Town of Winthrop : Record of Deaths 1961, Part 19

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 19


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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(Signed)


allen Papalini 200


M. D


Allen P ..... Jostin


(PRINT OR TYPE SIGNATURE)


15 Joslin Rd.


Date. Feb . 28 9 61


Winthrop Cemetery Winthrop


6


Piace of Burial or Cremation


(City or Town)


DATE OF BURIAL


March 3,


61


19


7 NAME OF


FUNERAL DIRECTOR


Vincent Rapino


9 Chelsea St., Last Boston, Mass.


ADDRESS


K Divo and filed WAR 3 1961 19


(Registrar)


PARENTS


17 NAME OF


FATHER


Louis Battaglia


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Concetta Presutti


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


21 Gaetano Frongello (husband)


Informant


(Address)


153 Locust St., Winthrop, Lass,


WHEREBY CERTIFY/the satis! listy segnilard certiscale of death Med with me DEyo t permit we imved:


....


(Signature of Agent of Board of Health or other),


A15373


May 1, 1961


(Official Designation) (Date of Issue of Permit)


V.B


UCTIONS FOR CERTIFICATE


giving OF DEATH 1 enter than one for each bland (c)


es mot mean of dring. heart failure. Is It means i. or compli- which caused


as, if any, i've rise to umse (a). the under- ause last.


ions contrib- rath but not the terminal dition given


Chapter 137. 1954. requires ns 10 prını or e cluse or of death on rtificates, and 48. Acts of quies Physi- print or type der signature. C.


14 1961 928145


-


The Commonwealth of Mansarquarts OF - TOWN JOSEPH D. WARD To be filed for burial permit with Board of Health or its Agent Registered No. 02113 SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


09


I1 IF STILLBORN, enter that fact here.


12


64


AGE ..


Years.


Months ..........


... Days


If under 24 hours


Hour ..........


.Minules


I3 Usual


Occupation :


Housewife


(Kind of work done during most of working hie)


14 Industry


or Business :


At home


15 Social Security No. unknown


OTHER


SIGNIFICANT


CONDITIONS


Obesity


No


IN CAVAL BETWEEN ONSET AND DEATH 10+ DAYS


10a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


9 COLOR


white


10 SINGLE (write the word)


MARRIED)


WIDOWED Married


or DIVORCED


8 SEX


female


f( Was deceased a U. S. War Veteran, no


(if so specify WAR)


( l'sual place of abode)


( If nonresident, give city or town and State)


(Give maiden name of wife in full)


Gaetano Frongello


(Husband's name in full)


Due To


Chronic nephritis


S Was disease or injury in any way related to occupation of deceased? If so, specify


(Address)


"Boston" Mass


16 BIRTHPLACE (City)


(State or country)


New York


'A TRUE COPY ATTEST: Charles it Mackie


City Registrar


RECEIVED


TOW


JF


ERK


1:1


1


6


WINTHROPA


JUN 1 41961 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


OUT- OF- TOWN To be filed for burial permit with Board of Health or its Agent. 90


Registered No.


02136


2 FULL NAME


ELMONS K. BERRY


( First Name) (Middle Name) (Last Name)


( If deceased is a married, widowed or divorced woman, give also maiden name.)


19 George


.St. Winthrop, Lass.


( If nonresident, give city or town and Staie)


Length of stay: In place of death years. 1 imonths 2 Qjays.


In place of residence .. 64


years


.. months .........


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS .


3 DATE OF


DEATH


March


1


1961


(Month)


(Dav)


(Year)


4 I HEREBY CERTIFY , That A attended deceased from January ...... 9. 19. 61 ...... March 1 19 61


death is said to


have occurred on the date stated above, at .4:05 .... A.m.


INTERVAL BETWEEN ONSET AND DEATH 4 mos


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


No


What test confirned diagnosis?


Clinical & Lab Findings


5 Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


Pennette Briggs


M. D.


(State or country)


Carada


Kenneth (TRYKT BE ISESSIGNATURE ) (Address) VAH Boston, Mass. Date Mar. 1 19 61


Winthrop Com. Winthrop, Mass.


