USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 55
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To be filed for burial permit with Board of Health or its Agent.
Lavflower Singing HOME No. .
George "illiam Adams
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15Fierce Str. et
DEvere, I.S. St.
(a) Residence. No .. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years months 5 days. In place of residence. ........ years. months ...._. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November 23 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,,
cet.
19.
60
That I attended deceased from
23
1960
I last saw h Inalive off CvEmber22 1960
death is said to
have occurred on the date stated above, at
6;20 cm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Chronic
Nephritis
Due To (b) ..
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
UREMIA
6 mos.
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 __ 4
(Signed)
M. D. Winthrop, Mats Date 11/13/1960
(Address)
6 oodicen Cemetery
Everett. L.SE (City or Town)
Place of Burial or Cremation DATE OF BURIAL ovemter :0 1900
7 NAME OF
FUNERAL DIRECTOR
"illiar J. Fillion
ADDRESS i Spraque Street Fevere
Received and filed RT 25 19 C-
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWEDVIGOT. IL
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Lary Ann
Livingstone
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
٠٨
Years
.Months ________ Days
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation :
Calinet Nakit - Btc
(Kind of work done during most of working life)
14 Industry
Busines
Furniture
15 Social Security No.
16 BIRTHPLACE (City) Delmouth, Isc. (State or country)
PARENTS
17 NAME OF
FATHER
unable to bier
18 BIRTHPLACE OF
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER Unable To learn
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
c.
21 Informant Tugene . /dms
(Address)
15 Differ itril
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) Diabete Mtien
(Official Designation)
(Date of Issue of Permit) 11/23/60
B .- THIS IS A ANENT RECORD. Jse 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, s 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 of of death on certificates. HAP. 46, §§ 9 & HAP. 114 $$ 45, CHAP. 38$6.)
1-10-58-923886
1
Registered No. 250
[(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
to
INTERVAL BETWEEN ONSET AND DEATH 5 yrs.
M R-301A
20 Sargent
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
RECEIVED
TOWN
OFFICE OF
11 12.
0
MIN
CLERK
1
6.5
M
THROP.
NOV 2 51960 AM
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.
X 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.
Registered No.
251
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
William Paton Jr.
(First Name)
(Middle Name)
(Last Name)
[(Was deceased a U. S. War Veteran, (if so specify WAR)
no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
811 Shirley St
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death ..
.years.
.. months.
days. In place of residence.
2
.years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
November 25, 1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
-
That I attended deceased from
JULY 10, 1958, o
NOV 25
60
I last saw h.f.Kmelive on
NOU
25
19.60
death is said to
have occurred on the date stated above, at 605 pm.
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
.74
AGE
Years.
Months.
Days
If under 24 hours .Hours. .Minutes
.13 Usual
Occupation :
Retired Fik
(Kind of work done during most of working life)
14 Industry
or Business :
Painter Hu
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Scotland
17 NAME OF
FATHER
William Paton
18 BIRTHPLACE OF
FATHER (City) (State or country) Scotland
19 MAIDEN NAME
OF MOTHER
Helen Whitehouse
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
21 Adella Paton
Informant (Address) 811 Shirley St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
1
(Signature of Agent of Board of Health or other)
11,38/60
(Official Designation) (Date of Issue of Permit)
50-928145
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means se, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not o the terminal condition given
:- Chapter 137, £ 1954. requires ians to print or the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.
(Signed)
Myron n. Kuig M. D. MYRON ON. KING MID
(PRINT OR TYPE SIGNATURE)
(Address) 222 PLEASANT ST Date 11/26 1960
WINYMOD
Woodmere Cemetery Detroit Mich. 6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL November ..... 29 19.60.
7 NAME OF
FUNERAL
DIRECTOR
Arthur J. O'Maley
Winthrop Mass.
ADDRESS
Received and filed
NOV-2-8-1960
19
(Registrar)
PARENTS
10a If married, widowed g jed Smalley
HUSBAND of
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
GENERAL CARCINOMATOSIS
Due To
(b)
PROSTATIC CARCINOMA
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NINE
Was autopsy performed?
No
What test confirmed diagnosis?
PATHOLOGICAL
No
5 Was disease or injury in any way related to occupation of deceased? If so, specify
INTERVAL BETWEEN ONSET AND DEATH 7mo. 1 1/2YRS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
St
{If nonresident, give city or town and State)
No. 811 .... Shirley ...... St.
M R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RECEIVED
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
TO!
i ?. 1
F
6
'INTHRO
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 diseaseAnd 2 31960 AM 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.
