USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 68
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{if so specify WAR)
2 FULL NAME
Elizabeth T. ... Hollihan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
135 Grover Ave.,
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years.
months
14
30
days. In place of residence
.years ...
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
DEC
25
14.54
(Month)
(Day)
(Year)
I HEREBY CERTIFY, That I attended deceased from
4
1959 to Lec
25
.59
I last saw hl ..... alive on
24
-
death is said to
have occurred on the date stated above, at
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Sáratral Thrombosis
(a)
Due To
Chronic Myocarditis
3yrs
Due To
Hypertension
(c)
OTHER
EdEman Extremities
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ?
-
No
5 Was disease or injury in any way related to occupation of deceased? 10 If so, specify
(Signed)
Georgs. H . Schwartz
M. D.
OF MOTHER
Elizabeth Cahalane
Same H, Schwart
(PRINT OR TYPE SIGNATURE)
(Address) 19 Princeton St Date.
12/25/56
6
St ....... Pauls E.Bustour Arlington
Place of Burial or Cremation December 29 19.
5$
DATE OF BURIAL
Arthur J. O'Maley
ADDRESS
Received and filed DEC-2-8-1959 19
(Registrar)
PARENTS
20 BIRTHPLACE OF MOTHER (City) (State or country)
John D. Holl1han
135 Grover Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Malplic Pereanne
(Signature of Agent of Board of Health or other),
Ticalthe fficer
12/28/59
(Date of Issue of Permit)
(Official Designation)
To be filed for burial permit with Board of Health or its Agent.
233
Winthrop Community Hospital
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWER,
or DIVORCER rried
10a If married, widowed, or divorced
HUSBAND of
John D. Holl1han
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
64
12
AGE.
.Years ....
Months ...
Days
If under 24 hours
Hours.
......
.Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Law
15 Social Security No.
Cambridge
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
John E, Kirby
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
Ireland
21
Informant
(Address)
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass.
(City or Town)
(b)
INTERVAL
BETWEEN
ONSET AND
DEATH
1/2 hr
3yrs
PERSONAL AND STATISTICAL PARTICULARS
Secretary
, to ....
No.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
WOW!
1.
3
::
RULES OF PRACTICE DEC 2 81959 AM
The fulfillment of the purpose of these laws calls for the observance of 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.
R-302
PLACE OF DEATH
NORFOLK
(County ) CROOKLINE
(City or Town)
34 Francis Street
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BROOKLINE
(City or Town making this return)
958
234
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.)
278 Main Street
Winthrop,
if so specify WAR
Massachusetts
(a) Residence. No. (Usual place of abode)
15
50
( 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
3 DATE OF
DEATH
(Month)
(Day)
(Year)
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
widowed
4 InHEREBY
December
er
19
"December 24
59
19
death is said to
1 last saw h ...... alive on
9:08 p.
.. m.
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH 3 mos
11 IF STILLBORN, enter that fact here.
12
86
5
12
AGE
. Years ......
.Months.
..... Days
Housewife
13 Usual
Occupation:
(Kind of work done during most of working life)
own home
14 Industry
or Business :
nono
15 Social Security No.
Concord
16 BIRTHPLACE (City)
(State or country)
Massachusetts
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ?
biopsy
5 Was disease or injury in any way related to occupation of deceased ? If so. specify
PARENTS
19 MAIDEN NAME
OF MOTHER
Ellen E. Cheney
Robert E. Brownlee
(Signed )
1180 Beacon St.
12-29
Date. 19
( Address)
Winthrop Cemetery, Winthrop, Massachusetts
Januar @ity2or Town) 60
19
Informant
(Address )
