USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 11
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71
15 Social Security No. 019-110-4218
t6 BIRTIIPLACE (City)_
(State or country)
OTHER
Peritonitis
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis ?...
Autors4
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify ...
(Signed).
(Address)_Aast .. Dir.Maas ._ Gon'] Hosp ._ Date
M. D.
1/12/ 19 59
6
Pine Chove
Place of Burial or Cremation ity or Town)
DATE OF BURIAL SOM 19 19 59
7 NAME OF
FUNERAL DIRECTOR
45 Talabelle Pack Lym
ADDRESS
Hans 7 Orchards
Received and filed
Charis H.
(Registrar)
PARENTS
17 NAME OF
FATIfER
Mark John Worthless
18 BIRTIIPLACE OF
FATHIER (City)
(State or country)
n.H.
19 MAIDEN NAME
OF MOTIIER
Could not be teor
20 BIRTHPLACE OF
MOTIFER (City)
not.
Known
Y (State or country)
21
Informant
(Address)
ord are aficstimmten
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with the BEFORE the burial or transit permit was issued: CNH Kana
(Signature of Agent of Board of Health or other)
982
1-16-59
(Official Designation) (Date of Issue of Vermit)
-
PyElpriEp KITis
Due To Chronic Pylonephritis
- (b)
Due To
CARCINOMA, PROSTATE
(c)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That"P attended deceased from
Dec. 30,
58
, f9 ..
In
Jan. 10,
59
19
WD lant saw h. IMblive on
Jan . .. ]0, ., 19 59 death is said to
have occurred on the date stated above, at
1.0 :12P. m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Uremia
(a)
2 wants
? Month
2 weeks
antium
30M-1-58-921876
No .-
MASSACHUSETTS GENERAL HOSPITAL
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No ...
(Usual place of abode)
3 DATE OF
DEATH
JANUARY
10
1959
A TRUE COPY ATTEST:
RECEIVED Charles & Mackie City Registrar 70
11.12
MAR 311959 AM
X
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 Aled for burial permit with Roerd of Health or its Agent. 00340
30
No.
Mass . Memorial Hospitals
2 FULL NAME
John .J ....... Dohorty
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 20 Oceanviow Street
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay : In place of death ............ years.
.. months ..... . days. In place of residence
years
months ......... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCED
Married
Mary E. Ahern
10a 11 married, widowed, or divorced,
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
II IF STILLBORN, enter that fact here.
12
58
AGE .. ...
Years
Months
Days
If under 24 hours
.. Hours .... Minutes
13 Usnal
Occupation :
Supervisor
(Kind of work done during most of working life)
14 Industry
or Business:
N.E. Tel. & Tel.
15 Social Security No.
unknown
16 BIRTHPLACE (City)
(State or country)
Worcester
17 NAME OF
FATIIER
John Doherty
18 BIRTHPLACE OF
unknown
FATIIER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Ellen Conlin
20 BIRTIIPLACE OF
MOTIIER (City)
(State or country)
unknown
6
DATE OF BURIAL 19
Informant
(Address)
Mary E. Doherty
20 Ocean view St.,
Winthrop"
7 NAME OF
Maurice W. Kirby
FUNERAL DIRECTOR
ADDR
210 Winthrop St., Winthrop
JAN IS 1959 19
Received and filed
Charles A. Mach
(Registrar)
PARENTS
50M-1-58-921976
PLACE OF DEATH
MR-301A I
TRUCTIONS FCR IL CERTIFICATE
OF DEATH not enter a than one le for each , (b) and (c)
does not mida e of dying. heart failure,
ese. or compli- which caused
ioas, if any. gave rise to (.). the under. last. 181
itioas contrib .- death but not to the terminal condition siora
Chapter 137, 1954, requires sna to print er he cause or Bof desth on ertffcates.
