USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 62
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(Signature of Agent of Board of Health or other) 11221 10-26-60
(Official Designation)
(Date of Issue of Permit) V &
.
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
MARRIED)
WIDOWED
WIDOWED
10a If married, widowed, or, divorced
HUSBAND of
REARDON
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
BRONCHOPNEUMONIA
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
DAYS
UNIC YEARS
Due To
(b)
.........
PULMONARY EMPHYSEMA
.....
Due To (c)
-301A 1
TIONS 1
RTIFICATE
ing DEATH enter n one r each and (c)
not mean of dying, rt failure, . It means or compli- ch caused
5271 if any, rise to se (a), : under- se last.
as contrib- tk but not e terminal tion given
apter 137, . requires to print or cause or death on cates, and Acts of es Physi- nt or type signature.
Irector . only 11%-1961 -925686
No.
MASSACHUSETTS GENERAL HOSPITAL
S(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
(write the word)
IRELAND
(Signed)
Charles L. Clay, M.D.
(PRINT OR TYPE SIGNATURE)
ROCKLAND (City or Town)
A TRUE COPY
Jackie 5 Chare
Cnc Registrar
OF TO
6
INTHROP
JAN #21961 AM
X
SUFFOLK
(County )
BOSTON
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN To he filed for burial permit with Board of Health or ils Agent.
Registered No.
10853
S(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 sc specify WAR) No
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
Mayflower Nursing Home
St.
Winthrop
(['sual place of abode)
39 Grovers Ave .
(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
October 28,
1960
DEATH
(Month)
(Day)
(Year)
4
October
50
That Heattended deceased
TClaet saw h.
... Alive on
October 20 ,60
death ia said to
have occurred on the date stated above, at
10:20pm
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Branchopreumonia
...
Due To
Infected decubitus alcar-ferm yuste
(b)
Due To (c)
.
OTHER
SIGNIFICANT Metastatic caremamme of
CONDITIONS
east To luent fachenals
19yas
Was autopsy performed ? yes What test confirmed diagnosis ? ....
5 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D.
(Address)
19.
6 Calvary
Bonton .... Maas
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
NOV.
2
19.60
7 NAME OF
FUNERAL DIRECTOR
Porcella Funeral Service
..... ADDRESS 10 ..... N ..... Bennett .... St ............ Boston
NOV 3 ,1960 19
Received and filed
Charles & mackie
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE (write the word)
MARRIED)
W11X)WED
or DIVORCED Widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles Solari
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
85
Years
„Months.
.Days
If under 24 hours
.. Hours .............. Minutes
13 Usual
Occupation :
At Home
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Not Know
17 NAME OF
FATHER
Joseph Fossa
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Louise Leverone
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Louise F. Larkin
Informant ... (Address) 19 Foster Rd., Belmont
I HEREBY CERTIFY that a satisfactory standard certlacate of death wanted with me BEFORE the burial or transit permit was issued: E- Cusack
11328
(Signature of Agent of Board, of Heaith or other) nov- 1-60
(Official Designation)
(Date of Issue of Permit)
X
-301A -
TIONS
RTIFICATE
ing DEATH enter n one r each and (c)
not mean of dying. rt failure, . It means or compli- ch caused .
'if any, e rise to se (a). under- se last.
ns contrib. th but not e terminal tion given
apter 137. . requires to print or cause or death on cates, and Acts of es Physi- nt or type signature.
rector · only Ink, 12 1961
-925686
PLACE OF DEATH
No.
MASSACHUSETTS GENERAL HOSPITAL
2 FULL NAME.
Mary Solari
I HEREBYOCERTIFOctober
19
INTERVAL
DETWEEN
ONSET AND
DEATH
-
(Signed)
Charles L. Clay, M. D.
(PRINT OR TYPE SIGNATURE)
Asa't. Dir., Mass. Gen'l. Hosp. Date ...
PARENTS
287
A TRUE COPY ATTEST:
markes it macker City Registrar
TO) ...
6
H
JAN 21961 AM
R-301A
1
Boston
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent. 288
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 deceased is a married, widowed or divorced woman, give also maiden name.)
145 Bartlett Road
St.
Winthrop, Mass.
( If nonresident, give city or town and State)
Length of stay: In place of death.
years.
months.
12
.days.
In place of residence
.. years
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
wwwwgarried
or DIVORCED
10a If married, widawnd & digrced Sheridan
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
72
AGE
Years.
.........
.Months.
.Days
If under 24 hours
.Hours .............. Minutes
13 Usual
Occupation :
Retired Inspector
(Kind of work done during most of working life)
14 Industry
or Business :
U.S. Gov't
15 Social Security No.
None
Fitchburg
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
Patrick Gould
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Katherine Kennedy
20 BIRTHPLACE OF
MOTHER (City)
...
