USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 38
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[if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 117 Shore Drive
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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
(write the word)
Married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Rubin
(Give maiden name of wife in full)
UBendersky
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
69
Years .....
.. Months.
Days
If under 24 hours
.Hours.
Minutes
13 Usual
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) medalis
17 NAME OF
FATHER
Gedalle Swartzberg
18 BIRTHPLACE OF
FATHER (City) (State or country)
Poland
19 MAIDEN NAME
OF MOTHER
Firma funknul
20 BIRTHPLACE OF MOTHER (City) (State or country) Nathan & Pransky.
21 Informant (Address)
70 Woodbine an Needham
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued:
7 NAME OF
FUNERAL DIRECTOR
TORF Funeral Service
ADDRESS 151 Washington Que Chelsea
Received and filed
AUG 1 1960
19
(Registrar)
7mo.
T GENERAL METASTASIS
Due To (c)
OTHER SIGNIFICANT CONDITIONS
GENERAL ARTERIOSCLERSO
2 YRS
Was autopsy performed ?
No
What test confirmed diagnosis ?
CLINICAL, YRAY, EEG
5 Was disease or injury in any way related to occupation of deceased ?. 2. If so, specify
(Signed) Mason h Ting ., M. D.
MYREN N. KINGUND
(PRINT OR TYPE SIGNATURE)
(Address) LUZ PLEASANT 51 7/30 19
60
6
Chevra Thilin
Everett
Place of Burial or Cremation DATE OF BURIAL
July
City or Town) 3
60
19
PARENTS
29
1960
(Month)
(Day)
(Year)
4
L
HEREBY CERTIFY .That I attended deceased from
, 1954
JULY
29
19
1
60
I last saw h. -. live on
7/29
194.0
death is said to
have occurred on the date stated above, at
3 3Pm
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
PULMONARY CARCINOMA
RT UPPER LOBE
DEATH
1 YR.
Due To
METASTASIS TO BRAIN
(b)
3 DATE OF
DEATH
July
No.
Sarah Bendersky (Swartzberg)
2 FULL NAME
(a) Residence. No. (Usual place of abode)
(Signature of Agent of Board of Health or other)
5/30/60
(Date of Issue of Permit)
(Official Designation)
Poland
Poland
1-19-925686
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 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.
ORM R-302
THIS IS A PERMANENT RECORD
(b) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)
50M-9-59-926111
PLACE OF DEATH
Middlesex ( County)
Malden
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Malden
(City or Town making this return)
172
Registered No.
S (If death occurred in a hospital or institution,
.St. 1
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.
210 Winthrop
( Usual place of abode)
10
... years .......... months .......... days. In place of residence ...
.. years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
July 31, 1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
June 23.
59
July 31
19
to
I last saw h.Sealive on
July 31
19.
Cheath is said to
have occurred on the date stated above, at& .: 15A
.. m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic Heart Disease
(a)
1-5 year
PERSONAL AND STATISTICAL PARTICULARS
SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
Narr.
10a If married, widowed, or divorced
HUSBAND of
William J. Lynch
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
80
12
AGE
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 :
15 Social Security No. ..
Gloucester
16 BIRTHPLACE (City)
(State or country)
Mas.s.
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
H. Steller
(Signed )
577 B'dway Eve.
8/1
M. D.
60
Winthrop Cem. Winthrop, 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Aug. 2,
60
19
(State or country)
Lynch Kirby( daughter)
210 Winthrop .... St ... , .... Winthrop
( Address )
Mass.
7 NAME OF
Maurice W. Kirby
A TRUE COPY
Hass.
ADDRESS
FUNERAL DIRECTOR 210 Winthrop St. ,Winthrop,
ATTEST :
Received and filed AUG 3 1900 .19
DATE FILED
(Registrar of City or Town where death occurred )
Aug. 1,
60
19
( Registrar of City or Town where deceased resided )
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country )
19 MAIDEN NAMEEllen Crowley
OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
Ireland
(Address )
Date
.19
Mass.
21
Cornelius Hennesy
17 NAME OF
FATHER
housewife
Due To
Senility
Length of stay:
In place of death.
1
St
Winthrop
( Was deceased a
U. S. War Veteran.
if so specify WAR
(If nonresident, give city or town and State)
60
19
(Give maiden name of wife in full)
1
..
Edna Brawn Nursing Home No Julia Lynch (Hennesy)
RECEIVED
TOWA
OF
OFFICE
11 17. 1
BILERK
5
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
AUG 3 1960 AM
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
. : -.
CM R-303 A
I
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
173
Registered No.
05829
En route to East Boston Relief Station
No.
2 FULL NAME
JOSEPH
SOMERS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
53 Trident Avenue
Sit
Winthrop,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
Viso specify WAR).
assachusetts
No
Length of stay : In place of death .............. years ..........
months.
