USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 54
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HUSBAND of
(or) WIFE of.
(Husband's name in full)
Months.
.. Years.3.
11
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Homemaker
unknown
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
at Home
15 Social Security No ..
6 BIRTHPLACE (City)
(State or country)
Mary
PARENTS
17 NAME OF
FATHER
James Carlin
18 BIRTHPLACE OF
FATHEP. (City) ..
(State or country)
Boston
Masa
19 MAIDEN NAME
OF MOTHER
alice Curtis
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Boston
Mass.
21 Informant
(Address)
79 Lincoln St Winthrop
I HERFRY CERTIFY the a satisfactory standard certificate of death was filed with/me BEFORE the burial or transit permit was issued:
Signature Agent of Bed of Health of Ther)
19656
12/13/63
(Official Designation)
(Date of Issue of Permit)
I
No.MASSACHUSET.T.S.GENERAL .. HOSPITAL
2 FULL NAME
Mary Carlen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
3 DATE OF
DEATH
December
12
A TRUE COPY ATTEST:
........
Mre John Mc Carthy
Boston
INTERVAL
BETWEEN
ONSET AND
DEATH
I day
12
AGESY.
(Give maiden name of wife in full)
A TRUE COPY ATTEST:
Williaml. Kane. City Registrar
JAN 2 41964 AN
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 mot medm e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, teve rise to (s), the under. conse last.
itions contrib- death but not . the terminal codition riven
141.9 44 271 24 1964
2-932382
PLACE OF DEATH PLAC
X SUFFOLK (County) BOSTON - (City of Town)
5
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) 12333
VEN ENGLAND DÄPTIST HOSPITAL
2 FULL NAME.
WILLIAMJ TELLE,
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
18# CIRCUIT ROAD
St
(If nonresident, give city or town and State)
Length of stay : In place of death ......... years .......... months ...
18.
10 days. In place of residence
3 years ........ months ......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
DEC
12th 1963
(Month)
(Day)
(Year)
4HHEREBY CERTIFY,
No V 24
19 03
to ...
DEC 12th
That I attended deceased from
I last saw h/2.alive on
DEC 11 TH 1963 death is said to
have occurred on the date stated above, at
1ºA. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ASPIRATION PNEUMONIA
INTERVAL
BETWEEN
ONSET ANO
DEATH
7 days
Due
To RECURRENT CARCINOMA OF TONGUE
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
...
Was autopsy performed?
NO
What test confirmed diagnosis ?
BIOPSY
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
NO
(Signature)
WLADYSLAW 2. ZUREK
(Print or Type Name)
605 COMMONWEALTH AVE BOSTON Date.
12/12 19 13
WINTHROP WINTHROP
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
DEC 14
19.63
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
..
a satisfactory standar certificate of death 210 (WINTHROP) St. COINTHIPO HEREBY CERTIFY filed with me BEFORE the burial or transit permit was issued:
De Rogercon le
AFC 1 6 1963 (Signature of Agefft of Board of Health or other)
Received and filed"
Lihaug Reduce
B 19637 12-12-63
(Registrar)| (Official Designation)
(Date of Issue of Permit)
A:TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED
UNKNOWN
MARRIED
11 If married, widowed, or divorced
HUSBAND of
ELIZABETH TYRRELL
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
60
Years
.. Months ............ Days
If under 24 hours
.. Hours ........ Minutes
13 Usual
LAWYER.
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
LAW.
15 Social Security No.
025-01-2508
16 BIRTHPLACE (City).
(State or country)
KAST BOSTON
17 NAME OF
FATHER
DENNIS J KELLEHER
PARENTS
18 BIRTHPLACE OF
FATHER (City).
BOSTON
19 MAIDEN NAME
OF MOTHER CATHERINE O'GRADY
BOSTON
20 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
MASS
21 Informant
MRS ELIZABETH KELLEHER
(Address) 184 CIRCUIT RO WINTHROP.
Registered No.
death occurred i al or institut St.t give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
NO
if so specify WAR).
WINTHROP MASS
(a) Residence. No.
(Usual place of abode)
MILE 1
63
(a)
1/2 year.
Wholjsem Z. Furets
. D.
