USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 69
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DEATH
Sept 19, 1959
(Month)
(Day)
(Year)
4IHEREBY CERTIFY,
That I attended deceased from
Sept 19
59
Sept 19
. 19
to
Sept 19
. 19 59
. 19
, death is said to
have occurred on the date stated above, &: 35. p
m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
ERYTHROBLASTOSIC
FATAHS
INTERVAL BETWEEN ONSET AND DEATH
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
YES
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ? . If so, specify
(Signed)
Joseph W. Sandler Longwood Ave. 9-19-59 19
(Address)
Winthrop Cemetery Winthrop (City or Town)
21 Informant (Address) Gaetano Carbone (father) 59 Shirley St., Winthrop
LHEREBY CERTIFY that a satisfactory standard certificate of death was Aled with me BEDRE the burial or transit permit was issued :
18 1960
MR.JA
-
THIS IS A NENT RECORD. se only APPROVED ink or black riter ribbon.
RUCTIONS FOR L CERTIFICATE giving OF DEATH
not enter than one e for each (b) and (c)
does not mean de of dring. heart lailive. etr. 11
om pli- which caused
any. ga:e ruse to (a). the under. last
itions contrib. death but mot to the terminal Pronditior giren
Chapter 137. 1954, requires ans to print or be cause or of death on ertifcates. IAP. 46 119 & CIAP. 114 :: 45. HAP. 38 :6.)
No. .
The Children's Hospital
(Registari - AxOfficial Designation)
59
I last saw FI alive on
St. Winthrop
95.0
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
JAN 1 1007 M
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. I.)
25M-2-58-922072
PHOTOCOPY REFERRING TO VITAL EVENT INVOLVING RESIDENT
OF YOUR STATE IN MINNESOTA.
MINNESOTA DEPARTMENT OF HEALTH Section of Vital Statistics CERTIFICATE OF DEATH
21078
1. PLACE OF DEATH: STATE OF MINNESOTA a. COUNTY Cass
2. USUAL RESIDENCE 4. STATE
(Where deceased lived
If institution: residence before admission.)
Mass
Suffolk
Unorganized 4
e, LENGTH OF "STAY In 1 b. 3 days
Winthrop
. NAME OF (If not in hospital or institution, give street address) HOSPITAL OR" INSTITUTION
d. STREET ADDRESS
POST OFFICE Winthrop
e. IS PLACE OF DEATH INSIDE CORPORATE LIMITS?
e. IS RESIDENCE INSIDE CORPORATE LIMITS?
I. IS RESIDENCE ON A FARM?
YES O NO X
YES O NO
YES O NO X
3. NAME OF DECEASED (Type or Print)
Raymond John Scott
4. DATE
DEATH Sept. 20, 1959
Day
5. SEX
6. COLOR OR RACE | 7. MARRIED A NEVER MARRIED O
8. DATE OF BIRTH
Hours Months Min. 9. AGE (In years |IF UNDER 1 YEARJIF UNDER 24 HRS. O last birthday) 53 Days 18
100. USUAL OCCUPATION (Give kind of work done during most of working life, even if retired)
10b. KIND OF BUSINESS OR INDUSTRY GOV't.
11, BIRTHPLACE (State or foreign country)
12. CITIZEN OF WHAT COUNTRY? U.S.a.
Aviation Inspector Aviation 13 .. FATHER'S NAME
136. MOTHER'S MAIDEN NAME
14. SPOUSE'S NAME
John. Scott Hannah Alexander Phyllis Scott.
15. WAS DECEASED EVER IN U. S. ARMED FORCES? 16. SOCIAL SECURITY NO.
(Yes, no, or (If yes, give war or dates of service) unknown) NO 342-07-5745 Ghullin Satt
Winthrop, the
18. CAUSE OF DEATH (Enter only one cause per line for (.), (b), and (c)
INTERVAL BETWEEN
PART I. DEATH WAS CAUSED BY: Cliente Myocardial Infarction Place
IMMEDIATE CAUSE (.)
DUE TO (b)- Coverauf acclusemi
10 horas
Conditions, if any, which gave rise to above cause (a), stating the under- lying cause on line
(c) DUE TO (e)
19
II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE IMMEDIATE CAUSE GIVEN PART IN PART 1(6)
19. WAS AUTOPSY ·PERFORMED?
YES O NO O
19a. DATE OF OPERA- TION
19b. MAJOR FINDINGS OF OPERATION
200. ACCIDENT, SUICIDE OR HOMICIDE, (SPECIFY):
[ 20b. DESCRIBE HOW INJURY OCCURRED. (Enter nature of injury in Part I or Part II of item 1B.)
