USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 56
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10a If married, widowed, or divorced
HUSBAND of
Joseph A. Covino
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CORONARY THROMBOSIS
(a)
...
Due To
(c)
ARTERIO SCHLEROSIS
M R-301A 1
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 cafe 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 recerft [medical attendance or whose physician is absent from home when the certificateof deathis 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.
PLACE OF DEATH
SUFFOLK BOSTON
(Cits of Town)
Na. .. ..
Thr Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN 255
To be filed for burial permit with Board of Health "! !!. Apent
10030
f(If death occurred in a hospital or institution. St ) give ita NAME instead of street and number) PHYSICIAN IMPORTANT
2 FULL NAME
Wendy Williams
( If deceased is a married, widowed or divorced woman, give also maiden name.)
12 George Street
Winthrop, Massachusetts
St
(If nonresident, give city of town and State)
length of stay : In place of death .............. years ....
months ....
2
days. In place of residence
9 years months.
.. days.
MEDICAL. CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
9.
1.9.6.0
(Year)
(Month)
(Day)
THERENY CERTIFY,
That I attended deceased from
October 7
60
October 9
19
60
wd last saw R.Lalive on
October 9, 19 60 death is said to
have occurred on. the date stated above, at
.5 .: 2.5 ..... P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Myeloblastic Crisis
INTERVAL BETWEEN ONSET AND DEATH 2mm
Due To
Chronic MyElogenous
(b)
LenRemia.
2.5 yrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
yes
What test confirmed diagnosis ? autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Ass' W. COM FRIGNATURE
Date ...
Oct. 9 1. 60
WINTHROP WINTITTEIT
Place of Burial(or Cremation
DATE OF BURIAL .
ACT. 11
(City or Town)
1966
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS ....
WINTHROP
OCT 13 1960 Received and filed ... 19 Charles & Iache
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FENIHLET
9 COLOR
WHITE
10 SINGLE
MARRIED)
WIDOWED
of DIVORCEIS
SINGLE
10a If married, widowed, or divorced 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
AGE 9
Years ..
11
Months.
.Days
If under 24 hours
Hours ........... .Minutes
13 Usual
Occupation
SCHLÜR
( Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country )
WINTHROP
MASS
17 NAME OF
FATHER
EARL WILLIAMS.
18 BIRTIIPLACE OF
FATHER (City)
DANVERS
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
MARY L BUCCI
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS.
21 Informant f .. ( ** )
E4ML WILIAMS
(Address) 12 GEORGE ST JUICYTHORUP
I HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE HE )burini or transit permit was Issued: Eliasd IN Callitia ) ( Signature of Agent of Board of Health or other
A11 902
Det 10, 14 60
(Official Designation)
(Date of Issue of Permit)
RM R-301A -
INSTRUCTIONS FOR CAL CERTIFICATE
In giving SE OF DEATH do not enter more than one use for each a), (b) and (c)
is does not mean mode of dying, as heart failure. mia, etc. It means disease, or compli- as which caused
ditions, i/ amy, ich gave rise to ve cause (a). ing the under- it cause last.
Conditions contrib- to death but not d to the terminal e condition given
e Chapter 137. of 1954. requires cians to print or' the cause or " of death on certibrates, and er 48, Acts of requires Physi- lo print or type under signature 1-19-60
rai Director: se use only .ACK ink. M-6-59-925686
PARENTS
M. I).
(Address)
EAST BOSTON
Registered No
[ (Was deceased a U. S. War Veteran, fif so specify WAR)
(write the word)
·
19
to
#: Re-fence No, il'smal place of abode )
MASSACHUSETTS GENERAL HOSPITAL ... ......
A TRUE COPY ATTEST:
nurles it. Mackie City Registrar
TOWN
OF
11 12 1
GILERA
01
MIN
4
5
VTHROP MASS.
DEC 191960 AM
1
R.301A
- -
BOSTON
"it's of Town)
MASSACHUSETTS GENERAL HOSPITAL
......
