Town of Winthrop : Record of Deaths 1958, Part 26

Author: Winthrop (Mass.)
Publication date: 1958
Publisher:
Number of Pages: 566

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 26

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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 healthor its agent appointed to issuc 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 is to be held, or 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 recent medical attendance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners 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

PLACE OF DEATH

Suffolk (County)

winthrop Mass. (City or Town)

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

CERTIFICATE OF DEATH

Registered No.

Winthrop Comunity Hospital

No.

2 FULL NAME

ARSENY GRISCHAK

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

(a) Residence. No. 79 Fayson Street,

Revere,

ass.

(Usual place of abode)

Length of stay: In place of death

years

months

1 7days. In place of residence.

years

.months

days.

MEDICAL CERTIFICATE OF DEATH

3 DATE O

DEATH

MARCH 31 1958 (Year)

(Month)

(Day)

That I attended deceased from

I last saw heMalive on

MARCH 31, 199, death is said to

have occurred on the date stated above, at

9.50Am.

DEATH WAS CAUSED BY: IMMEDIATE CAUSE

(a)

MYOCARDIAL INSUFFICIENCY

AURICULAR

FIBRILLATION

Due To

GENERALIZED ARTERIOSCLEROSIS

(b)

THROMBOSIS ESMORAL ARTERY

Due To

(c)

MULTIPLE EMBOLI

5 days 15days

OTHER SIGNIFICANT CONDITIONS

EMPYGMA GALL BLADDER

GANGRENE LEFT LEG

Was autopsy performed? What test confirmed diagnosis CHELECYSTOTOMY-AMP.LT.LEG 3.16.58 5 Was disease or injury in any way related to occupation of deceased ? ! YO If so, specify

(Signed)

Harolo F. Musgrave

,M. D.

(Address)

6 Woodlawn Cemetery Everett Mass.

Place of Burial or Cremation

(City or Town)

DATE OF BURIAL

April 2, 1958

7 NAME OF

RECT William Robernik

ADDRESS

105

Nash. Ave. Chelsea Mass.

Received and filed

APR 1

1958

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Male

9 COLOR

white

10 SINGLE

(write the word)

MARRIED

WIDOWED widowed

or DIVORCED

10a If married, widowed, or divorced HUSBAND of Alexandra (Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

If under 24 hours

_Hours ....

Minutes

13 Usual

Shoe worker

Occupation :

(Kind of work done during most of working life)

14 Industry

or Business:

Retired

15 Social Security No .....

011-01-8089

16 BIRTHPLACE (City)

(State or country)

Aussia

17 NAME OF

FATHER

Grischak

18 BIRTHPLACE OF

FATHER (City).

wolyn

(State or country)

Russia

19 MAIDEN NAME

OF MOTHER

unknown

20 BIRTHPLACE OF

MOTHER (City)

"olyn

(State or country)

hussia

Informant

Anthony n. Thomas

(Address) 79 rayson ut. nevere vass

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : 6

N/ (Signature of Agent of Board of Health or other)

4-11/20

(Official Designation)

(Date of Issue of Permit)

SOM-5-56-917575

301A 1

IONS

TIFICATE

ng DEATH nter one each nd (c)

not mean dying, : failure, It means compli- caused

if any, rise to (a), under- last.

contrib .- but not terminal on given

pter 137, requires print or ause or eath on ates.

XEVERe 4.7.55

>10.11 17.00/

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

[(If death occurred in a hospital or institution,

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

PHYSICIAN -- IMPORTANT

(Was deceased a

U. S. War Veteran,

if so specify WAR)

(If nonresident, give city or town and State)

4 I HEREBY CERTIFY,

MARCH 13

19.58.

MARCH 31

190.8

(Kalenuk) Grischak

INTERVAL

BETWEEN

ONSET AND

DEATH

TYAYS

18 BYS

AGEZ.5.

Years

Months

Days

Nolyn

PARENTS

620 BeachST Prock Date 5-31- 19

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 illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest 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 physician or officer and the date of his death. . . Gen. Laws, Chap. 46, 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 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 relicf expedition and the Philippine insurrection, which shall, for said purposes, be dcemed 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 ahortion, 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, from the clerk of the town where the hody is to he buried or the funeral is to he held, or 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.

(3) Medical Examiners will investigatejand 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.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT

SERVICE NUMBER

PLACE OF DEATH

SUFFOLK (County ) BOSTON (City or Town)

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

"OUT - OF - TOWN

To be filed for burial permit with Board af Health or Its Acont.

