USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 25
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No. TEWKSBURY HOSPITAL
......
........
94 Faun Bar Avenue,
winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
16
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Broncho-Pneumonia
(a)
INTERVAL BETWEEN ONSET AND DEATH 4dys.
Due To
Arteriosclerotic Feart
(b)
Disease
7yrs.
15yr$ .
Was autopsy performed ?
What test confirmed diagnosis ?
19
to ...
1
RECEIVED
MOI. :
OF
.1
KLERK
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
JUL 211961 AM
X
PLACE OF DEATH
Suffolk (County )
1
Chelsea
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
Registered No.
127
§ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Gertrude Fisher
(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.
51 .... Cutler
St
Winthrop Mass
(If nonresident. give city or town and State)
Length of stay: In place of death .... .. years .......... months ......
days. In place of residence.
.months.
....... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
(write the word)
Female
White
10a If married. widowed, or divorced
19.
63
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of ..
Charles
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
8 das
. AGI63
.. Years ....... Months ....... Days
If under 24 hours
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. - was meant
16 BIRTHPLACE (City)
(State or country )
Roumania
17 NAME OF FATHER Menasha Rothstein
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Roumania
19 MAIDEN NAME
OF MOTHIelda- (cannot be learned)
20 BIRTHPLACE OF
MOTHER (City )
(State or country) Roumania
21 Charles .... Fisher
Informant (Address) 51 Cutler St. Winthrop Mass
A TRUE COPY
ATTEST :
Ar Town where death occurred )
Received and filed
19
( Registrar of City or Town where deceased resided)
OPARENTS
..... 11961
6 Beth David Noburn, Mass ... Place of Burial or Cremation (City or Town)
DATE OF BURIAL June .... 14. 1961 19.
7 NAME OF
DIRECTO Ben jamin Birnbach
ADDRESS 10 Washington St. Dorchester
50M-9-59-926111
No ... No .... ( Usual place of abode) 3 DATE OF DEATH (a) Due To (b) Due To (c) OTHER SIGNIFICANT CONDITIONS Was autopsy performed ? no What test confirmed diagnosis ? .... FKG 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 none
( Month) June 12,1961.
(Year)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEParied
4 I HEREBY CERTIFY,
That I attended deceased from
June .. 4 19 ..... 6] to .. June 12
I last saw h. live on
June 18 ..
death is said to
have occurred on the date stated above, at 1.1.4.55pm
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial infarction
Chelsea ... Memorial Hospital
.......
DATE FILED
June 14.1961
19
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
C.
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
John A. Popi
M. D.
821 Saratoga St. F.Boston Jas
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
X PLACE OF DEATH
CHELSEA 17:2-8
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH
Registered No.
128
[(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)
(a) Residence. No.
(Usual place of abode)
19 Mer ford
St.
Chelsea
(If nonresident, give city or town and State)
47
Length of stay: In place of death
............. years.
2
months.
.7
days. In place of residence.
.years ..
... months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 1, 1961
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR
White
10 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY
June 12,
19.6.1 .. ,
July 1, 1961
That I attended deceased from
19
I last saw h.eralive on
June .... 30
67
death is said to
have occurred on the date stated above, at
77:46 P.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
.70
Years.
Months.
Days
If under 24 hours
Hours .........
Minutes
13 Usual
Occupation :
Housewife
14 Industry
or Business :
Out Home
15 Social Security No. ......
NONE
16 BIRTHPLACE (City)
(State or country)
Poland
17 NAME OF
FATHER
Wawrzyn Pigulski
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland.
19 MAIDEN NAME
OF MOTHER
Jozefa Golon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Walenty Nowicki
21
Informant
(Address)
19 Medford St Chelsea
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kalkhe. Sirianni
(Signature of Agent of Board of Health or other)
He
July 3, 1961
(Date of Issue of Permit)
X
RUCTIONS 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.
litions contrib- death but not o the terminal ondition given
Chapter 137, 1954. requires ns to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
6 Holy Cross Rovere, Nass
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
5 July
61
7 NAME OF
FUNERAL DIRECTOR
Walter S Walata
125 Washington Ave Chelsea
ADDRESS
19
(Registrar)
PARENTS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Walenty Nowicki
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Congestive cardiac failure
Due ToGeneralized arteriosclerosis (b)
severa years
Due To (c)
OTHER
SIGNIFICANT Diabetes Mellitus
CONDITIONS
several years
Was autopsy performed?
no
What test confirmed diagnosis ?
clinical
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
John 7. Collins
M. D.
(Signed)
John F. Collins, M.D.
