Town of Winthrop : Record of Deaths 1961, Part 18

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 18


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51


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 (County)


Winthrop


(City or Town)


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS


STANDARD


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


[(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.)


19 Wheelock


Winthrop


St.


14


Length of stay: In place of death .............. years .............. months.


1


days.


In place of residence.


.years ..


.. months ....


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCEDmarried


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Domenic Iannone


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


66


16


AGE


Years.


Months.


Days


If under 24 hours


Hours


Minutes


13 Usual


Occupation :


Housewife


14 Industry


or Business :


at home


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Rocco Gennaro


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Secondina


?


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


21 Domenic Iannone


Informant


(Address)


19 Wheelock 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 Julianne


(Signature of Agente


Eny Board of Health or other)


40


May 23-1961


(Official Designation)


(Date of Issue of Permit)


U.BU


TRUCTIONS FOR L CERTIFICATE


n giving OF DEATH not enter e than one se for each , (b) and (c)


does not mean ode of dying, heart failure, , etc. It means ase, or compli- which caused


tions, if any, gave rise to cause (a), g the under- cause last.


ditions contrib- death but not to the terminal condition given


Chapter 137, 1954. requires ans to print or he cause or of death on ertificates, and 48. Acts of quires Physi- print or type der signature.


Winthrop Cemetery, Winthrop 6


Place of Burial or Cremation


DATE OF BURIAL


May ..... 25,


(City or Town) 1961


7 NAME OF


FUNERAL DIRECTOR


Ernest P .Caggiano


ADDRESS 147 Winthrop St., Winthrop


Received and filed


MAY 23 1961


19


(Registrar)


PARENTS


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify


(Signed)


M. I.


MYRON N. KING MOD


(PRINT OR TYPE SIGNATURE)


(Address) 222 PLEASANT SI


WIN YA2012 Date ....


15MO


Due To (c)


OTHER


SIGNIFIC


CONDITIONS


NONE


Was autopsy performed?


NO


What test confirmed diagnosis ?


CLINICAL TOPERATION


(b)


MAY


22


1961


(Month)


(Dav)


(Year)


4 I HEREBY


CERTIFY


FEB


60


to ...


MAY 22


19


1 last saw h.E.Malive on


MAY 21


19 61


death is said to


have occurred on the date stated above, at


350 A. m.


INTERVAL


BETWEEN


ONSET AND


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


GENERAL CARCINOMATOSIS.


WITH JAUNDICE


DEATH


3 MO.


That I attended deceased from


61


(a) Residence. No. (Usual place of abode)


(If nonresident, give city or town and State)


2 FULL NAME


Amelia Iannone (Gennaro)


Winthrop Community Hospital No.


To be filed for burial permit with Board of Health or its Agent.


M R-301A -


11-59-926662


3 DATE OF


DEATH


Due To


CARCINOMA OF BREAST


(Kind of work done during most of working life)


5/22 10 61


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


OF


74.42


OF


3


LERK


3


RULES OF PRACTICE


1:11


6 The fulfillment of the purpose of these laws jappservance 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 certif Yun) QQfoniptas those of persons who, though disabled by recognized disease


injury, have died without recent medical atteridance 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.


X 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. 35


S(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.)


30 Circuit Rd


St


Winthrop


(If nonresident, give city or town and State)


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


MAY


22


1961


(Month)


(Day)


(Year)


That I attended deceased from


19.61


I last saw hey alive on


May 22


, 1961, death is said to


have occurred on the date stated above, at 1:00 A.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Arterios clerotic Heart Disease


Due


Cardiac Decompensation


(b)


3 mos.


Due To (c) T4. Howbout To PENIa PaspuRe


OTHER


SIGNIFICANTThrombocytopenia


CONDITIONS


Purpural


4yrs,


Was autopsy performed?


NO


What test confirmed diagnosis ?