CERTIFICATE OF DEATH MASS

750 HARRISON AVENUE MEMORIAL HOSS. No.

2 FULL NAME MARGARET O'MEARA (NOR) CURRY) ( If deceased is a married, widowed or dienered woman, give also maiden name)

37 SIRENST

WINTHROP MASS. ( If nentendent. c.ve to my town and State)

years

month" MY days

PERSONAL AND STATISTICAL PARTICULARS

F SFX 9 COLOR

· write the word)

FEMALE Write

WIDOWED DE DIVORCED

Ing If married. while re divorced

HUSBAND of

IGue maiden name . f wife in full?

(or) WIFF of

Joseph P O'MEARA

( Husband's name in tull;

11 IF STILLBORN. enter that fact herr

N.F 20 Years

Month of 1 ....

If anifer 24 hours

Ilout.

Minutes

1.3 t'qual

Occupation.

Housewife

( Kind of work done during most of working life)

14 Industry of Business AT NoMe

15 Social Security No.

16 BIRTHPLACE (City)

(State er country }

MALDEN

17 NAME OF FATHER JOHN CURRY

18 BIRTHPLACE OF

FATHER (City)

BOSTON

MASS

r State of country !

19 MAIDEN NAME

OF MOTHER

HELEN MCCARTHY

M BIRTIIPLACE OF MOTHER City) iState (r courtry

MALDEN MASS

21 Informant 37 SIREN ST WINTHROP

( MEREKY CERTIFY that a saftale field

standard certificate of death

; NAME OF HINEKAL DIRECTOR Gerard Cansel ADDRESS 721 Salam G JAN 2 1 1958

Received Charles H. IMa

ku D 2006

PARENTS

: 108

WINTHROP

Place of Hunal of Vormatro

DATE OF RI'RIAL JAN 18

195

00M.5-57.020345

MEDICAL CERTIFICATE OF DEATH

3 DATE OF

DEATII

JANUARY

1958

( Month:

( Year)

That I attended dereased from;i

4IHEREBY CERTIFY,

JANUARY .0. 10 58

JONMARY

1 last saw h

alive on

death is sail toi!

have ursurred on the date stated above, at INTERVAL BETWEEN ONSET AND DEATH

DEATH WAS CAUSED BY : IMMEDIATE CAUSE CARDIAC-RESPIRATORY ARREST. (a)

Due To

INTERNAL HEMORRHAGE

(b)

AND COMA

Due ACUTE HISTIOLYTIC LEUREMIA

OTHER SIGNIFICANT CONDITIONS

W'as autopsy performed' YES

What test confirmed diagnosis'

AUTOISY

S Was disease or injury in ary war related to occupation of deceased? If .0. specif. NO

( Signed)

Monecreo Canister D

(Address) 750 Horison Que Date

... Towni

Joseph P OMBARA

wf migran ent Suent Init of Heater. Jay 61958 ( Dair of Issue of Permiti

FRM R-301A 1

BE OF DEATH · mot enter or. .... ... use for each .. ). (.) ... . )

" dort ant meas

....

..... (.). .....

1hr

- sta drath but mot to the promise

, Chapter 137, tot lose, requires "clans to print er the cause of h, of death .. cortiscates

Registered No 0101532

death occurredl in a hospital or institution, Its NAME instead of street and number) PHYSICIAN - IMPORTANT

IHas decreased a t. S. War Veteran. if xo specify WAR,

(a) Residence.

NSTRUCTIONS FOR ( l'qual place of alite) CAL CERTIFICATE Length of stay: In place of death veart

months 10 days. In place of residence

JANUARY 15.10 58

MARRIED

A TRUE COPY ATTEST: Charles it Mackie City Registrar

APR 3 01950 7"

PLACE OF DEATH

Suffolk

Boston (fity or Tumn)

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

OUT - OF - TOWN

. 00983

Veterans Administration Hospital HARRY

A. ARALER

Ilf deceased is a sertied, and wet a deserted onman, rise also maiden name ,

(a) Residence. Sr 56 Shirley

Winthrop,

Massachusetts

( 11 ₱

..... ₼: ..... da ..

MEDION CERTIFICATE OF DEATHI

J DATE OF DEATII

January

27.

1958

4IHEREBY (IRTIL ). Il at attentes deceased tom

Ihle

White

July 23.

. 1,57

January 27,

. 12 58

IT'SBAND of

Mary Wichrire

+0+· randen name of wdr ur lull ;

( ** ) WIFE of

4Ha! art's name in lutli

DEATH WAS CAUSED BY . IMMEDIATE CAUSE

1. Acute bilateral bronchopneumondd !!! 2. Subacute (weoks) and healed

Due To

(months) myocardial infarction.

3. Extensive encephalomalacia,

arteriosclerotic.

Mos.

