Town of Winthrop : Record of Deaths 1961, Part 17

Author: Winthrop (Mass.)
Publication date: 1961
Publisher:
Number of Pages: 542


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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