(PRINT OR TYPE SIGNATURE)
(Address)27 Bennington Street Date July 3, 19 67
Received and filed
6-59-925686
A R-301A 1
(County)
Winthrop (City or Town)
Winthrop Convalesent Home
No.
2 FULL NAME.
Marianna Nowicki
(If deceased is a married, widowed or divorced woman, give also maiden name.)
To be filed for burial permit with Board of Health or its Agent.
(Official Designation)
Poland
1 day
(Kind of work done during most of working life)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE ..........
DATE OF DISCHARGE
RANK, RATING
OF TO"
ORGANIZATION AND OUTFIT
SERVICE NUMBER
BIRK:
3
51
ROR. MASS
-RULES OF PRACTICE JUL -51961 AM The fulfillment of the purposeof aws 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
PLACE OF DEATH
Suffolk (County)
1
Winthrop
(City or Town)
CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Winthrop
Nursing Home
f(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
406 Broadway
St.
Malden
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No
(a) Residence.
No.
(Usual place of abode)
Length of stay: In place of death years. months 2 days. In place of residence 7 years.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word).
MARRIED Widow
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
, 19
, to.
, 19.
I last saw h ..... alive on
. 19_
=, death is said to
have occurred on the date stated above, at
5:05%.
.m.
(a)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
INTERVAL
BETWEEN
ONSET AND
DEATH
Due
(b)
Arteriosclerotic Heart Disease
years
Due
(c)
Generalized Arteriosclerosis
years
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
(Sign
Arthur C. Murr
Arthur C.Murray
M. D.
(Addre Winthrop Roald Health ate 1 July
1961
6 Cambridge Conciery Cambridge Place of Burial or Cremation (City or Town) Mais DATE OF BURIAL July 6 61
7 NAME OF
William J. Fillion
ADDRESS iSPRAGue ST Revere
Received and filed
JUL 5-1961
19.
(Registrar)
PARENTS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Ernest B. Porter
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 89 Years.
0 Months 4 Days
If under 24 hours
Hours ....... Minutes
13 Usual
House wife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
AT Home
15 Social Security No. NoNe
16 BIRTHPLACE (City)
(State or country)
BOSTON MASS
17 NAME OF
FATHER
unable to learn TREANOR
18 BIRTHPLACE OF
FATHER (City).
unable to learn
(State or country)
19 MAIDEN NAME
OF MOTHER
unable to learn
20 BIRTHPLACE OF
MOTHER (City)
unable to learn
(State or country)
21
Informant
Mrs FANNIE VeRGe
(Address) 405 Broadway MALden
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Callh &
(Signature of
Current of Board of Health or other
HO
July 5/4/
(Official Designation) (Date of Issue of Permit)
X
.- THIS IS A NENT RECORD. se only E APPROVED ink or black writer ribbon.
TRUCTIONS FOR L 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 ase. or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
itions contrib -- > death but not to the terminal condition given
. Chapter 137, 1954, requires ans to print or he cause or of death on ertificates. HAP. 46, 55 9 & AP. 114 $$ 45, HAP. 38 $ 6.)
·10-58-923886
Malden 19-1-8
Convir
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
Registered No.
129
No. Mary Porter ( Treanor)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July 1, 1961
(Month)
(Day)
(Year)
(If nonresident, give city or town and State)
months ......_. days.
15101
MR-301A ·id
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECEIVED
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing 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 unrelated to any form of injury. Erik
(2) Board of Health physicians will certify to such deaths only as those of 7 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 (drugs or poisons) thermal, or electrical agents, and deaths following abortion, BRO ?! also deaths from disease resulting from injury or infection related to occupation. the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
JUL :: 51961 AM
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 import- ant, 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. Children 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)
ONSE PFT
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.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME Baby Boy
( First Name)
(Middle Name)
(Last Name)
(if so specify WAR) N.O ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
86 Sargent Street, Winthrop
8 minutes
Length of stay : In place of death. ... years. .. months. days. In place of residence .. .years.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX male
9 COLOR
white
MARRIED
WIDOWED
or DIVORCED
single
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY ,
That I attended deceased from
I last saw h ........ alive on
July 10
19 ... 1., death is said to
have occurred on the date stated above, at
2:39 .... A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Prematurity - 23 weeks
INTERVAL BETWEEN ONSET AND DEATH
(a)
Due To (b)
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed?
