USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 46
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 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88 | Part 89 | Part 90
17 BATI AND HOUR OF/ DEATH
April 8
19 COLOR GA HÀCA
20 Approximate Ape
7 IF STILLBOR
WIFE HUSBAND
of
Barnard
(Month)
(Day)
(Year)
MACHENT
If LESS than 1 day,
Usual 9 Occupation!
67,
days
hrs. of
pła.
Harlv, Mother
A Trade, profession, or particular kind of work dont, as aplus Mayer, bookkeeper, ett.
Housewife
11 Social Secu
Cause 1
12 BIRTHPLAC. (State or cou
094
() City, Towa or Village
() County
OF WHAT COUNTRY WAS DACIDENT A CITIZEN AT TIME OF DEATH?
I further certify that death + WA.S.N.q.Z. due to communi- cable disease requiring special preparation for shipment by common carrier.
· Creer out worda that do not apply.
t See frol instruction on reverse of certifcuts.
Type Auk
TI MATHPLACE OP FATHER
Russia
(State or country)
IT MAIDEN NAME
OF MOTHER
IDA Unknown
OF DECEDENT
TT BIRTHPLACE
Address
622 WEST 168th ST. C.Y.C.
19
y or Town) 12
23 FUNERAL
Park Nost Memorial Ch., Ino.
ADDRESS
115 West 79th St.,
PERMIT
NUMBER
2430
BUREAU OF RECORDS AND STATISTICS
DEPARTMENT OF HEALTH
CITY OF NEW YORK
nd state) days.
'ear)
eased from 19 ......
path is said
Duration
........
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
. M. D.
OF MOTHER (State or country))
Russtá
IT AUNATURE OF INFORMANT
LILATIONSHIP TO DECEASED
Yry South At. Brookline
17
Informant (Address)
Com
Å TRUE COPY ATTEST:
DATE FILED
19
Received and filed ..
JUL 1 9 1946
(Registrar of City or Town where deceased resided)
after the close of the mouth in which the death occurred. (Sec Chap. 46, Scc. 12, G. L.) 50m-10-'39. No. 8427-f
PARENTS
Operalisa
10 WAS DICLASED WAR VETERANT I SO, NAME WAR
no
O
TT NAME OF FATHER OF
JUDA BALTIMORE
DICEDENT
15 MAIDEN OF MOT
Witness my hand this E day of APAR
1946
Signature Silberttrung& M. D.
16 BIRTHPL MOTHER (State or
PARENTS OF DECEASED |
Furlustry or business in which work was done, at sik mill, sawmill, book, own business, one, Con Home
BIRTHPLACE OP DICEDENT: (a) State.
fussia
16 PLACE OF DEATHI
(a) NEW YORK CITY: (b) Borough MANHATTAN
(c) Name of Hospital PRESBYTERIAN HOSPITAL or Institution .... Uf not in hospital or institution, give street and number.)
(Year) | (Hour) A
3 HHALL, MARRIO, WIDOWIR, OR DIVORCED (trực the woord)
married
6 Age of husb
FEMALE WHITE
68
21 I HEREBY CERTIFY that (F-Monded-the-docensed)" (a staff physician of this institution attended the deceased)' APR. IST 10 46 to A pc. 8th 19 46 and last saw h. ER alive ar 9:30M on Apr. 8th 19 46
from
Industry 10 or Business
16
I further certify that death + WAS NOT caused, directly or indirectly by accident, homicide, suicide, acute or chronic poisoning, or in any suspicious or unusual manner, and that it was due to NATURAL CAUSES more fully described in the confi- dential medical report filed with the Department of Health.
13 NAME C FATHER
Natlv. Det. 16 Citta. Det.
S AGE Y
MEDICAL CERTIFICATE OF DEATH (To be Klied in by the Physician)
3 SEX
191 Bero Beeld.
8
MEN GH C
(a) Re (U Length of sta
Doro-Death
Certificate No. 8444
NT
WASSERMAN
Souli Security Number
ANNIE First Name
St.
No.
