USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 47
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(State or country)
Nova Scotia
Arthur W Corkhum
17 NAME OF
FATHER
Chester, N.S.
18 BIRTHPLACE OF
FATHER (City).
(State or country)
wn home
.70
9 COLOR OR RACE
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
Or DIVORCED
widow
of wife in full)
(or) WIFE of
10a If married, widowed, or divorced
HUSBAND of
.
Horace w Clark
(Husband's name in full)
8 SEX
F
......
(Usual place of abode)
No. Ness General Hospital - Fazer Memorial
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Mass
RECEIVED
TOWĄ
OF
OFFICE
. 11.12
GILERA
MAIN
5
6
MASS.
NTHR
JUL12 AN
X
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) 5026 Registered No. 136
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.) 55 Crescent St
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
May 24/55
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That
I attended deceased from
May 24
55
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
I last saw h ........ alive on
May ... 24
19 .. 55, death is said to
(or) WIFE of.
Joseph ... Sutkus
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY
TO DEATH (a)
Cholangiohepatitis
13 Daj
12
AGE67.
Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
At Hane
5 Mos
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
r'S (State or country)
Lithuania
17 NAME OF
FATHER
Nik Arlauskas
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Lithuania
19 MAIDEN NAME
OF MOTHER
Not know
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lithuania
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
May 26/55
19
21
Informant
(Address)
·Anna ... Foster
A TRUE, COPY
UE COPY Par de Lache
ATTEST:
....
(Registrar of City or Town where death occurred)
Received and filed.
JUL -14-1955
19
(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 ..
CI Clay
(Signed)
Mass General Hosphate 3-21 155°
(Address)
Bangor ... Maine Con Bangor Maine
Yes
Date of operation
Was autopsy performed?
What test confirmed diagnosis
a ut opsy
25M· 10.53.910621
PLACE OF DEATH
RM 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,
ANTE
CEDENT (b)
CAUSES
Due To Choledocholithiasis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Ne phros clerosis
Major findings:
Of operations.
7 NAME OF
FUNERAL DIRECTOR
East Boston Mass.
ADDRESS
F J Magrath
No.
Mass . General uns pt.
Elizabeth Sutkus
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No. (Usual place of abode)
Winthrop Ma.9S.
MARRIED
WIDOWED Widowed
or DIVORCED
May .. 11 ...
19 .. 55
to
have occurred on the date stated above. at
3:45A
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
DATE FILED
May 26/55
19
R
m. S.
RECEIVED
OF TOWN
11 12
1
330
.
S
IN
6 5
HAND
JUL 18 AM
RM R-302 1
PLACE OF DEATH
SUFFOLK BOSTON (County)
(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) 5277
Registered No.
137
J(If death occurred in a hospital or institution, SoKl give its NAME instead of street and number)
DANIEL POLIT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
42 Moore
St.
Winthrop ..... Mass
(a) Residence.
No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
... months
days. In place of residence.1.8
.years
months.
days.
15 hrs
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
1
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
5/31
19
to
6/1
15.5.
I last saw h .... im .. alive on
6/1
19
.. 5.5death is said to
have occurred on the date stated above. a3 :30a
m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
.Days
53
If under 24 hours
Hours .....
.Minutes
13 Usual
Occupation:
Jobber
(Kind of work done during most of working life)
14 Industry
Buttons
or Business:
15 Social Security No ...
014-12-01/3
16 BIRTHPLACE (City).
(State or country)
Boston, Hass
17 NAME OF
FATHER
Louis Tolit
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Dora Charak
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Poston, Mass
Sharon Nom Park
Place of Burial or Cremation
Sharon, Mass
(City or Town)
DATE OF BURIAL
Jun 2
1955
21
Informant
(Address)
Stella Polit
7 NAME OF
FUNERAL DIRECTOR
B Solomon
ADDRESS
Brookline ....... Jagg.
Received and filed.
JUL .2.1.1955
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
* Charles & Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Jun 3
1955
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, 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
Due To
ANTE
CEDENT
CAUSES
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
yo.s
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?.... no. If so, specify
(Signed).