ORM R-304
PLACE OF DELIVERY
SUFFOLK (County )
Winthrop (City or Town)
No.Win. Comm. Hospital
2 NAME OF FETUS (if given)
Baby Boy Hunter
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
252
- (If death occurred in a hospital or institution. give its NAME instead of street and number)
3 DATE OF
DELIVERY
11/26/60
( Month)
(Day)
(Year)
4 SEX
Malex
.. Female .... . Undetermined
5 COLOR (if
determined) W
6 THIS BIRTH (Check one)
SingleX
Twin
Triplet
7 IF MULTIPLE BIRTH, BORN:
1st ..
2nd.
3rd
FATHER
MOTHER
14
MAIDEN NAME
Thelma Day
PRESENT NAME
Thelma Hunter
9
RESIDENCE, NO
7 Johnson Terr.
STREET
CITY OR TOWN
Winthrop,
STATE.
Mass.
15
RESIDENCE, NO.
CITY OR TOWN
7 Johnson Terr.
Winthrop,
STATE
Mass.
10 COLOR OR
RACE
White
11 AGE AT TIME OF
THIS DELIVERY
43 (Years)
16 COLOR
RACE
White
17 AGE AT TIME OF
THIS DELIVERY
39
(Years)
12 PLACE OF
BIRTH
Spartansburgh, S. Carolina
(City or Town)
(State or country)
18 PLACE OF
BIRTH
London, England
(City or Town)
(State or country)
13
OCCUPATION
Traffic Manager
19 INFORMANT
Thomas D. Hunter
20 PREVIOUS DELIVERIES TO MOTHER
(Do not include this fetus),
Three (3)
(a) How many children are
now living?
2
(b) How many children were
born alive
dead?
1
but are now
(c) How many previous fetal deaths of ANY gestation age? 0
21 LENGTH OF
PREGNANCY
37
.completed weeks
22 WEIGHT OF FETUS
Lb.
Oz.
.Grams)
(or
23 WHEN DID FETUS DIE? Before Labor.
24 AUTOPSY
Yes
No
X
25 FETAL DEATH WAS CAUSED BY: IMMEDIATE CAUSE Twisted Cord (a)
Due To (b)
Premature Delivery
antepartum death.
Due To (c)
OTHER SIGNIFICANT
CONDITIONS
None
26
Winthrop
Place of Burial or Cremation
Winthrop
(City or Town)
DATE OF BURIAL
Nov. 29
1960
27
NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS winthrop, Mass
Received and filed
NOV 2.9 1960
19
(Registrar)
I HEREBY CERTIFY that this delivery occurred on the date stated above at. 2 -- A m., and product of conception was not a live birth.
Signature of Attending Physician or, Medical Examiner : UM. Tranytce
M.D.
M. Traunstein, Jr., M. D. (PRINT OR TYPE SIGNATURE)
73 Bartlett Road Address Winthrop 52, Mass. DatNov.29,1960.
I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued:
( Signature of Agent of Board of Health or other )
Mabile Cucur 1' 29 60 (Official Designation ) (Date of Issue of Permit)
In giving CAUSE OF TAL DEATH do not enter nore than one ause for each of (a), (b) and (c)
tal or maternal, dition causing al death (do t use such ms as stillbirth prematurity.) tal and/or ma- nal conditions, ny, which gave se to above ise (a), stating underlying ise last.
nditions of fetus mother which y have contrib- ed to fetal ath, but, in so · as is known, re not related cause given (a).
15M-6-60-928241
1
.St.
A TRUE COPY ATTEST :
X
During Labor
or Delivery.
Unknown
STREET
8
FULL
NAME
Thomas D. Hunter
FETAL DEATH
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48, ACTS OF 1960.
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, ... shall not be permitted except ... ".
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births. OP.
Section 12. " ... No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmNOM gogafslother city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
X
PLACE OF DEATH
SUFFOLK
1
(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.
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. FRED WRIGHT
PHYSICIAN - IMPORTANT
f(Was deceased a
(First Name)
(Middle Name)
(Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
241 Washington Avenue, Winthrop
St.
Length of stay: In place of death ..
......
years ..
......
months.
.days. In place of residence.
years.
.. months .........
days.
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
29,
1960
(Month)
(Day)
(Year)
perforation of brain.
5 Accident, suicide, or homicide (specify)
Suicide.
19.
Date and hour of injury
11/29
IF ACCIDENTAL, was injury causally related to the death ?
Where did
Winthrop, Massachusetts
Injury occur ?
(City or town and State)
Nature of
woundsHofid headcuand chest.
Injury
(Signe
Michael A. Luongo, M. D.
Boston
(Address)
Date
7
Winthrop Cemetery,
Winthrop
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
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. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
§§ 44-48.
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
DATE OF BURIAL
Dec
SOM-6-60-928145
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
While at work?