6


Place of Burial or Cremation


DATE OF BURIAL


March 4


19.61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS 79 Atlantic St. Winthrop, Mass.


3 1951


Record apo filed ...


Grace of Macht


( Registrar)


PARENTS


17 NAME OF


FATHER


Josoph Who


18 BIRTHPLACE OF


FATHER (City)


Nova Scotia


19 MAIDEN NAME OF MOTHER Martha Fondall


20 BIRTHPLACE OF


MOTHER (City)


Brighton


(State or country)


Lammachusetts


21


Hazel Berry


Informant


(Address)


19 George St. Winthrop, 1'309


I HEREBY CERTIFY that a satisfactory standard certifcate of death was sie with me BEFORE the burial or transit permit was issued: Jacqueline Casy. (Signature of Agent of Board of Health or other) A1049 3-2-61


(Official Designation) (Date of Issue of Permit)


X


MARRIED,


WIDOWEarrica


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of ... Hazel ... V.


... Phillips


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in fell)


II IF STILLBORN, enter that fact here.


12


AGE .... 65


Years


OMonthe


& Days


If under 24 hours


.. Hours


13 Usual


Occupation :


-


Calorman


(Kind of work done during most of working life)


14 Industry


or Business :


013 05 6331


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Massachusetts


Brighton


Due To


(c)


8 SEX


Malo


9 COLOR


Whito


10 SINGLE


(write the word)


No.


Veterans Administration Hospital


[(If death occurred in a hospital or institution,


St. ( give its NAME instead of street and number)


PHYSICIAN -- IMPORTANT ( Was deceased a U. S. War Veteran. if so specify WAR)


(a) Residence. No. (Usual place of abode)


CTIONS OR ERTIFICATE


iving F DEATH enter ian one or each ) and (c)


mot mean of dying, ust facture. r. It mrams or compli- ich caused


, if any, 1 1111 10 wir (s). e under- use last.


OMS Contrib- uth but not he terminal Istion given


193.


Chapter 137, 954. requires s to print or cause or [ death on tificates, and 48. Acts of uires Physi- print or type er signature.


14 196 28145


(City or Town)


R-301A -


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Brain tumor,


glioblastoma,


multiformi left occipital lobe


A TRUE COPY ATTEST: Charles it Mackie City Registrar


RECEIVED


TOV


OF


CLERK


OS ,


THROP.


JUN 1 41961 AM


RM R-303 B


3 SEX MALE HUSBAND of (or) WIFE of 35 -3 3 PARENTS If deceased was a U. S. War Veteran. G.L. Chap. 46. Section 10. requires physicians to insert a resta! to that e !.... 9 Occupation:


PLACE OF DEATH


1 SUFFOLK (County) BOSTON (Citv ur Towr)


The Commonwealth of flassachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


OUT - OF - TOWN. 91


To be filed for burial permit with board of Health or its Agent.


Registered In.


No. Veterans Administration Hosp. D. O.A+


J(If death occurred in a hospital or institution. \ Rive its NAME instead of street and number)


2 PULL. NAME John J. DeFreitas (If deceased is a married, widowed or divorced woman, give also maiden name.)


25UNDERHILL (a) Residence. No! (L'sual place of alxxle)


St ..


Ward. WINTHROP MASS


(If nonresident, give city of town and State)


mos.


days.


