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Jut~ 9~ 197Z White 1Kale ~
Date of Death Color Sex
~ Malcol~ Daniel Johnston . ~ ~
Name °
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Husband or Sinqle '
Wife of ;
Bn route to Sy~ses Hospital, Arlington~ Ms+ss. •
Place of Death
21 Ashland St.~ Ar2inqton, Mass. ~
Place of Aesidence
Age al.......................... Years Months 9.................... Days
i Marin~ - U.S.M.C. SSN024-40-6228
~ Occupation
~
~
, Red Bank, NQw Jersey
' Birthplace
E Malco2• Johnston .
~ Name of Father . . =
~ Ireland
~ Birthplace of Father . i
Anna Marie Serza New~an
Name of Mother -
ldew York City, t'~w Yozk
~ Birthplace of Mother _
~ Under investiqation
~ Cause of Death
~ _
~ Attending Phpsician ~~Ies R. Robinson~ M.D. .
~ or Diedical Examiner :
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~ Place of Interment Mt. Aubuzn ~etL~}~a~'.~i~f~l~Yi;dq~~ 1"~ass. `
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