USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 71
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PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
MARRIED)
WIDOWED
or DIVORCED
E
of dying. heart failure.
1. or compli- "rhich caused
APPROVED ink or black iter ribbon.
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
any.
days.
1 YAS.
Boston
PARENTS
, M. D.
20 BIRTHPLACE OF
MOTHIER (City)
(State or country)
Mass
No.
A TRUE COPY ATTEST: Charles it makes City Registrar
JAN 2 21900 C.
1
1301
1
Boston (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICATARRARINER'S CERTIFICATE OF DEATH
OUT - OF TOTT
Boston 254
(City or Town making this return)
Registered No.
10952
J(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
Jeanne Goldberg
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
14 Dolphin Av
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
November 18, 1959
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
, 19_
.. , to
,
19
I last saw h ______ alive on
., 19
, death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Aortic stenosis
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
Richard Ford
Boston
. M. D.
(Address)
Mt Lebanon, W Roxbury, Mass.
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
November 20,1959
19
7 NAME OF
FUNERAL DIRECTOR
Arnold Golov
1668 Beacon St, Brookline
ADDRESS
November 23, 1959
19
Received and filed Charles H. LA
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
10 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
Female
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Sampson Goldberg
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE71 Years.
Months
.. Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
(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
Morris Steinberg
18 BIRTHPLACE OF
Russia
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Myron Norman (Son)
Informant
(Address)
147 Payson Rd Brookline
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
1
5415
11- 20: 5 4
(Official Designation) (Date of Issue of Permit)
A TRUE COPY ATTEST:
818 Harrison Avenue
No.
PLACE OF DEATH
ONS
IFICATE
118 DEATH iter one each .nd (c)
Brot mean dying, failure, It means compli- caused
if any, rise to (a), under- last.
contrib- but not terminal on given
SOM-3-57-919789
22 1960
Suffolk (County)
Date
11/18/59
PARENTS
Housewife
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the 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 or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body n 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 uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shall exhume a human body and emove 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 hall have been delivered to such board, agent or clerk, as the case may be. satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, 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 nough for the purpose, or is insufficient, a physician who is a member of the board f health, or employed by it or by the selectmen for the purpose, shall upon pplication make the certificate required of the attending physician. If death is aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town o 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 he undertaker desiring to make such removal shall constitute a permit for such emoval; provided, that such body shall be returned to the town from which it was emoved within thirty-six hours after such removal, unless a permit in the usual orm for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. . - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1), Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) | Medical Examiners will investigate and certify to all deaths supposably due to injury.[ These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
100
time
Type
the Wat
C
No Acts
D
CA
U
11 52
R-301X
.
Boston
The Commonwealth of Massachus: ItBUT - OF - TOWN JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS To be filed for burial permit with Board of Health or its Agent. 10944 STANDARD CERTIFICATE OF DEATH Registered in
Veterans Administration Hospital
2 FULL NAME
Clarence ... R .... BAXTER
. If deceased is a married, widowed or divorced woman, give alan maiden name.)
14 Mermaid Ave.
Winthrop, Mass.
tlf nonresident. give city of town and State)
length of stay
In place of death
years
-1
days. In place of residence
-
years
. months
days
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
DEATH
November
19
1959
( Month)
( Dav)
(Year)
4I HEREBY CERTIFY,
That WAStended deceased from
November 18. 19 59 . to ... November 19
19
59
Xxxxxx, death is said in
have occurred on the date stated above, at
2:50 a. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here
12
AGE. 62 Years.
O .... Months
21
Days
If under 24 hours
Hours .....
Minutes
13 U'snal
Occupation
Painter
(Retired) .
( Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
021 - 20 - 4153
16 BIRTHPLACE (City)
(State of country )
Mass
Somerville
17 NAME OF
FATHER
Clarence Baxter
18 BIRTHPLACE OF
FATHER (City)
Nova Scotia
(State or country)
Canada
19 MAIDEN NAME
OF MOTHER
Sarah Sweet
20 BIRTHPLACE OF
Nova Scotia
(Address)
(PRINT OR TYPE SIGNATURE)
VAH, Boston, Mass. Date Now ....... 19 ... 19 ...
6
Woodlawn Cem., Everett, Mass.
