USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 44
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WINTHR
NOV (1 81963 AM
IX
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
221 ,
(City or Town making this retu.
Registered No.
10324
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME ..
Thomas F ..... Caffrey
(If deceased is a married, widowed or divorced wornan, give also maiden name.)
(a) Residence. No ...
15.2.Somerset Avenue
(Usual place of abode)
St.Winthrop, Mass
(City or town and Stale)
Length of stay: In place of death years months ] 3days. In place of residence ].3 ears months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
10
1963
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY , That Iwettended deceased from
September 24 19 63
... October ..... 10
19
6.3
Mf last saw h. imlive on .... October .... 10.
19.6.3 death is said to
have occurred on the date stated above, at
.10:00 .....
INTERVAL BETWEEN ONSET AND DEATH
ETIOLOGY
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
yes
What test confirmed diagnosis ?
......
autopsy.
S Was disease or injury in any way related to occupation of deceased ?
If so, specify ..
(Signature)
Charles.L ... Clay,. M. D. (Print or Type Name) (Address) Ass't .. Die, Mass .. Gen.L. Hasp ...... Date
Oct. 10 19. 63
winthrop
Winthrop
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Oct.
14
19.63
7 NAME OF
FUNERAL DIRECTOR
Ernest P Caggiano
ADDRESS
147 Winthrop St. Winthrop
Receive
OCT 15 1963
Veelland Rane
19
( Registrar)|
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
hale
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Married
11 If married, widowed, or divorced
HUSBAND of .Emily ........... La .: amosino.
(Give maiden name of wife in full)
(or) WIFE of.
( Husband's name in full)
12
71.
9
Months.
150
.Days
If under 24 hours
.. Hours ....... Minutes
13 Usual
Repairman
Occupation :
(Kind of work done during most of iworking life)
14 Industry
Tele phone
or Business :.
15 Social Security No ..
0.21-09-2039-4
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Unknown
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown
19 MAIDEN NAME
OF MOTIIER
Unknown
20 BIRTHPLACE OF
MOTHER (City) ...
(State or country )
Unknown
ir .
21 Informant MAPS .. . Emily Caffrey.
( Address)
152 Somerset Ave, Winthroo
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with ffe BEFORE the bury bor transit permit was issued:
Sixtyun of Agent of Board of Health or other)
B10338
10-12-63
(Official Designs tion)" (Date of Issue of Permit)
TIEV.
M R-301
1
burial permit of Health Agent. CTIONS R ERTIFICATE
R TYPE CAUSES ATH enter In one or esch ) and (e)
not mean of dying. art failure. :. It means or compli- ich caused
, if any, e rise to use (a), e under- use last.
ons contrib- ath but not ke terminal lition given m.C.
8
2- 1963 Director se only Ink.
933404
A TRUE COPY ATTEST:
No. MASSACHUSETTS.GENERAL.HOSPITAL
(Was deceased a
U. S. War Veteran,
No
if so specify WARY
.........
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ENCEPHALITIS UNKNOWN
20 DAYSE.
PARENTS
M. D.
A TRUE COPY ATTEST:
Vierianel. Kane.
OF TOW
71.12
TV
MERK
0
5
HROP
DEC - 21963 AM
OUI 1
PLACE OF DEATH :
Suffolk
(County)
I
Boston
(City or Town)
No
NisTed Mary" A.
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
82 Sargent Street
St
Winthrop, Mass.
Length of stay : In place of death .......... years.
1
months.
20
days. In place of residence 47 years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
(Month)
10 ..
(Day)
1.96.3
(Year)
4 IHEREBY CERTIFY , That I attended deceased from
August .20, 19 63
to
October.
196.3
.10
I last saw
EL.alive on
October
10
9.6.3 death is said to
have occurred on the date stated above, at
11:30 a
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) CARDIAC RUPTURE
INTERVAL BETWEEN ONSET AND DEATH MIN.
Due To
(b) MYOCARDIAL INFARCTION
DAYS
YEARS
8 SEX
Femald
9 COLOR
Thi te
10 SINGLE
MARRIED
WIDOWED
DIVORCED .. arried
UNKNOWN
11 Il married, widowed, or divorced HUSBAND of
(or) WIFE of
John
(Give maiden name of wife in full)
A Murphy
(Husband's name in full)
12
AGE .... .... Years.
