USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > 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 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- ng rules of practice :
Utending 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 ofinjury.
(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 froch home when the certificate of death is needed.
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
F R-302 1
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-5-55-915025
PLACE OF DEATH
SUFFOLK BOSTON (County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
BOSTON
(City or town making return)
Registered No.
11060278
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
JOSEPH .... GENACCO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR) ... NO
(a) Residence. No.
429 Winthrop
(Usual place of abode)
St.
Winthrop
(If nonresident; give city spi
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
3 DATE OF
Jay)
DEATH
December 4
Day 1955
(Month)
(Year)
Dati
en
4 I HEREBY CERTIFY,
That
I attended deceased from
Oct 30
1955
to.
Dec 4
19.
55
.. , 19.
death is said to
have occurred on the date stated above, at 5.150 ... m.
INTERVAL BE-
TWEEN ONSET
DISEASE OR CONDITION
Wilson's diseaseAND DEATH
DIRECTLY LEADING
TO DEATH (a)
Hepato Lenticular
Degeneration)
yrs
ANTE
Due To
Gastro-intestinal
CEDENT (b)
CAUSES
hemorrhage
hrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
.Was autopsy performed ?.
What test confirmed diagnosis?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D.
(Signed)
Theo Sannella
(Address)
BC.H
Date 12/4
.19.55
6 St. Michael Com., Boston, Mass
Place of Burial or Cremation
DATE OF BURIAL
December 7, 1955
19
21
Informant
(Address)
Pauline .... Gonacco
7 NAME OF
FUNERAL DIRECTOR
Vincent .... Rapino
ADDRESS
E ..... Boston, .... Mass ..
Received and filed.
JAN 10 102
19
(Registrar of City or Town where deceased resided)
8 SEX
t M
9 COLOR OR RACE
W
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND Pauline Boncore
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 4.3 Years
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Truck driver
(Kind of work done during most of working life)
14 Industry
or Business:
Unemployed
15 Social Security No 025-01-6350
16 BIRTHPLACE (City).
(State or country)
Hass
Boston
17 NAME OF
FATHER
Vincent Genacco
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Viola DiCesere
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
A TRUE COPY
ATTEST!
charles & Mack
(Registrar of City of Town where death occurred)
DATE FILED
December 9, 1955
.19 X
No.
Boston City Hospital
CERTIFICATE OF DEATH
TO:
6
JAN1
RI R-302 1
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.) 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 of town in which the deceased resided as soon as possible,
25M-5-55.915025
PLACE OF DEATH
SUFFOLK BOSTO (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.
11289277
f(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
LOUISA.S. .. JENKINS
(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.
95 Somerset Ave
....
St.
Winthrop ...
(If nonresident; give city of town and State)
8
Length of stay: In place of death
.. years.
.months.
21.days. In place of residence
LuQ.years
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December .... 11. 1955.
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED married
4 I HEREBY CERTIFY,
That I attended deceased from
.. No.v ..... 21.
19 55,
to
Dec ..... 11
1955
I last saw her ...... alive on .... Doc ..... 11
1955, death is said to
INTERVAL BE-
have occurred on the date stated above, at.
m.
(or) WIFE of.
F. H. Jenkins
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH (a).
Renal cell carci-
noma
e metastases
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Large
Major findings:Left renaltumor
Of operations.A.
Date of operation
12/29/55Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?. no
If so, specify
(Signed) ...... S .......... Price
M. D.
(Address) .... M.G.H.
Date. 1.2.7.3.
19 .. 55
6 Place of Burial or Cremation Brookline, Mass
DATE OF BURIAL
December 11 1955
19
7 NAME OF
FUNERAL DIRECTOR ... A .... B .... Marsh
ADDRESS.
Winthrop Mass.
Received and filed
JAN 2 1y00
19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE ... 7.6 Years.10.
.Months1.7.
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.
nono.
16 BIRTHPLACE (City)
(State or country)
Mass
Boston
17 NAME OF
FATHER
Geo Smith
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
M A Pace
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21
Informant.
