USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 13
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Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49
6076
3-1-62
Resetyed find filed Charles AR 721962 Kiel 19
(Registrar)
PARENTS
LINAS ATZEDEK
EVERETT
6
Piace of Burial or Cremation
3- 2 -
1962
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
TORF CHAPELS
ADDRESS
BROOKLINE
PLACE OF DEATH
OM R-301A 1
ISTRUCTIONS FOR DAL CERTIFICATE
In giving UE OF DEATH not enter sre than one eine for each ), (b) and (c)
h does not mean Code of dying, s heart failure. es, etc. It means lease, or compli- which caused A
'itions, if any, Ah gave rise to ' cause (a). Big the under- cause last.
onditions contrib- to death but not to the terminal condition given
600
bte :- Chapter 137. 1 of 1954. requires sicians to print or the cause or .es of death on h certificates, and pter 48, Acts of , requires Physi- s to print or type e under signature.
AY 8 - 1962
(County) Boston
(City or Town) Beth Israel Hospital
No.
2 FULL NAME
Rebecca
(First Name)
(Middle Name)
(Last Name)
Possich
3 DATE OF
DEATH
March
1
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Feb. 27, 1962
to
19
62
I last saw h&.Y.alive on ...
March
, 19 62, death is said to
have occurred on the date stated above, at ..
6:20 am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Acute Pulmonary Edena
(a)
INTERVAL BETWEEN ONSET AND DEATH
Due To
(b)
Hypertensive Heart Disease
Due To
(c)
Acute renal failure
OTHER
SIGNIFICANT
Chronic pyclonephritis
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis?
X ray, Blood tests,
... No
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
......
(Signed)
RAY MOND C. /YERKES
(PRINT OR TYPE SIGNATURE)
(Address)
Beth Isvalid Hosp Date
Mar 1 1962
11 days.
CERTIFICATE OF DEATH
(If nonresident /zive city or town and State)
(Official Designation) (Date of Issue of Permit)
(write the word)
A TRUE COPY ATTEST: Charles i. Mackie City Registrar
w ...
6
H
MAY - 81962 AM
PLACE OF DEATH
SUFFOLK OUT - OF - TO
(County)
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
63
To be filed for burial permit with Board of Health or its Agent. 02184
Registered No. ..
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Mary Terranova ( Loggia)
(First Name)
(Middle Name)
(Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
247 Main Street
St.
Winthrop ...... Massachusetts
( 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
8 SEX
female
9 COLOR
white
10 CITIZEN
OF U.S.
YES
NO
Il SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
February 28
19.62
to ...
March 2
attended deceased from 62
19
lla If married, widowed, or divorced
(or) WIFE of
HUSBAND of
(Give maiden name of wife in full)
Joseph Terranova
12 DATE OF BIRTH
July 25, 1889
13
AGE ..
72 Years ...
........
.. Months .............. Days
If under 24 hours
Hours .............. Minutes
.14 Usual
Occupation :
Retired Seamstress
(Kind of work done during most of working life)
15 Industry
or Business :
...
Garment
16 Social Security No.
029-10-2185
Was autopsy performed?
n.o.
What test confirmed diagnosis?
clinical
17 BIRTHPLACE (City)
(State or country)
Sicily
18 NAME OF
FATHER
Angelo Loggia
19 BIRTHPLACE OF
FATHER (City)
...
(State or country)
Siciliy
20 MAIDEN NAME
OF MOTHER
Bernadette Marino
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sicily
22 Joseph Terranova
Informant
(Address)
247 Main St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of deaf was filed with me BEFORE the bugial or transit permit was issued: 7ª Jo Braca A 23796
(Signature of Agent of Board of Health or other) March. 4 1962
(Official Designation)
(Date of Issue of Permit)
INSTRUCTIONS FOR MICAL CERTIFICATE
In giving A SE OF DEATH do not enter nore than one ause for each e(a), (b) and (c)
tis does not mean un mode of dying, u: as heart failure, senia, etc. It means u disease, or campli- ans which caused ch.
onditions, if any, hich gave rise to ove cause (a). ating the under- ing cause last.
