USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 19
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19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
.....
21 Informant (Address) John Simons
A TRUE COPY
X
(Registrar of City or Town where death occurred)
DATE FILED
March 27/53
19
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,
25M .(B)-11-51-905807
ANTE
CEDENT
CAUSES
Major findings:
Of operations.
WALLTHING, WITH VITALINO DIVITA- UNDDATENMANENT RECORD
OTHER
SIGNIFICANT
CONDITIONS
(Month)
Mass. Memorial Hospt.
No.
(Usual place of abode)
(Was deceased a
U. S. War Veteran,
[ if so specify WAR)
Winthrop Mass.
(write the word)
RECEIV . 9
OF TO:
il ??
.7
15
ROP
APR27
M R-302 1
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
25M.(B) 11-51-905807
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
63
Registered No.
253I
[(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME. Barbara .. Alu
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
( if so specify WAR).
(a) Residence. No. 23 .. Moodside Ave. St.
dinthron Heas town and State )
Length of stay: In place of death. .. years months .days. In place of residence ............ years. .. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 11/53
(Month)
(Day)
(Year)
4I HEREBY CERTIFY,
That I attended deceased from
Feb.27 ....
1953.
to ..
Harch .3.4",
19 .. 53
I last saw h alive on.
March 14. ...... 1953., death is said to
have occurred on the date stated above, at
7:304
.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
6 Weeks
12
AGE
Years ......... Months ?.
Days
If under 24 hours
Hours . .. Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ..
16 BIRTHPLACE (City).
(State or country)
Boston Mass.
17 NAME OF
FATHER
Vincent M Alu
18 BIRTHPLACE OF
FATHER (City)
(State or country)
"Boston Mass.
What test confirmed diagnosis ?.
PHpical
5 Was disease or injury in any way related to occupation of deceased? if so, specify
(Signed).
CL Clay
M. D.
(Address)
Misg.General Hospt
Date 3-1110 53
Place of Burial or Gamatochael's Doston Massy
DATE OF BURIAL.
March 16.1953
19
7 NAME OF
FUNERAL DIRECTOR
DiPetro and Vazza
East Boston Mass.
ADDRESS
Received and filed
APR ... 1.3 1953
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Mary A Marchiafara
20 BIRTHPLACE OF
MOTHER (City) ..
Baton Rouge .. La.
(State or country)
21
Informant.
(Address)
Father
A TRUE COPY
Charles 21 Zna
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
March 18/53
.19
X
8 SEX
F
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCESingle
(write the word)
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)
Bronchiopneumonia
7 Mos
Congenitalnephritis
7 Mos.
Date of operation
Was autopsy performed?
No
......
No.
Mass.General ... liospt
(Usual place of abode)
Due To
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
WRITE TWINGO, WITTTONFAVINO DLAGRING - THIS IS APERMANENT RECORD
ANTE
CEDENT (b)
Rickets.
-
RECEIVES
11 12
1
0
-
APR13
M R-302 1
3 DATE OF
DEATH
(c)
WRITETWINET, WETTTONPAVING DIALNY ING - THIS IS A PERMANENT RECORD
ANTE
CEDENT (b)
CAUSES
(Month)
March 11/53
(Day
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
March 12 19 53.
to ...
March 1
19.53
I last saw h.
.alive on.
March 14 19.
19 ... 5.3 death is said to
have occurred on the date stated above, at
11,2540
INTERVAL BE- TWEEN ONSET ANO DEATH
11 IF STILLBORN, enter that fact here.
12
AGE63
V.
XXXX Months .. 2.
..... Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :.
(Kind & tom dank
during most of working life)
14 Industry
or Business:
15 Social Security No ..
028 -05-7903
16 BIRTHPLACE (City).
(State or country)
Dublin Shore N.S.
17 NAME OF FATHER
18 BIRTHPLACE OF
John Croft
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Jane Smith
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Nova Scotia
6
Place of BuntokienShore Cem-Dublin Shore ... yor Town)
DATE OF BURIAL.
March 19/53
19
7 NAME OF
FUNERAL DIRECTOR
G E Carroll
ADDRESS.
Malden Mass.
Received and filed.
APR13 153
19
(Registrar of City or Town where deceased resided)
W PARENTS
21
Informant.
(Address)
Je e Hall
'A TRUE COPY
ATTEST of mackie
(Registrar of City or Town where death occurred)
DATE FILED
............
