USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 53
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3 DATE OF
DEATH
JUL 25. 1954
(Month)
(Day)
(Year)
8 SEX F
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
r DIVOR
MARRIED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Hugh H. Bradley
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
63 Years
6
Months
2
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)
Fitchburg Mass.
17 NAME OF
FATHER
Samuel Peterson
18 BIRT11PLACE OF
FATHER (City)
(State or country)
Sweeden
19 MAIDEN NAME
OF MOTHER
Anna Anderson
20 BIRTHPLACE OF MOTHER (City) (State or country) Sweeden
21
Info
Hugh L. Bradley-son
(Address) 62 Montmorency Ana E. Boston
I HEREBY CERTIFY That a satisfactory standard certificate of death was filed with me BEFORE the fourtal or transit permit was issued: of ertou
Signature of Agent of Board Health of gther)
3396
6 -26-59
(Official Designation)
(Date of Issue of Permit)
.
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS 917 Bennington St. E.Boston
Received and Grey?
JUN 2 9 1969
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH HOURS
YEARS
Due To (c)
OTHER SIGNIFICANTRIGHT MIDDLE CEREBRAL TERCIBOSIS CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?. AUT. PSY AND CLINICAL
Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Hielostein
, M. D.
Jest Mery Hosp. Date June 25
1959
(Address)
6
Winthrop Cemetery, Winthrop Place of Burial or Cremation (City of Town)
DATE OF BURIAL June 29th .
PARENTS
C.
CERTIFICATE OF DEATH
Registered No.
6185
MILDRED FRADLEY 2 FULL NAME.
( If deceased is a married, widowed or divorced woman, give also maiden name.)
4 I HEREBY CERTIFY. That I attended deceased from
JULY 5,
19 58, to. JUNE
25
I last saw h Ilealive on MME 25,
1.59
. death is said to
19.542
have occurred on the date stated above, at .12:20.P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
PULMONARY EDEMA
(a)
PLACE OF DEATH
MR-301A
-THIS IS A NENT RECORD. se only : APPROVED ink or black writer ribbon.
TRUCTIONS FOR L CERTIFICATE giving OF DEATH not enter than one for each (b) and (c)
does not mean e of dying. heart failure. etc It means 11. or compli- a kick caused
As, if any, case rise to ( 6 ) . the under. last. 422. tions contrib __ death but not the terminal ondition giers
Chapter 117. 954, requires a to print of cause of f death on tificates. P. 46, 11 9 & P. 114 $$ 45, AP 3816.) 1 1959
SUFFOLK (County)
Due TOARTERIOSCLERCTIC HEART DISEASE (b)
(write the word)
A TRUE COPY ATTEST:
Charles it Mackie
City Registrar
RECE VED
F TON
ERK
4)
HROP.
NOV - A1959 AM
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
173
OUT - OF - TOWN
To be filed for burial permit with Board of Health or Its Agent. .
CERTIFICATE OF DEATH
Registered No.
6358
2 FULL. NAME Ray Cometerf
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 63 Pleasant (Usual place of abode) Length of stay. In place of death years. months days. In place of residence years __. months ... days.
St ..
Winthrop
Massachusetts
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
1,
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That Lattended deceased from
June 25,
1959. to July
Welast saw dmalive on ..
July
1,
19 5.9, death is said to
have occurred on the date stated above, at
2:35P .m.
INTERVAL
BETWEEN
ONSET ANO
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)Coronary heart disease
with acute myocardial infarction
Due To (b)
Due To (c)
OTHER
SIGNIFICANTHypertension
CONDITIONS
5yrs
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
(Signed)
