Town of Winthrop : Record of Deaths 1961, Part 32

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 32


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


Y


PLACE OF DEATH


SUFFOLK (County) BOSTON (City or Town)


........


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


160 WUT - OF - TOWN To be filed for bur'a: permit with Board of Health or its A. en'.


05597 Registered No.


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Mf deceased is a married, widowed or divorced woman, give afso maiden name.)


71 GROVERS AVE


St. WINTHROP MASS


(If nonresident, give city or town and State)


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


2


.days. In place of residence


3


........ years ...... months ....


..... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATII


6


7


1961


(Month)


(Day)


(Year)


4I HERENY


6/5


CERTIF


That I attended deceased from


19


f last saw h .. .. Lalive on ...


6/7


12.45. ... , death is said to


have occurred on the date stated above, at


6


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Toxic SHOCK


INTERVAL BETWEEN ONSET AND DEATH


f1 IF STILLBORN, enter that fact here.


12


AGE ....... Years ..... Months. Days


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation :


BRUSHER


(Kind of work done during most of working life)


14 Industry


or Business


MEN'SCLOTHING FACTORY


15 Social Security No.


021-24-7772


=


16 BIRTHPLACE (City)


(State or country)


MASS.


17 NAME OF


FATHER


VINCENZO CORSANO


18 BIRTHPLACE OF


FATHER (City)


-


(State or country)


ITALY


19 MAIDEN NAME


OF MOTHER


ANNA DELLEA


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


ITALY


21 ADOLPHE D'AMICOJA.


(Address BERKSHIRE AVE SOUTHVIER


7 NAME OF FUNERAL DIRECTOSPIETROKVALLA ADDRESS HENRY ST, EAST BOSTON


Received And filed .......


AUN 19 1961


(Registrar)


I HEREBY CERTIFY that a satisfactory standard certificate of death was gled with me BEFORE the/burial of transit permit was issued: Daniel M Damora jl (Signature of Went of Board of Health or other) 2445 6/9/6/


(Official Designation) (Date of Issue of Permit)


.


1


Y


C


R-301A -


CTIONS OR ERTIFICATE iving P DEATH t enter han one for each ) and (c) s not meo. of dying, cart failure. c. It means or compli- rick caused Ca s, il/amy. ve rise to Iuse (a), ke rader. use lest. hapter 137. 4. requires to print or cause or death on hestes, and . Acts of res Physi- int or type · signature. Only cause of death Dr. wasVable to give this office. jd. oms contrib- ath but not the terminal dition given


25 1961


59-926662


8 SEX


FEMALE WHITE.


9 COLOR


10 SINGLE


.. (write the word)


MARRIER,


of DIVORCED


foa ff married, widowed, or divorced


HUSBAND of


(Give maiden name ol wife in lull)


(or) WIFE of


ADOLPHE. D'AMICO


(Husband's name in full)


Due To


SEPTICEMIA


(b)


Due To POST ABDOMINAL SURGERY


(c)


Abdominal adhesions.


OTHER


SIGNIFICANT


Suspension of Vaging.


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


yes


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


(Signed)


Time Today, M.D


M. D.


PIERRE TORBEY


OPRINT OR, TYPE SIGNATURES


(Address)NEW ENGLAND HER Ste 6/8


1961


6 ST.766ELS


BOSTON


(City or Town)


Place of Burial or Cremation


DATE OF NURIAL


JUNE 12


1961


PARENTS


CERTIFICATE OF DEATH


NEW ENGLAND HOSPITAL


No.


JEAN (CORSANO) D'AMICO


[(Was deceased a


U. S. War Veteran,


(if so specily WAR)


NO


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


BOSTON


A TRUE COPY ATTESTI Tuiles & Mackie City Repristrar


SEP 22 51961 AM


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


Massachusetts General Hospital BAKER MEMORIAL


No.


Cora Ella C. Lent


St. { give Its NAME Instead of street and number) PHYSICIAN - IMPORTANT


2 FULL NAME


(First Name)


(Middle Name)


(Last Name)


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


(a) Residence. No.


55 Sargent Street


Winthrop, Massachusetts


(Usual piace of zoode)


Length of stay: in place of death ............ years ...


months.


days. In place of residence.