Clinical


5 Was disease or injury in any way related to occupation of deceased? No If so, specify


Charles Liberman


(Signed) CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE) (Address) Winthrop Mass Date. 5/22/1961


M. D).


6


Liberty Progressive


Everett


Place of Burial or Cremation


DATE OF BURIAL


May 23


1001


7 NAME OF


FUNERAL DIRECTOR


TODE funeralsinclus


ADDRESS 151 Washingtontive Chelsea


Received and filed MAY 23 1961 ... 19.


(Registrar)


8 SEX


Fem


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


Widowed


or DIVORCED


(or) WIFE of


Max


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


7.3


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Housavile


(Kind of work /done during most of working life)


14 Industry


or Business :


At Home


15 Social Security No.


Nanne


16 BIRTHPLACE (City)


(State or country)


ficomania


17 NAME OF


FATHER


Hyman Rosenberg


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Roumania


19 MAIDEN NAME


OF MOTHER


CBL


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Roumania


21 Informant Betty


Lewis


(Address) 30 I Circuit Rd Winthers


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:


(Signature of Agent of Board of Health or other)


11.0


May 22, 1961


(Date of Issue of Permit)


(Official Designation)


1.1-59-926662


PLACE OF DEATH


I R-301A 1


TRUCTIONS FOR . 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, 954. requires ns to print or e cause or of death on tificates, and 48, Acts of quires Physi- print or type ler signature.


No.


Winthrop Com. HOSp


EVA MINSK


2 FULL NAME


(a) Residence. No. (Usual place of abode)


Length of stay: In place of death .............. years ......... months. 1.1days. In place of residence. 7 years.


PERSONAL AND STATISTICAL PARTICULARS


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


MINSK


4 I HEREBY CERTIFY


Dec


19


47


to ...


May 22


INTERVAL


BETWEEN


ONSET AND


DEATH


1yr.


12


AGE


.Years


Months.


Days


PARENTS


(City or Town)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


DE TOM


11.12 .7


ERK


WID


6


5


RULES OF PRACTICE MAY 2 31961 AM


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


X SUFFOLK (County) WINTHROP (City or Town) 26 WAVE


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS W35 STANDARD CERTIFICATE OF DEATH


To be filed for burial permit with Board of Health or its Agent.


86


Lena (Peckerman)


( First Name)


(Middle Name)


(Last Name)


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


26 WAVE WAY AVE


(Usual place of abode)


Length of stay: In place of death.


.years ..


months.


.days. In place of residence


3


.years.


.months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


FEMALE


9 COLOR


WHITE


10 SINGLE


(write the word)


MARRIED


WIDOWED WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


MORRIS


DIAMOND


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


81


If under 24 hours


AGE


Years


Months ...


.Days


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.


ROMANOW


16 BIRTHPLACE (City)


(State or country)


RUSSIA


17 NAME OF


FATHER


JOSEPH


PECKERMAN


18 BIRTHPLACE OF


FATHER (City)


UNKNOWN


M. D


(State or country)


RUSSIA


19 MAIDEN NAME


OF MOTHER


ZISEL (UNKNOWN)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


RUSSIA


MARY


BLOCK


21


Informant


(Address)


26


WAVE


WAY 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) Fracti 5/27/60


(Official Designation) 16


(Date of Issue of Permit)


UCTIONS FOR CERTIFICATE


giving OF DEATH ot enter than one for each b) and (c)


es not mean of dying, heart failure, etc. It means , or compli- hich caused


ns, if any, ave rise to cause (a), the under- ause last.


tions contrib- eath but not the terminal ndition given


Chapter 137, 1954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.


6928145


PLACE OF DEATH


No.


WAY AVE


[(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


Diamond


St.


(If nonresident, give city or town and State)


3 DATE OF


DEATH


Mar


22


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


19


I last saw h ........ alive on


19 ..