How long in U. S., if of foreign birth?


yrs.


mos days


MEDICAL CERTIFICATE OF DEATH


March 2 1961


(Month)


(Day fYear


19 I HEREBY CERTIFY that I have investigated the death of the perso- above-named and that the CAUSE AND MANNER thereof are as follows (If an injury wat involved, state fuljy.) Status epilepticas -


20 IN WHAT CITY OR TOM'S WAS INJURY SUSTAINED


(Signed)


M D


(Address)


3-3-02 Date


21 PLACE OF BURIAL CREMATION OR REMOVAYZ (Cemetery) (Cityfor town


mar 6 1961


DATE OF BURIAL


22 NAME OF UNDERTAKER ADDRESS/ 35 Koudou St S. Weitere


Recorvil and filed


1961


19


.‘


(Official Designation)


5 SINGLE


(write the word)


18


DATE OF


DEATH


MARRIED WIDOWED MARRIED or DIVORCED


years


Minutes


Social Security No. 215-07-4025- 11


OF MOTHER NELLIE CONNELLY


16 BIRTHPLACE OF MOTHER (Citv) (State or country) Mildredin Detriti Rapa Any 17 Informant /


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bugi or transit permit was issued: .


Praca f


(Supyture of Agent of Board of Ilealm or other)


150418


3/3/61


(Date of issue of Permit)


1 14 1961


of Death. See reverse side for extracts from the laws relative to the return of certificates of death.


D


...


1


information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF


DEATH in plain terms. so that it may be properly classified under the International Classification of Causes


Every item of


Length of residence in city of town where death occurred 8 yrs. PERSONAL AND STATISTICAL PARTICULARS 4 COLOR WHITE MILDREDM . FALLON (Give maiden name of wife in full) (Ilusband's name in full) 6 Age of husband or wife if alive 7 IF STILLBORN. enter that fact here AGE 76 Years Months If less than 1 day Hours Days Usual CLERK Industry U.S. POSTOFFICE 10 or Business 12 BIRTHPLACE (City) (Statr or country) EAST, BOSTON MASS. 14 BIRTHPLACE OF BAYONNE FATHER (City) (State or country) NEWJERSEY 15 MAIDEN NAME BOSTON SM-3-56-922187 -WRITE PLAINLY, WITH UNFADING BLACK INK. - THIS IS A PERMANENT RECORD 111 NAME OF FATHER ThiMAS DEFREITAS


PHYSICIAN - IMPORTANT ( Was decease 1 a U. S. War 1-2017. if so, specify WAR).


W.W. 11


( Registrar)


ichard


for


A TRUE COPY ATTESTI Charles H. ManKie City Registrar


RECEIVED


TOW


OF


CLERK


IN


6


HROZ


JUN 1 41961 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


OUT -OF A TOWN To be hled for burial permit with Board of Health or its Agent. 02736


Registered No


S(If death occurred in a hospital or institution. St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FU'l.1. NAME WATSON. C ...... LINDSEY. ( First Name ) (Aluldle Name)


(last Name)


(if w) specify WAK)


( If deceased is a married, willowed or divorced woman, give also maiden name.)


(a) Residence No. ( l'qual place of aborde)


47 Washington. A.ve


St.


Winthrop, Mass


( If nonresident, give city or town and State)


Length of stay: In place of death years.


months


2


days. In place of residence


45 years.


.months


days


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEAIIf


March 17, 1961


(Month)


(Year)


4I HEREBY


CERTIFY,


That Veattended deceased from


Mar.16


19. Cl, to. Mor ........ 1.7.


1961.


Thast naw b. dlalive on


Mar.


17,


19


death in said to


61


have accessed on the date stated alxive, at


.9:10p


INTERVAL BETWEEN ONSET AND DEATH 1 day


2 days


Due To (1)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


Yes


What test confirmed diagnosis?


Autopsy


S Was disease or injury in any way related to occupation of deceased?


If so, specify


(Signed)


M. D


Charles L, Clay, M. D. (PRINT OR TYPE SIGNATURE)


(Address)


A


n't. Dir., Mass. Goa'l. Hoop. Date Mar, 17 1961


6 Winthrop


Place of Burial or Cremation


Winthrop


(City or Town)


DATE OF BURIAL


March


21


1961


7 NAME OF


FUNERAL


DIRECTOR Howard S Reynolds Winthrop Mass


ADDRESS


und filed HAR 19.61


(Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Tennessee


19 MAIDEN NAME OF MOTHER Lillian Crowdes


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Tennessee


21 Susan Lindsey Informant (Addresshy .Washington Ave. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was Ned with me BEFORE the burial or transit permit was Laned:


