USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 81
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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, asthenia, 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 been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. Winthrop Community Hosp.
......
2 FULL NAME
Elizabeth Tassinari
( If deceased le a married, widowed or divorced woman, give also maiden name.)
61 Chelsea St.
St.
Ea.st .... Boston
( If nonresident, give elty or town and State)
Length of stay: In hospital or Institution
Hospital
years
months
1
days.
In this community
52 yrs.
mos.
days.
( Before death)
( Specify whether)
MEDICAL CERTIFICATE OF DEATH
3 SEX
femalel
4 COLOR OR RACE
white
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
56 If married, widowed, or divorced
HUSBAND of
(Cive maiden game of, wife In full)
(or) WIFE of
John Tassinari
{ Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
8
AGE 65
Years Monthe Days
If less than 1 dey
Hours
Minutes
Usual
9 Ocouoation :
house work
Industry
10 or Business :
At .... home
11 Social Security No.
none
12 BIRTHPLACE (City)
( State or country)
Italy
13 NAME OF
FATHER
John Campoli
14 BIRTHPLACE OF
FATHER (Clty)
Italy.
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary (unknown)
16 BIRTHPLACE OF
MOTHER (City)
Italy ................
(State or country)
17 Relation, if any ...... daughter
Informent
( Address)
61 Chelsea St. Fast Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death wes filled with me BEFORE the burial or transit permit, was issued : Matter A Male 8%.
(Signature of Agent of Board of Health or other)
If ealth spaces 17/2/48
...
(Official Designation)
( Date of Taque of Permit)
18 DATE OF
DEATH
nov30
1948
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet i attended deosased from
naray
19 42, ko
19
48
I last saw hon
alive on.
. 19 58, death is said to
heve occurred on the date stated above, at
.. m.
Immediate cause of death.
1:55P
IMPORTANT
145
Due to
o Car Thabasis
Ode to
Other conditions
( Include pregnancy within 8 mouthe of death)
Mejor findings :
Of operations
Date of
Of eutopsy
What test confirmed diegnosis
IMPORTANT Physician Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify .........
(Signed)
(Address) 19682
M. D.
Date /01/ 30/ 1948
21
Holy Cross Cemetery
Malden
Place of Burial, Cremation or Removal.
(City or Town)
)
DATE OF BURIAL ..
Dec. 3- 1948
.....
19
22 NAME OF
Lancer
FUNERAL DIRECTOR
ADDRESS
9 Chelsea St. East (Boston
Received and Aled. DEC 3 1948
( Regletrar)
100m. (g)-1-45-15510
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a reoltal to that effeot. extracts from the laws on back of certificate. terms, W fuer it may of property classified. Exact aratswear of VecerATION is very important. Se instructions and PARENTS
Boston 123/8/18
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. 231
Registered No. $ {If death occurred in 2 hospital or institution, st. ( give its NAME instead of street and number)
PHYSICIAN . IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR) .....
no
(a) Residence. No.
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
Duration
Mary .... Tassinari ........
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 the death of a persou 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, his 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 by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the 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 has been engaged, insert iu 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 he 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, or 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 where the body is buried. No such permit shall be issued until there shall have 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, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physi- 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 hereunder. If the death certificate contains a recital, as required
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 been engaged, such recital shall appear upon the permit. The board of 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, he shall 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 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 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 physiclans will certify to such deaths 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 physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of ir.jury, have died without recent medical attendance or whose phy- 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 deaths 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, asthenia, 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 been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
:
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State File No. Registrar's No. 232
State of
AMARSHIRE
1. PLACE OF DEATH:
(a) County
Rockingham
(b) City or town
Hampton-
(If outside citf or town limita. write RURAL)
(Lf outside city or town limita. write RURAL)
(c) Name of hospital or institution:
14 Towle Svenue
(If not in hospital or institution, write street number or location)
(d) Length of stay: In hospital or institution
In this community _
Five Years
(Specify whether
years. months or days)
7 MEDICAL CERTIFICATION
20. Date of death: Month
Sept.
day
7
year
87
hour
11
minute
50
21. I hereby certify that I attended the deceased from
6. (a)Single, widowed, married,
June
19.48 to _Sept
4
19_48:
divorced Married
6. (b) Name of husband or wife
6. (c) Age of husband or wife if
William Henry __ Creighton
7. Birth date of deceased __ Sept
3,
1865
(Month)
(Day)
(Year)
If less than one day Broncho pneumonia
2.days
8. AGE:
Years
83
0
Months
Days
7
hr.
min.
9. Birthplace
Milton
N.S
10. Usual occupation
Housewife
11. Industry or business
12. Name __ John Whittington
13. Birthplace .
Canada
(City. town, or county)
(State or foreign country)
14. Maiden name
Elizabeth-Dugan
15. Birthplace
Nova Scotia
(City, town, or county)
(State or foreign country)
Of autopsy
Underline the cause to which death should be charged sta- tistically.
16. (a) Informant's own signature
John Creighton
(b) Address ___ Hampton, New Hampshire
17. (a) Burial
(b) Date thereof9-7-18
(Burial, cremation, or removal)
(Month)
(Day) (Year)
(c) Place; burial or cremation
Winthrop.Cemetery
Winthrop, Mass.
