USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 16
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
(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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
PLACE OF DEATH
X Suffolk (County) WINTHROP, MASS (City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 68
WINTHROP COMMUNITY HOSPITAL {If death occurred in a hospital or institution. No.
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, {if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 99 Marshall St
St.
(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
March
23.
1960
(Year)
(Month)
(Day)
That I attended deceased from
mar 22
19 GO to
March 23
1960
I last saw h&J ... alive on
March 23, 1960, death is said to
have occurred on the date stated above, at $130 P
.. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Hemo peritoneum
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
Days
If under 24 hours
1.4 .... Hours.
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No."
16 BIRTHPLACE (City) (State or country) Masg
Winthrop
17 NAME OF
FATHER
John Mead
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country) Mags
19 MAIDEN NAME
(Signed)
a Part Cool asoplan
M. D.
OF MOTHER
Joan E. Murray
A Paul DERHAGOPIAN. M.12 (PRINT 'OR TYPE SIGNATURE)
(Address) SALARY AN CHELSEA Date Man 23 1960
6 Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL March 25, 19.60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop Mass
Received and filed MAR 25 1960 ... 19 ..
(Registrar)
PARENTS
20 BIRTHPLACE OF
Winthrop
MOTHER (City)
(State or country)
Mass
21 Elizabeth.A .. Murray
Informant (Address)
99 Marshall St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued: Kalkul E- Percanulx (Signature of Agent of Board of Health or other
Health Officer 3/35/60
(Official Designation)
(Date of Issue of Permit)
X
[ R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
400
What test confirmed diagnodis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORESE le
4 I HEREBY CERTIFY,
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To
5 mail perforation
(b)
...
of liver
(a) Residence. No. (Usual place of abode)
To be filed for burial permit with Board of Health or its Agent.
Celeste E. Mead Female Mead 2 FULL NAME
6-59-925686
Chapter 137, 954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
itions contrib- death but not the terminal ondition given
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 un; \ related 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 supposąbly due to injury. These include not only deaths caused directly or indirectly by | 2 1960 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
-
R-305 1
PLACE OF DEATH
Middlesex
(County) Framingham
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Framingham
(City or town making return)
Registered No.
69.
S (If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
Elizabeth A. Ezekiel (nee Castigan)
f(Was deceased a
U. S. War Veteran,
[if so specify WAR)
no
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death .. 2 ..
.. years ..
1months 24 days.
In place of residence ..
.. months.
.. days.
40 years ..
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March 24, 1960
(Month)
(Day)
(Year)
9 SEX
fem.
10 COLOR
white
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
4 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 injury was involved, state fully.)
lla If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Pyelonephritis & Bronchopneumonia
(or) WIFE of
John F Ezekiel
(Husband's name in full)
Death precipitated by recent accidental fracture of left hip
12 IF STILLBORN, enter that fact here.
5 Accident, suicide, or homicide (specify)
Accident involvedGE 78
.Years.
Months.
28 Days
If under 24 hours
Hours.
Minutes
Date and hour of injury
Dec. 21, 1959 1910: 00AM
If accidental, was injury causally related to the death ?
yes
Where did
Injury occur ?
Cushing Hosp. ,Framingham
(City or town and State)
15 Industry or Business :
16 Social Security No.
none
17 BIRTHPLACE (City)
(State or country)
Canada
18 NAME OF
FATHER
Thomas Castigan
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Bar Harbor Maine
20 MAIDEN NAME
OF MOTHER
Sarah Wheeland
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Medical ..... Office ..... Records.
DATE OF BURIAL
Mar. 28, 1960
19
& NAME OF
FUNERAL DIRECTOR
Arthur J. O. Maley
ADDRESS Winthrop ,Mass
Received and filed MAR 31-1960 19
(Registrar of City or Town where deceased resided)
PARENTS
nk
6 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
J. H. McCann
M. D.
(Address)Framingham Date 3/24/60
14 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
Cushing Hosp. Ward
(Specify type of place)
Manner
Slipped from chair to floor.
Injury
(How did injury occur ?)
Nature of
Fracture of left hip
While at work? .. no.
Was autopsy performed ?
no
7 Winthrop Cemetery, Winthrop
Place of Burial, or Cremation.