Due To (. )

SIGNIFICANT Acute (days) and

CONDITIONS healed (mos.) prelonephritis.

Was autupey perturme l Y08 Autopsy & clinical What test confirmeil diakn. ...

findings

(Signed) Cjan Jey I. Slosberg, MD

RENTS

1 FATHER I( 11+)

ÓMIO

Mary O'Donovan

BIKINPL. WE OF

CNBL

VAHospital Records (1 1 .... ]50 S. Huntington Ave., Boston

standard er! 9. ale of death

ADDRESS

210 Winthrop St., Winthrop, FEB 3 1958 Charles H. Mackie

5446 ........

1.29.58 (Date . 11-fseit l'rimett

V.B.V

MR VOIA 2 605 558 171697 25174

I TRUCTIONS FOR IL CERTIFICATE

: OF DEATH d not enter ve than one se for each ut (b) and (c)

. . ... ... ....

.... (b)

Chapter 137.

sere to print or . ..... or .f desth on

CHAH Boston, Lass. Dr. Jan. 27 1. 58 Winthrop Cemetery, Winthrop, Lass.

January 30

DATE (IF RI KI.VI.

Laurice W. Kirby 11 NERAI. DIRECTOR

SOM.357 120345

: FILL NAME

PHYSICIAN -

TVCORTAST

Spa. Amer. -

Y.WY I

Length of stay In plaer nl death ..... 6 months 4 In place at ceandere $5

PERSONAL AND STATISTICAL PARTICULARS

9 COLOR (write the word)

MARRIED WIDowinMarried

It under : hools

Cirutes

Oreupation

Grocery Store Proprieter

( Kind of work done during most of aneking life)

14 Ind ·· fr.

or Hus rei

GROCERY

16 BIRTHILVE KIVI

(State of country)

Dover

Chio

12 NAME OF FAATHEK Adam Kramer

IA BIRTHPLACE OF

Days

AGE.85

Years 9

Month 23 Days

INTERVAL

BETWEEN

ONSET AND 11 IP STILI RORY enter that fact here

have received on the date state! Ar -ge. a 2:30 A-

X death is wald in

SING HA NAME

. ,

A TRUE COPY ATTEST: Charles H. Mackue City Registrar

REDEIVO

: 12

MAY -11000 **

RM R-301A E

STRUCTIONS

(a) Residence. No. (T'qual place nf

115 Upland- Road

(If nonresident, give city of town and State>

Length of stay: In place nf death years 26months

days In place of rendent€5

years

months da).

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

A SEX

9 COLOR

female white

If It married. widowed, or divorced HUSBAND of (Give matien name of wife in full)

(np, BIFF. nt

alter Harald Sisler

11 IF STIL.I.BORN, enter that fact bete

1 WEEK AGES9 Year. 6

Month .26 Days

If under 24 hours

flours

Minutes

13 l'sual

Excupation

housework

IK.na CT

done during most of working life

14 Industry

nr Business

0mm home

15 Social Security No

022-10-5972-3.

16 AIRTELFILA( E (City)

(State (i country )

YOW3

17 NAME OF FATHER Frank Eenry Killer

JA BIRTHPLACE OF

FATHER (City)

Rockford

Illinois

12 MAIDEN NAME

OF MOTHER

Jeannette . Hart

D' BIRTHPLACE OF

MOTHER (Oty!

Peoria

(State of country)

Illinois

woodlawn Cemetery Everett, Lass

DATE OF BURIAL January 21.1958

, NAME OF

HINFRAAL DIRECTOR

Cesped 13. Marile

ADDRESS3 74 WintHrop FEB _ _ g5anthrop, M888. 19 Receive y'all Charles H. Mackie

195F ( Year)

(D)av)

That'dattended deceased from

Jan.

158

d last waw Pralive on

Jan.

28. . 158 . death is said to

have occurred on the date stated above, at 12.23AYRINTIRVAL

DEATH WAS CAUSED BY: IMMEDIATE CAUSE

BETWEEN ONSET AND DEATH

(a) BRONCHO? NEUMONIA,

BILATERAL

Due To (b) ASPIRATION

wF.V

Due To CARCINOMA, THYROID

MONTHS

OTHER SIGNIFICANT EMBOLUS, LEFT BRACHIAL CONDITIONS

- MONTHLY

Wes autopsy performed? YA8

What trat confirmed diagnosis? Autopsy

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

If so. specif)

chi@Com

. MD

(Address) Asst. Dir . Nass. Jen'y .... 1/28/56

PARENTS

Infaemart Capen Farmer 158-Beacon St. Boston, Has8. I HEREBY CHETIFY that a matiala ture standard certificate of death - BEFORE the Py

Thesea

INmanature of Agent of Hoaf 1 ! Health ..