The Commonwealth of Massarquartts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
OUT - OF - TOWN T. bu filed for bus | permit
1
10357
{{If death occurred in a hospital or institution, St. ) give its NAME instead of street and number)
IMIEI JANT
2 FULL NAME ... Julia Nowak
(Dontto)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
'al Residence No. 20 Floyd Street
it'sual place of abode )
(If nonresident, give city or town and State)
length of stay : In place of death ...... years .. ....... months. days. In place of residence ... years .. ...... months. .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF DEATH October 17 19.6.0
(Month) (Day)
(Year)
September 24,60 to October 17
6.0
4 1 HERENY, CERTIFY That weattended ileceased froin [Clast saw & Lalive on October 17, 19 60 death is said to have occurred on the date stated above, at 1:53 pm. INTERVAL BETWEEN ONSET AND DEATH (a) ..... 7 wks
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CARCINOMA OF RIGHT
BREAST
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
yes
What test confirmed diagnosis ?
autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify ....
(Signed)
@@@cay
M. 1).
Charles L. Clay, M. D. (PRINT OR TYPE SIGNATURE) (Address) .....!!!! , Dir. ,Mass. Gon'l. Hosp. Date.
Oct. 17,60
6
St ... Icheels Boston
Place of Burial or Cremation
Uitober
CO (City of Town) 60
19
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country)
Főland®
19 MAIDEN NAME
OF MOTHER
Anna
Cab1
20 BIRTHPLACE OF MOTHER (City) (State or country) toland
21 Edward Nowak ( husband ) Informant (Address) 2.0 Floyd St. Winthrop Lass
I HEREBY CERTIFY that a satisfactory standard certificate of death hled with me BEFORE the burial of Japan? permit, was Issued:
(Signature of Agent of Board of Health or other)
412/06
10/18/200
(Official Designation)
( Date of Issue of Permit )
X
10a If married, widowed, or divorced HUSBAND of Edward WOWER
me of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILL.BORN, enter that fact here.
65
12
AGE
Years
Months ...........
.1)ay *
If under 24 hours
Hour » .............. Minutes
13 UNUAl
Occupation :
housewife
( Kind of work done during most of working life)
14 Industry
or Business :
none
15 Social Security No.
Pielgrzymka
16 BIRTHPLACE (City)
(State of country)
Foland
17 NAME OF
FATHER
Alexander Danilo
DATE OF BURIAL
John ! . Baldyga
ADDRESS ..........
Received and filed
.......
OCT2 0 1960 19.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
[SW'as deceased a {U. S. War Veteran, (if so specify WAR)
Winthrop, Massachusetts St.
UCTIONS FOR CERTIFICATE
RIVIng OF DEATH ot enter than one for each b) and (c)
es not mean of dying, heart failure. sc. It means 1,or compli- hick caused
as, if any, ave rise to ause (a), the under. ause last.
ions contrib. eath but not the terminal dition given
hapter 137. 54 requires
death on lu ales, and * Aris of ires Physi- n1 o1 type r 'IKnature .19.1910 Director se only K Ink.
9-925686
PLACE OF DEATH
SUFFOLK
Registered No
10 SINGLE
MARRIED ATTfeed)
WIDOWED
Of DIVORCED
7 NAME OF
FUNERAL DIRECTOR
16 : Freble Et. So. Boston
A TRUE COPY ATTEST:
Charles & Mackie
City Registrar
TOWN
OFFICE OF
11 12
GLER
MIN
5
6
ROP. MASS.
DEC 1 91960 AM
X
Suffolk
(County) Chelsea
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this returo))
573
Registered No.
S (If death occurred in a hospital or institution. St. ¿ give its NAME instead of
street_and number)
I-WWII
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
114 Winthrop
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 ...
1months ....
Rays. In place of residence ..
.. yea
5
months.
......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Oct.18,1960
( Month)
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
4 I HEREBY
Sept.9
CERTIFY,
60
19
im
Oct.18
60
...
death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH
(or) WIFE of.
( Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial infarction
6 hrs
64 6
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation:
U.S.Army (Retired)
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
024-07-3023
Mohlndal Sweden
OTHER
Rheumatic heart disease
SIGNIFICANT
CONDITIONS
no
Was autopsy performed ?
What test confirmed diagnosis ?
FCG
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed )
Daniel A.Hart
M. D.
USNH, Chelsea, Mass.
