Town of Winthrop : Record of Deaths 1956, Part 73

Author: Winthrop (Mass.)
Publication date: 1956
Publisher:
Number of Pages: 534


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 73


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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


R-302 1


PLACE OF DEATH


Suffolk


(County)


Boston


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


2


Boatm


(City or Town making this return)


8138 202


Registered No.


(Was deceased a U. S. War Veteran,


if, so specify, WAR). Winthrop Mas's.


(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.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


10a If married, widowed, or divorced HUSBAND of


Alice E Coombs


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


7 Days


AGE .... 72.Years ............ Months.


.. Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Mechanic


(Kind of work done during most of working life)


Industry or Business : Auto


15 Social Security No ._


16 BIRTHPLACE (City)


(State or country)


Middleton .... Conp


OTHER SIGNIFICANT


Hemolytic anen ia ,


CONDITIONS


idi opathic


Yes


Was autopsy performed?


What test confirmed diagnosis ?.


autopsy


5 Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


C L Clay


M. D.


(Address)


Mass. General Hosnt


9 .- 10 ... 19 . 56


Winthrop Cem-Winthrop


Place of Burial or Cremation


(City or Town) Sept. 12/56 19


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


H V Kirby


ADDRESS


Winthrop Mass.


Received and filed. NOV 16 1956 19


(Registrar of City or Town where deceased resided)


PARENTS


17 NAME OF FATHER George A Steed


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Middleton Conn.


19 MAIDEN NAME OF MOTHER Julia Regan


20 BIRTHPLACE OF


MOTHER (City)


Ireland


(State or country)


21 Informant. (Address)


Alice E Steed


A TRUE COPY


ATTEST: (Registrar of City or Town where death occurred) Sept.12/56


DATE FILED


19


VIS. V


(c) 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To


50M -11.55-916145


3 DATE OF


DEATH


Sept. 9/56


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Jul .20 19.56. to Sept. 9


19 56


I last saw h ..... jalive on Sent .... .9 ... ... , 19 .. 56, death is said to 3 .; 2.34


have occurred on the date stated above, at


INTERVAL BETWEEN ONSET AND DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Broncho pneumonia


bilateral ,acute


Due To


Septicemia,cryptococcus


(b)


neoformans) with mening itis


10 Dax


"(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


Florence J Steed


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.) 5): Bel cher


St


(a) Residence. No. (Usual place of abode)


(City or Town)


No.


Mass .General Hospt.


M S


-


6 Weeks


MEDICAL CERTIFICATE OF DEATH


X


PLACE OF DEATH


MIDDLESEX (County)


NEWTON (City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


NEWTON


(City or Town making this return)


487203


Newton-Wellesley Hospital


No.


Baby Boy Skane


(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.)


Wilshire St.


Winthrop


St


(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.


.. years ..


months.


.... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


September


12


1956


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Sept. 12


56


19


to


Sept. 12


19.56


I last saw h .. ]lalive on


19


death is said to


have occurred on the date stated above, at


3:37


.a.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Erythroblastosis Fetol


(a)


INTERVAL BETWEEN ONSET AND DEATH


Due To


Rh Negotivity


(1))


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ?. If so, specify.


(Signed)


Robert Brown


M. D.


1101 Beacon


12 Sept. 56


Holy Cross Malden


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


September 13


1.56


7 NAME OF


FUNERAL DIRECTOR


Frederick J. Magrath


98 Havre St. East Boston


ADDRESS


Received and filed. September 14 NOV 21 TJ0 56


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


W


10 SINGLE


MARRIED


WIDOWED


or DIVORCEDSingle


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. Stillborn


If under 24 hours


12


AGE.


Years


.Months.


.Days


Hours ........ Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


Newton


16 BIRTHPLACE (City)


(State or country)


Mass.


17 NAME OF


FATHER


George Skane


18 BIRTHPLACE OF


East Boston


FATHER (City)


(State or country)


Mass.


19 MAIDEN NAME


OF MOTHER


Margaret Cox


20 BIRTHPLACE OF East Boston MOTHER (City). (State or country) Mass.


21 George Skane


Informant ..