(State or country)
Ireland
21
Informant
Anna .... B .......... Gould
(Address) 145 Bartlott Road Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed With me BEFORE the burial cor transit permit was issued:
(Signature of Agent of Board of Health or other)
11602
11-10-60
(Official Designation) (Date of Issue of Permit)
-
(write the word)
3 DATE OF
DEATH
November
16
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
19.
November
60.
November
16
to ..
19
I last saw h ........ alive on
November 16
196 0
death is said to
have occurred on the date stated above, at
10:45 P.
mm.
INTERVAL BETWEEN ONSET AND DEATH
(a)
Due To
Arterio se leitis
Jean
(b)
Disease
Due T
(c)
Diabetes Mellitus
16
OTHER
arterio selerobic paritaire
SIGNIFICANT
vascular dizanie"
CONDITIONS
ald bilateral few thich
Was autopsy performed?
What test confirmed diagnosis?
no
No
(Signed)
EROL AKSOY
(PRINT OR TYPE SIGNATURE)
(Address) N.E.D.H Date. Nov. 17 1960
6
St ...... Bernards .... Cemetery.
Fitchburg ...
Place of Burial or Cremation
(City or Town)
November 21
1. 60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maloy
ADDRESS
Winthrop Mass
Received and fied
NOV 2 2 1960
.. 19.
Charles H. Mackie
(Registrar)
28145
Chapter 137. 54. requires s to print or cause or death on ificates, and $8, Acts of aires Physi- rint or type er signature.
1 2 1961
PLACE OF DEATH
Suffolk .........
(County)
New England Deaconess Hospital
No.
2 FULL NAME
Mr. John F. Gould
(First Name)
(Middle Name)
(Last Name)
(if so specify WAR)
No
(a) Residence. No. (Usual place of abode)
TIONS R RTIFICATE
ving DEATH enter in one r each )and (c)
not mean of dying, us failure. . It means or compli- ch caused
, if any, e rise to use (a). e under. se last.
ns contrib- th but not he terminal Ition given
-
5 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D
DATE OF BURIAL
PARENTS
47
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bente myocardial infarction
A TRUE COPY ATTEST:
Charles it. Mackie City Registrar
F TO
91.12
11
6
THROP.
JAN 221961 AM
X
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
11596
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and numher)
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. 15 Wilshire S.t Winthrop, Mass
(Usual place of abode)
Length of stay: In place of death ............ years ... months .. 16 .. days. In place of residence. years. .. months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY
Nov 6,
19
to
60
Nov
22,
19
60
I last saw heralive on
.N.o.v .... 22,
19 .. 60 .. , death is said to
have occurred on the date stated above, at .... 10 .:. 50 PM
INTERVAL BETWEEN ONSET AND
....
Due To
(b)
Generalized Metastesis2
Due To
(c)
Ca Simplex of Stomach
OTHER
Thrombophlebitis of
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
(Signed)
Arnold W. Aleman
, M. D
ARNOLD ILLMAN
(PRINT OR TYPE SIGNATURE)
750 Harrison Ave, Boston
(Address)
HOLY CROSS
6
Place of Burial or Cremation
MALDEN
(City or Town)
DATE OF BURIAL
NOV 26,
,60
7 NAME OF
FUNERAL DIRECTOR
RICHARD C. KIRBY
ADDRESS
917 BENNINGTON ST. EBOSTON
Received and filed
DES I 1960
19
1
002-2-12
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
MARIANNA D'ELIA
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
ITALY
JOSEPH F. FISCHER
21
Informant
(Address)
15 WILSHIRE ST, WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death Mas filed with me BEFORE the burial or transit permit was issued: Jacqueline Casou /Signature of Agent of Board of Health, or other)
11659
11-23-60
(Official Designation)
(Date of Issue of Permit)
X
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving , OF DEATH not enter e than one e for each . (b) and (c)
does not mean de 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, f 1954. requires cians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.
1. 07.1961
OUT - U
To be filed for burial permit
89 with Board of Health or its Agent.
2 FULL NAME Mary Fischer (FIORILLO)
(First Name) (Middle Name) (Last Name)
(If nonresident, give, city or town and State)
56
3 DATE OF
DEATH
Nov
22.,
19.6.0
(Month)
(Day)
(Year)
That I attended deceased from
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
JOSEPH A. FISCHER
(Husband's name in full)
I1 IF STILLBORN, enter that fact here.
12
AGE56
Years ...
6
Months.
5
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.
026-22-1952
16 BIRTHPLACE (City)
(State or country)
MASS
BOSTON
17 NAME OF
FATHER
ORAZIO FIORILLO
2
Legs 6 mo
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Debilitation
DEATH 2yrs
Mass. Memorial Hospitals
No.
