Town of Winthrop : Record of Deaths 1957, Part 84

Author: Winthrop (Mass.)
Publication date: 1957
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 84


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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 army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the


death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec, 6., as amended by Chap. 632, Sec. 4, Acts of 1945.


No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, fromh, the.clerli of the town where the body is to be buried or the funeral is to be held, of from a person appointed to have the care of the cemetery or burial ground in which the interment is made.


Chap. 114, Sec. 46; G. L .; (Tercentenary Edition).


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


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


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without retent medical aftendance or whose physician is absent from home when the cer ffeate of death is needed.


(3) Medical Examiner's will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER .. .....


X


PLACE OF DEATH


SUF FOLK (Cnunty) BOSTON (City nr Town)


Nn. BETH


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


OUTUCE OFQWOW To be filed for bariat permit with Board of Health or Its Agent


CERTIFICATE OF DEATH


Registered Na.


Jeff death occurred in a hospital or institution, St. (give ita NAME. instead of street and number)


PHYSICIAN


IMPORTANT


( Was deceased a


S War Veteran,


un specify WARD


(a) Residence. Nn.


9


GROVERS AVE


WINTHROP.


(If nonresident, give city nt town and State)


(Usual place of about)


Length of stay: In place ni death


years


13/4.


4months


days. In place of residence40 years


months


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


SEPT


fMonth)


(Day)


30


1957


(Year)


4 I HEREBY CERTIFY.


That I attended deceased from


Aug. 8


1957


.


. 19


57, in SEPT.


30


I last saw her alive nn


SEPT. 30


. 19


, death is said to


have occurred on the date stated above, al


9


a.


m


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


HEMORRHAGE


Due To


CARCINO MATOSIS (OVARIES)


- (b)


Due To


(c)


142


OTHER


SIGNIFICANT


CONDITIONS


Was autopay performed'


YES


What test confirmed diagnosis?


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


If an, specify


No


(Signed)


1. Chaundof


. M


(Address)


330 Brookline Avelar Sept 30


1057


6 Tare of fariali


DATE OF BURIAL


October 3,1957


19


7 NAME OF


HI'NERAL DIRECTORAlfred B. Marsh


ADDRESS 174 Winthrop St. Winthrop,


OCT 8


Received and Hed


Charles H. Mack


8 SEX F


9 COLOR


W


10 SINGLE. (write the word)


MARRIED


WIDOWED WIDOWED.


of DIVORCED


30a If married, widowed, or divorced


HE'SHAND of


ffiive maiden name of wife in full)


(or) WIFE


John Malcolm Milne, Sr.


(Husband's name in full)


HI IPSTILLHORN, enter that fact here.


INTERVAL


BETWEEN


ONSET AND


DEATH


1 HOUR


12


Mit69 Years


8 Months


13)ay.


If under 24 hours


Hours


Minutes


13 l'anal


Occupation:


HouseWE UP fone during most of working file)


14 Industry


nr Business:


Own Home


15 Social Security No.


nono


16 HARTIIPLACF (City)


(State of country }


Scotland


17 NAME OF


FATHER


Robert Smith


PARENTS


18 MIRTIPLACE OF


FATHER (C'ity)


1


(State of country)


Scotland


19 MAIDEN NAME


OF MOTHER


Elizabeth Moir


MHIORTHPLACE OF


MOTHER (City )


(State of country )


Scotland


Winthrop Cemetery Winthrop ...


Ma88.


21


Informant


John Malcolm Milne, Jr.


( Address)


9 Grovere Aye. Winthrop


I HEREBY CERTIFY that a satisfactory standand cellficate of death


why me BEFORE the Mial of transit primit was issued


was hled


Mass.


Jacques


Une Comey'


Kent of Board of Health or other)


2- 3967


(D)fhcral Designation )


10 - 2 (5-7)


(Date nl Issue of Permil)


ERTIFICATE


ving


F DEATH enler an one or each ) and (c)


of dying. art failure.


or comple.


. op rite to (.). last.


ar contrib .. eth but not he terminal


bapter In, 4, requires to print or cause of death en Acales.


R-301A -


CTIONS


ISRAEL HOSP.


KATHERINE MILNE 2 FI'L.L. NAME


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


St.


PERSONAL AND STATISTICAL PARTICULARS


2 years.


--


Glasgow


A TRUE COPY ATTEST: Charles it mackie City Registrar


JAN 1 31150 14


MI-301A -


PLACE OF DEATH


Suffolk (County)


1


Boston 1


(City or Town)


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


OUT -OF- TOWN To be filed for burial permit with Board of Health of its Agent


69250


The Boston Floating Hospital No.


j{If death occurred in a hospital or institution,


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


PHYSICIAN -IMPORTANT


( W'as deceased a


no


IT S. War Veteran, if so specify WAR)


Winthrop,


Nass.


