Town of Winthrop : Record of Deaths 1956, Part 79

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 79


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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


..........


A R-303-A X


Suffolk


(County) Winthrop (City or Town En route to Mars. General Hospital No.


Tire Sammantoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or Its Agent.


Registered No.


223


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


PHYSICIAN-IMPORTANT


2 FULL NAME


Joseph Peter


Kaijes


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


(a) Residence. No. ..


125 Cliff


(Usual place of abode)


live. Wintrump


(f nonresident, give city or town and State)


Length of stay: In hospital or Institution


( Before death)


( Specify whether)


years


months


days.


In this community


yra.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


4 COLOR OR RACE


white


5 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


18 DATE OF


DEATH


april


2 1


1956


(Month)


(Day)


(Year)


5a If married, widowed, or divoroed HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full) :


6 Age of husband or wife If allve years


7 IF STILLBORN, enter that fact here.


8 AGE 66 Years ... Months .. ....... .. Days


If less than 1 day Hours. Minutes


11 Social Security No.


12 BIRTHPLACE (City)


(State or country)


13 NAME OF


FATHER


14 BIRTHPLACE OF


FATHER (City)


(State or country)


15 MAIDEN NAME


OF MOTHER


16 BIRTHPLACE OF


MOTHER (City)


(State or country)


17 Haveich P. 15 aires Relation, if any DATE OF BURIAL


Informant


( Address)


513 GARSIDE PL new Jersey


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was Issued :


(Signature of Agent of Board of Health or othery


1/2/57


(Official Designation) (Date of Issue of Permit)


20 Accident, sulolde, or homlolde (specify)


Date of ooourrenoe.


19


Where did Injury ooour ? (City or town and State)


Did Injury ooour in or about home, on farm, In Industrial place, or In publio


place?


(Specify type of place)


Manner of Injury


Nature of Injury


While at work?


Was there an autopsy? no


21 Was disease or Injury In any way related to occupation of deceased? 80, specy What The (Signed). (Address) 25 Shattuck Lt


M. D.


Date 1/2.1956


Boston


22


Place of Burial, Cremation or Removal.


3


(City or Town)


1958


19


23 NAME OF


FUNERAL DIRECTOR.


michael Villa Passi


ADDRESS


24 Fleet at Boste


Reoelved and filed


.19


(Registrar)


4


19 | 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.) Conchal hemorrhage


1 3 SEX MALE (or) WIFE of Usual 9 Occupation : PARENTS if deceased was a U. S. War Veteran, G. L. Chap. 46, Seotion 10, requires physicians to Insert a recitai to that effeot extracts from the laws relative to the return of certificates of death. so that it may be properly classified under the International Classification of Causes of Death. See reverse side for should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF DEATH in plain terms, Industry 10 or Business :


50m-(f) -6-43-12056


PLACE OF DEATH


(Was deceased a


U. S. War Veteran,


If so speolfy WAR)


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH


A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illnesa, at the request of an umlertaker or other authorized person or of any mieniber of the family of the deceased, furnish for registration a standard certificate of deatlı, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last Illness, when last seen alive by the pliyaician or officer and the date of his death ... Gen. Laws, Chap. 16, Sec. 9.


A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the ariny, navy or marine corps of the United States in any war in which it has been engaged, invert in the certificate a recital to that effect, speci- fying the war, und shall also certify In such certificate both the primary and the secondary or immediate cause of death as nearly as he can state the sante. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall inclinde the China relief ex- pedition and the Philippine insurrection, which shall. for said purposes. he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can bordler service of nineteen hundred aud sixteen and nineteen hundred and seventeen. G. L. Chap. 16, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a tuwn, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or ita agent appointed to Issue auch permits, or if there is no such hoard. from the clerk of the town where the person died; and no undertaker or other person shall exhumre a human body and remove it from s 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 haa received a permit from the board of health or ita agent aforesald or from the clerk of the town where the body is buried. No such permit shall be issued until there aball 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 he returned and recorded, which ahall he sccompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate aa hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificste cannot be obtained early enough for the purpose, or Is insufficient, a physi- cian 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 re- quired 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 an- otlier within the coniniouwesith cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the pos- session of the undertaker desiring to make such removal shall constitute a perniit for such removal; provided, that such body shall he returned to the town from which it was removed within thirty-six hours after such re- moval, unless s permit in the usual form for the removal of such body haa heen 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