4.5years.


... months ..


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


MARRIED


WHOWE.D


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of ...


(Give maiden name of wife In full)


(or) WIFE of


John Israel. Lent


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE .... 85.Yearf.


1


.Months.


7_Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


housework


(Kind of work done during most of working life)


14 Industry


or Business :


avm home


15 Social Security No.


012-03-3977-D.


East Boston


16 BIRTIIPLACE (City)


(State or country)


Massachusetts


17 NAME OF


FATHER


William C.Peters


18 BIRTHPLACE OF


FATHER (City)


East Boston


(State or country)


Massachusetts


19 MAIDEN NAME


OF MOTHER


Sarah Frances Hammond


20 BIRTHPLACE OF


MOTHER (City)


East Boston


(State or country)


Massachusetts


121 Miss Dorothy M Lent


Informant


(Address)


55 Sargent St. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death wu fled with me BEFORE the bartel or transit permit was lesmed: Mass. Danilo


Signature of Agent of Board of Health or other) 3526 6/15761


(Official Designation) (Date of Issue of Permit)


PARENTS


6


Woodlawn Cemetery Everett Mass


l'lace of Burial or Cremation


(City of Town)


DATE OF BURIAL June 15, 1961


7 NAME OF


FUNERAL DIRECTOR


acked B. Mars


ADDRESS


174 Winthrop St. Winthrop,


Rortyld jd fled JIN.16. 1961 Charles H Macke (Registrar)


6 days


Due To (c)


CARCINOMA OF BREAST


20 yrs


Was autopsy performed?


Yos


What test confirmed diagnosis?


Autopsy;


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


(Signed)


caillou


M. D


Charles.L. Cley, M. D.


(PRINT OR TYPE SIGNATURE)


(Address) Ain't. Die., Hans. Gen'l. Herp.


Date. June ..... 12.19 ... 61


R-301A 1


CTIONS a ERTIFICATE


ving F DEATH


tenter an one or each ) and (c)


-- of dying, ort failure. c. It means


3, if any. De rise to


he under-


ons contrib- etk but not the termined dition riven .C.


54%.


Chapter 137, 954. requires is to print or : cause or of death on tificates, and 48, Acta of viren Physi- print or type er signature.


İresten · only Ink. 25 1961


28145


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


OUT - OF - TOWN To be filed for burisi permit with Board of Hesith or ita Agent.


STANDARD CERTIFICATE OF DEATH


Registered No 1.220-


[(If death occurred in a hospital or Institution,


((Was decessed a U. S. War Veteran.


lif so specify WAR)


No.


3 DATE OF


DEATH


Juno ..... 12 ...... 1961


(Month)


(1)ay)


(Year)


4| HEREMY CERTIFY . ThatWE attended deceased from


19.


61


April .. 14 ...... 1961, to ..


June 12,


" last saw JOralive on


June .. 12.,., 1961 .. , death is said to


have occurred on the date stated above, at ..... 3.5.5 ..... p.m.


INTERVAL


BETWEEN


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) EXSANGUINATION


ONSET AND


DEATH


days


(b)


Due TO DUODENAL ULCERS, BLEEDING


OTHER


SIGNIFICANT


CONDITIONS


RECURRENT


10 SINGLE


mise the word),


Widowed


( If nonresident, give city or town and State)


A TRUE COPY ATTEST: Charles it Mackie City Registrar


SEP 2 51961 AM


M R-303 B


-


Boston (City or Town)


The Commonwealth of Casoarquestts EDWARD J. CRONIN 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. 05722


Registered No.


Ward { give its NAME instead of street and number) No. 818 Harrison Avenue Si.


2 FULL NAME Abraham A. Hercules


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


PHYSICIAN -- IMPORTANT


(Was deceased a


U. S. War Veterar ..


if so specify WAR)


no


....


(a) Residence. No. . 28L ... River Road,


.Ward. ... Winthrop. .. Mass.


(Usual place of abode)


(if nonresident, give city or town and State)


Length of residence in city or town where death occurred yrs.


mos.


days. How long in U. S., if of foreign birth?


yrs.


mos.


days.