Place of Burial or Cremation
DATE OF BURIAL
19
(City or Town)
November 21
59
7 NAME OF
FUNERAL DIRECTOR
Elwood G. Bryant
ADDRESS
181 Broadway, Somerville, dass.
Received and filed
JAN 22 1960
(Registrar)
* SEX
Malo
9 COLOR
White
10 SINGLE
( write the word)
MARRIED Married
WIDOWENN
or DIVORCED
10a If married, widnwed, nr. divorced
HUSBAND) of
Frances Adams
(Give maiden name ol wife in full)
(or) WIFE of
( Husband's name in full)
(a)
Rheumatic heart disease with ..
aortic and mitral stenosis
yr8
Due To
(b) Cardiac failure
days
Due To (c)
OTHER SIGNIFICANT CONDITIONS
W'as aumnpsy performed?
Yes
What test confirmed diagnosis ? Autopsy&Clinical Findings
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
James 8. 2 minos
1
JAMES ... S. QUINN.
PARENTS
59
MOTHER (City)
(State or country)
Canada
VÀ Hospital Records
21
Informant
(Address)
Boston 30 Magg
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issyed: Jacquel
Lignature of Agent of board of Health or other).
5825 U
100.20,1999
(Official Designation) (Date of Issue of Perfnit)
UCTIONS OR CERTIFICATE
EINIng OF DEATH t enter han one for each b) and (e)
's mot mean of dying. Heart failure. tc. It means or compli. hich caused
Is, if any, I've rise to ause (a). he under- Iuse last.
Tions contrib. Path but not the terminal dition given
hapter 137. 54. requires to print or cause or death on ficates, and 8. Acts of ores l'hyst. int or type r signature lical Iminer clines risdiction
19.925686
PLACE OF DEATH
Suffolk 1
I na1 ; lace il abode )
SiIl death occurred in a hospital or institution, St. I give its NAME instead of street and number) PHYSICIAN - IMPORTANT f( Was deceased a {U S. War Veteran, (if so specify WAR) WWI
5
.
255
M. D.
A TRUE COPY ATTEST:
JAN 2 21900 CM
OR
MARGIN RESERVED FOR BINDING
.302
1
BEDFORD
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bedford
(City or Town making this return)
256
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME. MARY DAVIDSON (If deceased is a married, widowed or divorced woman, give also maiden name.)
C#1 014 236
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WW I
(a) Residence. No ...
1167 BOYLSTON
(Usual place of abode)
BOSTON, MASS.
St
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years.
10
5
14
.months
days.
In place of residence.
.. years.
months.
...... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
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
AGE ... 8.2.Y
.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 :
15 Social Security No .. Not of record
16 BIRTHPLACE (City)
(State or country)
Scotland
17 NAME OF
FATHER
Andrew Davidson
PARENTS
18 BIRTHPLACE OF
Not of record
FATHER (City) (State or country) Scotland
19 MAIDEN NAME OF MOTHER Mary Stevens
20 BIRTHPLACE OF
Not of record
MOTHER (City)
(State or country)
Scotland
21 Informant (Address)
A TRUE COPY
ATTEST:
KLuth Webber
(Registrar of City or Town where death occurred)
DATE FILED
Dec 28
1959
(Registrar of City or Town where deceased resided)
resided as soon as possible, after the close of the month in which the death occurred. (See Cl:ap. 46, Sec. 12, G. 1 .. ) 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
50M.11.55.916145
7 NAME OF FUNERAL DIRECTOR Alfred B. Marsh
ADDRESS. 174 Winthrop St Winthrop, Mass.
Received and filed JAN 12 1900 19
M. D.
(Address) VAH BEDFORD MASS
Date
Dec. 22 , 59
Winthrop Cemetery, Winthrop, Mass. 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
(Month)
(Day)
(Year)
4 1 HEREBY CERTIFY,
That I attended deceased from
January 29
54
December 13
19 to ...
19
59
I last saw h .. elalive on .. December ..... 13 ...... , 19 .. 59., death is said to
have occurred on the date stated above, at
5:35
am.
INTERVAL BETWEEN ONSET AND DEATH
3 days
OTHER SIGNIFICANT CONDITIONS :
Due To
Chr .Br .Syn associated with (b) cerebral arteriosclerosis with psychotic reaction. 4-5-54 Due To Arteriosclerotic heart disease 1-29-54 (c)
THER, SIGNIFICANT CONDITIONS
Was autopsy performed?