Conditions contrib- is ta death but not led to the terminal ase candition given -
/
PC
Note :. Chapter 137, cts of 1954 requires Physicians to print or ype the cause or suses of death on eath certificates, and hapter 48, Acts of 939, requires Physi- ians to print or type ame under signature.
eral Director ase use only BLACK Ink. RAY 8 - 1962
M 3-61-930213
A TRUE COPY ATTEST:
PARENTS
Winthrop Cemetery, Winthrop
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
March 5,
1962
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received add filed
MAR 6 1962 acker 19.
Charles 4. 2
(Registrar)
4yrs
Due To
(c)
OTHER
Diabetes Mellitus
SIGNIFICANT
CONDITIONS
5yrs.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
ch@low
M. D.
Charles L. Cley, M.D.
(Print or Type Name)
Ass's. Dir., Maso. Coa l. t.c).
Date
March 2 ,62
(Address)
3 DATE OF
DEATH
March
2
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That
F last saw @T ... alive on
March .... 2
162
., death is said to
have occurred on the date stated above, 4:00 am.
INTERVAL
BETWEEN
ONSET AND
(Husband's name in full)
DEATH
(a)
carcinoma
Due To
Carcinoma of the
(b)
breast
-
ORM R-301 1 DOSTON
No.
MASSACHUSETTS GENERAL HOSPITAL
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
no
{if so specify WAR)
(a) Residence. No. .
(Usual place of abode)
21
A TRUE COPY ATTEST:
Charles it. Mackie
City Registrar
FTON
0 : 0
THROP
MAY - 81962 AM
X
PLACE OF DEATH
Suffolk Ocare OF - TOWN
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H, WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
64
To be filed for burial permit with Board of Health or its Agent. 02359
Registered No.
[(If death occurred in a hospital or institution, ( give its NAME instead of street and number)
2 FULL NAME
A.
Bonjomin
(First Name)
(Middle Name)
(Last Name)
Allan
((Was deceased a
U. S. War Veteran,
IM SAW
(If deceased is a married, widowed or divorced woman, give also maiden name.)
104 Highland Avo.
XX Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
0
.years.
Q .... months ...
& ... days.
In place of residence ..
......
... years ............ months .......
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Malo
9 COLOR
White
10 CITIZEN
OF U.S.
YES
X
NO
11 SINGLE
MARRIED
W WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divoreed
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
12 DATE OF BIRTH
March 3, 1877
13
AGE .. 85 .... Years ....
0
.Months ......... Days
If under 24 hours
....
.. Hours .............. Minutes
14 Usual
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business :
16 Social Security No.
17 BIRTHPLACE (City)
(State or country)
Maino
18 NAME OF
FATHER
CNBC
19 BIRTHPLACE OF
FATHER (City)
(State or country)
CNBC
20 MAIDEN NAME
OF MOTHER
CNBC
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
22
V. A. Hospital Records, 150 S.
Informant
(Addre
Huntington Ave., Boston 30, Mass,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
..........
(Signature of Agent of Board of Health or other)
6175
3-7-62
Il (Official Designation) (Date of Issue of Permit)
X
A TRUE COPY ATTEST:
PARENTS
Long Island National Com., L.I., N.Y.
6
(City or Town)
Piace of Burial or Cremation
DATE OF BURIAL March 9, 1962
19
7 NAME OF
FUNERAL DIRECTOR
Robert J. Lawlor
363 S. Huntington Ave., Boston Pass"
Received and filed MAR 49 1962
"Charies H. Mach!"
(Registrar)
wica.
Was autopsy performed?