15 Johnson Ave., Winthrop, Mass.
7 NAME OF
FUNERAL DIRECTOR
Winthrop, Massachusetts
A TRUE COPY
ATTEST :
(Registrar of City or Town where death occurred)
Received and filed
JAN-11-1960
19
( Registrar of City or Town where deceased resided )
10a If married, widowed, or divorced
HUSBAND of
Willfin maden Hoffe
den mame of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Carcinomato sis
Due To
Carcinoma
of Pancreas
(a) (b) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.) 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)
50M-9-59-926111
Howard S. Reynolds
ADDRESS
20 BIRTHPLACE OF Graf ton
MOTHER (City) .Massachusetts
(State or country)
21 Thomas E. Key
6 Place of Burial or Cremation
DATE OF BURIAL
17 NAME OF
FATHER
Benjamin F. Smith
18 BIRTHPLACE OF Boston FATHER (City) .Massachusetts. (State or country)
M. D.J
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
December
29
1959
That I attended deceased
December
29
from 59
19
St.
( Was deceased a
U. S. War Veteran.
no
No ... Cora P. Howe (Smith)
DATE FILED
December 31,
.19 .. 59
If under 24 hours
Hours ........ Minutes
JAN 1 1 1960 0%
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
R-301A 1
CTIONS OR ERTIFICATE
iving F DEATH : enter han one or each ) and (c)
s not mean of dying, art failure, c. It means or compli- ich
s, if any, ve rise to use (a), he under- use last.
ons contrib- ath but not the terminal Jition given
hapter 137, 4. requires to print or cause or death on ficates, and 8, Acts of ires Physi- int or type signature.
-59-925686
PLACE OF DEATH
Suffolk (County)
IHSE
Winthrop,Mass (City or Town)
No. 16 Moore Street
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
235
1.6.60
PHYSICIAN - IMPORTANT
2 FULL NAME.
Mary Bertha (Besom) Geppert
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Moore Street
St.
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years .............. months.
.days. In place of residence.
4.8years .............. months .....
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
30,
1959
(Month)
(Day)
(Year)
That I attended deceased from
19 59
I last saw Heralive on
Dec. 29, 195,99
., death is said to
11.
INTERVAL
BETWEEN
ONSET AND
(a)
Hypertensive and arterioscleroticDEATH
heard disease
Generalized
Due To
Arteriosclerosis
(b)
8 yrs
Due To Hypertrophic arthritis
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
no
What test confirmed diagnosis ?
Clinical & laboratory
5 Was disease or injury in any way related to occupation of deceased ? MO ... If so, specify
(Signed)
Au. Traunstein
M. D.
M. Traunstein, Jr., M. D.
73 BartIBLEYRA SI
(Address)
Winthrop 52 Mass
Date Dec. 30, 1959
Winthrop Cemetery Winthrop, Mass 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January .... 2 1960
7 NAME OF
FUNERAL DIRECTOR
Walked B March
ADDRESS
1.74 ...
Winthrop St. Winthrop
Received and filed
DE6-3-1-1959
19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Perry County
(State or country)
Pennsylvania
19 MAIDEN NAME
OF MOTHER
Mary VanNewkirk
20 BIRTHPLACE OF
MOTHER (City)
Perry County
(State or country)
Pennsylvania
Informant
Miss .PamelaV .Besom
(Address)
16 Moore St. Winthrop, Mass.
I HEREBY
CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued:
Mass.
Takah C.
Serianie
(Signature of Agent of Board of Health or other) 12/31/59
(Official Designation)
(Date of Issue of Permit)
10 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Edward FrancisGeppert
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
79
AGE.
Years
2
Months.
.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.
033-16-6585-B
Newport
16 BIRTHPLACE (City)
(State or country)
Pennsylvania
17 NAME OF
FATHER
Samuel Besom
5 year's
8 SEX
Femalel
White
9 COLOR
4 I HEREBY CERTIFY,
July ... 22,
95.3 .... , to ...
Dec 30.
have occurred on the date stated above, at
a .... m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
6 yrs
To be filed for burial permit with Board of Health or its Agent.
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
[(Was deceased a
U. S. War Veteran,
[if so specify WAR)
NO ..
caused
-= = . _
1
1
SPACE FOR ADDITIONAL INFORMATION
A
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
DE.C. 3.19591.
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 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.