20c. TIME OF INJURY"
Hour Month,
Day.
Year
20d. INJURY OCCURRED WHILE AT O NOT WHILE 0
AT WORK
9/20/55 to 9/20/55
_19
21. Icertify I attended the deceased from. fand that death occurred ?
_m on the date stated above and to the best of my knowledge, from the causes stated.
22b. ADDRESS
Hemester
22c. DATE SIGNED 9/21/59
23 .. SERIA
ORIAL CREMATION 23b. PATE 9/21/59 |23c. NAME OF CEMETERY OR CREMATORY
RicheWAL (Specify)
Burial 9/24/1959 Lakewood Cemetery Minneapolis, Minn.
24. DATE FILED BY LOCAL REG.
25. REGISTRAR'S SIGNATURE
26. SIGNATURE OF MORTICIAN OR FUNERAL DIRECTOR ADDRESS
.IL 1959
anna Reverse Gareth Thomas Walker
-
(If deceased is a married, widowed or divorced woman, give also maiden name. )
No.
Minnesota
(City or Town)
Unorganized #4
CASS
(County)
The Commonwealth of Massachusetts
(Sept.20,1959 )
CERTIFICATE OF DEATH
COPY OF
DIVISION OF VITAL STATISTICS
SECRETARY OF THE COMMONWEALTH
EDWARD J. CRONIN
Winthrop
240
(City or Town making this return)
Registered No.
ased a
St. { give its NAME instead of street and number) §(If death occurred in a hospital or institution,
U. S. War Veteran,
r
Burial or removal permit Issued. if so specify WAR), NO
2 FULL NAME
1
PLACE OF DEATH
RAYMOND JOHN SCOTT
Month
Year
Male White
WIDOWED O DIVORCED O
Sept. 2, 1906
Madelia, Minn.
Signature of Sub-Registrar
MEDICAL CERTIFICATION
20f. CITY, VILLAGE OR TOWNSHIP
COUNTY
STATE
WORK
a. M. p. m. 20€. PLACE OF INJURY (e. g., in, or about home, farm, factory, street office bldg., etc.)
(Degree or title)
fragen 91.0).
Deleur (
23d. LOCATION (City, village or county) (State)
FEB 2 - 1960
....
R-302
e. CITY, VILLAGE ÖR TOWNGI IIP
17. INFORMANITS OWN SIGNATURE ADDRESS
.
٣٠ ٠٠٤
ت: ٧
X PLACE OF DEATH
Suffolk (County) XXXXXXXX
Boston
(City or Town)
FAULKNER HOSPITAL No.
2 FULI, NAME.
PASQUALE SCARPULLA
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
1.20 HERMAN . STREET ...
st.WINTHROP
MASS.
(Usual place of abode)
Length of stay: In place of death
...... years
months .. 14
days. In place of residence 35
years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDmarried
4 I HEREBY CERTIFY,
That I attended deceased from
12.SEPTEMBER_59.25 SEPTEMBER
19
59
I last saw | Malive on
25 SEPTEMBER1959 death is said to
have occurred on the date stated above, at
7:05 PM
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Hepatic coma
(h) ...
Due To Severe liver cirrhosis
Due To (c)
OTIIER SIGNIFICANT CONDITIONS
Was autopsy performed?
yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? Ho If so, specify
(Signed)
Frederick Beerel
M. D.
(Address) Faulkner Hospital Date
9/26
1959
Winthrop Cemetery 6
(City or Town)
DATE OF BURIAL Sept ..... 29 1959 19
7 NAME OF
Ernest P Caggiano
147 Winthrop St Winthrop
ADDRESS 34 1959 Charles & Macke 19.
(Registrar)
YRS.
(Kind of work done during most of working life)
14 Industry
or Business :
Retired Mill Worker
. 15 Social Security No ..
024-07-2124
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF FATHER Charles Scarpulla
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Santa Madonna
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Italy
21 Informant:
Grace Harper (Address)120 Hermon 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: Gogerson
4673
(Signature of Agent of Board of Health or other), 09/28/54
(Official Designation )
(Date of Issue of Permil)
TRUCTIONS FOR L CERTIFICATE
1 giving OF DEATH
not enter e than one le for each . (b) and (c)
does not mean de of dying, heart failure, , etc. It means ase, or compli. which caused 181 itions, if any, gave rise to cause (a). o the under. cause last.
ditions contrib. o death but not to the terminal condition given
.:- Chapter 137, of 1954, requires ians lo print or the cause or of death on certificates.
