Town of Winthrop : Record of Deaths 1963, Part 8

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 8


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).


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MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


married


11 If married, widowed, or divorced HUSBAND of


(or) WIFE of.


(Give maiden name of wife in full)


Abraham Roitman


(Husband's name in full)


12


AGE342


Years


Months ..


.Days


If under 24 hours


Hours


Minutes


13 Usual


Occupation :


Physician (retired)


(Kind of work done during most working life)


14 Industry


or Business :


15 Social Security No ...


16 BIRTHPLACE (City)


(State or country )


Latvia


17 NAME OF


FATHER


Abraham Segal


18 BIRTHPLACE OF FATHER (City) (State or country)


Pussis


19 MAIDEN NAME


OF MOTHER


Treda (unknorm)


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


21 Informant


br-han Roitman


( Address)


47 Washington Avenue, Winthrop, Mass


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 6


(Signature of Agent of Board of Health or other) Hearthe office


(Official Designation)


(Date of Issue of Permit)


TV


A TRUE COPY ATTEST:


2-932382


1


(City or Town)


No.


47 Washington Avenue


(City or Town making this return)


Jennie S. Roitman


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


no


(a)


Residence. No


(Usual place of abode)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


presumably to


M. D. PARENTS


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE FEL DENC3 75


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths fromn disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


ORM R-301


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


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


Des not mean e of dying, heart failure, etc. It means e, or compli- which caused


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


itions contrib- death but not the terminal ndition given ,C.


2-932382


TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX FEM


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word) Widowed


11 1f married, widowed, or divorced HUSBAND of


(or) WIFE of.


BARNEY GLOOBERMAN


(Husband's name in full)


12


AGE 82


Fears


Months.


Days


If under 24 hours


Hours ..


Minutes


13 Usual


House wife


Occupation :


(Kind of work done during most working life)


14 Industry


or Business :


AT Home


15 Social Security No ...


None


16 BIRTHPLACE (City)


(State or country )


Russia


17 NAME OF


FATHER


LABE Sheits


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Russian


(State or country)


19 MAIDEN NAME


OF . MOTHER


CBC


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mrs Albert ARONOFSKY


21 Informant


(Address)


106 Summit itve, Winthrop


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


Signature of Agent of Board of Health or other)


Health Oficer


F 1- 27-1963


(Date of Issue of Permit)


1 X


1


PLACE OF DEATH


SUFFOLK


(County) Winthrop


(City or Town)


Wintheen Com, Hosp. No


[(If death occurred in a hospital or institution,


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


PHYSICIAN - IMPORTANT


2 FULL NAME


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


106 Summit Ave


Winthrop Mass


(If nonresident, give city or town and State)


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Feb


26


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That I attended deceased from


Det


1950


to ...


Feb. 26


1963


I last saw heV.alive on


Feb , 26


, 1963, death


.. , death is said to


have occurred on the date stated above, at 6:30p. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Arteriosclerotic Heart Disease


INTERVAL BETWEEN ONSET AND DEATH 14%.


(b) .


Myocardial Infarction


5 days


Due To (c)


OTHER


SIGNIFICANT


Nine


CONDITIONS


Was autopsy performed?


No


What test confirmed diagnosis ?


Clinical


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify


(Signature)


M. D.


CHARLES


LIBERMAN


(Print or Type Name)


(Addre WINTHROP, MASS Date 2/26/1963


TiFERETH IS. 01 Winthrop. Eventt


6


Place of Burial or Crematum


(City or Town)


DATE OF BURIAL


Relimany


27


19


63


7 NAME OF


TORF funeral Service Ine


FUNERAL DIRECTOR


ADDRESS


Washington Are Chelsea


Received and filed


FEB 27 1963


19.


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


(City or Town making this return)


CERTIFICATE OF DEATH


Registered No.


35


Rebecca


Glooberman


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO


(a) Residence. No ...


(Usual place of abode)


St


(Registrar) (Official Designation)


(Give maiden name of wife in full)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE. DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un - related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


63 AF


ORM R-301


or burial permit rd of Health s Agent. RUCTIONS FOR CERTIFICATE


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


oes not meon e of dying, heart failure, etc. It means se, or compli- which caused


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


itions contrib- deoth but not the terminal ondition given


2-933404


A TRUE COPY ATTEST:


8 SEX


MALE


9 COLOR


WHITE


IO SINGLE


MARRIED


WIDOWED


DIVORCED


(write the word)


MARRIED


11 If married, widowed, of divorced MARIE W AMIPAULT HUSBAND of (Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE: 53 Years.


Months ..