(State or country)
MIKSS
(Address)
-
A TRUE COPY ATTEST:
Williamil. Kane. City Registrar
6
JAN 2 41964 AM
RM R-301
r burial permit d of Health Agent. UCTIONS FOR CERTIFICATE
OR TYPE R CAUSES EATH
ot enter than one for each b) and (c)
es not mean : of dying, heart failure , etc. It means .or compli- kich caused
as, if any, eve rise to cause (a), the under- cause last.
tions contrib- death but not the terminal adition riven
34 70
24 1964
2-933404
PLACE OF DEATH
OUT - OF - TOWN SUFFOLK (County) ROXBURY (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
JEWISH MEMORIAL HOSPITAL No
JOSEPH PERLMUTTER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
62 LOCUST STREET.
(a) Residence. No.
>
Length of stay : In place of death .......... years .......... months.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWED
DIVORCED MARRIES
UNKNOWN
11 If married, widowed, or divorced HUSBAND of LENA
GRUND
(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 :
CARPENTER
14 Industry
or Business:
Building
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
Russia
PARENTS
17 NAME OF
FATHER
URBER PERLMUTTER
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
(CBK)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Informant
HERBERT PERLMUTTER
(Address)
51 Willow Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certifcate of death was filed with me BEFORE the burial or transit permit was issued:
(Sigusture of Agent of Board of Health or other)
1311722
12-12-63
(Official Designation)
(Date of Issue of Permit)
1
-
A TRUE COPY ATTEST:
1
278
(City or Town making this return)
Registered No.
12392
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, (if so specify WAR)
NO
WINTHROP
(City or town and State)
DECEMBER. 12.
1963
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
DECEMBER. 4,63
to DECEMBER -12 1963
I last saw hemalive on
DECEMBER 12 1963 death is said to
have occurred on the date stated above, at 8: 40 a.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
, BRONCHO-PNEUMONIA
INTERVAL BETWEEN ONSET AND DEATH DAYS.
Due To (b)
Due To (c)
OTHER
CERERAL ARTERY
SIGNIFICAN CONDITIONS/ HROM BOSIS WITH RIGHT
HEMIPLEGIA au APHASIA Was autopsy 'performed:
What test confirmed diagnosis ?
CLINICAL
T
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signature) marc hacamuli M. D. MARC NACAMULI .... (Print or Type Name) TENHA MEMORIAL HOSP Date 12.12. 63
Chevra MISHNAAS WOBURN
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
DECEMBER 13
1963
7 NAME OF
TORE funeral Servicio
FUNERAL DIRECTOR
ADDRESS Washmaton are Chelsea
Received and filed 19
folliauf lance.
DEC 16 1963
...
(Registrar)|
75 ..
(Kind of work done during most of iworking life)
MONTH
no
6
I
2 FULL NAME
(Usual place of abode)
9 days. In place of residence. 45 years ... ... months .......... days.
A TRUE COPY ATTEST:
Williaml. Kane. City Registrar
1
-
0
-
JAN 2 41964 AM
X
RM R-301
or burial permit rd of Health s Agent. UCTIONS FOR CERTIFICATE
OR TYPE R CAUSES EATH t enter than one for each (b) and (c)
es Rot meEN of dying, heart failure, etc. It means e,or compli- which caused
Rs, if any, ave rise to cause (). the under. cause last.
tions contrib. death but not the terminal adition riven
304.3 8 X?
24 1964
PLACE OF DEATH
I Boston (County) Suffolk (City or Town)
D
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
279
(City or Town making this return)
12435
Registered No. [(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME.
Lillian Locke
(If deceased is a married, widowed or divorced woman, give also maiden name.)
104 Highland Avenue
Winthrop,
Mass
(a) Residence. No ...
(Usual place of abode)
Length of stay: In place of death years ...
........ months.
2'pays. In place of residence.
70 years.
........ months
lys.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December 13, 1963
(Month)
(Day)
(Year)
Cent
4I HEREBY CERTIFY.
.De.c ....... 1.Q .... , 19 ......
.6.3
death is said to 1
have occurred on the date stated above, at
12:55 AM
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Shock
Due ToAcute myeloblastic leuk- (b)
emia
Due To (c) ....