1 19 19608
OUT - OF - TOWN 241
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
To be filed for burial permit with Board of Health or its Agent -09212
.
f(If death occurred in a hospital or institution.,
St. { give its NAME instead of street and number)
IMPORTANT .
L
PHYSICIAN
( Was deceased a
U. S. War Veteran,
no
if so specify WAR)
(If nonresident, give city or town and State)
vorced
HUSBAND
Maria Micciohe
(Give maiden name of wife in full)
(or) WIFE. of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
75
If under 24 hours
Hours ........ Minutes
13 l'sual
Occupation :
Machinist
INTERVAL BETWEEN ONSET AND DEATN 10c. Years 8 Months Days
3 DATE OF
SEPTEMBER ... 25
1959
DEATII
(Month)
(Day)
(Year)
MR.301A I
PARENTS
Winthrop
Place of Burial or Cremation
A TRUE COPY ATTEST: Charles It. Mackie City Registrar
JAN 0 1079 MM
-
242
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts UT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH To be filed for burisl permit with Bosrd of Health DIVISION OF VITAL STATISTICS STANDARD 05211 CERTIFICATE OF DEATH
MASSACHUSETTS GENERAL HOSPITAL
No.
2 FULL NAME. James Gallagher
(If deceased is a married, widowed or divorced woman, give also maiden name.)
f(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, WW /1
if so specify WAR)
St.
Winthrop
Mass
(If nonresident, give city or town and State)
6 days. In place of residence years months days.
MEDICAL CERTIFICATE OF DEATHI
3 DATE OF
DEATH
Sept. 26,
( Month) (Day)
1959
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVOMarried
4 I HEREBY CERTIFY.
Sept. 20059
to
Sept. 26,
59
10a If married, widowed, or divorced HUSBAND of
Catherine
L. Sheerin
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE62 Years
Months
... Days
If under 24 hours
Hours ...
Minutes
Due To
Acute myocardial infarction
7 days
unknown
years
16 BIRTHPLACE (City)
(State or country)
Charlestown Mas8
OTHER
SIGNIFICANT
CONDITIONS
Arteviolar nephrosclerosis
Was autopsy performed ?
What test confirmed diagnosis'
Yes
Autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
(Address)
Chorles L. Clay, M.D. Ass't. Diz., Mass. Gen'l Hosp .. Date
19
6 Winthrop
Winthrop (City or Town)
Place of Burial of Cremation
DATE OF BURIAL
September 29 1959
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley Winthrop Mass
ADDRESS
Chosepley 4 mackie 19
JAN 19 1960
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Agnes Murray
20 BIRTHPLACE OF
MOTHER (City)
Cambridge
(State or country)
M3 33
Gallagher
21 Informant Catherine L. (Address) 210 Main st: , Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me/BEFOREthe hurytor transit permit was issued : W. I have
Signature of Agebt of Board of Health gthex)
4669
9/28/59
(Oficial Designation) (Date of Issue of Permit)
BY-THIS IS A AWENT RECORD. she only TE APPROVED k ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE
E OF DEATH
› not enter re than one se for each ), (b) and (c)
, does not mean tode of dying. is heart failure. 1. el It means raie, or compli.
(a). the
under. last.
iditions contrib. to death but ant to the terminal
:. Chapter 137, { 1954, requires fans to print or the cause or of death on certificates. HAP. 46 9 4 9 & HAP. 114 ':45, CHAP. 38 $ 6.)
wral Director ase use only LACK Ink.
... 10 .........
Registered No.
(a) Residence. No. 210 Main
(L'sual place of abode)
Length of stay. In place of death
years
months
That Tattended deceased from
Toast saw
Limanve Sept. 26,
.
199 . death is said to
have occurred on the date stated above, at 5 : 20 Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Rupture of heart with
cardiac tamponade
INTERVAL
BETWEEN
ONSET AND
DEATH
4 min
13 Visual
Occupation :
Retired Police Officer (Kind of work done during most of working life)
14 Industry
or Business :
Police
15 Social Security No.
023-24-5305-
(c)
Due To
Coronary heart disease
unknown
years
17 NAME OF
FATHER
James Gallagher
, M. D.
