Town of Winthrop : Record of Deaths 1947, Part 72

Author: Winthrop (Mass.)
Publication date: 1947
Publisher:
Number of Pages: 544


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 72


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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5. Color or


4. Sex


m


race


w


that I last saw h.


__ alive on


, or ounty)


U. S. GOVERNMENT PRINTING OFFICE 16-13403 NOV 2 5 1947


-


P.202


Sate Board of Health Bureau of Vital Statistics


PLACE OF DEATH:


a County manatee


District Nos


1) Precinct


Precinct No.


(c) City or Town


Winthrop


(If outside city or toy'ff limits, write RURAL)


(d) Street No.


(E rural, give location)


(e) Citizen of Foreign country ?.


no


20


If yes, name country


making return) 214


1 or institution, et and number)


en and State)


mos.


days.


(Year)


ded deceased from


19 ...


death is said to


m.


Duration


Physician


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


of deceased ?


(a) (Probably) Accident, suicide, homicide (specify)


(b) Date of occurrence.


M. D.


(c) Where did injury occur?


(City or town)


(County) (State)


(d) Did injury occur in or about home, on farm, in industrial place,


Pin public placez (Specify type of place)


While at workz yot injury_


Amature


M. D.


(a) Address


Date Signed


ATTEST :


(Registrar of city or town where death occurred)


19


Received and filed .. NOV 251947


19


DATE FILED


20. Date of Death: Month march Day 28


Year 1947 Hour Minute


40 P.M.


make


5. Color or race white


I. Single, married, widowed or divorced manuel 6 (a) If married, widowed or divorced, husband of (or) Wife of mary Brinley 75


6 (b) Age of husband or wife, if allve. years


7 Birth date of deceased.


3 1872


(month)


(day)


(year)


& Age: Years


Months


Days


If less than one day


74


4


25


hrs


min.


1. Birthplace Boston


marc


(City, town or county> > (State or foreign country)


10. Usual occupation Salt. Alandan Co.


Il. Industry or business


12. Name


13. Birthplace


Barton man


14. Maiden name Catherine Slum


E 15. Birthplace Borta


1. Informant's Signature zur g. w. That (a) Address Withlos Mars.


7 Burial, cremation or removal? 7 (a) Date: 3/30/47 17 (b) Place Wind 1


1. Funeral Director's Signature. ER Shona


1 (2) Address: Ready To Ale.


2. USUAL RESIDENCE OF DECEASED


(a) State.


mark.


(b) County


(Write name, pot number)


City or Town Bradenton


down' No


Name of hospital or institution Bradesiden jemand (If not in hospital or institution, write street number or jocation) el Length of stay: In hospital or institution


3 month


At place of death (Specify whether years, months or days)


1 FULL NAME OF DECEASED John w. Her but


3 (a) If veteran,


3 (b) Social Security


name war


No home


MEDICAL CERTIFICATION


21. I hereby certify that I attended the deceased from Muy 28 1947 January 38 1842; that I last saw halive on Musel 3 8 1.47; and


Duration


that death occurred on the date and hour stated above. Imanediate cause of death


3 hours


Due to


Due to


Other conditions


(Include pregnancy within 3 months of death)


Major findings: of operations


(Give date of operation)


of autopsy


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


22. Lf death was due to external causes, fill in the following:


19


(City or Town) .19


Local Registrar


In Blake


CERTIFI NON RESIDENT


State File NOL


6294


Registrar's No.


73


FLORIDA


The Commonwealth of Massachusetts


109


ty or 30 5


yes or no


(Registrar of City or Town where deceased resided)


R-302


1


PLACE OF DEATH


(County)


(City or Town)


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


(City or town making return)


Registered No.


215


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


2 FULL NAME


JOHN VINCENT O'DONNELL


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


(a) Residence. No.


(Usual


DO NOT WRITE IN SPACES


PLACE OF DEATH


Registrar's No ..


S.


mos.


days.


(E


PLACE


County Chatting


State


Coupty __


PERSO


3 SEX


4 4444


City or Borough, Name of Hospital or Institution. 3 Nicholson


(If set in hospital or institution write atreet number or location)


Length of Stay In this Community


yTs.


mos. 2 days


brs.


foreign country ?. country


Kindly Type or Print


FULL NAME


(Surname last, first name here)


IF VETERAN, NAME WAR ..