.6 823 $200
IM R-301A -
litions, if any, h tot. mse to . ne the under. rawse last
onditions contrib- to death but not to the terminal condition gitem
... Chapter 137. of 1954. requires cians to print or the cause or s of death on certificates, and er 48. Acta of f requires Physi. to print or type under signature
1 18 1960
I M-6-59-925686
PLACE OF DEATH
Suffolk 7( ++111]1\ 1
Boston
(( it\ @ lown)
Veterans Administration Hospital
2 FULL NAME
William E. OSBORNE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
102 Barnes Avenue
East Boston, Moss.
(If nonresident. give city or town and State)
length of stay
In place of death
years
months
3
days. In place of residence
years .
months
days.
MEDICAL. CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED
Married
4I HEREBY CERTIFY.
August 2
. 19 59.
I hat A attended deceased from
September 5
.159
CX ., death is said to
have occurred on the date stated above, at
7,45 P.,
DEATH WAS CAUSED BY : IMMEDIATE'CAUSE
(a) Carcinoma of lung
INTERVAL BETWEEN ONSET AND DEATH 3 yrs
12
AGE
65
Years.
2
Months
22 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Drawtender
(Kind of work done during most of working life)
14 Industry
or Business :
CrbI
IS Social Security No.
012-20-3531
16 BIRTHPLACE (City) (State of country) Ireland
17 NAME OF
FATHER
John Osborne
18 BIRTHPLACE OF FATHER (City) (State or country) Ireland
19 MAIDEN NAME
OF MOTHER
Annie Mac Tiernan
20 BIRTHPLACE OF MOTHER (City) (State or country) Ireland
21
Informant
VA Hospital Records
(Address) 150 So. Huntington Ave. Boston
I HEREBY CERTIFY Abm a satisfactory standard certificate of death was filed with me BEFORE the burial, or transit permit yas issued:
offerton
438 9
( Signature of Agent of Board of Health or other ) 988159
(Official Designation)
(Date of Issue of Permit) X
Due To (c)
SIGNIFICANI CONDITIONS
Was autopsy performed?
No
What test confirmed chagnosis ?
Lt Pnoumonectomy 1956
5 Was disease or injury in any way related to occupation of deceased? NO If . . specify .
(Six 'ed). MICHAEL LEISS M 1).
(PRINT OR TYPE SIGNATURE) (Address) VA Hospital, Boston. Sept. 5 159
« Winthrop Cemetery, Winthrop, Mess. Place of Burial or Cremation (City or Town) DATE OF BURIAL September 9 19. . 59
7 NAME OF FUNERAL DIRECTOR Arthur S. Forcella
ADDRESS 876. Winthrop St.,. Revere, Mass.
Received and filed SEP 10 1959 Charles & Mach · (Registrar)
19
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN -26
236
To be filed for burial permit with Board of Health of its Agent 08525
Registered No.
{ (If death occurred in a hospital or institution. St. I give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
( (Was deceased a {U. S. War Veteran, lif so specify WAR)
(write the word)
3 DATE OF
DENTHI
September
5
1959
(Month)
(Dav)
(Year)
10a If marri
HUSBAND of
TAYY'A: Pozzuoli
(Give maiden name of wife in full)
(or) WIFE of
( Husband's name in full)
II IF STILLBORN, enter that fact here
63
1-12
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH o not enter ire than one se for each ), (b) and (c)
does not mean side of dying. is heart failure. a. ele It means trase, or romple. which caused
PARENTS
St.
(a) Residence No. ( l'sual place of abode)
1
A TRUE COPY ATTEST: Charles it Mackie City Registrar
JAN 1 81900 8
PLACE OF DEATH
SUFFOLK
BOSTON (Ony a lawit
The Commonwealth of ftlassachustils JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
237
Registered Na.
#8783
Massachusetts General Hospital
Atli death occurred in a hospital or institution. St. { give its NAME instead of street and number)
CARRIE SMALLEY
2 FULL NAME til dressed is a married, widowed or divorced woman, give also manden name ) 811 Shirley Street
Winthrop
St ...
(11 nomresident, give city in town and State)
vents. .