7 Months
.Days
II under 24 hours
.. Hours .......
13 Usual
Occupation :
Housewife
(Kind of work done during most of iworking life)
14 Industry
or Business :
t
Homme
15 Social Security No ..
Exeter
16 BIRTHPLACE (City)
(State or country )
New Hampshire
17 NAME OF
FATHER
James Freiger
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
Katherine Cooper
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
roland
21 Informant .
John A Murphy Jr.
(Address)
4-
i St, winthrop
I HEREBY CERTIFY that a satisfactory standard certifcate of death was filed with int BEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health or other)
1310337
10-12-63
(Official Designation)
(Date of Issue of Permit)
TX
ICTIONS OR CERTIFICATE
OR TYPE R CAUSES EATH t enter han one for each b) snd (c)
1 not mean of dying, ears failure. c. It means . or compli- ich caused
s, if any, De rise to use (a), he under- use last.
ons contrib- ath but not the terminal dition riven 1
H20. 81
6 Winthrop
Winthrop
.....
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Oct.
14
1963
7 NAME OF
FUNERAL DIRECTOR
Ernest 2 Caggiano
ADDRESS 147 Minthrou St. Winthrop
Received and filed
OCT 15 1963
19
Wellcaused Jane
....
(Registrar)|
A TRUE COPY ATTEST:
(Signature)
Steffen Podolsky
M. D.
STEPHEN
SaPOLSKY
(Print or Type Name)
(Address)
JOSLIN CLINE Date OCT. 10 1963
5 Was disease or injury in any way related to occupation of deceased ? ND If so, specify
Due
(c)
CORONARY ARTERIOSCLEROSIS
OTHER
SIGNIFICANT
DIABETES MELLITUS
CONDITIONS ARTERIOSCLEROSIS OBLITERANS.
Was autopsy performed ?
YES
What test confirmed diagnosis ?
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
(Was deceased a
U. S. War Veteran,
No
(if so specify WARI
(a) Residence. No ...
(Usual place ol abode)
f(If death occurred in a hospital or institution, .St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
Mrs. Veronica A. Murphy
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
222
(City or Town making this return)
New England Deaconess Hospital
Registered No.
or burial permit rd of Health s Agent.
RM R-301
2- 1963
933404
(City or town and State)
nutes
-09-1509 3
A TRUE COPY ATTEST:
Williaml. Kane. CHE Registrar
RECEIVED
OF
TOIVA
11.72 .
OFFI,
9:
DLERK
HROP
DEC -21963 AM
X
COPY OF CERTIFICATE OF DEATH
CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE
TOWN OR CITY CLERK'S NO
223 Winthrop. Mass
1. NAME OF
A. (FIRST)
DECEASED
(TYPE OR PRINT)
Edith
8. (MIDDLE)
Runnels
C. (LAST)
Quirk
2. DATE
OF
DEATH
(MONTN)
(DAT)
ITEARI
3. PLACE OF DEATH
A. COUNTY
Belknap
4. USUAL RESIDENCE
(WHERE DECEASED LIVED. IF INSTITUTION: RESIDENCE
B. COUNTY
BEFORE ADMISSION.)
B. CITY
OR
TOWN
Laconia
C. LENGTH OF
STAY (IN THIS PLACE)
days
C. CITY (GIVE ACTUAL TOWN OF RESIDENCE. NOT MAILING ADDRESS).
OR
TOWN
Winthrop
D. FULL NAME OF (IF NOT IN HOSPITAL OR INSTITUTION. GIVE STREET ADDRESS OR LOCATION)
HOSPITAL OR
INSTITUTION
Laconia Hospital
D. STREET (IF RURAL. GIVE LOCATION)
ADDRESS
64 Lincoln St.
NO
E. IS RESIDENCE
ON FARM?
YES
5. SEX
Female
6. COLOR OR RACE 7.
White
MARRIED
NEVER MARRIEO
DIVORCEO
WIDOWEO
8. NAME OF HUSBAND OR WIFE (MAIDEN NAME IF WIFE)
John J. Quirk
9. DATE OF BIRTH
9-2-1892
10. AGE (IN YEARS
AST BIRTHDAY)
76
IF UNDER I YEAR DAYS MONTNS
IF UNDER 24 HRS
HOURS
MIN.