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
y.e.s
What test confirmed diagnosis ?
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify ...........
(Signature)
M. D. M. WINTHROP O'CONNELL M. D.
(Print of Type Name)
ROSION CITY HOSPITAL
Date .... 12-1 ... 3-69.3.
GLENWOOD CEMETERY EVERETT
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
DECEMBER
16
1963
7 NAME OF
FUNERAL DIRECTOR
R.C. KIRBY, INC
ADDRESS 917 BENNINGTON ST. E. BOSTON
DEC 19. 1966 Processed and he Can leave. ......
PERSONAL AND STATISTICAL PARTICULARS
8 SEX F
9 COLOR
w
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
DIVORCED
11 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
CLARENCE
B. LOCKE
Months ..
11 Days
If under 24 hours
Hours ........ Minutes
13 Usual
HOUSEWORK
14 Industry
or Business.
AT HOME
15 Social Security No ..........
NO
16 BIRTHPLACE (City) EAST BOSTON, MASS (State or country)
17 NAME OF
FATHER
CHARLES MORRISON
PARENTS
18 BIRTHPLACE OF
FATHER (City)
PRINCE EDWARD IS.
(State or country)
19 MAIDEN NAME
OF MOTHER
CBL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
PRINCE EDWARD IS.
21 Informant
MR. EVERETT LOCKE
(Address)
112 MARION ST. E. BOSTON, MAS
I HEREBY CERTIFY that a satisfactory standard certificate of death WW filed with me BEFORE the buplal of transit permit was syled : Eugene howard
Signature of Agent of Beard of Health or other)
11731 12/13/69
( Registrar) || (Official Designation) .....
(Date of Issue of Permit)
62-934553
.A TRUE COPY ATTEST:
No ........
ROSTON CITY HOSPITAL
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
St
(City or town and State)
to .D.e.c.embe ........ 1.3 ... , 19. 63
INTERVAL BETWEEN ONSET AND DEATH 2hours 12 AGE 70 Years 9
6 weeks Occupation .
(Kind of work done during most of working life)
(Husband's name in full)
A TRUE COPY ATTEST:
Williamf. Kane. City Registrar
5
JAN 2 41964 AM
--
RM R-302
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town THIS IS A PERMANENT RECORD
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
PLACE OF DEATH
Middlesex (County )
1
Cambridge
(City or Town)
No.
Guardian Hospital
S(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Edith Lampel
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
33 Dolphin Ave.
St
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months.
13ays. In place of residence ..
16
.... years .......
.. months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December 19, 1963
DEATH
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY, That I attended deceased from
Dec . 6
noc.
19
.....
19.
63
to ...
I last saw l
...... alive on
Dec. 18
5 : A .
INTERVAL
BETWEEN
ONSET AND
DEATH
(or) WIFE of
h'ears
11
Ionths.
3
Day®
If under 24 hours
Hours ..
.Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business:
At Home
OTHER
Intercebereal Hematoma
SIGNIFICANT
CONDITIONS
11/1/636
BIRTHPLACE (City)
(State or country)
Maino
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
......
(Signed)
Vincent
Sena
M. D.
(Address)
1196 Broadway, Som.
12-19,63
Gethsemane Cem. West Roxbury
6 .
Place of Burial or Cremation
(City or Town)
Dec. 20,
63
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
J.S. atorman
ADDRESS Boston, Mass.
by David H. Cosa
auth.Agent
Received and filed
JAN 1-3-1964
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Wido wed
11 If married, widowed, or divorced
HUSBAND of
Da framrampel
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Hypostatic Pneumonia
(a)
Due ToCerebral Hemorrha,e
(b)
Due To (c) Hypertension
12/1/63
15 Social Security No ..
no
Leeds
17 NAME OF
FATHER
Frank Lindsey
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
Lewiston
19 MAIDEN NAME
OF MOTHER
(c.n.b.l.) Lane
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Lewiston
Irvin : Lampel
21 Informant
( Address)
42 Hiawatha Rd.
Mattapan
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Dec. 20,
19.63
280
(City or Town making this return)
Registered No.