(Address)
Mangeret .... Jenkins
A TRUE COPY
COPY harkes H. Läcker
ATTEST:
(Registrar of City or Town where death occurred) December 19, 1955
DATE FILED
19
.......... V.P.V
TWEEN ONSET AND DEATH
6mos
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(Usual place of abode)
No. . Mass .... Gen Hosp
RECEIVE?
JAN23
-302 1
PLACE OF DEATH
SUFFOLK BOSTON (County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
1
(City or Town making this return)
1134378
.........
$(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.)
53 Pebble Ave
St
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ............ months.
......... days. In place of residence.
10years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Patrick Neville
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
75 Years
Months ...
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
at
home
15 Social Security No ..
none.
16 BIRTHPLACE (City)
(State or country)
Boston
Mass
17 NAME OF
FATHER
John J Lynch
PARENTS
(Signed) M. A Single M. D.
(Address)
MMH
Date 12/11 55
19
Winthrop Cem
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Decomber 15, 1955
19
7 NAME OF
FUNERAL DIRECTOR
Frank M Donahue
ADDRESS Charlestown, Mass
Received and filed
19
DATE FILED
December 19, 1955
19
V.B.V
(a) Due To 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
3 DATE OF
December 11, 1955
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Dec 2
19
55
Dec 11
55
I last saw h.
OHive on
Dec
II
19.55
19 ...
death is said to
have occurred on the date stated ahove, at
11:10p
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Congestive heart failure
disease
(b)) Arteriosclerotic heart/
OTHER
Chronic pyelonephritis
SIGNIFICANT
CONDITIONS
no
Was autopsy performed? What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
no
18 BIRTHPLACE OF FATHER (City). (State or country) Ireland
19 MAIDEN NAME
OF MOTHER
Mary Thompson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
husband
21 Informant. (Address)
A TRUE COPY harkes 4. Inackie
ATTEST :
(Registrar of City or Town where death occurred)
Registered No.
Mass Mem hospitals
No
CATHERINE NEVILIE
(Was deceased a
U. S. War Veteran,
No
winthrop,
if so speri's
VAR)
(a) Residence. No. (Usual place of abode)
19.
INTERVAL BETWEEN ONSET AND DEATH 8dys
50M.11.55-916145
(Registrar of City or Town where deceased resided)
RECEIVED
OF TOM
...
5
6
THROP.
JAN25
VaTim bist. 45 TROVERSAVE
PLACE OF DEATH
Suffolk (County)
Revere
(City or Town)
214 Endicott
No.
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)
219
Registered No.
J(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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
winthrop
St.
(If nonresident, give city or town and State)
4
months.
.days.
In place of residence.
years
months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Year)
IThas I attended deceased from
·
612
19
35
death is said to
INTERVAL BE-
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
64 Years.
Months.
Days
If under 24 hours
Hours . ....
Minutes
13 Usual
Meat Cutter
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
Portland
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
Jacob Levy
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Jennie (Cannot be/
learned )
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant
Dora Levy
(Address)
221 Shore Drive, Winthrop
A TRUE COPY
,
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
December
29,
55
Samuel Levy
2 FULL NAME.
221 Prore Drive
(a) Residence.
No.
(Usual place of abode)
Length of stay: In place of death
.years
3
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DECOTOOT
DEATH
(Day)
(Month)
SUHEREBY CERTIFY.
19
peč:
23
I last saw h
alive on
9:45A.
have occurred on the date stated above, at
m.
DISEASE OR CONDITION
DIRECTLY LEADINGCerebral
TO DEATH (a)
ANTE
Due To
Cerebral
CEDENT (b)
Due To
Hypertension
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation.
autopsy performed?
What test confirmed diagnosis?
Date
6
Constantina Cem.
Place of Burial or Cremation mber
DATE OF BURIAL
2º.
,
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-302 to the clerk of the city or town in which the deceased resided as soon as possible,
CAUSES
Arteriosclerosis
25M.(B) 11-51-905807
5 Was disease or injury in any way related to occupation of deceased? If so, specify.Charlesbiberran (Signed) ..... winthrop, (Address)
Dec .. 27 MED.
W.