DESCRIPTION (for unknown person)


it has heen engaged. such recital shall appear upon the permit. The board of health, or its agent, ujuin receipt of such statement and certificate, shall forthwith countersign it all transmit It to the clerk of the town for regis- tration. The person to whom the permit is so given and the physician cer tifying 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 re- quire .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived 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 ia to be held, or from a per- son appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edi- tion ).


Medical examiners ahall make examluation upon the view of the dead bodies of only such persons as are supposed to have died hy violence. If a medical examiner has notice that there is within hia county the body of such a person, lie shall forthwith go to the place where the body llea and take charge of the sante; ... - General Laws, Chap. 38, Sec. 6.


... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- General Laws, Chap. 38, Sec. 7.


.. . The medical examiner certifies the cause and manner of death to the best of his knowledge and belief.


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rulea of practice :


(1) Attending physloisns will certify to such deaths only as those of persons to whom they have given bedside care during a last illnesa from disease unrelated to any form of injury.


(2) Board of Health physlolans will certify to such deatha 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 phyal- cian is absent from horne when the certificate of death ia needed.


(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or lo- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal, or electrical agents, and deathe following sbortion, but also desthis 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


Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify : (1) Under cause, the nature of an injury and of its consequences; and (2) under manner, the mode of its production together with the circumstances when these are known. For example: "Com- pound fracture of the femur with ensuing aepticenila (gss hacillua) caused by a steam railway sccident." "Pistol shot wound of the chest with asso- ciated hemorrhage, homicidal." "Asphyxiation by suspension, auicidal." "Syncope while under the influence of ether adininistered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sus- tained under circumstances unkonwn."


If disease or injury was related to occupation, specify. If Investigation showa the death to have been due to disease, specify: (1) Under cause it's known or presuntahle nature; and (2) undler manner, Indicate the circum- atancea leading to medico-legal inquiry. For example : "Hemorrhage spon- taneous of the brain (hasal ganglia) ( found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death. )"


NOTICE TO UNDERTAKERS: No embalming fluid, or any substitute therefor, shall be injected into the body of any person supposed to have met his death by violence, until a permit, signed by the Medical Examiner, has first been obtained .- General Laws, Chap. 38, Sec. 14.


THIS CERTIFICATE CONSTITUTES SUCH PERMIT


X -


PLACE OF DEATH


Suffolk


(County)


Boston


(City or Town)


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


Boston


(City or Town making this return)


-9709


Registered No.


221


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


2 FULL NAME


Joseph Shuman


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


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


6 Hutchins on


St


Winthrop Lass'


(If nonresident, give city or town and State)


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


.years ...


3.


.months.19 days. In place of residence.


12


.years


months.


... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Oct. 29/56


(Month)


(Day)


(Year)


4 | HEREBY CERTIFY,


July 1Q9


56


to


That I attended deceased from


Oct.29


I last saw h .. 1mlive on


Oct ...


29


19 56


death is said to


have occurred on the date stated above, at


10;50PM


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Bilateral broncho pneumonia


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


W


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


10a If married, widowed, or div Padline Grossman


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


13 Usual


Occupation :


Tailor


(Kind of work done during most of working life)


14 Industry


or Business :


Ladies Clothing


15 Social Security No.


011-05-80424


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF FATHER Usher Shuman


18 BIRTHPLACE OF


Russia


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Arma


20 BIRTHPLACE OF


Russia


Tifereth Israel of Everett-Ever ettHMAssiy)


Place of Burial or Cremation


City or Town)


DATE OF BURIAL


Oct. 31/56 19


7 NAME OF


FUNERAL DIRECTOR


H J Torf


ADDRESS


Chel sea Mass.


