USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 92
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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 inanner 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 only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; General Laws, Chap. 38, Sec. 6.
Ne-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)rAttending 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 formof 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 dicd without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
Npr Medical Examiners will investigate and certify to all deaths supposably Ltbinjury. 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
-301A
1
Tinthron (City or Town)
No. 41 Tashington Ave.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for bury permit with Board of Health or its Agent.
270
Registered No.
J(If death occurred in a hospital or institution. St. \ give its NAME instead of street and number)
2 FULL NAME vary E. Donovan
Brady
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 252 Winthrop Shore Drive
St
(If nonresident, give city or town and State)
Length of stay: In place of death years. 8 .months. 9 .days. In place of residence 10
years
.months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
December
29
1952.
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
11/26.
52
to
12/29
105 2
I last saw h ft alive on
12/29, 1957 death is said to
have occurred on the date stated above. at.
100
m.
INTERVAL BE- TWEEN ONSET AND DEATH 2Dias
11 IF STILLBORN, enter that fact here.
12
87
AGE
Years.
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
acs
17 NAME OF
FATHER
Henry Brady
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Ellen Sullivan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informant
Mrs John Haley
(Address)
252 Winthrop Shore Drive
7 NAME OF
FUNERAL DIRECTOR.
thu V. O malley
ADDRESS
Winthrop Mass
Received and filed HABEO 31, 1452
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
9 COLOR OR RACE !
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Tidowed
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Charles J. Donovan
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Cerebral Hemorrha
ANTE
CEDENT
CAUSES
Due To
generalizado
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
0
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
M. D.
(Address) 676 Baratita Date 12/30 1957
6
Holy Crocs
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
January 2
53
19
50M-(D)-6-51-904917
IONS TIFICATE 1g DEATH ter one each nd (c)
not mean ing, such asthenia. - e disease, s which
nditions. ise to the stating cause
contrib- h but not isease or ng death.
PLACE OF DEATH
Suffolk (County)
(Usual place of abode)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
1
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me/BEFORE the barjal or transit perunt was issued: Walter A. Baker 8 - Health Office 12/01/52 Signature of Agent of Board of Health of other)
(Official Designation) (Date of Issue of Permity
Charlestown
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 dicd, 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 army, 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., br, (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 deathsonly 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 .- 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
-302
50m-(e)-10-48-24658
L TOWN Leray . & CITY DN VILLAGE Camp Drumm 1. NAME OF DECEASED (Type or Print) &. SEX Male O. DATE OF BIRTH Oct. 27,1927 Or 19. (See Reverse for Instructions) 200. DATE DF DPERATIDR 222, ACCIDENT, SUICIDE, HOMICIDE (Specify) Accident 21d. TIME (Month) DF INJUNY MEDICAL CERTIFICATION BE LEGIBLE, THIS IS A PERMANENT RECORD. PENCILS, COLORED INKS, OR BALLPOINT PENS SHOULD NEVER BE USED. SIGNATURES SHOULD TYPEWRITE, HAND-PRINT, OR WRITE LEGIBLY IN PERMANENT BLACK OR BLUE-BLACK INK. THIS CERTIFICATE MUST BE FILED WITH THE LOCAL REGISTRAR WITHIN 72 HOURS AFTER DEATH ARTECEDENT CAUSES
New York State Department of Health OFFICE OF VITAL STATISTICS CERTIFICATE OF DEATH
49453
Registered No. 17
1. PLACE OF DEATH: STATE OF NEW YORK a. COUNTY Jefferson
& USUAL RESIDENCE 1. STATE
(Where deceased lived. If tutituthen: residence before L. COUNTY
Hass
€, TOWN
& CITY DR VILLAGE Winthrop
Is residence within its corporate limits?
Imo. 9day's
& NAME OF ( If not in hospital or Institution, pire street address or location) HOSPITAL OR INSTITUTION
e. STREET
ADDNESS
Villa Avenue
4 DATE OF
(Houth) Aug
(Day) 2
(Year)
Conant, Leonard G, Jr ; RA 107-355-10
6. COLON ON RACE |7. SINGLE, MARRIED. WIDOWED, White DIVORCED (Specify)
Single
&. IF MARNIED, WIDOWED ON DIVONCED, Name of Husband (or) Wife
11. BIRTHPLACE (State or foreign country)
12. CITIZEN OF WHAT COUNTNY!
New York
U.S.
138. KIND OF BUSINESS DH INDUSTRY
18. MOTHER'S MAIDEN NAME
DIrene Wheeler
18. WAS DECEASED EVER IN U. S. ANMED FORCES!
17. SOCIAL SECUNITY NO.
WOODY S WILSON Ist LE MSC USCH. CD Dreum NY
2 Aug
CAUSE OF DEATH
INTERVAL BETWEEN DUSET AND DEATH
I DISEASE OR CONDITION DINECTLY LEADING TO DEATH
Cerebral Laceration
14 days -
(This does not mean the mode of dying, e.g., beart fatture, setbenla, etc. It means the disease, Injury or complication which caused death.)