YES
What test confirmed diagnosis ?.
Clin.Lab ... &Autopsy .... fndgs
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
EARL B. WHEELER
PLACE OF DEATH
MIDDLE SEX
(County)
Registered No.
89
V.A. HOSPITAL, BEDFORD, MASS.
No.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DECEMBER 13, 1959
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Hemorrhage of left cerebral artery due to arteriosclerosis.
Dundee
December 15 1959
July 18, 1918 July 19, 1919 Not of record Army Nurse Corps Not of record
7
JAN 1. 01960 /M
F
-
C
lote
lapte
FE
R-301A
:TIONS
RTIFICATE
ring DEATH enter in one r each and (c)
wat mean of dying. rt failure. It means or compli- A caused
3
if amy. rise to se (a). under- The last.
Is contrib- h but mat le terminal Ation given
capter 137. , requires lo print or :ause or death on ates, and Acts of des Phyai- et or type signature.
- 1960
925686
PLACE OF DEATH
SUFFOLK
BOSTON (('ity or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
- OF - TOWN 11674
To be filed for burial permit with Board of Health or its Agent. 257
2 FULL NAME
Charles R. MacLauchlan
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
111 Main Street
(l'on.] place of abode )
St.
Winthrop
(If nonresident, give city of town and State)
length of stay. In place of death.
years
months
6
dave In place of residence.
10
year«
months
davs.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December 7,
(Month)
(Day)
1959
(Year)
× SEX
Male
9 COLOR
White
IO SINGLE
MARRIED
WIDOWED
(write the word)
of DIVORCED Married
4 I HEREBY CERTIFY.
Dec ...... 2
19.59 ... ... Dec. 7
That I attended deceased (rom
I last saw himalive on Dec ...... 7
19 .. 59 .. death is said to
have occurred on the date stated above, at .. 10:10 ... p ... m.
INTERVAL
BETWEEN
ONSET AND
DEATH
HUSBAND of MALEE
10a If married, wowed die Bennett
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Carcinoma of Lung
9 mos
12
AGE 76
8
Years
Months.
9
Days
If under 24 hours
Hours.
.. Minutes
13 Usual
Occupation :
Retired FireMan
(Kind of work done during most of working life)
14 Industry
or Business :
City .cf.Boston.
15 Social Security No.
023-22-1378
16 BIRTHPLACE (City)
( State of country)
Mass
17 NAME OF
FATHER
James A Maclauchlan
18 BIRTHPLACE OF
Nova Scotia
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary E Matthews
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Mass
21
Mrs Margaret Maclauchlan
Informant
(Address)
111 Main St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
ADDRESS
Char op &t wetbreak
Received and -
19
DEC 11 1959 - 1.1959
PARENTS
S Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Robert & Rosso
..... , M. 1). Robert S. Rosson, M. D. (PRINT OR TYPE SIGNATURE)
(Address) 170 Morton St. , J. Bate Dec. 7 1959
6 Winthrop
Winthrop Mass
Place of Burial or Cremation
DATE OF BURIAL
Dec 11
1$5.9.
(City or Town)
7 NAME OF FUNERAL DIRECTOR Ernest P Caggiano
(Signature of Agont of Board of Health or other)
5706
12-10-59.
(Official Designation) (Date of Isaue of Permit)
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis ?
PERSONAL AND STATISTICAL PARTICULARS
Registered No.
1621
LEMUEL SHATTUCK HOSPITAL No
f(If death occurred in a hospital or institution,
St. I give it< NAME instead of street and number)
PHYSICIAN - IMPORTANT
((Was deceased a
U. S. War Veteran,
lif so specify WAR)
no
1959
11 IF STILLBORN, enter that fact here.
Boston
A TRUE COPY ATTEST: Charles À Takie 1 .1 City Registrar
F
1
FEB -- 61360 MM
R-302 1
SOUTH CAROLINA
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
WINTHROP
(City or Town making this return)
258
{ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(If nonresident, give city or town and State)
(Usual place of abode)
- December ember It 13.2.7.
1.59
rears
S
MEDICAL CERTIFICATE OF DEATH
600
No.