(If nonresident, give city or town and State)


Length of atay: In place of death


years


months


days. In place of residence


years


months


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


& SEX


female


9 COLOR


white


10 SINGLE (write the word)


MARRIED


WIDOWED


single


of DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE. of


(Husband'a name in full)


11 IF STILLBORN. enter that fact here.


12


AC.F.


Years


Months


2


Days


If under 24 honra


I[ours


Minutes


13 l'sual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business:


15 Social Security No ..


16 BIRTHPLACE (City)


(State of country)


Boston, Mass.


17 NAME OF


FATHER


Aldo V. Belmonte


18 BIRTHPLACE OF


FATHER (City)


East Boston,


(State or country)


Mass.


19 MAIDEN NAME OF MOTHER Anna Karie Visco


20 BIRTHPLACE OF


MOTHIER (City)


(State or country)


East Boston


1888.


21 Aldo V .. Belmonte (father)


Informant


(Address) 6 Elmwood Ct., Winthrop, Mas8.


I HEREBY CERTIFY that a satisfactory standard seglificate of death was hed with me BEFORE the bunny of transit wiffit was toour quelanal a a.


e (SignatuPol Agent of luard of Health w others -4080


10/18/57


t(fhcial Designation)


(Date of Issue of l'esmit)


X


3 DATE OF


DEATHI


October


(Month)


(Day)


4,


1957


(Year)


4 I HEREBY CERTIFY.


That I attended deceased from


October 3,


19 57


October 4,


. 19


I last saw h alive on


October 4,


. 19 57, death is said to


have occurred on the date stated above, at 7:25 a. m.


INTERVAL BETWEEN ONSET AND DEATH


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Irreversible shock


( a)


Due To (b)


282.9


Due To (c)


OTHER


SIGNIFICANT


ilcal atresia, volvulus, with


CONDITIONSInfarction, perforation and


Was autopsy perlormed?


Yes


(peritonitis


What test confirmed diagnosis?


Operation


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


(Signed)


. M. D).


(Address) 20 Adli Street


Date


10-4


-1952


Holy Cross Cemetery kalden


Place of lurial or Cremat'October , 10 DATE OF BURIAL 19


(City of Town) 57


7 NAME OF


Q Anthony P. Rapino


FUNERAL DIRECTOR


9 Chelsea St., East Boston, Ma88.


ADDRESS


Received


OCT 1 4 1957 Charles H. Mackie


( Registrar)


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


2 FULL NAME.


R TIONS 11 IRTIFICATE


C DEATH center t.a one reach (I and (c)


de mot mran e of dying. Art failure.


sem compli-


car lot


del but not 1. terminal


C' pter 137, 199 requires asi print or . .... .. of eath on rtl ates.


PARENTS


Registered No.


6 Elmwood Ct. (a) Residence. No. (Usual place of abode)


10 hrs., 15 min.


St.


19


57


6


A TRUE COPY ATTEST: Charles it Mackie City Registrar


JAN 1 31058 AM


X


Suffolk (foanty )


West Roxbury


1City or Town)


CERTIFICATE OF DEATH


Registered Na


S(If death occurred in a hospital or institution.


St. \ Rive its NAME instead of street and number)


IMPORTANT


PHYSICIAN t Was deceased a U. S. War Veteran, WWI if an specify WAR)


Winthrop


( If nonresident, Rive city of town and State)


Years months days.


MEDICAL CERTIFICATE OF DEATHI


PERSONAL. AND STATISTICAL. PARTICULARS


A SEX M


9 COLOR


W


10 SINGLE


( write the word)


MARRIED Married


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


Mildred Jacobs


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLHORN, enter that fact here.


12


AGE


68years


9


Months


13Days


Hours ....... Minutes


I.t \'sual


Occupation :


( Kind of work done during most of working life)


14 Industry


or Business:


self-employed Machine Tools


15 Social Security No.


015 28 6794


16 MIRTHPLACE (City).


( State or country )


164661/1666


Russia


17 NAME OF


FATHER


Morris Beal


PARENTS


18 MIRTIPLACE OF FATHER (C'it1) ( State of country )


Russia


19 MAIDEN NAME OF MOTHER Sophie Rose


20 BIRTHPLACE OF MOTHER (City) (State of country)


Russia


I'Ince of Itarsal or Cremation (t'ity ni Town) 21 Informant Mrs. Mildred Beal


DATE OF BURIAL 19 57


7 NAMF. OF


FUNERAL DIRECTOR


Solomon funeral Home


BrooklineMasse


ADDRESS


OCT TI 1957 Charles H. Mackil


...


.... (Registrar)


INTERVAL BETWEEN ONSET ARO DEATH


Due To


(b) ....


Arteriosclerotic heart


disease


Due To (c)


4/20


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? yes What test confirmed diagnosis?


