USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 4
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days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January 19 1960
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Single
or DIVORCED
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
75
Years.
Months.
.Days
If under 24 hours
Hours.
.Minutes
13 Usual
Dress Designer
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
clothing
15 Social Security No. 010-09-2005
16 BIRTHPLACE (City) (State or country) Cape Breton. Canada
17 NAME OF
FATHER
Dougal
18 BIRTHPLACE OF FATHER (City) (State or country) Cape Breton, Canada
19 MAIDEN NAME
OF MOTHERMargaret MacEachern
20 BIRTHPLACE OF MOTHER (City) (State or cou Cape Breton, Canada
21 Informant Isabelle ..... Mackinnon
(Address) 556 Shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed/with me BEFORE the burial or transit permit was issued: Halka C. Tereauf (Signature of Agent of Board of death or other)
Health Officer
1/21/60
Official Designation) 00 (Date of Issue of Permit)/
VISV
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not meon e of dying, heart failure, etc. It meons e, or compli- which coused
ons, if ony, gove rise to cause (o), the under- couse lost.
itions contrib- deoth but not the terminol 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.
(Signed)> . M. D.
VOJTECH GREGORIE
(Address) .
(PRINT OR TYPE SIGNATURE) 19 flashnagyon de Date 1-1960
6 Winthrop Cemetery
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January 22.
19 60
7 NAME OF
FUNERAL DIRECTORO Maley Funeral Home
ADDRESS
Winthrop
Received and filed 1-21 1960
(Registrar)
PARENTS
OTHER
Gastro -Intestinal
SIGNIFICANT
CONDITIONS
bleeding
Was autopsy performed ?
What test confirmed diagnosis ?
.. , to .....
I last saw h.K.).alive on
JAN
19
19 C, death is said to
have occurred on the date stated above, at 11: 4/0 17.
INTERVAL
BETWEEN
ONSET AND
DEATH
3 hrs
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cerebro Vascular
Hemorrhage
Due To Carter wsclero815
(b)
generalized
Due To (c)
2 days
5 Was disease-or injury in any way related to occupation of deceased? If so, specify
I R-301A 1
No.
Winthrop Community Hospital
[(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)
60
4 I HEREBY
CERTIFY, That I attended deceased from
195
Jan
19
19 ..
Registered No.
6-59-925686
1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
JAN : . 1969 TH
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following les 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.
M R-301A
1
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.
Registered No. 15
LXxxxixxxxix1 Winthrop Community Hos If death occurred in a hospital or institution. ? give its NAME instead of street and number) No.
2 FULL NAME
Russo, Baby Boy
(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. 0. 42 MERIDAN ST
St.
EAST BOSTON
(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
8 SEX
M
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED S
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 ...
Years.
Months ........
Days
If under 24 hours
1
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)
17 NAME OF
FATHER
Russo, Augustine
18 BIRTHPLACE OF
FATHER (City)
Boston, Mass.
(State or country)
19 MAIDEN NAME
M. D.
OF MOTHER
O'Brien, Caryl
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston, Mass.
21 Informant (Address) 42 MERIDAN ST E. BOSTON
A HEREBY CERTIFY that a satisfactory standard certificate of death was hed with me BEFORE the burial or transit permit was issued: Dakikca: Sereanne 0 (Signature of Agent of Board of Health or other)
1/21/60
(Official Designation) (Date of Issue of Permits
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter e than one e for each (b) and (c)
does not meon de of dying, heart foilure, etc. It means ase, or compli- which
caused ox Bic 2.120.11
ions, if ony, gove rise to couse (o), the under- couse lost.
ditions contrib- deoth but not o the terminol condition given
Chapter 137, 1954, requires ans to print or he cause or of death on ertificates, and 48, Acts of quires Physi- print or type der signature.