SOCIAL SECURITY 20-05-664 NO ....


RESIDENCE


SEX


COLOR OR RACE


Single, Married, Widowed or Divorced (write the word)


I HEREBY CERTIFY, That A attended the deceased from


May 11


1347


7 IF STILLBORN,


If married, widowed or divorced HUSBAND OF


Age, If Ilving


8


DATE


AGE Years


BIRTH DATE OF DECEASED (Month, day sod year)


AGE


Months


Daye"


If Leve Hra.


Baumatic valisites tech Dug to.I. Bureau, aortic & mural


many


Industry 10 or Business :


CAUSE


11 Social Security


USUAL OCCUPATION. Industry or business


Other conditions. (Include pregnancy within 3 months of death)


PHYSICIAN -


12 BIRTHPLACE ( (State or country


NAME


13 NAME OF FATHER


CONT. CAUSE


BIRTHPLACE (City of town) (State of country)


MAIDEN NAME


BIRTHPLACE (CIU or two) Cercle · (State or country)


If death were due to external causes, All in the following: Accident, suicide, er homlake (specify)


Date of occurrence


Where did Injury encur?


-


15 MAIDEN NAM OF MOTHER


PLACE OF BURIAL


DATE


(Spydle ipe of place)


While at work ?.


Means ofpory


Dste


19


16 BIRTHPLACE MOTHER (Ci (State or cour


FUNERAL DIRECTOR (Aåren)


17 Informant ( Address)


RECEIVED


26. 20.47


Address!


129 Hunmich ave. Fremmich, .. " Đạio thịand


(City or Town) 19


22 NAME OF FUNERAL DIRECTOR ADDRESS


Reoelved and filed


NOV 25-1947


19


(Registrar of City or Town where deceased resided)


50m (e)-1-41-4667


A TRUE COPY. ATTEST : (Registrar of city or town where death occurred)


DATE FILED 19


Physician


Major findings: Of operations.


of autopsy


which death shouldbe charged tte.


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


PARENTS


14 BIRTHPLACE FATHER (Ci (State or cou


SIGNATURE OF INFORMANT


PLACE OF ACCIDENT


MOTHER FATHER


BIRTHPLACE (City of town). (State or country)


Due to.


to May 22 May It , 19/ / and that


that i Ist saw himlDalive on


death occurred on the date stated above, at.


(Cine full maldon name) (Or) WIFE OF


Imnydiate cause Carline Failure


Usual 9 Occupation :


Than-


One Day Min.


ttended deceased from


19


19 death is sald to


m.


Duration


6 Age of husband


City or Borough _. (Il gutaide city er Locough Noche, namy soyabip) Street No. 10 C Ce RET


1947


Citizen of (If rural give location) If so, neme


(Year)


Sa If married, wid HUSBAND of


(or) WIFE of


DATE OF DEATH


town and State)


NEW JERSEY DEPARTMENT OF HEALTH-BUREAU OF VITAL STATISTICS


Length of stay: In


DELOW


FORMER OR USUAL RESIDENCE


Township


ATH


.... nicu m ouvir or owns the tin of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)


No.


St.


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


. .. ...


atlon of deoessed ?.


(City ar tương) Did Injury cocur Is or sbout home, en farm, in industrial plast, la pebble piace?


M. D.


12


MEDICAL CERTIFICATION


R-302


Essex


(County)


Lynn


(City or Town)


No. 94 Franklin


St.


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


2 FULL NAME


Martha W Berry (Kendall)


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


(if U. S.


War Veteran,


speolfy WAR)


(a) Residenoe. No.


96 Bartlett Rd.


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)


years


months


days.


In this community


5Grs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


(write the word)


Female


White


MARRIED


WIDOWED


or DIVORCED Married


5a If married, widowed, or divoroed HUSBAND of


(or) WIFE of


Joseph W


Berry


(Give maiden name of wife in full)


(Husband's name in full)


85


6 Age of husband or wife if alive years


7 IF STILLBORN, enter that fact here.


AGE 77 Years 5 Months 13 Days


If less than 1 day


Hours ..........


