USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 40
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A
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
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 persons ast the supposed to have died by violence, or by the action of chemical, thermal or electrical' agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38; Sed 6. as amended by Chap. 632, Sec. 4, Acts of 1945.
-
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought ihto 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 feld, or from a person appointed to have the care of the cemetery of burial ground in which the interment is made.
Chap. 114. Sec. 46, G. L. (Tercentenary Edition).
6 BOLES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practicer . l .
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness front disease unrelated to any forti MAInjury- (2) for Health phylilians 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 traumatisin (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 occupa- 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
×
PLACE OF DEATH
(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
(City or town making return)
Registered No.
4052 115
[(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.)
(a) Residence. No.
39 Grovers Ave.
.
Winthrop,
Mass.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
... years.
months. 4
10
days. In place of residence.
.years
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
l'ar
29
1955
(Month)
(Day)
Was
( Year )
Pt
4 I HEREBY CERTIFY, Mar 2.5.
19 ..
5.5
to. MAR 29
19. 55
10a If married, widowed, or divorced
HUSBAND of.
Jenny (Cenva Italy)
(Give maiden name of wife in full)
I
.XXXX
death is said to
have occurred on the date stated above, at
3:30 P
.m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Pronchopneumonia
TWEEN ONSET AND DEATH 1 WK
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)
Italy
17 NAME OF
FATHER
Joseph Tadesco
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Isabelle-
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Public Welfare
7 NAME OF
FUNERAL DIRECTOR
J. L. Doran
ADDRESS
Dorchester
Received and filed
JUN 20 1955
19 55
CharApr
DATE FILED
26-
L
19
5.5.
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
O'Connell
(Signed).
PostonCity HOSP at Mar 30 55
(Address)
Fairview
Boston
(City of Town)
6 Place of Burial or Cremation DATE OF BURIAL
Apr
25
19
515 21
Informant
(Address)
roston
A TRUE COPY ATTEST:
(Registrar of City or Town where death occurred)
X
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-10-53-910621
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.
Boston City Hosp.
Frank Tedesco
(Was deceased a
U. S. War Veteran,
NO
if so specify WAR).
(write the word)
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
(or) WIFE of
64
None
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
Clinical
What test confirmed diagnosis ?.
Thety k attended x decaved from
(Usual place of abode)
RECEIVED
11.12
MIN
G
JUN20
X
PLACE OF DEATH
SUFFOLE 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.
3971 116
MassGeneralHospital No.
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.)
132 Pauline St
St.
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months.
19days.
45 years.
In place of residence.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Apr .... 19, .... 1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Mar 31
19 .... 5.5.
to .....
Apr 19
19.55
I last saw h
Oralive on
Apr 19
.19.55
death is said to
have occurred on the date stated above, at
3 ª
.. m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Jeremiah P Cronin
(Husband's name in full)
(or) WIFE of
FRAMR
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ..
Gangrene .... of ..... colon
20 dys12
AGE
73 Years
Months.
.. Days
If under 24 hours
Hours .....
Minutes
ANTE
Due To
Thrombosis .... of ..
CEDENT (b) ...
CAUSES
colic arteries
Due To
Arterio ...... sclerosis ..
4 yrs
15 Social Security No.
Ireland
OTHER
SIGNIFICANT
CONDITIONS
Broncho .pneumonia
5 dys
Major findings: Of operations.
Date of operation
Was autopsy performed ?..... y.es
What test confirmed diagnosis?
Autopsy
PARENTS
18 BIRTHPLACE OF
FATHER (City).
Ireland
(State or country)
19 MAIDEN NAME
OF MOTHER
- Mahon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
6
Winthrop Com
Place of Burial or Cremation
Winthrop ... Mass
(City or Town)
DATE OF BURIAL
Apr ... 22
19.5.5
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass
M W Kirby
ADDRESS
Received and filed.
AUN 16, 1955
19
(Registrar of City or Town where deceased resided)
A TRUE COPY "
2. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Apr ..... 25
1
19 .... 5.5 .... V
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, (c)
RM R-302 1
DIGERT
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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
E
Bridgit Cronin
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
20 dys
13 Usual
Occupation :.
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
CL Clay
M. D.
(Address)
M GH
Date
19
21
Informant
(Address)
Jeremiah P Cronin
25M-10-53-910621
11 IF STILLBORN, enter that fact here.
(a) Residence. No.
