Town of Winthrop : Record of Deaths 1963, Part 11

Author: Winthrop (Mass.)
Publication date: 1963
Publisher:
Number of Pages: 574


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 11


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).


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 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE. RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


PLACE OF DEATH


Suffolk


(County) Winthrop


(City or Town)


No.


55 Bellevue Ave.


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. 51


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


2 FULL NAME


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


V.I .. 239 Ilensan.T ST. '55 Bellevue Ave. (a) Residence. No. (Usual place of abode)


St.


30 (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


MARCH


10


1963


(Year)


8 SEX


Female


9 COLOR


White


widow


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED)


4 1


HEREBY CERTIFY, That I attended deceased from


NOVEMBER 20, 1952, to MARCH 10


1963


I last saw h. .... alive on


MARCH 9


19.


63, death is said to


have occurred on the date stated above, at 10:00 A


... m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) ACUTE MYOCARDIAL INSUFFIENCY


INTERVAL


BETWEEN


ONSET AND


DEATH


10a If married, widowed, or divorced


HUSBAND of


Albert W Abbott


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


85 2


21


If under 24 hours


Hours ............ Minutes


13 Usual


Occupation :


Housewife


14 Industry


or Business :


At Home


15 Social Security No.


002-03-1027


birmingham


16 BIRTHPLACE (City)


(State or country)


England


17 NAME OF


FATHER


Francis Davis


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


19 MAIDEN NAME


Elizabeth


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


21 Informant


Albert L Abbott


(Address) 4 Bald Rock au. Cochituate, 1.05.


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)


Pugnale 17, 1963


(Date of Issue of Permity


1 V.F. V


RUCTIONS FOR . CERTIFICATE


giving OF DEATH not enter : than one e for each (b) and (c)


does not mean de of dying, heart failure, etc. It means se, or compli- which caused


ions, if any, gave rise to cause (a), · the under- cause last.


ditions contrib- death but not o the terminal condition given


n -.


. Chapter 137, 1954, requires ns to print or ne cause or of death on ertificates, and 48, Acts of quires Physi- print or type der signature.


. .. inthrop


.inthrop


6


....


Place of Burial or Cremation


March


(City or Town) 19


7 NAME OF


FUNERAL, DIRECTOR


Howard J Reynolds


.. ... ..


ADDRESS


Received and filed


MAR 12 1963 19


(Registrar)


PARENTS


(Signed)


Dorothy Cheney appleton


M. D.


OF MOTHER


DOROTHY Cheney APPLETON


(PRINT OR TYPE SIGNATURE)


(Address) 197 Woodside WINTERASE


Date MARCH 11 1963


5 YRS


Due To


(c)


HYPERTENSION


10YRS


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


No


What test confirmed diagnosis ?


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify


IDAY


12


AGE


Years.


Months.


.. Days


(Kind of work done during most of working life)


Due To


(b)


HYPERTENSIVE HEART DISEASE


(Month) (Day)


liinnie G (Davis) Abbott


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


14


MI R-301A 1


-6-59-925686


(Official Designation)


DATE OF BURIAL


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


-


11 12 1.


OFFICE


NiW


GEERK


65


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.


MAR 1 21963 AM


RECEIVED


OF.TOWR


ORM R-301


for burial permit bard of Health its Agent. TRUCTIONS FOR L CERTIFICATE


FOR TYPE OR CAUSES DEATH not enter e than one e for each ,(b) and (c)


does not mean de of dying, heart failure, ,etc. It means ase, or compli- which caused


ions, if any, gave rise to cause (a), the under- cause last.


ditions contrib- death but not to the terminal condition given


1.0.


PLACE OF DEATH


Suffolk (County)


1


Winthrop (City or Town)


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


Registered No.


.......


52


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


Ida Saran Tick Doodlesack


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


(a) Residence. No.


17 Cutler St.


(Usual place of abode)


Length of stay: In place of death,2.


.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 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Widowed


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


Hyman Doodlesack


(Husband's name in full)


12


AGE 77 Years


Months ..