OR CREMATION
M PLACE OF JUMIAL Jewish Cemetery, Boston, Yessd
son-in-law
DATI OF BURIAL OR CREMATION April 10, 1946
14 BIRTHPL FATHER (State or
(Month) (Day)
19.4.6 19:30
17 Ocean Avenue
19
R-302
Middlesex
(County) Tewksbury, Mass.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Tewksbury State Hospital and Infirmary
(City or town making return) 123
Registered No.
16.7
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
2 FULL NAME.
William Davis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
249 Pleasant
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution ..
(Before death)
(Specify whether)
...
years 2
months
3
days .
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Male White
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 allve
years
7 IF STILLBORN, anter that fact here.
8
AGE ..
.6.8Years.2.
Months.
24 ... Days
If less than 1 day Hours. Minutes
Usual
9 Ocoupatlon :
Laborer
Industry 10 or Business :
11 Sooial Security No. Not learned
12 BIRTHPLACE (City)
(State or country)
Wales
13 NAME OF
FATHER
George T. Davis
14 BIRTHPLACE OF
FATHER (City)
Not learned
(State or country)
Wales
15 MAIDEN NAME
OF MOTHER
Sarah Anthony
16 BIRTHPLACE OF
MOTHER (City)
Not learned
(State or country)
Wales
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop,
Winthrop
DATE OF BURIAL
(Cemetery)
June"
'10,
46
(City or Town 19
A TRUE COPY.
ATTEST:
C.Wentvon Wrighton m. ]Supr.
(Registrar of city or town where death occurred)
DATE FILED
June 6,
19.46
22 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop, Mass.
Recelved and filed
JUL .3 1 1946
19
(Registrar of City or Town where deceased resided)
50m. (b) ·6-44-14607
resided in another city or town at the time of death słodte ot inade fortiwith and gemsmitted du Forts trova w tue ciers of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
1
-
No.
(City or Town) Tewksbury State Hospital and Infirmary
give
(If U. S.
War Veteran,
spoolfy WAR)
(a) Residence. No.
(Usual place of abode)
18 DATE OF
DEATH
June
6
1946
(Month)
(Year)
19 | HEREBY CERTIFY,
Apr.i.l .... 3 ...
19.46
.June ... 6
:
19.46
I last saw h. .1m .... alive on. June .6 .......... , 19 .... 4.6death Is sald to have occurred on the date stated above, at ... 1.1 ..:. 0.5.A ... ...... m.
Duration
Immedlate oause of death
Bronchogenic Carcinoma
of ..... Right ..... Lung.
1 ..... year
Due to
Due to ...
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be charged sta- tistically.
Of autopsy
X-ray
What test confirmed diagnosl
Clinical
20 Was disease or injury in any way related to oooupation of dscsased ?.
If so, speolfy
(Signed)
T.S.H. &h. TSkihergson
M. D.
(Address)
Date.
6/6 9 46
17 Hospital Records
Relation, if any
Informant.
(Address)
Cardiff ..
Underline the cause to which death
PARENTS
PLACE OF DEATH
(Day)
That i attended deceased from
R-302
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)
6021
Registered No.
121
2 FULL NAME
Sarah London
(If deceased ia a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
47 Tewksbury
Winthrop
ass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
7 days
In this community
yrs.
mos.
7
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
(write the word)
Widowed
1
5a If married, widowed, or divorced
HUSBAND of
(Giye maiden name of wife in full)
(or) WIFE of
.Harry ... London
(Husband's name in full)
6 Age of husband or wife If allve
years
7 IF STILLBORN, enter that fact here.
8 AGE. ... 7.5 Years. Months. Days
If less than 1 day Hours .Minutes
Usual 9 Occupation :
Housework
Industry
10 or Business :
At Home
11 Soolal Security No.
None
12 BIRTHPLACE (City)
(State or country )
Russia.
13 NAME OF
FATHER
Israel Penan
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Bessie -
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant. (Address)
I ... London
A TRUE COPY.
ATTEST :
(Registrar of city or we where
July
5/4 6 cœurred) 19
DATE FILED
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
June .... 26 ..
.....
19
46
to ..
That i, attended deceased
July
19
I last saw h .....
er allve on
July 3/46
19.
death Is said to
have ooourred on the date stated above, at
5;20₽
m.
Immedlate cause of death Pulmonary .... Embolus
3 Hrs
Due to
Due to
Other conditions.
