Bolesław Dominik Izbicki, son of Dominik Izbicki and Józefata Marianna Bizewska, husband of Wiktoria Kruczyńska, died on 10 March 1937 in Worcester, Worcester County, Massachusetts, USA and was buried on 12 March 1937 in Notre Dame Cemetery, Worcester, Worcester County, Massachusetts, USA.
The Death and Burial Record of Bolesław Dominik Izbicki – 1937
SOURCE: Worcester, Massachusetts, Death Records 1937, vol. 95: 363, Boleslaw D Izbicki, Massachusetts Registry of Vital Records and Statistics, Dorchester.
Click on the link for a PDF copy of the death and burial record of Bolesław Dominik Izbicki . The record states:
The Commonwealth of Massachusetts
OFFICE OF THE SECRETARY
DIVISION OF VITAL STATISTICS
MEDICAL EXAMINER’S
CERTIFICATE OF DEATH
WORCESTER (City or town making return)Â 363
Registered No. 685
1Â PLACE OF DEATHÂ WORCESTER (County) WORCESTER (City or Town)
No. 9 Esther St., Â Â Â Â Ward
{(If death occurred in a hospital or institution, give its NAME instead of street and number)
2Â FULL NAME Boleslaw D Izbicki (If deceased is a married, widowed or divorced woman, give also maiden name.)
{(If U. S. War Veteran, specify WAR)
(a) Residence . No. 9 Esther St., Â Â Â Â Ward, (If nonresident, give city or town and state)
Length of residence in city or town where death occurred 30 yrs . Â Â Â Mos . Â Â Â Days.
How long in U. S. if of foreign birth? 30 yrs .    Mos .    Days.
PERSONAL AND STATISTICAL PARTICULARS
3Â Â SEXÂ male
4Â Â COLOR OR RACEÂ white
5Â Â SINGLE MARRIED WIDOWED or DIVORCED (write the word)Â married
5a If married, widowed, or divorced HUSBAND of Victoria Kruczynska (Give maiden name of wife in full) or WIFE of     (Husband’s name in full)
6Â Â IF STILLBORN, enter that fact here.
7Â Â AGEÂ 57 Years – Months – Days
If less than 1 day    Hours    Minutes
OCCUPATION
8  Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc Laborer in 7871
9  Industry or business in which work was done, as silk mill, saw mill, bank, etc Street Department
10Â Date deceased last worked at this occupation (month and year)
11Â Total time (years spent in this occupation
12 BIRTHPLACE (City)   (State or country) Poland 20-7
PARENTS
13Â NAME OF FATHERÂ Dominick
14 BIRTHPLACE OF FATHER (City)   (State or country) Poland 20-7
15Â MAIDEN NAME OF MOTHERÂ Cannot be learned
16 BIRTHPLACE OF MOTHER (City)   (State or country) Poland 20-7
17 Informant Mrs. Victoria Izbicki
(Address)Â Worcester
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Peter O Shea, M. D.
(Signature of Agent of Board of Health or other)
Director (Official Designation)
March 12, 1937 (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18Â DATE OF DEATHÂ March 10, 1937 (Month) (Day) (Year)
19Â I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUS AND MANNER thereof are as follows: (If an injury was involved, state fully)
Probably coronary sclerosis
Coronary thrombosis.Unexpected
death. Found dead in bed.
94BÂ (no autopsy)
(See reverse side for description for unknown person)
20Â If death was due to external causes (VIOLENCE) fill in the following:
Accident, Suicide or Homicide? —
Date of Injury ___ 19
Where did injury occur? — (City or town and State)
Manner of Injury —
Nature of Injury —
21 Was disease or injury in any way related to occupation of deceased? No
If so, specify
(Signed) Frederick H Baker,Med.Exam M. D.
(Address) Worcester Date 3-10-1937
22Â PLACE OF BURIAL, CREMATION OR REMOVALÂ Notre Dame (Cemetery), Worcester (City or town)
DATE OF BURIALÂ March 12,1937Â Â Â Â 19
23Â NAME OF UNDERTAKERÂ L Karolkevicz & Son Inc.
ADDRESSÂ Worcester
Received and filed March 13, 1937Â Â Â Â 19
[signed] Malcolm C Midgley (Registrar)
A TRUE COPY, ATTEST:
Copyright © 2011 by Stephen J. Danko