1
IM R-301A
120.1
itions. if any. (b)
PERSONAL AND STATISTICAL PARTICULARS
À TRUE COPY ATTEST: 1 City Registrar
Charles H. Macker
-
-
JAN _ 51950 My
243
To be filed for burial permit with Board of Health or ita Agent.
No. JEWISH MEMORIAL HOSPITAL
2 FULL NAME
HERMAN BEIN
(If deceased is a married. widowed or divorced woman, give also maiden name.)
(a) Residence. No.
36 SARGENT ST. , WINTHROP
St
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
5
months
2 days. In place of residence 1.5
years
months ...
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
OCTOBER
3
1959.
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDMarried
or DIVORCED
4 I HEREBY CERTIFY, That I attended deceased from
SEPTEMBER 1, 1959, In OCTOBER
3
I last saw h/Malive on OCTOBER 3 _. 1959, death is said to
, 19
6.9
HUSBAND of
Nora
Reifel
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGEL 6. Years
Months
Daya
If under 24 hours
...... Houra .. . Minutea
13 Usual
Occupation :
AA torney
(Kind of work done during most of working life)
14 Industry
or Business:
Self Employed
IS Social Security No. .
16 BIRTHPLACE (City) (State or country)
Austria
Was autopsy performed?
NO
What test confirmed diagnosis? Clinical
5 Was disease or injury in any way related to occupation of deceased ?.. If so. specify Priscilla. R. Santos M.D.
(Signed)
Priscila R. Santos, m. D.
, M. D.
(Address) JEWISH MEMORIAL Date OCTOBER 3,1951
6 Chel Jacob
Place of Burial or Cremation
DATE OF BURIALOctober 5
19 5º
7 NAME OF
FUNERAL DIRECTOR
Arnold Golov
ADDRESS
1668 Beacon St. Brookline
Received firmarkes H. Chachi OCT - 6 1959 ( Registrar) JAN 19 1960
PARENTS
18 BIRTHPLACE OF
FATHER (City) (State or country) Austria .
19 MAIDEN NAME
OF MOTHER Charlotte C. B. L.
20 BIRTHPLACE OF MOTHER (City) (State or country) Austría
21 Informant (Address)
Nora Bein
(Wife)
Sf Sargent St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bunabor transit permit was issued: Login
(Signature of Agent of Board of wealth or other)
47701 (official Designation)
·5-54
(Date of Issue of Permit) X
TRUCTIONS FOR IL CERTIFICATE
OF DEATH
not enter 1 than one e for cach (b) and (c)
does not mean de of dving. heart failure. Il1. It means trAIc A
.. y. rise to (.). the under. last.
tions contrib. death but not · the terminal onditien tita
Chapter 137, 1954, requires na to print er le cause or of death en rtifcatea.
50M-1-58-92197G
X
PLACE OF DEATH
SUFFOLK (County)
ROX BURY (City or Town)
The Commonwealth of Massachusetts UT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
09421
[(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,
No
( if so specify WAR)
(Usual place of abode)
(Month) (Day)
have occurred on the date stated above, at
7:30 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Acute Myocardial Infarction
INTERVAL BETWEEN ONSET AND DEATH
minutes
Due To Hypertensive Cardio-VAS Ou Lan (b) Disease
yes.
Due To (c)
OTHER
Basilar Artery Thrombosis 5
SIGNIFICANT
CONDITIONS
Rt. Hemiparesia
*- 26.59
17 NAME OF
FATHER
Moses Bein
Woburn
(City or Town)
10a If married, widowed, or, divorced
PERSONAL AND STATISTICAL PARTICULARS
MR-301A -
A TRUE COPY ATTEST: D Charles it Mackie City Registrar
JAN 4 91039
244
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
The Commonwealth of ffassarfuerteOUT - OF - TOWN To be filed for burial permit with Board of Health Registered No. 19496 EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
2 FULL NAME
ALBERT GORDON
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence, No ..
273 SHIRLEY STREET
(l'sual place of abode)
10
2
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
OCTOBER
6
1959
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That Yattended deceased from
Oct. 5,
_.. 19.59. to Oct. 6,
19
59
welast saw am alive on _
Oct .. 6,
19.59, death is said to
have occurred on the date stated above, at
.m.