Minutes


Usuai


9 Occupation :


Housewife


Industry


10 or Business :


own home


11 Soolal Security No ..


none


Boston


12 BIRTHPLACE (City)


(State or country)


Mass.


13 NAME OF


FATHER


George Kendall


PARENTS


14 BIRTHPLACE OF


FATHER (City)


London


(State or country)


England


15 MAIDEN NAME


OF MOTHER


Mary A. Riley


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


England


17 Joseph S. Perry


informant.


obstation, if any


( Address) 38 Lowell Rd., Winthrop


A TRUE COPY.


ATTEST :


(Registrar of city or town where death 'occurred)


DATE FILED


19


Sept. 17.


47


18 DATE OF


DEATH


August 15, 1947


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


11/30


19 ... 4.6.


to


8/1.5.


19


47


I last saw h ............. allve on


8/15


19.4 .. 7, death Is sald to


have occurred on the date stated above, at


8:45 Dom


Duration


Immediate cause of death.


Chr. deg. myocarditis


10yrs.


& decomp.


Due to.


Gen, arteriosclerosis


15yrs.


Due to.


Other conditions.


Paralysis agitans


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of.


12yrs. Physician


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 ?.


If so, speolfy


(Signed).


EdmundA ........ Jannino


M. D.


(Address)


181 N. Common St. Date 8/15 19 47


21 PLACE OF BURIAL,


CREMATION OR REMOVALWinthrop.


Winthrop


(Cemetery }


(City or Town)


DATE OF BURIAL


August 18


19.47


22 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS


Winthrop, Mass.


Reoelved and filed


DEC 2 1941


19


(Registrar of City or Town where deceased resided)


of the city or town in which the deceased realded. (See Chap. 46, Sec. 12, G. L.)


50m (e)-1-41-4667


PLACE OF DEATH


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


Lynn


(City or town making return)


Registered No.


86.216


1


MEDICAL CERTIFICATE OF DEATH


That I attended deceased from


R-302


Essex


(County)


Lynn


(City or Town)


No.


Lynn Hospital


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


Lynn


(City or town making return)


Registered No.


909 217


- ( If death occurred in a hospital or institution, St. 3 give its NAME instead of street and number)


2 FULL NAME


Chester E. Donaghy


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


(a) Residence. No.


45 Pleasant


St.


Winthrop


(If nonresident, give city or town and State)


Length of stay: In hospital or Institution ..


hosp.


years


months


1


days.


In this community


yrs.


mos.


1 days.


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


4 COLOR OR RACE


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Widowed


5a If married, widowed, or divorced


HUSBAND of


à Nichols


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if allve


years


7 IF STILLBORN, enter that fact here.


8


AGE.


Years


53


5


.Months


28 Days


If less than 1 day Hours. .. Minutes


Usual


9 Ocoupatlon :


Auditor


Industry


10 or Business :


S.O.C.O., N. Y.


11 Social Security No.


087-09-2472


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


Elijah Donaghy


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Canada


15 MAIDEN NAME


OF MOTHER


Annie Briggs


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Canada


17 Fthel F. Allen


Relation if any


Informant


( Address)


16 Springvale Ave. , Lynn


A TRUE COPY.


ATTEST:


(Registrar of city or town where death occurred)


DATE FILED


Sept ....... 17,


19


47


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Aug. 30,


1947


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY, That I attended deceased from


AUG.


29


.....


...


1947


to.


Aug


30


19 ..... 4.7


I last saw h.


im .... allve on


Aug


30


1947


death Is sald to


have occurred on the date stated above, at


10:30a


m.


Duration


Immediate cause of death.


Circulatory failure


1day


Due to


Infection (organism


unknown )


Due to


Other conditions.


Arteriosclerosis


unknown Physician


(Include pregnancy within 3 months of death)


Major findings :


Of operations


Date of


charged sta·


What test confirmed diagnosis ?.


White blood count.


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


If so, speolfy


(Signed)


William M.


Leyton


M. D.


.


(Address)


381 Broadway


Date.


9/1 1947


21 "PLACE OF BURIAL,


Waterside Com.


CREMATION OR REMOVAL .


(Cemetery)


Faccio behead


DATE OF BURIAL


.S.e.p.t ..