(Usual place of abode)
RECEIVED
TO:V.
12
3
0
JUN10
M 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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-10-53-910621
PLACE OF DEATH
+ "Suffo bounty)
Bost(Ay or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
.. Boston
(City or town making return)
Registered No.
107 8 17
No. U.S.P. Health Service Hos pt.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Howard Thompson Dodge
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
379 Pleasant St
St.
in throp ... Masa
(If nonresident, give city or town and State)
Length of stay: In place of death
.years ..
6
... months ... ].7 ....
... days.
In place of residence.
.years.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
April.21(Year)
4 I HEREBY CERTIFY,
That
I
attended deceased from
"Oct. 10
...
19.52 ....
to.
.........
April-21 1955-
(Give maiden Hat
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Hemorrha.c,arterial
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE 53
Years .
3
Months
5
.Days
If under 24 hours
.Hours ..
. Minutes
Due To
ANTE
CEDENT (b)
CAUSES
Carcinoma of larynx
Due To
with metastases to pharynx
(c)
cervicalnodes-and .. brhin
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Prefrontal lobotomy
Date of operation
1-21-55
« .. Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
No
(Signed)
M. D.
(Address).
D' C"Villa
.. Datę.
$1955
US P & Service Hoopt
6
Place of Burial or Comatperm Cem-LVer(Chy on Town). DATE OF BURIAL
April 25/55
19
7 NAME OF
FUNERAL DIRECTOR
F J Magrath
Boston Mass.
ADDRESS
Received and filed.
JUN 20 1955
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
Nelville Dodge
FATHER (City).
(State or country)
Portland Naine
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portland Maine
21
Informant
(Address)
qdical Records
A TRUE COPY
ATTESTIONles Hy Mack ..
(Registrar of City or Town where death occurred)
April 26/55
DATE FILED 19
...............
(write the word)
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
of DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of.
I last saw h.
im
April 21
.. 3% ....... , death is said to
have occurred on the date stated above, at.
INTERVAL BE-
1,1051.m.
paratracheal vessels
30 Ming3 Usual
Occupation :
(Kind ofChief .. Engine
Hf working life)
14 Industry
or Business:
Herchant Marines
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Portland Maine
17 NAME OF
FATHER
Marry Tho pson
CERTIFICATE OF DEATH
2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WAR)
RECEIVED
TO:
78.72
5
JUN20
M R-302 1
WRITE PLAINLY, WITH UNFADING 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,
×
PLACE OF DEATH
... (County) )
(City or Town)
Boston City
Hosp ..
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No.
4282 118
1(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.)
(Was deceased a
U. S. War Veteran,
( if so specify WAR).
No
(a) Residence.
No.
(Usual place of abode)
374 Shirley 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
31
ears.
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Apr
29
1955
(Month)
(Day)
(Year)
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
Apr
29
That
19 ... 5.5.,
to
29
...
19
55
10a If married, widowed, or divorced
HUSBAND of
Leah.Cohen
(Give maiden name of wife in full)
I KS
₹19 death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Acute Myocardial
infarction
Days
12
AGE ... 61.Years.
Months.
.. Days
If under 24 hours
Hours ...
.Minutes
13 Usual
Occupation :
Operator
14 Industry
or Business:
Cap Mfg. Factory
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Beryl Cohen
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Pasha
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Leah Cohen
4
7 NAME OF
FUNERAL DIRECTOR
Schlossberg & Songlines Copy/
ADDRESS
Received and filed.
(Registrar of City or Town where deceased resided)
ATTEST:
19.5.5
(Registrar of City or Town where death occurred)
DATE FILED
May
3
19
55
X
TWEEN ONSET AND DEATH
ANTE
Due To
CEDENT (b)
CAUSES
Due To
Congestion and
(c)
Edema of Lungs
Days
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
Autopsy
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ..
Jees V. Sacchetti
(Signed).
M. D.
(Address) ..
oston City Hosphate Apr 29.55
6
Jewish Peoples Com
Place of Burial or Cremation
Everett
(City or Town)
DATE OF BURIAL.
May
7
19.5.5
21
Informant
(Address)
Winthrop
25M-10-53-910621
8 SEX
(write the word)
have occurred on the date stated above, at.
9:16.A.m.
INTERVAL BE-
11 IF STILLBORN. enter that fact here.
(Kind of work done during most of working life)
No.
