USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 82
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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 CERTIFICATE OF DEATH
TOWN 233
No.
Peter Bent Brigham Hospital
2 FULL NAME Mary Lappen
(Long )
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
15 James Ave. Winthrop, Mass
St.
(If nonresident, give , ity of f wr are State!
Length of stay: In place of death ........... years
months 2.
days. In place of residence
years
months
lavs
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Sept.
14
1958
(Month)
(Day)
(Year)
We HEREBY CERTIFY. Thhle attended deceased from Sept .12 , 19.58 19 58, to Sept 11
Wfast saw h. eralive on
Sent 14:
58
19
, death is said to
have occurred on the date stated above, at
1:25
.A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Dissecting Aortic Aneurysm
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
Left Hemothorax
CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
Autopsy
5 Was disease or injury in any way related to occupation of deceased ?
If so, ,pecify
(Signe( )
Victoria In Casa
M. D.
(Addre s)P. Bent Brigham Hosp.Date. Sept 14 19 58
6 Winthrop Cemetery
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
September 17, 1958 or Town)
19
7 NAME OF
FUNERAL DIRECTOR
Maurice W Kirby
ADDRESS
210 Winthrop St. Winthrop
SEP 1 7 1958 19
Received and filed Charles A. Mackie
PERSONAL AND STATISTICAL PARTY.'
8 SEX
9 COLOR
,10 SINGIF
Tu ile the w ...
Female
White
EDMarriedd
10a If married, widowed, or divorced
HUSBAND of
(Gier mailen na or
Eugene Lappen
(or) WIFE of
(Husbandt', name u !!
II IF STILLBORN, enter that fact here.
12
-
12 days AGM2
Years
Months
Days
If . . ..
13 Usual
Occupation :
( Kind of work done during most of Ruin A
14 Industry
G,E, Lamp Works
15 Social Security No.
Bonaocsta NewFoundland
16 BIRTHIPLACE (City)
(State or country)
17 NAME OF
FATHER
William Joseph Long
18 BIRTHPLACE OF
FATHER (City)
(State of country )
New Foundland
9 MAIDEN NAMargaret Ann Joy OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
NewFoundland
21 Eugene G Lappen
Informaut
(Address)
15 James Ave. Winthrop
I HEREBY CERTIFY that a satis actory vandail . was frled with me BEFORE the Pur if of t13 et je litet v
(Signature of Agent of Rand of Health un
(Ofhefal Designation)
(Date of Issue , le ...
IPV
CTIONS R ERTIFICATE
ving DEATH enter an one r each and (c)
swot meas of dying. art failure, Is means or compli- ich caused
--
If any, (a), · under- se last.
s contrib th but not he terminal
bapter 137, 4, requires to print or cause or death on ficates.
50M-3-57-920345
Registere ' Vc
J(If death occurred in a hospital .
St. (give its NAME instead of street and . | T "
PHYSICIAN
IMP .R"AN"
2 (Was deceased 3
U. S. War Veteran,
if so specify WAR!
(Usual place of abode)
8
VARR HD
WIDOWED
!
INTERVAL
BETWEEN
ONSET AND
DEATH
Operator
PARENTS
R-301A
RECEIVED
65
DEC 2 91953 AM
1
Charles ,T. ex que Cal Acalstrar
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 CERTIFICATE OF DEATH
OUT-OF - TOWN with B. a.A . or it. Ag
8918
((If death occurred in a hospital or institution .. St. ¿ give its NAME instead of street and number)
I HYDICIAN IMPORTAN
2 FULI. NAME
Anna Pransky
(If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Sea Foam Ave. Winthrop
St.
(If nonresident, give city or town and Statt)
40, cars
days. In place of residence .months ........... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wite in full)
(or) WIFE of
Joseph G. Pransky
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE. 78,
10 min.
Years
Months
Days
If under 24 hours
Hours. .... Mmate.
13 l'sual
Occupation :
(Kind of work done durmy most of working bte;
14 Industry
or Business :
At home
15 Social Security No ...
10 BIRTIIPLACE (City).
(State or country)
Russia
OTIIER
SIGNIFICANT
CONDITIONS
Pulmonary edema
2 months
Was autopsy performed ?...
no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? he If so, specify
(Signed) Joseph Seltzer M. D. 1990 Unive St. Newtonse Sept 20 55
Tifereth Israel of Winthrop ..... Everett (State or country)
Place of Burial or Cremation (City or Town) DATE OF BURIAL
September ...... 22 ....... 19 58
7 NAME OF
FUNERAL DIRECTOR Morris W. Brezniak ADDRESS470 Harvard.St.,Brookline
Received and filed 19
SEP 23 194
Charles it Mach
PARENTS
17 NAME OF
FATHER
Samuel Kachelnick
18 BIRTHPLACE OF FATHER (City ) .... (State or country)
Russia
19 MAIDEN NAME
OF MOTHER
( unknown )
20 BIRTHPLACE OF
MOTHER (City).