(Address)


30 Wilshire St. Winthrop


A TRUE COPY Monte M. Basbas


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


September 12


56


19


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 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, (i. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


50M -11-55-916:45


6


(Address)


Date.


PARENTS


Registered No.


(Was deceased a


U. S. War Veteran,


No


if so specify WAR)


(write the word)


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 this return)


8540 20-


Registered No.


§(If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


2 FULL NAME Baby Girl Belcher


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No. 291 Winthrop St.,


Winthrop, Mass.


S


(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.


.... years.


months ............ days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


September 21,


1956


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Sept. 21,


19


56


to


Sept. 21.


50


19.


I last saw h ... e.Rive on


Sept. 21,, 19 5 death is said to


have occurred on the date stated above, at


9:57P


.m.


INTERVAL BETWEEN ONSET AND DEATH


Due To (b)


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?.


Yes


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased ?........ O If so, specify


(Signed)


H. E. Brooks, Jr.


M. D.


. (Address)319 Longwood ..... Ave Date


9/21/ 19 500


6 Winthrop ..... Cem. Winthrop ........ Mass.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL September 24.


50


19


7 NAME OF


FUNERAL DIRECTOR


Alfred B. Marsh


ADDRESS Winthrop, Mass


Received and filed NOV 2 1956 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


(write the word)


WIDOWED


or DIVORCED


Single


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.


Months ...


.Days


If under


30


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)


Massachusetts


17 NAME OF FATHER Harold W. Belcher


18 BIRTHPLACE OF


FATHER (City)


Winthrop


(State or country)


Massachusetts


19 MAIDEN NAME OF MOTHER Madelon L. Clatue


20 BIRTHPLACE OF


Tewksbury


MOTHER (City)


(State or country)


Massachusetts


21 Boston Lying-In Hospital


Informant


(Address)


Boston, Mass.


A TRUE COPY


ATTEST:


charles 26


Mackie


(Registrar of City or Town where death occurred)


DATE FILED


September


27,


19


56


No.


Boston Lying-In Hospital


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Prematurity


50M -11-55.916145


Boston


PARENTS


(Was deceased a


U. S. War Veteran,


if so specify WAR)


1


NOVEIT


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (Sce Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


October


4,


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


That I attended deceased from


August 17 19. 56


to. October 4


19


56


I last saw helalive on October 4, 19 56 death is said to


have occurred on the date stated above, at


12:35am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Infarction myocardium,


acute


INTERVAL BETWEEN ONSET AND DEATH


(b) Possible pulmonary infarction


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased?nQ If so, specify


(Signed)


J. L. Duffy


M. D.


(Address)


Waltham, Mass.


Date


10-4


56


19


Wilson cem., Barre, Vermont 6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


October 6


1,56


7 NAME OF


FUNERAL DIRECTOR


Alfred.B. ........ Marsh


ADDRESS. Winthrop Ma.s.s.


Received and filed. NUV 6- 1000 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEDWidowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Chester Orin Weaker


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE64 Years ...


13 Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Vermont


17 NAME OF


FATHER


William Ducharme


18 BIRTHPLACE OF


FATHER (City)


Barre


(State or country)


Vermont


19 MAIDEN NAME


OF MOTHER


Lillian Claremore


20 BIRTHPLACE OF


Barre


MOTHER (City)


(State or country)


Vermont


21 Sheldon C Meaker


Informant.


(Address)


Winthrop, Mass


A TRUE COPY


ATTEST:


(Registrer of artsfor Town where death occurred)


DATE FILED


October 24


V1956


R-302 1


PLACE OF DEATH


Middlesex (County)


Waltham


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Waltham


(City or Town making this return)


517


205


Murphy Army Hospital No.


$ (If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


2 FULL NAME.


Ruby Lucady Meaker


(If deceased is a married, widowed or divorced woman, give also maiden name.)


32 Putnam


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Winthrop, Mass.


St


No


(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.


......... years ...


months.


........... days.


1956


50M - 11-55-916145


Barre


PARENTS


Registered No.


R-302 1


PLACE OF DEATH


SUFFOLK


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 this return)


8893206


Registered No.