Roxbury
(City or Town) 55 19
7 NAME OF 70 Horvafarete Brookline FUNERAL DIRECTOR
ADDRESS
Received and filed.
JAN 16 1950
19
(Registrar of City or Town where deceased resided)
10a If married, widowed, or divorced
Dora Rubinstein
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
TWEEN ONSET AND DEATH 1 đây
5 years
5
years
TTO
no
PARENTS
RI R-302 -
27,
1955
RECEIVE
TOV
-
5
6
THAT !!
JAN16
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, (1. 1 .. )
PLACE OF DEATH
Suffolk (County)
Boston
(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 this return)
12024230
Boston City Hospi al ... No.
§ (If death occurred in a hospital or institution, of St. { give "its NAME instead of street and number)
FRANK GINEPRA
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Marion St., E. Boston
S
(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 M
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month) (Day) was depatient
That hatten dece from
4 I HEREBY CERTIFY Dec 26 19 55 Dec 30, 1955 19
to
AXX ... , death is said to
have occurred on the date stated above, at 4:30p ..... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Arteriosclerotic heart (a)
disease
mo s
Due To
Old myocardial infarc-
(b)
tion
2wks
Due To
Congestion edema
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed? What test confirmed diagnosis ?.
autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
Henry Nigro
M. D.
(Address)
BCH
Date.
12/30
19 55
6 Winthrop
Place of Burial or Cremation
Winthrop, Mass
(City or Town)
DATE OF BURIAL January 3, 1956 19
21
Informant
Wife
(Address)
7 NAME OF
FUNERAL DIRECTOR
F J Magrath
E. Bos ton, Mass.
ADDRESS
4 FEB 6 1955 19
Received and filed.
(Registrar of City or Town where deceased resided)
10a If married, widowed, jøn drerence Gillis 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 59 Years
Months ...
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Bartender
Occupation :
(Kind of work done during most of working life)
14 Industry
or
Business :
Trainor's Cafe
15 Social Security No ...
012-20-9382
16 BIRTHPLACE (City) (State or country) Mass.
L. Boston
17 NAME OF
FATHER
Chas Ginepra
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Lida Varney
20 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Nass.
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
January 9, 1956
19
Y
[ R-302 1
WRITEIPLAINLY WITTEUNFADING 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
Registered No.
(Was deccased a
U. S. War Veteran,
WW I
if so specify WAR)
(a) Residence. No. (Usual place of abode)
December 30, 1955
3 DATE OF
DEATH
married
INTERVAL BETWEEN ONSET AND DEATH
days
50M - 11-55.916145
2 FULL NAME
RECEIVED
TO'
il
.1
5
6
HROP.
FEB-G
Oct 19 1917 Jun 20 1919 Pvt 345th FA, US Army 10 743 93
7
A R-302
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-3-53-909098
Form VS No. 60b. 12-54-10Mf Books (4C-114)
THIS CERTIFICATE MUST BE FILED WITH THE LOCAL REGISTRAR WITHIN 72 HOURS AFTER DEATH.
TYPEWRITE, HAND-PRINT OR WRITE LEGIBLY IN PERMANENT BLACK OR BLUE-BLACK INK. PENCILS, COLORED INKS, OR BALLPOINT PENS SHOULD NEVER BE USED. SIGNATURES SHOULD BE LEGIBLE. THIS IS HARMANENT RECORD.
29 08
Dist. No.
To be Inserted by registrar
1. PLACE OF DEATH: STATE OF NEW YORK a. COUNTY Nassau
2. USUAL RESIDENCE (Where doconsed Itved. If institution: recidence before admission,). a. STATE
Massachusferry Suffolk
b. TOWN North Hempstead
STAGE IN
TOWN, CITY OR VILLAGE
4 days
d. CITY OR VILLAGE Winthrop - -
Is residence within its corporate limalia?