31 1959
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
January 11, 1959
DEATH
(Month)
(Day)
(Year)
I HEREBY
CERTIFY,
That I attended deceased from
Jan. 2
59
Jan. 11
59
- --
to
I last ssw h AMove on
Jan. 11. ..... 159 ., death is said to
have occurred on the date stated above, al _2:35P. m.
DEATH WAS CAUSED CY: IMMEDIATE CAUSE
Carcinomatosis
(a)
Due To
Carcinoma of Bladder
(b)
Due To (c)
OTIIER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
YOU
What test confirmed diagnosis ?...
S Was disease or injury in any way related to occupation of deceased ?...
If so, specily
(Signed)
Charles Alucas
M. D
(Address) 750 Harrison AVOpate.
1-11 ,59
Boston®
Com-Winthrop 2M899
I HEREBY CERTIFY that a satisfactory standard certificate of death wasfiled with me BEFORE the burial or transit permit was issued: w" J"." "Kane
(Signature of Agent of Board of Health or other)
879
1-12-59
(Official Designation) (Date of Issue of Permit)
V.B.V
Registered No.
[(If death occurred in a hospital or Institution,
St. [give its NAME instead of street and numher)
PHYSICIAN -- IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of chode)
INTERVAL
BETWEEN
ONSET AND
DEATH
A TRUE COPY ATTEST: Charles & mackie
City Registrar
T !!
1
1
.....
MAR 3 11959 AR
X
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 filed for burial permit with Board of Health 00522
31
f(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 Ro specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In place of death. www .... years. months. 1 days. In place of residence
50 yes
years
.months.
_ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
JANUARY
13
1959
DEATH
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
Jan. 13, ():15P)
to
That Pattended deceased from
19
59
Jan. 13,
WP last saw h_&tlive on
Jan . 13, . 1952_, death is said to
have occurred on the date stated above, at .
11:58P
m.
INTERVAL
BETWEEN
ONSET AND
DEATH
1 day
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Alfred D Allen
(nr) WIFE of
(llusband's name in full)
II IF STILLBORN, enter that fact here.
12
71
AGE
Years
Months .. ..
... Days
If under 24 hours
....__ Hours .... Minutes
13 Usual
Occupation :
Nurse
(Kind of work done during most of working life)
14 Industry
or Business :
Household
15 Social Security No ..
None
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Andrew Norton
18 BIRTHPLACE OF
Unable to obtain
FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Mary Smith
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Unable to obtain
21 Records Town of Winthrop
Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death
ed with me BEFORE IhO
Omal or transit pern
(Signature of Agent of Board of Health or other)
Received and filed
Cracia H.
JAN - 0,1959 Jackie"
(Registrar)
PARENTS
M. D.
1/14/
.19 59
6 Winthrop
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
(City or Town) Jan. 17 59
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
Winthrop, Mass
ADDRESS
COM-1-88-921876
PLACE OF DEATH
MR-301A 1
TRUCTIONS FOR L CERTIFICATE
1 giving Of DEATH not enter than one · for each (b) and (c)
does not mean dring. heart failure. rt. It means 1 .. or compli- › 420
joas, if cay, gave rise to (.). the under.
litions contrib. death but not to the terminal candition giorn
. Chapter 137, 1954, requires nos to print or the cause of of death on Partidcates.
..
R 31 1959
600965
1-16-59
(Official Designation)
(Date of Issue of Permet)
V.B.V
(a)
Due To
Hypertensive heart disease
(b)
year
(c)
Due To
Arteriosclerotic heart disease
yrs
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?.
No
What test confirmed diagnosis ?_. Clinical
$ Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed).
Callan
(Address) Asst. Dir. Mass. Gen'l Hosp. Pate
PERSONAL AND STATISTICAL PARTICULARS
2 FULL NAME
(If deceased Is a married, widowed or divorced woman, give also maiden name.)