§ (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.)


233 Winthrop


St.


Winthrop


(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.


5


.years.


months ..


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


October


1


1956


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended. deceased from


viewed


19.


to


I last saw h ........ alive on


Oct 4


19 ... 5.6


death is said to


have occurred on the date stated above, at


7:30P


.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) POST MORTEM OPINION


INTERVAL BETWEEN ONSET AND DEATH


(b)


Due To


Coronary Thrombosis


2 hrs


Due To General Carcinomatosis (c) .


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


NO


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


" Shields


M. D.


(Address).


Poston


Date.


Oct 4


19 56


Lawrence Ave Baker Ct W. Roxbury 6


Place of Burial or Cremation


(City or Town)


Oct 5 19 56


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


M W Brezniak


ADDRESS Brookline, wass.


Received and filed. 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


idowed


10a If married, widowed, be digd wise


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


AGE.


12


79x


ars


Months.


.. Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Retired


(Kind of work done during most of working life)


14 Industry


or Business :


Paint and Paper


15 Social Security No ..


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


-- Slobodkin


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME OF MOTHER


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


21 Informant (Address)


A TRUE COPY"


ATTEST:


V. Inactive


DATE FILED


(Registrar of City or Town where death occurred)


Oct 8


56


19


V.BL.


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, ( ;. L.)


50M .: 1.55.916: 45


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


(City or Town)


No.


52 Prookledge


Samuel Slobodkin


(Was deceased a


U. S. War Veteran,


if so specify WAR)


"rs. Jennie Brown


PARENTS


4 yrs


19


NOVOU


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


PLACE OF DEATH


Suffolk


(County) Bosta


(City or Town)


Mass .General Hont.


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 this return)


9992 20


§(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


Agnes G Flynn


2 FULL NAME.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


97 Grovers Ave.


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Winthrop Ka93.


St


(If nonresident, give city or town and State)


Length of stay: In place of death ............ years.


1


months


3


days. In place of residence


......... years.


months


....... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


10 SINGLE


MARRIED


WIDOWED


.


or DIVORCED


(write the word)


Widowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


John D Flynn


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


76


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:


Own Home


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


17 NAME OF FATHER Charles P Mooney


18 BIRTHPLACE OF


Ireland


FATHER (City) (State or country)


19 MAIDEN NAME


OF MOTHER


Agnes Lorimer


20 BIRTHPLACE OF


Ireland


MOTHER .(City). (State or country)


21 Informant. (Address)


Mr John E Flymn


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Oct/10/56


19


50M.11.55.916145


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Oct.10/56 19


7 NAME OF


FUNERAL DIRECTOR


W H Mckenna


Somerville Mass"


ADDRESS


Received and filed. NOV 3, 1600 19


(Registrar of City or Town where deceased resided)


(Year)


4 I HEREBY CERTIFY,


Sept.4


56


19


to


Oct. 7


56


19.


death is said to


have occurred on the date stated above, at


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Pyelonephritis,acute,


(a)


and chronic, left (rt. previously


resected)


Due To


(b)


Ureteral obstruction


u2


Due To (c)


OTHER


Pap illary carcinoma of bindder


SIGNIFICANT


CONDITIONS


Yes


Was autopsy performed?


What test confirmed diagnosis ?


autopsy


5 Was disease or injury in any way related to occupation of deceased ?. If so, specify


CL Clay


(Signed)


Vaas.General Hospt


Date


19.


(Address) Holy Cross -Malden Mass .


M. D.


PARENTS


Registered No.


No.


(a) Residence. No ... (Usual place of abode)


Oct. 7/56


3 DATE OF


DEATH


(Month)


(Day)


That I attended deceased from


Oct. 7


19


56


I last saw h ..


alive on


1;15A


m.


INTERVAL


BETWEEN


ONSET AND


DEATH


5 Yrs


Housewife


Somerville Mass


5 Yrs


R-302 1


1.01


MEDICAL CERTIFICATE OF DEATH


1


PLACE OF DEATH


SUFFOLK (County)


BOSTON (City or Town)


No .. Mass General Hospital


2 FULL NAME


Reah L. Johnson


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No ...