11A. USUAL OCCUPATION (KIND OF WORK
DONE DURING MOST OF WORKING LIFE, EVEN IF RETIRED)
Diatician
Hospital
12. BIRTHPLACE ICITY OR TOWN, STATE
FOREIGN COUNTRY)
Lakeport, N.H.
13. CITIZEN OF WHAT 14. FATHER'S NAME
William Runnels
COUNTRY?
U. S. A.
15. MOTHER'S MAIDEN NAME
Julia Kinney
16. WAS OECEASEOEVERIN U.S. ARMED FORCES? 17. SOC. SEC. NO.
(YES. NO. OR UNKNOWN) | [IF YES. GIVE WAR OR DATES OF SERVICE)
no
mone
18A. INFORMANT
Mrs. Esther Mccullough
188. ADDRESS
64 Lincoln St., Winthrop, Mass.
19. CAUSE OF DEATH IENTER ONLY ONE CAUSE PER LINE FOR (A). IB), AND (C)
PART I DEATH WAS CAUSEO BY,
Acute coronary occlusion
INTERVAL BETWEEN
ONSET AND DEATH
9-10-hrs
DUE TO (8)
Arteriosclerotic heart disease
MEDICAL CERTIFICATION
21A. ACCIOENT SUICIOE HOMICIDE
218. OESCRIBE HOW INJURY OCCURREO IENTER NATURE OF INJURY IN PART I OR PART 11 OF ITEM 10.)
21F. CITY. TOWN OR LOCATION
COUNTY
STATE
210. INJURY OCCURRED
WHILE AT
WORK
AT WORK
NOT WHILE
10-13-63
10-13-63
and last saw'
her
alive on . . 10-13-63
22. I attended the deceased from
to
Death occured at
3:50
a
. m on the date stated above; and to the best of my knowledge, from the causes stated.
23A. SIGNATURE
H. E. Trapp, M. D.
238 ADDRESS
Laconia, N.H.
23C. DATE SIGNED
10-15-63 /1
IF ENTOMBED
24€. PLACE OF BURIAL
NAME OF CEMETERY)
LOCATION (CITY. TOWN, COUNTY)
ISTATEI
DATE
25. FUNERAL DIRECTOR'S SIGNATURE
E. P. Caggiand, Winthrop, Mass.
ADDRESS
COUNTERSIGNED - AGENT (CITT BD. OF NEALTM)
William L. Gage, MD
DATE
10-13-63
DATE REC'D BY TOWN OR CITY CLERK
Oct. 21st, 1963
CLERK'S OWN SIGNATURE
Kenneth R. Dunlap
CLERK OF
Laconia, N.H.
A true copy, Allest:
Kenneth R. Dunlap
Clerk of Laconia, NH
Dated . . 10-21- 19.63
¥$ 17
EVANS 17311-10-61.10M
IMMEDIATE CAUSE (AI
CONDITIONS. IF ANY. WNICN GAVE RISE TO ABOVE CAUSE IA). STATING THE UNDER. LYING CAUSE LAST. DUE TO (CI.
PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART I(A)
20. WAS AUTOPSY
PERFORMEOF
YES
NO
21C. TIME
OF
INJURY
MONTN DAT
YEAR
NOUR
M.
21E. PLACE OF INJURY (E. G., IN OR ABOUT
NOME. FARM. FACTORT. STREET. OFFICE BLOG .. ETC.
(DEGREE OR TITLE)
InAn IACATIAN .....
.. .......
Oct. 13, 1963
A. STATE
Mass.
11B KINO OF BUSINESS OR
INOUSTRY
A
١٢ TOWA
.140
.
GLERK
THROP.
NOV 1 41963 AM
X
PLACE OF DEATH
Suffolk County)
Boston (City or Town)
To Boston Lyin
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
NTTTT
Registered No.
10517
[(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 so specify WARI.
(a) Residence. No.
17 Cliff Avenue
St
(If nonresident, gife chty 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
F
9 COLOR
w
10 SINGLE
MARRIED
WIDOWED
DIVORSED
UNKNOWN
(write the word)
single
11 1f married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE
.. Years
Months.