., death is said to


have occurred on the date stated above, at


7A


... m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a)


Natural Causes


INTERVAL


BETWEEN


ONSET AND


DEATH


Due To


(b)


Presumably Coronary Occlusion


Due To


(c)


Anteriosclerotic Heart Disease


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


no


What test confirmed diagnosis? post mortem judgement


5 Was disease or injury in any way related to occupation of deceased? no. If so, specify ..


arthur C. Murray.


(Signed) ARTHUR C MURRAY


(PRINT OR TYPE SIGNATURE)


27


(Address Nathrop Board of Health may1 61


EMERALD


ST SHUL CE/M.


WOBURN


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL MAY 28 19 61


7 NAME OF


FUNERAL


DIRECTOR


MURRAY


GOLDMAN


ADDRESS 174 FERRY ST MALDEN


Received and filed MAY 29-1961 .. 19.


(Registrar)


PARENTS


(UNKNOWN)


6


R-301A 1


2 FULL NAME


Registered No.


[ (Was deceased a


U. S. War Veteran,


(if so specify WAR)


19


-


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


( TO :.


11.12 1


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


6


MAY 2 91961 AM


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.


R-302 1


PLACE OF DEATH


Middlesex (County) Waltham


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Waltham


(City or Town making this return)


Registered No.


243


No. Walter E. Fernald State School


Charles Francis Hamburger


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No ... cannot be learned


(Usual 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.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


malo


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWED ngle


or DIVORCED


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


.61


8


23


If under 24 hours


AGE


Years


.Months.


Days


.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)


(State or country)


Onset


Mass"


17 NAME OF


FATHER


Charles M. Hamburger


18 BIRTHPLACE Hos ton


FATHER (City)


Mass


(State or country)


19 MAIDEN NAMEina A. Lovaren OF MOTHER Medford


20 BIRTHPLACE OF MOTHER (City) .. (State or country)


Mass.


21 WEF School


Informawaltham Mass.


(Address)


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


June 2


1961


(a) (c) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


May


28,


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


May 1


19.


60


May 28


1957


....


I last saw halve on


May 26


1901


death is said to


6:00am


have occurred on the date stated above, at


.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Coma due to cirrhosis of


the liver


Due To


Bronchial pneumonia of


(h)


right lung.


48hrs


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


autopsy


What test confirmed diagnosis?


....


no


5 Was disease or injury in any way related to occupation of deceased? If so, specify ...


(Signed)


Silvio Margulis


Waverley, Mast ·


5-29


M. B.1


.Date.


19


(Address) Met Forn cem. , Waltham


6 Place of Burial or Cremationune 2


(City or Town) 61


DATE OF BURIAL


19


7 NAME OF


Lee M. Fraser


FUNERAL DIRECTOR Waltham, Mass


ADDRESS


Received and filed ..


JUN


9 1961


19


(Registrar of City or Town where deceased resided)


PARENTS


25M-2-58-922072


2 FULL NAME


§(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)


(Was deceased a


U. S. War Veteran,


if so specify WAR).


No


Winthrop, Mass.


St


to ..


INTERVAL BETWEEN ONSET AND DEATH life


None


-


1


6


JUN - 91961 AM


RM R-302


Suffolk


( County )


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


Revere


(City or Town making this return)


1


Revere


CERTIFICATE OF DEATH


Registered No.


( (If death occurred in a hospital or institution,


St.


¿ give its NAME instead of street and number)


2 FULL NAME


Joseph A. Recomendes


( Was deceased a


U. S. War Veteran,


( If deceased is a married, widowed or divorced woman, give also maiden name.)


436 Pleasant


Winthrop


St


( If nonresident, give city or town and State)


Length of stay: In place of death .......... years .......... months.


7


.days. In place of residence


... years


months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


May


29,


(Day)


( Year)


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


( write the word )


Married


4 I HEREBY CERTIFY.


May 23 61


19


to ..


19


61


19 ...


death is said to


have occurred on the date stated above, at


m.