Elillan
M. D.
(Address) Charles L. Clay. Ass't Dire Mann, Ge g. P. Here Date 7-1 - 1, 59
6 HOLYCROSS CEMETERY MALDEN Place of Burial or Cremation (City of Town)
DATE OF BURIAL
JULY4TH
1957
7 NAME OF FUNERAL DIRECTOR RICHARD C. KIEDY INC. ADDRES 917 BENNINGTONOT EAST BOSTON
Received andifiled Charles H. Mache -6 1959 (Registrar) NOV 10 1959
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
VY
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
MARRIED
10a If married, widowed, ot divorced
HUSBAND of
EDITH
AVALLONE
(Give maiden name of wife In full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE Y Years
> .... Months
.. Days
If under 24 hours
Hours ...... Minutes
13 Usual
DRESS DESIGNER
(Kind of work done during most of working life)
14 Industry
or Business :
CLOTHING
15 Social Security No ..
0 1 1 . 0 3 - 7 346
16 BIRTHPLACE (City)
(State or country)
ITALY
17 NAME OF
FATHER
DOMENICA SECATORE
18 BIRTHPLACE OF FATHER (City) (State or country) ITALY
19 MAIDEN NAME
OF MOTHER
ADELE DESIDERIO
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
ITALY
21 Informan MRS. EDITH SECATORE-LIFE (Address)) PLEASANT ST WINTHROP I HEREBY CERTIFY That & sati factory standard certificate of death was filed with me STORE the zontal or transit permit was issued :
(Signature bf Agent of Board of Health or other)
3456 (17-2-59
(Official Designation) (Dateof Issue of Fermit)
Y
IR-501A -
-THIS IS A ENT RECORD. . only APPROVED nk or black iter ribbon.
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and fc)
ors NO! MINE of dring. heart failure. Ic. It means r. or compli- rkich caused
.
U. if any, are file to (.), the under. aus last
ions contrib .- death but not the terminal Adition firm
Chapter 137, 954, requires s to prin1 or cause of death on tificates. P. 46 15 9 & P. 114 :: 45. AP. 38 $6.)
Director: use only CK Ink.
0.58-023866
1
No.
Massachusetts General Hospital
BAKER MEMORIAL
[(If death occurred in a hospital or instilulion,
St. [give ks NAME instead of street and number)
(RANETO SECATORE
PHYSICIAN - IMPORTANT
20
(Was deceased a
U. S. War Veteran,
if so specify WAR)
19
59
1 week
PARENTS
A TRUE COPY ATTEST:
Charles it mackeSCENE0 City Registrar
TOW
-1 12 -
LERK
:- )
6
THROP
NOV 20 01959 AM
0-41179
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
174
OF - TOWN
To be filed for burial permit with Board of Health
Registered No.
J(II death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME
JOHN M. BENSON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 85 Cottage Avenue
x x Winthrop, Mas Be
(II nonresident, give city or town and State)
Length of stay: In place of death ........ years. months -1days. In place of residence 3 .... years .... ... months. ...... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
3
1959
(Month)
(Day)
(Year)
4I HEREBY CERTIFY.
July 3
1959
10
July 3
19.59
XXXXXXXX -, death is said to
have occurred on the date stated above, at 4:00 P .m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
( a )
Acute myocardial infarction
INTERVAL BETWEEN ONSET AND DEATH
Hours
Due ToArteriosclerotic heart disease (b) ..
with coronary thrombosis.
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 . John J Schmidt
( Signe
M. D. (Address) VAH Boston, Mass.
DateJuly 4 1959
6 Forest Hills Cemetery
Boston, Lass (City or Town)
Place of Burial or Cremation DATE OF BURIAL July 19.59
7 NAME OF FUNERAL DIRECTOR Granstrom Funeral Home ADDRESS 821 Cummins Highway Mattapan -Mass.
Received you filed
NOV 9 1959
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Malo
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED Single
or DIVORCED
10a II 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
AGE
62
9
Months
3
.Days
If under 24 hours
Hours _._ Minutes
13 Usual
Occupation :
Printer
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No .. 817 16 0686
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Martin
18 BIRTIIPLACE OF
FATIIER (City) (State or country ) Sweden
19 MAIDEN NAME OF MOTHER Matilda Magnuson
20 BIRTHPLACE OF MOTHER (City) (State or country) Sweden
21 Hospital Records
Informant. (Address) 150 S. Huntington Ave. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: E 20269
N. L. Ummary
(Signature ol Agent of Board of Health or other)
(DateofIssue of Permits July 6, 1959
(Official Designation)
V.B.V
-
--- +
does not mean of
dving. heart failure. ett It means Y. or compli. which caused
*1. 1/ any. a:4 rue to (a). the wander. last.