10/18/60
(Address)
Winthrop Cem. , Winthrop, Mass. 6
Place of Burial or Cremation City or Town)
DATE OF BURIAL
Oct.21,1960
19
7 NAME OF FUNERAL DIRECTOR
Reynolds Fun. Home
ADDRESS 180 Winthrop st. , Winthrop, Mass.
Received and filed DEC 9 1900 19
ATTEST :
( Registrar of City or Town when death occurred)
DATE FILED
Oct.19,1960
19
( Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME OF MOTHER Hannah Olson
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Sweden
Informant
21
V.MacNeil (wife)
( Address)
114 Winthrop St. , Winthrop.
Mass.
A TRUE COPY
Pocephe atTuare 20
50M-9-59-926111
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) 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)
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
1
PLACE OF DEATH
(City or Town)
U.S.Naval Hospital No
Edmund Lambert MacNeil
(Was deceased a
U. S. War Veteran.
(if so specify WAR,
&Korea
That I attended deceased from
Oct.18
60
19
10a If married, widowedpor divorced
HUSBAND of
4.Trask
(Give maiden name of wife in full)
I last saw h
anve on
1:15p.
m.
11 IF STILLBORN. enter that fact here.
12
AGE.
Years.
Months .......... Days
Due To (b) Coronary atherosclerosis
16 BIRTHPLACE (City)
(State or country)
17 NAME OF FATHER Frederick P.
18 BIRTHPLACE OF FATHER (City) (State or country) Boston, Mass.
V.B.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
191.7
DATE OF DISCHARGE
1955
RANK, RATING
M/Sgt.
ORGANIZATION AND OUTFIT
U .S.Army
SERVICE NUMBER
RA20120424
1
CLERK
RECEIVED
ASS
Vi
IP.
TO
1.2
TH
OF
WIN
OFF/~
DÉC = 91960 AM
PLACE OF DEATH
Suffolk (County)
East Boston (City or Town)
The Commonwealth of Massachusetts OUT - OF - TOWN JOSEPH D. WARD To be filed for burial perming with Board of Health SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS 10483 STANDARD CERTIFICATE OF DEATH Registered No.
Princeton-Shelby Nursing Home [(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number) No.
2 FULL NAME ... Triantos (Rodopoulos)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
195 Court Road
St
Winthrop Lass
(Usual place of abode)
Length of stay: In place of death
.........
... years ...
months ..
.. 10 ... days. In place of residence.
.4.8.years .......... months ...
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
3 DATE OF
DEATH
October
(Month)
(Day)
1960
(Year)
4 1 HEREBY CERTIFY, That I attended deceased from
1.057
19.
to Cantinhar 70
a
10a If married, widowed, or divorced delen Stathopoulos
HUSBAND of
(Give malden name of wife in full)
(or) WIFE of
(Husband's name In full)
11 IF STILLBORN, enter that fact here.
12
CAGE 76
Years
7
Months ...
4. Days
If under 24 hours
Hours ...........
.. Minutes
13 Usual
Occupation :
retired proprietor
(Kind of work done during most of working life)
14 Industry
or Business :
wholesale fruit and produce
15 Social Security No. none
16 BIRTHPLACE (City) (State or country) Greece
17 NAME OF FATHER Theodore Rodopoulos
1% BIRTHPLACE OF
FATHER (City)
(State or country)
Greece
19 MAIDEN NAME
OF MOTHER
unable to obtain
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Greece
. 21 Informant (Address)
Irs. Harvey A Herbert
195 Court Road, Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with. me AEFORE the burlas or transit permit was issued: E Cusack
(Signature of Agent of Board of Health or other)
11141
10-21-60
(Official Designation)
(Date of Issue of Permit)
VI.
+
M R-301A 1
TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH not enter e than one se for each , (b) and (e)
does not mean ode of dying, heart failure, . etc. It means asr, or rompit. which caused
tions, if any, gave rise to cause (a). g the under. cause last.
ditions contrib. death but not to the terminal conditton fitem
1.5,
. Chapter 137, 1954, requires ans to print or he cause or of death on ertificates, and 48. Acts of quires Physi- print or type der signature.
