Town of Winthrop : Record of Deaths 1943, Part 47

Author: Winthrop (Mass.)
Publication date: 1943
Publisher:
Number of Pages: 594


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 47


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).


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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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