Abram I. Pransky
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial of trane prima an issued. i
Ja ! i ( Signature of Agent of Hoard of Health or other)
(Official Designation )
(Date of Issue of Permit)
X
R-301A 1
CTIONS R ERTIFICATE Iving F DEATH enter an one or each ) and (c)
e's not mean of dying, art failure, c. It means or compli- ich cuused
s, if aut, ve risc to usc (a), he under. use last.
ons contrib- ath but not the terminal dition given
Chapter 137, 54, requires to print or rause or death 00 ifuites.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Sept.
20,
DEATH
195F
( Month)
(Day) '
(Year)
4 I HEREBY CERTIFY, That I attended deceased frym July 28, 1958 58 Xept 20
last saok hlalive on Sept 1kg
195, death is said to
have occurred on the date stated above, at 8:20 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Acute myocardial
INfaretNON
Due To (b)
Congestive heart
failure
Due To (c)
INTERVAL BETWEEN ONSET AND DEATH
2 years
10 SINGLE
(write the word)
( Was deceased a U. S. War Veteran, if so specify WAR). No
(a) Residence. No ... . (Usual place of abode)
Length of stay: In place of death ............ years ... 1 month2.3
No.
1245 Centere St.
Registered No.
Russia
21 Informant ( Address ) 126 Manet Rd., Newton
House-wife
RECEIVED
TO'
-
6
DEC 291658 AM
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 MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
Registered No.
9158 235
N.n. Aldrich
route to Mass General Hospital. ( give its NAME instead of street and number)
[(ff death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
2 FULL NAME
VIOLET . ...... LEONARD
(If deceased is a married, widowed or divorced wontan, give also maiden name.)
if so specify WAR)
(a) Residence. No.
24 Cottage Avenue, Winthrop
(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 .... O ... years .......... months ........... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September
2.5
1958
(Month)
(Day)
(Year)
4I 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.) BRONCHIAL ASTHMA
9 SEX
10 COLOR OR RACE
11 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
Ila lí married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
Ries Eumano Leopard
12 IF STILLBORN, enter that fact here.
13
AGE .. 69 Years .. ]
.Months.
.4 ... Day's
If under 24 hours Hours .......... Minutes
14 Usual
Occupation :
Editor
Work done during most of working life)
15 Industry or Business WWinthrop Sun Newspaper
16 Social Security No. ....
027-28-2563
17 BIRTHPLACE (City)
(State or country)
Illinois
18 NAME OF
FATHER
C. N.b.l
Aldrich
19 HIRTHPLACE OF
FATHER (C'ity)
· Chicago
(State or country)
Illinois
20 MAIDEN NAME
OF MOTHER
21 BIRTHPLACE OF
MOTHER (Citv)
(State of contitry)
unknown
Informant Judge Thomas E. Key ( Address)
15 Johnson ave Winthrop
I HEREBY CERTIFY What a sati factorfest was filed with wie BEFORE the band of transit permit was issued;
(Signature of Agent of Board of Health or other)
9614
Charles 21: In d'ex"
PARENTS
(Signed)
Leonard Cottura
M. D.
(Address)
25 Shattuck Store .9/26.
.. 19 ... 58
Woodlaym Creamatory Everett, Mass 7 Place ol Burial, of DATE OF BURIAL. ........... September 29. 19589 * NAME OF FUNERAL DIRECTOR
ADDRESS 174 Winthrop-St. Winthrop, Mass. Received and hled OCT - 1-1938
DEC 24 1950-57.920750
1
R-303 A
EL Manner of Injury Nature of Injury DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of Death. See reverse side for extracts from the laws relative to the return of certificates of death. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF public place ? If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to inen a recital to that effect.
5 Accident, suicide, or homicide (specify)
Date and hour of injury 19
Where did
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
(Specify type of place)
(How did injury occur?)
Chicago
While at work?
Was antopsy perforined?