.. months ..
d.v ..
3 DATE OF
September
13,
1959
(Year)
IIHEREBY CERTIFY that I have investigated the death ad the porn dove named and that the CAUSE AND MANNER thereof .ne as follows. cli an mpy was involved, state fully.) Fracture of femur. Pulmonary embolism.
9 SEN
10 COLOR
11 SINGLE
(write the word)
Female
White
la If married, widowed, or divorced
HUSBAND of
Have maiden name of wife m full)
(or) Will of
Fred Smalley
( Husband & name in fill)
12 IF STILL. BORN, emer that fact lere
V, F. 81
Years
13.000
Hou.
Minu't-
14 l'anal
Housewife
t kind of work done during most of working life)
Own Home
In Social Security S ...
17 BIRTHPLACE (CH))
Boston
Mass
!R \\ME 111.
Melitius Jackson
19 BIRTHPLACE OF
FATHER ('0)
Belfast
(State of country)
Maine
: MOTHER Phoebe Jane Draper
BIRTHPLACE OF
MOTHER 'in)
Old Town
Maine
Fred Smalley
Informant
811 Shirley St., Winthrop
I HEREBY CERTIFY that a jatractors standard critilite of death
was tiled with me BEFORE the burial of transn presmit was issued :
1/10/91
( Rect-11.11 )
PARENTS
Boston
9/14 .59
- Norfolk Cemetery Norfolk Mass
Ther of Bund, or Ciones. 14 17 % 101 |+4% 111 DATE OF BURIAL
September 16 ,59
TIVERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
Charles H. Mackie
נין.
PHYSICIAN - IMPORTANT
1W .- deceased a
C. § War Veteran,
il su specify WAR)
months
14
days. In place of residence
40
1.0) Residence No. it'snot place of aller Length of stay: In place of death MEDRAI. CERIDICATE AF DEATH 1 M . ntlet 5 Soculent, stole, ca honderdle (specify) Date and hom of mmr :: 8/31 Michael A. Luongo, M.D. (Print or Typr Signature) Itate of Death. See reverse side for additional information. Ser also Chap. 38. >> 6. 20; Chap. 16. >¥ 9. 10: Chap 114. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes :$ 44-45. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF Fracture of femur. It deceased was at S. War Veteran, . I. Chip, in Section Jo, requires physicians to mert a recital to that effect. = N. B .- WRITE PLAINLY. WITH UNFADING BLACK INK- TIHS IS A PERMANENT RECORD. Every item of While At w rk 1.00 cloques performed:
Accident
1. 59
IF ACCIDENTAL, was mjury causally related to the death?
Where did
Winthrop, Mass.
.went home, on farm, in industrial jdace, or inį 'Home
Manter
"Fall
to floor from couch.
| 11 :411 %
No
.. , M. D
I
IRM R-303 A
0-2.
OH TYPE THE CAUSE UN CAUSES OF DEATH ON DEATH COMITIVAILS. .
N 18 1960
PERSONAL AND STATISTICAL. PARTICULARS
MARRIED
@ |\\ORI Married
If undet 14 hours
A TRUE COPY ATTEST: Charles A Machine City Registrar
- :
JAN 1 81960
OUT - OF - TOWN
To be filed for burial permit with Board of Healt !. or its Agent.
Registered No.
488
MASSACHUSETTS GENERAL HOSPITAL No. Henry
Soli death occurred in a hospital or institution,
St. I give its NAME instead of street and number)
? FULL NAMEJOHN . SEARS ( JOHN HENRY SEARS)
sofis i manned. widowed of divorced woman, give also manden name )
24 Orlando Ave. (a) Resilence. No.
Winthrop, St ...
(Il nomesident, give city of town and State)
Length of stay: In place of death Ve.IT . months .. . 4 days. In place of residence 46 years .months. days.
MEDICAL. CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL. PARTICULARS
9 SEN
10 COLOR
11 SINGLE
(witte the word))
MARRIED
" Divorceharried
Hale
White
HUSBAND ETTSabeth Ellsworth Stone
Have manden name of wife in fum
12 IF SH11.1 BORN, entre that fact lege
\1 +1111* M.F. 46 Years 4 Mml. 28 Mm.
