USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 50
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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.
OFFICE OF
MIN
5
MASS.
WINTERAR
X
PLACE OF DEATH
Middlesex (County) Cambridge
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
Cambrid-e
(City or Town making this yeturn)
Registered No.
1613
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME John Mc Lean
(If deceased is a married, widowed or divorced woman, give also maiden name.)
44 Pleasant Px. Rd.
inthrop,
Mass.
(If nonresident, give city or town and State)
months ..
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October 25, 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct. 11
60
Oct. 25
160
I last saw h.
1 live on
Oct. 25,
1900
death is said to
have occurred on the date stated above, at
11:23AM
.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral Thrombosis
(a)
Due TArteriosclerotic Heart Disease (b)
OTHER SIGNIFICANT CONDITIONS
no
Was autopsy performed?
clinical
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
Lorenzo Ameriso
(Signed)
(Address) Camb.Ctiy Hosp.
Date.
Oct.25, 60
Cambridge
It. Auburn Cem. 6 Place of Burial or Cremationct. 27, DATE OF BURIAL
(City or Town) 60 19
7 NAME OF
Howard S. Reynolds
FUNERAL DIRECTOR Anthrop, Mass.
ADDRESS
Received and filed.
NOV 3 1960
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED. dowed
10a If married, widowed,or divorced Jean Harris
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
AG
78
Years
Months.
_Days
Hours ........ Minutes
13 Usual
Occupation :
Laborer
14 Industry
Cemetery
or Business:
15 Social Security No ..... None
16 BIRTHPLACE (City)
(State or country)
Scotland
17 NAME OF
FATHER
Daniel McLean
18 BIRTHPLACE OF
FATHER
(City).
Scotland
(State or country)
19 MAIDEN NAME
M. D.
OF MOTHER
Margaret McBurnie
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Scotland
21 Isabella Mclean
Informant ........
(Address) Winthrop, Mass.
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Oct. 26.
-19 60
25M-2-58-922072
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 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 Due To (c)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
M R-302 1
CambridgeCity Hospital No. ..
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death ............ years ... months 1/1 days days. In place of residence. 4 years
(Was deceased a
U. S. War Veteran,
if so specify WAR)
10 SINGLE
(write the word)
Male
19
to ...
INTERVAL BETWEEN ONSET AND DEATH
PARENTS
If under 24 hours
(Kind of work done during most of working life)
٤٢٤١٤٥-
FT ERK
F
1
TI
NOV - 31960 AM
1 PLACE OF DEATH
Suffolk (County)
SENSE P
STANDARD
CERTIFICATE OF DEATH
Registered No.
225
S(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) No.
2 FULL NAME
Lydia Mancuso (De Giacomo)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
158 Main
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .. ....... ... years.
.. months
11
. .. days. In place of residence
ears
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
28
60
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIE1)
WIDOWED
or DIVORCED
Marri
4 1. HEREBY CERTIFY
11 au
1958, to ...
Oct, 78
That I attended deceased from
19.
60
I last saw h.d.1.alive on
Oct.
28
19 60, death is said to
have occurred on the date stated above, at
7: 28 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
10 min
12
AGE
62y
5
Months.
Days
Years
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.
034-18-1960
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Joseph De Giacomo
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Joseph Mancuso
21
Informant
(Address)
158 Mian St, Winthrop
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) 10/29/60
(Official Designation) (Date of Issue of Permit)
L
TRUCTIONS FOR AL CERTIFICATE
n giving OF DEATH
not enter e than one se for each , (b) and (c)
does not mean ode of dying, heart failure. , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not to the terminal condition given
- Chapter 137, 1954. requires ans to print or he cause or of death on ertificates, and 48, Acts of equires Physi- o print or type nder signature.
I-6-59-925686
(Registrar)
PARENTS
19 MAIDEN NAME
(Signed)
ed) maple Juegone
M. D.
OF MOTHER
Rose Seminara
Joseph, GREGORIE
(PRINTVOR TYPE SIGNATURE)-
194 Le ash ington Date 10/29/06
(Address)
6
Winthrop
winthrop
Place of Burial or CremationOct 31
DATE OF BURIAL
(City or Town) €
19
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS 147 Winthrop St Winthrop
10-28-60 19%
Received and filed
gv5
(c)
arteriosclerosis -
gen.