Was autopsy performed ?
Yes
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
male
10 COLOR
white
11 SINGLE
(write the word)
MARRIED
WIDOWED)
or DIVORCED Widowed
4 I 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.) Gunshot wound of head with
11a If married, widowed, of divorced
A. Sullivan
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
Years .....
Months.
14
'Days
.Hours
Minutes
14 Usual
Occupation :
Carnival Worker (retired)
(Kind of work done during most of working life)
15 Industry
Show business
or Business :
16 Social Security No.
053-16-7965
17 BIRTHPLACE (City)
(State or country)
Indiana
18 NAME OF
FATHER
William G. Wright
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Indiana
20 MAIDEN NAME
OF MOTHER
Mary E.
?
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Indiana
22 Gertrude Preen
Informant
(Address)
241 Washington 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)
Wealth Ofere
(Official Designation)
(Date of Issue of Permit)
Joe 2 , 1460,
Received and filed
DEC ---- 4060
19
PARENTS
6 Was disease or injury in any way related to occupation of deceased ?.
If so, spec Haushalthong What Congo M. D.
(Print or Type Signature)
11/29
60
19.
Place of Burial, or Cremation. (City or Town)
1960
8 NAME OF
Ernest P. Caggiano
FUNERAL DIRECTOR
ADDRESS
147 Winthrop St., Winthrop
60
Did injury occur in or about home, on farm, in industrial place, or in public place ? Home
(Specify type of place)
Manner of Self-inflicted pistol shot
Injury
Princeton
If under 24 hours
80
4
(If nonresident, give city or town and State)
ORM R-303 A
VI HILL HIL CAUSE UR CAUSES OF DEATH ON DEATH CERTIFICATES.
En route to Winthrop Community Hospital
U. S. War Veteran,
(if so specify WAR)
no
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE:
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
RECEIVED
SERVICE NUMBER
OF TOWN
1. ??
RULES OF PRACTICE
9
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 Po 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 DEC - 51960 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 administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture 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.)"
PLACE OF DEATH
Suffolk
(County)
LINSE PETIT
Winthrop
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
NOV. rg
To be filed for burial permis with Board of Health or its Agent.
Registered No.
2254
f(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Eva Covino
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
45 Buchanan St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
years.
.months.
days. In place of residence.
35
.. years.
months ............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWEMarried
or DIVORCED
(write the word)
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19 60
MARCH 14, 1957, to.
NON 30
I last saw h .. CZalive on ....
30
19.00, death is said to
have occurred on the date stated above, at
3.30 Pm.
INTERVAL BETWEEN ONSET AND DEATH
1 HR
Due To
(b)
HYPERTENSIVE HEART DISEASE
2YRS
6 YRS
OTHER
SIGNIFICANT
HYPERTENSION
CONDITIONS
Was autopsy performed?
......
NC
What test confirmed diagnosis?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? NO
If so, specify
(Signed)
darles Vertingi
M. D
CHARLES SALEMI
(PRINT OR TYPE SIGNATURE)
(Address)
342 HANDVERST
.. Date ..
11/30/1960
BESTEN
Winthrop Cemetery Winthrop
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL December 3 19 60
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop, Mass
Received and filed DEC -2 ....... 1960 19
(Registrar)
PARENTS
Studeinska
17 NAME OF
FATHER
Jacob Studziske
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
19 MAIDEN NAME
OF MOTHER
Josephine
20 BIRTHPLACE OF MOTHER (City) (State or country) Poland
21 Joseph A. Covino
Informant
(Address)
45 Buchanan St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E. Virianne (Signature et Agent of Board of Health or other) city Dec.2-1960
HO
(Official Designation)
(Date of Issue of Permit)
STRUCTIONS FOR AL CERTIFICATE
In giving E OF DEATH
not enter re than one se for each ), (b) and (c)
does not mean ode of dying, s heart failure, , etc. It means ease, or compli- which caused
itions, if any, gave rise to . cause (a), g the under- cause last.
nditions contrib- o death but not to the terminal condition given
e :- Chapter 137, of 1954. requires icians to print or the cause or s of death on certificates, and ter 48, Acts of requires Physi- to print or type under signature.
60-928145
11 IF STILLBORN, enter that fact here.
6 %
12
AGE.
66%
ears ..
Months .......
... 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.
16 BIRTHPLACE (City) (State or country)
Poland
No.
45 Buchanan St.
Studzinska.) Studziske ) {(Was deceased a { U. S. War Veteran, (if so specify WAR)
PHYSICIAN - IMPORTANT
(a) Residence. No.
(Usual place of abode)
3 DATE OF
November 30, 1960
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