PEACON VILLA
31 Villa Ave. St. WINTHROP, MASS
(If nonresident, give city or town and State)
No. MARY ALLEN
MASSACHUSETTS GENERAL HOSPITAL
Registered No.
(write the word)
Kingston
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial infarction
19
A TRUE COPY ATTEST:
Crumbs # Mackie City Registrar
TO,
1
6
MAR 31 1959 AM
OUT - OF - TOWN
To be filed for burial permit with Board of Hesith or i ·· Agent. 32
Registered No. 00908
j(If death oeeurred in a hospital or institution,
St. [give it. NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
No
(a) Residence. No. .. (Usual place of abode)
25 Minutes
Length of stay: In piace of death
years
months
days. In place of residence
8 years
months
day ..
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
23,1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I sttended deecased from
January 22 19 59,
January 2. 3. 1959
I last saw hittalive on January 23, 1957, death in said to
have occurred on the date stated above, at 12:20 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
PULMONARY EDEMA
INTERVAL BETWEEN ONSET AND DEATH 1 day
11 IF STILLBORN, enter that fact here.
12
AGE
7 9Years
Months
....
. Dsys
If under 24 hours
.Hours ...... Minutes
13 U'Rual
Oeeupation :
PAINTER
(Kind of work done during most of working life)
14 Industry
or Business
RETIRED
15 Social Security No LIDL
16 BIRTHPLACE (City)
(State or country)
RUSSIA
17 NAME OF
FATHER
MYER SHORE
18 BIRTHPLACE OF
RUSSIA
FATIIFR (City)
(State of country)
19 MAIDEN NAME OF MOTHER
SARAH - Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
JACK SHORE
21
Informant
(Address)
3 Maple CT., Roxbury
I HEREBY CERTIFY that a satisfactory standard certificate of death was Aled with me BEFORE the burial or transit permit was issued: mende
(Signature of Agent of Board of Health or other)
1105
1-26-9
(Official Designation) (Date of Issue of Permit)
MAR 31 1959
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
WIDOWED
10a If married, widowed. fr divorced .
HUSBAND of
TANNIE
ALPERT
(Give maiden name of wife in full)
(or) WIFF. of
(Ilushand's name in full)
(b)
Due To
MYOCARDIAL INSUFFICIENCY
(c)
Due To
ATHEROSCLEROTICHEART
DISEASE
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?.
yes
What test confirmed diagnosis ?..
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
I. D.
( Address )
(Signed) Beth Israel Hop, Date //2-3 1959
W. Roxbury
of Forest Hills Crematory- Place of Burial or Cremation (City or Town) DATE OF BURIAL January 26 1954
7 NAME OF
Benjamin Birnbach
FUNERAL DIRECTOR
ADDRESS 10 Washington St. Dorchester
Received
Chiederle, ANANAS, 1959-19
(Registrar)
-
PLACE OF DEATH
Succolk (County)
The Commmuralth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Beth Israel Hospital.
No.
2 FULL NAME
DavidH. Shore
(if deceased in a married, widowed or divorced woman, give also maiden name.)
110-GAIN46 TEWKSBURY SK BC
U. S. War Veteran,
if Ro specify WAR)
WINTHROP.
(If nonresident, give city or town and State)
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter more than one ause for each (a), (b) and (c)
his does not mean mode of dying. as heart failure, wie, etc. It means disease, or compli- which caused
-420
iditions, if any, ch gave rise to (.). ing the ig case lat.
conditions contrib. - to death but not Id to the terminal 'e condition sion
·:- Chapter 137, of 1954, requires iclans to print or the cauce or is of death on certidestes. CHAP. 46, 11 9 & CHAP. 114 /145, CHAP. 3816.) risdiction lined by lical aminer I'M.10 ..........
PARENTS
Boston (City or Town)
N.B .- THIS IS A MARIENT RECORD. Use only ATE APPROVED ack ink or black pawriter ribbon.
