USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 17
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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.
X
PLACE OF DEATH
Suffolk Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
CERTIFICATE OF DEATH
Registered No.
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
122
Broadway
St. Genere mars
(If nonresident, give city or town and State)
Length of stay :
In place of death.
.. years.
months ..
1
.days. In place of residence.
years ..
.....
months ..
.....
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
5
61
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
1961
SEPT 5
19 60 to
MAY
5
I last saw HER alive on
MAY
5
1961, death is said to
have occurred on the date stated above, at
6 55 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
LEFT VENTRICULAR DILATATION
Due To (b)
AORTIC STENOSIS AND REGURG.
Due To
(c)
RHEUMATIC HEART DISEASE
OTHER
SIGNIFICANT
ANTERO POSTERIOR MY SCAR
CONDITIONS
DIAL INFARCTION
Was autopsy performed?
NO
What test confirmed diagnosis?
Ec6
5 Was disease or injury in any way related to occupation of deceased? Na If so, specify
(Signed)
Charles J. Cat aldo
M. D.
CHARLES J. CATALDO
(PRINT OR TYPE SIGNATURE)
(Address) 48 BYRON ST EBOSTI Date MAY 6 1961
Holy Cross Com. Malden 6 Place of Burialor Cremation
DATE OF BURIAL May 8,
19
61
7 NAME OF
FUNERAL
DIRECTOR
Paul Buonfiglio
ADDRESS 128 Severe St Revere
Received and filed
MAY 8 1961
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female white
9 COLOR
10 SINGLE
MARRIED
WIDOWE
or DIVORCED
(write the word) Widowed
10a If married, widowed, or divorced HUSBAND of
(or) WIFE of
an Give maiden
(Give maiden name of wife in full) orino Cataldo (Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
61
AGE
Years.
Months
... Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
at Home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Edward Columbo
18 BIRTHPLACE OF
FATHER (City)
Italy
(State or country)
19 MAIDEN NAME
OF MOTHER
Cannot Be Learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Informant (Address)
mrs. many Cella 36 ambrosedit Revere
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)
May7, 1961
(Official Designation)
(Date of Issue of Permit)
V
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
es not mean of dying, heart failure, tc. It means , or compli- hich caused
ns, if any, ave rise to ause (a), the under- ause last.
ions contrib- eath but not the terminal dition given
Chapter 137, 1954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type der signature.
928145
R-301A 1
No.
Winthrop Comm. mary Cataldo
Hosp.
(First Name)
( Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
[(Was deceased a U. S. War Veteran, (if so specify WAR)
(a) Residence. No. (Usual place of abode)
EVERY
INTERVAL BETWEEN ONSET AND DEATH 4 DAYS
15 YEARS
15YEARS
4 YEARS
PARENTS
(City or Town)
2 -
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
11
ERK
0
THROP. N.P.
MAY =81961
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 bad 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
X Suffolk ( County )
l'L Chelsea 69.61 Winthro (City or Yown) Cresthavenhuwing Home No.
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. 80
[(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
(If deceased is a married, widowed of divorced woman, give also maiden name.) 4Massen Que
(a) Residence. No. (Usual place of abode)
Length of stay : In place of death ......... ... years ... .months ... days. In place of residence
53 years.
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
9
1961
(Months
(Day)
(Year)
4 Į HEREBY
CERTIFY
May
9
That I attended deceased from
19 .. 60/
I last saw ha.Malive on
May
11
1961, death is said to
have occurred on the date stated above, at ges Am.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
....
Coronary heart disease
5yrs
12
AGE
76
Years.
Months ....
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Building Contractor
(Kind of work done during most of working life)
14 Industry
or Business :
Building Trade
15 Social Security No. 022-16-7468
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Barney Zigman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Lifoha (CBL)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lillian
Russia
21
Informant
(Address)
9 Strathmore Ra Brockling
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E. Reliance
(Signature of Agent of Board of Health or other) May 10-1961
(Official Designation)
(Date of Issue of Permit)
X
8 SEX
male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Divorced
or DIVORCED
HUSBAND of
dowed, or divorce ed Kala Shapiro
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Due To
Arteriosclerosis
(b) ...
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Pulmonary Emphysema
Was autopsy performed ?
No
What test confirmed diagnosis ?
E C,G.