(Signature of Agent of Board of Health or other)


1253 3/50/61


(Official Designation) (Date of Issue · Permit)


92


R-301A 1


UCTIONS OR CERTIFICATE


IVIng OF DEATH t enter han one for esch c) and (c)


, not mean of dying. cart failure. // mruns or compli. sich caused


he under. Iuse lust


ons contrib- ath but not the terminal dition given


1


Chapter 137. 014 irque. A to print or ' cause of of death on ouicases, and 4M. Acts of mores l'hyn1- print or type er signature.


Direction se only K Ink. 14 1961 28145


10a If married, widowed, or diwffgan Thomas


HUSHAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


67


11


6


AGE


Years


Months


Days


If under 24 hours


Hours ...


„Minutes


13 Usual


Occupation :


Sales Engineer


( Kind of work done during most of working life)


14 Industry


or Business :


Tile


15 Social Security No. ... 019-11 .6670 St Louis


16 BIRTHPLACE (City)


(State or country) Missouri


17 NAME OF FATHER Watson Lindsey


8 SEX


Male


9 COLOR


White


10 SINGLE (write the word)


MARRIED


WIDOWED


or DIVORCED


Married


DEATII WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Pulmonary Edema


(11)


Acute myocardial Infarction


s. if amy,


[ ( W'as deceased a


U. S. War Veteran.


No


No.


Massachusetts General Hospital BAKER MEMORIAL


A TRUE COPY ATTEST: Charles it Mackie City Registrar


RECEIVED


TO!


OF


1: 10


VERK.


6


HI


JUN 1 41961 AM


X 1


M R-303 >


-524-6-50-929145


916


14 1961


PLACE OF DEATH


SUFFOLK BOSTON (C'ity of 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. 02735


Registered No.


MASSACHUSETTS GENERAL HOSPITAL St. No.


[(If death occurred in a hospital or institution,


2 FULL NAME KATHLEEN (JenKS) ( First Name) (AHadle Name) (Last Name) U. S. War Veteran, (If to specify WAR)


(If dec card is a married, widowed or divorced woman, give also maiden name.)


332 PLEASANT STREET


St.


WINTHROP


(If nonresident, give city or town and State)


......... months ........


days.


3 DATE OF


DEATH


MARCH


18


1961


4I HERENY CERTIFY that I have investigated the death of the person above named and that the CAUSE AND MANNER thereof arc as follows : (If an injury was involved, state fully.) THERMAL BURNS OF SKIN, TRACHEA AND BRONCHI


(Year)


9 SEX


10 COLOR


Female White


11 SINGLE


MARRIED


WINXWED Widowed


or DIVORCED


lla If married, widowed, or divorced


HUSBAND Of .......*******!!


(Give maiden name of wife in full)


(or) WIFE of


DAVID


ARMSTRONG


(Husband's name in full)


12 IF STILLBORN, enter that :


here.


13


AGE ....


6 Years.' Montha2


If under 24 hours


„Minutes


14 Usual


Occ !. ion:


DOMES


(L'ind of work don


aring most of working life )


15 Inc


y


or 1


ho-


work


Social


erity No.


17


RTHI


te or .


[City)


BOSTON


MAIS


٦٠


IME OF


.THER


MARTIN JenKS


19 BIRTHPLACE OF


FATHER (City)


(State or country)


IRELAND


20 MAIDEN NAME


OF MOTHER


CATHERINE BURKE


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


IRELAND


22


MARGARET CONVERY


Informant


(Address)


PAGUMET MAULDIN


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Of milliman


(Signature of Agent of Board of Health or other)


1252


3/20/6/


(Official Designation)


(Date of Issue n' Permalt)


X


(a) Residence. No.


( ('sual place of aluxe)


MEDICAL CERTIFICATE OF DEATH


(Month)


(Day)


Injury occur ?


