USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 41
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(Addre- 34 Hainstemaure Washiop
I HEREBY CERTIFY what a satisfactory standard certificate of death was hlert with/mo BEFORE the burial of transit permit was issued :
( Signature of Agents of Board & Health of other)
2405
(Official Designations)
2/15/59
(Date uf Issue of Permit)
Nature of Injury (Signed) If deceased was a U. S. War Veteran. ( L. Chap. +6, Section 10, requires physicians to avert a recital to that effect. = information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF of Death. See reverse side for extracts from the Isws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes 25M. 8-57.420750 B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Manner of Injury
26 1959
1
M R-307 A
1
tato E. Boston Solid Station
2 FULL NAME (Ruth
$I HEREBY CERTIFY that I have investigated the death of the person above named and that the CAUSE AND MANNER thereof are as follows: (If an mjury was involved, state lully.)
HYPERTENSIVE CARDIOVASCULAR DISEASE
CORONARY EXCLUSION
5 Acculent, suicide, or homicide (specify )
Date and hour ol injury
19
Where chid
Injury occur ?
(City or town and State)
Und injury occur in or about home, on larm, in industrial place, or in
pubhe place ?
(Specify type of place)
(How did injury occur ?)
While at work ?
Was autopsy performed? The
6 Was disease for injury in any way relation acompanion of deceased?
.. M. 1).
( Address) bonton.
19.59
PARENTS
Sales land
thi nonresident. give city en gown and State)
ased is a married, widowed of divorced woman, give alwooden name ) 36 Hawthorne Clve Hlin
- 'A TRUE COPY ATTEST: Charles At Mackie City Registrar
RECEIVED
-
AUG 2 61059 PM
The Commonwealth of Massachusetts UT - OF - TOWN EDWARD J. CRONIN To be filed for burial permit with Board of Health or its Agent. SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS Registered No. :3888 STANDARD CERTIFICATE OF DEATH
MASSACHUSETTS GENERAL HOSPITAL No.
f(If death occurred in a hospital or institution, St. (give its NAME instead of street and numher)
2 FULL NAME GEORGE ROWE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT (W'as deceased a U. S. War Veteran, No
if so specify WAR)
(a) Residence. No .. 46 MADISON
AVE.,
St ....
WINTHROP MASS.
(If nonresident, give city or town and State)
Length of stay : In place of death years .... months 1 days. In place of residence 45 years months days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
l'ale
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
4I HEREBY CERTIFY, That I attended deceased from
April 17, . 19 59. April 17
, 19 59
I last saw himalive on April 17,
1959. , death is said to
have occurred on the date stated above, at 9 ; 111 P
m.
10a If married, widowidow divorced N.
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
.69
12
AGE
Years
Months
If under 24 hours
Hours
Minutes
13 l'sual
Occupation :
Painter
(Kind of work done during most of working life)
14 Industry
or Business:
Self
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Springhill
7. Scotia
17 NAME OF
FATHER
El1 Rowe
PARENTS
18 BIRTHPLACE OF
Newfoundland
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTIIER
Mary Ann Crawford
Newfoundland
20 BIRTHPLACE OF MOTIIER (City) (State of country)
Y&r Town) 21 Informant Lillian Ellis
7 NAME OF
FUNERAL DIRECTOR
Maurice W Kirby
ADDRESS
210 Winthrop St. Winthrop
Received and filed
( Registrar)
.....
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
"@RClay
(Signed)
M. D.
C.L. CLAY MD
(Address) SST DIR MASS, GENEL Date Apr. 18 19 59
Winthrop
Winthrop
6
Place of Burial or Cremation
DATE OF BURIAL April 21,1958 19
INTERVAL BETWEEN ONSET AND DEATH
(a) acute Myocardial
Infarction
8 Yrs
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?...
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
1
B .- THIS IS A ANENT RECORD. Use only TE APPROVED k ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH
· not enter re than one se for each ), (b) and (c)
s does not mean ode of dying. I heart failure. a. etc. It means sale, or compli-
4700 if any. cair rise to (a). the under. cause last.
editions contrib .. to death but mot to the terminal condition goers
Chapter 137, f 1954, requires ians to print or the cause of of death on certificates. CHAP. 46, 11 9 & HAP. 114 :$ 45, CHAP. 3816.)