(City_or Town)
22
Informant
(Address)
Cushing Hospital
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
March 25, 1960
19.
Bar Harbor, Maine
25M-4-59-925100 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided Injury
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 40 Bates Avenue
XSX
Winthrop .Mass
(If nonresident, give city or town and State)
No. Cushing Hospital
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
PLACE OF DEATH
SUFFOLK (County) WINTHROP (City or Town)
Invitons
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
MAYFLOWER NURSING HOME
S(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number) No./ JOSEPH L'ASSETINA
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
55 BENNINGTON SI
EAST BOSTON St.
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years ......... months.
.days. In place of residence ...
7 years ..
.months ..
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MARCH
250
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Mar 1.5
196
to ....
19.6
That I attended deceased from
I last saw halm.alive on
Mar
5 , 19, death is said to
have occurred on the date stated above, at
2.3. 1 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cardiac failure
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE0 % Years.
Months.
Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
TAILOR
(Kind of work done during most of working life)
14 Industry
or Business :
RETIRED
15 Social Security No.
032-01- 7605 1
UNKNOWN
16 BIRTHPLACE (City)
(State or country)
ITALY
17 NAME OF
FATHER
ASCHAE: L'ASIETINA
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
LUCY IT ARE.
1
NATHANIEL DANS
(PRINT OR TYPE SIGNATURE) (Address) I TRIMerTon L. Bo.Ly Date
35 1966
6 TISHAEL BOSTON
Place of Burial or Cremation
DATE OF BURIAL
MARCH
v
(City or Town)
0 60
7 NAME OF
FREDERIKNI. MAGRATH
FUNERAL DIRECTOR
ADDRESS EAST BOSTON
Received and filed
MAR 28 1960
19
(Registrar)
PARENTS
21
ALFRED ASTINA
Informant
(Address) 414 SUMMER YEAST DOSTON
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Tatfice : tereacerca q (Signature of Agent of Board of Health er other)
3/06/60
(Official Designation)//
(Date of Issue of Permit)
X
RM R-301A 1
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH o not enter re than one se for each ). (b) and (c)
does not mean tode of dying, s heart failure, a, etc. It means sease, or compli- which caused
ditions, if any, h gave rise to e cause (a), ng the under- cause last.
onditions contrib- to death but not to the terminal condition given
:- Chapter 137, f 1954, requires ians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type inder signature.
4-11-59-926662
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED WIDOWVED
or DIVORCED
--
10a If married, widowed, or divorced
CATHERINE LAMAVEHIA
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To
Bronchial pneumonia
(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)
Nathanelv. damit
M. D.
Registered No.
0
PHYSICIAN - IMPORTANT
[(Was deceased a U. S. War Veteran,
[if so specify WAR)
No
(a) Residence.
No.
(Usual place of abode)
7 days
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
ITALY
UY YOLUN
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE 1
The fulfillment of the purpose of these laws calls for the observance of the following 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 un- related to any form of injury.
MAR 2 1300
(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 occu- pation, 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 impor - tant, 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. Chil- dren 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.
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
21
No.
Winthrop Community 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,
no
[if so specify WAR)
(a) Residence. No. 69 Locust St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
..... ... years.
months
.days. In place of residence.
.years.
16
months.
.davs.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
MARCH 25 1960
(Month)
(Day) /
(Year)
4 I HEREBY CERTIFY,
MARILY
0
60
to ....
MAR. 25, 1960
I last saw himMalive on
MAR. 25,
, 19.60, death is said to
have occurred on the date stated above, at 1:55 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) CARDIAC DE COMPENSATION
INTERVAL
BETWEEN
ONSET AND
DEATH
1 DAY
12
69
Years
3
Months.
5
Days
If under 24 hours
Hours ........
Minutes
13 Usual
Occupation :
Retired Watchman
(Kind of work done during most of working life)
14 Industry
or Business :
U.S Lines
15 Social Security No. .
002-09-8983
Charlestown
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Dennis Connelly
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown
19 MAIDEN NAME
OF MOTHER
Bridget Unknown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unknown
6 Holy Cross
Malden Mass.