March 18/53
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,
25.M.(B) 11-51-905807
PLACE OF DEATH
Suffolk
(County)
Bortkept Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
2574
64
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME. Gur Smith Grof
(If deceased is & tatli widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
( if so specify WAR).
(a) Residence. No. 1.7.Tewksbury ... St St.
(Usual place of abode
Length of stay: In place of death ............ years
months ....
.days. In place of residence
2
Years.
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
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
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Basilar artery.
thrombosis
Due To Broncho pneumonia
Cardio meraly
Due To
due to coronary
artery sclerosis
Yrs
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
None
Date of operation
Was autopsy performed ?.
Yes
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
M. D.
(Signed).
(Address)
Peter Bent BrighPata Hoopt 3125-53
Term.
2 Wks
Hospital
town and State)
No. Peter Bent .Brigham ... Hospt.
Medical Examiner Declined Jurisdiction
19
RECEIVED
1
9
.....
1
5
APR13
AM
M R-302 1
PLACE OF DEATH
Suffolk (County)
Chelsea (City or Town)
No. U. S.Naval Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
65
Registered No.
152
j(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Baby Girl "A" Brown
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 56 Park Ave.
Winthrop, Less.
St
(If nonresident, give city or town and State)
Length of stay: In place of death. .years ....... .. months days. In place of residence. .years. months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Ispch .... 16,1955
Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDin 10
4 I HEREBY CERTIFY,
That I attended deceased from
Mar 16
19 .... 53,
to .........
Mar.16.
63
I last saw h CP alive onlar. 16
19.5.3 death is said to
have occurred on the date stated above,
11.15A
.m.
INTERVAL BE- TWEEN DNSET AND DEATH 9 hrs
11 IF STILLBORN, enter that fact here.
.12
AGE
Years.
Months.
Days
If under 24 hours
Hours .....
Minutes
13 Usual Occupation: (Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
Chel ca, Mass
17 NAME OF
FATHER
Roderick. L.
18 BIRTHPLACE OF
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary F. Altpoter
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Rochoston, IL.Y.
Godlaim, Everett, Dass Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
IFr. 18,1953
19
7 NAME OF
FUNERAL DIRECTOR
J.Vi.cont Murray
ADDRESS Revere
Received and filed
APR 13 1953
19
(Registrar of City or Town where deceased resided)
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) Atelectasis
Due To
Promaturity
Date of operation
.. Was autopsy performed?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
APT R Eaters
M. D.
PARENTS
21
Roderick L.Brown
Informant ... . . nurron tass
(Address)
A TRUE COPY. ATTEST: Joseph a Tyrrell
(Registraf of City or Toyn where death occurred) Mar.18,1953
DATE FILED
19
WRITE PLAINLY, WITH ONFADING BLACK INK - THIS IS A PERMANENT RECORD
(Usual place of abode)
(Month)
ANTE
CEDENT (b)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
What test confirmed diagnosis ?.
(Address)
6
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
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
Due To
(c)
Immaturity
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
Bartlett. N.H.
(Signed).
Naval Inen, Chel Date 3/ 16/53 19
.
REGERESERVE
-
1.2
9
5
APR1 APR13
X
PLACE OF DEATH
Suffolk (County)
Chelsea
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea (City or town making return) 3.53
GS
Registered No. J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Baby Girl "B" Brown
(If deceased is a married, widowed or divorced woman, give also maiden name.)
56 Park Ave,
St.
.....
(If nonresident, give city or town and State)
Length of stay: In place of death ......
.years ......
months
days. In place of residence.
.years ...
months
.....
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Mar .16. 19.53
(Month)
(Day)
(Year)
8 SEX
Pomalo
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED Sin; le
of DIVORCED"
(write the word)
4 I HEREBY CERTIFY.
That I attended deceased from
Mar.16.
Mor ... 16
19.53
I last saw
h.C ......
alive on
March 16. 153
death is said to
11:45A
m.
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)
Atc Loctagis
9 hrs
ANTE
Due To
Promaturity
CEDENT (b)
CAUSES
Due To
(c)
Immaturity
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?
If so, specify ..
(Signed) and R. Peters
(Address) Naval Hosp.
Uhel Date 3/10/5319
M. D.
6
Place of Burial or Cremation
DATE OF BURIAL
Mer 18 1953
19
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Roderick L.Brown
(Address)
Informant6 Park Ave. Winthrop, Lass
7 NAME OF
FUNERAL DIRECTOR
J.Vincent Murray
ADDRESS Revere , Mass.