Days
If under 24 hours
/ Hours /Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
15 Social Security No.
none
16 BIRTHPLACE (City) Boston, MAJS. (State or country )
17 NAME OF
FATHER
Dudley Holden
18 BIRTHPLACE OF
FATHER (City) ..
Melrose Mass.
(State ,or country)
19 MAIDEN NAME
OF MOTHER
Barbara Connolly
20 BIRTHPLACE OF
MOTIIER (City).
(State or country)
Tewksbury, Mass.
Holy Cross Cemetery
Malden Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
October 18
1963
19.
7 NAME OF
FUNERAL DIRECTOR
William J. Killion
ADDRESS 1 Sprague St. Rever, Mass.
Received and hled
OCT 22 1963
(Registrar ) !!
A TRUE COPY ATTEST:'
October
14
1963
(Year)
(Month)
(1)ay)
4 I HEREBY CERTIFY , That I attended deceased from Octoberit, 1963, to October 14 19 63
I last saw heralive on
October 14, 1963, death is said to
INTERVAL
BETWEEN
ONSET AND
DEATH
have occurred on the date stated above, at ...
P ... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
NeoNatah Death
(a)
Due To
Respiratory
(b)
ALLES
Due To
Probable Hyaline
(c)
Membrane Disease
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)
(Address)
Theodore Faustat
M. D.
221 Longwood Are 10/14
63 ...........
19
PARENTS
Boston Lying In Hospital
21 Informant
( Address )
221 Longuend Are.
I HEREBY CERTIFY the satisfactory standard certificate of death is filed with mpe BEFOUR the burial or transit permit was issued: fy forelig" Senature of Agent of Board of Health or pher) 10/8/63
1839 (Official Designation)
(Date of Issue of Permiy)
X
R-301
urial permit f Health ent. OMS
IFICATE
TYPE CAUSES TH nter I one each nd (c)
not mean f dying, failure. It means compli- caused
if any, rise to e (). ander- last.
contrib- but not terminal lon riven
23 135
- 1963
224
(City or Town making this return)
CERTIFICATE OF DEATH - In Hospital
Robin Ann Holden Baby Girl ... Iden
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Winthrop
Mass.
(Usual place of abode)
3 DATE OF
DEATH
-
12382
-
ot, Kon trar
IF
6
THROR
DEC - 41963 AM
7
-303
burial permit of Health Agent.
PLACE OF DEATH
SUFFOLK
(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
225
(City or Town making this return)
Registered No.
10458
NEn route to East Boston Relief Station [(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)
2 FULL NAME
SARAH
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
85 Sagamore Avenue,
S Winthrop, Massachusetts
(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 ...
.davs.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 14, (Day)
1963
9 SEX
FEMALE
10 COLOR
White
Il SINGLE
MARRIED
WIDOWED
DIVORCEI)
UNKNOWN
Single
4I 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.) Hypertensive and arteriosclerotic .....
heart disease.
(husband's name in full)
13 AGE 69 .Years
Munths ..... .......
If under 24 hours
.. Hours ............ Minutes
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
IF ACCIDENTAL, was injury causally related to the death ?
Where did
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or
public place ?
(Specify type of place)
Manner of
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
Was autopsy performed>
6 Was discreetinjury in any way related to mappa Von of depersed ?. If so, specie .....
(Signed)
MichaelA. Luongo, MD
(Address) Boston ( Print or Type Kame)
Date
10/15 163
T .....
, Winthrop CEMETERY EVERETT
Place of Burial or Cremation.
(City or Town)
DATE OF BURIAL October 16, 1963 19
8 NAME OF
FUNERAL DIRECTOR
Arnold Golov
ADDRESS
1668 BEACON ST.
BROOKLINE
OCT 1 7 1983 19.
Received and filed .
Will carry.
A TRUE COPY ATTEST:
(Registrar)
PARENTS
18 NAME OF
FATHER
MOSES LOURiE
19 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
20 MAIDEN NAME
OF MOTHER
LENA BAND
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
-
22
Informant
(Address)
LilliAN SAGAN (SistER)
85 SAGAMORE Ave., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFOREThe burial or transit permit was issued: R.J. Rogerson
(Signature of Agent of Board of Health or other)
B18332
10-16-63
(Official Designation)
(Date of Issue of Permit)
V. A. V
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,
ff 44-48.