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral thrombosis
INTERVAL
BETWEEN
ONSET ANO
DEATH
1 dy
11 IF STILLBORN, enter that fact here.
12
AGE 644
Years
Months
Days
If under 24 hours
Hours ___ Minutea
13 L'sual
Occupation :
Sheet Metal Worker
(Kind of work done during most of working life)
14 Industry
or Business :
Retired
15 Social Security No. 034-01-7114
16 BIRTHPLACE (City)
10+ yrs. (State or country)
Poland
Was autopsy performed?
NO.
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Charles L. Clay, M.D. Ase's Dis., Mass. Gon' !! Houp. Date.
M. D.
(Address)
r.t.
6
Place of Burial or Cremation
DATE OF BURIAL
October 7, 59
19
7 NAME OF
FUNERAL DIRECTOR
Benjamin Birnbach
ADDRESS
10 Washington St. Dorch
OCT - 8 15:1
.
JAN 19 1960
PARENTS
21 Esther Gordon
Informant
(Address)
273 Shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bupeber transit permit sued : parma
(Signature of Agent of Board of Health or other) 4802
10-7-59
(Official Designation)
(Date of Issue of Permit)
VI.
the
last
itions contrib. death but not to the terminal Prondition giren
Chapter 137, 1954, requires ina to print of le cause or of death on ertificatea. KIAP. 46, 35 9 & CAP. 114 ': 45, HAP 38>6.)
al Director! se use only LACK Ink.
110.58.923866
> 1
MR-301A
.- THIS IS A ANENT. RECORD. Jse only E APPROVED r ink or black writer ribbon.
TRUCTIONS FOR IL CERTIFICATE
OF DEATH mot enter e than one ne for each , (b) and (c)
does not mean de of dying. heart failure. etc. It means sie. or romp/t-
334
(b) .
Due To
Cerebral arteriosclerosis
Due To (c)
OTHER
Hypertension
SIGNIFICANT
CONDITIONS Diabetes mellitus
4 yrs
17 NAME OF
FATHER
Jacob Gordon
18 BIRTHPLACE OF
Poland
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Rebecca Leminard
20 BIRTHPLACE OF
MOTIIER (City)
(State or country)
Poland
Lebanon, W. Roxbury
(City or Town)
Received and
Charles & lack
MASSACHUSETTS GENERAL HOSPITAL
No.
f(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and numher)
-
PHYSICIAN - IMPORTANT (M'as deceased a U. S. War Veteran, if so specify WAR)
(write the word)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, wido@s endirrecHoffman
HUSBAND of
(Give maiden name of wife in full)
3 yrs
10/6/
159
St WINTHROP, MASS.
(If nonresident, give city or town and State)
A TRUF COPY ATTEST: Charles & Mackie City Registrar
245
The Commonwealth of MassachusettsUT - OF - TOWN JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
09557
Veterans Administration Hospital
[(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)
WW2
(a) Residence No.
( I'mnal place of abode)
34 Pico Avenue
Winthrop, Mass.
(Il nonresident, Rive city nr town and State)
length of stay
In place of death
years
months
22 days.
In place of residencelife ears.
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEAIR
October
7
1959
( Month)
(Day)
(Year)
JIHEREBY
SERTIFY
ThaVA
attended deceased from
September 151, 59 ... October
59
..... , death ts said to
have occurred on the date stated above, at
4 :30 Р.
.. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinoma of the lung with
mediastinal metastasis
INTERVAL BETWEEN ONSET AND DEATH
1 yr
51.55
3
Months.
13
If under 24 hours
Hours.
.. Minutes
13 L'sual
Occupation :
Civil Engineer
(Kind ol work done during most ol working life)
14 Industry
or Business :
15 Social Security No. . 031 22 0810
Winthrop
16 BIRTHPLACE (City)
(State of country)
Massachusetts
17 NAME OF
FATHER
Thomas J.
18 BIRTHPLACE OF
New York
FATHER (City) (State or country) New York
19 MAIDEN NAME OF MOTHER Mary Burke
20 BIRTHPLACE OF MOTHER (City) (State or country)
Middletown
Connecticut
6 Parsonsfield, Maine
fCity or Town) Place of Burial or Cremation DATE OF BURIAL October 10 19 59
7 NAME OF FUNERAL DIRECTOR O'Maley Funeral Home ADDRESS 79 Atlantic St. Winthrop, Mas8. Charles H Mackie
OCT-1-3-1958 (Registrar)
PERSONAL AND STATISTICAL. PARTICULARS
& SEX
Malle
9 COLOR
White
10 SINGLE
( write the word)
MARRIED Married
WIDOWERM
or DIVORCED
IOa If married, wiraufHin Wel ton
HUSBAND) of
(Give maiden name of wife in full)
(or) WIFE ol
( Husband's name in full)
11 IF STILLBORN, enter that lact here
Due To (b)
Due lo (c)
OTIfER SIGNIFICANT CONDITIONS
W'as autopsy performed ?