NO
6 Was disease or injury in any way related to occupation of deceased ? If so, specify
unknown
(Otherdl Designation) (Date of Issue of Permit) X
female
white
(Was deceased a
U. S. War Veteran,
NO.
RECEIVED
F TOI
71 12 3
6
A TRUE COPY ATTEST: Charles it Mackie City Registrar
PLACE OF DEATH
suffolk (County) Boston (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS OUT
STANDARD
CERTIFICATE OF DEATH
Registered No.
9101
Massachusetts Memorial
No.
Robert
Magee
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
6 Court Road
St
Winthrop
Mass
(If nonresident, give kity or town and State)
Length of stay: In place of death .........
years.
5
months
days. In place of residence 14 years
......
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
DEATH
3 DATE OF
September
25,1958
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY, That I attended deceased from
Sept 21, 1958 to Sept ..
25
, 19SE
I last saw himalive on
Sept 25
1952, death is said to
have occurred on the date stated above, at
6:00 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Pulmonary Edema
(a)
Due To
Aortic & Mitral
(b)
Stenosis of Insufficiency
Due To
Subacute Bacterial
(c)
Endo carditis
OTIIER
SIGNIFICANT
Rheumatic Heart
CONDITIONS
Disease
Was autopsy performed ?
No
What test confirmed diagnosis?
EKG
X-RAY
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Elizabeth Cilera. M. D.
Mass, Mem. Hosp. Date
9.25 1958
(Address)
6
l'lace of Burial or Cremation (City or Town)
7 NAME OF FUNERAL DIRECTOR Sec, m. nestor ADDRESS
SEP 30 .1958
19
Revived And filed Charles It Macker (Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
NALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
pr DIVORCED
MARRIED
10a If married, wilowed, or divorced
HUSBAND of alimintis
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGB 35 Years 1
Months
4 Days
If under 24 hours
Hours .. Minutes
13 Usual
Occupation :
Service mail
(Kind of work done during most of working life)
14 Industry
or Business :
Vending machines
15 Social Security No.
0231-17-213
16 BIRTHPLACE (City) East Bestow
(State or country)
17 NAME OF
FATHER
James magel
18 BIRTHPLACE OF
FATHER (City)
Brata
Fine
(State or country)
19 MAIDEN NAME
Frances Jardyon
OF MOTHER
20 BIRTHPLACE OF-
MOTHER (City)
(State or country)
21 Www. finances? mage (Address) quetraces. Acht Informant I HEREBY CERTIFY that a satisfactory standard certifiche of death was hled with me BEFORE the burial or transit perinit was issued : 11478 (Signature of Agent of Board of Health or other)
91127
(Othcial Designation) (Date of Issue of Permit)
X
1
R-301A
/
CTIONS
ERTIFICATE Iving F DEATH enter an one or each ) and (c)
es not mean of dying. art failure, . It means of compli- caused U
, if any, 'e rise to (a). re under- ase lass .
As contrib. ath but not the terminal dition giren
Chapter 137, 54, requires to print or cause or death on ficates.
.
1566
50M-5-57-920345
Heather DATE OF BURIAL Sept. 291
To be filed for hurlal permit with Board of Health or Its Agent .. "
36
f(If death occurred in a hospital or institution,
St. (give its NAME i: tead of street and number)
2 FULL NAME
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
INTERVAL
BETWEEN
ONSET AND
DEATH
-
PARENTS
RECEIVE:
-
6
DEC 311958 AM
A TRUE COPY ATTEST: Charles it Mackie City Registrar
Y 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 CERTIFICATE OF DEATH
To be fled for burial permit with Board of Health or Its Agent. 9294
Registered No.
St. (give its NAME instead of street and number)
No.
2 FULL NAME
MADELINE JESSOP
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No ..
187 BARTLETT ROAD
St
WINTHROP, MASS
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months
14days. In place of residence
3.5. years.
_. months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
OCTOBER
1
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That Jeattended deceased from
Sept. 18, 19
58
October 1,
19
58
W.last saw heralive on
October 1, . 1958 , death is said to
have occurred on the date stated above, at _6; A .
.. m.
INTERVAL
BETWEEN
ONSET AND
DEATH
id.
Due To
CORONARY HEART DISEASE
(b)
THROMBOSIS ANTERIOR DESCENDING ? a.
BRANCH LEFT AND RIGHT CORONARY
Due To ARTERY
(c) .