(C'ity or town and State)


(Specify type of place)


Injury


THERMAL


BURNS


(Signed)


(Addr


25 SHATTUCK ST.


( Punt or Type ... hall


1


i.Holy CROSS


Place of Burial, or Cremation.


DEATH in plain terme, so that it may be properly classified under the International Classification of Causes


Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF


If deceased was a l'. S. War Veteran, G.L. Chap. 46. Section in, requires physicians to insert a recital to that effect.


of Death. See reverse side for additional information. See also Chap. 38, ff 6. 20; Chap. 45, 55 9, 10; Chap. 114,


§§ 44-48.


-WNIIL TLAMALI , WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of


While at work ?


Was autopsy perle


·d?


S Accident, sincule, or honnenle (specify)


ACCIDENT


Date and hour of injury


MARCH


15 1961


IF ACCIDENTAL, was injury causally related to the death ?


YES


Where did


WINTHROP , MASSACHUSETTS


Did injury occur in or about home, on farm, in industrial place, or in


public place ?


HOME


Manner of


CONFLAGRATION CAUSED BY 'S!


Injury


Nature of


(flow did injury occur?) C! AB.


6 W's disease or injury in any way related to occupatio . [ deceased ? If so, specify


...... , M. D.


LEON.


1


SINS. M.D.


Date


MARCH 19961


MALDEN


(City or Town)


DATE OF BURIAL


MAR


22


1941


& NAME OF


FUNERAL DIRECTOR


Gerard & Cassael


ADDRESS 221 Schon Chang Malden


Received und bled


MAR 1961


.......... 19.


(Registrar)


PAREN.


ve its NAME inste


ARMSTRONG


PHYSICIAN - IMPORTANT


(( Was deceased a


Length of stay : In place of death years months. 3 days. In place of residence Af


PERSONAL AND STATISTICAL PARTICULARS


(write the word)


A TRUE COPY ATTEST:


Charles H. Mackie Of Resistrar


RECEIVED


TOW


OF


71 12. 1 ---


CLERK


6


HROP


JUN 1 4 1961 AM


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(('sty or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


OUT OF - TOWN filed for burial permit with Board of Health or its Agent.


Registered No.


S(If death occurred in a hospital or institution. St. { give its NAME instead of street and number)


2 FU1.1. NAME . Mary Dodge ( First Name)


(Middle Name)


(Last Name)


( If deceased is a married, widowed or divorced woman, give also maiden name.)


54 Buchanan Street


Winthrop, Massachusetts


(a) Residence. No. (l'sual place of abode)


1.ength of May : In place of death. years months 7


days. In place of residence.


50 years


months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


to SINGLE


MARRIED)


( write the word)


( Month) (b)av)


( Year )


March 21 19


HEKI CE 611 March 28


19


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife In full)


(or) WIFE of


Arthur ..... D ........ Dodge


(Husband's name In full)


we last saw he Lalive on


1961, death is said to


have occurred on the date stated above, at0: Of a am.


INTEXVAL


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


II IF STILLBORN, enter that fact here.


(a) INTRACEREBRAL HEMORRAGE


BETWEEN


ONSET AND


DEATH


7 day


AGE.


7.1.Yes


... Months ............. Days


12


Due To (b)


Due To (c)


OTHER Stt.NIFICANT CONDITIONS


Was autopsy performed?


yes


What test confirmed diagnosis?


autopsy


S Was disease or injury in any way related to occupation of deceased? If so, specify


(Signed)


M. D


Charles L. Clay, M. D. (PRINT OR TYPE SIGNATURE)


(Address) Ana's. Dir., Mass. Gea'L. Hosp .. Date. Mar. 28161


6 Winthrop Cemetery Winthrop Place of Burial or Cremation (City or Town)


DATE OF BURIAL


March .... 31. 1951.