What test confirmed diagnosis? Autopsy
5 Was disease or Injury in any way related to occupation of deceased? If so, specify
(Signed
Herbert & Oubin
M. D.
Hertort E. Rubin
(Print or Type Name)
VAH, Boston, Maos.
Date.
Mar. 6 _. 19 ...
.19.
62
(Address)
....
occlusion
OTHER
SIGNIFICANT
CONDITIONS
2:55A.
have occurred on the date stated above, at ...
.... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bilateral bronchopneumonia
(a)
....
March
5
1962
(Day)
ITA(Year)
4 I HEREBY CERTIFY.
Fob .. 25
19
62
Mor. 5
19
to OD ........ , death is said to
DETWEEN
ONSET AND
acy's
Due To
(b)
Arteriosclerosis, gonoralizod
yrs.
Due To
(c)
Right middlo cerobral artery
That I Attended deceased from
6
3 DATE OF
DEATH
INTRUCTIONS FOR 1CL CERTIFICATE 1 giving E, OF DEATH d not enter Que than one ale for each (1, (b) and (c)
i daes mat mean ude af dying, heart failure, my etc. It means fase, or campli- which caused
tions, if any, gave rise to cause (a). fr the under- cause last.
Csditions contrib- death but mat to the terminal condition
450
te :- Chapter 137. of 1954 requires icians to print or the cause or :s of death on 1 certificates, and iter 48, Acts of requires Physl- I to print or type · under signature.
AY 8- 1962
3-61-930213
OM R-301 1
wx ..... atorenc ... Administration. Hospital
x
PHYSICIAN - IMPORTANT
{if so specify WAR)
(If nonresident, give city or town and State)
ADDRESS ....
...
CNBC
....
(or) WIFE of
(Month)
O9Y ATTEST: Chaves it. Takie City Registrar
6
THROT
MÁY - 81962 AM
IM R-301 1
ERUCTIONS FOR CERTIFICATE
giving OF DEATH
not enter than one : for each (b) and (c)
ploes not meon the of dying, heart failure, i etc. It means lise, or compli- r which coused
tions, if ony, a gove rise to couse (a), the under- cause last.
ditions contrib- death but not l'o the terminal condition given
93
R :- Chapter 137, of 1954 requires icians to print or the cause or :s of death on 1 certificates, and ter 48. Acts of requires Physi- i to print or type : under signature.
AY 8 - 1962
PLACE OF DEATH
OUT SUFFOLK TOW
(County) ROXBURY (City or Town) JEWISH MEMORIAL No. ... SONIA
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial perm 55 with Board of Health or its Agent.
Registered No.
02304
S(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
((Was deceased a
U. S. War Veteran,
No
( If deceased is a married, widowed or divorced woman, give also maiden name.)
46 SAGAMORE/ST. A
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
1 years.
3
20 days.
In place of residence ..
.... years ..........
.. months ............ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
MARCH
6
1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
Nov. 17
1960
That
March
6
attended deceased from
52
I last saw heralive on
March 5
1962
...............
., death is said to
have occurred on the date stated above, at
..... A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) PNEUMONIA
Due To (b)
3 days
Due To (c)
OTHER
ARTERIOSCLEROTIC HEART DISEASE
SIGNIFICANT
CONDITIONS
DIABETES VIELLITUS
Was autopsy performed?
No
What test confirmed diagnosis?
CLINICAL
17 BIRTHPLACE (City)
(State or country)
Russia
18 NAME OF
FATHER
DAVID ARKIN
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
20 MAIDEN NAME
OF MOTHER
Sophie TABLIN
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Puessia
22 Informant SAMUEL ARKIN . (Address) 54 QUINCY AND WINTHROP
7 NAME OF
FUNERAL
DIRECTOR
TORR funeral Serr, Inc.
Washington Are Chalsra
ADDRESS MARI 7 1962 Charles & Mack
A TRUE COPY ATTEST:
( Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Fem
9 COLOR
White
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divorced
HUSBAND of
(Give mailen name of wife in full)
SALMAN
(or) WIFE of
LOUIS
(Husband's name in full)
12 DATE OF BIRTH
13
ACE 59 Years.
