USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 2
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(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.
& TO.
i 12 :
r
JAN - 81960 CM
X PLACE OF DEATH
BasTeri 1-11-60
Suffolk (County )
East Boston (City or Town)
Winthrop
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
6
St. { give its NAME instead of street and number) No. WinthropCommunity.Hospital
2 FULL NAME
Pasquale Catalano
(If deceased is a married, widowed or divorced woman, give also maiden name.)
{if so specify WAR)
(a) Residence. No.
524 Sumner St. East Boston, Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
.. months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
January
9
1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
1953
19
....... , to ....
Jan 9
That I attended deceased from
60
1.60
I last saw h.j.Mnalive on
Jan.
8
death is said to
have occurred on the date stated above, at
9:05 Am.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Carcinomatoris
(a)
Due
Carcinoma of Call
(h)
Bladder
1gr
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis? a peration -pathclass
5 Was disease or injury in any way related to occupation of deceased? M If so, specify ...
(Signed) Jagpti thegirl Dr. Gregorie
(Address)
(PRINT OK TYPE SIGNATURE)
19 y ellis huden are Date.
1-9-60 19
6 The Holy Cross Cemetery Walden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
January 12,
60
19.
7 NAME OF
Vincent Rapino
FUNERAL DIRECTOR
ADDRESS
9 Chelsea St. East Boston, Mass.
Received and filed JAN 11 1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
10a If married, widowed, or divorced Antonette Baldassaro HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
69
12
AGE
Years ...
Months ....
Days
If under 24 hours
Hours.
Minutes
Bartender
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Self Employed
15 Social Security No.
018-10-4020
Italy
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Marcello Catalano
18 BIRTHPLACE OF
Italy
FATHER (City)
(State or country)
19 MAIDEN NAME
Pasquilli Porcari
M. D.
OF MOTHER
PASQUALINA
20 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
21 Antonette Catalano (wife)
Informant
(Address)
524 Sumner St., E. Boston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with/me BEFORE the burial_ or transit permit was issued: Halble 6 creaun4, 8-
(Signature of Agent of Board of Health of other)
Health Officer
1/11/60
(Official Designation) (Date of Issue of Permet)
TRUCTIONS FOR L CERTIFICATE
n giving OF DEATH not enter e than one se for each , (b) and (c)
does not mean de of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), g the under- cause last.
ditions contrib- death but not to the terminal condition given
:- Chapter 137, 1954. requires ans to print or the cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
1-6-59-925686
3
S(If death occurred in a hospital or institution,
PHYSICIAN - IMPORTANT
[(Was deceased a U. S. War Veteran, no
Length of stay: In place of death .............. years ......... months. 11 days. In place of residence. .... years.
To be filed for burial permit with Board of Health or its Agent.
M R-301A 1
PARENTS
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE JAN 1 :1 1960 0)
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.
M R-301A 1
TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH
not enter e than one se for each , (b) and (c)
does not mean ode of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), g the under- cause last.
ditions contrib- death but not to the terminal condition given
:- Chapter 137, : 1954, requires ians to print or the cause or of death on certificates, and r 48, Acts of equires Physi- o print or type nder signature.
Mc 5.
PLACE OF DEATH
SUFFOLK (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.
7
WINTHROP HOSPITAL Joseph La Kalish
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
37 MERMAID AVE
St.
WINTHROP
(If nonresident, give city or town and State)
Length of stay: In place of death.
............ years.
months ... 3 days. In place of residence. .. years.
38
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
JANUARY
9
1960
DEATH
(Month)
(Day)
(Year)
8 SEX
MALE
9 COLOR
WHITE
MARRIED
WIDOWED
or DIVORCED
MARRIED
4 I HEREBY CERTIFY
July
19.
50
to ....
Jan
9
I last saw h. Malive on
1 un. 9
1960, death is said to
have occurred on the date stated above, at
11:30Pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Pulmonary Embolus
(a)
(b)
Coronary Artery Heart
Disclase
Due To (c)
OTHER
Acute Cholecystitis
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis Clinical
5 Was disease or injury in any way related to occupation of deceased? Ao If so, specify
(Signed)
Charles Liberan
M.D.
OF MOTHER
(C. B. L.)
19 MAIDEN NAME
Charles
Liberman
(PRINT OR TYPE SIGNATURE)
(Address) Winthrop, Mass Date.