I Was disease or injury in any way related to occupation of deceased? no


1.Signed)


C. E. Forkner, Jr.


. M. D.


(Address). VAH, West Roxbury, Ma'ss. 10/8/2 57 Hand-in-Hand Cemetery. W. Roxbury. MABB 6


October 9


The Commonwealth of MassachusettsUT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH Is be filed for burial permits with Hadid of Health DIVISION OF VITAL STATISTICA STANDARD


Veterans Administration Hospital


No. .


2 FU'L.I. NAME


DAVID BEAL


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


7 Amelia Ave.


(a) Residence. No.


( I'sual place of almale)


Length of stay: In plare of death 0 yeni. O


months 9 days In plare of trsiden


3 DATE OF


October 8, 1957


DEATII


( Month)


(Day)


(Year )


9/29/


57


10/8/


4 I HEREBY CERTIFY,


That I attended deceased from


19


(o


19


57


19 57 death is said to


I last saw himalive on


10/8/


have occurred on the date stated alive, at


7:30 A.


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Coronary thrombosis


PLACE OF DEATH


R-301A -


CTIONS OR CERTIFICATE giving OF DEATH t enter ban one for each b) and (c)


ces not mean of dying. eart failure. tc. It mean! ,.or campli. which caused


as, if any, are rise ta ause (a). the under. ONse last. -


ions contrib. cath but mot the terminal adition given


Chapter 117. D'A, requires . to print or cause of I death on tifcates.


( Address) 7 Amalia Ave., Winthrop, Mass. I HEREBY CORTIS that a tuttefactory standard estimate of death wydal with me BEFORE the burialge transit prinny seemed: Jacqueline lacey At Agent of Board of Health or other)


10 -4051 10-9-50


fOfficial Designation ) flate of lesue of Permit)


V.B. V


If under 24 hours


Merchant


10 days


St


A TRUE COPY ATTEST: Charles it. mackie City Registrar


JAN 1 81950 :


73488 06107 MR-301A -


PLACE OF DEATH


Suffolk (County)


Boston (City or Town)


Veterans Administration Hospital No.


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


PHYSICIAN IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)


WW II


« Winthrop, Mass.


( If nonresident, give city of town and State)


(I'qual place of ahade)


Length of stay : In place of death years


months 12 days. In place of residence years


months


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


October


8


1957


(Year)


(Manth)


(Dav)


4I HERERY CERTIFY.


That I attended deceased from


Sept. 26


. 12 57 . 1 October 8


. 19


57


, death is said to


have occurred on the date stated above, at


11:55 Pm.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Glioblastoma, multiforme


Due To Arteriosclerotic heart (b)


disease


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed ?


Yes


What test confirmed diagnosis?


Autopsy


5 Was disease or injury in any way related to occupation of deceased > No If so, specily


(Signed)


Charles E. Marton


, M. D.


6


Winthrop Cemetery, Winthrop, Mass. Place of Burial or Cremation October 14, 1957


DATE OF BURIAL 19


7 NAME OF


FUNERAL DIRECTOR


Howard Reynolds


ADDRESS


Winthrop St., Winthrop, Mass.


OCT 14 1857


19


Received Charles H. Mackie


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE (write the wurd)


MARRIED


Malo White


or DIVORCED


Married


Lifil'an Brems


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(llusband's name in full)


11 IF STILLBORN, enter that fact here.


12


8


AGE 71 Years 8


Months 8 Days


If under 24 hour»


Hours


Minutes


13 ['sua!


Lieutenant - BFD


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business:


Boston Fire Department


15 Social Security No.


555-74-3643


16 BIRTHPLACE (City)


(State or country )


Massachusetts


17 NAME OF


FATHER


Thomas Dunbar


18 RIRTIIPLACE OF


Rye


FATHER tCity)


(State or country )


New Hampshire


19 MAIDEN NAME


OF MOTHER


Hattie Chick


20 BIRTHPLACE OF


MOTHER (City)


(State of country )


Tama New Hampshire


Informant


Hospital records, VA Hospital


( Address)


150 S. Huntington Ave., Boston


I FLEREHY CERTIFY that a satisfactory standard certificate of death bled with me BEFORE by linsal or transypermit was issued. Jacqueline Casey (State of Agent of Board of Health of other) (


2-4075


10-10.59


( Date of Issue of l'ermit)


(Official Designation)


11


RUCTIONS FOR CERTIFICATE


giving OF DEATH


not enter than one for each (b) and (c)


dort ant mren le of dying. heart failure. str. It meant tr. or compli which caused


ows. if any.


(a). the


under- last


finnı contrib. death but not o the terminal omdition 2114.


Chapter 1.37. 1954, requires Ins to print or be cause of of death on ertlocates.