OTHER
SIGNIFICANT
CONDITIONS
essenticel
Hypertension
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? e If so, specify
PERSONAL AND STATISTICAL PARTICULARS
10a If married, widowed, or divorced
HUSBAND of
{Give,maiden name of wife in full)
Joseph Mancuso
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Coronary occlusion
massive
(b)
Myocardial Heart
Disease
(Month)
(Day)
(Year)
PHYSICIAN - IMPORTANT
((Was deceased a
{ U. S. War Veteran,
lif so specify WAR)
(a) Residence. No.
( Usual place of abode)
15
To be filed for burial permit with Board of Health or its Agent.
Winthrop (City or Town)
WINTHROP COMMUNITY HOSPITAL
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
M R-301A 1
g
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
RECEIVED
DATE OF DISCHARGE
TO !!!
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
INTHROP.
RULES OF PRACTICE OCT 311960 AM
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.
E OF
1 12
ERK
REC.
MR-301A 1
STRUCTIONS FOR AL CERTIFICATE
n giving OF DEATH not enter e than one se for each , (b) and (c)
does not mean ode of dying, s heart failure, , etc. It means case, or compli- which caused
tions, if any, gave rise to cause (a), g the under- cause last.
ditions contrib- - o death but not to the terminal condition given
:- Chapter 137, f 1954, requires ians to print or the
cause or of death on certificates.
SOM-5-56-917573
7 NAME OF
FUNERAL DIRECTOR.
MAURICE W. KIRBY.
ADDRESS
WINTHROP.
Received and filed NOV 2 1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED MARRIED
10a If married, widowed,or diyorced
HUSBAND of MARY ANNE OSBORNE
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 20 Years
Months
Days
If under 24 hours
Hours ..... Minutes
13 Usual
Occupation :
WATCHMAN RETIREd)
(Kind of work done during most of working life)
14 Industry
or Business:
WATER FRONT DOCKS
15 Social Security No ....
010-03-4166
BOSTON
16 BIRTHPLACE (City)
(State or country)
MAIS
17 NAME OF
FATHER
JAMES PHILLIPS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
IRELAND
19 MAIDEN NAME
OF MOTHER
ISABEL O'NEIL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
CANADA
21
Informant,
MRS JAMES PHILLIPS
271 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:
(Signature of Agent of Board of Health or other)
Dearte Culche
11/2/60
(Official Designation)
(Date of Issue of Permit)
NOT
Bel
To be filed for burial permit with Board of Health or its Agent.
230
271 SHIRLEY ST No ..
JAMES PHILLIPS 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 271 SHIPLEY ST
St.
(If nonresident, give city or town and State)
Length of stay: In place of death 56 years months days. In place of residence
31 years
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Oct
31
1960
(Year)
DEATH
(Month)
(Day)
That I attended deceased from
1960
I last saw h.1Malive on
Quy 31
, 19 66, death is said to
have occurred on the date stated above, at
11:40 17
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Bronchopneumonia
(Terminal)
INTERVAL
BETWEEN
ONSET AND
DEATH
2 days
(b)
Due To Cerebro Vascular
accident -
iweek
Due To arteriosclerosis
(c)
generalized
40
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
no
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify ...
(Signed)
(d) Sophie Gregoire
M. D.
(Address). 19 cf WorkingCiVE
Date 11-2
1960
SAINT JOSEPHS
BOSTON
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
NOV 3
1960
PARENTS
[(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
(Usual place of abode)
PLACE OF DEATH
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.