0-928145
VII ATTEST:
Charles it Mackie City Registrar
RECEIVED
TOW/
OF
---
in . . .
F
1
-3.
ILERK
8
6
THROP MASS
JAN 2 '71961 AM
PLACE OF DEATH
SUFFOLK (County)
BOSTON, MASS (City 'or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
290
To be filed for burial permit with Board of Health or its Agent 11757
Registered No.
No. PETER ... BENT .... BRIGHAM ... HOSPITAL
B.
2 FULL NAME. Richard Donovan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(if so specify WAR)
(a) Residence. No.
292 .... Pleasant .... Street,
(Usual place of abode)
......
St. Winthrop, .... Mass
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years.
.. months.
29
days. In place of residence 50 years months
.......
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
November 25, 1960
DEATH
(Month)
(Day)
(Year)
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIannied
Wer HEREBY CERTIFY, That @ attended deceased from
Oct ... 28,
1960 to November
25,
,60
Waast saw himMlalive on November 25 19 60
death is said to
have occurred on the date stated above, at .0:40.P ..... m.
INTERVAL
BETWEEN
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
ONSET ANO
DEATH
6 mos
10a If married, widok& tHeine Lyng
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
(a)
Carcinoma of Lung, right
12
AGE.
64 Years.
Months.
Days
If under 24 hours
Hours.
Minutes
Due
Diabetes Mellitus
years
(b)
Arteriosclerosis
Due To
Obliterans
(c)
OTHER
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
(Signed)
DR. LESLTE E. RUDOLF
(PRINT OR TYPE SIGNATURE)
PEAFR.) BENT BRIGHAM HOSPITAL. Nov. 26, 160
Winthrop Cemetery
Winthrop
(City or Town)
Place of Burial of
DATE OF BURIAL
November 29
19
60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop Mass
Received: and filed
NOV 30 KOLS
19
(Registrar)
PARENTS
21 Katherine Donovan
Informant
(Address)
292 Pleasant St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: En Cuauch
(Signature of Agent of Board of Health or other)
11692
nov. 28-60
(Date of Issue of Permit)
(Official Designation)
1
11
13 Usual
Occupation :
Retired Salesman
(Kind of work done during most of working life)
14 Industry
or Business :
Candy
years
15 Social Security No.
East Boston
16 BIRTHPLACE (City)
(State or country)
M888.
17 NAME OF
FATHER
William M. Donovan
18 BIRTHPLACE OF
East Boston
FATHER (City)
(State or country)
Mass
Lesle & Ridel
19 MAIDEN NAME
M. 1).
OF MOTHER
Gertrude Baldwin
20 BIRTHPLACE OF
East Boston
MOTHER (City)
(State or country)
Mass
6
:- Chapte: 137. 1954. requires jans to print or the cause of of death on certificates, and r 48, Acts of equires Physi- o print or type nder signature.
71. 27, 1961
-11-59-926662
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 ease, or compli- which caused
162,1
litions, if any, h gave rise to e cause (a). ng the under- cause last.
nditions contrib- to death but not to the terminal condition given
VPV
(write the word)
8 SEX
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran,
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
A TRUE COPMIATTST! Charts. rackés City Registrar
RECEIVED
TOWA
OF
301330
11 12 1
CL
10
ERK
00
1
6 5
ASS
WIN
HROZ
JAN 2 71961 AM
PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
S(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. 206 BARTLETT RQ.
St.
WINTHROP, MASS.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years .............. months ...... 4 .days. In place of residence /0 years months .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
11/26/60
(Month)
/ (Day)
(Year)
4 I
HER
EBY
CERTIFY,
19
That I attended deceased from
11/22
160
19.
11/26/60
I last saw hERalive on
11/26/60
19 ............ , death is said to
have occurred on the date stated above, at
9:05pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
MYOCARDIAL INFARCTION -
ACUTE
....
Due To ARTERIOSCLEROSIS HEART
(b)
DISEASE
Due To (c)
OTHER
SIGNIFICANT DIABETES MELLITUS
CONDITIONS
Was autopsy performed ?
YES
What test confirmed diagnosis ?
EKG
5 Was disease or injury in any way related to occupation of deceased ? Ifso, specify
10
M. D). HOWARD D. HSINGTYREYJR. (PRINT OR TYPE SIGNATURE)
(Address) 19
Date ........
6 .
ST. Mary's Leineter, Pittsburgh Pelina.