PERSONAL AND STATISTICAL PARTICULARS


MEDICAL CERTIFICATE OF DEATH


3 SEX


male


COLOR


white


5 SINGLE


MARRIED


WIDOWED Single


or DIVORCED


Sa If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


6 Age of husband or wife if alive years


7 IF STILLBORN. enter that fact here.


8


AGE. 76 .Years


Months


Days


If less than 1 day


Hours


.Minutes


Usual


9 Occupation:


Salesman


(retired)


Industry


10


or Business:


Cigar.


Social Security No. ...


010-1/1-1765


Boston,,


12 BIRTHPLACE (City) (State or country) Mass


13


NAME OF


FATHER


Nathan Hercules


14 BIRTHPLACE OF


FATHER (City)


(State or country)


Germany


15 MAIDEN NAME


OF MOTHER


Erma Mehlinger


16


BIRTHPLACE OF


MOTHER (City)


Wachenheim, Rhine Bavaria,


(State or country)


Germany


17 Informant.Morton ... Fcinberg


Relalion, if any


(Address) 95 Jechington Street, Dorchester.


I HEREBY AFPTIFY that a satisfactory standard certificate of death was Nød with mp 51.1 01;K the burial or tounsit permit was issued:


(Signature of Agent of Board of health or other


5.10. . 115 16-


(() "cial I) .. (L'ate of Issue of Porini!)


18


DATE OP


DEATH


June 13 1961


(Month)


(Day)


(Year)


19 I 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.)


Coronary


Occlusion


Collapsed au


Side walk


20 IN WHAT CIPY OR TOWN


WAS INJURY SUSTAINED ?.


Wheels


(Signed)


.. M. D.


6-14-61


(Address)


25 .... Shattuck. St.


Date


21


PLACE OP BURIAL.


Moses, Mendelsohn.


CREMATION OR REMOVAL ... .. West Roxbury.


(Cemetery)


(City or towa)


DATE OP BURIAL


June ... 16,


.1961


22


NAME OF


UNDERTAKER


Benjamin F.Solomon


420 Harvard Street, Brookline


ADDRESS


JUN 16.1961


19


Charles & Mackie


(Registrar)


PARENTS of Death. See reverse side for extracts from the laws relativo to the return of certificates of death. DEATH In plain terms, so that it may be properly classified under the International Clus. ication of Causes If deceased was a U. S. War Veteran, G.L. Chap. 45, Section 10, requires physicians to insert a recital to that efect Information should be carsis y supplied. . ILALEA. s. o. C ... ORLINER OF 11


SM-3-56-922107


m.C. 20.1


25 1961


PLACE OF DEATH


Suffolk (County)


(write the word)


1.


Nephew


OUT - OF - TOWN


1(If death occurred in a hospital or institution.


A TRUE COPY ATTEST:


un ho H. Mackie City Registrar


.


SEP 251961 AM


R-301A 1


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 e, or compli- which caused


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


tions contrib- leath but not the terminal ndition given 11C


PLACE OF DEATH


Suffolk (County)


INSEPFTE


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.


142


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


2 FULL NAME


Katherine McGillicuddy


( First Name)


(Middle Name)


(Last Name)


[(Was deceased a


U. S. War Veteran,


[if so specify WAR)


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


(a) Residence. No.


39 Pico Avenue


St.


(If nonresident, give city or town and State)


Length of stay: In place of death ..


......


.years ..


.months.


.days. In place of residence.4.8.


.. years


.months .......


.days.


PERSONAL AND STATISTICAL PARTICULARS


10 SINGLE


(write the word)


MARRIED


WIDOWEDSingle


or DIVORCED


4 I HEREBY CERTIFY,


2/14


19.


61


to ...


19


61


That I attended deceased from


9/1


I last saw her.alive on


4/1


1961


death is said to


have occurred on the date stated above, at


7A


m.


INTERVAL BETWEEN ONSET AND DEATH


Due To


BRONCHO.


.


(b)


PNEUMONIA


2 DAYS


KMO.


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


0


What test confirmed diagnosis?


