Town of Winthrop : Record of Deaths 1963, Part 44

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 44


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


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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