.. Days


If under 24 hours


Hours. .... Minutes


13 Usual


Occupation :


WELDER.


(Kind of work done during most of iworking life)


14 Industry


or Business :


CONSTRUCTION (BLDG,)


15 Social Security No 349-01-1201


BELVEDERE


16 BIRTHPLACE (City)


(State or country)


ILh.


17 NAME OF


FATHER


WILLIAM STURGES


18 BIRTHPLACE OF


FATHER (City)


(State or country)


ILL.


ELGIN


19 MAIDEN NAME


OF MOTHER


ANNE ACTON


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


ILL.


DECATUR.


6


WINTHROP


WINTHROP


Place of Burial or Cremation (City or Town)


DATE OF BURIAL MARI 1963


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS WINTHROP


Received and filed


FEB 28 1963


19


(Registrar )


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


CERTIFICATE OF DEATH


Registered No.


36


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


2 FULL NAME.


WILLIAM A STURGES


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


(a)


Residence. No ...


25 TEMINS BURY ST.


... St. .....


(City or town and State)


Length of stay: In place of death / 2 years


months.


days. In place of residence years months


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Feb. 26, 1963


(Month)


(Day)


(Year)


4 IHEREBY CERTIFY


May29 1939, 10


Feb. 22


1963


That I attended deceased from


I last saw h.). @live on


Feb. 22.


1963, death is said to


have occurred on the date stated above, at


939 am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Coronary Occlusion


(a)


INTERVAL BETWEEN ONSET AND DEATH


Due To


Arteriosclerofic heart


(b)


Syv;


(c)


Due To


disease


Chronic Asthma


15423


OTHER


Chronic Emygewandloyal


SIGNIFICANT


CONDITIONS Epilepsy JuJUS


Was autopsy perfornfed ?


What test confirmed diagnosis ?


Wil


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


If so, specify


None


(Signature)


Imple Zawieller


M. D.


Joseph Zambella


"(Print or Type Name)


(Ad 324 SummerStiE


2- -8-63


PARENTS


21 Informant


MARIE W STURGES


(Address).


25 TEWKSBURY ST WINTHROP


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Nespole E. fireanni (3) (Signature of Agent of Board of Health or other) Health office Feb . 25 - 16 2


(Official Designation)


(Date of Issue of Permit)


TX


PLACE OF DEATH


X SUFFOLK (County) WINTHROP (City or Town) 1


ATE


25 TEWKSBURY ST. No.


(City or Town making this return)


(Was deceased a U. S. War Veteran, (if so specify WAR) NO


(Usual place of abode)


PERSONAL AND STATISTICAL PARTICULARS


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE FEL 86 63/


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths froin disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


M R-301


burial permit of Health Agent. TIONS 1


RTIFICATE


TYPE CAUSES ATH enter in one r each and (c)


not mean of dying, rt failure, . It means or compli- ch caused


if any, : rise to se (a). : under- se last.


ns contrib- th but not e terminal ition given


002


13 1963


PLACE OF DEATH


Suffolk


(County) Boston


(City or Town)


KEVIN H. WHITE SECRETARY OF THE COMMONWE DIVISION OF VITAL STATISTICS


STANDARD CERTIFICATE OF DEATH


Registered No.


183


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


PHYSICIAN - IMPORTANT


2 FULL NAME ..


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


80 Johnson Avenue


St


Winthrop, Mass.


(a) Residence. No.


(Usual place of abode)


Length of stay : In place of death .......... year ........... months


47


.days. In place of residence.


60


ears ...... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Married


11 If married, widowed, or divorced


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12


AGE ... 8.4 ears 2.


Months.2.1 .. Days


If under 24 hours


Hours ..


.. Minutes


13 Usual


Occupation :


Caretaker ( retired)


( Kind of work done during most working life)


14 Industry


or Business


Real Estate


15 Social Security No ....


none


16 BIRTHPLACE (City)


Boston,Mass.


(State or country )


Was autopsy performed ?


No


What test confirmed diagnosis?


SPUTUM CULTURES & SMEARS


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


....


If so, specify ....


NO


(Signature)


Stewart Wright


M. D.


STEWART WRIGHT


(Address)


........


Forest Hills Cemetery, Boston


6


Place of Ilurial or Cremation


(City or Town)


7 NAME OF


FUNERAL DIRECTOR


J.S.Waterman & Sons


ADDRESS


495 Commonwealth Ave, Boston


Recorml aff f


JAN 9 1963


Charles H. Mackie


....


(Registrar)


PARENTS Q


17 NAME OF


FATHER


John W.Day


18 BIRTHPLACE OF


FATHER (City)


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Eliza Cox


20 BIRTHPLACE OF


MOTHIER (City) ..