Received and filed ..


JAN? 4957 19


(Registrar of City or Town where deceased resided)


4 Mos


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? No. What test confirmed diagnosis? Physical exam. xray


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


(Signed) Henry W Polchipek M. D.


(Address) Jewish emorial Hospt 10-29-56


PARENTS


(State or country)


21 Informant (Address)


Bernard Shuman


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Nov. 1/56


19


V.R.V/


50M.11-55-916145


(a) Due To (b) 6 at the time of death should he 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. (Scc Chap. 46, Sec. 12, G. L.) Due To (c)


R-302 1


No.


Jewish Memorial Hospt.


(Was deceased a U. S. War Veteran,


if so specie WAR)


56 HUSBAND of


INTERVAL BETWEEN ONSET AND DEATH 10 Days2 65 Years Months. Days


If


under 24 hours


Hours ........ Minutes


Basilar artery thrombosis


19


X


MindenSeSEX


(County) LowellLOWELL


(City or Town)


Axon Nursing Home


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


LOWELL


(City or Town making this return)


225 1030 --


$ (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.) 83 Lincoln St.


( Winthrop",


St


May's WAR)


(a) Residence. No ... (Usual place of abode) 5


46


(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


Nov. 1,


1956


DEATH


(Month) (Day)


(Year)


CA HEREBY CERTIFY


How hat


attended deceased


19


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


19


death is said to


have occurred on the date stated above, at 11:15 Pm


DEATH WAS CAUSED BY: IMMEDIATE CAUSE .Mieriosclerotic heart


(a) ciscase


mos


Due To (b)


Due To (c)


OTHER SIGNIFICANT CONDITIONS


no


Was autopsy performed? physicalelectrocardio What test confirmed diagnosis ?..


NO


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


Canuel A. Dibbins


(Signed)


(Address)


und at.


11-2


56


19


int.


Winthrop, dass.


6


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


ov. 5, 1956 19


7 NAME OF


alter . Medlund


FUNERAL DIRECTOR


ADDRESS


Received and filed. DEC 11 1955 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


MARRIED


WIDOWED


or DIVORCED


widowed


10a If married, widowed of divorced. Wile


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


74


4


13


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. of Port edway


16 BIRTHPLACE (City) __


(State or country)


Nova Scotia


17 NAME OF


FATHER


Ozias Hanlin


18 BIRTHPLACE OF NOVA Scotia FATHER (City). (State or country)


19 MAIDEN NAME


Catherine Clattenburg


OF MOTHER


20 BIRTHPLACE OF


MOTHER (City) ...


ove cotia


(State or country)


Horace .11 e


(Address)


21


Informant.


727 . Terrianck St.


A TRUE COPY


V Villiam . Sullivan


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


Nov. 5, 1956


19


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.)


50M .11.55-916145


PLACE OF DEATH


R-302 1


No Ethel b. bile


( noe Hanlin)


Registered No.


(Was deceased a


U. S. War Veteran,


10 SINGLE


(write the word)


19 ..


56


INTERVAL BETWEEN ONSET AND DEATH


gran


PARENTS


M. D.


Date.


At hore


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, G. L.)


X


Suffolk


(County)


Revere


(City or Town) Grover Kanor


No.


Annie V. Ferrins


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


31 Belcher St.


St


40


(If nonresident, give city or town and State)


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


.. months


1


days. In place of residence


.. years ..


months.