(Signed)
ar Caplan A.N. CAPLAIN MD (PRINT OR TYPE SIGNATURE)
(Address).86 ..... Princeton St Date
.1-20-60
6 East Boston, Mass BOSTON Place of Burial or Cremation JAN 22 4(City of Town) DATE OF BURIAL STMICHAELS BOSTON 14.66
7 NAME OF
FUNERAL DIRECTOR
Why. Cine calle
ADDRESS S Cooper 11 Besten
Received and filed 19
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH
-
4. Club hands and feet.
Due To (c)
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
PARENTS
3 DATE OF
DEATH
Jan
19
1.9.6.0.
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
1-19-
60
1Thtol_attended deceased from
19
to.
I last saw himlive on
1-19-60
19.
, death is said to
have occurred on the date stated above, at
4.08 A.M.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
1.Atalectasis ..... of ...... lungs
2. Congenital heart disease
3. Multp. congenital abnormal
(b)
.........
ities.
(write the word)
PHYSICIAN - IMPORTANT
litaslow
-6-59-925686
AGUSTINA RUSSO
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE JAN 3 5. 1960 0.
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.
I R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop ......
(City or Town)
No. ........................ ..... 5 .... Ocean View
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.
Registered No. 16
[(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)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
5 .... Ocean .... View
St
(If nonresident, give city or town and State)
5
Length of stay: In place of death
20
yearsmonthsdays. In place of residence ..... years ....... months ........ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
(write the word)
or DIVORCED Widowed
4 I HEREBY CERTIFY, That I attended deceased from
Feb 1
1956
to ...
19
I last saw h.
Halive on
11/30
59
death is said to
have occurred on the date stated above, at
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL
BETWEEN
ONSET AND
DEATH
Чуп
12
AGE .. 80
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)
N.F.
17 NAME OF
FATHER
Richard Hurrell
18 BIRTHPLACE OF
FATHER (City)
S.t ....... John
(State or country)
N.F.
19 MAIDEN NAME
OF MOTHER
Unknown
20 BIRTHPLACE OF
MOTHER (City)
St. John
(State or country)
N.F.
21 Informant (Address)
.......
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E Serami
(Signature of Agent of Board of Health or other) Jan 14.1960
(Date of Issue of Permit)
(Official Designation)
LX
RUCTIONS FOR . CERTIFICATE
giving OF DEATH
not enter : than one e for each (b) and (c)
loes not mean de of dying, heart failure, etc. It means se, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not o the terminal ondition given
. Chapter 137, 1954. requires ns to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
6
Holy .... Cross
Malden
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
... January ...... 25.,
6.0
7 NAME OF
FUNERAL DIRECTOR
Maurice W Kirby
ADDRESS
210 Winthrop St.
Received and filed
JAN 2.5 1960
19
(Registrar)
10mg
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way relate 1 to occupation of deceased?
If so, specify Dr Fred O Regan
(Signed)
M. D.
113 Pleasant ED Virtual mais
(PRINT OR TYPE SIGNATURE)
(Address) . Wintheich Date
1/23 1960
PARENTS
(Usual place of abode)
3 DATE OF
DEATH
(b)
Due To HYPERTENSION
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Medical Examiner Declined Jurisdiction
(a)
ARTERIO - SCLEROTIC
HEART DISEASE
1
23
1960
(Month)
(Day)
(Year)
Female
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
David O'Connell
10A
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Mary .... O' Connell
2 FULL NAME
·6-59-925686
St. John
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.
.1 1
6
ROR
JAN 2 51960 AM
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. 47 Douglass
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.
Registered No. 17
f(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT [(Was deceased a
2 FULL NAME
Dorothy ... A Oesterle
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
47 .... Douglas$.
.....
.......
St.
(Usual place of abode)
2
23
(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
9 COLOR
10 SINGLE
(write the word)
Female
White
MARRIED
WIDOWED
or DIVORCEMarried
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
ThomasA Oesterle
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ...
61 .. Years .........
... Months ..
.......
.Days
If under 24 hours
Hours ...........
