USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1949 > Part 14
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2 FULL NAME
Minnie Mason
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Month)
female white
London
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 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, his supposed age, the disease of which he died, defined as required 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 in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate 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 section 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 nineteen 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 shallexhume 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 inter- ment, 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 physician 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 required of the attending physician. If death is caused by violence, the medical 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 registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary 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 persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received 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 follow- ing rules of practice:
(1) Attending physicians 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 injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occup ::- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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, 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
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
A R-302 1
PLACE OF DEATH
Suffolk
(County) Chelsea
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
80
Registered No.
41
(City or Town) Soldiers' llome Hospital No.
[(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.) 93 Locust
Winthrop
St.
Mass.
(a) Residence. No. (Usual place of abode) hospital
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
months.
7
days. In place of residence.
.....
.. years ..
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
Feb.2,1949
DEATH
(Month)
(Day)
(Year)
deceased from
49
19.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Fannie L.Levine
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINCardiac failure , acute
TO DEATH
(a)
-4das
.12
AGE51
Year
2
Months
Days
If under 24 hours
Hours.
Minutes
Coronary thrombosis, recurrent
with anterior myocarufal 11
ction
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER
Coronary artery disease.yr
SIGNIFICANT
CONDITIONSPonchopneumonia
Major findings:
Of operations
Date of operation
Was autopsy performed?
clinical
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify.James p. Collins (Signed) soldiers Home 2/3/19 19
M. D.
(Address) wolener Soc. Melrose, dass.
6
Place of Burial or Cremation
Tob. 4,1949
(City or Town)
DATE OF BURIAL 19
7 NAME OF
II.J .Torf
FUNERAL DIRECTOR.washington Ave . hc13ca ADDRESS
Received and filed.
MAY 3 1949
.. 19.
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Ida Handler
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia"
21
Hospital Records
Informant Soldiers Home Hospital
(Address)
A TRUE COPY Smaple GITurrell
ATTEST:
(Registrar of City or Town where death occurred)
2/3/49
DATE FILED
....................... 19. .......
(write the word)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
Divorced
or DIVORCED
4 I HEREBY CERTIFY,
Jan.27
49
19
to
im
Feb. 2
$9
death is said to
I last saw h.
alive on
9 : 50р.
have occurred on the date stated above, at.
m.
INTERVAL BE-
TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
Cleanser
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
Cleaning ( Clothes )
or Business:
15 Social Security NCannot be learned
16 BIRTHPLACE (City)
Russia
(State or country)
17 NAME OF
FATHER
Myer Goldstein
50m-(e)-10-48-24658
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk 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.)
2 FULL NAME
Josephus Goldstein
(Was deceased a
U. S. War Veteran,
if so specify WAR)
That I attended
Feb,2,
Date of entering military service 10/22/18 Date of Discharge 12/19/18 Rank, Rating-Private
Co.a 61st Amn.Tr.N.WWI
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)
202812
Mass.Memorial Hospital
J (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.)
304 River Road
St.
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
.. months.
12
.days.
In place of residence
35.years
.. months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 6/49
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Feb. 22
49
to
March 6
That I
attended deceased
from
49
19
I last saw
h
im ... alive on
March 6
49
19.
death is said to
have occurred on the date stated above, at.
m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Carcinoma of
biliary system
11 IF STILLBORN, enter that fact here.
12
52
Months
Days
If under 24 hours
Hours.
Minutes
·13 Usual
Occupation:
Lamb Salesman
(Kind of work done during most of working life)
14 Industry
or Business:
Wholesale Meats
15 Social Security No.
022-09-3011
16 BIRTHPLACE (City)
(State or country)
Boston Mass.
17 NAME OF FATHER Frank F Dyar
18 BIRTHPLACE OF
FATHER (City).
Boston Mass.
tor (state or country)
19 MAIDEN NAME
OF MOTHER
Louise C Guinasso
(Address)
W ER Greer
M.
Date.
3-6
19.
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
March 9/49
19
7 NAME OF
FUNERAL DIRECTOR
R.C. Kirby
ADDRESS
Boston Mass.
