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