.. days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


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


87


AGE


Years


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 :


Housekeeper


15 Social Security No ....


16 BIRTHPLACE (City)


(State or country)


Ireland


17 NAME OF


FATHER


Ja es Perrirs


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Ireland


19 MAIDEN NAME


M. D.


OF MOTHER


Katherine Grady


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


cIntyre


21 Informant .... (Address) 31 eiCher winthrop


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


November 6,


56


19


X


2 FULL NAME (a) Residence. No. (Usual place of abode) 3 DATE OF November DEATH (Month) 4 50 (a) sclerosis Due To (c) OTHER Obesity SIGNIFICANT Was autopsy performed ?. What test confirmed diagnosis ? (Signed). (Address) .... Levere St. Patrick's 6 Place of Burial or Cremation. DATE OF BURIAL 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 CONDITIONS Arthritis


MEDICAL CERTIFICATE OF DEATH


2, 1956


(Day)


(Year)


Į HEREBY CERTIFY June 30 19 November 2 ,56


That I attended deceased from November 2


19. 56


death is said to


have occurred on the date stated above, at


INTERVAL BETWEEN ONSET AND 2 DEATH days


several


years


many years


several years


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


John F. Collins M.D. 27 Den ington St.


Date


11/3


56


19


watertown


November 56


19


Arthur J. O'r'aley


ADDRESS. Winthrop, Macs.


Received and filed DEC 11 1956 19


(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


RIVL.


(City or Town making this return)


Registered No.


226


$(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)


Winthrop


I last saw er .alive on 4:55 P. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE Urenia


Due To Generalized Arterio- (b)


50M.11.55.916:45


6


PLACE OF DEATH


R-302 1


PARENTS


(City or Town)


Hospital


DATE FILED


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 MEDICAL EXAMINER'S CERTIFICATE OF DEATH


NEWTON (City or town making return)


Registered No.


227


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


2 FULL NAME


Abraham N. Flanders


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


234 River Road


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


M


10 COLOR OR RACE


W


11 SINGLE


MARRIED


WIDOWED


or DIVORCED


Married


11a If married, widowed, or divorced


Esther


Schwam


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


70


Months.


Days


If under 24 hours


Hours.


Minutes


14 Usual


Occupation :


Furrier


(Kind of work done during most of working life)


15 Industry


or Business :.


Fur Shop


16 Social Security No ...


025-12-1040


17 BIRTHPLACE (City)


(State or country)


Poland


18 NAME OF


FATHER


Solomon Flanders


19 BIRTHPLACE OF


FATHER (City)


(State or country)


Poland


20 MAIDEN NAME


OF MOTHER


Esther Wallenberg


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


Poland


22


Esther Flanders


(Address) 234 River Road, Winthrop


Informant


A TRUE COPY.


ATTEST:


Monte 2. Basban


(Registrar of City or Town where death occurred)


DATE FILED


November 8 1956


19


V.P.V


No.


(a) Residence.


No.


(Usual place of abode)


DEATH


Where did


place?


Street in Auto


Injury


Heart


If so, specify


(Signed)


John J. Kraw


(Address)


7


Har Moriah


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 occur?


Newton, Mass.


3 DATE OF


November


7


1956


(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.) Coronary Sclerosis


5 Accident, suicide, or homicide (specify)


Natural


Date and hour of injury


8:30 pm 11.7


19


56


(City or town and State)


Did injury occur in or about home, on farm, in industrial place, or in public


Manner of


(Specify type of place)


Injury


Collapsein Auto


Nature of


(How did injury occur?)


While at work?


No


Was autopsy performed?


No


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


No


M. D.


421 High St. Decham


Date.


11/7


19 50


...


West Roxbury


Place of Burial, or Cremation. (City or Town)


DATE OF BURIAL


November 8


19.5.6


8 NAME OF


Benjamin F. Solomon


FUNERAL DIRECTOR


ADDRESS.


420 Harvard Street, Brookline.


Received and filed


20


1462 19


(Registrar of City or Town where deceased resided)


PARENTS


25m-(c)-11-49-900.475


I R-305 1


Newton Wellesley Hospital


35


(Was deceased a


U. S. War Veteran,


No


if so specify WAR).




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