USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 34
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... months ...
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September
14
1961
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
to ...
Full
19.
60
Lexx 14
19
61
06/
death is said to
I last saw h halive on
9/14
have occurred on the date stated above, at
1.15 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
BRONCHO-PNEUMONIA
(a)
Due
(b)
ARTERIO SCLEROTIC
HEART DISEASE
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
0
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
0
FRED O' REGALI 11.0
(PRINT OR TYPE SIGNATURE)
(Address) 113PLEASANT
Date 9/15 1961
WINTHRO
Aspen Grove Cemetery Ware, Mass .
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Sept. 16, 1967
19
7 NAME OF
FUNERAL DIRECTOR
alfred-B Mars
ADDRESS
174 Winthrop St. Winthrop,
Received and filed SEP 15-1981 .......... 19.
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Mary Stuart
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
21
Informant
John McCarthy
....
(Address)
18 Plummer Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the, burial or transit permit was issued:
Mass, tireanno ......
(Signature of Agent of Board of Health or other) Health Officer 9/15/6/1
(Official Designation) (Date of Issue of Permit)
928145
[ R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
Does not mean e of dying, heart failure, etc. It means e, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ndition given
Burnt ...... Isle
16 BIRTHPLACE (City)
(State or country)
Scotland
17 NAME OF
FATHER
Robert Farquhar
18 BIRTHPLACE OF
FATHER (City)
Burnt ...... I.s.le
(Signed)
the otheran
M. D
(State or country)
Scotland
If under 24 hours
12
AGE34
4
Years.
0 Months.
8 Days
Hours ........
.. Minutes
13 Usual
Occupation :
housework-
(Kind of work done during most of working life)
14 Industry
or Business :
own home
15 Social Security No.
024-01-9876-B
5 mg
8 SEX
9 COLOR
female
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
That I attended deceased from
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Albert Justin Mccarthy
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
INTERVAL BETWEEN DNSET AND DEATH 3 DAYS
St.
(If nonresident, give city or town and State)
To be filed for burial permit with Board of Health or its Agent.
No. Winthrop Convelescent Home
Chapter 137, 1954. requires ans to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
6
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT.
SERVICE NUMBER
%
ERK
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice: (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un.Ill . 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 phydan is5 1961 AM 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.
PLACE OF DEATH
IX SUFFOLK (County) WINTHROP (City or Town) IMSE PIT 56 SHIRLEY ST.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
No. FRANCIS (First Name) (Middle Name)
WILLIAM
IRWIN
(Last Name)
[(Was deceased a
¿U. S. War Veteran,
{if so specify WAR)
WWII
(If deceased is a married, widowed or divorced woman, give also maiden name.)
56 SHIPLEY ST. St.
Length of stay :
In place of death.
.. years.
months.
.days.
In place of residence.
15. .years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED WIDOWED TARRIED or DIVORCED
4 I HEREBY CERTIFY,
19
to ..
That I attended deceased from
19
I last saw h ........ alive on
, death is said to
have occurred on the date stated above, at
App. 11.2019
19.
INTERVAL BETWEEN ONSET AND DEATH
....
Due Neattimas presiality
(b)
que to national causes Due To (c) probably coronary occlusion.
OTHER SIGNIFICANT Winthrop Board ( Health CONDITIONS Charles Liber man, m 16 BIRTHPLACE (City)
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Charles Liber mane M. D
Charles
Kerman, M.D
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date .. 9/18/ 1961
HOLY CROSS
MALDEN
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
SEPT20
1961
7 NAME OF
FUNERAL DIRECTOR
JOHN T. WHITE SP.
ADDRESS 135 LONDONST. EAST BOSTON
Received and filed
SEP-19-1961
... 19 ..
(Registrar)
PARENTS
17 NAME OF FATHER WILLIAM IRWIN
18 BIRTHPLACE OF
FATHER (City)
EAST BOSTON
(State or country) MASS.
19 MAIDEN NAME
OF MOTHER
JULIA DORGAN
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS.
(WIFE)
21 Informant
CECELIA V. IRWIN (Address) 56 SHIRLEYST. WINTHROP
I HEREBY, CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Jaiku 5, tereanus (Signature of Agent of Board of Health or other) health puede 9/18/1/
(Official Designation) (Date of Issue of Permit)
28145
R-301A 1
4
UCTIONS OR CERTIFICATE
giving OF DEATH t enter than one for each b) and (c)
es not mean of dying, eart failure, tc. It means or compli- hich caused
ns, if any, ive rise to ause (a), the under- ause last.
ions contrib- eath but not the terminal dition given c.