.. 3.,


19


47


22 NAME OF


FUNERAL DIRECTOR


.. W/m ....... C ....... Good.ri.cb


ADDRESS


128 Washington St ..


ynn


Reoelved and filed


DEC 2 1947


19


(Registrar of Clty or Town where deceased realded)


50m (e)-1-41-4667


icasuru m 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


(If U. S.


War Veteran,


speolfy WAR)


no


(Usual place of abode)


(Before death)


(Specify whether)


Male White


(Give maiden name of wife in full)


Underline the cause to which death should be


Of autopsy


Visceral congestion of


brood .


tistically.


+


DEPARTMENT OF COMMERCE


BUREAU OF THE CENSUS


STANDARD CERTIFICATE OF DEATH


FORM APPROVED Budget Bureau No. 41-R132-42


State File No.


Registrar's No.


218


State of New .. Hampshire


1. PLACE OF DEATH:


2. USUAL RESIDENCE OF DECEASED:


(a) State


Mass


(b) County


Suffork


(b) City or town


Bartlett


(If outside city or town limita, write RURAL)


(c) Name of hospital or institution:


Bartlett Village


(If outside city or town limita, write RURAL)


(d) Street No.


39 Coral Avenue


(If not in hospital or institution, write street number or location)


(If rural, give location)


(d) Length of stay: In hospital or institution


In this community


3 weeks


(Specify whether


If foreign born, how long in U. S. A .?


years.


3. (a) FULL NAME Michael J. Connelly


20. Date of death: Month


Sept.


day


5


year


1947


hour


12


minute


30


A.M


21. I hereby certify that I attended the deceased from


6. (a)Single, widowed, married,


Aug 28,


19_


470


Sept. 5,


1947


4. Sex __ Male


race


white


divorced Widoved


6. (b) Name of husband or wife


MargaretE, Driscoll


alive


6. (c) Age of husband or wife if


and that death occurred on the date and hour stated above.


Immediate cause of death


Cardiac Failure


Code 200A


8. AGE: Years 80


Months


If less than one day


hr.


min


9. Birthplace


Boston,


Mass


(City, town.,or county) (State or foreign country)


10. Usual occupation


Rigger


11. Industry or business


12. Name


John Connelly


13. Birthplace


Ireland


(City. town, or county)


(State or foreign country)


14. Maiden name


Margaret


15. Birthplace


fraland


(City, town, or county) (State or foreign country)


16. (a) Informant's own signature Frank H. Connelly


(b) Address _. 39Coral Ave, Winthrop Lass.


22. If death was due to external causes, fill in the following:


fa) Accident, suicide, or homicide (specify)


(b) Date of occurrence


(c) Where did injury occur?


(City or town) (County) (State)


(d) Did injury occur in or about home, on farm, in industrial place, in public


place?


(Specify type of place)


While at work? (e) Means of injury


423 Signature


John i. Twaddle MD


(M. D. or other)


Address


Glen, N. H.


Date signed _9/5/


47


DER


1047 DEC


194 k


3. (b) If veteran,


name war


3. (c) Social Security No.


5. Color or


(Month)


(Day)


(Year)


Due to


Due to


Other conditions.


HInolude pregnancy within 3 months of death)


PHYSICIAN


Major findings: Of operations


autopsy


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


17. (a)


Burial


(b) Date thereof __ 9/8/47


(Month) (Day) (Year)


(c) Place; burial or cremation


(Burial, cremation, or removal) Talden, Mass. Toly Cross Cemetery


18. (a) Signature of funeral director Arthur H. Furber


(6) Address


North Conway ....... H.


19. (a) 9/8/47 (b) .Frad L. Garland


(Date received local registrar) (Registrar's signature)


8-6917 8


U. S. GOVERNMENT PRINTING OFFICE 16-13493-1


that Nast saw him


__ alive on


Sept. 4,


19 __ 47


Duration


years


7. Birth date of deceased


Sept. 16, 1866


11


Days 19


MOTHER FATHER


years, months or days)


MEDICAL CERTIFICATION


(a) County


Carroll


(c) City or town


Winthrop


DEC->>


A R-302


1


PLACE OF DEATH


SUFFOLK LEGION


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


JUSTON


(City or town making return)


Registered No.


$$19


No. Boston Psychopathic Hoso


(If death occurred in a hospital or institution,


St.


give its NAME instead of street and number)


Alfonzo Sanden


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


20 Crescent


St.


