USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 61
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Mass
Received and filed
NOV 16 1959
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
Widow
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Fred S Taylor
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
82
AGE
Years
9
Months
26
Days
If under 24 hours
Hours_
Minutes
13 Usual
Occupation :
Housewife
(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)
Mass
17 NAME OF
FATHER
Patrick Power
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Ellen
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informant.
L'rs C N Fisher
(Address) Fort washington
Pa.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Diculpa 2 (Signature of Agent of Board of Health or other)
Nov 15, 1954
(Official Designation)'
(Date of Issue of Permit)
V.B.V
IONS
TIFICATE Ing DEATH nter n one each and (c)
not mean f dying, t failure, It means r compli- h caused
if any, rise to e (a), under- last.
contrib- but not terminal ion given
pter 137, requires print or ause or leath on ates.
50M-1-58-921876
301A 1
No.
19 Orlando Ave. Aka Sadie Sarah Helen (Power) Taylor
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Registered No.
Grafton
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) CEREBRAL HEMORRHAGE
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 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 n 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 uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shall exhume a human body and emove 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 eceived 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 hall have been delivered to such board, agent or clerk, as the case may be. satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, 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 nough 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 pplication make the certificate required of the attending physician. If death is aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town o 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 he undertaker desiring to make such removal shall constitute a permit for such emoval; provided, that such body shall be returned to the town from which it was emoved 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, ete. 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
R-303 A 1
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. §§ 44-48.
25M-3-59-924934
PLACE OF DEAT
SUFFOLK
(County) WINTHROP
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
206
S(Ii death occurred in a hospital or institution, St. [ give its NAME instead of street and number) No. 427 Winthrop Street, Winthrop
2 FULL NAME
FILOMENA ALBANO
(If deceased is a married, widowed or divorced wonan, give also maiden naine.)
(a) Residence. No.
427 Winthrop Street, Winthrop
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
3 DATE OF
DEATH
November
15,
1959
(Montlı) (D)ay)
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Coronary occlusion.
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
5 Accident, suicide, or homicide (specify) Date and hour of injury 19
IF ACCIDENTAL, was injury causally related to the death? Where did Injury occur ? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
(Specify type of place)
Manner of
Injury
(How did injury occur ?)
Nature of
Injury
While at work ?
.Was autopsy performed ? N.o
6 Was theale or injury in any way related to getupation of deceased?
(Signed Malade
M. D.
Michael A. Luongo., M.D. ( Print or Type Signature)
BOSTON
11/16
19.59
(Address)
Date
7
HOLY
CROSS CeinETERy
MALÍEN
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL Nov
18,
1919
8 NAME OF
FUNERAL DIRECTOR
Wihr Cincotti + SONS
ADDRESS 7 Cooperpost 189939.
Received and filed 19
(Registrar)
PARENTS
18 NAME OF
FATHER
NiCOLO ALBANO
19 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
20 MAIDEN NAME
OF MOTHER
ANGELINA BERNARDO
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
22
Informant
SAMUEL. ALBANO (BRITIER
(Address)
427 WINTHROP ST. WINTARIA.
I HEREBY CERTIFY that a satisfactory standard certificate of death was tied with me BEFORE the burial or transit permit was issued: Viackie
(Signature of Agent of Board of Health or other)
11/15/59
(Official Designation);
(Date of Issue of Vermit )
V. B. V
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114, DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK IVA-1 -A -----..
12 IF STILLBORN, enter that fact here.
48
13
AGE.Z
Years.
Months ............
Days
If under 24 hours
.. Hour
.Minutes
14 Usual
Occupation :
CANDY DiPPER
( Kind of work done during most of working life)
15 Industry
or Business :
FACTORY
16 Social Security No.
012-09-2576
17 BIRTHPLACE (City) Kosten, (State or country ) MASS
9 SEX
10 COLOR
FEMALE White
11 SINGLE
MARRIED
(write the word)
SINGLE
or DIVORCED
PHYSICIAN - IMPORTANT J (Was deceased a 1U. S. War Veteran, (if so specify WAR)
ITALY
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent metrical attendance or whose physician is absent from home when the certificate of death is needed. 01859 TH
(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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether ad- ministered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Frac- ture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
-302 1
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
Danvers
(City or Town making this return)
Registered No.
207
Danvers State Hospital .... Hathorne St. { give its NAME instead of street and number) No.
2 FULL NAME Helen Frider Noves (Brider)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... LO Washington Avenue Winthrop & Mass (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years 1 months. Mays. In place of residence. „years .... .months ............ days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November 15 ,1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
Oct. 12,
19 53 Nov. 15,
19.
59
I last saw h ...... Mive on
Nov. 15,
., 19 ....... 2, death is said to
have occurred on the date stated above, at 9:40 am
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinoma of Pancreas
Due To (b))
Due To (c)
OTHER
Arteriosclerotic Heart Yrs
SIGNIFICANT Piseuse-& rs
CONDITIONS
General Arteriosclerosi
Was autopsy performed? no Clinical&Laborator
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, Mass .Date.
