USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 46
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24b. ADOHESS
Ne. DATE SIGHED 2/5/51 19
25a. PLACE DF BUHIAL, CHEMATION DR REMOVAL VA Center, Bath, N.Y.
25b. BATH 2/6/51 19
26a, UNDERTAKER'S SIGNATURE inald
4909
=
27. DATE FILED BY LOCAL | 28. CEGISTRAR'S SIGN, 2/5/51 19
HEG. To al
28b. UNDENTAKEH'S ADDHESS Bath N.Y.
Burial or
Permit Assued by Jos. A.Chiappone
Date of issue
2/5/51
19
JUN 2 1 1951
(See Reverse for Instructions)
50m-(e)-10-48-24658
Form VS No. 66b.
THIS CERTIFICATE MUST BE FILED WITH THE LOCAL REGISTRAR WITHIN 72 HOURS AFTER DEATH
PENCILS, COLORED INKS, OR BALLPOINT PENS SHOULD NEVER BE USED. SIGNATURES SHOULD BE LEGIBLE. THIS IS A PERMANENT RECORD. TYPEWRITE, HAND-PRINT, OR WRITE LEGIBLY IN PERMANENT BLACK OR BLUE-BLACK INK.
(City or Town)
11980
Dist. N5098 To be inserted by registrar
1. PLACE OF DEATH: STATE OF NEW YORK a. COUNTY Steuben
2. USUAL RESIDENCE (Where deceased lived. 2. STATE Massachusetts b. COUNTY Suffolk
e. LENGTH DF STAY IN TOWH, CITY DR VILLAGE
Winthrop
e. STHEET ADOHESS 125 Pleasant st.
11, BIHTHPLACE (State or foreign country)
12. CITIZEN DF WHAT FOUNTHY!
26
-
13b. KIHO OF BUSINESS OR IHOUSTRY
16. MDTHEH'S MAIDEN NAME unknown
(A)-
MEDICAL CERTIFICATION
600,0
22f. HOW OIO INJURY OCCUH?
VA
m.
VA Bath2 N.Y.
LICENSE NO.
MARGIN RESERVED FOR BINDING
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
M R-305 1
PLACE OF DEATH
SUFFOLK (County)TON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Benson W Brown
(If deceased is a married, widowed or divorced woman, give also maiden name.)
12 Sewall Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years.
months.
1
.days.
In place of residence.
.years
10
months.
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May 29/51
(Month)
(Day)
(Year)
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.) Crushing injury of chest and fracture of pelvis incurred accidentally in collision of motor car and tree
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
M
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
11a If married, widowed, or divoHazel Hamm HUSBAND of (Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
3
AGE.28
5
.Years.
Month
Days
If under 24 hours
.Hours ......
. Minutes
Radio Man 2nd Class
14 Usual
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business:
U.S. Coast Guard
16 Social Security No.
003-20-1920
17 BIRTHPLACE (City)Haverhill Mass. (State or country)
18 NAME OF
FATHER
Charles W Brown
19 BIRTHPLACE OfHampton N.H.
FATHER (City)
(State or country)
20 MAIDEN NAME
OF MOTHER
Sylvia Wheeler
21 BIRTHPLACE OF
.MOTHER (City)
(State or country)
Atkinson N.H.
Mrs H Brown
Wife
A TRUE COPY.
ATTEST:
/(Registrar of City or Town where death occurred) active
DATE FILED
June 1/51
19
......
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible
25m-(c)-11-49-900.475
If so, specify
(Signed)
Michael A Luongo
M. D.
25 Shattuck St.
(Address)
Orchard Grove Kittery
5-2010 57
7 Place of Burial, or Cremation. May 31/51
(City of Town)
DATE OF BURIAL
19
8 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS Boston Mags
Received and filed.
JUN 1 1-1951
......... .......... 19.
(Registrar of City or Town where deceased resided)
PARENTS.
5 Accident, suicide, or homicide (specifaccident
Date and hour of injury.
May25/51
19
Where did
Marshfield Mass.