(State or country)


England


21 Informant


Rosanna Day


( Address)


80 Johnson Ave, Winthrop, Mass.


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


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


603844


(Simimare of Agent of Board of Health or other) 1-8-63


(Official Designation) (Date of Issue of Permit)


A TRUE COPY ATTEST:


3 MOS


Due To (b)


Due To (c)


to ..


January 7


19


I last saw AMalive on


January


.7


63


19


death is said to


HUSBAND of


Rosanna .... M.B.e.v.e.lander ...


have occurred on the date stated above, at


2.45 a


„.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL BETWEEN ONSET AND DEATH.


TUBERCULOSIS PULMONARY & ORAL (a)


3 DATE OF


DEATH


(Month)


(Day)


January


7


1963


(Year)


4IHEREBY CERTIFY


November 21


19


62


That I attended deceased som


Male


OUTSOSTODWIT


(City or Town making this return)


1


No ...


......


New England Center Hospital


Mr. George Compton Day


(\'as deceased a


U. S. War Veteran,


if so specify WARI


none


(If nonresident, give city or town and State)


OTHER


SIGNIFICANT


CONDITIONS


NEW ENGLAND"ENTER HERE. 7 JAN 63


DATE OF NURIAL


January 9,1963


19


32382


A TELL COPY ATTEST: Cartes & Mackie City Reoxtar


OF


TOWA


OFFICE


GLERK


00


6 0


THROP M


MAR 1 31963 AM


1


ORM R-301


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


·OR TYPE OR CAUSES DEATH not enter than one e for each (b) and (c)


does mot meon de of dying. heart foilure, etc. It means ase, or compli- which caused


ioms, if any, gave rise to cause (0). the under- cause last.


ditions contrib- death but not o the terminal condition given


.c.


634 R 9 1963 1963


Director use only K Ink.


62-932382


PLACE OF DEATH


SUFFOLK


(County )


qu'il TU


STANDARD CERTIFICATE OF DEATH


1047


Registered No.


f(If ileath occurred in a hospital or institution, St. I give its NAME instead of street and number)


2 FULL NAME ..


James. J .... Sharkey


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


19 Buchanan Street


Winthrop, Mass.


(If nonresident, give city or town and State)


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


January


29


1963


DEATII


(Month)


(Đầy)


(Year)


4IHEREBY CERTIFY , That we attemiled deceased from


November 281. 63


19


63


10.


January


29


63


January 29


19


., death is said to


wel last saw h ...... alive on


9:00a.


have occurred on the date stated above, at


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a).


le Cerebral Artery


Thrombosis


(b) .. Due To theesclerosis


vars


Dite To (c)


OTHER


SIGNIFICANT CUSO Tubular Necrosis


CONDITIONS


3


Y ?- S


Was autopsy performed?


Yes


What test confirmed chagnosis ?


Autensy


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


If so, specify


(Signature)


Caclay


M. D.


Charles to. Clay, M. D ... (Print or Type Name)


(Address Ase's. Din, Moss, Gon'L Hosp ......... Date ....


Jan. 29.63


6


WINTHROP


WINTHROP


Place ol Burial or Cremation


(City or Town)


DATE OF BURIAL


FEB 1


1) 63.


7 NAME OF


FUNERAL DIRECTOR


MAURICE 1. KIRBY


ADDRESS


19 413 7


Received any hled


Charles it Mackie


8 SEX


9 COLOR


(write the word)


MALE


WHITE


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


MARRIED


Il If married, widowed, or divorced


HUSBAND of


ELLA V.


THORNTON


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGES Wear.


Month-


Days


If under 24 hours


Hours .. ..... Minutes


13 l'sual


Occupation :


CLERK.


( Kind of work done during most working life)


14 Industry


or Business


LING STORING


15 Social Security No. 0.21-09-6014


16 BIRTHPLACE (City). LAST Desicil (State or country )


17 NAME OF


FATHER


JAMES P SHLARNEY


18 BIRTHPLACE OF


FATHIER (City)


(State or country)


BOSTON


19 MAIDEN NAME


OF MOTHER


MARY & MACEACHERN


20 BIRTIIPLACE OF


MOTHER (City)


GLIVINSTER.


(State or country )


MASS


21 Informant


MiPS ELLA SHARNEY


( Address)


19 BUCHANAN ST WINTHROP MASS


HEREBY CERTIFY that a satisfactory standard certificate of death is filed with me BEFORE The burial or transit permit was issued: Prima T. Manmale (Signature ol Agent ol Board of Health or other)


14945 1/31/63.