5 Was disease or injury in any way related to occupation of deceased? No. If so, specify
(Signed)
Abraham Hold
M. D.
Abraham Gold MD
(PRINT OR TYPE SIGNATURE)
(Address)
160 Washington Que
( Date may 9 1961
6
Liberty Progressive
EVERETT
Place of Burial or Cremation
DATE OF BURIAL
May 10
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
TORF Funeral Service Inc
ADDRESS 151 Washington Ave Chiprea
Received and filed MAY 1-0-1961
(Registrar)
PARENTS
Examenes
M R-301A 1
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH
not enter e than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means ase, 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 ans to print or he cause or of death on ertificates, and 48, Acts of :quires Physi- print or type der signature.
6-59-925686
William Zignan 2 FULL NAME
St.
Chelsea
(If nonresident, give city or town and State)
Mendelsohn
PERSONAL AND STATISTICAL PARTICULARS
Nov.
1959, to
.
William Zigman 4
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
022-16-746 Social Security
RULES OF F
The fulfillment of the purpose of these following rules of practice : (1) Attending physicians will certify to > to whom they have given bedside care during . related to any form of injury.
(2) Board of Health physicians will certify to such us persons who, though disabled by recognized disease unrelat. injury, have died without recent medical attendance or whose . absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths suppos. 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-302
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town 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
PLACE OF DEATH
Essex ( County )
Danvers
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
( City or Town making this return)
No. Danvers State Hospital, Hathorno.
give its NAME instead of street and number)
2 FULL NAME Eva Fronduto (Fortin)
( Was deceased a
(If deceased is a married, widowed or divorced woman, give also maiden name.)
U. S. War Veteran.
(if so specify WAR,
No
(a) Residence.
No ..
60 Pebble Avenue
6.1
Winthrop
( Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years ... .4+months .......... days. In place of residence .......... years .......... months .......... days.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
( Month)
(Day)
( Year)
4 I HEREBY CERTIFY,
That I attended deceased from
January ..... ]7., 19 ...
61 to ..... Ma.y ..... 17 ,.
19
61
I last saw h.Ellive on
May ..... 17,.
19 ... 61death is said to
have occurred on the date stated above, at 5: 30.p.m.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
month
SAGE
55 Years 10 Months.
17avs
If under 24 hours
.Hours ........
Minutes
13 Usual
Occupation:
housewife
( Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
030-16-1177
Quebec
16 BIRTHPLACE (City)
( State or country )
Canada
17 NAME OF
FATHER
Seraphin Fortin
18 BIRTHPLACE OF
Unknown
FATHER (City)
(State or country )
Canada
(Signed)
Andrew Nichols III
M. D.
( Address)
Hathorne, Mass.
Date
5-17-
61
19
PARENTS
19 MAIDEN NAME
OF MOTHER
Virginia, maiden name u
20 BIRTHPLACE OF
MOTHER (City)
( State or country)
Unknow
Canada
Holy Cross Cemetery, Malden 6
Place of Burial or Cremation May 20,
(City or Town)
DATE OF BURIAL
19
Informant
( Address )
Hathorne, Mass.
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS
E. Boston Mass.
JUN 6 1961
Received and filed
19
A TRUE COPY Powiep & Toomey
ATTEST :
(Registraf &f/City or Town where death occurred)
DATE FILED
May 24,
.. 19 ..
61
( Registrar of City or Town where deceased resided)
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
10a lf married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Nicholas .... Frondut.o
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Cancer of Uterus with metastases
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Decubitus of back
Was autopsy performed?
no
What test confirmed diagnosis ?
Clinical & Laboratory
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
61
21 Mary E. Sheehan
50M-9-59-926111
1
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
MEDICAL CERTIFICATE OF DEATH
1.7.
1.961
Registered No.
§ (If death occurred in a hospital or institution,
JUN - C1961 AM
SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
PLACE OF DEATH
SUFFOLK (County) Bis Tox 6-9-61
Winthrop, Mass. (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No. 82
[(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
(a) Residence. No. 237 Everett, St
.......
(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
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
May
17
1961
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
4 I HEREBY CERTIE
That I attended deceased from
6
, to .....
0 61 May 17
10a If married, widowed, or divorced
HUSBAND of
Vincenza Stampone
(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
14 Industry
or Business :
******
15 Social Security No.
010-14-2230
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Nicola Zichello
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria Rosa Mariano
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Informant
(Address)
237 Everett St., Cast. Boston
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS
9 Chelsea St, East Boston, Mass.
19
Received and filed
MAY 17-1961
(Registrar)
PARENTS
M. D.
(Address)
(Signed)
(d) Sureple Free
Joseph GREGORIE
(PRINT/ OR TYPE SIGNATURE)
..... Date.M. 1577
19. 61
6
St. Michael Cemetery Boston
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
May 20
1961
Vincenza Zichella (wife)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or ffansit permit was issued: Ralph E. Seriaum (Signature of Agent of Board of Health or other) May 17-1961
H.O.