Received and filed.
APR 1 5 1949
19
(Registrar of City or Town where deceased resided)
1 Y
ANTE
CEDENT (b)
CAUSES
with metastases
Due To
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
None
Of operations
Date of operation
Was autopsy performed ?.... NO
What test confirmed diagnosis?
Physical ... Exam. and labor
5 Was disease or injury in any way related to occupation of deceased? If so, specify
N.o
PARENTS
50m-(e)-10-48-24658
Winthrop Cem-Winthrop Mass.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Louise C Kelley
21
Informant
(Address)
A TRUE COPY.
ATTEST:
.....
DATE FILED
!
(Registrar of City or Town where death occurred)
March 9/49
19
W W #1
(a) Residence. No. (Usual place of abode)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
8;15A
TWEEN DNSET AND DEATH
AGE
Years
3
11
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
M R-302 1
No.
Edward Dyar
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Registered No.
Boston Mass.
(Signed)
BostonMass.
19
Entered Service 9-20-17 Discharged 1-18-1919 P.F.C. Battery C 301st Fld Artillery Service No. 1662894
+
PLACE OF DEATH
Suffolk (County)
Revere
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or town making return)
Registered No. 43
Revere Memorial Hosp . St. [ give its NAME instead of street and number)
2 FULL NAME Arthur Albert Ames
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(a) Residence. No.
1.95Lincoln
(Usual place of abode)
St.
Winthrop, Mass,
(If nonresident, give city or town and State)
Length of stay: In place of death.
years
months.
.days.
In place of residence.
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
1.0
1949
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
Feb. 24
1949
to
March 10
19.
49
I last s
him.
alive on.
March 10, 149.
h is said to
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at.
2:10 P
a.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
4 yearsAGE
.7.5.Years
2 .. Months 2.4 ... Days
If under 24 hours
.Hours .... ... Minutes
13 Usual
Occupation :
Watchman
(Kind of work done during most of working life)
4 years14 Industry
or Business :.
Ritz-Carleton Hotel
15 Social Security No.
011-05-5304
16 BIRTHPLACE (City).
(State or country)
England
OTHER
SIGNIFICANT
CONDITIONS
Fecal fistula
Major findings:
Mucocele of appendix,
Of operations
gangrene
2/25/88stric epiploic
What test confirmed diagnosis ?.
NO
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
Joseph Gregorie
My, D.
(Address)
336 Summer Bastonate 3/10
1949
6 Winthrop Cemetery Winthrop, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL
March 12.
.19 ...
19.
49
Mrs. Harry Chase
21
Informant
(Address)
19 Centre Str
Winthrop
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS
174 Winthrop St. Winthrop, MagstTEST:
Received and filed.
APR-1-4-1949
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
(Registrar of City or Town where death occurred)
DATE FILED
March 24.
1949
......
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk 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.)
50m-(e)-10-48-24658
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Myocardial
heart disease
ANTE
Due To
Arteriosclerosis
CEDENT (b)
CAUSES
generalized
Due To
(c)
Bronchopneumonia
3 days
17 NAME OF
FATHER
Frederick Ames
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Elizabeth Brown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
No.
(City or Town)
[(If death occurred in a hospital or institution,
9 COLOR OR RACE
10 SINGLE
(write the word)
8 SEX
Male
White
MARRIED
WIDOWED
or DIVORCED
Married
Mary
Roberts
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
14
24 years
4 R-302 1
Date of operation ...
9 ..... Was autopsy performed?
N.c
+
PLACE OF DEATH
Suffolk (County)
Boston
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return) 2287
Registered No.
Children's Hospital
§(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.) 142 Pauline St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years. .months.
gdays. In place of residence
... years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 13/49
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
March 12
19
49
to
March 13
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Resp.failure
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.
Years
Months.
3
Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation :
-
(Kind of work done during most of working life)
14 Industry or Business:
Due To
(c)
Aspiration of feeding
24 Hrs
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
17 NAME OF
FATHER
William B Devlin
Major findings:
Of operations.
Broncho pneumonia
Date of operation.
Was autopsy performed?
