Town of Winthrop : Record of Deaths 1961, Part 25

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 25


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


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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