Town of Winthrop : Record of Deaths 1963, Part 37

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 37


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


ORM R-301


1


Sipt 50


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


.


1


RULES OF PRACTICE SEP 3 01963 /M


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 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.


ORM R-301


for burial permit ard of Health ts Agent. RUCTIONS FOR CERTIFICATE


OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)


oes mat mean le af dying, heart failure, etc. It means se, or campli- which caused


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


litians contrib- death but nat o the terminal ondition given


PLACE OF DEATH


Suffolk


(County)


1


Winthrop


(City or Town)


Winthrop Community Hospital No.


§(If death occurred in a hospital or institution,


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


2 FULL NAME.


Ferrara, Baby Boy


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


225 Endicott Ave


.St


Revere


(a)


Residence. No.


(Usual place of abode)


Length of stay: In place of death .......... years .......... months .......... days. In place of residence .......... years ......... months .........


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


9


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased, from


SEPT


27. 19.63


63


to SEPT 27


I last saw himlive on


SEPT 27


19.6.3 death is said to


have occurred on the date stated above, at 110Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


HYALINE MEMBRANE DIS


Due To


(b)


PREMATURITY


Imo.


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


NONE


Was autopsy performed?


No


What test confirmed diagnosis? CLINICAL & X-RAY


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


(Signature) myron r Kung M. D. MYRONN. KING MD


(Address)


WINTHE


6


woodlawn


Everett Loss


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


19 .... 65.7


7 NAME OF


FUNERAL DIRECTOR


Ernest P Caggiano


ADDRESS 14 ISt intur Of


Received and filed


SEP 30 1963


19


( Registrar )


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


Single


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


INTERVAL BETWEEN ONSET AND DEATH (or) WIFE of 12 1 day AGE .......... Years .. ....... Months ......... ... Days


(Husband's name in full)


If under 24 hours


A .. Hours ........ Minutes


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


or Business :


NONE


15 Social Security No .....


16 BIRTHPLACE (City)


(State or country )


17 NAME OF


FATHER


John Ferrara Jr.


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Doston


19 MAIDEN NAME


OF MOTHER


1


Joen Nolan


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


Revere


21 Informant


John Ferrara ....


(Address)


225 Tudicott Ave everc


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


(Signature of Agent of Board of Health or other) Herethe officer 9/28/63


(Official Designation) 6


(Date of Issue of Permit)


X


62-932382


A TRUE COPY ATTEST:


TEVERE 10: 3-63


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


(City or Town making this return)


Registered No.


1.83


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR).


(write the word)


Male


......


(If nonresident, give city or town and State) days.


27


1963


(a)


NOIVO


winthe


PARENTS


(Print or Type Name> LIZPLEASANT Date.


€ 9/28 19 63


Sept 28


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 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 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.


RM R-301


PLACE OF DEATH


Suffolk (County) 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.


184


11 TRIDENT Ave


§(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 Veteranl,


if so specify WAR).


NO


(a) Residence. No ...


Il TRIDENT


Ave


.St


WINTHROP


(If nonresident, give city or town and State)


Length of stay: In place of death .......... years .......... months .......... days. In place of residence.A ..... years ..


....... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


MARRIED


11 If married, widowed HUSBAND of


or divorced Sophie


HOFFMAN


"(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in lul1)


Months ...


.. Days


13 Usual


Occupation :


CABINET MAKERS


(Kind of work done during most working life)


14 Industry


or Business:


FURNITURE MFG


15 Social Security No ...


16 BIRTHPLACE (City)


(State or country )


Russia


PARENTS


17 NAME OF


FATHER


NATHAN BRAVERMAN


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


SARAH


CBC


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


21 Informant


HAROLD BRAVERMAN


(Address)


11 TRIDENT Ave Winthrop


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


1


(Signature of Agent of Board of Health or other)


1/29/63


(Date of Issue of Permit)


6


TX


A TRUE COPY ATTEST:


1963


(Year)


4 IHEREBY CERTIFY , That I attended deceased from


Feb


19 63


to.


Sept. 28


, 1963


I last saw hiwalive on


sept.


27, 163, death is said to


have occurred on the date stated above, at


9:00A.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Emphysema


Due To


(b)


Due To (c)


OTHER


Arteriosclerotic Heart


CONDITIONS


Disease


8mos


NO


Was autopsy performed?


What test confirmed diagnosis ?


Clinical.