Place of Burial or Cremation
(City dr Town)
DATE OF BURIAL November 30 1900
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
210 Winthrop St Winthrop
Received and filed- VOV 38 19502 10% 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
w
10 SINGLE
MARRIED
WIDOWED Widowed
or DIVORCED
IOa If married, widowed, or divorced
HUSBAND of
Joseph
(Give maiden name of wife In full)
Natali
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 80
Years.
Months.
Days
If under 24 hours
.Hours ..
.. Minutes
13 Usual
Occupation :
at home
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
nove
16 BIRTHPLACE (City)
(State or country)
ITALY
17 NAME OF
FATHER
Bartholomew Picardo
18 BIRTHPLACE OF
FATHER (City)
IT01"
(State or country)
19 MAIDEN NAME
OF MOTHER
Unknown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy.
21 Tas Tierrile
Informant
266 Bartlett RD Winthrop
HEREBY CERTIFY that a ;ati ctor standar - certificat of death fil'{ with me BEF/ RE the isit/ ermit was
(Signature of Agent of Brand of Health or other)
A12933
(Date of Issue of bermit)
(Official Designation)
F
291
To be filed for burial permit with Board of Health 11713
No MASSACHUSETTS MEMORIAL HOSPITALS
2 FULL NAME .. HARRIET M. NATALI
(If deceased is a married, widowed or divorced woman, give also maiden name.)
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH not enter re than one se for each ). (b) and (c)
does not mean ade of dying, s heart failure, , etc. It means ease, or compli- which caused
itions, if any, s gave rise to cause (a). g the under- cause last.
ditions contrib- o 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 quires Physi- print or type der signature. 7+ 1
11-59-926662
(write the word)
(or) WIFE of
INTERVAL
BETWEEN
ONSET ANO
DEATH
PARENTS
Maurice Kirby
M R-301A 1
Charles i Mackie
City Registrar
TOWA
OF
11 12 1
--
OFFI
CLERK
9
*
WINTHROP M
JAN 2 71961 AM
OUT
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
292 To be filed for burial permit with Board of Health or its Agent.
12645
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) no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
43 Dolphin Avenue Winthrop
St. Winthrop
(If nonresident, give city or town and State)
months ... 7 days. In place of residence. .years ............. months .............. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
21
1960
(Year)
(Month)
(Day)
4 I
HEREBY
CERTIFY
Vec. 14
=
19 00
to.
That I attended deceased from
21
19
€
I last saw H ...... alive on
Peci
21
19 26, death is said to
have occurred on the date stated above, at
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ONSET AND
(a)
Pulmonary estema
DEATH
1 day
Due To
GI melismoney-terminal
(b)
(GASTRO-INtestiNAL)
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
W'as autopsy performed ?
No
What test confirmed diagnosis ?
5 W'as disease or injury in any way related to occupation of deceased 6 ... If so, specify
(Signed)
M. D.
LONNIE HANAUER
(PRINT OR TYPE SIGNATURE)
(Address)
330 Brookline the
Date .....
Wilerek Avail y Winitrop Avereet
(City or Town)
l'Lice of Burial or Cremadog
Dec 22
1960
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Jorg Funeral Service Inc
ADDRESS
Brochure
Received and filed
DEC 3/ 1960
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
10 STIGLE
(write the.word)
8 SEX
Female
9 COLOR
D'hôte
MARRIED
WIDOWED Y coloured
ar DINGNEED
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Bernard Voldalan
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
89
AGE
Years
-
Months.
Days
If under 24 hours
Ilours.
Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business :
(Kind of work done during most of working life)
15 Social Security No.
16 BIRTIIPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
C.B.L.
Wanetik
18 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER .
C.B.I.
20 BIRTHPLACE OF
Russia
21 Eli Walkon
Informant
(Address) 43 Colchinare Winthrop
I\HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE the burial or transit permit was issued:
ec.
(Signature pf Agent of Board of Health or other)
00051
£
12-22-60
(Official Designation)
(Date of Issue of Permit)
-
PARENTS
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 ode of dying. s heart failure, a, etc. It means case, or compli- which caused
153.8. 1
itions, if any, gave rise to cause (a), ig the under- cause last.
nditions contrib- o death but not to the terminal condition given
. Chapter 137, 1954. requires ans to print or the cause or of death on ertificates, and : 48, Acts of cquires Physi- print or type nder signature. 1
-11-59-926662
X Suffolk Boston (County) (City or Town) Beth Israel Hospital No. PLACE OF DEATH Rebecca Goldstein 2 FULL NAME.
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death.
5
1 year
Dec.21
19
60
MOTHER (City)
(State or country)
A TRUE COPY ATTEST:
Charles it Mackie
City Has trar
RECEIVED
TOW:
F
7/ 12 1
OFF !!
10.
CLERK
00
*
W
6
MASS.
P
JAN 2 71961 AM
.4
44
中非
ste
中4
4444
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