CORONARY HEART DISEASE
YRS.
OTHER
SIGNIFICANT
CARCINOMA OF CECUM
CONDITIONS
TYR.
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)
ERClay
, M. D.
(Address) Asst. Dir. Mass. Can't Hosp .. Late
10/11, 58
Winthrop
9
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Oct. 4
19 58
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop,
Mass
OCT -7 1958 19
Received and filed
.
,
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCE 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
AGE66
Years
8
Months
22 Days
If under 24 hours
_.__ Hours _._. Minutes
13 Usual
Occupation :
Housekeeper
(Kind of work done during most of working life)
14 Industry
or Business :
Private home
15 Social Security No.
621-26-0587
16 BIRTIIPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
John J Jessop
18 BIRTHPLACE OF
Boston
FATIIER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Mary E Rourke
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Cambridge
21
Laurette Earl
Informant
(Address) 239 Pleasant St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with jye BEFORE the burialor transit permit was issued:
(Signature of Agent of l'oard of Health or other)
4703
10 8-11
(Official Designation)
(Date of Issue of Permit)
ICTIONS OR CERTIFICATE
tving F DEATH t enter han one for each ) and (c)
es mot mees of dying, cart failure, c. It means or compli- kich caused
1/20 -
s, if any, ve rise to anse he
(a), kader- last.
as contrib. ath but not the terminal dition given
Chapter 137, 54, requires s to print or Cause or death on locates.
50M-1-58-921876
C
1
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
[(If death occurred in a hospital or institution,
MASSACHUSETTS GENERAL HOSPITAL
OUT - OF - TOWN
PARENTS
Cambridge
(write the word)
to
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) MYOCARDIAL INFARCT WITH
MURAL THROMBUS
R-301A 1
RECEIVED
TOMI
5
DEC 2 91058
A TRUE COPY ATTEST: Charles it Mackie City Registrar
X Suffolk
PLACE OF DEATH
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF - TOWN To be Aled for burial permtt with Board of Health or Its Agent.
9504
New England Deaconess Hospital No.
f(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
2 FULL NAME Mrs. Marion F. Hey ( Nee Farquhar)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
53 Nahant Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years
months - 12
days. In place of residence 8 years
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
9
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
September 27 1,58
to
October
9
That I attended deceased from
19
58
I last saw Her alive on
October 9
... . 1958
, death is said to
have occurred on the date stated above, at
11:58 P. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Acute MyoCARDIN INFART
DEATH 2 mentes
Due To
CORONARY throm Boris
(b)
Due To (c)
OTHER
CA CERVix E Pulm. m & tAst
1 YR.
CONDITIONS
, Pelvic metrest
Was autopsy performed?
YES
What test confirmed diagnosis? .
EKG, TRANSAMINASE
5 Was disease or injury in any way related to occupation of deceased ? If so, specify NO .
(Signed)
James P. Fronton
, M. D.
(Address) 15 Joslin ROAD Date Oct. 10 1958
6 Aspen Greve
Word
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Oct 13
19%
7 NAME OF
FUNERAL DIRECTOR
IFr.
B. Mars
ADDRESS >Ų Logo ST. W.nothing OCT 14 1908 19
Received and filed Charles &t. Mycket .
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
MARRIED)
WIDOWED
or DIVORCED
( write the word)
witows ..
10a If married, widowed, or divorced
HUSBAND of
....
(Give maiden name of wife in full)
(or) WIFE of
Albert
Edward they
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
7Years. 11
3
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)
Burnt Island
Scotland
17 NAME OF
FATHER
Robert Forscher
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME
OF MOTHER
Mury
Stuart
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Scot land
21
Informant
(Address)
Miss Aund L. Hey 53 Newest Avo. Winter
1 HEREBY CERTIFY that a satisfactory standard certificate of deat! was fed with me BEFORE the bunal or transit perunit was issued : 1 1 (Signature of Agent of lloard of Health of otber)
1
1
(Official Designation )
(Date of Issue of l'ermit )
UCTIONS FOR CERTIFICATE giving OF DEATH .
ot enter than one for each (b) and (c)
Der not mean · of
dying, heart failure, tc. It means e, or compli- which caused
ws, if any, ave rise to cause
(a), the under- cause last.
oms contrib. death but mot the terminal adition giver
Chapter 137, 954, requires os to print or e cause or f death on tlfcates.
SOM-5-57-920345
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
if so specify WAR)
No
Winthrop,
Mass.
