USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 1
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காற்வண்டி
جمــ
معـ
حمـ
நாட்டின் போது ---
一
THOMAS GROOM & CO. INCORPORATTO STATIONERS. ((105 State Street) } BOSTON.
TO DUPLICATE THIS BOOK SIND Nº 5-21/73
Digitized by the Internet Archive in 2016 with funding from Boston Public Library
https://archive.org/details/townofwinthropre1960wint
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF §§ 44-48. N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Nature of Injury 35M-11-59-926662
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) Distan 2- 4-1.6
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
1
No. Winthrop.Community Hospital [ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME .. J.O.S.E.P.H. MARCUCCILLI (AKA Joseph Marcucell&PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 419 Meridian St., Boston (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In place of death. ............. years ............. months. 5 days. In place of residence. 38
.years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
7
1960
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR
White
11 SINGLE
MARRIE1)
(write the word)
WIDOWED
or DIVORCED)
Widowed
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
lla If married, widow
HUSBAND of
Margherita Caucci
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
83
9 Months. 12 .. Days
If under 24 hours
Hours
Minutes
IF ACCIDENTAL, was injury causally related to the death?
Where did
Injury occur ?
Boston , ...... Mass ....
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
Home ..
(Specify type of place)
Manner of
Injury
Slipped on stairs
(How did injury occur ?)
While at work ?
Was autopsy performed ? . N.O.
6 Was disease or injury in any way related to occupation of deceased ?
What Phong
(Signed)
Michael A. Luongo, M. D.,
M. D.
(Print or Type Signature)
(Address) Boston, Mass Date
1/1
19.60
St. Michael's Cemetery,
Place of Burial, or Cremation.
(City or Town)
Boston
DATE OF BURIAL
January 4th
19.
60
8 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby,
Inc.
ADDRESS
917 Bennington St. E.Boston
Received and filed
JAN-4-1960
(Registrar)
PARENTS
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
20 MAIDEN NAME
OF MOTHER
Rose Rea
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
22
InformanMr. James V ....... Marcucella-son
(Address)
419 Meridian St. E.Boston
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)
(Date of Issue of Permit)/ 1/-
(Official Designation) 1v
Vas deceased a
U. S. War Veteran,
(if so specify WAR).
No
St
East Boston
Coronary occlusion following blunt force injury of chest with multiple fractured ribs.
5 Accident, suicide, or homicide (specify) Accident ..
Date and hour of injury
12/27
.19 .... 5.9
14 Usual
Occupation :
Real Estate Retired
(Kind of work done during most of working life)
15 Industry
Real Estate
or Business :
16 Social Security No.
030-07-7146
17 BIRTHPLACE (City)
(State or country)
Italy
18 NAME OF
FATHER
Francis Marcuccilli
Registered No.
M R-303 A 1
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 unrelated 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 poison) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
STATEMENT OF CAUSE OF DEATH
JAN -- 4 1960 %
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
M R-305 1
2 FULL NAME.
Joseph Maio
(Usual place of abode)
3 DATE OF
DEATH
(Month)
Coronary Heart Disease
Sudden Death
5 Accident, suicide, or homicide (specify)
Manner of
(Specify type of place)
Injury
Nature of
Injury
(Address) Cambridge, Mass.
Cambridge Com.
7
25M-4-59-925100
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at
Where did
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place ?
6 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signed) David .... C ....... Dow M. D.
DateJan.4.9.60
Cambridge
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL January.7th 60
8 NAME OF
FUNERAL DIRECTOR Richard C. Kirby
ADDRESS 917 Bennington St. E. Easton
Received and filed
is it. Have 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR
11 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
lla If married, widowed, or diyorced
HUSBAND of
Helen ... Marcella
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE.60
.Years ...
.6.
Months.
15 Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :
Electrician
(Kind of work done during most of working life)
15 Industry
or Business :
East Boston Lamp
16 Social Security No. ... yes.
024-05-7640
17 BIRTHPLACE (City)
(State or country)
Italy
18 NAME OF
FATHER
Peter Kolo
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
20 MAIDEN NAME
OF MOTHER
Domenica Calapa
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
22 Helen .... Maio (@Lfe)
Informant
(Address)
05 Court Rd Winthrop Mass
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Jan. 5,
19
60
VIL
WRITE PLAINLY, WITH UNFADING BLACK INK OR OSE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
B 4 - 1960
PLACE OF DEATH
Middlesex (County)
Cambridge
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Cambridge (City or town making return)
Registered No.