Diabetes mell.
Physician
(Include pregnancy within 3 months of, death) Arterio sclerotic heart di's.peritonitis
Major findings: Diverticulitis, melanosis
Of operations.
coli
Date of
should be
Of autopsy
Pulm.embolus peritonitis
charged sta- tistically.
What test confirmed diagnosis ?
autopsy
No
20 Was disease or injury in any way related to oooupation of deopased?
If so, speolfy ..
D"B"Hackel
(Signed)
(Address)
Beth Israel HosptDat.
7-3
..
M. 4%
19
Montifiore Cem-Woburn
(City or Town)
DATE OF BURIAL
22 NAME OF
B Birnbach
FUNERAL DIRECTOR
ADDRESS
Dorchester Mass.
Received and filed JUL 24 1946
19
50m-(b)-6-44-14607
reaided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk -- of the city or town in which the deceased resided. (See Chap. 46, Sec. 12. G. L.)
1
PLACE OF DEATH
No.
Beth Israel Hospital
St.
(If death occurred in a hospital or institution give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
St.
July 3/46
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
PARENTS
Relatiog jf any
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ..
(Cemetery )
July 4/46
19
Underline the cause to which death
Duration
2-301 A
1
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) Winthrop Community Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
125
2 FULL NAME
Baby que Boyle
(If deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No.
143 Pleasant St
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or institution Hospital
(Before death)
{Specify whether
years
months
2
days.
In this community
yrs.
mos.
2
days.
PERSONAL ANO STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIEO
Single
WIOOWEO
or DIVORCEO
5a If married, widowed or divorced HUSBANO 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 1F STILLBORN, enter that fact here.
2
8
AGE
Years
Months
Oays
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No ..
12 BIRTHPLACE (City)
Winthrop
(State or Country)
Massachusetts
13 NAME OF
FATHER
Joseph E. Boyle
14 BIRTHPLACE OF
FATHER (City).
Chicago
(State or Country)
Illinois
15 MAIOEN NAME
OF MOTHER
Catherine V. McAllister
16 BIRTHPLACE OF
MOTHER (City).
New York
(State or Country)
New York
17 Joseph E Boyle ( Từ thế py )
Informant (Address' 143 Pleasant St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
Walter
(Signature of Agent of Board of Health or other) Healthe Office 7/8/46
(Official Designation) (Date of Issue of Permit)
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
H. airlines
, M. O.
(Address) 192 Shuntely St
Date 7-7-1946
21
Winthrop
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July 8, 1946
...
19
22 NAME OF
FUNERAL DIRECTOR
John F. qualey
AODRESS
Winthrop Massachusetts
Received and Filed JUL 0 1946
19
(Registrar)
1946 (Ycar)
19
1 HEREBY CERTIFY,
That 1 attended deceased from
July 5,
. 194C , to
July)
19 40
.
I last saw HER
alive on
July 70
, 1946,
death is said to
have occurred on the date stated above, at
5:30 A: m.
Immediate cause of death
Congenital Heart Disease
Que to
Cardine farline
Que to
atelectasia
atelectasia
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Oate of
1 - 4 - 46
Of autopsy
Congenital Heart
What test confirmed diagnosis?
Duration IMPORTANT
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
0m-9-44-14955
See instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
St.
-
(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) .
St.
MEDICAL CERTIFICATE OF DEATH
18 OATE OF
DEATH
July
(Month)
Zati
(Day)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after tbe death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, bis supposed age, the disease of which he died, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive hy tbe physician or othcer and the date of his death ... Gen. Laws, Cbap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by tbe preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it bas heen engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary and the secondary or immediate cause of death as nearly as be can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty five, forty-six and forty seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, nr its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town wbere the body is buried. No such permit sball be issued until there shall bave been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, bis certificate cannot be obtained early enough for the purpose, or is insufficient, a pby si- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained bereunder. If the death certificate contains a recital, as required
by section ten ot chapter 1oily . six, qual the deceased served in the army, navy nr marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board nf health, or its agent, upon receipt of such statement 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 neces- sary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as 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, be sball forthwith go to the place where the body lies and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
No undertaker or other person sball bury a human body or the ashes tbereof which have been brought into the commonwealth until he bas re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be 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 Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physfcfans will certify to such deaths only as those nf persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to sucb deaths only as those of persons wbo, though disabled by recognized disease unrelated to any forum of injury, have died without recent medical attendance or whose pby - sician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deathis 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 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 means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, astbenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, 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 heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children 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, how- ever, 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
R-302
SUFFOLK
BOSTON
(City or Town)
No.