Minutes
13 Usual
Occupation :
Hairdress.e.r.
(Kind of work done during most of working life)
14 Industry
or Business :
Self
15 Social Security No.
012-18-4193
16 BIRTHPLACE (City)
(State or country)
Boston
17 NAME OF FATHER James J Danahy
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston
19 MAIDEN NAME
M. D. OF MOTHER Mary A Sweeney
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
21 ThomasA Osterle
Informant
....
(Address)
47 Douglass St
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)
Oprette Offen.
tan 24 , 1960
(Official Designation)
(Date of Issue of Permit)
-
JURISDICTION-
RUCTIONS FOR CERTIFICATE
giving OF DEATH
not 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.
itions contrib- death but not the terminal ondition given
Chapter 137, 1954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
7HS.
6-59-925686
MEDICAL EXAMINER DECLINED
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
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)
myron b. King
MYRON IN. KING
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST
Date ......
1/23 1960 ........
6
Old Calvary
Boston
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
January ...... 25.,
19.60
7 NAME OF
FUNERAL DIRECTOR ...
Maurice ... W .... Kirby
ADDRESS
.... 210 .... Winthrop .... St ..
Received and filed JAN 2.5 1960 19
(Registrar)
PARENTS
3 DATE OF
DEATH
January ..... 22,
19.60
(Month)
(Day)
(Year)
That I attended deceased from
1/22
4 I HEREBY CERTIFY,
1/5
1950
., to.
I last saw h ER live on
1/22
19.
death is said to
60
8 A
have occurred on the date stated above, at
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE MYOCARDIAL INFARCT
(a)
...
INTERVAL
BETWEEN
ONSET AND
DEATH
15MIN
(or) WIFE of
U. S. War Veteran,
lif so specify WAR)
I R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
RULES OF PRACTICE
.
JAN 2 5 1960 AM
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 certincate 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.
RM R-302 1
PLACE OF DEATH
Essex
(County) Lynn
(City or Town)
No.
Lynnview Hosp.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Lynn
(City or Town making this return)
Registered No.
18
S(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
David Brettman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
30 Highland Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ...
.months ..
19days. In place of residence.
............ years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Jan. 24, 1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
1/5/60
to.
1/21/60
19
19
death is said to
have occurred on the date stated above, at
5:55A
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral thrombosis
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
dy
DGeneralized arteriosclerosis
OTHER
SIGNIFICANT
CONDITIONS
Myocarditis
Was autopsy performed?
no
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased no.
If so, specify ...
(Sign
Claranca London
M. D.
(AddreLynnview Hosp.
Date 1/24/60 19
oak Hill Peabody
Place of Burial or Cremation
1/25/60
(City or Town)
DATE OF BURIAL
19
7 NAME OF
Arnold Goloy
FUNERAL168 Beacon st. Brookline
ADDRESS
Received and filed
FEB 10 1960
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDried
10a If married, widowed, or divorced
HUSBAND
of
Ruth cki vohune of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
A69
Years
Months
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(KildeAdmititring most of working life)
14 industry
or
BusinSterling Heel CO
15 Social Security Nº29-07-0984
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF FATHER man
18 BIRTHPLACE OF
Russia
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHEEsther Barenberg
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 InformHerman Brettman (son)
(Address
47 Glendale Rd., Marblehe
A TRUE COPY
ATTEST
Restrict City or Towir where death occurred)
DATE FILED 2/3/60 19
V.B.V
HARGIN KEDARY AU FUR DINDING
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) 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)
25M-8-56-918227
PARENTS
(Was deceased a
U. S. War Veteran,
specify WAR)
winthrop
(a) Residence. No ..
(Usual place of abode)
That I attended deceased frommale
I last saw in
... alive on
1/23/60
19
FEB 1 01960 AM
L SUFFOLK (County) WINTHROP (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 19
[(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.
142 PLEASANT
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years 3 months days. In place of residenceel years. .months __ _ days.
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