(a) Residence. No.
(Usual place of abode)
STANDARD CERTIFICATE OF DEATH
Registered No.
IR-301A 1
(a)
INTERVAL
BETWEEN
ONSET AND
PARENTS
RECEIVED
OF TOM
6
1
DEC 291359 AM
A TERE CON ATTEST:
Cit Rautrer
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
STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or Its Agent.
9647
No. New England Deaconess Hospital
f(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME Mrs. Mary A. Jones
(If deceased is a married, widowed or divorced woman, give also maiden name.)
9 Crystal Cove Ave.
St.
Winthrop,
Mass.
(a) Residence.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ... ..
years 1
months 7 days. In place of residence years
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
11
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
September 4 1958 .October 11
1958
I last saw her alive on
October .11 . 19 58, death is said to
have occurred on the date stated above, at 3:45 P
m
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Carcinomatosis
INTERVAL BETWEEN ONSET AND DEATH
? 2 yr
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
9 COLOR
10 SINGLE
(write the word)
MARRIED MMarried
WIDOWED
or DIVORCED
10a If married, widoofhisivgreed Jones
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 77 Years
Months
. .. Days
If under 24 hours
Hours
Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
At Home
15 Social Security No. NONE
16 BIRTIIPLACE (City) Newton (State or country) Massachusetts
17 NAME OF
FATHER
William Bennet
18 BIRTIIPLACE OF
FATHER (City)
(State or country)
Canada
19 MAIDEN NAME OF MOTHER Louise boucher
2 BIRTHPLACE OF MOTHER (City) (State or country )
Nova Scotia
21 ag nas Jones
Informant (Address) C Crystal Cove Ave . Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit perouit was issued :
(Signature of Agent of Board of Health or other)
(Othcial Designation)
! (Date of Issue of Fermit) J
UCTIONS OR CERTIFICATE
lvIng OF DEATH t enter ban one for each b) and (c)
es mot mres of dying. rart failure. c. It means or compli- hich caused 54
s, if any, ve rise to ause (a). the under- last.
rath but not the terminal dition gives
Chapter 137, 954, requires s to print or cause or death on ifcates.
SOM-3-57-92C345
1
Due To Carcinoma of Rectum (b) .._
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
TERMINAL PNEUMONIA
3 d
Was autopsy performed ?.
YES
What test confirmed diagnosis? Surgical Exploration
5 Was disease or injury in any way related to occupation of deceased? No If so. specify
(Signed)
Thomas
N. E . Dearouca
(Address)
Boston, man
Date Oct. 11, 14 58
Winthrop 6 Place of Burial or Cremation
ninthroo
(City or Town)
DATE OF BURIAL
October
15.53
7 NAME OF
FUNERAL DIRECTOR Maurice W. Kirby
ADDRESS ~10 Winthrop St. winthrop
Received and hled
OCT 1 6 195819 Charles H Iger ...
, M D.
PARENTS
Registered No.
PHYSICIAN - IMPORTANT -
(Was deceased a
U. S. War Veteran,
if so specify WAR)
R-301A
RECEIVED
TOW
E OF
?
GLEN
15
6
DEC 291358 AM . .
C
50M-1-58-921876
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 of Health or Its Agent.
9593
2 FULL NAME
BARNET ZELICKMAN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
409 Shirley
St.
Winthrop
Mass
(Usual place of abode )
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months 2 days. In place of residence years.
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
11
1958
(Month)
(Day
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
Oct. 9
1958.
to.
Oct.
11
1958
I last saw himalive on
Oct
19.S&, death is said to
have occurred on the date stated above, at
7:15 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cardiac arrest following
sudden arrhythmia
INTERVAL BETWEEN ONSET AND DEATH 2 min
(b)
Due To
Arterioscleratic
heart disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Pulmonary emphysema
Was autopsy performed?
No
What test confirmed diagnosis ?...
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
norman & Mages
M. D.
(Address
330 Brookline, Boston Date Oct 1/ 1958
Tlfereth Israel of Winthrop-Everet Place of Burial or Cremation (City or Town)
DATE OF BURIAL
October
12,
1958
7 NAME OF
Benjamin Birnbach
FUNERAL DIRECTOR
ADDRESS
10 Washington St. , Dorchestr
Received and hled
Charles H. Inal
( Registrar)
OCT 75 1958 KURI
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divorcesarah Ginsberg
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
86
AGE
Years
Months ...... Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
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