7 NAME OF FUNERAL DIRECTOR Arthur J .O' Maley


Winthrop Mass


Kereun Charles


MAR 30 1961 il Enacker


(Registrar)


PARENTS


17 NAME OF


FATHER


Peter Christopher


18 BIRTHPLACE OF FATHER (City) (State or country) Newfoundland


19 MAIDEN NAME OF MOTHER Bridget Fitzgibbons


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21 Holón Christopher


Informant


(Address)


11 Barral St., Winthrop


I HEREBY CERTIFY that a sailsfactory standard certificate of death wu hled with me BEFORE the burial of transit permit was issued; "Candy


(Signature of Agent of Board of Health pr other)


A1424


3/29/61


(Official Designation) (Date of Issue of Permn)


JCTIONS OR CERTIFICATE


IVIng F DEATH t enter han one os rach b) and (c)


s Mot mran of dying. curt failure. 1. Il meuns or compli- ich caused


ons contrib. uth but not the terminal dition given


331


Chapter 137. 954. requires is to print or


i death on ...... trs, and 4X Acis of . Phys. ..


Irector · only Ink. 14 1961 28145


R-301A 1


s. i' UNY.


If under 24 hours


. Hours


Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry


or Business:


Own-Homo


15 Social Security No.


16 BIRTHPLACE (City)


East Boston


(State or country)


Mass


3 DATE OF


DEATH


March


28


1961


[( Was deceased a


..


U. S. War Veteran. No


li( so specify WAR)


rried


or DIVORCED


March 28


That why iended deceased


61


St (If nonresident, give city or town and State)


No. MASSACHUSETTS .. GENERAL.HOSPITAL


PHYSICIAN - IMPORTANT


use (a). he under. use last.


A TRUE COPY ATTEST: Charles H. Mackie City Registrar


RECEIVED


TOWA


7/ 12. "


CLERK


OFFI


-3


.


5


6


WIN


ROR.


JUN 1 41961 AM


X


PLACE OF DEATH


SUFFolk (County) BOSTON (C'ity or Town)


No.


Beth Israel


The Onmmmmuralth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


OUT - OF . TOMA e hled for burta with Board of Health or its Agent.


STANDARD


CERTIFICATE OF DEATH


Registered No. 03071


f(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.


lif so specily WAR)


No


( If deceased is a married, widowed or divorced woman, give also maiden name.)


lat Residence Nu it'sual place of almale)


122 Washington Ave


St. WINThrop


Length of stay: In place of death years months .. / .... day. In place of residence 30 years.


... months. .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


A SEX


Male


9 COLOR


White


10 SINGLE


( write the word)


MARRIED Married


WIDOWED


or DIVORCED


41 HERENY CERTIFY.


That I attended deceased from


March 29, 161, 80


March 30


I last new lifelive mit


March 30, 1961, death is said to


have occurred on the date stated above, at 3:10 Am.


INTERVAL


(or) WIFE of


(Husband's name in full)


Il IF STILLBORN, enter that fact here.


12


AGE.


78 Years


Months ..........


.Days


If under 24 hours


.Hours .......__ Minutes


13 Usual


Occupation :


Pediatrician


(Kind of work ilone during most of working hle)


14 Industry


or Business :


Medicine


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


(unknown) Guralnick


18 BIRTHPLACE OF


FATHER (City)


-


(State or country)


Russia


19 MAIDEN NAME


OF MOTHIER


(unknown)


20 BIRTHPLACE OF MOTHER (City) (State or country)


Russia


21


Informant


Dr. Walter C. Guralnick


(Address) 118 Wallis Rd. Chat a1


I HEREBY CERTIFY the satisfactory standard certificate was Aled with me BEFORE by burial or trang-permit dorina


death


( Signature of Agent of Board of Health or other )


1440


3 -94-61


(Oficial Designation)


(Date of Incur ol Permit)


V.


UCTIONS FOR CERTIFICATE


giving OF DEATH


than one for each (b) and (c)


ns. i! amy. are rise to uuse tul,


lions contrib- ruth but not thr terminal


at death all


48. Acts of „,tırrs Physi.


Place of Burial or Cremation


(City or Town)


DATE OF DURIAL


March


31


161


7 NAME OF


FUNERAL DIRECTOR


Paul R. Levine


ADDRESS 470 Harvard St., Brookline ...