1001 contrib .. death but not the terminal adition girm
Chapter 137, 954, requires s to print or cause of f death on tificates. P. 46, 51 9 & ₱ 114 :$45, AP: 3816.) aminer clined risdiction
0.58.023606
MR-301A
-THIS IS A VENT RECORD. . only APPROVED ink or black riter ribbon.
RUCTIONS FOR CERTIFICATE
giving OF DEATH
ot enter than one for each (b) anđ (c)
(write the word)
-
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, il so specify WAR)IMMI
(Usual place of abode)
ThaA attended deceased from
(Years)
Hour a
Roxbury
PARENTS
1
Veterans Administration Hospital Nc.
A TRUE COPY ATTEST: Cruces Ht Mackie City Registrar
TOW.
THE
NOVÉ01959 AM
K
Suffolk
The Commonwealth of Massachusetts - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
175
To be filed for burial permit with Board of Health or ita ABer
6613
No. . FRIEDA R. CHANCEY -
HOSP
J(If death occurred in a hospital or Institution,
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT (Was deceased a
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 9 FAUN BAR Ave.
St
WINTHROP
MASS
(L'sual place of abode)
9 hours
(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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX 7-
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCED
Momed
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Nathan Chancey
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Myocardial Infarction
INTERVAL BETWEEN ONSET AND DEATH 9 hours
11 IF STILLBORN, enter that fact here.
12
AGE H7 Years
... Montha
Days
If under 24 hours
....... Houra ...... Minutes
13 Usual
Occupation
Book Keeper
(Kind of work done during most of working life)
14 Industry
or Business :
Marton
Deportivont
15 Social Security No ....
020-30-7760
16 BIRTHPLACE (City)
(State or country)
Boston Mess
17 NAME OF
FATHER
Jack Marks
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIE
19 MAIDEN NAME
OF MOTIIER
Celva Marks
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russian
21
Informant
Isaac Dubchansky
(Address) 3 Dana St Revend
7 NAME OF FUNERAL DIRECTOR Tox Funeral Service Inc. ADDRESS 1. Washington St Chelsea
Received and
Charles H macke
JUL 1.4 1959 19
(Signature of Agent of Board of Health or other)
03569
Culuio, 1989
NOV 4 1959
28 years
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?.
EKG
S Was disease or injury in any way related to occupation of deceased ?/20 If so, specify
(Signed)
Jacob E. Berger
M. D.
330 Brukline ave. Barton 9 July 1959
(Address)
6
Tifeet Iswel of Fevere
Place of Burial or Cremation
DATE OF BURIAL July 10
(City or Town) 19:59
(Registrar)
(Official Designation)
(Date of base of Permit)
I
PLACE OF DEATH
(County) Boston (City of Town)
BETH ISRAEL
2 FULL NAME
DEATH
3 DATE OF
July
9
1959
(Year)
(Month) (Day)
4 I HEREBY CERTIFY
That I attended deceased from
ICE AM 9 July, 1959, to 12" PM 9 JULY
59
19
I last saw helalive on 9 July . 19.5.8. death is said to have occurred on the date stated above, at 12 ?? - P m.
(Give maiden name of wife in full)
Due To
Hypertensive ARTerioscleroTe
(b)
Heart disease
the
TRUCTIONS FOR L CERTIFICATE giving OF DEATH not enter than one for each (b) and (c)
does not mean de of dring , heart failure. ets le means re. or compli-
420 any. gate mur to (a). under- lest.
tions contrib .- > death but not the terminal condition gives
Chapter t37, 954, requires s to print or cause f death on tificaten. AP. 46, 15 9 & P. 114 ;: 45, AP. 3816.) MINER VERS59
0-58.923666 1
M R-301A 1
.- THIS IS A NENT RECORD. Jao only E APPROVED ink or black writer ribbon.