Winthrop


(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


M


4 COLOR OR RACE|


Col.


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED ingle


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY,


9/11/47


19


to ..


10/11/47


19


I last saw h ...... 1.m ....


17/11/47


19


death Is sald to


(or) WIFE of


( Husband's name in full)


6 Age of husband or wlfs If allve years


7 IF STILLBORN, enter that fact here.


AGE Years ... 1.O .... Months 4 Days


If less than 1 day Hours .Minutes


Usual


9 Ocoupation :


Cleanser


Industry


Pullman Co


10 or Business:


11 Soolal Security No ..


unknown


12 BIRTHPLACE (City)


(State or country )


Charleston SC


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings:bilateral prefrontal


Of operations


lobotomy


Date


of


9/22/47


Of autopsy


10/11/47


What test confirmed diagnosis ?.


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


If so, speolfy


(Signed)


HJ De Shon


M. D.


(Address) 7L Fenwood Ra


Date 7/11/197


21 PLACE OF BURIALMIT Hope - Boston


CREMATION OR REMOVAL


(Cemetery )


27/14/47


19


DATE OF BURIAL


(City or Town)


22 NAME OF


FUNERAL DIRECTOR


N G Davis


ADDRESS


Boston


Received and filed


19


NOV 121917


(Registrar of City' or Town where deceased resided)


50m-(b) -6-44-14607


resided 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.)


PARENTS


14 BIRTHPLACE OF


FATHER (City)


S.C


(State or country )


15 MAIDEN NAME


OF MOTHER


Perolee Logan


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Relation, if any


InfoMED Records (Address)


A TRUE COPY.


ATTEST :


(Registrar of city ort 10/15/47 19


death occurred)


DATE FILED


have ooourred on ths date stated above, at


9 452


m.


Duration


Immediate cause of death. cerebral infarct-right


3 wks


terminal cardine failure


3 da ...


Due to.


Due to.


13 NAME OF


FATHER


John A Sanden


18 DATE OF


DEATH


Oct 11/47


(If U. S.


War Veteran,


speolfy WAR)


.no


(a) Residence. No.


(Usual place of abode)


hoso


7


months


days.


years


In this community


yrs.


mos.


30days.


5a If married, widowsd, or divorced


HUSBAND of


(Give maiden name of wife in full)


That I attendsd deceased from


Underline the cause to which death should he charged sta- tIstically.


J


2 FULL NAME


(City or Town)


RM R-305


PLACE OF DEATH


SUFFOLK 1 BOSTON


(City or Town)


No.


818 Harrison Ave


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


BOSTON


(City or town making return)


Registered No.


9053220


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


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


7 Wave Way Ave.


St.


(If nonresident, give city or town and State)


months


days.


In this community


mos.1


days.


MEDICAL CERTIFICATE OF DEATH


18 DATE OF


DEATH


Oct/17/47


(Month)


(Day)


(Year)


19 | HEREBY CERTIFY that f heve 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.) Coronary sclerosis


treated .... therefor.


20 Acoldent, sulolde, or homlolde (specify)


Date of ooourrence.


19


Where did Injury ooour ?


(City or town and State)


Did Injury ooour In or ebout the home, on ferm, In Industrial place, or In


publlo pleoe?


(Specify type of place)


Collapsed at place of business


Manner of


Injury


Neture of Injury


While et work ?.


Was there an autopsy ?


No


21 Was diseese or Injury In any way related to oooupation of decessed ?.


If so, speolfy


(Signed)


Timothy Leary


(Address)


Date. 10-1719 4


22


Pultusker Cem-West Rox.


Place of Burial, Cremation or Removal.


(City or Town)


DATE OF BURIAL


Oct ..... 19/47


19


23 NAME OF


FUNERAL DIRECTOR


L Levine


ADDRESS


Brookline


ass.


Received and filed NOV 1 2 19 17


19


(Registrar of City or Town where deceased resided)


25m-(d) .6-43-12056


17


Informant.


(Address)


Dr ... Jagob Walla &glatlog dyrDy In-Law


A TRUE COPY


ATTEST :


(Registrar of clty or town where death occurred)


DATE FILED


Qct .. 2.1/47.