Place of Burial or Cremation March 28
60
21
Informant
(Address)
John J Connelly 69 Locust St Winthrop
7 NAME OF
FUNERAL DIRESTOR.
Ernest P Caggiano
147 Winthrop St Winthrop
ADDRESS
Received and filed MAR-25-1960-
... 19.
(Registrar)
8 SEX
M
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
10a If married, widoAnnelive FeedConnelly of HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
(b)
Due To
HYPERTENSIVE HEART
DISEASE
(c)
Due To
ARTERIOSCLEROSIS
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
a.n. Caplan M. D.
(Signed) A. N. CAPLAN MD
(PRINT OR TYPE SIGNATURE)
(Addre 186 PRINCETONST E-POSTDate MAR 2 0 60
DATE OF BURIAL
(City or Town) 19
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death SAfiled with me BEFORE the burial or transit permit was issued: Kalklec. Sereally (Signature of Agent of Board of Health orother) Health Officer 3/5/60
(Official Designation) (Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
Does not mean e of dying, heart failure, etc. It means e, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 954, requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
11.5.
6-59-925686
R-301A - 1
To be filed for burial permit with Board of Health or its Agent.
2 FULL NAME John E. Connelly
(If deceased is a married, widowed or divorced woman, give also maiden name.)
( Usual place of abode)
That I attended deceased from
-
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the R 22 GIOCO ' ' following 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 un- related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
Des not mean e of dying, heart failure, etc. It means e, or compli- which caused
ms, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
Chapter 137, 954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
6-59-925686
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D WARD 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.
72
Registered No.
[(If death occurred in a hospital or institution,
St. ? give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
f(Was deceased a U. S. War Veteran, (if so specify WAR)
NO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
Length of stay : In place of death .. ... . .. years.
months
6
.days. In place of residence.
.years.
months .. .
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MARCH
26
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
1
1955
That I attended deceased from
60
I last saw h. Malive on
MMICH L': 1960
death is said to
have occurred on the date stated above, at
12.15 /m.
INTERVAL
BETWEEN
ONSET AND
DEATH
6 DAYS
58
12
AGE
Years ..
Months ...
Days
13 Usual
Occupation :
Salesman
(Kind of work done during most of working life)
14 Industry
or Business
Drygoods
15 Social Security No.
012-05-6079
16 BIRTHPLACE (City)
(State or country)
( Poland ) Russia
17 NAME OF
FATHER
Charles Kalman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Clara
c.b.l.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
SAMUEL ARKIN
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Talplic.
Serramir
(Signature of Agent of Board of Health or other)
IA.C.
March 2% 1960
(Official Designation)
(Date of Issue of Permit)/
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
10a If married, widowed, or divorcebnia Arkin
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
MYOCARDIAL INFARCT- ANTERIOR
(a)
Due To
ARTERIO-SCUEROTIC HEART DIS
(b)
AND GENERAL PETITS-SCLEROSIS
2 YRS.
WITH ANGINA PECTORIS
Due To
DIABETES MELLITUS
(c)
PERSISTENT SINGULTUS
OTHER
OLD POSTERIOR MYOCARDIAL
SIGNIFICANT
CONDITIONS
INFARCTION
?
Was autopsy performed?
No
What test confirmed diagnosis ?
CLINICAL + ERG
5 Was disease or injury in any way related to occupation of deceased: If so, specify
(Signed)
Myron b. King
M. D.
MYRON NOKilIG MID
(PRINT OR TYPE SIGNATURE)
212 PLEASANT ST
3/26 1960
(Address) WETPRIE MAS.{ Date ...
Place of Burial or Cremation
DATE OF BURIAL ...... March 27
Torf Funeral Service Inc
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
Chelsea
Received and filed MAR 28 1960
19
PARENTS
(City or Town)
60
19
Tifereth Israel of
winthrop, Everett
21
Informant
(Address) 54 Quincy StAvWinthrop
10 YRS.
8 DAYS
If under 24 hours
Hours ...
Minutes
11 IF STILLBORN, enter that fact here.
20
(If nonresident, give city or town and State)
No. Winthrop Community Hospital
2 FULL NAME Kalman, Louis
38 Summit Ave., Winthrop
St.
to.
MARCH 26
19 6
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
"HAR 21233
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
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.