Registered No.
U. S. War Veteran,
no
-
if so specify WAR)
PARENTS
Event
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE-e burial or transit permit-was issued :
M. g. Dunkuster
A TRUE COPY ATTEST:
Charles it Mackie City Registrar
T'
-
EnK
THE
NOV - 41959
X 1 PLACE OF DEATH
Suffolk (County)
Boston
(City or Town)
The Commonwealth of Massachusetts - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No.
176
To be filed for burlal permit with Board of Health or its, Ag 6801
BAKER MEMORIAL, MASSACHUSETTS GENERAL HOSPITAL
No.
A.
2 FULL NAME
Charles Ring
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
(a) Residence.
No ..
176 Woodside Ave.
St.
Winthrop,
Mass
(L'sual place of abode)
Length of stay: In place of death .....
years
mon
10
days. In place of residence
years
(If nonresident, give city or town and State)
3
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
14
1959
(MonthY
(D)ay)
(Year)
4IHEREBY CERTIFY.
Thal I attended deceased from
July 10
59. in July,
14
1959
I last saw hl Malive on
uly
14
., 19
59 death is said to
have occurred on the date stated above, at 4:40am.
INTERVAL BETWEEN ONSET AND DEATH 2 yrs
11 IF STILLBORN, enter that fact here.
12
AGE
85, ,,11
29
Months
Days
If under 24 hours
Hours ..... Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business
Mason Regulator
15 Social Security No ....
011-01-0179
16 BIRTHPLACE (City).
(State or country)
Canada
17 NAME OF
FATHER
Ezekiel Ring
PARENTS
18 MIRTIIPLACE OF
FATHER (City) (State or country) Canada
19 MAIDEN NAME
OF MOTHER
Unable to be Learned
20 BIRTHPLACE OF MOTHER (City) (State of country)
Canada
21 Mrs. Geneva Aver-Daughter
Informanl
(Address)
176 Woodside Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial ontransit permit was issued:
(Signature of Agent of Board of Health of other)
E 20479 (Official Designation) (Date of Issue of Permit)
X
-
10a If married, widowed, or divorced Blanche E Roberts
HUSBAND of
(Give maiden name ot wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Metastatic squamous cell
carcinoma of thumb to skin
to arm and lungs
Due To
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?.....
no
What test confirmed diagnosis ?_
clinical
5 W'as disease or injury in any way related lo occupation of deceased? If so. specify
Chillar
(Signed)
C.L. Clay
M. D.
Date.
7-14-59
(Address) Asst. Dir. Mass. Gen. Hoso.
6
Blue Hill Cemetery,
Place of Burial or Cremation
DATE OF BURIAL
Braintree (City of Town) July 16
1959
7 NAME OF
L DIREC
Mortimer N. Peck
ADDRESS Braintree Massachusetts
Received and filed 171952 19
Charles H Mackie
(Registrar)
..... 29 ...
1959
1
1
IR-301A
THIS IS A ENT RECORD. · only APPROVED nk or black iter ribbon.
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each b) and (c)
oes not mean of
dying. heart failure. Ic. It means . or compli- which caused 11 us. if any. are rise to cause
(a). the under. last.
ons contrib __ leath but not the terminal adition given
Chapter 137, 54, requires s to print or cause of death on locates. P. 46, 55 9 & P. 114 $$ 45, AP. 38$ 6.)
J(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED1.
WIDOWED Vidowed
or DIVORCED
(or) WIFE of
(Husband's name in full)
Maintenance Worker
-
A TRUE COPY ATTEST: Charles it Mackie City Reporter
:.
0
11
NOV - 41959 AM
X
PLACE OF DEATH
Suffolk
(County)
1
Boston
STANDARD
CERTIFICATE OF DEATH
Registered No.
6896
2 FULL NAME Daniel J. MURPHY
(If deceased is a married, widowed or divorced woman, rive also maiden name.)