19


(write the word)


Married


widowed, or divo Regina Mochedlover


years


If lese than 1 day Hours .Minutes


2 FULL NAME.


Abraham Klier


(a) Residence. No.


(Usual place of abode)


Length of stay: In hospital or Institution.


(Before death)


(Specify whether)


PERSONAL AND STATISTICAL PARTICULARS


3 SEX


M


4 COLOR OR RACE


W


5 SINGLE


MARRIED


WIDOWED


or DIVORCED


50 If married,


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


60


7 IF STILLBORN, enter thet faot here.


8


AGE


60


Years


Months


Deys


Usual


9 Oocupation :


Leather Worker


10 or Business :


11 Soolal Seourlty No.


12 BIRTHPLACE (City)


Russia


(State or country)


13 NAME OF


FATHER


Rubin Klier


14 BIRTHPLACE OF


Russia


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


Zlateh


-


PARENTS


16 BIRTHPLACE OF


Russia


MOTHER (City)


(State or country)


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.)


resided in another city or town at the time of death should he made forthwith and transmitted on Form R-805 to the clerk


Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased


Industry


Repairer of Notions


years


(If U. S.


War Veteran,


speolfy WAR)


Winthrop Mass.


1


M.


M R-302


Suffolk


(County)


Boston


(City or Town)


No.


Jewish Memorial .... Cospt


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


Boston


(City or town making return)


9251


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


2 FULL NAME


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


10 Wave Way Ave.


Winthrop


Mass.


(a) Residence. No.


(Usual place of abode)


St.


(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


M


4 COLOR OR RACE


W


5 SINGLE


(write the word)


Married


1


5a If married, widowed, or divorce Rose Lurensky


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


60


years


7 IF STILLBORN, enter that faot here.


8 AGE. 64 Years Months Days


If less than 1 day


.. Hours.


Minutes


Usual


9 Ocoupation :


Tailor


Industry


Z & C Clothing Co.


10 or Business:


11 Soolal Security No ... .


Cannot .... be ... learned


12 BIRTHPLACE (City)


(State or country)


Russia


13 NAME OF


FATHER


Samuel Boiarsky


PARENTS


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


15 MAIDEN NAME


OF MOTHER


Cannot be learned


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


17


Informant


(Address)


Dr Samuel H, Boajon if any


Correct Namo "Son


A TRUE COPY.


ATTEST!


I Manning


(Registrar of city or town wherg death occurred) Oct.21/47 19


Received and filed.


19


DATE FILED


18 DATE OF


DEATH


(Month)


(Day)


(Year)


19 I HEREBY CERIAFY.


Sept .30


19


That I, attended deceased from


19


47


ot/18


.. Y.


I last saw h.


im allve on.


ct/18/47


19.


.. , death Is said to


have ooourred on the date stated above, at


5,45AM


m.


Duration


Immediate cause of death.


Broncho Pneumonia


Epidermoid carcinoma


1 ..... Yr.


Due to.


of the larynx


Due to.


Other conditions


(Include pregnancy within 3 months of death)


Physician


Major findings:


Total laryngectomy


Of operations


June 1946


Date of


Underline the cause to which death 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 ?


If so, spoolfy


(Signed)


RM Phillips


M. D.


(Address)


Boston .. Mass


Date


10-18 9 47


21 PLACE OF BURIAL,


CREMATION OR REMO


Kenesseth


-srael-Woburn Mass.


(Cemetery)


(City or Town)


DATE OF BURIAL


Oct.


19/47


19


22 NAME OF


FUNERAL DIRECTOR


B ... Birnbach


ADDRESS


Dorchester Mass.


NOV 13 1947


( Registrar of City or Town where deceased residled)


50m- (b).6.44-14607


resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk of the city or town in which the deceased resided. (See Chap. 16, Sec. 12, G. L.)


1


PLACE OF DEATH


Benjamin Boiarsky


(If U. S.


War Veteran,


spoolfy WAR)


Oct. 18/47


MARRIED


WIDOWED


or DIVORCED


months


18 days.


In this community


yrs.


.18


days.


years


Registered No.


.. 6-Mos.


A R-302 7


Suffolk


(County)


Boston


(City or, Town) ass.


General Hospital


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.


9417 222


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




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