XBAX-BIOPSY


0


(Signed)


Thed o' Began


M. D


FRED O' REC


SIGAN


11.0


PRINT OR TYPE SIGNATURE) 113PLEASANTLY .. Date 9/1 1961


(Address)


WINTHROP


6


Winthrop Cemetery


Winthrop


Place of Burial or Cremation


(City or Town)-


DATE OF BURIAL


September 5


19


61


7 NAME OF


FUNERAL


DIRECTOR


Arthur J .O.Maley


ADDRESS Winthrop Mass


Received and filed


SEP 1 1961


19


(Registrar)


PARENTS


18 BIRTHPLACE OF


Boston


FATHER (City)


(State or country)


Mass


19 MAIDEN NAME


OF MOTHERMary A. Harron


20 BIRTHPLACE OF MOTHER (City) Everett (State or country) Mass


21


Nancy McGillicuddy


Informant


(Address)


39 Pico Ave., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or ,transit permit was issued: Raucht foram (Signature of Agent of Board of Health or other)


9/1/61


(Official Designation)


(Date of Issue of Permit)


L 1


1


11 IF STILLBORN, enter that fact here.


12


48


AGE


Years.


Months ....


Days


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation :


Operator


(Kind of work done during most of working life)


14 Industry


or Business:


Telephone


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Winthrop


Mass


17 NAME OF


FATHER


William McGillicuddy


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


3 DATE OF


DEATH


September 1, 1961


(Month)


(Day)


(Year)


8 SEX


Female


9 COLOR


White


MEDICAL CERTIFICATE OF DEATH


(Usual place of abode)


No. 39 Pico Avenue


-928145


1.0


Due To


CARCINOMA


(c)


OF


LUNG.


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


If so, specify


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE. " ;


DATE OF DISCHARGE


RANK, RATING CSEP -1961 PM


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE


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


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


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


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


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


Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. 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)


Prostor 12-9-61


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


WINTHROP CONVALESCENT HOME


give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


[(Was deceased a


{U. S. War Veteran,


{if so specify WAR)


NO


St EAST BOSTON, MASS (If nonresident, give city or town and State) 2 .. years months days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


SEPT.


6,


1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


~ That I attended deceased from


JAN -8,


19 .... , to ....


SEPT.


L


19.6/


I last saw heRalive on


19.6/, death is said to


have occurred on the date stated above, at ....


2:30 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) CARDIAC DECOMPENSATION


2 DAYS


Due To ARTFRIOSCLEROTIC (b) .. . HEART DISEASE


10 YRS.


Due To (c)


OTHERLEFTCEREBRAL HEMORRHAGE I MONTY SIGNIFICANT CONDITIONS PARKINSON'S DISEASE 15YRS


Was autopsy performed ?


NO


What test confirmed diagnosis ?


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


(Signed) an. Caplan M. D. A. N. CAPLAN M.D. (PRINT OR TYPE SIGNATURE)


(Address) 186 PRINCETONSTE. B Date.


9-6- 19.61


6 HOLY CROSS Place of Burial or Cremation (City or Town) DATE OF BURIAL SEPT. 9 1961


7 NAME OF DIPIETROXVAZZA ADDRESS HENRY STEAST BOSTON


Received and filed


SEP 8 -1961


19


(Registrar)


PARENTS


16 BIRTHPLACE (City) (State or country)


ITALY


17 NAME OF


FATHER


RICCI


18 BIRTHPLACE OF


FATHER (City)


(State or country)


ITALY


19 MAIDEN NAME


OF MOTHER


NOT LEARNED


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


21 AUGUSTUS MANGONE Informant 68 FALCONST, EAST BOSTON


I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial or transit permit was issued: Talkle Jereannex ( Signature of Agent of Board of Health or other) Heath Prices 9/8/1


(Official Designation)


(Date of Issue of Permit)


& hosp


FRANCESCA MANGONE


2 FULL NAME.


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


68 FALCON


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


months.


16


... days.


In place of residence .....


8 SEX


FEMALE WHITE


9 COLOR


(write the word)


10 SINGLE


MARRIED


WIDOWENDO WED


or DIVORCED


10a If married, widowed, or divorced HUSBAND of


(or) WIFE


(Giye maiden name of wife in full) BENJAMIN MANGONE


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


86


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 :


OWN HOME


15 Social Security No. NONE


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


tions contrib- death but not the terminal ndition given


Chapter 137, 954. requires is to print or : cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.