Chapter 137, 954. requires ns to print or e
cause or of death on tificates, and 48, Acts of uires Physi- print or type Ler signature.
3 DATE OF
DEATH
SEPT
17
1961
(Month)
(Day)
(Year)
landendivorced A DONAHUE
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 515 Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
INSURANCE BROKER
(Kind of work done during most of working life)
14 Industry
or Business :
RETIRED
15 Social Security No.
028-20-7415
EAST BOSTON
(State or country) MASS.
BOSTON
To be filed for burial permit with Board of Health or its Agent.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) ......
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE. 11- 3 -42
DATE OF DISCHARGE
12-19-42
RANK, RATING
S.K. 2C
ORGANIZATION AND OUTFIT
21. S. NAVY
SERVICE NUMBER
203-71-84
17. ?
...
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .-- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
SEP 1 91961 FM
I R-301A -
PLACE OF DEATH
Suffolk (County)
MINST PET
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME Emma
L. Hughes (Thurston) [ (Was deceased a
(First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
97 Woodside Ave., Winthrop ... Mass.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .. .years. .. months 11days. In place of residence .years
38
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
Wid
(write the word)
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Richard ... 0 Hughes
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.
78
Years ..
1
Months.
11Days
If under 24 hours
Hours ...
......
.. Minutes
13 Usual
Occupation :
House Wife
(Kind of work done during most of working life)
14 Industry
or Business :
Own Home
15 Social Security No.
East .... Boston
16 BIRTHPLACE (City)
(State or country)
Mass.
PARENTS
17 NAME OF
FATHER
George Thurston
18 BIRTHPLACE OF
FATHER (City)
Uxbridge
(State or country)
Mass,
19 MAIDEN NAME
OF MOTHER
Lizzie Andrews
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Boston
21 Dorothy E Hughes
Informant
(Address)
97 Woodside Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: talkh E Serianni
(Signature of, Agent of Board of Health or other) HO Tate
Jakp. 22/61x
(Official Designation)
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH
ot enter than one for each (b) and (c)
Des not mean e of dying, heart failure, etc. It means e, or compli- which caused
os, if any, rave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ndition given 1. C
Chapter 137, 1954. requires ins to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
6 Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Sept. 23 1.61
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop
Mass,
Received and filed
19
J
(Registrar)
3 DATE OF
Sept. 20,
1961
DEATH
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY,
That I attended deceased from
Sept ..... 9.
19.61
, to ..... Sept .20
19
61
I last saw her .. alive on
Sept 20
19.61
death is said to
have occurred on the date stated above, at
1.30
P.m
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Acute Antero-septal Myocardial
infarction 11
days
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
No.
What test confirmed diagnosis?
Clinical & Electrocard-
iogram
5 Was disease or injury in any way related to occupation Of deceased? If so, specify
(Signed) Dorothy Cheney appleton
M. D
DOROTHY CHENEY APPLETON
(PRINT OR TYPE SIGNATURE)
(Addre 197 Wladside AVE Date Sept 201961 WINTHROP, MASS
No.
Winthrop Community Hospital
¿ U. S. War Veteran,
{if so specify WAR)
6.928145
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1.
ROLFPROT
E PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice: (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside fars dering aflast 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.
X
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
21 SeaForm
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT f(Was deceased a { U. S. War Veteran,
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[if so specify WAR)
21 Sex Fern
St.
Wintheon
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years
months ..
.days. In place of residence
.... years.
months.
........... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September
21,
1961
8 SEX M
9 COLOR
10 SINGLE
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
Dec. 27,
,60
to .... Sept .21
19
61
death is said to
have occurred on the date stated above, at
5:45 P.m.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
76
Years
.Months ......
Days
13 Usual
Occupation :
M.T.A. Retained
(Kind of work done during most of working life)
14 Industry
or Business :
Maintenance
15 Social Security No.
024-10,4148
16 BIRTHPLACE (City)
(State or country)
Austria
17 NAME OF
FATHER
DAVID
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Austria
19 MAIDEN NAME
OF MOTHER
Leah ICHBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Dustria
6
LIBERTY
PROGRESSIVE EVERETT
Place of Burial of Cremation
Sept 22
1961
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
TORF funera (Service Inc.