1825
) (Was deceased a
U. S. War Veteran,
(if so specify WAR
Winthrop, Mass.
(a) Residence. No ...
(Usual place of abode)
19
63
19.
,death is said to
have occurred on the date stated above, at
m.
e in full)
12/6/63
3GE
84
Housework
PARENTS
50M · 10.61.931673
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Cambridge
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
RECEIVED
TOW
OF
71 12.
CE
10
NIW
CLERK
WIN
5
6
OP. MASS
JAN 1 31964 Alt -
FORM R-301
ed for burial permit Board of Health tits Agent. STRUCTIONS FOR AL CERTIFICATE
T OR TYPE OR CAUSES : DEATH not enter re than one se for each ). (b) and (c)
does not mean lode of dying. s heart failure. a. etc. It means ease, or compli- which caused
titions, if any, h gave rise to e cause (.). at the under. cause last.
nditions contrib. to death but mot so the terminal condition riven
53.8 47 X7/ N 241964
12-62-934553
PLACE OF DEATH
(County)
Boston
(City of Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital nr institution, St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
KENNETH G. SHIPLEY
(If deceased is a married, widowed of divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
Cif so specify WARI. WWI
110 Hermon
(Usual place of abode)
St. Winthrop, Mass.
(C'ity or town and State)
length of stay: In place of death ... years
1 months. 28 days. In place of residence 30 year-
. ... months . days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
( write the word )
MARRIED
WIDOWED
DIVORCEDMarried
UNKNOWN
11 11 married, widowed, or divorced
HUSBAND of
Catherine O'Connell
(or) WIFE of.
( Husband's name in full)
12
AGE
68 Years.
7
Months 17
If under 24 hours
Hnurs ...... Minutes
13 Usual
Occupation
Merchant Seaman
14 Indust*v
or Business
15 Social Security
No
030 10 5156
16 BIRTHPLACE (City).
(State or country }
Maryland
17 NAME OF
FATHER
William T.
Shipley
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Annapolis
Maryland
19 MAIDEN NAME
OF MOTHER
Bessie Curry
20 BIRTHPLACE OF
MOTHER (City) .. .
(State or country )
Maryland
VA Hospital Records, 150 So.
21 Informant
Huntington Ave., Boston, Mass.
I HEREBY CERTIFY that A satisfactory standard certificate of death was hled with me BEFORE the burial op wansit permit was issued: Les Boulle
Signature of Agent of Board of Health or other)
/11983 12-22-63
(Official Designation) (Date of Issue of Permit)
REV
A TRUE COPY ATTEST:
20
(Dav)
1963
(Year)
+THEREBY CERTIFY . That A attended deceased from October 22 . 19 63 . i December 20 1º 63
.. death is said to
have occurred on the date stated above, at 4:00 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
2 Wks ago
INTERVAL
BETWEEN
ONSET AND
(a) Myocardial infarction 1 Day)
DEATH
Due To Bronchopneumonia right & left (b)
5 Days
(c)
Due To postoperative adenocarcinoma of sigmoid.
3 Yrs
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)
Gaulle Leubut
M. D. Paul W. Dishart
(Address)
(Print or Type Name) VAH Boston, Mass. DateDec. 21 .1963
6 Winthrop Cemetery Winthrop, Mass.
l'lace of llurial or Cremation
(City or Town)
DATE OF BURIAL
December 23 1,63
7 NAME OF
Maurice w. Kirby
FUNERAL DIRECTOR
210 Winthrop St.
Winthrop, Hassash 30 1967
ADDRESS
Received and filed William& Raul
(Registrar ),
-
X OUT - OF - TOWNA Suffolk
281 (City or Town making this return) 12717
No. Veterans Administration Hospital
MEDICAL CERTIFICATE OF' DEATH
3 DATE OF
DEATII
December
(Month)
lower lobes.
(Kind of work done during most ní working life)
Annapolis
PARENTS
Annapolis
(Give maiden name of wife in full)
(a) Residence. Nn.
A TRUE COPY ATTEST:
William& Kane. City Registros
1
6
JAN 2 4 1964 AM
X
PLACE OF DEATH
Essox. (County)
I
Danvers
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
282
(CitydettawGnkking this return)
Registered No.