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


(Signature)


Charles Liberman


M. 1).


CHARLES


LIBERMAN


(Address)


(Print or Type Name)


WINTHROP, MASS Da


9/28/1963


6


STARO CONSTANTINO


W. Roxbury


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Sept 29


63


7 NAME OF


FUNERAL DIRECTOR


TORE Funeral Service In


151 Washington ave Chelsea


ADDRESS


Received and filed


SEP 30 1963


19


(City or Town making this return)


ISADORE BRAVERMAN


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


2 FULL NAME ..


for burial permit rd of Health s Agent. UCTIONS FOR CERTIFICATE


OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)


oes not meon e of dying, heart foilure, etc. It meons se, or compli- which coused


A


ons, if any, gave rise to couse (o), the under- cause lost.


itions contrib- death but not the terminal ondition given C


52-932382


3 DATE OF


September 28


DEATH


(Month)


(Day)


(Usual place of abode)


No.


( Registrar )| (Official Designation)


If under 24 hours


Hours .......


.Minutes


INTERVAL BETWEEN ONSET AND 12 DEATH yours AGE. 72


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE -


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


1


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : SEP 3 01563 AM


(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.


RM R-301


I


PLACE OF DEATH


Suffolk (County)


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. 185


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


PHYSICIAN - IMPORTANT


2 FULL NAME.


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


(a) Residence. No ..


16 Lincoln St.


St


Winthrop ,Mass


(If nonresident, give city or town and State)


Length of stay: In place of death. .years .... months ......... days. In place of residence 35 2 ... years. ....... months .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


September


30,


1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY, That I attended deceased from


1:1 cup


19 60,


Sept. 30


1963


I last saw hetalive on Sept. 30, 1963 death is said to have occurred on the date stated above, at 2:50 Am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Coronary


Thrombosis


INTERVAL BETWEEN ONSET AND DEATH 1/2 kr


(b)


arteriosclerosis-qua


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed ?


What test confirmed diagnosis ?


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


If so, specify


(Signature)


prepar Aregone, M. D.


Joseph GREGORIE


(Print or Type Name)


(Address).


194 Washington ale


9/30 63 19


6 Winthrop


Winthrop


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


oct. 2


63 19.


7 NAME OF


FUNERAL DIRECTOR


Howard & Foynolds


ADDRESS


.inthron, Las :.


Received and filed OCT 1 1963 19


(Registrar)|


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


(write the word)


Female


Thite


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


Clifford !. hall


(or) WIFE of


(Husband's name in full)


12


.72


9


1


If under 24 hours


Hours


Minutes


13 Usual


digion clerk


Occupation'


(Kind of work done during most working life)


14 Industry


or Business :


Hospit-1


15 Social Security No.


013-28-5498


16 BIRTHPLACE (City)


(State or country )


Cifloride


17 NAME OF


FATHER


Charles Cole


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Lass


19 MAIDEN NAME


OF MOTHER


Leurs . CLey Land


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


Carmel


laine


21 Informant


Mildred Car bine


(Address) 16 Lincoln St. Mithrop, Menc.


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


(Signature of Agent of Board of Health or other)


Let 11763


(Official Designation) (Date of Issue of Permit)


A TRUE COPY ATTEST:


62- 2382


r burial permit d of Health Agent. CTIONS OR ERTIFICATE


R TYPE CAUSES CATH tenter han one or each ) and (c)


s not mean of dying, part failure, c. It means or compli- ich caused


s, if any, vve rise to use (a), le under- use last.


ions contrib- uth but not The terminal o ition given


(City or Town making this return) ....


WinthropCommunity Hospital No ....


Marion Hall


(Cole)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(Usual place of abode)


2 hour


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN widow


AGE


Years.


Months


Days


PARENTS


Boston


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 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 6 occupation by the appropriate terms, as housekeeper-private family, cook hotel, etc. For a person who had no occupation whatever write none. HROP.


. . 1


OCT 1 1963 AM


M R-303


ed for burial permit Board of Health r its Agent.


Injury (Address) Death. See reverse side for additional information. See also Chap. 38, §5 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain ternis, so that it may be properly classified under the International Classification of Causes Largased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. ............. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF -WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Nature of Injury


1-3)62-932695


PLACE OF DEATH


SUFFOLK


1


(County)


BOSTON


(City or Town)


Che Commonwealth of Alassachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


186 OUT - OF - TOWN


(City or Town making this return)


Registered No.


07806


215 Charles St., Boston


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


2 FULL NAME


JOHN


J


GORMAN


(First Name)


(Middle Name)


(Last Name)


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


(a) Residence. No.


(Usual piace of abode)


Length of stay: In place of death.


............ years .............. months ..............


days. In place of residence 5 years.


.. months ..


davs.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


11 SINGLE


(write the word)


MARRIED


WIDOWEDMarried


DIVORCED


UNKNOWN


12 If married, widowed, or divorced


HUSBAND of


Catherine ..... Boland


(or) WIFE of


(Husband's name in full)


46 13 AGE Years.


.Months ..


If under 24 hours


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


14 Usual


Occupation :


Medical Doctor (Kind of work done during most of working life)


15 Industry on Business : ....... Pediatrician


K Social Security No. 039-10-8125 ...