Received and filed.
APR 13 1953
19
(Registrar of City or Town where deceased resided)
A TRUE COPY.
ATTEST:
Joseph a. Tyrrell
(Registrar of City or Town where death occurred)
DATE FILED
March 18,1953
......
.. 19 ..
WRITE PLAINGT , WITTY ONFADING BLACK INK - THIS IS A PERMANENT RECORD
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
50m-(e)-10-48-24658
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Bartlett, N.H.
19 MAIDEN NAME
OF MOTHER
Mary F.Altpeter
Rochester, N.Y.
Woodlawn verett lass (City of Town)
11 IF STILLBORN, enter that fact here.
12
AGE
Years ..
Months.
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :.
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Chelsea, Heos
17 NAME OF
FATHER
Rodorici: L.
M R-302 1
No.
.U.S. Naval ... Hospital
(Was deceased a
U. S. War Veteran,
{ if so specify WAR)
Winthrop,ICcs
(a) Residence. No.
(Usual place of abode)
have occurred on the date stated above, at
INTERVAL BE- TWEEN ONSET AND DEATH
TEG.CIV
1.2
N
S
6
APR13
3
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)
BOSTON (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston (City or town making return)
Registered No.
2841
67
Of death occurred in a hospital or institution. 45 Townsend St. Jewish Mem. HOSve its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
23 Waveway -Ave
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
.years
1
mont 5
days. In place of residence.
20years
0
months O
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
March 21, 1 953
DEATH
(Month)
(Day)
(Year)
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCEWidowed
4 I HEREBY CERTIFY,
That I attended deceased from
2-16
19.5.3.
to
3 -21
153
I last saw h ... 1.m ... alive on
3- 21
19.5.3death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
lobar .... pneumonia
5 days
ANTE
Due To
CEDENT
CAUSES
apinal cord tumor
6 mos
14 Industry
or Business:
Hebrew Schools
15 Social Security No.
16 BIRTHPLACE (City) ... Russia (State or country)
OTHER
SIGNIFICANT
CONDITIONS
gen ..... arterioscleros
15 yrs.
Major findings:
Of operations
bladder s tone
Date of operation
1947
. Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?.. nQ
If so, specify
J. W. Chandler
M. D.
(Signed)
(Address)
J .. M .. Hospital ....... Date 3-21-5319
Tefereth Israel of Winthrop .... Everetttate or country) 6
Place of Burial or Cremation
DATE OF BURIAL
March 23, 1 953
19
21
Informant.
( Address)
Max.Pell 364 Walnut Ave Roxbury
7 NAME OF
FUNERAL DIRECTOR
Hyman J. Torf
ADDRESS
151 Washington Av.Chelsea
Received and filed
APR 4 1 1953
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Louis Pelof sky
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
Russia
MOTHER (City)
A TRUE COPY ATTEST: Charles
(Registrar of City or Town where death occurred)
4
DATE FILED
March 25, 1953
25M.(B) 11-51-905807
11 IF STILLBORN, enter that fact here.
12
AGE .... 7.O.Years.
Months.
Days
If under 24 hours
.Hours .... ... Minutes
13 Usual
Occupation:
teacher
(Kind of work done during most of working life)
Due To
(c)
10a If married, widowed, or divorced
HUSBAND of
Lena G. Kraft
(Give maiden name of wife in full)
have occurred on the date stated above, at
10:55 F
INTERVAL BE-
TWEEN ONSET
AND DEATH
(write the word)
(Was deceased a
U. S. War Veteran,
no
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
TI
M R-302 1
No.
Joseph Pelof sky
(City or Town)
TOWA
OF
OFFICE
11 12
0
bis in
8
5
6
APR21 PH
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, 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.
25M-(B)-11-51-905807
PLACE OF DEATH
SUFFOLK COUSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No ..
68
f(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
XXX
2 FULL NAME. BRIDGET .... F ..... BABRY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
6 Edge Hill Road
St
(Usual place of abode)
give cib&bS Sun and State)
Length of stay: In place of death. ...... .. years ............ months ... 5 ..... days. In place of residence2.5 .... years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDiarri ed
4 I HEREBY CERTIFY,
That I attended deceased from
...
3/19
19
to
3/24
19 ... 5.3
I last saw h ...