(Registrar)


10a If married, widowed, or divorced


IIUSIIAND of


Nina Hazman


(Give malden name of wife in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(1) CUFFMYOCARDIAL INFARCTION


BETWEEN ONSET AND DEATH 10 m3


Due To (b)


Due To (1)


OTHER


SIGNIFICANT


ATHEROSCLEROTIC HEART


CONDITIONS


DISTANE


Was autopsy performed? Vis


What test confirmed diagnosis?


AUTOPSY


5 W'as disease or Injury in any way related to occupation of deceased? Il so, specify ...


(Signed)


Helal Rosenblatt


M. D


Gerald Rosenblatt


(IKINT OR TYPE SIGNATURE)


(Address)


330 Brookline Ave Boston


43-30 1961


6


Chel . Jacob


Woburn


PARENTS


Hospital


? FU'L.I. NAME+


Dr. Reuben ( First Name)' (Middle Name)


GuralNick


(Last Name)


( If nonresident, xive city or town and State)


J DATE OF


DEATH


March


30


1961


(Month)


(Day)


(Year)


R-301A -


IC.


| 14 1961 928145


2/201


Chapter 137. 1954. requnes fis to print or


fri signature


...


· of dying. heart failure. rt it meums r. or 10mpli-


A TRUE COPY ATTEST:


Charles it mackie RECEIVED City Registrar


OF TOW 71 12. 3


...


OFFI


...


CLERK


*


6


WINTHROP M


JUN 1 4 1961 AM


X Suffolk (County)


Roxbury ( City of Town)


The Commonmuralth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


OUT - OF- TOWN To be filed for burial permit with Board of Itealth of its Agent.


Robt. B. IRRigham Hospitals {(If death occurred in a hospital or institution.


St. [give its NAME instead of street and number) No. MAUDE MRS MARy BAUMeister ( Waters) 2 FULL NAM PHYSICIAN - IMPORTANT


(If deceased is a marrier, widowed or divorced woman, give also maiden name.) 12 Prospect Avc. Winthrop


(If nonresident, give city or town and State)


5 days. In place of residence 26 years months days.


MEDICAL. CERTIFICATE OF DEATII


PERSONAL AND STATISTICAL PARTICULARS


8 SEX F


9 COLOR


W.


10 SINGLE


(write the word),


MARRIED MARRICE


WIDOWED


or DIVORCED


4IHEREBY CERTIFY.


That I attended deceased from


MAR 28


. 19 61.10


APRIL


1


. 161


I last saw herlive on


April-


, 1961, death is said to


have occurred on the date stated above, at


2021m.


(or) WIFE of


Fred A. BAUMeister


(Ilusband's name in full)


11 IF STILLBORN, enter that fact here.


AGE 69 Years 1 Months 23 Days


If under $4 hours


_Ilours


Minutes


13 Usual


Occupation:


House wife


(Kind of work done during most of working life)


14 Industry


or Business:


Lun Homek


13 Social Security No ..


none


No. HARTland


SCOLIOSIS


Loyrs


Was autopsy performed?


Yes


What test confirmed diagnosis?


Autopsy


S Was disease or injury in any way related to occupation of deceased No If so, specify


(Signed) Theodore Feldman .. , M. D. .) 454 BROOKLINE AUT " Apr. 2.61


(Addie


Winthrop Cemetery, Winthrop, ... Place of Burial or Cremation (City or Town)


DATE OF BURIAL April 5, 1961 19


7 NAME OF


FUNERAL DIRECTOR


alfred B. March


ADDRESS


174 Winthrop St. Winthrop,


Received and filed


APR -6-1961


19


(Registrar)


PARENTS


17 NAME OF


FATHER


Julian Waters


18 BIRTHPLACE OF


FATIIER (City)


(State or country)


Vermont


19 MAIDEN NAME


OF MOTHIER


Bessie Perrce




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