)RM R-301
A TRUE COPY ATTEST:
RECEIVED Checks & Mackie
City Registrar
T
MAR 3 11959
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Mannachusetta 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. 3 010305
Registered No.
J(If death occurred in a hospital or institution. St. { give its NAME instead of street and number)
Albert Mardon
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
29 James Ave.
(Usual place of abode)
4
Length of stay: In place of death years months days. In place of residence
2
.years
.months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE. OF
DEATII
January 24, 1959
(Mooth)
(Day)
(Year)
That
I attended deceased from
1959 ..
I last saw him alive on
Jan.
24
,
19
5 Sarath is said en
have occurred on the date stated above, at 1 : 00
Pm.
INTERVAL DE. TWEEN OFSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATII (a)
pneumonia
ANTE
Die To
cerobral vascular
CEDENT (b)
CAUSES
accident
2wk8
Due To
(c)
generalized
arteriosclerosis
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operation .!.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
I Was disease or injury in any way related to occupation of deceased? Il so. specify 21 cécile élange M. D
(Signed) (Address05WashingtonSt.
Date 1-24="
10.59
6 It Hope
Place of Burial or Cremation
(City of Town)
DATE OF BURIAL
Jan .... 27.
19. 59
7 NAME OF
PUNERAL DIRECTOR
Howard S Reynolds
ADDRESS Winthrop Mass
Received and Alled ...
.. 19
€
(Registrar)
8 SEX Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCEDWidowed
10a If married, widowed, or divorced
HIUSBAND of ...
Fannie Bassett
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IP STILLBORN, enter that fact here.
12
2 day AGE 70 Years
5
Months
27Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :.
Distiller
(Kind of work done during most of working life)
14 Industry
or Business:
Drugs
15 Social Security No. 012-10-0728
16 BIRTIIPLACE (City)
(State or country)
Hass
Boston
17 NAME OF PATHE David Marden
18 BIRTHPLACE OF PATHER (City) (State or country) Mass
Boston
19 MAIDEN NAME OF MOTHER Mary Jane E-N-P2V
20 BIRTIIPLACE OF MOTIIER (City) (State or country)
Boston
Mass
21 Albert M Marden Jr
Informant 29 James Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buplal or transit permit was issued: f meadr. (Signature of Agent of Board of Health or other)
115
1-26-39
(Offilim Designation)
(Date of Issue of Permit)
X
-
PHYSICIAN - IMPORTANT SWas deceased a U. S. War Veteran, if so specify WAR) NO.
Winthrop
St.
(If nooresident, give city or town and State)
INSTRUCTIONS FOR DICAL CERTIFICATE
In elving AUSE OF DEATH do not enter more than one cause for each ! (a), (b) and (e)
This does not mean mode of dying. such sarl failure, asthenia, > It means the disease. complications which sed death.
Morbid conditions. ny, citing rise to the * cause (a) staling underlying
Conditions contrib. It to the death but not 'ed to the disease of lition causing death.
AR 31 1959
FORM 2-301A - Boston
(City or Town) 95 Moreland St.
No.
2 FULL NAME
PERSONAL AND STATISTICAL PARTICULARS
PARENTS
Dor. Boston
SOM-5-52-007046
4THEREBY CERTIFY.
Jon ...... 11 ,. 19 59 ... .
10
Jan.
.24
A TRUE COPY ATTEST: Charles it mackie City Registrar
MAR 31 1959 AM
X
PLACE OF DEATH
Essex
(County) Danve s
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danver's
(City or Town making this return)
34
Registered No.
"(If death occurred in a hospital or institution, Denvera State Hospital, dethornest. ( give its NAME instead of street and number) No ..
2 FULL NAME
Puth C. Homing
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 70 Bowdoin St., Winthro, dass. Sı
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death 0 years & months 7 days. In place of residenceyears months ............ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February
15,
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
copt. 8,
That I attended deceased from
19
58
0. 15,
19.