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place? Public Highway
Manner of
(Specify type of place)
Motor car collided with
Injury
(How did injury occur?)
Nature of
tree crushing injury
Injury of chest fracture of pelvas
While at work?
Was autopsy performed?
.No
6 Was disease or injury in any way related to occupation of deceased ?.
(Was deceased a
U. S. War VeterW. W #2
if so specify WAR)
Winthrop Mass.
(a) Residence. No. (Usual place of abode)
+
No.
Brighton Marine Hospt.
....
22
Informant.
(Address)
Entered Service Sept. 20,1946 In Service at time of death Radio Man 2nd Class U S Coast Guard Service No. 255-986
M R-302 1
WRITE PLAINLY, WITH ONFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Ser 12. G. L.) of death should be transmitted on Form R-302 to the clerk of the city of town in which the deceased resided as soon as possible
PLACE OF DEATH
SUFFOLK
(County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
5288 21
No.
Baker Memorial Hosp. (Mass Gen Hosp)
J (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
Margaret .... Bellamy.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ........ .years months.
days. In place of residenbei fe time
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY,
June 1
51
19
to
19
I last saw h ... er ... alive on J.une .... 6. 1951 death is said to
have occurred on the date stated above, at.
1:10 p
m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Rheumatic.heart
disease
40 yrs
12 66
Yea
10
Months.
7
Days
If under 24 hours
.. Hours.
.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)
Boston Mass
17 NAME OF
FATHER
William Bellamy
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston Mass
19 MAIDEN NAME
OF MOTHER
Anna M Johnson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Owego NY
21 Informant (Address)
R Bellamy (brother)
7 NAME OF
FUNERAL DIRECTOR
C P Chapman
ADDRESS Boston Mass
Received and filed
JUN 19 1951
19
(Registrar of City or Town where deceased resided)
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.
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation.
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify E Mora
(Signed)
(Address Mass Gen Hosp
M. D.
Date .. June 6 ... 19.5]
Mt Auburn " Cem
6
Cambridge Mass
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
June 8
00
19.51
A TRUE COPY/
Charles H. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED June 11 .19.51
25M (E)-6.50.902253
3 DATE OF
DEATH
June 6, 1951
(Month)
(Day)
(Year)
.deceased from
That I
attended
June 6
51
135 Grovers Ave
$.
Winthrop Mass
(write the word)
--..
×
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
122
No. Winthrop Community Hospital St.{" Baby Boy Marino
(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. No. 35 Moore . Street St.
(Usual place of abode)
(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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY.
19
to
19
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.
Stillbord
12
AGE
Years
Months
Days
If under 24 hours
.Hours . . 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) Mass.
17 NAME OF FATHER Anthony V. Marino
18 BIRTHPLACE OF FATHER (City) (State or country)
Somerville, Mass
19 MAIDEN NAME
OF MOTHER
Frances Massa
Sommeren!
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
21 Informant Anthony V. Marino
35 Moore St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Halter
(Signature of Agent of_ Board of Health or other)
Malthe
Officer
6851
/(Official Designation)
(Date of Issue of Permit)
50M-2-19-25666
6
Oak Glove Cemetery Medford Place of Burial or Cremation
(Cit;/ or Town)
DATE OF BURIAL June 8. 125/
7 NAME OF
FUNERAL DIRECTOR
Anthony 7. CiataA
ADDRESS 197 Washington It. Somerville
Received and filed .. JUN 8 1951
19
(Registrar)
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
ING Stillborn
ANTE
Due To
Card textil twice
CEDENT (b)
CAUSES
about the neck
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
., M. D. (Address) 25 Stages 8 Wanting Date game 7 19 SI
PARENTS
J(If death occurred in a hospital or institution,
its
2 FULL NAME.
June (Month)
7 1951 (Year)
(Day)
That I attended deceased from
I last saw h
alive on
19
death is said to
have occurred on the date stated above, at
m.
(write the word)
3 DATE OF
DEATH
TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH not enter e than one se for each , (b) and (c)
is does not mean e of dying, such failure, asthenia, cans the disease. lications which eath.
bid conditions, iring rise to the use (a) staling derlying cause
ditions contrib- the death but not o the disease or causing death.