V.I.V
4 I HEREBY CERTIFY,,
may
19.5 7.
to
Oct 31
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 in 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 such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove 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 shall have been delivered to such board, agent or clerk, as the casc may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician. if any, as required by law, 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 enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to 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 the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form 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
RECEIVED
CLERK
SEVIV
NIL
11 1,2
OF
INAM
01
NOV -21960 AM
OFFICE
FORM R-301A at 55 Wair way
INSTRUCTIONS FOR MEDICAL CERTIFICATE
In giving AUSE OF DEATH do not enter more than one cause for each of (a), (b) and (c)
This does not mean e mode of dying, ch as heart failure. thenia, etc. It means e disease, or compli- tions which caused atk.
420.
Conditions, if any, which gave rise to above cause (a), stating the under. lying cause last.
Conditions contrit- ing to death but not lated to the terminal sease condition given (a).
Note :- Chapter 137. ts of 1954. requires ysicians to print or pe the cause or uses of death on ath certificates, and sapter 48. Acts of 59. requires Physi- ins to print or type me under signature.
JOV 30 1960
SOK-11-59-926662
PLACE OF DEATH
No.
Peter .... Bent ..... Brigham ... Hospital
2 FULL NAME
Ada
Foster
(If deceased is a married, widowed or divorced woman, give aiso maiden name.)
(if so specify WAR)
(a) Residence. No.
......
sea
Foam
Avec
Winthrop, Mass.
(Usual place of abode)
(If nonresident, give eity or town and State)
Length of stay : In place of death .............. years ..
.months.
5
days. In place of residence .............. years ..........
months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL. PARTICULARS
3 DATE OF
DEATH
August
27.
1960.
(Month)
(Day)
(Year)
That
TEattended deceased from
WOI HEREBY CERTIFY,
Aug
22
19.
Aug
27
19
60
Haast saw hexalive on
Aug
27
19 .. 60 .. death is said to
have occurred on the date stated above, at .3 .: 5,3 .... P ...... m.
10a If married, widowed, or divoreed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Joseph Foster
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
· AGE
.2.2 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)
Russia
17 NAME OF
FATHER
Abraham Berg
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
(unknown )
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Sharon Mem Park Sharon Mass.
6
....
Place of Burial or Cremation
DATE OF BURIAL August 28th 1960
7 NAME OF FUN 46 HarvardistRegzniak
ADDRESS BkIn .... Mas.s
Received and filed .........
AUG 30,1993 Kez 19.
Charles
(Registrar)
Years
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
......
ics
What test confirmed diagnosis ?
Autopsy
......
5 Was disease or injury in any way related to occupation of deceased? If so, specify
PARENTS
21
Warren Foster
Informant.
19 Larch Cir. Belmont Mass.
& HEREBY CERTIFY that a satisfactory standard certificate of death was filed with The BEFORE the burial or transit permit _was issued:
A10979
(Signature of Agent of Board of Health or other) Que 88 1565
(Official Designation)
(Date of Issue of Permit)
V.D.X
1
231
X BOSTON, MASS. (City or Town)
1 SUFFOLK (County)
The Commonwealth of MassachusettsU'l - OF - TOWN JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH To be filed for hurial permit with Board of Health or its Agent. 08530 DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No.
§(If death occurred in a hospital or institution,
St. I give its NAME instead of street and number) PHYSICIAN - IMPORTANT ((Was deceased a U. S. War Veterao.
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWEwidowed
or DIVORCED
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Coronary Insufficiency -
"Myocardial Infarction
INTERVAL
BETWEEN
ONSET AND
21 Hrs
Due To Arteriosclerotic Heart Disease (b)
(Signed)
Janla Route
DR. .. SAUL ... A ...... ROS.ENBERG.
(PRINT OR TYPE SIGNATURE)
19
(AREJER .... BENT BRIGHAM HOSP Date.
(City or Town)
A TRUE COPY ATTEST:
Charles H. Mackie City Registrar
RECEIVED
TO!
OF
71.12 1
7
CLERK
6"
THROP MASS
NOV 3 01960 AM
X
PLACE OF DEATH
Suffolk (County) Boston (City or Town) Beth Israel Hospital
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
OUT - OF - TOWN
232
To be filed for burial permit with Board of Health or its Agent.
CERTIFICATE OF DEATH
Registered No.
08799
[(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, .....
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