(Registrat)|| (Official Designation)


(Date of Issue of Permit)


1., V


A TRUE COPY ATTEST:


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


38


(City or Town making this return)


1


BOSTON


(City or Town)


NMASSACHUSETTS GENERAL HOSPITAL


PHYSICIAN - IMPORTANT


) (Was deceased a


U. S. War Veteran, 29 is IT


if so specify WAR


(a) Residence. No .....


(Usual place of abode)


St ..


PERSONAL AND STATISTICAL PARTICULARS


PARENTS


INTERVAL BETWEEN ONSET ANO DEATH 2 mos


TOW


: 32


1-10


LERK


WI


THROW


APR -51963 AM


1


ORM R-301 -


-


PLACE OF DEATH


Suffolk


County) Barton (City or Town) BOSTON CITY TOSPITAL


CERTIFICATE OF DEATH


Registered No.


1174


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


2 FULL NAME ..


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


2 Lorean ferr.


St Winthrop, Mass.


(a) Residence. No.


(Usual place of abode)


Length of stay: In place of death ....


years ...... months! 9 days. In place of residence 2 years.


. .. . months davs.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX 7


9 COLOR


10 SINGLE


(write the word)


MARRIED


WIDOWED,;


DIVORCED Vuelound


UNKNOWN


11 if married, widowed. or divorced HUSBAND of


(Give maiden name of wife in full


//( Husband's name in full)


If under 24 hours


Hours ..


Minutes


13 t'sual


Lecretary


Occupation


( Kind of work done during most of iworking life)


14 Industry


or Business


unknown Social Security


036-04-6140


16 BIRTHPLACE (City).


(State or country )


17 NAME OF


FATHER


John F. Harding


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Vermont


19 MAIDEN NAME


OF MOTHER


Current Lassen


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


41.4


21 Informant


ant Jeannette Paturiquel


in Coper Law Firentry Course


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


.......


(Signature of Agent of Board of Health or other)


14 960


2/1/63


(Official Designation)


(Date of Issue of Permit)


TVRV


A TRUE COPY ATTEST:


within Olan all, M. D).


M. WINTHROP O'CONNELL, M.D. (Print fr Type Name) BOSTON CITY HOOPHAL Date 1-31-63


6 Place of Burial or Cremation Fel 19.63


(City of Town)


DATE OF BURIAL


7 NAME OF FUNERAL DIRECTOR


W. C. Parker


ADDRESS


Recemed and filed


FEB 5 10 3 1.19 Charles et Mackie


( Registrar)


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


40


(City or Town making this return)


or nur:al permit a's o. Heaith


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. el: 18 means se, or ( pl- which caused


give rise to cause (a). the under. cause last.


litions contrib- death but not o the terminal condition giver


1.C.


443


×


5 1963


2-133404


3 DATE OF


January 30, 1963


DEATH


( Month) (Day) Was a patient


4 1 HERE Jan. 21, 1963 FY, Jan. 30,.1963


1


alive of 4:15 P.M


Cardiac Insufficiency


Due l'o


(h)


( Clinical)


Due To (c) Hypertensive Cardiac Disease


OTHER SIGNIFICANT CONDITIONS


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


PARENTS


No.


Martha Smith


(HARDING)


( Was deceased a U. S. War Veteran, if so specify WARY


(C'ity or town and State)


have occurred on the date stated above, at ·INTERVAL BETWEEN DEATH WAS CAUSED BY: IMMEDIATE CAUSE ONSET AND (or) WIFE of. 12 DEATH days AGE GSTea Years 0 Months 23 Days


death is said to


RECEIVED


OF TOW 17 12 -- -


1


: CLERK


VIN


/THROP


APR -51963 AM


1


41


To be filed for burial permit with Board of Health } or its Agent.


No.


St ...... Elizabeth's ..... Hospital


(If death occurred in a hospital or institution,


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


FRANCIS


J.


SHEA


[ ( Was deceased a


U. S. War Veteran,


(if so specify WAR) WW .... ]


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


63 PAINE


WINTHROP


(a) Residence. No.


( l'sual 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 35


years ..


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


(write the word)


3 DATE OF


DEATH


FEB


4


1963


(Month)


(Day)


(Year)


4 1


HEREBY


CERTIFY,


That I attended deceased from


14


1/20


19


to ...


63


I last saw hin


...... alive on


2/4


19 43


death is said to


have occurred on the date stated above, at


10 2- 0m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


MULTIPLE


MYELOMA


Due To


(b)


PATHOLOGIC FRACTURES


( OVER)


Due To


(c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


YES


What test confirmed diagnosis?


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


(Signed)


M. D ASSETHAT A. MARTINS




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