17 BIRTHPLACE (City)


....


Central Falls ...


(State of country )


Rhode Island


18 NAME OF FATHER James H. Gorman


19 BIRTHPLACE OF


FATHER (City)


(State or country)


England


20 MAIDEN NAME


OF MOTHER


Margaret Dalton


21 BIRTHPLACE OF MOTHER (City) (State or country)


Ireland


7 .M.t ....... S.t ...... Mary ..!. s. ....... Pawtucket , ...... R .I .....


I'lace of Burial or Cremation.


(City or Town)


DATE OF BURIAL .....


August ...... 1


1963


8 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS Winthrop Mass


AUG 2 1963


Received and fried ".


Withany Kane.


(Registrar)


PARENTS


Sono, M. D.


(Suned), Michael A. Luongo, Vel


Boston ( Print or Rype Kame)


Date


7/30


63


19.


Catherine ..... Gorman


22 Informant (Address) 240 Pleasant St., Winthrop


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


(Signature o) Agent of Board of Health or other)


18906


7/31/63


(Official Designation)


(Date of Issue of Permit)


.......


240 Pleasant Street


St Winthrop, Massachusetts


(If nonresident, give city or town and State)


3 DATE OF


DEATH


July


29,


1963


(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.) Asphyxia, due to hanging.


5 Accident, suicide, or homicide (specify)


Suicide.


Date and hour of injury


July 29,


19.


.63


IF ACCIDENTAL, was injury causally related to the death ?


Injury occur ?


Where did


Boston, Massachusetts


(City or town and State)


Did injury occur in or about home, on farm, in industrial place, or


public place ?


Cell-door of Jail


(Specify type of place)


Manner of


Suspension by undershirt.


(How did injury occur ?)


While at work ?


Was autopsy performed? ...


Yes.


6 Wardisease or injury in any way related to odeupavon of deceased ?


......


X


IN DEATH CERTIFICATES.


63


A TRUE COPY ATTEST:


9 SEX


Male


10 COLOR


White


(Give maiden name of wife in full)


No.


MEDICAL EXAMINER'S CERTIFICATE OF DEATH


[(Was deceased a


U. S. War Veteran,


[if so specify WAR) ..


A TRUE COPY ATTEST:


Williamf Kane 7 1


RECEIVED


IF


TOW 11.12 1


KLERK


10.


4 (MIN)


8


W


THRO


OCT 3 1963 PM


...


7


PLACE OF DEATH


(County)


-


BOSTON


(City or Town)


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


STANDARD CERTIFICATE OF DEATH


Registered No.


08188


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


2 FULL NAME ..


Eva Hambro


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


(a) Residence. No .....


15.5 .... River .... Road.


(Usual place of abode)


St.Winthrop, Massachusetts


......


(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


DIVORCED


UNKNOWN


widowd


11 If married, widowed, or divorced HUSBAND of


(or) WIFE of.


Morris Hambro


(Husband's name in full)


12


AGE.90


Years


.Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most of working life)


14 Industry or Business :


15 Social Security No ..


16 BIRTHPLACE (City)


(State or country)


Germany


17 NAME OF


FATHER


Abraham Mayer


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Germany


19 MAIDEN NAME


OF MOTHER


Caroline (unknown)


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


Germany


21 Informant


Mrs.Harold Rosen


38 Embassy Road, Brighton, Mass.


(Address)


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFOREThe burial or transit permit was issued: ( W) and kg


(Signature of Agent of Board of Health or other)


AUG 1 2 1983 218565


8-9-63


(Registrar)|| (Official Designation) (Date of Issue of Permit)


1 X


A TRUE COPY ATTEST:


MEDICAL EXAMINER TO COUNTERSIGN


Due To (b)


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? no.


What test confirmed diagnosis ?


clinical


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


If so, specify


@@@low


(Signature)


M. D.


Charles L. Clay, M.D.


(Print or Type Name) (Address) Ass's .. Din, Mass. Gon'I, Hosp ...... Date. Aug ....... 8 .19 63


¿Hand in Hand.


West Roxbury


.....


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


August 9, 10 63


7 NAME OF


FUNERAL DIRECTOR


Benjamin F. Solomon


ADDRESS


420 Harvard Street Brookline


Received and filed 19


......


..........


............


3 DATE OF


DEATH


August


8


19.6.3


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY , That Iwattended deceased from


19


.63.


August .... ] ...... , 19 .....


63 ... ..... August .... 8.


we last saw h .. Ellive on


August .... 8


19 ... 6.3 death is said to


have occurred on the date stated above, at


.6:15 ... p .... m.


(Giye maiden name of wife in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Fracture of right hip


INTERVAL BETWEEN ONSET AND DEATH


1 week


X


ORM R-301


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




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