Days


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation :


House-wife


(Kind of work done during most working life)


14 Industry


or Business:


At home


15 Social Security No ..


none


16 BIRTHPLACE (City)


(State or country)


Poland


17 NAME OF


FATHER


William Blotnick


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Po.Land


(State or country)


19 MAIDEN NAME


OF MOTHER


Esther (unknown)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Poland


21 Informant


William Tick


( Address)


40 Court St., Boston


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),


Pilarch. 11,196.3


(Official Designation)


(Date of Issue of Permit)


A TRUE COPY ATTEST:


(Registrar) ||


........


PHYSICIAN -- IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


No


Winthrop


St


(If nonresident, give city or town and State)


3 DATE OF


DEATH


MARCH


10


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That, I attended deceased from


July


19 52


MARCH 10


19


63


......


to ....


I last saw h&M.falive on


MARCH 10


1963


death is said to


have occurred on the date stated above, at


7:00Pm.


INTERVAL BETWEEN ONSET AND DEATH


3yrs.


Due To


(b)


Due To (c)


OTHER


SIGNIFICANT


NONE


CONDITIONS


No


Was autopsy performed?


What test confirmed diagnosis? Clinical


1


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


(Signature)


Oleartes Liberman


. D.


CHARLES LIBERMAN


(Address WINTHROP, MASS Date.


3/10/1963


Isaac Elchonon


Everett


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March


12


19 63


7 NAME OF


FUNERAL DIRECTOR


Paul R. Levine


ADDRESS


470 Harvard St.,


Brookline


Received and filed


MAR 11 1963


19


.......


62-932382


X


No ...... 17 Cutler St.


(City or Town making this return)


2 FULL NAME


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Hypertensive-Coronary Artery


Heart Disease


(Print or Type Name)


6


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE. RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


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 uhs .. . related to any form of injury.


3 75


(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 froin 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.


MR-301A


1


PLACE OF DEATH


Suffolk (County) Winthrop


(City or Town)


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


STANDARD CERTIFICATE OF DEATH


Registered No. 53


[(If death occurred in a hospital or institution,


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


MORRIS BARD


2 FULL NAME


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


21 Pearl Avenue


St.


Winthrop Mass.


(a) Residence. No.


(Usual place of abode)


(If nonresident, give city or town and State)


3


Length of stay: In place of death


3


.. years.


months


_. days. In place of residence


years.


months.


days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


MARCH


12


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


JULY


28


50


to.


1963


MAR. 12


I last saw h//h alive on


MAR 12 1963,


death is said to


have occurred on the date stated above, at


845 A


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


ACUTE CORONARY INFARCTION


Due To CHRONIC MYOCARDIAL DIS (b)


+ ARTERIO-SCLEROTIC HEART DIS


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


NONE


Was autopsy performed?


Nu


What test confirmed diagnosis? ....


CLINICAL


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


(Signed Japon b. King MN M. D. 22/2 PLEASANTOST MAR 12 1963 (Address) INFIERAR AINSI Date.


Beth El. Cem 6


Baker St W Rox.


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March 13th


63


7 NAME OF


FUNERAL DIRECTOR


Philip Briss


ADDRESS+70. Harvard St Brookline


Received and filed MAR 13 1963 19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED married


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


Dora Shapiro.


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


70


12


AGE


Years.


Months


.. Days


If under 24 hours


Hours ...... Minutes


13 Usual


Occupation :


self employed


or Business:


15 Social Security No ..


UNKNOWN


16 BIRTHPLACE (City) ..... Israel


(State or country)


17 NAME OF


FATHER


Isaaih Bard


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Israel


19 MAIDEN NAME


OF MOTHER


Gittel (unknown)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Israel


21 Dora Bard


Informant


(Address)


21 Peerl Ave. Winthrop Mass


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Ralph E . fireanni (3) (Signature of Agent of Board of Health or other)


Health Care


(Official Designation))


(Date of Issue of l'ermit)


Draud 13 19613


TV.KV


.- THIS IS A NENT RECORD. Ise only E APPROVED ink or black writer ribbon.