(If death occurred in a hospital or institution,
.St. ¿ give its NAME instead of street and number)
Harry A. Spector
(If deceased is a married, widowed or divorced woman, give also maiden name.)
230 Shore Drive, Winthrop, Mass.
(Usual place of abode) 0 0 11
Length of stay: In place of death
... years .....
.... months.
.days. In place of residence .......... years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Dec. 21, 1963
(Day)
(Year)
DetHERCE BY CERET IF Y) That hattended deceased from
19
Dos. 21,
1263
2:1119g., death is said to
have occurred on the date stated above, at
.. 111.
INTERVAL BETWEEN ONSET AND DEATH
Due To
(c)
empyema with Ift. homithoras
OTHER
coronary ht dis.
yrs.
Was autopsy performed?
autopsy.
5 Was disease or injury in any way related to occupation of deceased? If so, specify IHard -M.Hausman
(Signed) Willard M. Hausman M. D.
Hathorne, Mass.
12.24 63
Date.
19
(Address) Askinago , Everett, Mass.
Place of Burial or Crem December (City or Town) 2.7
DATE OF BURIAL Torf funeral Service Inc (Address)
63 Georgie T. Brimigion
2[ Informant
Danvers, Mass.
7 NAME OF FUNERAL DIRECTOR Chelsea, Mas3.
ADDRESS ....
Dec. 27 1963
Received and filed
FEB . 6 1964
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
ATTEST:
Egistrar of City or- Town where death occurred)
DATE FILED
19
XX
......
-...
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
married
If married, ifuyorGoddess
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
60
09
19
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
cleaning
(Kind of work done during most working life)
14 Industry VS or Business :
15 Social Security No ..
London
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Daniel Spector
PARENTS
18 BIRTHPLACE OF
unknown
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Sadie 11122816
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
unknown
Russia
SOM - 10-61-931673
2 FULL NAME. (a) Residence. No. DEATH (Month) I last saw h ...... alive on (a) Due To (b) SIGNIFICANT What test confirmed diagnosis? 0 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased CONDITIONS TOS
M R-302
THIS IS A PERMANENT RECORD
L
Danvers State Hos, Hathorne No.
(Was deceased a
U. S. War Veteran,
(if so specify WAR
(If nonresident, give city or town and State)
19
DEATH WAS, CAUSED BY: IMMEDIATE CAUSE
bronchopmeumonia
AGE ......
... Years ..
............ Months ..
Dayz,
England
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
TOW
6 5
THROP
FEB - 61964 PM
FORM R-301
for burial permit oard of Health its Agent. TRUCTIONS FOR L CERTIFICATE
TOR 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
tions, if any, gave rise to cause (a). & the under- cause last .
ditions contrib. death but not to the terminal condition given
70.1 81 X70 10. 1968
i Director . use only
.62-932382
PLACE OF DEATH
SUFFOLK
(County)
I
BOSTON
(City or Town)
No. MASSACHUSETTS.GENERAL. HOSPITAL
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
283
(City or Town making this return)
Registered No.
13137
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME.
Albert ... Lythgoe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
23 .... Fairview
[tr t
St
Winthrop, Mass
(Usual place of abode)
(If nonresident, give city or town and State)
C
... years .........
.months.
2 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
2.7
19.63
(Month) (Day)
(Year)
4 I HERERY CERTIFY , That lwattended deceased from
to
19
63
December 27
December 24. 19.
63
We last saw amalive on
December ........ 27 ... , 19.63 death is said to
have occurred on the date stated above, at 1.2 .;. CONoon
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
MYCORDIAL INFARCTION
(a)
CORONARY THROMBOSIS
(b)
Due To (c)
OTIIER
SIGNIFICANT
CONDITIONS
EMPHYSEMA
YEARS
Was autopsy performed ?
