Wiktoria (Kruczyńska) Izbicki, daughter of Kazimierz Kruczyński and Franciszka (or Elżbieta) Maslowska, widow of Bolesław Izbicki, died on 24 August 1948 in Worcester, Worcester County, Massachusetts, USA and was buried on 27 August 1948 in Notre Dame Cemetery, Worcester, Worcester County, Massachusetts, USA.
The Death and Burial Record of Wiktoria (Kruczyńska) Izbicki – 1948
SOURCE: Worcester, Massachusetts, Death Records 1948, vol. 103: 407, Victoria (Kruczynski) Izbicki, Massachusetts Registry of Vital Records and Statistics, Dorchester.
Click on the link for a PDF copy of the death and burial record of Wiktoria (Kruczyńska) Izbicki. The record states:
The Commonwealth of Massachusetts
OFFICE OF THE SECRETARY
DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
WORCESTER (City or town making return) 107
Registered No. 2005
1 PLACE OF DEATH WORCESTER (County) WORCESTER (City or Town) F
No. 29 Belleview St., Ward
{(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Victoria (Kruczynski) Izbicki (If deceased is a married, widowed or divorced woman, give also maiden name.)
{PHYSICIAN – IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. (Usual place of abode) No. 29 Belleview St., Ward, (If nonresident, give city or town and state)
Length of stay: (Before death) (Specify whether) In hospital or institution years months days
In this community 40 years months days
PERSONAL AND STATISTICAL PARTICULARS
3 SEX female
4 COLOR OR RACE white
5 SINGLE MARRIED WIDOWED or DIVORCED (write the word) widowed
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full) (or) WIFE of Boleslaus Izbicki (Husband’s name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE 66 Years – Months – Days
If less than 1 day Hours Minutes
9 Usual Occupation: at home
10 Industry or Business:
11 Social Security No. none
12 BIRTHPLACE (City) (State or country) Poland 20-7
PARENTS
13 NAME OF FATHER Kazimierz Kruczynski
14 BIRTHPLACE OF FATHER (City) (State or country) Poland 20-7
15 MAIDEN NAME OF MOTHER Franciszka Maslowska
16 BIRTHPLACE OF MOTHER (City) (State or country) Poland 20-7
17 Informant Walter Izbicki (Relation, if any son)
(Address) Worcester
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
George D Melican
(Signature of Agent of Board of Health or other)
Dep Comm (Official Designation)
Aug 26, 1948 (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH Aug 24, 1948 (Month) (Day) (Year)
19 I HEREBY CERTIFY that I attended deceased from
Aug 16, 1948 to Aug 24, 1948, death is said to
have occurred on the date stated above, at 4:30aM.
Immediate cause of death
Chronic myocarditis
93d
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
Of autopsy –
What test confirmed diagnosis? –
Duration Important years
Important Physician – Underline the cause to which death should be charged statistically.
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed) Waldo Hagberg M.D.
(Address) Worcester Date 8-25 1948
21 Place of Burial, Cremation or Removal. Notre Dame, Worcester (City or town)
DATE OF BURIAL Aug. 27, 1948 19
23 NAME OF UNDERTAKER L Karolkewicz
ADDRESS Worcester
Received and filed Aug 27, 1948 19
[signed] Malcolm C Midgley (Registrar)
A TRUE COPY, ATTEST:
Copyright © 2011 by Stephen J. Danko