SOM-5-57-020345


EDWARD J. CRON N SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


OUT - OF- TOWN To be fed for burial permit with Board of Health


STANDARD CERTIFICATE OF DEATH


Registered Nn.


.


2 FULL NAME FRANK B. DUNBAR


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


(a) Residence. No. 10 Eleanor Court


INTERVAL BETWEEN ONSET AND DEATH Month


Years


2/20


(Address) VAH Boston, Mass. Date Oct. 9 1º 57


PARENTS


Boston


.


A TRUE COPY ATTEST: Charles it Mackie City Registrar


DECE'Y


JAN 1 81059 14


2.302 1


PLACE OF DEATH


Suffolk


(County)


Boston


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


Boston ......


(City or Town making this return)


9215


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.)


LO Elmwood Avenue


St


Winthrop,


Mass


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


2


12


(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


October


8


1957


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


8/8


57


10/8


19


I last saw h.Qualive on


19


8/8


19 ...


2.7death is said to


have occurred on the date stated above, at


11:30 a


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Septicemia.


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


?


Due To


Osteomyelitis


4 wks


(b)


Due To


R hip fracture


(c)


OTHER


Diabetes


SIGNIFICANT


CONDITIONS


ASHD


Was autopsy performed?


no


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased ?..... 11Q If so, specify.


(Signed)


Gordon Kooth


M. D.


(Address)


330 Brookline Ave


Date


10/8


5'


19


Tifereth Israel of Winthrop 6


Place of Burial or Cremationverett, Nass Town)


DATE OF BURIAL. 10/9 19


57


7 NAME OF


Henry Letine


FUNERAL DIRECTOR


ADDRESS 470 Harvard St Brookline


Oct 11 57


Received and filed.


7-13-58


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Fem


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)


Bernard Tratt


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


69


AGE


Years.


.Months ............ Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


At home


or Business:


15 Social Security No ._.


none


16 BIRTHPLACE (City)


(State or country)


Riga


Latvia


17 NAME OF


FATHER


Samuel Wolfson


PARENTS


18 BIRTHPLACE OF Riga


FATHER (City).


(State or country)


Latvia


19 MAIDEN NAME


OF MOTHER


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Estelle Weiner


21


Informant.


(Address)


40 Elmwood Ave Winthrop


A TREE Charles H. Mackie


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED OCT. 11, 1957


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


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


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


SOM.11.55.916:45


(City or Town)


CERTIFICATE OF DEATH


Beth Israel Hospital


No


Rose Tratt


(Was deceased a


U. S. War Veteran,


if so specify WAR)


None


That I attended deceased


from


57


Housewife


8 wks


Riga


Latvia


1


JAN 1 91258 /*


R- 301A 1


UCTIONS FOR CERTIFICATE giving OF DEATH t enter


for each ৳) and (c)


oes set mr .. of dytag. Acest failure. fc. It mrest . or compli- Aich caused


ve rise fa (.). the under. last.


ratk bat not the terminal


Chapter 137, 954, requires as to print er cause er f death on tiscates.


COM-5-57-920345


PLACE OF DEATH


SUFFOLK (County) ROXBURY (City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN


SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


OUT - OF - TOWN To be filed for burial permit w11h Rozid of Health of Its Agent


STANDARD


CERTIFICATE OF DEATH


Registered No.


f(If death occurred in a hospital or institution.


St. \Rive its NAME, instead of street and number)


2 FULL NAME


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


(a) Residence. No. 35 Sea View Ave


St.


Winthrop


( If nonresident, sve city or town and State)


Length of stay: In place of death


years 3


months 5


days. In place of residence


/


years


months


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


OCTOBER (Month)


14,


Day)


1957 (Year)


4I HEREBY CERTIFY, That I attended deceased from


JULY


1


. 1957 in


OCTOBER


14


. 19 57


Mive on


I last saw h


OCTOBER 14, 19 57, death is said to


have occurred on the date stated above, at 2:40 P.m.


INTERVAL


BETWEEN


ONSET ANO


>


DEATH


YRS


10a If married. widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFF. of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


78


12


AGE


Years


Months


- Days


If under 24 hours


Hours


Minutes


13 \'sual


Occupation :


Housework


(Kind of work done during most of working life)


14 Industry


or Bustor ..


At Home


15 Social Security No.


None


16 BIRTHPLACE (City)


(State or country )


Russia


17 NAME OF


FATHER


Hyman Libber


18 BIRTHPLACE OF


FATHER (City)


(State or country )


Russia


19 MAIDEN NAME


OF MOTHER


Zelda Portnoy


20 BIRTHPLACE OF


MOTHER (City)


(State ur country)


Edward Kurland


of (som)


I HEREBY CERTIFY that a satisfactory standard certificate of death


u Med with ine IF.Fr)RF. the


Massa


(Signature of Agent of Hoard in Health or other)




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