100M-3.62-932695
- 1963 +20 81 X 70
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
PHYSICIAN -- IMPORTANT
LAURIE
(Was deceased a
U. S. War Veteran.
[if so specify WAR)
NO
(write the word)
( Month)
(Year)
12 If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
14 Usual
Occuparten :
BOOKKEEPER
(Ku of work done during most of working life)
15 Industry on Business : .....
Columbia Pictures
N Social Security No. ...
17 BIRTHPLACE (City) .... (State of country) Boston
Wo.
, M. D.
1
A TRUE COPY ATTEST:
Williaml. Kane. CHAT Regist. "
OF TOWN
11 12 3
İLERK
THRORN
DEC -21963 AM
X
PLACE OF DEATH
SUFFOLK (County) Roxbury (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
226
OUT
(City or Town making this return)
19538
Registered No.
JEWISH MEMORIAL HOSPITAL, (If death occurred in a hospital or institution. No ....
( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
BELLA KLEIN
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Av-
(a) Residence. No ...
119 SEWALL
ST
WINTHROP
(Usual place of abode)
Length of stay : In place of death. 1 years 11 months days. In place of residence ......... years.
months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
( write the word)
DEATH
(Month)
(D)ay)
(Year)
4I HERENY CERTIFY , That I attended deceased from
11-7-
1961
....
to.
10
18
-
19.
63
I last saw he live on
10-18 -
19. 6.3death is said to
have occurred on the date stated above, at
7:25A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
STATUS EPILEPTICUS
INTERVAL BETWEEN ONSET AND DEATH
(a)
(b) CEREBRAL ARTERIOSCLEROSIS
YEARS
Due To (c)
OTHER
GENERALIZED ARTERIOSCLEROSIS
CONDITIONS
YEARS
NO
Was autopsy performed ?
What test confirmed diagnosis ? CLINICAL
5 Was disease or injury in any way related to occupation of deceased ? N.O If so, specify
(Signature)
¿Samuel Haar
M. D.
SAMUEL HASSID
(Print or Type Name)
Jeux Mien. Hon, Date
10-18-1963
(Address)
Place of Burial or Cremation
Oct 20
63
DATE OF BURIAL
7 NAME OF
FUNERAL DIREC
ADDRESS Chilla
Received and filed Williamel. Kane.
OCT 22 1963 19
(Registrar ) || (Official Designation)
(Date of Issue of Permit)
Y
.
ORM R.301
for burial permit ard of Health ts Agent. RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH not enter than one e for each (b) and (c)
does not mean de of dying, heart failure. etc. It means use, 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 riven
334 74
1- 1963
62-933404
A TRUE COPY ATTEST:
PARENTS
17 NAME OF
FATHER
Hagman Mendel Glass.
18 BIRTHPLACE OF
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Mary Cau.
20 BIRTHPLACE OF
MOTHER (City).
(State or country }
21 Informan
119 Seminars Winthrop
(Address)
....
I HEREBY CERTIFY that a satisfactory standard certificate of death fled wvih me BEFORE the burial or transit permit was issued:
FP- Graca
B 10509
(Signature of Agent of Board of Health or other) Oct 20 1963
HVORCE.D
11 If married, widowed, or divorced IIUSBAND of
(or) WIFE of.
Harry
(Give maidex pame of wife in full) Rein
(Husband's name in full)
12
HOURS
AGF Years
Months ... ...
Days
If under 24 hours
Hours ......
Minutes
13 Usual
Housewife
Occupation :
( Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No ...
noni
16 BIRTHPLACE (City L
(State or country )
(City or Town)
1
CERTIFICATE OF DEATH
2 FULL NAME
(Was deceased a
U. S. War Veteran,
if so specify WARI
(C'ity or town and State)
3 DATE OF
OCTOBER 18
1963
JF TOW
11 12.
CLERK
00
6 5
WINTHRO
DEC - 41963 AM
X
PLACE OF DEATH
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
227
OUT - OF
Registered No.
10619
f(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Mr. Julius Maged
(If deceased is a married, widowed or divorced woman, give also maiden name.) ·
33 Nevada
St
Winthrop, Mass.
(('ity 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
9 COLOR
8 SEX
male White.
WIDOWED
Wielewiel
UNKNOWN
11 lf married, widow ... HUSBAND of Sarah Hertilman- (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12.84
7m
.Years ..
