Town of Winthrop : Record of Deaths 1956, Part 86

Author: Winthrop (Mass.)
Publication date: 1956
Publisher:
Number of Pages: 534


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 86


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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 he 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


X


PLACE OF DEATH


SUFFOLKY (County) WINTHROP. (City or Town)


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.


247


CARMINE C IANNACCONE


2 FULL NAME.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


88 PUTNAM


ST


(a) Residence. No ... (Usual place of abode)


Length of stay: In place of death


6


.years


months. ....... days. In place of residence .years months. ........... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


december 30


(Day)


(Month)


1956 (Year)


4 I HEREBY CERTIFY,


That I attended deceased from


- 19 to


I last saw h ........ alive on


19-, death is said to


have occurred on the date stated above, at


4 p. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Natural Causes


(a)


To Presumably Coronary


(b)


Occlusion


1 hr.


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis ?.


clinical


5 Was disease or injury in any way related to setupation of deceased? no If so, specify .....


Winthrop Board of Health M. D. Date 31Dec 1956


WINTHROP 6 Place of Burial or Cremation (City or Town)


WINTHROP.


DATE OF BURIAL JAN 2 1952


7 NAME OF


FUNERAL DIRECTOR ...


ADDRESS. 210 H-INTHBURST WINTHALF


Received and filed. JAN 2 1957 19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED


MARRIED


10a If married, widowed ogdiyorsed


HUSBAND of JOSEPHINE PETRALIA


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


AGE.Z


12


44


Months.


... Days®


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Meus Cutter


14 Industry


or Business :


(Kind of work done during most of working life)


7


15 Social Security No ..


16 BIRTHPLACE (City)


(State or country)


Bacon


17 NAME OF


FATHER


BUY J IANNACCONE


18 BIRTHPLACE OF


FATHER (City)


(State or country)


ITALY


19 MAIDEN NAME


OF MOTHER


GRACE (UNKNOWN


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


ITALY.


21 JOSEPHINE IANNACCONE


(Address)


SSPUTNAN ST WINTHROP


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)


1/2/57


(Official Designation )


(Date of Issue of Permit)


V.P/


CTIONS


M.U.T.


ERTIFICATE Iving F DEATH enter an one or each ) and (c)


s not mean of dying, art failure, :. It means or compli- ich caused


s, if any, je rise to use (a), te under- use last.


ns contrib- ath but not he terminal dition given


Chapter 137, 54, requires to print or cause or death · on ificates.


100M-11-55-916145


No


SS PUTNAM ST


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)


St


(If nonresident, give city or town and State)


6


19.


INTERVAL BETWEEN ONSET AND DEATH


(Give maiden name of wife in full)


PARENTS


R-301A 1


1


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- te 'n, 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. 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


.......


.......


1


-


M R-305


1


PLACE OF DEATH


(County)


(City or town making return)


248


Registered No.


..... [(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.)


(Was deceased a U. S. War Veteran, if sn 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. .... . dove In place of residence. .. Vears. months ......... days.


16H (Rev. 9/54)


ISM-1011022 (54)


Certificate of Death


56-320820


Boro Death


FILED


Certificate No.


10


Institution


1. NAME OF DECEASED (Print or Typewrite)


JAMES


CROTTY


×800


Boro-Resid.


PERSONAL PARTICULARS (Te be filled in by Funeral Director)


MEDICAL CERTIFICATE OF DEATH (Te be filled in by the Physician)


e of wife in full)


me in full)


If under 24 hours Hours. Minutes


Nativ. Dec.


(If in rural area, give location)


16 DATE AND HOUR OF


(Month)


(Year)


DEATH


November


(Day) 6th, 1956


(Hour A.


-


3 SINGLE, MARRIED, WIDOWED, OR DIVORCED


(write the word)


MARRIED


Cause I 902


DATE OF BIRTH OF DECEDENT


(Month)


(Day)


(Year)


OCTOBER 10 1893


Cause 2


this ...... 7th ....... day of ... .November


19 .. 5.6


S AGE 163,5L


days


bra. or


I further certify from the investigation and Odettbak xptopder Gaxtak amojaxix Hocking (examination) that, in my opinion, death occurred on the date and at the hour stated above and resulted from


Operation


Usual Occupation (Kind of work done during most of 'working life, even if-retired) SERMAN


0


b. Kind of Business or Industry in which this work was done MERCHANT MARINE


7 SOCIAL SECURITY NO.


(a) Immediate Cause


Crushed Chest :


3


(b) and (c) Antecedent Causes with


đua bọ Fractured Skull: (b) .....