TRUCTIONS FOR L CERTIFICATE n giving OF DEATH not enter e than one e for each , (b) and (c)


does not mean de of dying, heart failure, ,etc. It means ase. or compli- which caused


ions, if any, gave rise to cause (a), the under- cause last.


itions contrib -- > death but not to the terminal condition given n. c. . Chapter 137, 1954, requires ans to print or he cause of of death on ertlicates. HAP. 46, 55 9 & AP. 114 $$ 45, CHAP. 38 $ 6.)


. 10.58-923600


DI.A


No.


21 Pearl Avenue, Winthrop


To be filed for burlal permit with Board of Health or its Agent.


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


NO


if so specify WAR)


(Give maiden name of wife in funl)


INTERVAL


BETWEEN


ONSET AND


DEATH


15MIN


14YRS.


(Kind of work done during most of working life)


14 Industry


Merchant


PARENTS


SPACE FOR ADDITIONAL INFORMATION. TOWA


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


OFF


Mi !!!


RANK, RATING


B


6


ORGANIZATION AND OUTFIT


NTHROR


SERVICE NUMBER


LERK


MAR 1 31983 AM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


(1) Attending physicians will certi y to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated 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 occupation, the sudden deaths of persons not disat led 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 import- ant, 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. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of hore housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeepe. - private family, cook-hotel, etc. For a person who had no occupation whatev 'r write none.


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS (City or Town making this return;


STANDARD


CERTIFICATE OF DEATH


Registered No. 541


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


2 FULL NAME. KATHARINE


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


73 WOODSIDE


AUF


St WINTHROP MASS,


(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 SINGLE


MARRIED


WIDOWED


(write the word)


SINGLE


UNKNOWN


11 If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE 95 Years - Months."


Days


13 Usual


Occupation :


MAID


(Kind of work done during most of iworking life)


14 Industry


or Business :.


HOUSE WORK


15 Social Security No.


025-26-5848


16 BIRTHPLACE (City). (State or country ) NOVA SCOTIA


17 NAME OF


FATHER


HUGH MCISAAC


18 BIRTHPLACE OF


FATHER (City)


(State or country)


NOVA SCOTIA


19 MAIDEN NAME


OF MOTHER


NOT KNOWN


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


NOVA SCOTIA


21 Informant


MRS. EDWARD HANNAFORD


(Address)


75 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: Kniph E. Aireanni (3) (Signature of Agent of Board of Health or other) Health Officer


mendla 19196-3


(Date of Issue of Permit)


-62-933404


2622


FORM R-301


d for burial permit Board of Health its Agent. STRUCTIONS FOR AL CERTIFICATE


IT OR TYPE OR CAUSES F DEATH


not enter re than one se for each ), (b) and (c)


does not mean sode af dying, s heart failure, a, etc. It means ease, or campli- which caused


litions, if any, h gave rise to e cause (a), ng the under- cause last.


nditians contrib- to death but nat to the terminal condition given


WINTHROP CEM.


WINTHROP


(City or Town)


6


Place of Burial or Cremation


DATE OF BURIAL


MARCH


19


, 1963


7 NAME OF


FUNERAL DIRECTOR


MAURICE W. KIRBY


ADDRESS 210 WINTHROP, MASS.


Received and filed MAR 19 1963. 19


A TRUE COPY ATTEST:


PLACE OF DEATH


SUFFOLK (County) WINTHROP (City or Town)


LINSE PETITEPU


WINTHROP


CONV. HOME


MC ISAAC


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


no


(a) Residence. No ..


(Usual place of abode)


MARCH


16


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


6-19-


1959, to


3-16-63


19


I last saw haftlive on 3-16-63, 19 ., death is said to


have occurred on the date stated above, at


1030 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


UREMIA.


INTERVAL BETWEEN ONSET AND DEATH


WWEEK


Due To ARTERIOSCLEROSIS


(b)


Due To CHRONIC NEPHRITIS


(c)


OTHER SIGNIFICANT CONDITIONS


W'as autopsy performed?