10
days. In place of residence.
.years ..
.. months ..
.days.
PERSONAL AND STATISTICAL, PARTICULARS
9 SEX
Male
10 COLOR
white
II SINGLE
(write the word)
MARRIED
WIDOWED Married
of DIVORCED'
Baron
4 I HEREBY CERTIFY that I have investigated the death of the person above. nained and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Coronary occlusion.
lla If married, widowed, or divorced
HUSBAND of
ROSS
(Give maiden name. of wife in full)
(or) WIFE of
(llusband's name in full)
12 IF STILLBORN, enter that fact here. .
13
18.
?
Months.
?
Years .......
.Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
Tailor
( Kind of work done during most of working life)
15 Industry
or Business :
Tailor
Shop
16 Social Security No.
011-10-6409
17 BIRTHPLACE (City) .
(State or country)
Russia
18 NAME OF
FATHER
Lazer Somers
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
20 MAIDEN NAME
OF MOTHER
Sylvia SwarTn
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
,
Rose
Somers
I HEREBY CERTIFY that a satisfactory standard certifie Rob death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other) .
Received, and filed:
JUN
7 1960
19.
Charles if mache
(Redictrar)
PARENTS
M. D.
Date
19 60
Ahavath aslin
Eweralt
060
DATE OF BURIAL
8 NAME OF
FUNERAL DIRECTOR
ADDRESS
17, 200
٢٥٠٠
6 1960
PLACE OF DEATH
SUFFOLK
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
June
3.
1960
(Month)
(Day)
(Year)
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
IF ACCIDENTAL, was injury causally related to the death?
Where did
Injury occur ?
(City or town and State)
Manner of
(Specify type of place)
Injury
(Ilow did injury occur ?)
Nature of
Injury
6 Was diseany or injury in any way relever my occupation of deceased?
If si
(Sign)Shall
Michael A. Luongo, M.D.
(Print or Type Signature)
(Address)
Boston
6/4
7
Place of Burial, or Cremation,
June
5
of Death. See reverse side for additional Information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114.
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
§§ 44-48.
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section (9) requires physicians to insert a recital to that effect.
0.
(City or Town)
Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
.
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
While at work ?
.Was autopsy performed ?
No
35M-11-59-926662
Did. injury occur in or about home, on farm, in industrial place, or in public place ?
24.5
22
Informant
( Address)
53-Trident are
5 14982
6/4/20
(Date of Issue of Permit)
: 13.
(Official Designation)
[(If death occurred in a hospital or institution, St. { give its. NAME instead of street and number)
(If nonresident, give city or town and State)
A TRUE COPY ATTEST: Charles A. Mackie City Registrar
INTHROPY
SẾP - G1960 AM
IM R-301A
ATRUCTIONS FOR NEL CERTIFICATE
i giving S OF DEATH d not enter 1: than one ae for each (2 (b) and (c)
islaes not mean Ate of dying, 4, heart failure, mi etc. It means liise, or compli- which caused
ky4.
cions, if any, ic gave rise to cause (a), til the under- na cause last.
Celitions contrib- t death but not d) the terminal re andition given ).
e Chapter 137, of 954. requires c 15 to print or : cause or s if death on ctificates, and ( 48, Acts of ruires Physi- Aprint or type u er signature.
5.
6 1960
ON 1-59-926662
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
No.
Veterans Administration Hospital
2 FULL NAME
John M. NORRIS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
95.Loring Road
Winthrop, Mass.
(Usual place of abode)
11
days. In place of residence .. .. years .... ......... months. .... days.
MEDICAL CERTIFICATE OF DEATH
.
3 DATE OF
DEATH
June
4
1960
(Month)
(Day)
VA (Year)
4 I HEREBY CERTIFY,
May 24
0
60 to. June 4 .60
....................................... , death is said to have occurred on the date stated above, at 12:40 .... Pen.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
1. Malignant hypertension
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy perfornied ?
No
What test confirmed diagnosis Clinical & lab. findings
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
NV. E. Summan
M. D.
H.E. SIMMONS
(PRINT OR TYPE SIGNATURE)
(Address)
VA Hospital, Boston, Mass.
6/4/60
6 Winthrop Cemetery Winthrop Mass Place of Burial or Cremation DATE OF BURIAL June .... 7
(City or Town)
160
7 NAME OF
FUNERAL DIRECTOR
Maurice Kirby
ADDRESS 210 Winthrop St., Winthrop Mass.
19 Charles A.
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIE1)
WIDOWED
of DIVORCSingle
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.
45
.
Years ...
6
Months ....
6
.Days
If under 24 hours
.Hours ....