G 26 1959
M-10-50-923066
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
APRIL
17,
1959
(Year)
(Month)
(Day)
Warions
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(Usual place of abode)
-
(Address)
16 Madison Ave Winthrop
I HERENY CERTIFY that a satisfactory standard certificate of death ras filed, with me BEFORE the burial or transit permit was issued: d E15617 (Signature of Agent of Board of Health or other) April 19- 1959
(Official Designation) (Date of Issue of Permit)
RM R-301A
A TRUE COPY ATTEST: Charles r. Jackie City Registrar
RECEIVED
AUG 2 61059 PX
X
PLACE OF DEATH
SUFFOLK (County)
ROXBURY (City or Town)
No.
JEWISH
MEMORIAL
HOSPITAL
J(II death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
PHYSICIAN . IMPORTANT
(W'as deceased a ". S. War Veteran, if so specily WAR)
NO
(a) Residence. No. 44 TRIDENT STREET, WINTHROP St. (Usual place ol ahode)
Length of stay: In place of death
years ....
months / 3
days. In place ol residence
years _
months
days.
MEDICAL CERTIFICATE OF DEATII
3 DATE OF
DEATH
APRIL
(Month)
20 (Day)
1959 (Year)
4 I HEREBY CERTIFY.
That I attended deceased from
APRIL
8
19
59
10
APRIL
20,
59
I last saw hif?alive on
APRIL
20
. 19 59, death is said to
have occurred on the date stated above, at 1 2:20 1 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(2) CHRONIC PYELONEPHRITIS WITH UREMIA
Due To (b) __
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
HYPERTENSIVE ARTERIOSCLERITAS HEART DISEASE
YEARS
Was autopsy performed ?
NO
What test confirmed diagnosis?
CLINICAL
S Was disease or injury in any way related to occupation of deceased ? II so, specify
(Signed)
Priscila R. Santia, m. D
JEWISH MEMORIAL
(Address)
6 Chevra T
IniJIM of Boston
Place ol Burial or Cremation
DATE OF BURIAL
April
(City_or Town) 21,
1,59
7 NAME OF FUNERAL DIRECTOR Benjamin Birnbach ADDRESSLO Washington St. ,Dorchester
Received and filed
12 APR 2 3 1959 19
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
idowed
10a If married, widowed, or divorced
HUSBAND oI
(Give maiden name ol wile in full)
(or) WIFE ol
Yetta-Cannot be learned
(Ilusband's name in full)
11 IF STILLBORN, enter that Iact here.
12
6 MONTHS AGE 79 Years Months Days
If under 24 hours
Hours
Minutes
13 l'sual
Occupation :
Paper & Twine
14 Industry
or Business :
Stone & Forsyth
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Louis Nathanson
18 BIRTIIPLACE OF
FATIIER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Cannot be learned
30 BIRTIIPLACE OF
MOTIIER (City)
(State or country)
Russia
21 Informant Jacon Nathanson
(Address)
80 Strathmore Bd. Brighton
I HEREBY CERTIFYULS
was filed with me BE YERS
it permit was issued :
RIMac FAAS dard certificate of death
(Signature ol A) APR "1ª 19591th or other)
2479 (Official Designation) BOSTON HEALTA DEPF.P
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH
not enter e than one se for each , (b) and (c)
does not mean de of drink. heart failure. er. Is means 11. of compli- trhich caused .
the
(a). under- last.
itions contrib. death but not · the terminal Condition given
Chapter 137, 1954, requires as to print or e cause or of death on ertificates.
26 1959
SOM-11-36-910978
RM R/301A 1
OUT -OF - TOWN To be filed for burial permit with Board of Hesith or its Agent
Registered No.
: 14006
2 FULL NAME ABRAHAM NATHANSON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If nonresident, give city or town and State)
30
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
PARENTS
, M. D.