45 Waldemar Ave.
(a) Residence. No. ( L'sual place of abode)
Length of stay : In piace of death
O year ... 8
months 17 days. In place of residence .50
years ......... months days.
MEDICAL. CERTIFICATE OF DEATH
3 DATE OF
July
16
1959
DEATH
(Month)
(Day)
(Year)
4| HEREBY CERTIFY.
October 29 . 19 58, .. July 16
19.59.
XX XXXXXX , death is said to
have occurred on the date stated above, at 11:15₽ .m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
1. bronchopneumonia
(days)
2. A .- Septisemia (days)
3. Decubiti (months)
Due To
(b) -
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Cerebral infarction
10 moc
Was autopsy performed?
les
What test confirmed diagnosis? Autopsy&Clinical Findin
.. ....
5 Was disease or injury m any way related to occupation of deceased ?. If so, spaly
Allucu Rublee M. b.
(Address).
Holy Cross Cem., Malden, Mass. 6
Piace of Burial or Cremation
DATE OF BURIAL
July 20
59
19
7 NAME OF
FUNERAL DIRECTOR
Maurice Kirby
ADDRESS 210 Winthrop St., Winthrop, Mass
Received and filed
JUL 2-1 1959
19
(Registrar)
Charles A. Macke
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
MARRIED
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCED
10a Il married, widowed, or divorced
HUSBAND of Catherine Campbell
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 59 Years
9 Months
23Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation :
Lawyer
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No 025-03-3643
Boston
16 BIRTHPLACE (City)
(State or country)
Mass,
17 NAME OF
FATHER
Dennis Murphy
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Boston
19 MAIDEN NAME OF MOTHER Mary Abley
20 BIRTHPLACE OF
Salem
MOTHER (City).
(State or country)
Mass.
21 VA Hospital 150 S. Huntington Informant (Address) Ave., Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the total or transit permit was issued:
(Signature of Agent of Board of Health or other)
9 20546
1459
FOfficial Designation)
(Date of Issue of Permit) சுக்குநாடு
U.R.
RM R-301A
B .- THIS IS A ANENT RECORD. Use only TE APPROVED k ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE
In giving OF DEATH hot enter e than one se for each , (b) and (c)
does not mean ode or dring. heart failure. . etc. It means are of comple.
715 ions, if any, (.). the vader.
Minions costeId. death but not In the terminal condition sites
Chapter 137, 1954, requires na to print or e cause of of death on rtincates. AP. 46. 91 9 & AP. 114 :; 45, HAP. 38%6.) .S.
/1 1959
10.88 ... 3 ...
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF - TO177
To be fled for burial permit with Board of Health of Its ABery
No.
Veterans Administration Hospital
[(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) ...
WWI
Winthrop, Mass.
(If nonresident, give city or town and State)
PARENTS
(Signed).
VAR, BOSTON, MASS.
Date
19
(City of Town)
(City or Town) 1
That I attended deceased from
INTERVAL
BETWEEN
ONSET AND
DEATH
A TRUE COPY ATTEST: Denk it Mackie C · Revetrar
-
NOV - 41959 AM
PLACE OF DEATH
Suffolk
(County)
Boston
(City of Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
OUT - OF - TOWN
To be filed for burial permit with Board of Health or Its Arent 6929
No. New England Deaconess Hospital
[{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)
No
(a) Residence. No ..
107 Locust
(L'sual place of abode)
St
Winthrop.
Lass
(If nonresident, give city or town and State)
months ........... days.
MEDICAL CERTIFICATE OF DEATH
J DATE OF
DEATH
July
18
1959
(Monthy (Day)
(Year)
II HEREBY CERTIFY.
That I attended deceased from
.July
11 1959 to
July
18
1959
I last saw himlive on ... July. 18 19.59 , death is said to have occurred on the date stated above, at 1:35 p. m. INTERVAL BETWEEN ONSET AND (a) DEATH 1/2 HOUR
10% If married, widget of thisred Remer
HUSBAND of
(Give maiden name of wife In full)
(ot) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE56 Years. Months Day
If under 24 houra
Hours
Minutes
13 Usual
Occupation :
Jeweler
(Kind of work done during most of working life)
14 Industry
or Business :.