19
2
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Winthrop, Massachusetts
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years.
............ months.
1 ... days. In place of residence.
4 years.
... months.
.. days.
(a) Residence. No. 95 Court Road MEDICAL CERTIFICATE OF DEATH January 3. .1960 (How did injury occur ? ) as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) the time of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided If accidental, was injury causally related to the death ?
(Day)
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
[(Was deceased a
{ U. S. War Veteran,
(if so specify WAR)
No
(write the word)
(Give maiden name of wife in full)
Date and hour of injury 19
While at work?
Was autopsy performed ?
No
PARENTS
No. 149 Lake View Avenue
.
1
FEB -4.1960 MR
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
X Suffolk (County ) Winthrop (City or Town) Winthrop
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number) No.
Ann Louise (Statham) Albee
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
510 Harbor View
Ave
St.
(If nonresident, give city or town and State)
Length of stay : In place of death .............. years ...
.......
40
months!
2
days. In place of residence
years ...
......
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
January
2
1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
, That I attended deceased from
Jan
3
, 1960
to
Jan 7
60
I last saw hE Ralive on
Jan
6-1960
death is said to
have occurred on the date stated above, at
3.30Am.
INTERVAL
BETWEEN
ONSET AND
DEATH
3 days
82
12
AGE
Years.
11
Months
8
Days
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business :
Own .... home
15 Social Security No.
None
Liecester
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
George Statham
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Ellen Scampton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 Informant.
Pauline Smith
(Address)51 Harbor View Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop
Mass
Received and filed JAN -8 1960
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDWidow
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Edward E Albee
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Coronary Thrombosis
(b) Due To Arterio Sclerotic Heart
Disease
Due To Arteriosclerosis
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
No
What test confirmed diagnosis? ECG.
5 Was disease or injury in any way related to occupation of deceased/ VO If so, specify
(Signed)
Data 7 Ccluis
M. D.
John F. Collins MD
(PRINT OR TYPE SIGNATURE)
Revere MASS Date 7 Jan
.19 60
6
Mt .
Auburn
Cambridge
Place of Burial or Cremation
DATE OF BURIAL
Jan. 9
19
(City or Town)
60
PARENTS
(Signature of Agent of Board of Health or other) Health Rffice 1/7/60
(Official Designation)
(Date of Issue of Permit)
V.P.V
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH
not enter re than one se for each ), (b) and (c)
does not mean ode of dying, s heart failure, 1, etc. It means ease, or compli- which caused
itions, if any, gave rise to , cause (a), g the under- cause last.
nditions contrib- o death but not to the terminal condition given
:- Chapter 137, f 1954, requires ians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.
M-6-59-925686
PLACE OF DEATH
M R-301A 1
Community Hosp
To be filed for burial permit with Board of Health or its Agent.
A 3
hourse- Albee
PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, [if so specify WAR)
(a) Residence. No.
(Usual place of abode)
(write the word)
NOT Known
(Kind of work done during most of working life)
NOT Known
(Address)
7 NAME OF
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 from 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.
K TODO
JAN - 81960 24
PLACE OF DEATH
Suffolk (County)
INSF
STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
{ U. S. War Veteran,
{if so specify WAR)
NO.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
(Usual place of abode)
31 Villa Avenue
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
3 years
... months ...
.........
.. days. In place of residence.
3.7.years.
... months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
7
19.60
(Year)
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED Widowed
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
George Townsend
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.8.4.
Years ...
Months.
6
... Days
If under 24 hours
Hours.