„Date APRIL 20 1959
Everett
(write the word)
. 19
INTERVAL
BETWEEN
ONSET AND
DEATH
(Kind of work done during most of working life)
C
iomr. if .y.
A TRUE COPY ATTEST:
Charles it Mackie City Registrar
RECEIVES
AUG 2 61:53 PM
De! 6/10/51
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Page 1480
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
No. MASSACHUSETTS GENERAL HOSPITAL
J(If death nccurred in a hospital or institution.
St. [give its NAME instead of street and numher)
2 FULL NAME. JOSEPH PAMAS (TA'ASIUMS) TAMOSIUNIS
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 124 READ STRIET
St.
WINTHROP,
MASS.
(L'suaf piace nf abode)
Length of stay: In place of death
years
months
Bys. In place of residence
3 years _ months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
AFRTL
(Month)
22
1959
(Day)
(Year)
8 SEX
Male
9 COLOR
"Thite
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCEDMarried
4 1 HEREBY CERTIFY.
That WEttended deceased from
Aril 20,
5
19
to
April 22,
. 19
59
I last sawh Inlive on . April 22, . 19.59. death is said to
have occurred on the date stated above, at _ 4: ICA m.
10a lf marri
HUSBAND of
Cannot be learned
Mary SUENADRidS game of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Senticaemia
INTERVAL
BETWEEN
ONSET AND
DEATH
3 dys
11 IF STILLBORN. enter that fact kere.
72
18
12
AGE
cars
Months
L Days
If under 24 hours
Hours
Minutes
13 Vun
Occupation:
Textile ;orker
(Kind of work done during most of working life)
14 Industry
or Business:
Textiles
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Lithuania
17 NAME OF Joseph Tamostunis FATHER Cannot be-learned
18 BIRTHPLACE OF
FATHER (City)
(State or country )
Gannot- be-learned
Lithuania
19 MAIDEN NAME
OF MOTHER
Maggie Tinasiueie
Cannot be learned-
30 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannot be-learned Lithuania
21
Informant
Conly & Fahey
(Address)
Lewiston, Meine
7 NAME OF
FUNERAL DIRECTOR
Fahey & Conly
ADDRESS
Lewiston, Meine
Received and filed
APR 2 4 1958 19 Charles A. Inak
. M. D.
4/22/ 1959
Mt. Hope Cemetery
6
Place of Burial or Cremation
Lewiston, Me
(City or Town)
DATE OF BURIAL
April 25,
19
5
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kine
2537
(Signature of Agent of Board of Health or other) 9537
(Official Designation)
(Date of Issue of Permit)
X
M R-301A
B .- THIS IS A ANENT RECORD. Use only TE APPROVED k ink c, black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE
n giving OF DEATH
not enter e than one se for each , (b) and (c)
does not mean O' dVIRg. heart failure.
. or compli- thick 501
Io05. 1/ any. ta:e rue to (a). the under- last.
irions contrib -- > death but not . the terminal condition gires
Chapter 137. 1954, requires ens to print or De cause or of death on rtincates. AP. 46.99 9 & AP. 114 $$ 45, HAP. 38$6.)
26 1959 5 .
10.5.923 ...
PLACE OF DEATH
SUFFOLK
(County)
BOSTON (City or Town)
1
(b)
Acute general peritonitis
Due To
(c)
Post-necrotic cirrhosis of
the liver
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
NO
What test confirmed diagnosis ?-
Clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
Che@low
(Signed)
C. L.CIAY. NO.
(Address) ASST. DIR .. ASS. GENELDate
3 dys
23 yrs
Due To
Registered No.
4071
No
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran.
if so specify WAR)
(If nonresident, give city or town and State)
A TRUE COPY ATTEST: Charles it Mackie City Registrar
. :
AUG 2 6ICC3 PM
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusett@UT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health 30
4467
No. MASSACHUSETTS GENERAL HOSPITAL
2 FULL NAME. angelo fanta
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 23 Wood side (Usual place of abode)
QUE.
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.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
8 SEX
MALE
9 COLOR
WHITE
(write the word)
10 SINGLE
MARRIED
WIDOWEDWIJOWED
or DIVORCED
4I HEREBY CERTIFY.