10 Revere


Winthrop,


Mass


(If nonresident, give city or town and State)


Length of stay: In place of death ............ years


2


months.


7


days. In place of residence 4 years


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


October


11


1956


(Month) (Day)


(Year)


8 SEX


9 COLOR


Female


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Divorced


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


Walter D. Johnson


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


4 6Years.


Months .......


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housework


(Kind of work done during most of working life)


14 Industry


or Business :


At ..... Home


15 Social Security No.


----


16 BIRTHPLACE (City).


Binghampton


(State or country)


New York


17 NAME OF


FATHER


Jacob B. Freeman


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Hussia


19 MAIDEN NAME


OF MOTHER


Laura Brandow


20 BIRTHPLACE OF


MOTHER (City)


Oneanta


(State or country)


New York


21


Informant.


Jacob B. Freeman


(Address)


Brookline, Mass


A TRUE COPY


Charles & Inack


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Oct 17


56


19.


3 DATE OF


DEATH


I last saw h ........ alive on


(a)


Due To


(c)


SIGNIFICANT


Place of Burial or Cremation


7 NAME OF


FUNERAL DIRECTOR


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, See. 12, G. 1 .. )


CONDITIONS


right.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Mitral Stenosis


INTERVAL BETWEEN ONSET AND DEATH


Years


Years


OTHER


Pulmonary infarction


Days


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


(Signed) C. L. Clay


M. D.


(Address)


Asst Dir Mass Gen


19


Mt. Lebanon


West Roxbury, Mass


(City or Town)


DATE OF BURIAL.


October 14


1956


Aaron Golov


ADDRESS.


Brookline , Mass.


Received and filed. DEC 4 - 1956 1956


(Registrar of City or Town where deceased resided)


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 this return)


9179 208


Registered No.


§(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(Usual place of abode)


4 I HEREBY CERTIFY,


That I attended deceased from


Aug 2


19


56


to October 11


19 .. 5.6.


Oct 11


1956, death is said to


have occurred on the date stated above, at m.


(b) Due To Rheumatic carditis


PERSONAL AND STATISTICAL PARTICULARS


PARENTS


50M .: 1-55.9:6145


R-302 1


N/


X


NORFOLK


(County) BROOKLINE


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


BROOKLINE


(City or Town making this return)


Registered No.


645


209


§ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)


2 FULL NAME Etta Wolk ( Woodman )


(If deceased is a married, widowed or divorced woman, give also maiden name.)


15 Cross Street


St


Winthrop, Massachusetts


(If nonresident, give city or town and State)


Length of stay: In place of death.


5 years.


20


........ months. days. In place of residence .years. .. months ............ days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


October


16


1956


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Sept. 30,


1956, to October 16


19.5.6.


I last saw heralive on


October 16, 19.56, death is said to


have occurred on the date stated above, at


7:10 2 ..... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Coronary Occlusion with


Myocardial Infarction


24 hrs


10+ yrs


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased ? NO If so, specify.


Harold Horwitz


M. D.


(Address)


Brookline, Mass. Date Oct. 16 1956


6 Oheil Jacob Cemetery , Woburn Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL.


October 17


19 56


7 NAME OF FUNERAL DIRECTOR Morris W. Brezniak


ADDRESS ..


470 Harvard St., Brookline, Mass


Received and filed


NOV 14-1956


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


widowed


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Max .Wolk


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE ... 8.7 Years.


.. Months.


.. Days


If under 24 hours


.Hours ........ Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business:


at home


15 Social Security No ...


16 BIRTHPLACE (City) (State or country) Russia


17 NAME OF


FATHER


Israel Woodman


PARENTS


18 BIRTHPLACE OF FATHER (City) (State or country)Russia


19 MAIDEN NAME OF MOTHER Lora (cannot be learned)


20 BIRTHPLACE OF MOTHER (City) (State or country ) Russia


21


Informant.


Mrs. M . Frank


(Address)


80 Mountwood Rd. Swampscott, Mass.


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


October 19


56


19


X 1.


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible. after the close of the month in which the death occurred. (See Chap. 46. Scc. 12, G. L.)




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