What test confirmed diagnosis ?


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


If so, specify


NO


(Signatury a.M. Caplan A. M.CAPLAN MD (Print or Type Name) (Address 186PRINCETON STEB Date: 3 -18 1963


M. D.


PARENTS


(Official Designation) ( Registrar )


1


No ..


3 DATE OF


DEATH


That I attended deceased from


(a)


If under 24 hours


Hours ...... . Minutes


1 YEAR


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


TOW. .OF


ORGANIZATION AND OUTFIT


SERVICE NUMBER


6


ROR.


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for following rules of practice :


MARselv 91983h&M


(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.


ORM R-304


PLACE OF DELIVERY No.


Suffolk (County )


Winthrop (City or Town)


Winthrop Community Hospital


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH (STILLBIRTH)


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


Registered No. 55


(If death occurred in a hospital or institution, give its NAME instead of street and number)


3 DATE OF


DELIVERY


March 18, 1963 ( Month )


( Day)


(Year )


4 SEX


Male. X.Female .....


Undetermined.


5 COLOR (if


determined)


W


6 THIS BIRTH (Check one)


Single. X


Twin


Triplet


7 IF MULTIPLE BIRTH, BORN :


1st .. . ... 2nd


.3rd


FATHER


MOTHER


14


MAIDEN NAME


PRESENT NAME


Doris Larle


Doris Imbrici


9 RESIDENCE, NO. 0


16 Paris Street


.. STAT


STREET


Mass


15


RESIDENCE, NO.


CITY OR TOWN


16 Paris


STREET


E. Boston,


STATE.


Mass.


10 COLOR OR RACE White


11 AGE AT TIME OF


THIS DELIVERY


49 .(Years)


16 COLOR OR


RACE ..


W


18 PLACE OF


BIRTH


(City or Town


Maine (State or country )


(Cu:


13 OCCUPATION Retired


20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus) TWO


(a) How many children are


now living ?


3


(b) How many children were born alive but are now dead? 0


(c) How many previous fetal deaths of ANY gestation age ? 0


21 LENGTH OF PREGNANCY 40 .completed weeks


22 WEIGHT OF FETUS 8 Lb. 15 Grams )


Oz.


23 WHEN DID FETUS DIE Y Before Labor


24 AUTOPSY


Yes


No


25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Prolapse of Cord


Due To (b) Due To (c)


OTHER SIGNIFICANT


CONDITIONS


None


26


Holy Cross Cemetery Malden


Place of Burial or Cremation


March


22


(City or Town) .63


19


27 NAME OF FUNERAL DIRECTOR


Vincent Rapino


ADDRES 9 Chelsea t., East Boston, Mass.


Received and filed


MAR 21 1963 19


Registrar )


I HEREBY CERTIFY that this delivery occurred on the date stated above at7 : 20A . m., and product of conception was not a live birth.


Signature of Attending Physician or Medical Examiner :


1


M.D.


Maurice Traunstein, Jr., M.D. (PRINT OR TYPE SIGNATURE)


Address 73 Bartlett Road


Date


3/18


1963


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


Parph


(Signature of Agent of Board of Health or other ) . Health Officer (Official Designation )


march 21,1963"


(Date of Issue of Permit )


In giving CAUSE OF ETAL DEATH


do not enter more than one cause for each of (a), (b) and (c)


·tal or maternal ndition causing tal death (do 't use such ·ms as stillbirth prematurity.) ·tal and/or ma- ·nal conditions, any, which gave se to above use (a), stating e underlying use last.


nditions of fetus mother which hy have contrib- ed to fetal ath, but, in so . as is known. re not related | cause given (a).


5M-6-60-928241


1


2 NAME OF FETUS (if given)


Baby Boy Imbrici.


A TRUE COPY ATTEST.


19 INFORMANT


Ralph Imbrici (father)


During Labor or Delivery


Unknown


17 AGE AT TIME OF


THIS DELIVERY 38


.(Years)


12 PLACE O


BIRTH


Italy


4


DATE OF BURIAL


(or


CITY OR TOWN




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