INTERVAL BETWEEN ONSET ANO


hours


12


61


AGE.


Years.


.. Months .......... Days


If under 24 hours


........ Hours ........ Minutes


Due To Paroxysmal Auricular


(b)


Tachycardia


10 days


13 Usual


Occupation:


Retired Salesman


( Kind of work done during most of working life)


14 Industry or Business :


15 Social Security No.


Boston


16 BIRTHPLACE (City)


(State or country)


Nass


17 NAME OF


FATHER


Joseph Recomendes


Boston


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Mass


19 MAIDEN NAME OF MOTHER Annie ₺. Connelley


20 BIRTHPLACE OF


Boston


.. Ma.s.s.


.....


Winthrop Cemetery Winthrop


Place of Burial or Cremation


(City June 1, Town) 61


19


PARENTS


21


Informant


( Address )


436 Pleasant St. , Winthrop


A TRUE COPY


ATTEST :


(Registrar of City or Town where death occurred)


Received and filed


JUN 5-1961


19


( Registrar of City or Town where deceased resided )


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


3 DATE OF


DEATH


(a)


Due To


(c)


6


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


SIGNIFICANT


CONDITIONS


50M-9-59-926111


7 NAME OF


FUNERAL DIRECTOR


Winthrop


Arthur J. O'Maley


ADDRESS


clinical


no


5 Was disease or injury in any way related to occupation of deceased ?


If so, specify


(Signed )


Joseph J. Palermo


"20 crescent Ave:


M. D.


( Address )


Revere


.Date.


5/29


.. 61 19


DATE OF BURIAL


8yrs.


10a If married, widowed; of fixoffed 1. Krovitz


HUSBAND of


( Give maiden name of wife in full)


(or) WIFE of ...


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Cerebral Thrombosis


That I attended deceased


29


May


from 61


I last saw


h


Ative on


May


29


im.


2:30P


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town THIS IS A PERMANENT RECORD


PLACE OF DEATH


( City or Town)


Grover Manor Hospital No ..


20


if so specify WAR,


(a) Residence. No .. ( Usual place of abode)


1961


( Month)


OTHER


Cirrhosis of liver


Was autopsy performed ?


What test confirmed diagnosis ?


Fish


MOTHER (City)


( State or country)


Lillian 1. Recomendes


DATE FILED


May 31.


.......... 19 ..


61


02. 1


M


LRK


1


5


6


IN


ROR NA


JUN =51961 AM


os triw


9IBM


SİİVOTA .. I NBiffiJ


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE May 22, 1918


DATE OF DISCHARGE


Sept. 30, 1921


RANK, RATING


Yeoman 3 Cl. Prov.


ORGANIZATION AND OUTFIT


USNRF


SERVICE NUMBER


182 62 06


X


PLACE OF DEATH


Suffolk


Boston


(City or Town)


No.


New .... England .... Deaconess .... Hospital


f(If death occurred in a hospital or institution. St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME Mrs. Anna M. Frongello (nee Battaglia) (First Name) (Middle Name) (Last Name)


(II decraved is a married, widowed or divorced woman, give also maiden name.)


(a) Residence. No.


153 Locust ... St.


St.


Winthrop ...


Mass


length of stay. In place of death years. months 10 .. days. In place of residence. .. years ..


.months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


February


28


196 1


( Month)


(Day)


(Year)


4I HEREBY CERTIFY,


That I attended deceased from


February


18


19 61


In Peb.


28


19 ... 6.1.


I last saw hCL.alive on


February


27


2.61


death is said to


have occurred on the date stated above, at


..... m.


6:00


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Myocardial infarction


(a)


Due


(b)


Arteriosclerotic heart disease


(c)


Diabetes


10+ YEARS 10 + YEARS 15+ YRS


30+YRS.


Was autopsy performed?


What Jest confirmed diagnosis? Physical examination &


Laboratory data


NO.




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