"er .. alive on ...
3/24
19.
.... 5-death is said to
have occurred on the date stated above,
9:45p
.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.8.3 Years.
.Months.
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
At home
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
t
homo
16 BIRTHPLACE (City)
(State or country)
Boston
Mass
17 NAME OF
FATHER
Michael Shechen
18 BIRTHPLACE OF
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
Catherine Hyan
Ireland
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informant
(Address)
A TRUE COPY-
ATTEST:
arbeit Macht
(Registrar of City or Town where death occurred)."
DATE FILED
Mar 30
....................
1953.
ANTE
Due To CEDENT (b) ..... CAUSES
arteriosclerosis
yrs.
Due To (c)
OTHER SIGNIFICANT .. pulmonary .... embolism. CONDITIONS
lday
Major findings:
Of operations.
Date of operation. Was autopsy performed? no
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
(Signed) ..... R ..... Dowst
Date ..
(Address)+ 211% Hosp
no
M. D.
19
3/24 53
of Bufido Cremation
dialton
DATE OF BURIAL.
Mar 28 53
7 NAME OF
FUNERAL DIRECTOR M .Kirby
ADDRESS
winthrop Mass.
Received and filed. APR 28 7503 19
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Edmundhusbands name
my full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)heartdisease
yrs.
3 DATE OF DEATH Mar(Month) 24 (Day) 1955 (Year)
No. St Fifzabeth's Hospital
I R-302 1
PARENTS
F. Barry
RECEIVE1
TO.
05
11.12
98
*
5
6
TH
APR27 AM
R-301A 1
PLACE OF DEATH
Suffolk (Bounty) Whichrap (City or Town) 14 Sea Foam Wwe 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.
69
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Berman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 Sea Fram
Oule
St.
Winthrop
(If nonresident, give/city or town and State)
Length of stay: In place of death
years.
0
0
.. months.
days.
In place of residence
.years
0
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April (Month)
(Day)"
1
1953
(Year)
8 SEX
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
(write the word)
Wieland
I HEREBY CERTIFY,
That I attended deceased from
nov. 8
19
49.
to.
april 1
53
I last saw h.
.alive on.
March 27. 1953, death is said to
have occurred on the date stated above, at 10:20 Pm.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of
Max Berman
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING) TO DEATH (a) .
TWEEN ONSET AND DEATH 3 hours.
11 IF STILLBORN, enter that fact here.
12
AGE 82
0
Months
0
Days
If under 24 hours
Hours .....
.Minutes
13 Usual
Occupation :..
House will
(Kind of work fone during most of working life)
14 Industry
or Business:
at home
15 Social Security No. .
014-22-60230
16 BIRTHPLACE (City)
(State or country)
Russie
17 NAME OF
FATHER
Wolf Brickton
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME OF MOTHER
(CBC)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
G.
Russia
6 Shoro. Tailo Com W. Roxbury Place of Burial or Cremation (City or Town)
DATE OF BURIAL
april 3
53
7 NAME OF
FUNERAL DIRECTOR +-J .- Torf
ADDRESS
151 Wash Taw chelsea
Received and filed PR 3 1953 .19
(Registrar)
4 years
Due To
(c)
generalized artÃstico-
sclerosis
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Lo.
Date of operation.
Was autopsy performed ?.
What test confirmed diagnosis
Clinical + laboratory
5 Was disease or injury in any way related to occupation of deceased? no.
If so, specify ....
Maurice Traunstein
(Signed)
..
M.
. D
(Address) 562 Skelly St With maladie,
19 23
PARENTS
21
Informant
(Address)
Bargad 55 Parken St chelsea
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued; Walter f Haber Signature of Agent of Board of Health orlother) Health Office 4. 3.53 X
(Official DesignationY (Date of Issue of Permit)
JCTIONS OR
ERTIFICATE
iving F DEATH t enter han one or each ) and (c)
Does not mean dying, such re, asthenia, s the disease. tions which 1.
conditions. g rise to the (a) stating ving cause
ons contrib. death but not e disease or using death.
100M-(D)-10-48-24658
2 FULL NAME
Leah
(a) Residence. No. (Usual place of abode)
35
0
35
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
or DIVORCED
(Give maiden name of wife in full)
ANTE
anteriorderatic and
CEDENT (b)
CAUSES
hypertensive tradice
6 years.
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 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 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
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