Months .............. Days
If under 24 hours
...
.. Hours .............. Minutes
14 Usual
Occupation :
House with
(Kind of work done during most of working life)
15 Industry
or Business :
our Home
16 Social Security No. ....
NONE
5 Was disease or Injury in any way related to occupation of deceased? NO If so, specify
(Signed)
Gli R.4500
M. D.
RLIE A.
IMORN.
(Print or Type Name)
Jewish Narazil 119 Date.
3- 6
1962
(Address)
TiferetH ISRAEL
Everett
6
Place bf Burial or Cremation
(City or Town)
DATE OF BURIAL MARCH 7 1962
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death was fued with me BEFORE the burial or transit permit was issued: Jacqueline Derata (Signature of Agent of Board of Health or other) 6144- 3/6/65
(Official Designation)
(Date of Issue of Permit)
X
2 FULL NAME
(First Name)
(Middle Name)
HOSPITAL KALMAN
(Last Name)
lif so specify WAR)
WINTHROP, MAS.
(a) Residence. No ..
( Usual place of abode)
to ....................
INTERVAL DETWEEN ONSET AND DEATH
.........
-61-930213
1.
1.
H
MAY - 81962 AM
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
n giving E OF DEATH not enter e than one se for each ). (b) and (c)
does not mean ode of dying, s heart failure, 1, etc. It means ease, or compli- 'which caused
hitions, if any, -
gave rise to cause (a). & the under- cause last.
"ditions contrib- , death but not to the terminal condition given -120
Chapter 137, 1954. requires ans to print or he cause or of death on :rtificates, and 48, Acts of quires Physi. · print or type ider signature.
AY 8 - 1962
-11-59-926662
PLACE OF DEATH
X SUFONTE = TOWER
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
66
To be filed for burial permit with Board of Health or its Agent.
Registered No.
02467
No. MARY A. (MC GUNNIGLE) MACDONALD
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
81 SUNNUSIDe Ave
St.
WINTHROP-MASS.
(Usual place of abode)
Length of stay: In place of death .............. years .......
,21
days. In place of residence 5 years.
months ...........
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAR
9
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
JAN 12 1962
to ....
MAR 9
I last saw h. MRalive on
MAR
9
That I attended deceased
from
,62
10a If married, widowed, or divorced
HUSBAND of
6
DUNCAN DI MAC DONALD
19
(Give maiden pame of wife in full)
........ , death is said to
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 8
Years ..
3
.Months.
7 Days
If under 24 hours
Hours ......
.Minutes
13 Usual
Occupation :
AT Home
(Kind of work done during most of working life)
14 Industry
or Business :
Norve
15 Social Security No.
NONE
16 BIRTHPLACE (City)
(State or country)
NewYORK
17 NAME OF
FATHER
William Mc GUNNiGle
18 BIRTHPLACE OF
FATHER (City)
(State or country)
BOSTON - MASS
19 MAIDEN NAME
(Signed)
Mudou n. Rug
M. D.
OF MOTHER
MARY MECAllOUGH
MYRON NI KINGM.D
(PRINT OR TYPE SIGNATURE)
3
19
62
6 CALVARY
BROCKTON
l'lace of Burial or Cremation
DATE OF BURIAL
MARCH 12
1962
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
JAMES F. Hickey
ADDRESS
403
MAIN ST. BRICKTON
MAR 12 1962
RecsOd and filed
19 Charles & Maca (Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FERIALE
9 COLOR
White
MARRIED
WIDOWED
or DIVORCED
have occurred on the date stated above, at 125A
...... m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
ARTERIO-SCHEMATIC
8
HEART
Dis
DEATH 6 mo.
Due To
(b)
...