Self Employed
15 Social Security No. Cn 61
16 BIRTHPLACE (City).
(State of country)
Lowell, Mass.
OTHER
SIGNIFICANT
AORTIC STENOSIS, DIABETES CONNATIONS POST AORTIC VALVEWORLDEDISON
Was autopsy performed ?...
Fes
What test confirmed diagnosis ?. Autorees
17 NAME OF
FATHER
Henry Greene
18 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
19 MAIDEN NAME OF MOTHER Fannie (CBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Ohel Jacob, Woburn 6
Place of Burial or Cremation
(City of Town)
DATE OF BURIAL
July 19,
1959
7 NAME OF
FUNERAL DIRECTOR
Arnold Golov
ADDRESS 1668 Beacon St . Brookline
Received
21 1959 Charles H macker (Registrar)
PERSONAL AND STATISTICAL PARTICULARS
SEX Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
Ot DIVORCED Married
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CARDIAC ARREST
Due To
VENTRICULAR FIBRILLATION
(b)
1
Due To (c)
1/2 HOURS
PARENTS
21
Henry Greene
Informant
(Address) 95 Cross Hill Rd. Newton
I HEREBY CERTIFY that a satisfactory standard certificate of death s filed with me BEFORE the burial or bansit permit was issued: 320540
Signature of Agent of Board of Health or other) Jacky 19 1959
(Official Designation) (Date of save of Vermit)
R-301A -
-THIS IS A VENT RECORD. e only APPROVED ink or black riter ribbon.
RUCTIONS FOR CERTIFICATE giving OF DEATH ot antat than one for each (b) and (c)
does not mean e of drink. heart failure. etc. It means 1. or compli- 433
At. if any, gave rise to (a). the ... cause last.
death but not the terminal ondition tives
Chapter 137. 934, raquires as to print er e cause er f death on. tlfcates. AP. 46, 11 9 & P. 114 $$ 45, ΑΡ. 381 6.) 5.
1959
V 4 o-88. 2 ....
Î
STANDARD CERTIFICATE OF DEATH
Registered No.
2 FI'LL NAME. ir. Frank Greene
(If deceased is a matried, widowed or divorced woman, give also maiden name.)
Length of stay: In place of death ...... years .......
months 7 days. In place of residence 11year.
178
5 Was disease or injury in any way related to occupation of deceased ? ........ If so, specily Alberto ... Palatchi, !!!. D.
(Signed)
Adeterto Palatalho
M. D.
VOV FRANCE ST
Date JULY 18 1959
(Address)
A TRUE COPY ATTEST: Charles it Mackie City Registrar
1
NOV - 61959 AN
1
1
1
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
179 AT - TOWN
To be Aled for burial permit with Board of Health
$7086
BETH ISREAL No. CHARLOTTE ROUILLARD
Hosp
[(II death occurred in a hospital or Institution,
St. [give its NAME instead of street and number) -
(II deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 62 TEMPLE
St
WINTHROP
(Usual place ol abode)
Length of stay: In place of death.
.. years
months
I days. In place of residence
years ..
.months ....
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
JULY
23
(Month)
(Day)
1959
(Year)
4 I HERERY CERTIFY,
That I attended deceased from
JULY 22
V.
JULY 23
1959
I last saw h&Cative on
JULY 23, 19 57 death is said to
have occurred on the date stated above, at ... | ) .
A m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) ACUTE RENAL
FAILURE
INTERVAL BETWEEN ONSET AND DEATH 2 0415
MONTHS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
BRONCHOPNEUMONIA
DAYS
Was autopsy performed ?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? II so, specify no.
(Signed) David tempold
. M. D. ... (Address) 33c Brukline Due, Boston Date July 23
6 Henthon
Place of Burial or Cr mation DATE OF BURIAL July 25
(City of Town)
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