Primary Cause Stated Last


(e) Fractured Pelvis :- fell or


PART II


jumped from window,


of YMCA


Contributory Causes.


George wtiger


13/2006


13 NAME OF INFORMANT RELATIONSHIP TO DECEASED| ADDRESS


WINTHROP MASS.


ANNA B. CROTTY WIFE 25 WILLSHIRE-ST


14e. Name of Cemetery or Crematory


14c. Date of Burial or Cromatina


HOLY CROSS CEMETERY SI FUNERAL DIRECTOR NEWYORK FUNERAL ADDRESS


SERVICE CO INC


BUREAU OF RECORDS AND STATISTICS


DEPARTMENT OF HEALTH


THE CITY OF NEW YORK :


19


Vil V ...


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-(h)-10-48-24658


THIS CERTIFICATE NOT VALID UNLESS FILED IN THE HEALTH DEPARTMENT DO NOT WRITE IN THIS SPACE, MARGIN RESERVED FOR CODING AND BINDING


MASS


IS PLACE OF DEATH: (a) NEW YORK CITY: (b) Borough ...


Brooklyn


2 USUAL RESIDENCE: (a) State ...


Area-Dist


(c) Name of Hospital 55 Hanson Place


or Institution


201341


(If not in hospital or institution, give street and number.) (d) If elsewhere than in hospital. or owa residence, specify character place of death, as hotel, office, store, etreet, taxicab, etc.


(d) No 25 WILL SHIRE


STATE St


(e) Length of residence or stay in City of New York immediately prior to death NON-PES 17 SEX


IS COLOR OE RACE White


19 Approximate Age 64


Male


20 I HEREBY CERTIFY that, in accordance with the provisions of law, I took charge of the dead body at


Kings County Morgue


circumstances pending further investigation), and that the causes of death were: PART I


Att-Autop,


& BIRTHPLACE (State or Foreign Copptry)


NEW FOUND LAND


OF WHAT COUNTRY WAS DECEASED A CITIZEN AT TIME OF DEATH?


U. S.A.


10b. IF YES, Give war or dates


|Type Accd.


IOL. WAS DECEASED EVER IN UNITED STATES ARMED FORCES? YES


of verrice W.W. I


Signed.


WILLIAM CROTTY


Occurrence


12 MAIDEN NAME


OF MOTHER OF DECEDENT ELLEN MOORE


No. 586LA


Assistant Medical Braminer milton Helpen In. 8. Approved ... Chief Medical Eruminst


1957


TEB 7


PARTICULARS


GLE RRIED DOWED DIVORCED


(write the word)


3


...


. .


...


(City or Town)


No.


The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH


24-


ing most of working life)


here death occurred)


14b. Location (City, Town or County and State) MALDEN, MASS Nov. 17, 19.56.


II NAME OF FATHER OF DECEDENT


If under I year IF LESS than 1 day


Ni6 Occupation


(b) Ca. SUFFOLK (c) Post OBENWINTHROP ... and Zone ....


First Name


Middle Name Last Name


St.


RECEIVED


TOW


OFFICE 0


11 12. 1


-


NINA!


CLERK


6 5


155


FEB 71957 PM


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. )


PLACE OF DEATH


(County)


Danvers


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Danvers


(City or Town making this return)


Registered No.


249


$(If death occurred in a hospital or institution, No. Danvers State Hospital, Hathorne,St. ( give its NAME instead of street and number)


Albert L. Glassett


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No ..


26 Beacon Street


(Usual place of abode)


Winthrop, Mass.


St


(If nonresident, give city or town and State)


Length of stay: In place of death ........... years.


2 months.


10


In place of residence


... years.


months.


......... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Lale


White


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 ... 61Years.


5 Months 3 Days


If under 24 hours


Hours ........ Minutes


13 Usual


Dental Technician


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No.