Phillips
(Address)
NEDH
Date.
6/1
19 55
PARENTS
10a
If married,
st& Ifiworceswett
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)
Cerebral hemorrhage
-24hrs
8 SEX
M
9 COLOR OR RACE
..
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
That I attended deceased from
25M-10-53.910621
No ..
N E. Deaconess Hospital
2 FULL NAME.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
MEDICAL CERTIFICATE OF DEATH
RECEIVED
TOWA
OF
OFFICE
11 12 1
1
6
NTHROP
JUL22 AM
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
SUFFOLK
1 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.
5745 138
Beth Israel Hospital No.
J(If death occurred in a hospital or institution, St \ give its NAME instead of street and number)
ABRAHAM KUHN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
74 Locust
St.
Winthrop,
Mass
(a) Residence. No. (Usual place of abode)
2
20
(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
June
16
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
6/15
6/16
19 55
If married, webos diversed c Gadon
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
4
13
Months
Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Self-employed
15 Social Security No.
nostov
Aussia
17 NAME OF
FATHER
Mitchell Kuhn
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Anna-
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Bessie Kuhn
Informant
(Address)
ATTEST:
A TRUE COPY Parles 21 Zack
(Registrar of City or Town where death occurred) Jun 21
55
19
(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.
no
(Signed) RF Grenier M. D.
(Address) DTH
Date 6/16 1955
Beth Israel Com 6
No.Reading, Mass
Place of Burial or Cremation Jun 17
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
Maiden, Muss
ADDRESS
Received and filed.
AUG 3 1955
19
(City or Town)
55 21
25M-10-53-910621
ANTE
Due To CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
no
Date of operation
Was autopsy performed ?.
186.
What test confirmed diagnosis?
INTERVAL BE- TWEEN ONSET AND DEATH ?1yr
8 SEX
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
I last saw
h ..... mówi .. alive on.
6/16
1955, death is said to
.. m.
have occurred on the date stated above, at 7.500
DISEASE OR CONDITION
DIRECTLY LEADINGCarcinoma lung
TO DEATH (a)
19
to.
...
That I attended deceased
from
HUSBAND of
Į (Was deceased a
U. S. War Veteran,
if so specify WAR)
2 FULL NAME
ORM R-302 1
M. Goldman
DATE FILED
V
73
Jeweler
16 BIRTHPLACE (City).
(State or country)
RECEIVED
OF
TOWN
11 12
1
1
6
IR
AUG-3 AM
L
Suffolk
(County)
Bostan
(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) 5424
Registered No. 139
Peter Bent Brigham Hospt.
[(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.) 26 Cliff Ave.
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ...... .. years. 3
.months.
days. In place of residence
.years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month) (Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
June .... 16
19.
55.
to.
I last saw h ...
imalive on.
June 19/55
19.
death is said to
have occurred on the date stated above, at.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE67
Years
8
Months.
Days
If under 24 hours
Hours ........ Minutes
Retired Dist.Mgr.
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Optical Go
15 Social Security No.
029-05-6958A
16 BIRTHPLACE (City)
(State or country)
Scotland
OTHER
SIGNIFICANT
CONDITIONS
Pulmom.ry ..... dema
Major findings:
Of operations.
No
Date of operation
.Was autopsy performed?
Yes
What test confirmed diagnosis ?... auto.psy ...
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify V M Cans M. D.
(Signed)
(Address)
Peter Bent Brigh Datospt
6-39 -. 55
Winthrop Cem Winthrop Mass
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
June 22/55
19
Alfred B Marsh
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass.
ADDRESS
Received and filed
AUG 5
1955
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF FATHER John Leitch
18 BIRTHPLACE OF FATHER (City). (State or country)
Scotland
19 MAIDEN NAME OF MOTHER Elizale th Douglas
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
21
Informant
.Mra .... R .. V .... Atcherly
(Address)
Address: D Demnachie
A TRUE COPY
ATTEST: (Registrar of City or Town where death occurred)
DATE FILED
June 22/55
.. 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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
25M-10-53.910621
PLACE OF DEATH
No.