5926 1-29-58"

I hate of four col l'errant) V/B.V

.....

...... last

LLafter In7. 1.ª.4. requires · ant to print of

of death on mertincates

X PLACE OF DEATH

SUFRWY (County) BOSTON (City of Town)

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

OUT - OF - TOWN 65

To be tied for barial proit with Board of Real!» Or Its Agent.

00977

MASSACHUSETTS GENERAL HOSPITAL No. .. Vera

I( If death occurred in a hospital as institution. St. | give its NAME instead of street and number) PHYSICIAN - IMPORTANT

2 FULL NAME.

Tibwed or divorced woman. mive also maiden name )

( Was deceased a it' S. War Veteran.

Winthron

In SINGLE. (orite the word)

MARRIED

WHwwwID Widowed

3 DATE OF

DEATH

January C

(Month) I HERERY CERTIFY. Jan .? . 19

AL CERTIFICATE

la giving E OF DEATH

not enter re than one se for each ). (b) ... (c)

death but ant

Stanwood

ARTERY

STANDARD CERTIFICATE OF DEATH

Registered No.

'A TRUE COPY ATTEST .: Charles it mackie

PLACE OF DEATH

SUFFOLK (County ) BOSTON (City of Town)

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

STANDARD CERTIFICATE OF DEATH

Ta he flied fer bortal permit with Board of Health ar Ita Agent

01478

No. MASSACHUSETTS GENERAL HOSPITAL

mit

2 FULL NAME Lucy Murray ( Cat)s.)

(If deceased lo a married, widowed or divorred woman, give also maiden name )

169 Main St.

Winthrop,

( If nonresident. give city of town and State)

Length of stay : In place of death

years

months

daye In place of revidence years_ _ month ___ daya

PERSONAL AND STATISTICAL PARTICULARS

J DATE OF February 8,

DEATHI

( Month)

(Year)

& SE.X

Female

9 COLOR

White

10 SINGI.F. ( write the word)

MARRIED . ..

WIDOWEDdard

of DIVORCED

4THEREBY CERTIFY.

That Sattended deceased from

February 5 . 19 58 . February 8

We love wow her alive on

February 8

. death is said toff

have occurred on the date stated above, at

2:58 A

DEATH WAS CAUSED BY: IMMEDIATE CAUSE

(a) FUI. MENARY : MBOH

MASSIVE

Due To PHLEBOTHECHBOSIS, LEFT (b)

POSTERIOR TIBIAL VEIN

Due To (c)

OTHER SIGNIFICANT CONDITIONS

W'as autopey performed'

YES

What test confirmed diagnosis'

AUTOPSY

S M'as disease of injury in any way related to occupation of deceased' If so. specily

(Signed) (Add .... )Asst. Dir. Mass.Cen']

. MD

2/3/

1958

l'lare of Burial of ( remation

DATE OF BIRIAL .

11,

(( I1; c' Town) 19

, NAME OF

+1 ATKAL. DIRECTOR

ADDRESS -

Receiweil and hled

FEB 1 3 155019

( Registrar)

PARENTS

18 BIRTHPLACE OF

Cutlow

FATHER (City) ( State of coun !!! )

1º MAIDEN NAME

OF MOTHER

Lucy C. NAbor

N BIRTHPLACE OF MOTHER (CHy) ( State in country)

Informant

(Address)

I HEREBY CERTIFY that a satisfactory standard certificate of death **. his.1_».U BEFORE Mr burtal or transit permit .a. issued merry ( Signature of Agent of Board of Health of other)

6135

2-11-18

(O)mhcial Designation ) ( Date of four of Permit)

RM R-301A -

ISTRUCTIONS FOR CAL CERTIFICATE Im giving E OF DEATH · .· t ·ater .. .... ... use for each ), (b) and (c)

r dorr et mras

adifiner ........ ta death bat ant

. . Dapter 17.

elana to print er the ravie af

certiac.to.

5 1958

I] IF STILLBORN, enter that fact here.

AGE

75 Years 12 Months 2 Days

If under 24 hours

Hours

Minutes

Occupation .

(Kind of work done during most of working life)

14 industry

of Business.

15 Social Security No. 045-20-033.

16 BIRTHPLACE (City)

( State (or country )

17 NAME OF

F.ATIIE.R

It's is married. widowed, or divorced

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Town of Winthrop : Record of Deaths 1958, Part 26

Author: Winthrop (Mass.) Publication date: 1958 Publisher: Number of Pages: 566

Author: Winthrop (Mass.)
Publication date: 1958
Publisher:
Number of Pages: 566