Unknown


16 BIRTHPLACE (City) ..


Last Boston


(State or country)


Mass.


17 NAME OF


FATHER


Thomas C. Glassett


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Unknown


19 MAIDEN NAME


OF MOTHER


Elizabeth Whelen


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Unknown


21 llary I. Sheehan


Informant.


(Address)


Hathorne,


Article i Say


ATTEST:


(Registrar of City or Town where death occurred)


December 12, 1956


DATE FILED


19


2 FULL NAME


3 DATE OF


DEATH


(Month)


Mar.


2


to ...


Due To


(b)


Due To


(c)


SIGNIFICANT


CONDITIONS


Was autopsy performed ?.


Yes


(Address)


Hathorne, Mass.


Holy Cross


6


DATE OF BURIAL.


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


What test confirmed diagnosis?


Autopsy


December


12,


1956


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


19


56


Dec.


12


19


56


I last saw h.


itve on


Dec. 12,


1955


death is said to


have occurred on the date stated above, at


4:25 a.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Hypertensive Heart Disease


INTERVAL BETWEEN ONSET AND DEATH


LOS.


OTHER


Terminal Pneumonia


days


5 Was disease or injury in any way related to occupation of deceased? If so, specify.


(Signed)


Andrew Nichols III


M. D.


Date


12/12


50


19


llalden, mass .


Place of Burial or Cremation (City_or Town) 144, December


56


19


7 NAME OF


FUNERAL DIRECTOR


Winthrop, Mass.


Arthur J. O'Malley


ADDRESS.


Received and filed.


IAN 21 1047 19


(Registrar of City or Town where deceased resided)


MEDICAL CERTIFICATE OF DEATH


50M .11.55.916145


R-302 1


A TRUE COPY


(Was deceased a


U. S. War Veteran,


if so specify WAR)


R-302 1


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 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


PLACE OF DEATH


Essex


(County)


Danvers


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Povera


(City or Town making this return)


250


" (If death occurred in a hospital or institution, Danvers State Hospital, dathorne 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.)


316 Revere


St


Winthrop, Hlass.


(If nonresident, give city or town and State)


Length of stay: In place of death ..


.... years.


1


months.


2 days. In place of residence.


years.


months


.. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


December 12,


1956


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Oct.


13,


19 56 Deç, 12. to


19


56


19


5 death is said to


have occurred on the date stated above, at


6:10


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Hypertensive Heart Dis.


INTERVAL BETWEEN ONSET AND DEATH


Yrs.


Due To (b)


Due To


(c)


OTHER


Hypertrophy of


SIGNIFICANT


CONDITIONS


prostate


Yrs.


Was autopsy performed?


clinical & Lab.


What test confirmed diagnosis ?.


5 Was disease or injury in any way related to occupation of deceased ?. If so, specify


(Signed)


Andrew Nichols III


M. D.


(Address)


Hathorne, Nass.


Date


12/12


19


5


North Burial Ground, Providence, 6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


December 14,


19


56


21


Informant.


(Address)


Hathorne, Hass.


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


Received and filed.


MAL 2. OFT


19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


Married


10a If married, widowed, or divorced


HUSBAND of


Florence, maiden name unk.


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


6Gears.


7.Months .... 2.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Waiter


(Kind of work done during most of working life)


14 Industry or Business :


15 Social Security No.


059-01-14,58


16 BIRTHPLACE (City)


(State or country)


Greece


Agrinion


17 NAME OF


FATHER


Euthemois Constandopoulos


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Greece


19 MAIDEN NAME


OF MOTHER


Visilo Colovos


20 BIRTHPLACE OF


MOTHER (City)


F


.I


(State or country)


Greece


lary E. Sheehan


7 NAME OF


FUNERAL DIRECTOR


Howard S. Reynolds


ADDRESS winthrop, Mass.


DATE FILED


December 17,


.. 19.


56


Registered No.


No.


Charles Poulos


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence.


No ...


(Usual place of abode)


I last saw h. Lave on Dec. 12,


50M -11.55.916145


X


PLACE OF DEATH


(County) 7


(City or Town)


No.


Kenmore Hos pt


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) 251


Registered No.


¿(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.)




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