Ne
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
PEUT
M ...... Traunstein Jr. (PRINT OR TYPE SIGNATURE)
(Address) Winthrop Date 7/10/60
6
Winthrop Cemetery, Winthrop, Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL July 11 1961 19
7 NAME OF
FUNERAL
DIRECTOR
Cafed B. March
ADDRESS 194 Winthrop It Winthrop Vliet
Received and filed
19
(Registrar)
PARENTS
17 NAME OF
FATHER
Harold Addison Ham. Jr.
18 BIRTHPLACE OF
FATHER (City)
Winthrop
M. D
(State or country)
Massachusetts
19 MAIDEN NAME OF MOTHER Elizabeth Ann Tewksbury
20 BIRTHPLACE OF
MOTHER (City)
Winthrop
(State or country)
Massachusetts
21 Informant (Address) 86 Sargent St. Winthrop
I HEREBY CERTIFY that a satisfactory. standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Hacks S. Saranno (Signature of Agent /of Board of Health or other) Hi O latteBes July 11-1961
(Official Designation)
(Date of Issue of Permit)
RUCTIONS 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, f 1954. requires ians to print or the cause or of death on certificates, and r 48, Acts of requires Physi- o print or type inder signature.
50-928145
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
10
19.61
im
19 to ....
19
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 ...
Months ..
.. Days
If under 24 hours
Hours ........ ) ..... Minutes
13 Usual
Occupation :
unemployed
(Kind of work done during most of working life)
14 Industry
or Business :
none
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Massachusetts
Winthrop
Harold A Ham
Registered No.
130
Winthrop Community Hospital No.
Ham
[(Was deceased a
U. S. War Veteran,
.St.
(If nonresident, give city or town and State)
months.
days.
in
10 SINGLE
(write the word)
M R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the RECEIVED 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.
TOWA
OF
.1
NIK
6
(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- nation, the sudden deaths of persons not disabled by recognized disease, and hose 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- fanyso that the relative healthfulness of various pursuits can be known. Make JUL: 1 1 196tome 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.
RM R-303 A 1
(County) WINTHROP
(City or Town)
19 FairView 35., Winthrop
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
131
§ (If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
No.
DOMINIC P. IFRARDO
Derardi
PHYSICIAN - IMPORTANT
f ( Was deceased a
U. S. War Veteran,
[if so specify WAR)
no
(First Name)
(Middle Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Last Name)
19 Fairview &t., Winthrop
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.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR
white
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
(Month)
(Day)
(Year)
4I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Acute myocardial infarction.
lla If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AG50
Years ...........
.. Months.
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation:
Assistant District Engineer
(Kind of work done during most of working life)
15 Industry
Busin
New England Power System
16 Social Security No.
011-16-7773
Malden
17 BIRTHPLACE (City)
(State or country)
Masso
18 NAME OF
FATHER
Philip Jerardi
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
20 MAIDEN NAME
OF MOTHER
Carmela Kinaldi
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
Carmela Verardi (mother)
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL
July 13
16.1.
8 NAME OF
FUNERAL DIRECTOR
Vincent Kapino
ADDRESS
9 Chelsea St, Last Boston Mass.
Received and filed
JUL 12 1961
19.
(Registrar)
PARENTS
6 Was diseasgor injury in any way related to occupation of deceased ?
(Signed)
Michael A. Luongo,
., M. D.
M. D".
Type Signature)
7/10
61
19
Holy Cross Cemetery Malden
50M-6-60-9281115
42.1
PLACE OF DEATH
SUFFOLK
2 FULL NAME
(a) Residence. No.
(L'sual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
July
DEATH
Manner of
(Specify type of place)
Injury
(How did injury occur ?)
Nature of
Injury
If so, spechy ..
Boston
(Address)
Date
7
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
DEATH in plain terms, so that It may be properly classified under the International Classification of Causes
m.c.
Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
P§§ 44-48.
N. B .- WRITE PLAINLY. WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of
While at work?
... Was autopsy performed ?
5 Accident, suicide, or homicide (specify)
Date and hour of injury
19
IF ACCIDENTAL, was injury causally related to the death?
Where did
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place ?
No.
Boston
22
Informant
(Address)
19 Fair View St L'intheron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFOREThe hnptal on transit permit wasissued : Dalkh & Lissanne "ture of Agent of Board of Health on riner ) Health officer puh 131461 (Official Designiction f (Date of Issue of Permit)
10,
1961
male
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
V 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 unrelated 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 poison) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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