DUE TO
Pneumothorax, Hemothorax, Fracture of
(B) DUE TO
6th Dorsal Vertebra
DISEASES DN CONDITIONS, if any, giving rise to the above cause (A) stating the UNDENLYING CONDITION Jast.
(C).
DTHEN SIGNIFICANT CONDITIONS contribut- ing to the death, but not related to the disease or condition causing it.
20L. MAJOR FINDINGS DF DPERATIDR
21. AUTORSY? YES
NO
22h. PLACE OF INJURY (e.g., In or about bombe, farm, factory. street, otce bldg., etc.) Street
22c. WNENE DID INJUNY OCCUN?
(City or town) Fargos
(County) Jefferson
NY
(Day) (Year) (Hour) Aug 1 1952 2:30 m
22e. INJURY DCCUNNED While at Work
Not While at Work
Automobile Accident
19 52, 10 2 Aug
19.52, that I last saw the
and that death occurred at 9:00p.m., from the causes and on the date stated above. 1 5
SIGNATURE Sunand BERNARD GOTTFRIED
M. D.
USAH CD Deum. New York
4 Ang 19 52
Sa. PLACE OF BUNIAL, CHEMATIDR ON NEMDVAL Winthrop,Mass.
35h/DATE Aug 8 19 52
ZSa. UNDERTAKER'S SIGNATUNE HerbertBement
5208
27. DATE FILED BY LOCAL | 28. REGISTRAR'S SIGNATURE
19 REG.
Calle
26b. UNDENTAKEN'S ADDRESS watertown ny.
Buried or Transit
Permit issued by
Date of issue august 5, 1952
FUNERAL DIRECTUK
ADDRESS
Received and filed
Jan, 13.1953
19
(Registrar of City or Town where deceased resided)
ATTEST:
...
(Registrar of City or Town where death occurred)
DATE FILED
............
.......................... 19
..........
Months
Days
Min. IF UNDER 34 NRS. Hours
10. AGE Years 24
9
5
-
18a, USUAL OCCUPATION (Che kind of work done during most of working life, even if Aircraft Engine Mechanic reLived)
14. FATHER'S RAME Leonard G Conant, Sr
ADDNESS
-
MARGIN RESERVED FOR BINDING
Form VS No. 60b. 8-15-50-10M Books (D-172)
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 of town at the time
Dist. No .: 2260 To be inserted by registrar
&LENGTH DF STAY IN TOWN. CITY DR VILLAGE
NO
USAH, Camp Drum, New York
DEATH
19 52
1952
$2
(State)
22f. HOW DID INJURY OCCUR!
2. I hereby certify that I attended the deceased from deceased akve on. Aug
Aug
24b. ADDRESS
Mc. DATE SIGNED
LICENSE NO.
BIRTH NO.
STATE OF
(1949 Revision of Standard Certificate) CERTIFICATE OF DEATH New Hampshire
272
Form a; . tovedl. Budget Bureau No. 68-R375.
STATE FILE NO.
1. PLACE OF DEATH
a. COUNTY
Carroll
2. USUAL RESIDENCE (Where deceased lived. If institution: residence before
a. STATE
b. COUNTY
Mass.
Suffolk:
c. CITY (If outside corporate limita, write RURAL and give township)
OR
TOWN
Winthrop
d. FULL NAME OF (If not in hospital or institution, give street address or location)
HOSPITAL OR
INSTITUTION
d. STREET
ADDRESS
(If rural, give location)
123 Quincy Ave.
3. NAME OF
DECEASED
( Type or Print )
a. (First)
Thomas
b. (Middle)
Edmund
c. (Last)
Pigott
4. DATE
OF
DEATH
Oct. 22,1952
5. SEX
M
6. COLOR OR RACE
W
7. MARRIED, NEVER MARRIED,
WIDOWED, DIVORCED (Specify)
M
8. DATE OF BIRTH
Jan. 7, 1886
9. AGE (In years
last birthday)
66
IF UNDER 1 YEAR Months | Days
IF UNDER 24 HRS. Hours Min.
10a. USUAL OCCUPATION (Givekind of work done during most of working lifo, even if retired) Retired banker
10b. KIND OF BUSINESS OR IN- DUSTRY
II. BIRTHPLACE (State or foreign country)
Boston, Mass.
12. CITIZEN OF WHAT
COUNTRY?
U.S.A.
13. FATHER'S NAME Thomas E. Pigott
14. MOTHER'S MAIDEN NAME
Katherine Murtagh
15. WAS DECEASED EVER IN U. S. ARMED FORCES?
(Yes, no, or unknown)
(If yes, give war or datse o service!