That attended deceased from
april.
29. 1959. to May
3
. 1979
Welast saw h! Malive on May
.. 3
1957
, death is said to
10a If married, widowed, or divorced, HUSBAND ROSINA VENTIMIGLIA (Give maiden name of wife in full )
(or) WIFE of
(Ilusband's name in full)
11 IF STILLBORN, enter that fact here.
12
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupa
LABORER (RETIRED)
(Kind of work done during most of working life)
14 Industry
ROAD CONSTRUCTION
15 Social Security No. 011-12-9195
16 BIRTIIPLACE (City)
(State or country)
ITALY
17 NAME OF FATHER ANGELO CALDARELLA
18 BIRTHPLACE OF
FATHER (City)
(State or country )
ITALY
19 MAIDEN NAME
OF MOTIIE
CARMELA LOVETERE
20 BIRTHPLACE OF MOTIIER (City) (State or country )
ITALY
21 Informa CARMELA LAMONICA (Address]WOODSIDE.VE. WINTHROP
I HEREBY CERTIFY hat satisfactory standard certificate of death was filed with me BEFORE Abe burial or transit permit was issued: flagerson (Signature of Agent of board of health or other)
2687 (Official Designation)
5-5-59
(Date of Issue of Permit)
X
>
(a)
PNEUMONIA
RIGHT
LOWER CODE, LOBULAR
Due To
BRAIN STEM
(b)
INFARCTION
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 ? If so. specify
(Signed.t. Clay, MD -
, M. D.
(Address Asst Dir Mass Gen'] Date 5 /3/
195%
WINTHROP
Place of Burial or Cremation
WINTHROP (City or Town)
DATE OF BURIAL MAY 6
7 NAME OF FUNERAL DIRECTOR DIPIETROKVAZZA ADDRESS HENRY ST EAST BOSTON
Received and filed Les 21 DAY- 19 Reg
PERSONAL AND STATISTICAL PARTICULARS
Way
3
1959
(Year)
have occurred on the date stated above, at 7
0
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
.m. INTERVAL BETWEEN ONSET ANO DEATH 4 DAYS
5 PAYS
R.301M
-TAMIS IS A TENT RECORD. · only APPROVED nk or black iter ribbon.
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each b) and (c)
Does not mean of dying. heart failure. fc. It means . . or compli. hich caused
332 any. De rise to ause the
(a).
last.
ns contrib .- ath but not the terminal dition giren
Chapter 137, 4, requires to print or cause or death on dcates. . 46,959 & . 114 $$ 45, P. 38$6.) 6 1959
1
CERTIFICATE OF DEATH
Registered No.
[{If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
CALDARELLA
PHYSICIAN - IMPORTANT
( Was deceased a
(T. S. War Veteran,
if so specify WAR)
Mass.
PARENTS
RECEIVEY
A TRUE COPY ATTEST: Charles H. Mackie
City Registro
AUG 2 61C53 PM
X
PLACE OF DEATH
SUFFOLK
(County)
POSTON
(City or Town)
The Commonwealth of Massachusetts OUT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burisi permit. with Board of Health .. or its Agent. 4466
No. MASSACHUSETTS GENERAL HOSPITAL
2 FULL NAME HENDRICITS. John W
(If deceased is a married, widowed of divorced woman, give also maiden name.)
[(If death occurred in a hospital or institution,
Si. (give its NAME instead of street and number)
-
PHYSICIAN - IMPORTANT
( Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No. 28 RIVER Rd .. WINTHROP St. MASS
(Usual place of abode)
Length of stay : In place of death
years
... months 1
days. In place of residence 35ears
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(1)ay)
4 I HEREBY CERTIFY.
That's attended deceased from
MAY 3
1959
MAY
3
. 1959
welast saw HAY slive on
MAY
3
... 19 > 7, death is said to
have occurred on the date stated above, at
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Mesenteric emboli è
(a)
infarction of bowel extensive
hours
Due To
Rheumatic heart
(b) .
disease - mural thrombus
urs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
accidents multiple do urs
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
@@@com
c.treClay.