Lewis S Lei tch
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
June 19/55
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widowed, or divorced
HUSBAND of.
Katherine V
McDonald
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Endo carditis
TO DEATH (a).
of artic and
pulmonic valve
ANTE CEDENT (b)
Due To
Arterio scherotic
heart disease
Due To (c)
6 Yr
June 19
55
19.
45
RM R-302 1
M.S.
Bausch and Lamb
RECEIVED
TOWĄ
OF
1
BLEKK
OFF
3
TH
AUG-5 AM
RM 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,
7
PLACE OF DEATH
Middlesex
Lexington
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
&printon making return)
Registered No.
140
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME .. Emily Andrews Ineed Consane)
iden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR) ... TTO
1.2 (Usual place of atiode)
"Beal
St.
intenTio and State)
Length of stay: In place of death.2.7 ..... years
... months] ..... days.
In place of residence.
.. years.
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
ร้านachin)
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
4 I HEREBY CERTIFY,
That I attended deceased fromnemalp
April 4,
19 .. €
54
June 23,
19 ....
I last saw
h
er
alive on.June 22 ...
19, death is said to have occurred on the date stated above, a5 75 Am. INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.2
Years .......... Months. x)
.Days
If under 24 hours
Hours.
. Minutes
13 Usual
Occupation:
work doffe during most of working life)
14 Industry
or Business :.
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Cannot learn
ringand
17 NAME OF
FATHER
18 BIRTHPLACE OF
Charles Cousens
FATHER (City).
Cannot learn
(State or country)
England
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
Elizabeth Fuller
MOTHER (City)
Cannot learn
(State or country)
England
21
Informant ..
Records , et. State Hospital
(Address)
A TRUE COPY
ATTEST:
James J. Carroll
(Registrar of City or Town where death occurred)
Received and filed JUL 15 1955
(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.
(Signed).
K.T.Dussik
M. D.
(Address) t.State flosp
Dat
6/23/ 1955
6 Westview
Place of Burial or Cremation
DATE OF BURIAL
June 25,
7 NAME OF
FUNERAL DIRECTORA ............. Douglass
ADDRESS. 844 Mass. - Ave. Lexington
19
"10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
HarryHandAndnews
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Coronary Occlusion
2
ANTE
Due To
CEDENT (b) ..... Arteriosclerotic heart
-
CAUSES
disease
years
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
None
Date of operation
Was autopsy performed ?.... NO
What test confirmed diagnosis ?. Clinical
25M-10-53-910621
No. Metropolitan State Hospital
....
(If deceasedels a married,
(a) Residence. No. ...
Harried-
DATE FILED
June 27
19
55
X
R
RECEIVED
TOWN
OFFICE O
11 12
1
OLEIK
*
5
6
HROP. M
JUL 15 AM
X
PLACE OF DEATH
SUFFOLK BOSTON
(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
BOSTO. !
(City or town making return) 5:189
Registered No.
5.989 141
J(If death occurred in a hospital or institution. St. Į give its NAME instead of street and number)
2 FULL NAME
Gordon L Turner
(If deceased is a married, widowed or divorced woman, give also maiden name.)
431 Winthrop St
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 .. years. .months. .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX Male
10 COLOR OR RACE
White
MARRIED WIDOWED or DIVORCED
Married
11a If married, widowed, or divorced HeIgh T Dolan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
Years
Months.
Days
27
If under 24 hours
Hours .....
Minutes
14 Usual
Occupation :
Boatman
(Kind of work done during most of working life)
15 Industry
Mckie Lighter Co.
or Business:
031-03-9376
16 Social Security No ...
Bos ton mass
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
Leroy Turner
PARENTS
19 BIRTHPLACE OF
Maine
FATHER (City).
(State or country)
20 MAIDEN NAME
OF MOTHER
Harriet Osgood
21 BIRTHPLACE OF
Ma ine
MOTHER (City)
(State or country)
Wife
22 Informant (Address)
A TRUE COPY.