GENERAL ARTERIOSCLEROSIS
5 YRS.
Due To (c) ....
OTHER
SIGNIFICANT
MYXEDEMA
CONDITIONS
GLAUCOMA
Was autopsy performed?
N.
What test confirmed diagnosis ? CLINICAL
5 Was disease or injury in any way related to occupation of deceased 0 If so, specify
PARENTS
21 Informan Mrs. Jones MakeinA (Address) 81 SUNNYSIDE AVE, WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Danato
(Signature of Agent of Board of Health or other)
6223-
2/9/62
(Official Designation) (Date of Issue of Permit)
X
2 FULL NAME ..
(County) EAST BOSTON (CityAY PRINCETON Shelby NURSING HOME
CERTIFICATE OF DEATH
§(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
No
(If nonresident, give city or town and State)
10 SINGLE
(write the word)
80
5 YRS
(Address)222 PLEASANT ST. ............. Date ..........
20 BIRTHPLACE OF
MOTHER (City)
....
BROCKTON - MASS.
(State or country)
BUFFALO,
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
-
-
....
L
6
raro
MAY - 81962 AM
PLACE OF DEATH
M R-301A 1 SUFFOLK (County) OF's TU ROXBURY (City or Town) JEWISH MEMORIAL HOSPITAL
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
67
To be filed for burial permit with Board of Health or its Agent. 02481
Registered No.
S(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
U. S. War Veteran,
no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
117 SHORE DRIVE St.
(a) Residence. No.
(U'sual place of abode)
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
MARCH 10
1969
(Year)
8 SEX
male
9 COLOR
white
10 SINGLE (write the word)
MARRIED
married
AI HEREBY CERTIFY,
That I attended deceased from
FEBRUARY 7, 1962, to
MARCHIO
1962
I last saw h/M.alive on
MARCHIO
1962, death is said to
have occurred on the date stated above, at 6:30 A.m.
INTERVAL
DETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) HYPERNEPHROMA WITH
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
CLINICAL, OPERATION
5 Was disease or injury in any way_related to occupation of deceased? If so, specify NONE
(Signed)
Shanta Sharing
M. D
SHANTA SHERRING M.D
(PRINT OR TYPE SIGNATURE)
(Address JEWISH MEMORIAL Date MARCH 10,962
HOSPITAL
Shara Tfilo (Lebanon) W.Roxbury
6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
March 1l.
.19.62
7 NAME OF
FUNERAL DIRECTOR
Benjamin F.Solomon
ADDRESS
....
420 Harvard St., Brookline.
Received and
MAR 1 3 1962 Charles 2 Mache
( Registrar)
PARENTS
17 NAME OF
FATHER
Carl Witten
18 BIRTHPLACE OF FATHER (City) (State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Sarah
(unknown )
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
21 Robert Witten
Informant (Address) 209 winchester St Brooklin
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial .or,transit permit was issued:
FPstracci
423418
(Signature of Agent of Board of Health or other) march 10, 196€
(Official Designation)
(Date of Issue of Perdit)
TRUCTIONS FOR IL CERTIFICATE
n giving E OF DEATH not enter re than one se for each ), (b) and (e)
daes nat mean ode of dying, s heart failure. 1, etc. It means Lease, or compli- which caused
'itions, if any, ih gave rise ta e cause (a), ng the under- cause last. -
onditians contrib- ta death but nat ta the terminal condition given
80
n. C.
›te :- Chapter 137, 1 of 1954. requires sicians to print or : the cause or les of death on h certificates, and pter 48, Acts of , requires Physi- s to print or type e under signature.
AY 8 - 1962
No. Louis Witten WITTEN
2 FULL NAME
LOUIS (First Name) (Middle Name) (Last Name)
(if so specify WAR)
WINTHROP,
Mass.
or DIVORCED
IOa If married, widowed, or divorceBertha Badanes
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
II IF STILLBORN, enter that fact here.