NO
d. NAME OF (If not in bomple Der institution, give street address or location) HOSPITAL OR INSTITUTION
.. STREET ADDRESS
230 Revere Street
J. NAME OF DECEASED (Type or Print)
Eleanor Oliver
4. DATE OF DEATH November 24 19 55
5. SEX Female
6. COLOR OR RACE |7. SINGLE, MARRIED, WIDOWED, DIVORCED {Specify) white Widowed
8. IF MARRIED, WIDOWED OR DIVORCED, Name of Husband (or) Wife George Oliver
9. DATE OF BIRTH 5/16/1880 75
10. AGE Years Months
Days
IF UNDER 24 HRS. Hours Min.
11. BIRTHPLACE (Stale or foreign country)
12. CITIZEN OF WHAT COUNTRYZ U. S.
13a. USUAL OCCUPATION (Qire kind of work done during most of working Life, Housewife tra if rettred)
14. FATHER'S NAME
15. MOTHER'S MAIDEN NAME Mary McGillivary
18, INFORMANT'S NAME
ADDRESS
16. WAS DECEASED EVER IN U. S. ARMED FORCES? (Yes, no, or unknowni | (If yes, dive war or dates of service)
17. SOCIAL SECURITY NO. 026-1825-60
Maude LeMoine 230 Revere St. Winthro
19.
1
Browary
CAUSE OF DEATH pro Lato des
INTERVAL/BETWEEN ONSI AND DEATH
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH
(A). DUE TO
Coronary Partenopeterza
ANTECEDENT CAUSES
(B). DUE TO
DISEASES OR CONDITIONS, If any, diving rise to the above cause (A) dating the UN- DERLYING CONDITION last.
(C).
=
OTHER SIGNIFICANT CONDITIONS COD- tributing to the death, but not related to the
Gscase or condition cutting it.
200. DATE OF OPERATION
20b. MAJOR FINDINGS OF OPERATION
21. AUTOPSYT
NO
220. ACCIDENT, SUICIDE HOMICIDE (Specify)
22b. PLACE OF INJURY (e.g. in er about home, farm, factory, street, office bide., etc.)
22e. WHERE DID INJURY OCCUR?
(City er towe)
(County)
DEC14/5
HEALTH
23. I hereby certify
then' amended the degegeed from. 19.2 and that death occurred at.
SSP Lm., from the causes and on the date stated above.
24%. SIGNATUR Hoy hemelek
24b, ADDRESS 276
M. D.
25a. PLACE OF URIAL, CREMATION, OR REMOVAL
25b. DATE
260/ UNDIFLAKES'S STRUTTURE X PULL
Winthrop Cent
11/28
19 55 Mineola Funeral Home, Inic
REGISTRATION NO.
L1/25/ 19 55
mary & Quinbarth
190 Ist St. Mineola, N. Y. Acquau
pl or
Permit Issued by. Tary C. Eisenbarth- Deputy Date of Issue.
11/25/55
....
.....
(County)
A FYL. COM . ONWEALTH OF ETA STATISTICS COPY OF
......
(L y of town mai < /turn)
281
KATH
X
The Commonwealth of Massachusetts EDWARD.J. CRONIN
New York State Department of Health OFFICE OF VITAL STATISTICS CERTIFICATE OF DEATH
72363
Registered No. 377
LENGTH OF
c. TOWN Winthrop
E. CITY OR VILLAGE
317 Wellington Rd.
(Month)
(Day)
Sidney, Nova Scotia
136. KIND OF BUSINESS OR INDUSTRY
MARGIN RESERVED FOR BINDING
(See Reverse for Instructions)
MEDICAL CERTIFICATION
830
22d. TIME (Month) (Day) OF INJURY
(Year) (Hour) |22e. INJURY OCCURRED
22f. HOW DID INJURY OCCUR?
While at Work
Net While
Hp 14.
SÍ JAN. 24
19
19 that Mast saw the
deceased alfve on
24c, DATE SIGNED
Winthrop,
DATE FILED BY LOCAL |28. REGISTRAR'S SIGNATURE REG.
26b. UNDERTAKER'S ADDRESS
6
8
James Marshall
(This does not mean the mode of dying. o.E., heart failure, asthenia, cte. It means the Grease, Injury or complications which caused
4 474
一
44 44
1 444
牛牛
一
牛
64
444
444414年
S44444 44 44
一本
-4
一一牛
中生牛
中国
4号
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