Minutes
13 Usual
Occupation :
Foreman - Tree Department
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
012-16-5722
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
John M. Norris
18 BIRTHPLACE OF
FATHER (City)
Lynn
(State or country) Massachusetts
19 MAIDEN NAME
OF MOTHER
Irene Morrison
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Massachusetts
21 Mrs Irene Norris (Mother).
Informant
(Address)
95 Loring Road, Winthrop, Mass.
· I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: J. Casey
(Signature of Agent of Board of Health or other)
8430
6-6-60
(Official Designation)
(Date of Issue of Permit)
1
V. V.B.
To be filed for burial permit with Board of Health or its Avypl 05882
Registered No.
[(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) WW 2
St.
(If nonresident, give city of town and State)
Length of stay: In place of death .............. years .............. months.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION CF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN
174
PARENTS
(write the word)
That 7 attended deceased from
INTERVAL BETWEEN ONSET AND DEATH
2 yrs
Revere
North Brookfield
A TRUE COPY ATTEST: Charles it Mackie City Registrar
SEP 1-61960 1:31
YTHROW
X
PLACE OF DEATH
Suffolk
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Chelsea
(City or Town making this return)
353 175
CERTIFICATE OF DEATH
Registered No.
S (If death occurred in a hospital or institution,
.St.
( give its NAME instead of street and number)
2 FULL NAME
William Jacob "cinz
(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 ..
44 Birch Rd.
1
Winthrop,
( Usual place of abode)
(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
3 DATE OF
DEATH
Juno 5,1960
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
(write the word)
4 I HEREBY CERTIFY, That I attended deceased from
Apr.20.
19
60 June 5
I last saw
hilmive on
June ..... 5
19 ... 6.9 death is said to
have occurred on the date stated above, at"
12:35p.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Chock
Chronic congestive heart
INTERVAL
BETWEEN
ONSET AND
DEATH
hrs
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
Months.
.. Days
If under 24 hours
Hours ......
Minutes
Due To
failure.
(b)
yrs
13 Usual
0
Occupation:
Bartender
(Kind of work done during most of working life)
14 Industry
cannot be learned
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston,Masy
OTHER
SIGNIFICANT
CONDITIONS
Cirrhosis
yrs.
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
6
Winthrop Com. , winthrop, mass. 6
Place of Burial or Cremation June 8,1960
(City or Town)
DATE OF BURIAL
19
7 NAME OF
M.W.Kirby
FUNERAL DIRECTOR,
210 Winthrop St., winthrop
ADDRESS
Received and filed
AUG 3.0 1960
.. 19.
(Registrar of City or Town where deceased resided )
PARENTS
17 NAME OF
FATHER
Francis
18 BIRTHPLACE OF
FATHER (City)
Boston ,Mass.
(State or country )
19 MAIDEN NAME
OF MOTHER
Agnes Schuler
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
"Boston, Hass.
21 Hospital Records
Informant
(Address )
"Soldiers Home , Cheirca
A TRUE COPY Joseph a. Tyrrell.
ATTEST :
DATE FILED
( Registrar of City or Town where death occurred)
June 5,1960
19
DRM R-302
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town THIS IS A PERMANENT RECORD
50M-9-59-926111
1
(County)
Chelsea
(City or Town)
Soldiers! Home Hos ital
No.
hospital
10a If married, widowed, or divorced
19
60
HUSBAND of
Marjorie Ambler
(Give maiden name of wife in full)
Due To
Aortic stenosis
yrs
(c)
(Signed )
Lawrence Baker
M. D.
( Address)
Soldiers' Home
Date
Juno 5
19
69
10
25
WWI
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
Oct. 4,1917
DATE OF DISCHARGE June 5 1919
RANK, RATING
.Corp
ORGANIZATION AND OUTFIT
Co.B.326th Inf.
SERVICE NUMBER
1900876
ORM R-302
THIS IS A PERMANENT RECORD
( Month) (a) (c) DATE OF BURIAL at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To disease resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46. Sec. 12. G. L.)
PLACE OF DEATH
Suffolk
(County )
Chelsea
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this returny
176
Registered No. 336
(If death occurred in a hospital or institution,
........ .. St. ¿ give its NAME instead of street and number )
2 FULL NAME
Carl .... I.Nelson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
( Was deceased a
U. S. War Veteran.
WWI
18 ..... Plummer ....
Are.
St.
Winthrop, Maas
(a) Residence.
No ...
( Usual place of abode)
(If nonresident, give city or town and State)
Length of stay:
In place of death.
hospital
Bears ...
months.
dagg In place of residence ..
.months.
...... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June ..... 6.1960
(Day)
(Year)
8 SEX
Nale
9 COLOR
White
10 SINGLE
(write the word)
4 I HEREBY CERTIFY,
Aug.14.
19
540
June 6
That I attended
deceased from
19.
HUSBAND of
610a If married, widowed, or divorced.