1/9/1960
TIFERETH ISRAEL OF WINTHROP EVERETT. Place of Burial or Cremation (City or Town)
DATE OF BURIAL
JANUARY 10
1960
7 NAME OF
FUNERAL DIRECTOR
ARNOLD GOLOV
ADDRESS 1668 BEACON ST, BROOKLINE
19
(Registrar)
PARENTS
16 BIRTHPLACE (City)
(State or country)
RUSSIA
17 NAME OF
FATHER
HARRY KALISH
18 BIRTHPLACE OF
RUSSIA
FATHER (City)
(State or country)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
EDWARD KURLAND
21 Informant (Address) 30 MERMAID ATTI WINTHROP
I HEREBY-CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
(Signature of Agentice Board of Health or other)
HO
.
Jan. 10, 1960
(Date of Issue of Permit)
(Official Designation)
1
[(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)
10 SINGLE
(write the word)
10a If married, widowed, or divorced GOLDEN
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
.66
Years.
.Months ....
.Days
If under 24 hours
Hours.
......
.. Minutes
13 Usual
Occupation :
PRINTER
(Kind of work done during most of working life)
14 Industry
or Business :
RETIRED
15 Social Security No. 013-28-7287
INTERVAL
BETWEEN
ONSET AND
DEATH
3 days
8 yrs.
3 days
Received and filed
1-6-59-925686
Registered No.
No.
(a) Residence. No.
(Usual place of abode)
That I attended deceased from
19 60
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 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.
JAN 1 11960 MM
X
PLACE OF DEATH
Suffolk (County)'
1
Winthrop
(City or Town)
Mayflower Rest Home No.
39 ^rovers Avel(If death occurred in a hospital or institution, t. (give its NAME instead of street and number)
Thomas Naughton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 780 N. Shore Rd.
(Usual place of abode)
Length of stay: In place of death 1 .years. 1 months. 2%
days. In place of residence. ......_ years months .. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
vale
9 COLOR
Thite
10 SINGLE
(write the word)
MARRIED 17. WIDOWED Tidowed or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
ary 1. Gorrin
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12 AGE 92 Years Months Pays
If under 24 hours
Hours ...... Minutes
13 Usual
Retired
Stationary Engineer
Meater Plumber (Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
None
16 BIRTHPLACE (City)
Somerville
(State or country) Mass
17 NAME OF
FATHER
ichael "aughton
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Julia - Unable to Learn
20 BIRTHPLACE OF MOTHER (City) (State or country)
Boston
Nass
21 Marie Dugan
Informant
(Address)
780 " Shore 3d Fevere
I HEREBY CERTIFY that a satisfactory standard certificate of death was fited with me BEFORE the burial or transit permit was issued : Taich ( pereacute;), (Signature of Agent of Board of Health or/other)
felelte fericit (Official Designation)
1/15/60
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?
(Signed
Edward Rosi +64 chula e Rete
Date 1.13
19
Holy Cross
Malden
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Jan 15, 1960 19
7 NAME OF
FUNERAL DIRECTOR
Leslie ". Pike
ADDRESS 305 Beach St Revere
Received and filed
JAN 15 1960
19
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.
Registered No. 8
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
Reve re
St
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
l.
12
60.
(Month)
(Day)
(Year)
HEREBY CERTI
That I attended deceased from
19.
to.
Jan. 12
15
I last saw h ___ alive on Craft 12,160
death is said to
have occurred on the date stated above, at
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Congestive Jaulini (a) CONGRESINE.
ONSET AND DEATH FAILUREIleDe
Due To
Chunic
Endocardi
- (b)
CHRONIC ENDOCARDITIS
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?.
What test confirmed diagnosis ?.
M. D.
(Address)
KÉVERE
07-5-6
M R-301A
.- THIS IS A ANENT RECORD. Use only E APPROVED ‹ ink or black writer ribbon.
STRUCTIONS FOR AL CERTIFICATE
n giving OF DEATH not enter e than one se for each , (b) and (c)
does not mean ode of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib -- death but not to the terminal condition given
- Chapter 137, 1954, requires ans to print or the cause or of death on certificates. HAP. 46, §§ 9 & HAP. 114 §§ 45, CHAP. 38§ 6.)
1-10-58-923886
(Date of Issue of Permit)/ X
2 FULL NAME
9.159. .m.
... ...
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 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.
JAN 1 5 1960
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)
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
January 16, 1960
DEATH
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY ..
That I attended deceased
from
9/29
60
19.
59
January 16,
I last saw hl .. malive on
January 16
19 ..... Q,death is said to
8.10a
have occurred on the date stated above, at
.m.
INTERVAL BETWEEN ONSET AND DEATH
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Status Epilepticus
Due To
(b)
Chronic Epilepsy
yrs
13 Usual
Occupation :
Unknown
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No.
None
Naples
OTHER
Psychosis with mental Defic.
SIGNIFICANT
CONDITIONS
years
Was autopsy performed?
IVO
What test confirmed diagnosis ?