12
79
AGE
Years.
.. Months .........
.Days
If under 24 hours
.Hours .......
Minutes
13 Usual
Occupation :
Salesman ...
(retired)
(Kind of work done during most of working life)
14 Industry
or Business :
Dry Goods
15 Social Security No.
010-07-4376
16 BIRTHPLACE (City)
(State or country)
Russia
-
Due To
METASTASES
MONTH.
(If nonresident, give city or town and State)
(Month) (Day)
CERTIFICATE OF DEATH
19
A TRUE COPY ATTEST: Charles &. Mackie City Registrar
0
MAY - 81962 AM
PLACE OF DEAT
SUFFOLK
OF
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health" or its Agent.
Registered No.
02577
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) No.
PHYSICIAN - IMPORTANT
2 FULL NAME
MARY
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
115
Washington Avenue,
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
(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.
PERSONAL AND STATISTICAL PARTICULARS
10 COLOR
11 CITIZEN
OF U.S.
YES
/NO
12 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
12a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
13 DATE OF BIRTH
april 2 1881
5 Accident, suicide, or homicide (specify)
Accident
Date and hour of injury
February ......
28 ...... 19
62
Yes.
IF ACCIDENTAL, was injury causally related to the death ?
Where did
Winthrop, Mass.
Injury occur ?
(City or town and State)
Did injury occur
HOWabout home, on farm, in industrial place, or in
public place ?
Manner of
Fallsrootflour?
Injury
(How did injury occur ?)
Nature of
Facture of femur
Injury
While at work ? Was autopsy performed ........
NO
6 Was disease or injury in any way related to eur tion of de cased ?
(Signed)
Michael
Luonce ......
..... M.D.
Bostomp
ype Vame) 3/12 62 19
(Address),
Date
malde
7 ...... Place of Burial/ or Cremation.
(City or Town) 62
DATE OF BURIAL
8 NAME OF FUNERAL DIRECTOR ADDRESS 1404 Mart -
Jaings fro Spray in
14 1962
.. 19.
Received. ar ? filed ............. Charles 21 In
(Registrary
A TRUE COPY ATTEST :.
X -
RM R-303 1
B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of
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
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
SOM -3-61-930213
m.C.
903 TAY 8 - 1962
· If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. §§ 44-48.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March
11,
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows : (If an injury was involved, state fully.) Coronary thrombosis and myocardial in- farction following fracture of femur.
14
80 .Years.
.Moriths .......
.. Days
...
Paketen Manger
(Kind work done during most of working life)
16 Industry
Business:
Federal Blele Juela
1 Social Security No. 031-01-55+29
18 BIRTHPLACE (City)
(State or country)
19 NAME OF
FATHER
Michael Breslin
20 BIRTHPLACE OF
FATHER (City)
(State or country)
........
21 MAIDEN NAME OF MOTHER
22 BIRTHPLACE OF
MOTHER (City)
(State or country)?
23
Informant
(Address)
35 Nicas St / Malcher
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 1.
A4016
(Signature of Agent of Board of Health of other) MHR .12. 1962
(Official Designation)
(Date of Issue of Permit)
68
Massachusetts General Hospital
BRESLIN
((Was deceased a
U. S. War Veteran.
lif so specify WAR)
No
St.
9 SEX
Finale While
(Give maiden name of wife in full)
If under 24 hours .Hours .Minutes
15 Usual
Occupation :
PARENTS
1 M. D.
.)
A TRUE COPY ATTEST: Charles it Jenckie City Registrar
0
MAY - 81962 AM
M R.302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Due To (b) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
25M-2-58-922072
X
MIDDLESEX
(County) NEWTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
NEWTON (City of Town making this return)
69
141-62
Registered No.
((If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
Nickerson )
Stabb
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
(a) Residence. No.
Unknown
St
unknown nonresident, give city or town and State)
Length of stay: In place of death.
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