Beth - grael Hospital
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Charles I Floyd
(If deceased is a married, widowed or divorced woman, give also maiden name.)
249 Winthrop Shore Drive
St.
Winthrop
(Usual place of abode)
Hospital
years
months
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE!
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed Y diyored McConnell
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 faot here.
8 AGE 78 Years Months.
Days
If less than 1 day .Hours .. ..... Minutes
Usual
9 Ocoupation :
Clerk
Industry
10 or Business :
Railroad
11 Soolal Security No.
12 BIRTHPLACE (City)
(State or country)
Haverhill Mass
13 NAME OF
FATHER
Charles Floyd
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cannot be learned
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannot be learned
17 Robert S Floyd
Informant (Address)
Rel&ernif any 249 Winthrop Shore Drive
A TRUE COPY. ATTES Michael & Manning
(Registrar of city or town where death occurred) July 12
46
.19
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.
61.73
126
1
PLACE OF DEATH
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
50m. (b)-6.44-14607
DATE FILED
Received and filed JUL 23 1946
( Registrer of Cite or Town where
resided )
19
I last saw h.
1.m ...... allve on
.. ,
19
to.
July 7
1946
death is sald to
have occurred on the date stated above, at .m.
Immediate cause of death
Myocardial infarct
Duration 10 days
Due to.
Hypertension &
Arteriosclerosis
? yrs
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
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? No
if so, speolfy.
Erwin O Flinch
(Signed)
(Address)
BIH
Date 7/8
19
46
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Woodlawn
Everett
(Cemetery)
(City or ToIrb
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
John F O' Maley
ADDRESS
Winthrop
19
deooased Lifegm
18 DATE OF
DEATH
July
7th
1946
(Month)
(Day)
(Year)
June 26 CERTAFY,
(if U. S.
War Veteran,
speolfy WAR)
No
(a) Residence. No.
Length of stay: In hospital or institution ..
(Before death)
(Specify whether)
10
days.
(If nonresident, give city or town and State)
July il
19
Underline the cause to which death
01 A
1
PLACE OF DEATH
...
Auffach. (County)
-or Toro Hunting Com
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
127
Thank
S& & (If death occurred in a hospital or institution, give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (W'as deceased a U. S. War Veteran, if so specify WAR)
(a) Rasidenca. No.
(Usual [ilace of abode)
Shop.
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
Chro 3 8 min.
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR/OR RACE
While
5 SINGLE
MARRIED
WIDOWED
or DIVORCED Lance
( write the word)
fugle
5a If married, widowed, or divorced HUSBAND of
(Cive maiden name of wife in full)
(or)" WIFE of
( Husband's name In full)
6 Age of husband or wife if aliva
years
7 IF STILLBORN, enter that fact here.
8 AGE Years Months Days
If lass than 1 day
5 Hours 3 8 Minutes
Usual
9 Occuoatlon :
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( Siste or country)
13 NAME OF
FATHER
William Alivey
14 BIRTHPLACE OF
FATHER (City)
....
Baston U
( Stale or country)
15 MAIDEN NAME
OF MOTHER
Ctele & Kinky
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
17 Informant ( Address Y 22 Real off Aux
I HEREBY CERTIFY that a satisfactory standard oartiftoate of daath was fled with me' BEFORE the burial or, transit permit was Issued :
(Signature of Agent of Board of Health or other) 1/10/40
18 DATE OF
DEATH
July
Months
(Daf)
7
1946 ( Year)
19 | HEREBY CERTIFY,
That
attandad deosased from
Ło
19
46
I last/ssw h ... +HAA allva on .. July 7 / 1946 death Is sald to have occurred on the dato stated above at 155b Duration .m. Immediate oause of death. Prematurity
IMPORTANT ....
Due to Placental Deharation
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.