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).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87
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.)
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.