.. Minutes
13 Usual
Occupation :
Retired Teacher
(Kind of work done during most of working life)
14 Industry
or Business :
Public ..... School
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Mass
Hingham
17 NAME OF
FATHER
Charles Alger
18 BIRTHPLACE OF
FATHER (City)
Hingham
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Katherine 2
20 BIRTHPLACE OF
MOTHER (City)
Hingham
(State or country)
Mass
Florence I Pratt
(Address)
31 Villa Avenue, Winthrop
7 NAME OF
FUNERAL DIRECTOR
Alfred B. March
ADDRESS 174 WinthropSt Winthrop ......
Mass
(Signature of Agent of Board of Health or other)
Heatthe Office 1/8/60
(Date of Issue of Permit)
(Official Designation)
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed) Dorothy Cheney appleton M. D. DOROTHY Cheney APPLETON, M.D.
(PRINT OR TYPE SIGNATURE)
(Address) 197 Woodside DUE Date JAN 7 1960
6
Place of Burial or Cremation
DATE OF BURIAL
January
9,1960
(City or Town)
19
To be filed for burial permit with Board of Health or its Agent.
No. Bayview Nursing Home
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
M R-301A 1
TRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter re than one se for each , (b) and (c)
does not meon ode of dying, s heart failure, , etc. It meons cose, or compli- which caused
tions, if ony, gove rise to couse (o), g the under- couse lost.
nditions contrib- o death but not to the terminol condition given
:- Chapter 137, 1954. requires ians to print or the cause or of death on certificates, and r 48, Acts of requires Physi- o print or type nder signature.
1-6-59-925686
VOV
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
MARCH 26
1955
.....
JANUARY 7
1960
I last saw hEn ... alive on
JANUARY 6
1960, death is said to
have occurred on the date stated above, at
7:50 Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) CEREBRAL HEMORRHAGE
INTERVAL
BETWEEN
ONSET AND
DEATH
2 WEEKS
Due T
CEREBRAL ARTERIOSCLEROSIS
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
No
What test confirmed diagnosis ?
5YEARS
WITH Hingham Cemetery .......... Hingham, Mass · 21 Informant .....
Received and filed JAN 8-1980 19
I HEREBY CERTIFY that a satisfactory /standard certificate of death was filed with me BEFORE the burial or transit permit was issued: alble CHereapuro
Winthrop (City or Town)
2 FULL NAME
Edna Frances Townsend (Alger)
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 from 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.
1
.....
JAN - 81960 FM
PLACE OF DEATH
Suffolk (County) Winthrop
(City or Town)
2015001 0.7-6-x
CINSI FATTO
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
5
2 FULL NAME
Baby Boy Vataland( Christopher Vatalanos deceased a
(If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Leyden
East Boston
St.
(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
Jan
7
1960.
(Day)
(Year)
4 I HEREBY CERTIFY,
1960
to.
That I attended deceased from
19
I last saw h.l. malive on
1. 66, death is said to
have occurred on the date stated above, at
16.00 p.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
atelections
(a)
Atelectasis
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed) marion C Salira M. D.
MARION C SAB14
(PRINT OR TYPE SIGNATURE} (Address) 241 Maverick S. Ex Date m2
1959
6 St. Michael's Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Jan.9.
19
60
7 NAME OF
Ernest C. Caggiano
ADDRESS 147 Winthrop St., Winthrop 19
Received and filed
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
single
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ...
.......
... Years .............. Months ..........
.. Days
If under 24 hours
7
Hours /C) Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Anthony F. Vatalaro
18 BIRTHPLACE OF
Boston
FATHER (City)
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Roberta Stover
20 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Massachusetts
Anthony F. Vatalaro
21
Informant
(Address)
35 Leyden St., E. Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Malble C. Periannis 8 (Signature of Agent of Board of Health or other) Theater Officer 1/8/60
(Official Designation) (Date of Issue of Permit)
TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH
not enter 'e than one se for each , (b) and (c)
does not mean ode of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), g the under- cause last.
aditions contrib- o death but not to the terminal condition given
:- Chapter 137, 1954. requires ians to print or the cause or of death on certificates, and r 48, Acts of requires Physi- o print or type nder signature.
1-6-59-925686
M R-301A 1
Registered No.
Winthrop Community Hospital No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
U. S. War Veteran,
[if so specify WAR)
(a) Residence. No.
(Usual place of abode)
(Month)
PARENTS
Winthrop
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.
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