Yes
What test confirmed diagnosis ?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signature)
el.@la
M. D.
... Chorles.L .. Clay ... M. D ..... (Print or Type Name) (Address) Ass's. Dir., Mass .. Gan'] .. Hosp ..... Date.Dec ...... 27.19.63
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Dec. 20
19.50
7 NAME OF
FUNERAL DIRECTOR
Howard & Rommolds
ADDRESS
Received and filed .. William Kane
JAN
2-1964
(Registrar) || (Official Designation)
(Date of Imue of Permit)
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
(write the word)
10 SINGLE
MARRIED
WIDOWED
DIVORCED Married
UNKNOWN
11 If married, widowed, or divorced: + HUSBAND of
(or) WIFE of.
(Husband's name in full)
12 AGE ... 4 Years ...
5 Months.
22_Days
If under 24 hours
Hours.
.Minutes
13 Usual
Ci toni.n
(Kind of work done during most working life)
14 Industry or Business :
15 Social Security No ..
5
:-: 27
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
18 BIRTHPLACE OF
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Judit: D Gili om
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Informant
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was, Gled with me BEFORE the burial or transit permit was issued: ILegal
(Signature of Agent of Board of Health or other)
1519884
17/20/62
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
Length of stay : In place of death .......... years .......... months ....... days. In place of residence.
INTERVAL BETWEEN ONSET AND DEATH
3 DAYS
3 DAYS
Occupation
(Give maiden name of wife in full)
PARENTS
Everett
A TRUE COPY ATTEST:
Williaml. Kane. City Registrar
1.
1
5
5
YTHROP.
FEB 1 01964 AM
I
BOSTON
(City or Town)
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
284
(City or Town making this return)
13125
Registered No.
f(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, (if so specify WAR) ..... NO .......
(a) Residence. No.
789 Shirley
St Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... 1
6 days. In place of residence.3. 5.years. .months. ......... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Male
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
Widowed
DIVORCED
UNKNOWN
Il If married, widowed, or divorced
HUSBAND of
Mary Gorska
(or) WIFE of.
(Husband's name in full)
12
AGE93 ... Vears.
Months.
.Days
If under 24 hours
Hours ...... . Minutes
13 l'sual
Occupation :
Retired
( Kind of work done during most working life)
14 Industry
S S Captain
15 Social Security No ..
16 BIRTHPLACE (City). Sam Mar tinoEr (State or country )
Q DeChiesa
17 NAME OF
FATHER
Giovanni Linardi
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Austria
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF MOTHER (City) (State or country) Austria
21 Informant
(Address)
Archie Moriarty
789 Shirley St.,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or, transit permit was issued:
19922
(Signature of Agent of Board of Health or other) 1- 1-64
(Official Designation) (Date of Issue of Permit)
A TRUE COPY ATTEST:
(Day)
(Year)
4I HEREBY CERTIFY , That I Mftended deceased from
December24 1.63
.....
., to .. December ....
30
19 ..
63
Hast saw himlive on .. December ..
30 ..... 1963, death is said to
have occurred on the date stated above, at
7:35 .... P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Coronary Heart Disease,
INTERVAL BETWEEN ONSET AND DEATH Yrs
severe
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Status post-operative 3 days for acute cholecystitis
Was autopsy performed ?
Yes
What test confirmed diagnosis ?
Autopsy
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) Aus't, Dir., Mass. Gon'l. Hopp. Date ...
Dec.30 163
6 Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January ...... 3. 196.3.
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O' Maley
ADDRESS Winthrop Mass
JAN
Received and hled ...... 6-19644 19 Williamof Kane.
(Registrar)|| ....
2-932382
PLACE OF DEATH
SUFFOLK
ORM R.301
for burial permit oard of Health its Agent. RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
Mions contrib- death but not the terminal ondition given
+20.1 81
l Directon . use only ACK Ink.
(County)
MASSACHUSETTS GENERAL HOSPITAL No.
2 FULL NAME
Nicholas Linardi
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
30
1963
(Month)
(Give maiden name of wife in full)
PARENTS
......
A TRUE COPY ATTEST:
William Kance. City Registrar
6
FEB 1 01964 AM
٥٠هـ
二千年
年4月号六合4 4444494444
4ールーム44
صادر
一
கருவி
44444 2
44
나44 444
-
中中ーキルク
中华与业
செய்து பக்தர்கள்
45小中で
النصر
به
44章
北海中學年年
---
中華奇
-
キラムー キー4
المالية البحيرة المقدسة
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