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<\/a><\/p>\nThe Death and Burial Record of Boles\u0142aw Dominik Izbicki – 1937<\/em><\/p>\n SOURCE:\u00a0 Worcester, Massachusetts, Death Records 1937, vol. 95: 363, Boleslaw D Izbicki, Massachusetts Registry of Vital Records and Statistics, Dorchester.<\/p>\n Click on the link for a PDF copy of the death and burial record of Boles\u0142aw Dominik Izbicki<\/a> .\u00a0 The record states:<\/p>\n The Commonwealth of Massachusetts 1\u00c2\u00a0 PLACE OF DEATH\u00c2\u00a0 WORCESTER (County) WORCESTER (City or Town) 2\u00c2\u00a0 FULL NAME Boleslaw D Izbicki (If deceased is a married, widowed or divorced woman, give also maiden name.) PERSONAL AND STATISTICAL PARTICULARS I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: MEDICAL CERTIFICATE OF DEATH 22\u00c2\u00a0 PLACE OF BURIAL, CREMATION OR REMOVAL\u00c2\u00a0 Notre Dame (Cemetery), Worcester (City or town) Received and filed March 13, 1937\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 19 Copyright \u00a9 2011 by Stephen J. Danko<\/p>\n","protected":false},"excerpt":{"rendered":" Boles\u0142aw Dominik Izbicki, son of Dominik Izbicki and J\u00f3zefata Marianna Bizewska, husband of Wiktoria Kruczy\u0144ska, 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, … Continue reading
\nOFFICE OF THE SECRETARY
\nDIVISION OF VITAL STATISTICS
\nMEDICAL EXAMINER’S
\nCERTIFICATE OF DEATH
\nWORCESTER (City or town making return)\u00c2\u00a0 363
\nRegistered No. 685<\/p>\n
\nNo. 9 Esther St.,\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Ward
\n{(If death occurred in a hospital or institution, give its NAME instead of street and number)<\/p>\n
\n{(If U. S. War Veteran, specify WAR)
\n(a) Residence .\u00a0 No. 9 Esther St.,\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Ward, (If nonresident, give city or town and state)
\nLength of residence in city or town where death occurred 30 yrs .\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Mos .\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Days.
\nHow long in U. S. if of foreign birth?\u00c2\u00a0 30 yrs .\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Mos .\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Days.<\/p>\n
\n3\u00c2\u00a0\u00c2\u00a0 SEX\u00c2\u00a0 male
\n4\u00c2\u00a0\u00c2\u00a0 COLOR OR RACE\u00c2\u00a0 white
\n5\u00c2\u00a0\u00c2\u00a0 SINGLE MARRIED WIDOWED or DIVORCED (write the word)\u00c2\u00a0 married
\n5a\u00c2\u00a0 If married, widowed, or divorced HUSBAND of Victoria Kruczynska (Give maiden name of wife in full) or WIFE of\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 (Husband’s name in full)
\n6\u00c2\u00a0\u00c2\u00a0 IF STILLBORN, enter that fact here.
\n7\u00c2\u00a0\u00c2\u00a0 AGE\u00c2\u00a0 57 Years – Months – Days
\nIf less than 1 day\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Hours\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 Minutes
\nOCCUPATION
\n8\u00c2\u00a0\u00c2\u00a0 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc\u00c2\u00a0 Laborer in 7871
\n9\u00c2\u00a0\u00c2\u00a0 Industry or business in which work was done, as silk mill, saw mill, bank, etc\u00c2\u00a0 Street Department
\n10\u00c2\u00a0 Date deceased last worked at this occupation (month and year)
\n11\u00c2\u00a0 Total time (years spent in this occupation
\n12\u00c2\u00a0 BIRTHPLACE (City)\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 (State or country)\u00c2\u00a0 Poland\u00c2\u00a0 20-7
\nPARENTS
\n13\u00c2\u00a0 NAME OF FATHER\u00c2\u00a0 Dominick
\n14\u00c2\u00a0 BIRTHPLACE OF FATHER (City)\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 (State or country)\u00c2\u00a0 Poland\u00c2\u00a0 20-7
\n15\u00c2\u00a0 MAIDEN NAME OF MOTHER\u00c2\u00a0 Cannot be learned
\n16\u00c2\u00a0 BIRTHPLACE OF MOTHER (City)\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 (State or country)\u00c2\u00a0 Poland\u00c2\u00a0 20-7
\n17\u00c2\u00a0 Informant\u00c2\u00a0 Mrs. Victoria Izbicki
\n(Address)\u00c2\u00a0 Worcester<\/p>\n
\nPeter O Shea, M. D.
\n(Signature of Agent of Board of Health or other)
\nDirector (Official Designation)
\nMarch 12, 1937 (Date of Issue of Permit)<\/p>\n
\n18\u00c2\u00a0 DATE OF DEATH\u00c2\u00a0 March 10, 1937 (Month) (Day) (Year)
\n19\u00c2\u00a0 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUS AND MANNER thereof are as follows:\u00a0 (If an injury was involved, state fully)
\nProbably coronary sclerosis
\nCoronary thrombosis.Unexpected
\ndeath. Found dead in bed.
\n94B\u00c2\u00a0 (no autopsy)
\n(See reverse side for description for unknown person)
\n20\u00c2\u00a0 If death was due to external causes (VIOLENCE) fill in the following:
\nAccident, Suicide or Homicide?\u00c2\u00a0 —
\nDate of Injury\u00c2\u00a0 ___ 19
\nWhere did injury occur?\u00c2\u00a0 — (City or town and State)
\nManner of Injury\u00c2\u00a0 —
\nNature of Injury\u00c2\u00a0 —
\n21\u00c2\u00a0 Was disease or injury in any way related to occupation of deceased?\u00c2\u00a0 No
\nIf so, specify
\n(Signed) Frederick H Baker,Med.Exam M. D.
\n(Address)\u00c2\u00a0 Worcester\u00c2\u00a0 Date\u00c2\u00a0 3-10-1937<\/p>\n
\nDATE OF BURIAL\u00c2\u00a0 March 12,1937\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0\u00c2\u00a0 19
\n23\u00c2\u00a0 NAME OF UNDERTAKER\u00c2\u00a0 L Karolkevicz & Son Inc.
\nADDRESS\u00c2\u00a0 Worcester<\/p>\n
\n[signed] Malcolm C Midgley (Registrar)
\nA TRUE COPY, ATTEST:<\/p>\n