18. (a) Signature of funeral director __ Raymond.Sturgis
(b) Address
Hampton,New Hampshire
19. (a) 9-6-48 (b) .. William Brown
(Date received local registrar) (Registrar's signature)
22. If death was due to external causes, fill in the following:
(a) 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
23. Signature Wayne P. Bryer
(M. D. or other) DI ._ D.
Address
Hampton, New Hampshire Date signed 9-4-48
(If rural, give location)
If foreign born, how long in U. S. A .? years.
3. (a) FULL NAME
Mary Jane Creighton
3. (b) If veteran,
name war
3. (c) Social Security
No. =
5. Color or
race White
4. Sex Female.
that I last saw her __ alive on
Sept. 4
19.48:
and that death occurred on the date and hour stated above.
Duration
1 day __
Due to
Due to
Code No.83A
107
Other conditions.
{Include pregnancy within 3 months of death)
PHYSICIAN
Major findings:
Of operations
MOTHER FATHER
8-6917
U. S. GOVERNMENT PRINTING OFFICE 16-13493 DEC 2 1 1948
2. USUAL RESIDENCE OF DECEASED:
(a) StateMassachusetts_ (6) County ... Suffolk-
(c) City or town
Winthrop
(d) Street No.
125 Sargent St.
alive years Immediate cause of death Cerebral hemorrhage
(City. town, or county)
(State or foreign country)
RECEIVED
11 12
3
5
5
6
Tři
DEC201948 M
M R-302
1
PLACE OF DEATH
SUFFOLK! BOSTON
(City or Town) Boston City Hosp
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
233
Registered No.
9.9.07
S (If death occurred in a hospital or institution, St. give ita NAME instead of street and number)
2 FULL NAME
David J. Kneeland
(If deceased ia a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
26 Pleasant
St.
Winthrop
(If nonreaident, give city or town and State)
Length of stay: In hospital or institution.
(Before death)
(Specify whetber)
years
months
4
da y s.
In this community
yrs.
mos.
4
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
N.o.v ........
16, 1948
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY,
11/12 /48 , 19.
to
11. 1.6.48
19
That I attended deceased from
I last saw h
.. alive on.
19
death is said to
have occurred on the date stated above, at
3 05A
m.
Duration
Immediate cause of death
Cerebral hemorrhage
4 da
....
Essential hypertension
20 Y
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
What test confirmed diagnosis?
clin
20 Was disease or Injury in any way related to occupation of deceased ?.
If so, speolfy
(Signed)
M W O'CONNELL
M. D.
(Address)
BCH
Date 11/16/48
21 PLACE OF BURIAL,
CREMATION OR REMOVAWinthrop-Winthrop
(Cemetery )
DATE OF BURIAL
11/19/48
(City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
J F O'Maley
ADDRESS
Winthrop
Received and filed 19
DEC 1.1 1948
(Registrar of City or Town where deceased resided)
50m- (b) -6-44-14607
(Usual place of abode)
3 SEX
4 COLOR OR RACE|
W
M
1
(or) WIFE of
7 IF STILLBORN, enter that faot here.
8
AGE 67
Years
Months.
Days
Usual
9 Ocoupation :
Chauffeur
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Cal.
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Cal.
17
informant.
dau.
(Address)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
11 Social Security No ..
025-09-8409
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Wid.
5a if married, widowed, or divorced.
HUSBAND of
Josephine .... Ryan
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive years
If less than 1 day
Hours
.Minutes
Due to ..
Industry
10 or Business :
Newspaper Dely
San Francisco Cal
13 NAME OF
FATHER
Kneeland
Relation, if any
A TRUE COPY.
ATTEST :
Michael & Honning
(Registrar of city or town where death occurred)
DATE FILED
11/19/48
19
Underline the cause to which death
No.
(If U. S.
War Veteran,
speolfy WAR)
R-302
1
Concord
(City or Town)
No. Emerson hospital
St.
(If death occurred in a hospital or institution, 3 give its NAME instead of street and number) 1 (If U. S. War Veteran, specify WAR)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maideu name.)
(a) Residenoe. No.
33 Paine
St.
Winthrop
1.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
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE| 5 SINGLE
(write the word)
White
1
MARRIED
WIDOWED
or DIVORCED
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
19
That I attended deceased from
to
Nov.
17,
19.4.8
I last saw h
im
allve on.
NOV.
17.
19.4.8
death is said to
have ooourred on the date stated above, at
m.
Duration
Immediate cause of death Intra-uterine asphyxia
7 IF STILLBORN, enter that faot here.
Stillborn
8
AGE.
Years.
Months.
Days
If less than 1 day Hours. .Minutes
Usual
9 Ocoupatlon :
Industry
10 or Business :
11 Soolal Security No.
12 BIRTHPLACE (City)
(State or country)
lass.
13 NAME OF
FATHER
Ralph J. Paone
14 BIRTHPLACE OF
FATHER (City)
Revere ,
(State or country)
Lass.