What test confirmed diagnosis ?.
autopsy
PARENTS
18. BIRTHPLACE OF FATHER (City) (State or country)
BostonMass.
19 MAIDEN NAME
OF MOTHER
Marguerite C Herbert
Winthrop Mass.
Winthrop Cem-Winthrop Mass.
Place of Burial or Cremation (City or Town)
DATE OF BURIAL March 15/49
19
7 NAME OF
FUNERAL DIRECTOR
R C Kirby
Boston Mass.
ADDRESS
Received and filed. MAX 9 1949
19
MAY 9 --- 1949
DATE FILED
(Registrar of City or Town where death occurred) March 18/49
19
×
M R-302 1
(City or Town)
No.
Baby Boy Devlin
(Was deceased a
U. S. War Veteran,
( if so specify WAR)
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
That I attended deceased from 49
I last saw h
im .. alive on
March 13 10
19 49
death is said to
have occurred on the date stated above, at. 6;50A
m.
12 Hrs
ANTE Due To Broncho pneumonia
CEDENT (b)
OTHER
SIGNIFICANT
CONDITIONS
5 Was disease or injury in any way related to occupation of deceased ?.. If so, specify. sw Royce Jr.
No
(Signed)
(Address)
Children's Hospt Date .....
3-13"
19
M.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
W B Devlin Father
21 Informant (Address)
A TRUE COPY, ATTES Cenas
.....
(Registrar of City or Town where deceased resided)
-
6 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES 50m-(e)-10-48-24658
(write the word)
Revere Mass.
1 R-302 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE (City or town making return)
Registered No.
45
J(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME ..
Wesley Agar Hamilton Gordon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
59 Somerset Ave.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
14
.. months
days.
In place of residence
2
years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
16
1949
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
10a If married, widowed, or, divorced.
HUSBAND of.
Lubell E Brown
(Give maiden name of wife in full)
I last saw h.
im
alive on March 16, 1949, death is said to
have occurred on the date stated above, at
1.0: 25 Pm.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
7.2 Years
4
Months
26
Days
If under 24 hours
Hours .. ... Minutes
ANTE CEDENT (b) CAUSES
Due To Cerebral Hemorrhage
& mos
13 Usual
Occupation
Police Officer (Retired)
(Kind of work done during most of working life)
14 Industry
or Business :.
Boston Police Dept.
Due To
Gastric Ulcer
10 yrs
15 Social Security No.
021-18-5486-A
East Clifton
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? NO
If so, specify
(Signed)
LouisF Salerno
M.18.
(Address) .
175 Pleasant,
T .Date
3/18
19 49
6
.Winthrop
Place of Burial of Cremation
(City or Town)
DATE OF BURIAL
March 19
,49
19.
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
Winthrop, Mass.
ADDRESS
Received and filed 19
APR 14 1949
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Elizabeth Hamilton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
C BL
Ruby .... Douglas
21
Informant
(Address)
59 Somerset Ave .. Winthrop
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
March 24.
.19 49
...
MARRIED
WIDOWED
or DIVORCED Widowed
March 2.
1949
to
March 16
19
49
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Bronchopneumonia
3 days
(c)
16 BIRTHPLACE (City).
(State or country)
Quebec, Canada
17 NAME OF
FATHER
William Gordon
Winthrop
Winthrop
50m-(e)-10-48-24658
No.
Resthaven Home
¿ ¿ Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
1
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Bos ton
(City or town making return)
Registered No.
2595 46
Peter Bent Brigham Hospital
No.
2 FULL NAME.
Samuel Burstein
(If deceased is a married, widowed or divorced woman, give also maiden name.)
44 Hawthorne Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years
months.
... years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
March 23/49
(Day)
(Year)
8 SEX M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
(write the word)
WIDOWED Married
or DIVORCED
4 I HEREBY CERTIFY,
That I
attended deceased
from
March. 22 19.
49
to ..
March 23
19.
49
I last saw
h.
im .. alive on
March 23
19
death is said to
49
have occurred on the date stated above, at
8;10R
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.70
Years
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Clothing Mfg.
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No ..
None
16 BIRTHPLACE (City)
(State or country)
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