(Address).sst .Dir. kass .Jen'die
5.4
6 Winthrop Cemetery, Winthrop
Place of Burial or Cremation
DATE OF BURIAL May 6th 19
59
7 NAME OF
DIRECTO Richard C. Kirby 917 Bennington St.,E.Boston
Received Charles 24 MAY 6 1959 19
PARENTS
17 NAME OF
FATHER
Sabino Hendricks
18 BIRTHPLACE OF
FATHER (City)
Madieros Islands
(State or country )
Portugal
19 MAIDEN NAME
M. D.
OF MOTHER
Maryann DeMattos
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portugal
Madieros Islands
21 Mrs. Victoria Hendricks-wife (Address) 28 River Rd .. Winthrop
I HEREBY CERTIFY the was filled with Ded BY FPT a satisfactory standard certificate of death the burial or transit permit was issued:
Doperson
2686
(Signature of Agentsof Board of Health or other)
5-5-59
(Official Designation)
(Date of Issue of Permit)
1
THIS IS A NT RECORD. only APPROVED k or black er ribbon.
CTIONS OR CERTIFICATE iving
F DEATH tenter an one or each ) and (c)
es mot mra. of diving. art failure. . It means or compli. ich caused 416 . if any, 's rise to (a). he wader- last.
As contrib .- ath but mot the terminal dition sites
bapter 137, 4, requires to print or cause of death on dcates.
. 46, 159 & . 114 3: 45, P. 38$6.) 26 1959
ADDRESS
MAY
3
1959
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of
Victoria LaVoie
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in fall)
11 IF STILLBORN, enter that fact here.
12
AGE 75 Years 8
Months 4 . Days
If under 24 hours
Hours
Minutes
13 L'sual
Occupation :
Power foreman
(Kind of work done during most of working life)
14 Industry
or Businesé
N.E. Telephone Co.
15 Social Security No.
011-07-9278
16 BIRTHPLACE (City) (State or country) Mass.
East Boston
Cerebro vascular
.
INTERVAL
BETWEEN
ONSET AND
DEATH
PERSONAL AND STATISTICAL PARTICULARS
(If nonresident, give city or town and State)
CERTIFICATE OF DEATH
Registered No.
3
R-30LA
TECCity Registrar
-
AUG 2 6 1259 PX
Injury Nature of Injury (Signed) of Death. See reverse side for extracts from the laws relative to the return of certificates of death If deceased was a U. S. War Veteran, G.I .. Chap. 46, Section 10, requires physicians to insert a recital to that effect. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF public place ?
PLACE OF DEATH
Suffolk (County)
..... Boston (City or Town)
Che 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.
4637
No. Army Base Infirmary, .So. Boston St. } give its NAME instead of street and number)
2 FULL NAME
DANIEL ... G ...... SEARS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
52 .... Pable Avenue
( l'sual place of abode)
St
Winthrop,
Ma.s.8.
(If nonresident, give city of town and State)
Length of stay : In place of death ........
.years ..
.. months
.days. In place of residence.
..... years .......... months ...
.days.
MEDICAL CERTIFICATE OF DEATII
3 DANTE OF
DEATH
May
8
1959
(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.)
CORONARY THROMBOSIS
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
male
IO COLOR OR RACE
white
HI SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
HUSBAND of
lla If married, wHelen Fuller
(Give maiden name of wife in full)
(or) WIFE of
(Ilusband's name in full)
12 IF STILLHORN, enter that fact here.
13
AGE.
53 ... Years
Months ...
Days
If under 24 hours
Hours ........ Minutes
stevedore
14 Usual
Occupation :
(Kind of work done during most of working life)
15 Industry
I. L. A.
or Business :
16 Social Security No.
029-03-3761
17 BIRTHPLACE (City)
East Boston, Ma88.
(State or country)
IR NAME OF
FATHER
William E. Sears
19 BIRTHPLACE OF
FATIIER (City)
St. John's
(State or country )
New Brunswick
20 MAIDEN NAME
OF MOTHER
Mary A. Murphy
21 BIRTHPLACE OF
MOTHER (Citv)
(State or country)
Boston Mass.