59
I last saw h ...... alive on
to
b. 12,
1929, death is said to
have occurred on the date stated above, at 7:45A. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) 17sheimer's Disease
INTERVAL BETWEEN ONSET AND DEATH
OTHER
Generalized
SIGNIFICANT
CONDITIONS
Arteriosclerosis
yrs
Was autopsy performed?
What test confirmed diagnosis? Clinical :laboratory
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) Andrew Nichols, III M. D.
(Address)
nathome, w239. Date
2/19/10
Cambria e cemetery-Cambrid 6 6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
February 17, 1999
7 NAME OF
FUNERAL DIRECTOR
Watertown, dass.
ADDRESS.
Received and filed. 3-20- 59 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
Thito
10 SINGLE
(write the word)
MARRIED
WIDOWEDLidowca
or DIVORCED
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
1.Maurice Dustin
(or) WIFE of2 Prank
Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 64 Years 2
.Months.
15 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 ..
486-32-7071
16 BIRTHPLACE (City).
(State or country)
welinton
17 NAME OF
FATHER
Charles Coolidge
18 BIRTHPLACE OF
unk.
FATHER (City)
(State or country)
unz.
19 MAIDEN NAME OF MOTHER Julia Streeter
un'.
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
upk.
21
Informant.
(Address)
iathorne, Masa
A TRUE COPY
ATTEST:
Daniel Toomey
(Registrar of City or Town where death occurred)
DATE FILED tev. 20
19. 59
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Due To (b)) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c) ....
25M-2-58-922072
A R-302 1
PARENTS
iary L. Shechan
J. . MacDonald
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Housekeeper
no
X PLACE OF DEATH
(County) Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
36
(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).
non-e
St. Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death. years. 35 months 3 days. In place of residence years months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MARCH
3
1959 (Year)
(Month)
(Day)
That I attended deceased from
4 I HEREBY CERTIFY,
Feb. 28, 159
to.
MARCH
3
59
I last saw himglive on
March 3, 1959, death is said to
have occurred on the date stated above, at
9:30 A.m.
INTERVAL BETWEEN ONSET AND
DEATH 4 days
Due To (b)
ns, if any, gave rise to cause (a), the under- cause last. Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONe.
No
Was autopsy performed ?
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? If so, specify.
No PARENTS
Sharon "em. Park SharonMass. Place of Burial or Cremation (City or Town)
DATE OF BURIAL
3-5-59
19
" NAME OF Schlossberg & Sons
FUNERAL DYRE
1257 Blue Hill Ave. Matt.
ADDRESS
Received and filed
MAR 5 1959
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
white
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Eva Smaller
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 73 Years
Months
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
Salesman
(Kind of work done during most of working life)
14 Industry
or Business:
Hardware Business
15 Social Security No ...
034-14-3660
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER Mendel Leventhal
18 BIRTHPLACE OF FATHER (City) (State or country) Russia
19 MAIDEN NAME
(Signed).
Charles Liberan
M. D.
OF MOTHER
Leah ( c.n.b.I)
20 BIRTHPLACE OF
MOTHER (City)
...
(State or country)
Russia
21 Informant +. Tillie Richards
(Address)
566 Harvard St. Matt.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the parial or transit permit was issued:
Health office (Signature of Agent of Board of Health or other) (Official Designation) (Date of Issue of Permit) 3/4/59
-
AR-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean , of dying, heart failure, etc. It means e. or compli- which caused
ions contrib -- death but not the terminal ondition given
Chapter 137, 954, requires is to print or cause or f death on
tificates.
Winthrop, Muss Date 3/3/
1009
6
50M-11-56-918978
2 FULL NAME Israel 4 eventha?
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 58 Summit Ave.
(Usual place of abode)
Winthrop Comm. Hosp. No ..
Registered No.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(2) Cerebral Hemorrhage
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 if 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 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 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 of ly 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 ( ne 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 rinety-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 shal 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
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.