Year)
5a If married, widowed, or divorcednna Arnold son
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 cannot ..... b.e ... learnedears
7 IF STILLBORN, enter that faot here.
8 AGE.8.O .... Years. Months Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
.Unemp ...... ar ... ti.s.t.
Industry 10 or Business :
11 Social Security NoCannot be learned
12 BIRTHPLACE (City)
Gottenburg
(State or country)
Sweden
13 NAME OF
FATHER
Hendrick Hossing
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Sweden
15 MAIDEN NAME
OF MOTHER
Amlie Seiostal
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
If so, speolfy.
(Signed)
Pasquale Buoniconto
M. D.
(Address )Hathorne., .... Mass ......... Date .... 6.2519
....
43
21 PLACE OF BURIAL,
Winthrop Cemetery,
CREMATION OR REMOVAL .. Winthrop. .... Mass.
(Cemetery)
(City or Town)
1943.
DATE OF BURIAL
June ..... 22
22 NAME OF
Howard S. Reynolds
FUNERAL DIRECTOR
ADDRESS
Winthrop, Mass.
Received and filed JUL 10 1843
19
DATE FILED
(Registrar of city or town where death occurred)
June 28
43
19
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
1
Registered No.
(If U. S.
War Veteran,
speolfy WAR)
1.943
19 | HEREBY CERTIFY,
May 16
...
19
40,
June 20
1943
I last saw h ...
im .. alive on
June 2019 43death is said to
have occurred on the date stated above, at
3:45 8.
m.
Duration
Immediate oause of death
Arteriosclerotic heart disease
8 yrs [
Due to
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
r
Major findings :
Of operations
Underline the cause to which death
Date of
should be charged sta- tistically.
Of autopsy
clinical
What test confirmed diagnosis?
20 Was disease or injury in any way related to oooupation of deceased?
50m (e)-1-41-4667
17 Mary ..... K ..... McPhillips. .(. Relation, if any (Address) Hathorne Mass.
A TRUE COPY.
ATTEST :
5
years
9 months
1Gays.
In this community
yrs.
mos.
days.
(Registrar of City or Town where deceased resided)
Ł
PLACE OF DEATH
18 DATE OF
DEATH
June.
20
That I attended deceased from
2-302
PLACE OF DEATH -
SUFFOLK BOSTON
(City or Town)
No.
Hebrew Ladies Home for Aged
St.
S (If death occurred in a hospital or institution,
give its NAME instead of street and number)
Minnie Box
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if U. S.
War Veteran,
specify WAR)
(a) Residenoe. No.
(Usual place of abode)
46 Nevada
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: in hospital or Institution.
(Before death)
(Specify whether)
2 years
months
days.
in this community 2 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
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.
8
AGE72
Years
Months.
Dayı
If less than 1 day
Hours
Minutes
Usual
9 Ocoupatlon :
Housework - at home
industry
10 or Business :
11 Sooial Seourity No ...
none
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Morris Brother
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Jennie -
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
informant.
(Address)
James Bix
(
········ &on
A TRUE COPY
ATTEST :
Francis
(Registrar of city or (town where death occurred)
June ... 24 1943
18 DATE OF
DEATH
June
22
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
June .... 2.0 ...... , 19.
43.
to
June .... 22 .. , 19.43.
That i attended deceased from
i last saw her ......... alive on
June 22
1943 death is said to
have oocurred on the date stated above, at
3
a .
m.
Duration
immediate oause of death
Coronary thrombosis
6-22-43 r
Due to
Arteriosclerosis
?
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician r
Major findings :
Of operations.
Date of.
Underline the cause to which death should be charged sta- tistically.
What test confirmed diagnosis?
20 Was disease or Injury in any way related to oooupatlon of deceased?
If so, specify
(Signed)
B. A. Udelson
M. D.
(Address)
Boston
Dato.
6-22 19 43
21 PLACE OF BURIAL, Anshe Libavitz
CREMATION OR REMOVAL
(Cemetery )
DATE OF BURIAL
Cem
Woburn .. Mass.
(City or Town)
June 22 19 43
22 NAME OF
FUNERAL DIRECTOR
M. Stanetsky
ADDRESS
Boston
Received and filed
JUL 1 2 1943
(Registrar of City or Town where deceased resided )
19
DATE FILED
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.
6057
1
50m (e)-1-41-4667
Relation, if any
Of autopsy
1943
-302
Suffolk
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.
922. 416
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
Ruth Upton Tisdale Henderson
2 FULL NAME (If deceased is a married, widowed or divorced woman, give also maiden name.)
Vi.tur speolfy WAR)
(a) Residenoe. No.
(Usual place of abode)
14
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
18 DATE OF
DEATH
June 22, 1943
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that faot here.
57
11
29
8
AGE
Years.
Months ..
Days
If less than 1 day
Hours ......
Minutes
At tromo
Usual
9 Occupation :
Industry 10 or Business:
11 Social Security No ........
Boston Mass ..
12 BIRTHPLACE (City)
(State or country)
George R.
13 NAME OF
FATHER
Boston, Maco
14 BIRTHPLACE OF
FATHER (City)
(State or country) Josephine Walsh
15 MAIDEN NAME
OF MOTHER
Boston, Mass.
16 BIRTHPLACE OF
MOTHER (City)
(State or country forge R. Henderson father
17 49 Lovell Rd. "Inkhof, if any
Informant
(Address)
A TRUE COPY.
Josephe Q. Vieress
22 NAME OF
FUNERAL DIRECTOR
170 Winthrop 3+. winthrop
ADDRESS
ATTEST :
(Registrar of city z"Here death occurred)
DATE FILED
6/24/43
19
Reoelved and filed JUL 12 1943 19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
PLACE OF DEATH
ChoIsea
1
PARENTS
Of autopsy
Date of
x-ray-
should be charged sta- tistically.
What test confirmed diagnosis?
20 Was disease or Injury in any way related to oooupation of deceased?
If so, specify ....... 2016Tuspravo
(Signed)
620 DouchSt.ROVere6/23/23
(Address),
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
(only) 29, 194 (City of Town)
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