Months.
Days
Il under 24 hours
Hours .....
.. Minutes
13 Usual
Occupation :
Vailar
( Kind of work done during most of working life)
14 Industry
or Business :
Vailaring
15 Social Security No 021-28-2884
16 BIRTHPLACE (City) ....
(State or country)
Russia
17 NAME OF
FATHER
Benjamin Maged-
18 BIRTHPLACE OF
FATHER (City) .. '
(State or country)
19 MAIDEN NAME
OF MOTHER
(C.R.L.)
20 BIRTHI'LACE OF
MOTHER (City).
(State or country)
Russia
Lec millas. 337urade St Wirthrin
21 Inlormant
I HEREBY CERTIFY that a satisfactory standard certificate of death wis filed with me BEFORE the bigrul or transit permit was issued:
OCT 23 1963 Pasmand Ragelangt
(Signature of Agent of Board of Health or other) 18401 10/31/63 /
(Date of Issue of Permit)
(Registrar)|| (Official Designation)
A TRUE COPY ATTEST:
(D)ay)
(Year)
4 IHEREBY CERTIFY , That I attended deceased from
October 17
., 19.6 3
to ...
October 19
19.
.6.3
im
I last saw
.... alive on
October 19
19.6 3
death is said to
have occurred on the date stated above, at 8: 40 P
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) .... CA.CSLMUMA
erphages
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
-
Was autopsy performed ?
٣٥٠
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceasedWO. If so, specify .....
www, M. D.
RONALD 7. KNUDTUN (Print or Type Name) (Address) BS Francis St. Dale Get 19 1963
WEckmanteicle Melere
6
l'lace of Ilurial or Cremation
(City or Town)
CO.ET.21
19
DATE OF BURIAL
6.3
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
.......
chelsea
4 - 1963
2-933404
RM R-301
or burial permit rd of Health Agent. UCTIONS FOR CERTIFICATE
-
OR TYPE R CAUSES EATH ot enter than one for each (b) and (c)
es mot mean : of dying, heart failure. etc. It means e, or compli- which caused
as, if any, ave rise to camse fa), the under- cause last.
tions contrib- death but not the termine adition riven AC ..
0
45
-
No.
New England Deaconess Hospital
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
(a) Residence. No ....
(Usual place of abode)
2
3 DATE OF
October
19
196 3
(write the word)
DEATH
(Month)
INTERVAL BETWEEN ONSET AND DEATH
PARENTS
(City of Town making this return)
William X Kare. City Registrar
1 MCL
1
THROW
DEC - 41963 AM
ORM R-301
for burial permit ard of Health ts Agent.
RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH not enter than one for each (b) and (c)
loes mot m ... le of dying, heart failure, etc. It means se, or compli- which caused
lons, if any, gove Nie to camse (.). the under. cause last.
ditions contrib- death but not · tat temind condition given
420.1 81 X70 4- 1963
62-933404
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OF
228
(City or Town making this return)
BETH ISRAEL HOSPITALOf death occurred in a hospital or institution. No ..
(RIVEits NAME instead of street and number) PHYSICIAN - IMPORTANT
CHRISTOPHER ALEXANDER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
210
(a) Residence. No.
(Usual place of abode)
length of stay : In place of death .......... years .......... months ...... days. In place of residence.
4 years.
.months ... .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIEM
WIDOWED
Married
UNKNOWN
11 lí married, widowed. pr divorced HUSBAND of
DESPINA ARHONDY (ALEXANDER) (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 AGE .. Y 45 years
Months ...
Days
If under 24 hours
Hours
.Minutes
Usual
Occupation :
CHEF- RESTAURANT
( Kind of work done during most of working life)
14 Industry
or Business:
...
Food
15 Social Security No ...
021-01-5363
6 BIRTHPLACE (City)
( State or country }
HARTFORD, .... corn.
17 NAME OF
FATHER
MICHAEL ALEXANDER
18 BIRTHPLACE OF
FATHER (City)
(State or country)
mesSINIA
GREECE
19 MAIDEN NAME
OF MOTHER
EVA
(Unknown)
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
messiNiA.
GREECE
63 21 Informant
MRS. DESPINA ALEXANDER 155 PLEASANT ST. WINTHROP
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