Clinical
18 BIRTHPLACE OF
FATHER (City) (State or country )
Italy
(Signed )
L. J . Valcarce
M. D.
M. C.I. Bridgewaterate
1/16
60-
19
PARENTS
60M-9-59-926111
PLACE OF DEATH
Plymouth (County) Bridgewater (City or Town )
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bridgewater
(City or Town making this return)
9
M.C.I.Bridgewater State Hospital
[ (If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
Antonio Biancardi
(If deceased is a married, widowed or divorced woman, give also maiden name.)
6 Argyle
St
Winthrop, Mass.
(a) Residence. No .. ( Usual place of abode)
Length of stay:
In place of death 1 1years 5 months 4 days. In place of residence.
?
years .....
.months.
.days.
?
(If nonresident, give city or town and State)
?
DATE FILED
Jan. 22.
19.60
{ Registrar of City or Town where deceased resided )
A TRUE COPY
ATTEST :
Sennie W Carroll
(Registrar of City or Town where death occurred )
Received and filed 19
20 BIRTHPLACE OF
MOTHER (City)
( State or country )
Italy
Holy Cross 6 Place of Burial or Cremation
Malden
(City or Town)
DATE OF BURIAL
January ..
19 60
21 Informant (Address)
M. C.I. Bridgewater records
7 NAME OF FUNERAL DIRECTOR Ernest C. Caggiano
ADDRESS
147 winthrop
St. winthrop
JAN 20 1960
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
11 IF STILLBORN, enter that fact here.
12
AGE47 Years ..
4 Months.
4
Days
If under 24 hours
.. Hours ........
Minutes
16 BIRTHPLACE (City)
( State or country )
Italy
17 NAME OF
FATHER
Francisco Biancardi
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify IVO
19 MAIDEN NAME
OF MOTHER
Marie Dimartino
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
ORM R-302
1
No.
Registered No.
( Was deceased a
U. S. War Veteran.
if so specify WAR,.
NO
(write the word)
to .....
19
X
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
JAN DU10"
X
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving : OF DEATH
not enter e than one se for each , (b) and (c)
does not mean de of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not to the terminal condition given
- Chapter 137, 1954, requires ans to print or the cause or of death on ertificates, and r 48, Acts of equires Physi- o print or type nder signature.
N 19 1960 4.5.
1-6-59-925686
PLACE OF DEATH
Winthrop (County)
Suffolk (City or Town)
No. 4 Lorean Terrace
. .......
S(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Howard Malcolm Davis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 4Lorean Terrace St.
(Usual place of abode)
Length of stay: In place of death
4.2years ..
.......... months. X2days. In place of residence .............. years.4.2
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
Married
Male
White
10a If married, widowed, or divorced
HUSBAND of
Helen .... Clair .Johnson
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ..... 7.5.Years.
s .....
5 ... Months .. 21 .. Days
If under 24 hours
Hours ............
.Minutes
13 Usual
Occupation :
Broker-Salesman
(Kind of work done during most of working life)
14 Industry
or Business :
.Wholesale Flour Sales
15 Social Security No. 021-03-6904
16 BIRTHPLACE (City)
Philadelphia
- - (State or country) Pennasylvania
17 NAME OF
FATHER
Daniel Fitler Davis
18 BIRTHPLACE OF
FATHER (City)
Tuckerton
(State or country)
New Jersey
19 MAIDEN NAME
Arthur@Murray
M. D.
OF MOTHER
Emilie Mustin
Arthur C. Murray of Health (PRINT OR TYPE SIGNATURE)
(Address) Minshrops Date 18 Jan 1960
6
Winthrop Cemetery Winthrop Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL January 19 1960 .19.
7 NAME OF
FUNERAL DIRECTOR
alhed B. Marile
ADDRESS 174 WinthropSt.Winthrop ....
1-14
(Registrar)
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.
10
Registered No.
((Was deceased a
{ U. S. War Veteran,
[if so specify WAR)
NO.
(If nonresident, give city or town and State)
months ...........
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
16
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19.
to.
19
I last saw h ........ alive on
19 ............ , death is said to
have occurred on the date stated above, at
11:45 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
(a)
...
Due To
Presumably Coronary Occlusion
(b)
(c)
....
Due
Arteriosclerotic Heart Disease
OTHER
SIGNIFICANT
CONDITIONS
-
Was autopsy performed?
no
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? MO If so, specify ........
PARENTS
21
Informant
Mrs ........ Howard .... M ...... Davis
(Address)
4 Lorean Terrace Winthrop
I HEREBY CERTIFY tbat a satisfactory standard certificate of death was filed with me BEFORE the burial op transit permit was issued:
Mass ...
(Signature of Agent of Board of Health or otber) Health Officer 1/19/60
(Official Designation) (Date of Issue of Permit)
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