-59-925686


821 1.6


R-301A 1


UCTIONS FOR CERTIFICATE


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


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


INTERVAL BETWEEN ONSET AND


MALDEN


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


Registered No.


(a) Residence. No.


(Usual place of abode)


SEPT 6,


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


TOW


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


63


ERK


RULES OF PRACTICE SEP -81961 FM


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 1 PLACE OF DEATH


SUFFOLK (County) WINTHROP (City or Town)


REVERE 12-2020


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.


165


WINTHROP CONVALESCENT HOMETIL death occurred in a hospital or institution.


give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


CONCETTARIVOIRE


2 FULL NAME


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


14 ARCADIA


REVERE MASS


St.


(If nonresident, give city of town and State)


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


.. months.


.days. In place of residence


8


... years ..


... months .......


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


Sept


7


1961


(Month)


(Day)


(Year)


8 SEX


FEMALE


9 COLOR


WHITE


10 SINGLE


MARRIED


(write the word)


WIDOWAWIDOWED


or DIVORCED


4 I HEREBY CERTIFY,


Oct. 11


19.00, to


Sept. 7.


1961


I last saw h .. CYalive on


sept


...................... , 19 ......... , death is said to


have occurred on the date stated above, at


1:00 P.m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Cerebral Hemorrhage


(a)


INTERVAL


BETWEEN


ONSET AND


DEATH


2mths


11 IF STILLBORN, enter that fact here.


12


AGES ... Yearsm


.. Months ...


.Days


....


.. Minutes


Due To


Generalized Arteriosclerosis


.5


(b)


years


Due To


DIABETES Mellitus.


(c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


NO.


What test confirmed diagnosis ?


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


NO


(Signed) Morris I. Sacks M. D. MORRIS 1, SACKS M.A (PRINT OR TYPE SIGNATURE) (Address) 45 Shirley Ave. 2. Da Sept. 1 19 61


6. FOREST HILLS BOSTON


Place of Burial or Cremation


DATE OF BURIAL


SEPT.


......


(City or Town)


1961


7 NAME OF


DIPIETROLAVAZZA


ADDRESS 1HENRY ST, EAST BOSTON


Received and filed SEP 8 1961 19


(Registrar)


PARENTS


19 MAIDEN NAME


OF MOTHER ANNA LACÍVITA


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


TINA LUCEY


21


Informant


(Address)4 ARCADIAST, REVERE


I HEREBY, CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit_permit was issued: Jacka 8. Sercaune 8- (Signature of Agent of Board of Healthy or other)


9/8/6/


(Official Designation)


(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- which caused


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


tions contrib- leath but not the terminal ndition given


Chapter 137, 954. requires s to print or cause or f death on tificates, and 48, Acts of uires Physi- print or type er signature.


59-925686


13 Usual


Occupation :


HOUSEWIFE


(Kind of work done during most of working life)


14 Industry


or Business :


OWN HOME


15 Social Security No.


028-03-7857


16 BIRTHPLACE (City)


(State or country)


ITALY


17 NAME OF.


FATHERSALVATORE CASSIANI


18 BIRTHPLACE OF


FATHER (City)


(State or country)


ITALY


104+5


10a If married, widowed, or divorced


HUSBAND of


(or) WIFE of


LAMY


(Give maiden name of wife in full) RIVOIRE


(Husband's name in full)


If under 24 hours


.. Hours ..........


That I attended deceased from


[(Was deceased a


U. S. War Veteran,


lif so specify WAR)


NO


(a) Residence. No.


(Usual place of abode)


Registered No.


R-301A 61 1


19%-6


SPACE FOR ADDITIONAL INFORMATION


RECEIVED


DATE OF ENTERING MILITARY SERVICE


OF TOW.


DATE OF DISCHARGE


11 12


·!


RANK, RATING


SHO


ORGANIZATION AND OUTFIT


SERVICE NUMBER


WIN


NTHROP


SEP -81961 FM


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.




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