Town of Winthrop : Record of Deaths 1963, Part 54

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


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



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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