ADDRESS 151 Washington tor Chalsion
Received and filed 19.
SEP 22 1961
(Registrar)
PARENTS
Benjamín Hoffman
21
Informant
(Address)
121 Sea fram Are Weatherp
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Palko & Virianeue
(Signature of Agent of Board of Health or other)
arte
9/2/61
HO
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
es nat mean of dying, heart failure, etc. It means e, or campli- which caused
1 ns, if any, ave rise ta cause (a), the under- cause last.
tians contrib- leath but nat the terminal nditian given
Chapter 137. 54. requires s to print or cause or death on ificates, and 48, Acts of aires Physi- rint or type er signature.
(Signed)
M. D.
M. Traunstein, Jr., M. D.V
(PRINT OR TYPE SIGNATURE) 73 Bartlett Rd. Date.
Sept. 21161
(Address)
Was autopsy performed?
no
What test confirmed diagnosis? Clinical & laboratory
5 Was disease or injury in any way related to occupation of deceased ? .. no If so, specify
1} yrs
(c)
Due To
Generalized arteriosclerosis
5 yrs
OTHER
Diabetes mellitus
5 yrs
SIGNIFICANT
CONDITIONS
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Massive cerebral hemorrhage
(a)
INTERVAL
BETWEEN
ONSET ANO
DEATH
10a If married, widowed, or divorced
HUSBAND of
Rose Shaffer
(Give maiden name of wife in full)
If under 24 hours
Hours.
Minutes
1 hr.
24
To be filed for burial permit with Board of Health or its Agent.
No. ISADORE HOFFMAN
10
(a) Residence. No.
(Usual place of abode)
24
MARRIED
WIDOWED
or DIVORCED
Widowed
I last saw
im alive on
Sept. 20
19.61
(b) Due To Cerebral arteriosclerosis
R-301A 1
-59-925686
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE SEP 2 21961 AM
The fulfillment of the purpose of these laws calls for the observance of following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
=
PLACE OF DEATH
Suffolk (County)
CONS
Winthrop
(City or Town)
No.
Winthrop Community Hospital
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Benjamin
(First Name)
(Middle Name)
Ruskin
(Last Name)
[if so specify WAR)
NO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
159 Locust St
(L'sual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years
5
months.
24
.days.
In place of residence,
.years,
.....
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September
21
1961
(Month)
(Day)
(Year)
4 I HEREBY
June
1960 to.
Sept. 21
That I attended deceased from
I last saw h. Inalive on
Sept. 21
, 19 61
death is said to
(or) WIFE of
Eleanor
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Cancer
, Left Kidney
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None.
Was autopsy performed?
What test confirmed diagnosis clinical and Pathological.
5 Was disease or injury in any way related to occupation of deceased? If so, specify Charles Liberman M. D.
NO
(Signed)
Charles Liberman
(PRINT OR TYPE SIGNATUREY
(Address)
Winthrop Mass Date 9/21/
1961
6
Beth EL W. Roxbury
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Sent 24 1961 21 MAS EALEVOR Ruskin
7 NAME OF
FUNERAL DIRECTOR
TORE funeral Service das
ADDRESS 151 Washington Ave Chelsea
Received and filed
.19
(Registrar)
PARENTS
17 NAME OF
FATHER
Abraham Ruskin
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
C.B.L.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
(Address)
159 Locast St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued: Ralph E Levarme CHESignature of Agent of Board of Health or other) 10 Loff, 21 - 1961x
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
es nat mean of dying, heart failure, tc. It means ,or campli- hich caused
ns, if any, ave rise ta ause (a), the under- ause last.
ians contrib- eath but not the terminal sditian given C
Chapter 137. 1954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
928145
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
PHYSICIAN - IMPORTANT
( Was deceased a
{ U. S. War Veteran,
10 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Toutes
have occurred on the date stated above, at
7:30 Am.
11 IF STILLBORN, enter that fact here. INTERVAL BETWEEN ONSET AND DEATH 16 months 12 68 Years ... Months ........... ... Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Shoe Mfar
RE ?
(Kind of work done during most of working life)
14 Industry
or Business :
Shoes
15 Social Security No. Yes?
16 BIRTHPLACE (City)
(State or country)
Russia
8 SEX
Mule
9 COLOR
White
CERTIFY
R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
RULES OF PRACTICE
The fulfillment of the SERE 6 2019 69NS :9 daws,calls for the observance of the following rules of practice :
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