15 MAIDEN NAME
OF MOTHER
Louisa Venti
16 BIRTHPLACE OF
Concord,
MOTHER (City)
(State or country)
I ass.
17
Ralph J. Paone
Relation, if any
Informant ..
(rather
(Address) 38 Paine St. , Winthrop,
Lass.
A TRUE COPY.
Cornelia Lawrence
ATTEST :
(Registrar of city or town where death occurred)
November 27,
19 48.
22 NAME OF
FUNERAL DIRECTOR
R. J. Delleill
ADDRESS
Revore,
Jass.
Received and filed
DEC-2-0-1949
19
(Registrar of City or Town where deceased resided)
.
Major findings :
Of operations
Date of
Physician Underline the cause to which death
Of autopsy .......
Intra-uterine asphyxia
Pulmonary atelectasis
should be charged sta- tistically.
What test confirmed diagnosis?
20 Was disease or Injury In any way related to occupation of deceased? NO
If so, speolfy.
(Signed)
Randolph Piper
(Address)
Concord, Less.
Date . OV. - 19
M. D.
40
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ...
Holy Cross
halden
(Cemetery)
(City or Town)
DATE OF BURIAL
November 19.
19 48
50m-(b)-6-44-14607
PLACE OF DEATH
liddlesex
(County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
23.3
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
18 DATE OF
DEATH
November
17,
1948
5a If married, widowed, or dlvoroed
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
Due to.
Pressure on cord
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
concord
DATE FILED
Paone
RECEIVE X
11 12
6
DEC201348 M$
R-302
PLACE OF DEATH
SUFFOLK (County)
1
BOSTON
(C'ity or Town) JEWISH MEM HOSP
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BO.S .. T.O.N
(City or town making return)
235
1040515
- (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
BARNETT COHEN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
35 SEAFOAM AVE
St.
WINTHROP MASS
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution ..
HOSP
years
1
months 6
days.
In this community
yTs.
-
mos.
26
days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE| 5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
WIDOWED
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
OCI.6
19.4.8.
to
DEC .. 2
That I attended deoeassd from
19
48
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at.
1.5.35₽
m.
Duration
Immediate cause of death. CEREBRAL VASCULAR ACCIONET
R.E.C.U.A.R.E.N ......... A.N.D ..... B.R.O.N.C.H.O.P.N.EUMON.I.A.
3 DAYS
Due to .. G.E.N .... A.R.I.E.R.J.O .... S.C.L.E.R.O.S.L.S
Y.R.S ...
HYPERTENSION RT SIDED
PARESIS 4 MOS
Due to.
LEFT HEMIPLEGIA
3 DAYS
Industry
MEN'S VESTS
10 or Business :
11 Social Security No .....
12 BIRTHPLACE (City) POLAND (State or country)
13 NAME OF
FATHER
ABRAHAM COHEN
Major findings :
Of operations
Date of
should be
Of autopsy
What test confirmed dlagnosis ?.
C.L.J.N.J.C.AL
20 Was diseass or injury in any way related to occupation of deosased ?
If so, specify.
(Signed)
DAVID ULUNTS
M. D.
(Address) ... F .. R.A.NK.L ... +·N ···· G.A.R.DE.N.S ........
Date .. V.E.c ..... 2 .. 19 .... 48.
21 PLACE OF BURIAL,
APLE HILL CEM PEABODY
₹
CREMATION OR REMOVAL
(Cemetery)
(City or Town)
SON.
DATE OF BURIAL
U.E.C .... 3 .. , ..... 1.9.4.8.
19
22 NAME OF
FUNERAL DIRECTOR
B BIRNBACH
ADDRESS
10
WASHINGTON ST DOR
Rsoeived and filed
DEC 6, 1948 19
DATE FILED
19
7
A TRUE COPY.
ATTESTE
(Registrar of city or town where death occurred,
25M-(f)-11-42 10746
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
·POLAND"
15 MAIDEN NAME
OF MOTHER
MOLLIE
16 BIRTHPLACE OF
MOTHER (City)OL .. A.N.D.
(State or country)
17
Informant ......
ABRAHAM COHEN
(
Relation, if any (Address)
If less than 1 day .Hours ... ...... Minutes
AGE
Usual
9 Oooupation :
OPERATOR RETIRED
(Give maiden name of wife in full)
I last saw hl.M ........... allve on ...... E.C.
2
19.4.8 .. , death Is sald to
6 Ags of husband or wife If alive years
7 IF STILLBORN, snter that faot here.
8 74 Years .. .. Months. Dayı
Other conditions
(Include pregnancy within 3 months of death)
Physician Underline the cause to which death
charged sta- tistically.
5a If married, widowed, or divorced
HUSBAND of
JUNE LEVY
18 DATE OF
DEATH
DEC 2. 1948
(If U. S.
War Veteran,
speolfy WAR)
Registered No.
No.
St.
(Registrar of City or Town where deceased resided)
RECEIVE
1.2
-
5
6
DEC271948 AM
R-303-A
PLACE OF DEATH
Suffolk [ (County) Bartin Winthrop (City or Town) 23 Sturges St Mouthrob No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
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