Samuel Cohen
RECEIVED
10
JUN23
X
Suffolk
never(County)
(City or Town) CI'( VEP
ar
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS (City or town making return) COPY OF CERTIFICATE OF DEATH ital J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
Registered No ..
119.
No. in ie Lio 01 (Sadoffsky)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1.3
irloy
(a) Residence.
No.
(Usual place of abode)
17
30
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
7
months.
days.
In place of residence
... years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
(Year)
AI HEREBY CERTIFY,
That, I 7 attended deceased from
er
19 ...
Apto11 29,
55
19
10a If married, widowed, or divorced
HUSBAND of
Adolp (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Uremia
INTERVAL BE- TWEEN ONSET AND DEATH 4days
11 IF STILLBORN, enter that fact here.
91
12
AGE
Years.
Months ..........
.. Days
If under 24 hours
Hours ........ Minutes
ANTE
Due To
Carcinoma of left
CEDENT: (b)
CAUSES
broust
Due To
Congestive heart
(c)
failure
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 amog F. Burns (Signed). 537 Dawy, verott 1. ¥2.9 M.5B
(Address).
Date
19
6 Place of Burial or Cremation
l'ay ](City or Town)
55
19
Informant.
(Address)
rall iver, ha-s.
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
May 2,
19
55
X
-
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
2 yrs
৳ 15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Russia
17 NAME OF
FATHER
Ruben . edoffchy
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Cannot be learred
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 DOy or you las
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTOR
Paul N. Levine
ADDRESS.
JUN 13 1955 19
Received and filed.
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8. SEX
io ale
9 COLOR, OR RACE
ito
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
I last saw h
.alive on.
1.00 A:
death is said to
have occurred on the date stated above, at.
.m.
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, Ser 12, G. L.)
25M (E)-6.50.902253
PLACE OF DEATH
R-302 1
PARENTS
acusowife
1 yr
At LOC
(Was deceased a
U. S. War Veteran,
Winthrop
if so specify WAR)
St.
29,
-
RECEIVED
TOW
11 12
MIN
$
6
JUN13
M R-305 1
PLACE OF DEATH
SURTOL (County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
POSTON
(City or town making return)
Registered No.
4674$20
j(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Ida Annapolsky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
105
Almont St. Winthrop
St.
Length of stay: In place of death. .years. 1 months. 16v ys. In place of residence. 35 years
months
.days.
MEDICAL CERTIFICATE OF DEATH
lay
12
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have 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.)
Fractured Rt. femur
Fractures left- uherus
Arterto Sclerotic Heart disease
Accidental
5 Accident, suicide, or homicide (specify)
Date and hour of injury
ay 12
55
Where did
Winthrop
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
Manner oFell acc ffoftapplaceat Hospital
Injury
Nature &en Winthropd F 20", 1955
While at work?
.. Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased ?.
If so, specify ..
................... pickley
(Signed) ........
Post.on
(Address) Date.
19.
7 Winthrop Com. Everett
Place of Burial, or Cremation.
13 (City or Town) 55 19 ...
8 NAME OF
P.R. Iovino
FUNERAL DIRECTOR ooktine
ADDRESS
Received and filed
JUL 5 1955
55
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
F
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
11a If married, widowed, or divorced
HUSBAND of
1'7 : 2 (Give maiden name of wife in full)
(or) WIFE of.
Morris Annapolsky
(Husband's name in full)
12 IFSTILLBORN, enter that fact here.
13
81
AGE
Years
Months.
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :.
Housewife
(Kind of work done during most of working life)
15 Industry
or Business:
At home
16 Social Security No.
Russia
17 BIRTHPLACE (City).
(State or country)
Abraham Berman
18 NAME OF
FATHER
PARENTS
19 BIRTHPLACE OF
FATHER (City).
Russia
(State or country)
20 MAIDEN NAME'grriet-
OF MOTHER
21 BIRTHPLACE OF,
MOTHER (City)
(State or country)
Russia
22
Informant
Rose "Anna
(Address)
Winthrop
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
X
DATE FILED
May
16
19
55
WRITE PLAINET , WITH ONFADING BAGS INS - THIS IS APERMANENT 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.)
3 DATE OF
DEATH
Injury
25M.5-52-907046
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible
Injury occur?
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
(write the word)
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Mass. Gen Hosp. No.
DATE OF BURIAL
None
RECEIVED
12
JUL-5
X
Essex
(County)
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers
(City or town making return)
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