21 Znackis
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed
19
(Registrar of City or Town where deceased resided)
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-305 to the clerk of the city or town in which the deceased resided as soon as possible Injury
25m-(c)-11-49-900.475
6 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed)
R .... Ford
M. D.
(Address)
Date.
6/24.55
, Winthrop Cem
Winthrop .... Mass
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL.
June 27
1955
8 NAME OF
D Malcolm
FUNERAL DIRECTOR
(Specify type of place)
Manner of
Injury
(How did injury occur?)
Nature of
While at work?
Was autopsy performed?
ves
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Month)
3 DATE OF
DEATH
June 23., 1955
(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.)
Acute coronary insufficiency,
precipitatedby .... carbonmonoxide while at work neart gasoline eng Accidental ....... Boston.
11 SINGLE
(write the word)
(Was deceased a U. S. War Veteran, if so specify WAR) WW2
(a) Residence. No. (Usual place of abode)
No. 818 Harrison Avo
M R-305 1
WRITE PLAINLY , WITH UNFADING BLACK INS - THIS IS A PERMANENT RECORD
2.5.
DATE FILED June 27 1955
.......
ADDRESS. Reading Mass
37
2
RECEIVED
OF
TOWA
OFFICE
11 17
1
V
9
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X
SUFFOLK 1 BOSTON (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
BOSTON
(City or town making return)
Registered No.
60961 42
hospital institution,
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
274 Bowdoin
St.
winthrop.
.. Nass
(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
3 DATE OF
DEATH
June
25
19.55.
(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.) Crushed chest with multiple
ruptures of thoracic viscera
accidental
5 Accident, suicide, or homicide (specify)
Accident
Date and hour of injury ...
June .... 25.
19 .... 5.5.
Where did
Injury occur?
Boston
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Public highway
(Specify type of place)
Manner of
Operator of motor vehicle
Injury
(How did injury occur?)
Nature of
which struck tree
While at work?
.Was autopsy performed?
NO
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
M Luonco
(Address)
Boston
Date 6/26 1955
7
.Winthrop
Winthrop Mass
Place of Burial, or Cremation.
DATE OF BURIAL.
Jun 29
19
8 NAME OF
FUNERAL DIRECTOR
DiPietro & Vazza
ADDRESS E Boston, Mass
Received and filed. AUG 10 www. 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
11a If married, widowed, or divorced
Carmella Caldarella
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
Years
Months.
.Days
If under 24 hours
.. Hours.
.Minutes
14 Usual
Occupation :.
Chipper
(Kind of work done during most of working life)
15 Industry
or Business:
032-07-1481
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Italy
18 NAME OF
FATHER
Salvatore LaMonica
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
20 MAIDEN NAME
OF MOTHER Agostina Lazzara
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Frances Paris
A TRUE COPY.
ry harkes H Has
ATTEST:
(Registrar of City or Town where death occurred) Jun 30 55
DATE FILED
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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-5-52-907046 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-305 to the clerk of the city or town in which the deceased resided as soon as possible Injury
11.5.
PLACE OF DEATH
No.
enroute to East Boston Relief Station
death occurred give its NAME instead of street and number)
JOSEPH C LA MONICA
(Was deceased a
U. S. War Veteran.
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
(Month) (Day)
RM R-305 1
PARENTS
22
Informant
(Address)
(City or Town) 55
M. D.
55
Ship Building
RECEIVEL
TOW,
11 12
1
?;
6 5
WINTHRO
AUG10 AM
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,
X
PLACE OF DEATH
SUFFOLK 1 BOST (County)
(City or Town) N E Center Hospital No.
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) 6031143
Registered No.
[(If death occurred in a hospital or institution, .... ( give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Nevada Ave .,
Winthrop,
Mass
(a) Residence.
No.
(Usual place of abode)
112 hrs
(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
June
27
1955
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
Cattended deceased
6/21
55
55
...
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
1
.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)
winthrop,
Mass
17 NAME OF
FATHER
Alfred Dolgoff
18 BIRTHPLACE OF
Forth Adams, Mass
FATHER (City)
(State or country)
19 MAIDEN NAMELoreli Goldston OF MOTHER
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