Anna K Knudson
(Give maiden name of wife in full)
I last saw h ...... altyp on
Juno ... 6.
19 ..
death is said to
have occurred on the date stated above, at ......
3:55m.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
64
AGE.
Years.
Months 27 Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business :
Town of Winthrop
15 Social Security
No.
262-42-5094
16 BIRTHPLACE (City) (State or country) ...... West ... Newton, Mass.
17 NAME OF FATHER Gilbert
18 BIRTHPLACE OF
FATHER (City)
(State or country)
St. Louis,Mo ..
19 MAIDEN NAMEMargaret McCleane OF MOTHER
20 BIRTHPLACE OF
North River, P.E.I.
MOTHER (City)
( State or country )
21
Hospital Records
InformantSoldiers Home , Chelsea,Mass.
( Address )^
7 NAME OF
Alfred B.Marsh Fun . Home
A TRUE COPY ALtas's .
Souple a Tyrrell
FUNERAL DIRECTO 174 Winthrop St. , Winthrop
ADDRESS
ATTEST :
(Registrar of City or Towy where death occurred)
Received and filed AUG-3-0-1960 .19
( Registrar of City or Town where deceased resided)
PARENTS
(Signed )
James N.Yannios
M. D.
( Address)
Soldiers' Home
Date.
6/6/60,
Winthrop Cem., Winthrop, mass. 6
Place of Burial or Cremation- June 9,1960 19
or Town)
50M-9-59-926111
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Massive pulmonary emboli
?
Due To (b) Arteriosclerotic heart
?
OTHER
Cardio-vascular accident
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
Tax Collector (retired)
0
(or) WIFE of.
( Husband's name in full)
1
....
No ..
Soldiers .!..... Home .... in ..... lass ..
DATE FILED
June 6 1960
19
(if so specify WAR,.
MARRIED
WIDOWED
or DIVORCEDMarried
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
Dec. 14, 1917
DATE OF DISCHARGE Apr ... 18,1919
RANK, RATING Pfc
ORGANIZATION AND OUTFIT Medical Dept.
SERVICE NUMBER
31 .. 164 ... 52.7.
55 44-48. 35M-11-59-926662 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item ol Nature of
6 1960
PLACE OF DEATH
Infull (County) Barton (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD 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. 06352
Registered No.
2 FULL NAME
Julian
JULIUS N. Pepper
(UL deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
26
Nevada St
Winthrop
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years ..
......... months .............. days. In place of residence .............. years .............. months ..
.. days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
MALE
10 COLOR
WHITE
11 SINGLE
(write the word)
MARRIED
WIDOWED)
or DIVORCED
SINGLE
lla If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that iact here.
AGE 79 Years.
Months .....
Days
If under 24 hours
Hours
.Minutes
14 Usual
Occupation :
SALESMAN (PET)
(Kind of work done during most of working life)
15 Industry
or Business :
DEPARTEMENT STORE
16 Social Security No.
024-03-0200
BOSTON
17 BIRTHPLACE (City)
(State or country)
MASS.
18 NAME OF
FATHER
HARRIS PEYSER
19 BIRTHPLACE OF
FATHER (City)
(State or country)
POLAND
20 MAIDEN NAME
OF MOTHER
CAROLINE NELSON
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
BOSTON
22
Informant
LESME N. BROWN
(Address) 26 NEVADA SE WINTHROP
HEREBY CERTIFY-that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued:
8650
(Signature of Agent of Board of Health or other)
34-60
(Date of Issue of Permit)
(Official Designation)
Received And Ale UN 2 3 1950 Charles it Vanille sfrr)
19
PARENTS
.
Date
6/20
19 60
DAVID VIEVA CHOUMIN (LEBANON)
W. BUTB.
Place of Burial, or Cremation
Leity or Town)
JUNE 22.
60
DATE OF BURIAL
.......
8 NAME OF
FUNERAL DIRECTOR
BENU. F. SOLOMON
120 HARVARD ST. BROOKLINE
ADDRESS
20, 1960
(Year)
4 I HERERY 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.)
MULTIPLE TRAUMATIC INJURIES INCLUDING FRACTURES OF SKULL, PELVIS AND LEG. CRUSHING INJURY OF CHEST
accident
5 Accident, suicide, or homicide (specify)
Date and hour of injury
6/14 1960
IF ACCIDENTAL, was injury causally related to the death? yes
Where did
Injury occur ? .
Boston
Did injury occur bryr about home, on farm, in industrial place, or in
public place ?
Public highway
Manner of
Pedestrian struck
Injury
buy motor cal
While at work?
Was autopsy performed? no
6 Was disease or injury in any way related wo pecupation of deceased ?
If so, specify.
Wehall( Trong .
M. D.
(Print or Type Signature)
Beth Vianael Hospital No.V
(If death occurred in a hospital or institution,
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