6 Forest Dale Cemetery, Malden, Mass Place of Burial or Cremation (City or Town)
DATE OF BURIAL October 22. 1960 albert 3 March
7 NAME OF
FUNERAL DIRECTOR
ADDRESS 174 Winthrop St. Winthrop,
Received and filed
OCT 2-5 1960
19
Charles 21. Machen
7 Freir.
Due To interin lerntin heart Ticeare (b)
Due To
.
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ? um
What test confirmed diagnosis ?
5 Was disease & injury in any way related to occupation of deceased? 20 If so, spe
(Signed)
M. 1). ... John. (PRINT OR TYPE SIGNATURE)
(Address) 2.2 .......... arington trebate Cot, 20, 1960
PARENTS
PHYSICIAN
IMPORTANT
f(Was deceased a
U. S. War Veteran,
[if so specify WAR)
NO.
MARRIED
WIDOWED
or DIVORCED
widowed
I last saw himalive on Onlahan ?"
19 ........... , death is said to
have occurred on the date stated above, at 1 ......: [ ... 5 ...... m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
I'mnotatin noumonin
.....
.......
(If nonresident, give city or town and State)
V.B.
5-59-925686
9.60
A TRUE COPY ATTEST:
Cautley Pt Mackie
City Registrar
TO!
JO 301
11 12
,2
GILERI
OF
0
MIN
3
8
WIR
5
6
HROP MASS.
DEC 191960 AM
602
×
Worcester
(County)
Worcester
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
259
To be filed for burial permit with Board of Health or its Agent.
Registered No. 2773
2 FULL NAME
ANNIE E. GRADY
(First Name)
(Middle Name)
(Last Name)
[( Was deceased a U. S. War Veteran,
lif so specify WAR)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
63 Crest Ave.
Winthrop, Mass.
( L'suai piace of abode)
(If nonresident, give city or town and State)
Length of stay: In piace of death. .. years .. months .. .days. In place of residence 5.0. years. months. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
20
1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from November ..... 18.19.60, to.November 20, 196.0 I last saw h.eralive on .November 18 , 19 60, death is said have occurred on the date stated above, at .2:00 p .... m.
IOa If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Generalized arteriosclero-
DEATH
sis
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
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)
Comand M. Forny
1. M. D
Edmond M. Koury, M.D.
(PRINT OR TYPE SIGNATURE)
(Address) .S.t .... Vincent .... Ho.sp .. 11/20
16.0
St.John's
Clinton, Mass.
6
Place of Burial or Cremation
(Clty or Town)
DATE OF BURIAL
Ked.Nov .23
196.0
7 NAME OF
FUNERAL DIRECTOR
Callahan Brothers bv Francis Callahan
ADDRESS
36 Trumbull St.
Received and filed .NOV. 29 1960
Robert J. O Keefe 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City) (State or country) Ireland
19 MAIDEN NAME
OF MOTHER
Mary Hoban
20 BIRTHPLACE OF MOTHER (City) (State or country) . Ireland
21 Mary O' Donnell
Informant
....
(Address)
8 Hitchcock Road
I HEREBY CERTIFY that a satisfactory standard certificate of death & issued: As filed with me
the burial or transit cermit hack
(Signature of Agent of Bond of Health or other)
atestonet of Pablo .Heshtk.
Date of Issue of ser'
(Oficial Designation)
Charles M.Callahan 11-20-60
TRUCTIONS FOR IL CERTIFICATE
n giving E 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
e :- Chapter 137, of 1954. requires cians to print or the cause or of death on certificates, and er 48, Acta of requirea Phyal- to print or type under aignature.
10. 19,60
PLACE OF DEATH
No ..
Providence Hlouse -73 Vernon
S(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
10
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
khite
10 SINGLE
(write the word)
If under 24 hours
Hours ..........
Minutes
13 Usual
Occupation :
At home
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Mass.
Clinton
17 NAME OF
FATHER
Michael Grady
-
-
M R-301A 1
50-928145
12
? YrsAGE .... 9.8.Years ..
Months .............. Days
INTERVAL BETWEEN ONSET AND Il IF STILLBORN, enter that fact here.
MARRIED
WIDOWED
or DIVORCED
Single
St
RECEIVED
TOV
OF
11.12.