14 0°%11.11
Bank Clerk
Commercial Bink 020-14-4089
12 BI1 1 111'1 \( 1 City ) salem Hasanchusetts
John sears
-
Danvers massachusetts
111 \111111K
Laura Belle Vood
MI BIRLIPI ACE DI
Baltimore Maryland Iirs. John H. Sears 34 Orlando ave. Winthrop
-
filed with me BEFORE the hand made perint was lespaul =
Mass.
fightmeni Agent of Board of Health of other )
9-17.59
Charles H Mackie ( + 1 : 11.1 )
V. 11 PARE\ ʻ
Michael 'A. 'Luongo,
" Print or Type Signature I
Boston 9/15
1.59
iinthron Jemetery. winthrop, Lass . ! '
Winthrop, WIR1 174 Winthrop St,
8 1959
September
15,
1959
( |).11 )
(Year)
VI HERE BY TERI11\ that I have investigated the death of the potom above named and that the CAUSE AND MANNER thereof. uv was mvolved, state fully.) Intracranial hemorrhages, including intracerebral, subdural and epidural hemorrhages.
=
IF ACIDENTAL., was injury cansally related to the death" 111 :11 % ** * 1}1
M.umet . Collapsed in MTA Station
September 10, 1959.
Yes
I deresor I war . War Veteran. 1. 1 .. Chp, se, Section I sestre physicians to insert a recital to that effect. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes of Death. See reverse side for additional information. See also Chap. 3x, {{ 6, 20; Chap. 46, }} 9, 10; Chap. 111, $$ 44-48. information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF . 111 01 N. B .- WRITE PLAINLY. WITH UNFADING BLACK INK THIS IS A PERMANENT RECORD. Every item of While of myth
X
PLACE OF DEATH
SUFFOLK
BOSTON ('ity @ low1)
The Commonwealth of ftlassachusells JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Į
RM R-303 A
331
1 18 1960
+330 ( 1!hat tal The sign.ctwem )
(Date of Issue of Permit)
PHYSICIAN - IMPORTANT (Was deceased " U. S. War Veteran, sperify WAR) Mass.
A TRUE COPY ATTEST: Charles At Mackie City Registrar
JAN 1 8 1960 /
239
OUT - OF - TOWN
To be filed for burial permit with Board of Health or its Agent.
0897
2 FULL NAME Baby Girl Carbone
(If deceased is a married, widowed or divorced woman, give also maiden name.)
59 Shirley St.
(a) Residence. No.
(\'suat place of ahode)
6hrs45 min
(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.
hospital
MEDICAL CERTIFICATE OF DEATII
PERSONAL AND STATISTICAL PARTICULARS
8 SEY
female
9 COLOR
white
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
(Ilushand's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months Days
If under 24 hours Hours42Minutes
13 l'sual
Occupation :
none
(Kind of work done during most of working life)
14 Industry
or Business:
none
15 Social Security No. none
16 BIRTIIPLACE (City)
(State or country)
winthrop, Kass.
17 NAME OF
FATHER
Gaetano Carbone
PARENTS
18 BIRTHPLACE OF
FATIIER (City) (State or country)
Boston, Mass.
19 MAIDEN NAME
OF MOTHER
Anna Rose Oliva
20 BIRTHPLACE OF
MOTHIER (City)
(State or country)
Boston, Lass.
6 Place of Burial or Cremation
DATE OF BURIAL
September 21,
1959
7 NAME OF
Vincent Rapino
FUNERAL DIRECTOR
ADDRESS 9 Chele S99 -29-1959Boston, Lass.
Received and filed . 19
Day
Signalouragent of Board of Ilealth or other)
9 -21.54
(Date of Issue of Fermin)
0.10.58-#23886
PLACE OF DEATH
Suffolk Boston
(County)
(City or Town)
The Commomuralth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
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)
no
3 DATE OF
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