CERTIFICATE OF DEATH Vital Statistics - State Board of Health
59-018829
No.
COUNTY
Beaufort
· CITY, TOWN, OR LOCATION
GTA OWN, OR LOCATION
C. LENGTH OF STAY IN 1b
Winthrop
Beaufort
d. STREET ADDRESS
(U not to kospi's), give street offrese)
126 Loucust Street
USMCAAS Beaufort, S. C.
IS RESIDENCE INSIDE CITY LIMITS?
NO L IS RESIDENCE ON A FARM? YES
& N PLACE OF DEATH INSIDE CITY LIMITS?
YES F
NO
NO .
int
4. DATE OF DEATH 12
14
59
Fre ar print)
George
6. DATE OF BIRTH 9. AGE (In years |If Under 1 Yr. If Under 24 Hr.
0. COLOD OR RACE
7. MARRIED
MARRIED
last birthday)
Dayı
Hours
Male
Cauc.
WIDOWED DIVORCED
11. BIRTHPLACE (Stata or
18. CITIZEN OF WHAT COUNTRY? USA
-
Military
USMC
TI. HISBAND OF WIFE'S NAME
Jeorge Kenneth Bibbey
Not available.
...
A DECEASED VEL IN U. S. ARMED FORCES? @ delagua)| (If yes, Eve war or detss of service)
022-26-7153
Official Records
IL. CAUSE OF DEATH [Enter only one canse per line for (a), (b), and (c).] PART L DEATH WAS CAUSED BY:
less than
IMMEDIATE CAUSE (a)
right kidney.
Ofadicione, if any. ali gave rise to
DUE TO (b).
Mating the
DUE TO /o
10. WAS AUTOPSY
PERFORMED?
TES NO
ACCIDENT SUICIDE HOMICIDE . LECHIAE HOW INJURT OCGLILI- D. (Enter nature of injury io Part ) or Part 11 / 1tem 18.) Deceased was sucked into air intake of jet aircraft.
Hour Month, Day, Year
12 14 59
SO. CITY, TOWN, OR LOCATION
County State
Not While
120. PLACE O INJURY (e. f., in or about home, farm, factory, street, onico bldg., etc.)
Beaufort S.C.
at Work Plicht Line.
and Last saw bim alive on ....
I offended the deceased from. 2.10
Dam, co the date stated sluis; and to the best of my knowledge, from the causes stated.
22b. ADDRESS
MENATURE
USNR MCAAS Beaufort S.C. 12-16-59
Ekd ochTION l'city, towa, or county
230. NAME OF CEMETERY OR CREMATORY
Malden Mass.
TION 12/16/59 MIOVAL
Holy Cross Cemetery 26. DATE T. FUGL TRAES TICNA CURE
BY LOCAL MEG.
rall Funeral HomeBogu forte
Form No. VS-6
"ARTMENT OF HEALTH, EDUCATION, AND WELFARE - Public Health Service
NON-RESIDENT
Rec'd May 11, 1960
in another city or town h in which the deceased
56, Sec. 12, (i. 1 .. )
PLACE OF DEATH
BEAUFORT
BEAUFORT
Registered No.
XX .. USMCAAS
GEORGE KENNETH BIBBEY
(Was deceased a u. S. War Veteran, if so specify WAR)
South Carolina
Stato File No.
before admalıdon
b. COUNTY
Suffolk
. STATE Mass.
Kenneth
BIBBEY
2 Nov 1936 23
TARTA OCCUPATION (Og Lind d Ag most of worldug life,
10b. KIND OF BUSINESS OR INDUSTRY
foreign country)
Massachusetts
9-4-57 to 12-14-59
CHEVALE TWEEN ONSET AND DEATH
Traumatic rupture of liver stomach
one minute
FART IL ITER TONIFIANT TERMINAL DISEASE CONDITION GIVEN IN PART I(0)
CONDITIONS CONTRIBUTING TO DEATH BUT NOT WULATED TO THE
MCAAS, Beaufort her
DATE SICHED
LOREAL DIRECTOR'S SIGNATURE
126Locust Street
PERSONAL. AND ST TICAL PARTICULARS
17 mos.
-
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1
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●ライ 64号
465
L444
.
44
..
-
46号
4464
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காட்டு
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4号一
..
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