(Official Designation)
(Date of Issue of Permit)
X
TRUCTIONS FOR L CERTIFICATE
giving : OF DEATH not enter e than one e for each , (b) and (c)
does not meon de of dying, heort foilure, , etc. It meons ase, or compli- which coused
tions, if ony, gave rise to cause (a), gthe under- cause last.
ditions contrib- deoth but not to the terminol condition given
. Chapter 137, 1954, requires ans to print or ne cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
11-59-926662
2 FULL NAME .. Michael Zichello deceased is a married, widowed or divorced woman, give also maiden name.)
St.
East Boston, Mass.
(Usual place of abode)
2
Y last saw h.Allalive on
may
- 160, 1961
death is said to
have occurred on the date stated above, at 9:04#
.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinomatosis
Du
(b)
To Carcinoma of Cep
and neck
12 hrs
Due To (c)
OTHER
arteriosclerosis
SIGNIFICANT
CONDITIONS
Generalized
Was autopsy performed ?
What test confirmed diagnosis? operation
5 Was disease or injury in any way related to occupation of deceased? As If so, specify
(Kind of work done during most of working life)
(Give maiden name of wife in full)
M R-301A 1
To be filed for burial permit with Board of Health or its Agent.
No. Winthrop Community Hospital
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 hil - dren not gainfully employed may be returned as at school or at homterror a woman whose only occupation was that of home housework, write house wirk. For a person engaged in domestic service for wages, however, designatr the occupation by the appropriate terms, as housekeeper-private family cook hotel, etc. For a person who had no occupation whatever write none.
OFFICE
IM
NIW
11 12
T
TOWN
P. MASS.
CLERK
RECEIVED
PLACE OF DEATH
SUFFOLK (County) Winthrop, Mass. (City or Town)
INSEN
STANDARD
CERTIFICATE OF DEATH
Registered No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
{(Was deceased a U. S. War Veteran, if so specify WAR)
NO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 377 Frankfort (Usual place of abode)
St. East .. Boston, .... Mass
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years .. ...... .. months. 1.5days. In place of residence .......... years ......... months .. .days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
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
Years.
6 Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
Boston, Mass
(State or country)
17 NAME OF
FATHER
Joseph Petroccione
18 BIRTHPLACE OF FATHER (City) (State or country)
East Boston, Mass
19 MAIDEN NAME
OF MOTHER
Mary Rodrigues
20 BIRTHPLACE OF MOTHER (City) (State or country)
East ..... Boston., ...... Mas.s ...
Informant
(Address)
21
JOS. PETROCCIONE
377 FRANK FORT ST., E.B.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kalkh E Kirianna
(Signature of Ages of Board of Health or other)
Hi0
May 18, 1961
(Official Designation)
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed)
Le. Patito
(Address)
(PRAIT OR TYPE SIGNATURE) 1)A Benn FEB
5/18 /06/
St. MICHAEL CEM.
Place of Burial or Cremation DATE OF BURIAL
MAY 19
(City or Town) 61 0
7 NAME OF FUNERAL DIRECTOR
ADDRESS
PENNACCHIO + SON 59 50 MARGIN ST, BOSTON
MAY 18 1961 19
Received and filed
mos
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no.
What test confirmed diagnosis ?
INTERVAL BETWEEN ONSET AND DEATH 4/2
19 death is said to
have occurred on the date stated above, at ..
10:43 AM
19
I last saw h. live on
(Month)
CERTIFY
19
.. , to ....
That J
MAY
attended deceased from
4 I HEREBY
5/3
May
18.
1961
(Day)
(Year)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Oppenheime Disease
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
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.
nditions contrib- death but not to the terminal condition given
- 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.
.11-59-926662
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hospital No.
2 FULL NAME Richard Petroccione
M R-301A 1
6
D
Potito
M. D.
BOSTON
(Date of Issue of Permit)
(write the word)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
OF TOW
DATE OF DISCHARGE
RANK, RATING
3
ORGANIZATION AND OUTFIT
SERVICE NUMBER
INTHREAD.
MAY 1 81961 PM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(!) 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.
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