22 Helen Sears
Informant
(Address)
52 Febble Ave. Winthrop
& NAME OF
FUNERAL DIRECTOR
Frederick J. Magrath East Boston
ADDRESS
Received and · filed
19
(Registrar)
PARENTS
7 Minthrop Cremation. Winthrop
DATE OF BURIAL May
.11 19.59
25M- 8-57. 920750
26 1959
1
R-303 A
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
Manner of
(Specify type of place)
(Ilow did injury occur ?)
While at work ?
Was autopsy performed? Mea
6 Was unsere or intry in any way related to semination of ideased?
M. D. (Address) Boston, Mass Da'e 5/8 .. 19.59
I HEREBY CERTIFY that a satisfactory standard certificate of death Was filed with nt BEFORE the burial or wassit permit was issued : TusenE FEonall' S 19684 (Signature of Agent of Board of Health or other) Thay 5 1959
(Official Designation) ( Date of Isine of Permit)
Registered Nn.
f(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
(W'as deceased a
U. S. War Veteran,
if so specify WAR)
no
A TRUE COPY ATTEST:
Charles it. Mackie
City Registrar
AUG 2 61CC9 PM
X
PLACE OF DEATH
Suffolk (County)
Boston
(City of Town)
CERTIFICATE OF DEATH
Registered No.
4713
No .. Garfield Sophie
St. (give its NAME instead of street and number) PHYSICIAN (Was deceased a IMPORTANT
U. S. War Veteran.
No
(a) Residence. No.S
(Usual place of abode)
Length of stay : In place of death. years. months
18 days. In place of residence 3
years
months.
. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
11
1959
(Day)
(Month)
(Year)
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED
(write the word)
Widowed
CERTIFY
That I attended deceased from
I last saw he alive on
may
11
89
., 19
death is said to
have occurred on the date stated above, at 3:25 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral Hemorrhage
INTERVAL BETWEEN ONSET ANO DEATH
11 IF STILLBORN, enter that fact here.
18 days 12 AGE 72 Years Months Days
If under 24 hours
Hours ..... Minutes
13 L'sual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
At Home
15 Social Security No ...
none
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Isaac Segal
18 BIRTHPLACE OF FATHER (City) (State or country )
Russia
19 MAIDEN NAME
OF MOTHER
Gertrude Gisse Solomon
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
7 NAME OF
DIRE Torf Funeral Service, Ins ADDRESS 615 Beacon St. Brookline
Received and Med
1 3 1959
-- 19 Charles ? I nack ( Registrer)
279 (Official Designation) (bite of Issue of Permit)
5- -89
X
- -
PARENTS
S Was disease of injury in any way related to occupation of deceased? NO If so, specify
(Signed)
Robert & Besnick
(Address).
M. D. Robert M. Ites Bien 5/4 059
Anshe Sfard of Lynn Cem. - Danvers Place of Burial or Cremation (City or Town) DATE OF BURIAL
May 12, 59 19
21 Informant John N. Garfield (Address)11 Clements Rd. Newton
HEREBY CERTHY theya satisfactory standard certificate of death was filed with MetBEFOREthe burial or transit permit was issued :
26 1959 s .
The Commonwealth of Massachusetts UT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH To be filed for burial permit with Board of Hewith- or its Agent. DIVISION OF VITAL STATISTICS STANDARD
Beth Israel Hospital
[(11 death occurred in a hospital or institution,
2 FULL NAME
(If deceased is a married, widowed or divorce woman, give also maiden name.)
24 Shore Drive
St ..
Winthrop
if sg specify M'AR)
Muss
(If nonresident
give city or town and State)
-
(Ilusband's name in full)
(a)
Due To Hypertensive at Cerebrovascular Disease
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
No
What test confirmed diagnosis' ..
SpinalCanal Puncture
least
3yrs
10. If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Joseph Garfield
does not mean of dying. Arest failure. etc. It means e, of comple- which caused 334 . if any. ate rise to cause
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