No
What test confirmed diagnosis?
Clinical & Laboratory
S Was disease or injury in any way related to occupation of deceased ? Il en, specify ..
(Signed) M. 1).
MICHAEL MEISS
(PRINT OR TYPE SIGNATURE)
VAH Boston, Mass .... Date.Oct .... 7
19.59
(Address)
PLACE OF DEATH
Suffolk (('nuni )
Boston
(('ity or Town)
NO.
2 FULL. N
S'UCTIONS FOR . CERTIFICATE
CIVIng OF DEATH
ct enter î than one for each )(b) and (c)
Yes not MOON " of dying. sheart failure. detr. It means er. or compli. which caused
63 3
is, if any, are rise to humse (a). the under. rause last
lions contrib. feath but not the terminal ndition titen
Chapter 137 1954. requires Is to print or cause or of death on eltificates, and 48. Acts of Quires Physi - print or type Ber signature
IN 20 1960
4-59.925686
PARENTS
21 Hospital Records Informant 150 S.Huntington Ave. , Boston
(Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with preBEFORE ( Serial or transit permit was issued: rogercon .......
Signature of Agent of Boart of Health or other)
4836 18-9-59
(Official Designation) ( (Date of Issue of Permit)
.
HAYES
(If deceased is a married, widowed or divorced woman, give also maiden name.)
To be filed lor burial permit with Board of Health 13K"1- Pq. #49
R.301A
12
AGE ...
Years.
.Days
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
JAN 2 01900
246
OUT - OF - TOWN
To be filed for burial permft with Board of Health or Its Agent.
Registered No.
No.
M RAYMOND CTOFFI
( If deceased is a married, widowed or divorced woman, give also maiden name.)
11 CHESTER AVENUE
St ..
WINTHROP,
MASS.
(If nonresident, give city or town and State)
Length of stay. In place of death
years
months
4
days. In place of residence 40 years
months
days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORMarried
10a If married, widowed, or divorced
HUSBAND of
Olive Solari
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH 5DAYS 12 AGE. 54 Years
Months
- Days
If under 24 hours
Hours ... Minutes
13 l'sual
Occupation :
Salesman.
(Kind of work done during most of working life)
14 Industry
or Business :
Grocery
15 Social Security No.
16 BIRTIIPLACE (City)
(State or country )
Italy
17 NAME OF
FATHER
Carlo Cioffi
18 BIRTHPLACE OF FATHER (City) (State or country) Italy
19 MAIDEN NAME
OF MOTHER Maria D. Martini
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
(Address)
Olive Cioffi
If Chester Ave Winthrop
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS
OCT 23 0. 1950 . 19
Received and fled
Charle
PLACE OF DEATH
SUFFOLK
(County)
1
BOSTON
(City or Town)
MASSACHUSETTS GENERAL HOSPITAL
f(If death occurred in a hospital or institution, St. (give its NAME instead of street and numher)
PHYSICIAN
IMPORTANT
(Nas deceased a U. S. W'ar Veteran, if so specify WAR)
No
(a) Residence. No (l'sual place of abode )
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
OCTOBER
( Month)
(Day)
15
1959
(Year )
4IHEREBY CERTIFY.
Oct. 11,
19
59. to
Oct. 15,
. 19.
59
Hast saw himlive on
Oct. 15,
. 19 59. death is said to
have occurred on the date stated above, at
2:26₽
m.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
BLEEDING ESOPHAGEAL
(a)
VARICES
Due To
CIRRHOSIS OF THE
(b)
LIVER
Due To (c)
OTIIER SIGNIFICANT CONDITIONS
Was autopsy performed ? What test confirmed diagnosis'
5 M'as disease or injury in any way related to occupation of deceased ? If so. specify
(Signed)
C.C.Clay
, M. D.
(Address)
Chorles L. Clay, M.D. Asa't Dir., Mass. Gon'l Hosp .. Date
10/15/1.59
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