11/15/59
.. 19
PARENTS O.
18 BIRTHPLACE OF
Kennebunk,
FATHER (City).
(State or country)
Maine
19 MAIDEN NAMEAnna Little
OF MOTHER
20 BIRTHPLACE OF
Louisville,
MOTHER (City).
Kentucky
(State or country)
Cary E. Sheehan
21
DATE OF BURIAL
Wm.H. Crosby, Inc.,
7 NAME OF UNERAL DIRECTO Darvers, Mass.
ADDRESS
Received and filed.
DEC 18 1959
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDSidowed or DIVORCED
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Byron W. Noyes, Sr.,
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
N
73
If under 24 hours
AGE
Years.
Months ...
... Days
Hours ........ Minutes
Salslady
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ...
028-16-3479
Gran,
16 BIRTHPLACE (City)
(State or country)
Missouri
17 NAME OF
FATHER
Henry Brider
Place of Burial or Crematien November 17. 19
City or Town)
5
Informant.
(Address)
Hathorne, Mass.
A TRUE COPY
Daniel Toonly
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
November 20,
59
.19.
19
28M-2-58-922072
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. I .. )
$(If death occurred in a hospital or institution,
(Was deceased a
U. S. War Veteran,
no
if so specify WAR)
6.
That I attended deceased from
to ...
INTERVAL BETWEEN ONSET AND DEATH mont
Oakdale Cemetery-Middleton, Mass 6
=٠٤٠٤٠١
٦٠
٠٠٥
0
DEC 181959 AM
1 -301A
1
PLACE OF DEATH
SUSFOLK (County) WINTHROP (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
208
WINTHROP COMMUNITY HOSPITAL (If death occurred in No.
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
{ U. S. War Veteran,
[if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
57 SEA VIEW AVE.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years ............
.months
9
days. In place of residence.
49
years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November
18-1959
(Month)
(Day)
(Year)
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVORCED married
4 Į HEREBY
Oct 20
1959
to
Nov
CERTIFY
That I attended deceased from
18
959
I last saw helalive on
NOV
18
1.5 9, death is said to
have occurred on the date stated above, at
9.10 P
.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Congestive Cardiac
(a)
Failure
INTERVAL
BETWEEN
ONSET AND
DEATH
1 Day
11 IF STILLBORN, enter that fact here.
12
AGE
Years
4
Months.
9
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No.
West Newton
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Gustave Jacobs
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Norway
19 MAIDEN NAME
OF MOTHER
Leonora Halversen
20 BIRTHPLACE OF
MOTHER (City)
(State or country) Norway
21 Richard D. Cox
Informant
(Address)
57 Sea View Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
11/19/94
(Official Designation)
(Date of Issue of Permit)
.B.
¿TIONS F
CERTIFICATE
ging C DEATH o enter tin one r each and (c)
not mean of dying, rt failure, It means or compli- ch caused
if any, e rise to use (a), e under- tse last.
ns contrib- ith but not he terminal 'ition given
napter 137, 4. requires to print or cause or death on icates, and , Acts of res Physi- int or type signature.
S .
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed
NOV-19 1959
19
(Registrar)
PARENTS
(Signed)
John 7 Lectures
M. D.
John F. Collins
MD
(PRINT OR TYPE SIGNATURE)
(Address)
Kever MASS Date 18 Nov 1959
eral fears
OTHER
SIGNIFICANT
CONDITIONS
of Uterus
2 Month.
Was autopsy performed?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify
....
0,
6
Winthrop Cemetery,
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Nov. 21,
19
59
10a If married, widowed, or divorced
HUSBAND of
Richard D. Cox
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due To
Myocardial
(b)
Disease
Due To
Hypertension
Sey
(c)
Adeno carcino MA
....
Few
years
67
Days
Registered No. hospita
LILLIE B. COX
2 FULL NAME
(a) Residence.
No.
(Usual place of abode)
9-925686
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECEIVED
TO !;
10
CLERK
-
1
6
A
ROE
NOV 1 91959 AM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
1-301A 1
I TIONS FI IRTIFICATE
Fing C DEATH center 1an one r each ( and (c)
@ not mean e of dying, lut failure, 1. It means se or compli- uch caused
o, if any, gie rise to se (a), e under- lise last.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? Wo If so, specify Q.
(Signed)
Louis 7 Salerno
M. D.
Louis F. Salerno M. D.
(PRINT OR TYPE SIGNATURE)
(Address) 175 Pleasant St Đate Nov. 21, 59
Winthrop Cemetery, Winthrop 6
Place of Burial or Cremation
November 24,
19
59
7 NAME OF
FUNERAL DIRECTOR
Ernest P. Caggiano
ADDRESS
147 Winthrop St., Winthrop
Received and filed
NOV 24 1959
19 .. .
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
MARRIED
WIDOWED
or DIVORCED
widoweć
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
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