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