Town of Winthrop : Record of Deaths 1961, Part 34

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 34


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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... 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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