M R-301A 1
Registered No.
Winthrop
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the arrny, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which Shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec.46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing 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 poisons) 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 .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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. Children 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND. OUTFIT
SERVICE NUMBER
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Ser 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
1
PLACE OF DEATH
UFFOLK OSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
5314.23
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
152 Pleasant St
St.
Winthrop Mass
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
.. years.
1
months.
2
days. In place of residence.
......
.. years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June 7, 1951
(Month)
(Day)
(Year)
THEREBY CERTIFY,
May 5
51
19.
to
3:55
a
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Carcinoma of cervix
extension
to bladder
3 yrs
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
James J Ryan
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
1
Months ..
Days
Housewife
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Ireland
17 NAME OF
FATHER
John Dunn
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
-
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
May F Young
DATE OF BURIAL
June 9
151
21
Informant
(Address)
A TRUE COPY Sr: Larsestar
I a/(Registrar of City or Town where death occurred)
DATE FILED
June 11
19
51
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify.N. A Wilhelm
(Signed) ..
P Bent Brig Hosp
Date .
June 7 1951
MP
(Address)
Holy Cross Cem
6 ...
Malden Mass
Place of Burial or Cremation
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
Wilmington Mass
Received and filed JUN 19 1951 19
J B McMahon
ADDRESS
Was autopsy performed ?.
.Yes
What test confirmed diagnosis?
Autopsy
25M (E)-6.50-902253
ANTE
Due To
Abdominal aortic
CEDENT (b)
CAUSES
aneurysm with
Due To
Retroperitoneal
(c)
hematoma
term
OTHER
SIGNIFICANT
CONDITIONS
Arteriosclerosis
years
Major findings:
Of operations.
Ureterostomy
Date of operation ..
5 .: 11:51
Thatre
attended deceased from
June 7
19
51
WE last saw
h
er
alive on
June 7 19 51 death is said to
have occurred on the date stated above, at
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
M R-302 1
No.
Peter Bent Brigham Hospital
Mary Ryan
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
......
L
If under 24 hours
Hours ....
Minutes
76
1
PLACE OF DEATH
SUFFOLK (County)
M R-301A 1 Winthrop (City'or Town)
No. 142 PleasANT ST.
J(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
(a) Residence. No. (Usual place of abode)
645 Washington AVE
St.
Chelsea
MASS
(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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
of DIVORCED
(write the word)
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
84 Years
. Months
Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation:
AT Home.
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No. .
16 BIRTHPLACE (City) (State or country)
17 NAME OF
FATHER
Rossi
18 BIRTHPLACE OF FATHER (City) (State or country)
ITALY
19 MAIDEN NAME OF MOTHER AIDA DeGIOVANNI
20 BIRTHPLACE OF MOTHER (City) (State or country)
ITALY
-
21 Informant (Address)
John Rossi ( Nephew)
445 Washington AVE Chased
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled withme BEFORE the burial or transit pernuit was issued:
ADDRESS 314 Washington que chelsea Walter
Received and filed 19
JUN 14 1951
(Registrar)
from
Dune 4 ..
19 51.
last saw h BR .alive on .. 1:45 p.
June
88
SI
, death is said to
have occurred on the date stated above, at
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Myo carditis
ANTE CEDENT (b) CAUSES
· Arteriosclerosis
Due To (c)
Click
OTHER SIGNIFICANT CONDITIONS
Cholecystitis
Major findings:
Of operations .
Date of operation.
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify.
n. D. Granturco. The ??
(Signed)
140 Terhelt an Chedar Date June 11
1951
(Address)
M. D.
6 Holy Cross
MALDEN
Place of Burial or Cremation (City or Town) DATE OF BURIAL June 12 1951
7 NAME OF FUNERAL DIRECTOR Saltro C. Panialta
7 Chelsea 6/5'
The Commonwealth of Massachusetts EDWARD J. CRONIN 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.
Registered No. 124
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one e for each (b) and (c)
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