OFFICE
10.
9.
MIN
GLERK
8
W
6
MASS.
DEC 1 91960 AM
ORM R-302
DEATH (b) Due To (c) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased CONDITIONS
PLACE OF DEATH
Suffolk
(County) Chelsea
(City or Town)
Soldiers' Home
The Commonwealth of Massarhusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
643
Registered No.
Hospital § (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
John Vincent Lynch
(If deceased is a married, widowed or divorced woman, give also maiden name.)
363 Pleasant
St.
Winthrop, Mass.
(If nonresident. give city or town and State)
Length of stay:
In place of death .......... years.
months.
26
3
days. In place of residence
.. months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
Nov.22,1960
( Month)
(Day)
(Year)
4 LHEREBY CERTIFY,
7/26/60
That I attended deceased from
11/22/60
19
19 ...
death is said to
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Recurrent episodes of (a)
cerebral vascular accident
?
Due To
Cerebral arteriosclerosis
?
Cachexia
clinical
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
Vincent Capodilupo
M. D. (Address soldiers ' Home
Date.
11/22/60
Woodlawn, Everett, Mass. 6
Place of Burial or Cremation Nov.25,1960 19
7 NAME OF
Maurice W.Kirby Fun. Home
FUNERAL DIRECTOR 210 Winthrop St. , inthrop
ADDRESS
Received and filed 12-29-60 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
White
9 COLOR
10 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCEMarried
10a If married, widowed. gr.divorcedargan 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
69
8
9
If under 24 hours
...
.Hours ....
.Minutes
AGE
Years.
Months ......
... Days
Salesman
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
not known
15 Social Security No.
cannot be learned
16 BIRTHPLACE (City)
(State or country )
Charlestown, Mass.
17 NAME OF
FATHER
Hugh A.
18 BIRTHPLACE OF
FATHER (City) ...... Boston, Ma'ss.
(State or country )
19 MAIDEN NAMEry F. McGowan OF MOTHER
20 BIRTHPLACE OF MOTHER (City) ...... Boston, Ma.s.s.
(State or country )
Hospital Records
( Address) 91 Crest Ave . , Chelsea, Mass
21 Informant
A TRUE COPY
Joseph a Tyrrell
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
Nov. 22.1960
19
V.BL
-
1
No ..
2 FULL NAME
19
I last saw h ...... anve on
OTHER
SIGNIFICANT
Was autopsy performed ?
DATE OF BURIAL
resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)
What test confirmed diagnosis ?
50M-9-59-926111
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town .
WWI
( Was deceased a
U. S. War Veteran.
if so specify WAR,
(a) Residence. No. ( Usual place ofnbsdsp ..
im 11/22/60
3:40A
PARENTS
(City or Town)
RECEIVED
- OFFICE OF
TOW,
11 12. 1
10
$2
ERK
MIN
6.5
THRO
JAN 41961 AN
I R-301A 1
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one : for each (b) and (c)
oes not mean le of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
S
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?
NO
If so, specify
(Signed)
JOHN F. PEPRM.D.
(Address)
6 St. Michael Boston
Place of Burial or Cremation (City or Town)
DATE OF BURIAL Dec, 7 1960
7 NAME OF
FUNERAL DIRECTOR Permacchio ES on ADDRESS 5980, Margin St. Boston
Received and filed DEC 6 1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
Female White
(writeathe word)
10 SINGLE
MARRIED
WIDOWED Andone
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Frank
(Give maiden name of wife in full),
Bellamacina
( Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE & 6 Years.
Months.
Days
If under 24 hours
Hours.
......
.Minutes
13 Usual
Occupation :
House wife
(Kind ot work done during most of working life)
14 Industry
or Business :
15 Social Security No.
une
16 BIRTHPLACE (City)
(State or country)
messina Italy
17 NAME OF
FATHER
Lea
(NU) ~ ~ Knowing>
18 BIRTHPLACE OF
messina
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
concetta (LNU)
20 BIRTHPLACE OF
messina
Joseph Gentile
....
I HEREBY CERTIFY /tbat a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mapple ferranul . (Signature of Agent of Board of Health of other)
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