16. SOCIAL SECURITY
NO.
No
17. INFORMANT
Mrs. Thomas E. Pigott wife
18. CAUSE OF DEATH Enter only one cause per line for (a), (b), and (c)
MEDICAL CERTIFICATION
INTERVAL BETWEEN
ONSET AND DEATH
10 mins.
ANTECEDENT CAUSES
Morbid conditions, if any, giving
rise to the above cause (a ) stating
the underlying cause last.
DUE TO (b) Hypertensive. cardiovascular disease 10 yrs
DUE TO (c)
Il. OTHER SIGNIFICANT CONDITIONS
Conditions contributing to the death but not
related to the disease or condition causing death.
19b. MAJOR FINDINGS OF OPERATION Code #4201
20. AUTOPSY?
YES
NO
21a. ACCIDENT
SUICIDE
HOMICIDE
(Specify)
21b. PLACE OF INJURY (e.g., in or about home, farm. factory, street, office bldg., etc.)
21d. TIME
OF
INJURY
(Month) (Day) (Year) (Hour)
m.
21e. INJURY OCCURRED WHILE AT WORK NOT WHILE AT WORK
2If. HOW DID INJURY OCCUR?
22. I hereby certify that I attended the deceased from
alive on
10/22
19_52, to10/22
, 19 __ 52 that I last saw the deceased 1:00 PM., from the causes and on the date stated above.
23a. SIGNATURE
Harold E. Gregory
(Degree or title)
M. D. Deputy Medical exam.
23c. DATE SIGNED
10/22/52
24a. BURIAL, CREMA-
TION, REMOVAL (Specify)
Burial
24b. DATE
Oct. 25,'52
24c. NAME OF CEMETERY OR CREMATORY
Winthrop Cemetery
24d. LOCATION (City, town, or county)
Winthrop, Mass.
(State)
DATE REC'D BY LOCAL REG. Oct. 22,1952
REGISTRAR'S SIGNATURE
Irene B. Hardie
25. FUNERAL DIRECTOR
Edmund A. Jewell
ADDRESS Wolfeboro, N.H.
1
PHS-798(VS) REV. 4-48 FEDERAL SECURITY AGENCY PUBLIC HEALTH SERVICE
U. S. GOVERNMENT PRINTING OFFICE 16-55457-2
b. CITY (If outside corporate limits, write RURAL and give
OR
TOWN
Tuftonboro
township)
c. LENGTH OF
STAY (in this place)
4 mo .
NONRESIDENT
1.5.
19
and that death occurred at
23b. ADDRESS
Wolfeboro, N.H.
21c. (CITY. TOWN, OR TOWNSHIP)
(COUNTY)
(STATE)
19a. DATE OF OPERA- TION
I. DISEASE OR CONDITION
DIRECTLY LEADING TO DEATH* (a)
Coronary occlusion
*This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the dis- ease, injury, or complica- tion which caused death.
(Month)
(Day)
(Year)
RECEIVE
Til
11.12
1
1.
6
JAN19
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 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,
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25M-(B)-11-51-905807
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or town making return)
Registered No. 273
Revere Mem. Hospital
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Domenica Malta (Catanuso)
(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. 36 Shore Drive
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ......... years. months: days. In place of residence. .years
1
o
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
17,
1952
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
Nov .. 3
52
to
Dec. 17
1952
I last saw h.
er
Dec. 17
19.52
death is said to
10a If married, widowed. or divorced
HUSBAND of.
Joseph Malta
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a)
Peritonitis
Rt. Pneumonitis
ANTE
CEDENT (b)
Due To
Multiple
CAUSES
Infarctions
10 days
Due To
Paralytic Ilius
(c)
OTHER
SIGNIFICANT
CONDITIONS
Nephritis
Major findings: salpingit Appendicitis fibroid uteri ufarine .... polyps bilateral Date of operation 12/4/52 .. Was autopsy performed? No
What test confirmed diagnosis?
NO
5 Was disease or injury in any way related to occupation of deceased? If so, specify .... A Andrew Catino
(Signed).
(Address) Revere
Holy Cross Cemetery,
(City or Town) Place of Burial or CremationDecember 20,
52
DATE OF BURIAL.
Paul Buonfiglio
7 NAME OF
la&cRevere St .... Revere
ADDRESS
Received and filed.
JAN 20 150
19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
9
.Months.
......
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Skirt Factory
15 Social Security No.
Boston,
16 BIRTHPLACE (City)
(State or country)
Mass.
17 NAME OF
FATHER
Vincent Catanuso
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Josephine Serra
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Mr. Joseph Malta
Informant
(Address)
36 Shore Drive Winthrop
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