Town of Winthrop : Record of Deaths 1961, Part 42

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 42


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).


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(a) Residence No. . ... ( l'sual place of abode)


85 Shore Drive


.St.


Winthrop


Length of stay: In place of death. 0 years. 0 months. 2 .days. In place of residence .... ..... years, months .. days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


August


13


1961


(Mouth) (Day)


(Year)


HEREBY CERTIF


August 12


. 1961


, to ...


August


13


That 1 attended deceased from


.


19


61


I last saw hl M.alive on


August 13


19 Gl, death is said to


have occurred on the date stated above, at . 12:55 p.m.


INTERVAL


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


.. Years


Months ...


Inmy 7 hrs.


Days


If under 24 hours


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)


1


1


17 NAME OF


FATHER


DAVID Williams


18 BIRTHPLACE OF


FATHER (City)


BOSTON, MASS.


(State or country)


19 MAIDEN NAME


OF MOTHER


MARIL JONNSM


20 BIRTHPLACE OF-


MOTHER (City)


(State or country)


Träninghan, Mass.


21


Informant


(Address)


St. Elizabeth's ofteital


I HEREBY CERTIFY that a satisfactory standard ortificate of death was filed with me BEFORE the burial -- or-wansit permit was issued:


(Signature of Agent of Board of Health or other) 3290


-


1.1


harkes It mack an


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


W


10 SINGLE


(write the word)


MARRIED


WIDOWED


or DIVORCED


SINGLE


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Prematurity Atelectasis


DETWEEN ONSET AND DEATH


Due To tb)


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


Yes


What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased? If so, specify William L. Babacan M. D.


(Signed)


William L. Babaian


(Address)


OR TYPE SIGNATURE) c/o St. Eliz, Hosp Date August 13 19 61


Mit Bene dicteen Wist her bu 6


Place of Burial or Cremation


(City or Town)'


DATE OF BURIAL


august 18.


1961


7 NAME OF


FUNERAL DIRECTOR


27 Sullivans (Was)


360 Market St. Button


Record hin rich A AUG 22 1961 R ... 19


ADDRESS


27 190


1


R-301A 97 S Roz.


CTIONS JR ERTIFICATE


iving F DEATH enter an one or each ) and (e)


not mean of dying. art failure. . It means or compli. ich caused


. if any. rise to use (a). · under- use last.


ns contrib- th but not se termine ition 62.5


Chapter 137. 54. requires s to print or cause or death on ficates, and 8. Acts of ires Physi- int or type r signature.


PARENTS


U. S. War Veteran.


lif so specify WAR)


(If nonresident, give fity or town and State)


(Official Designation) (Date of Issue of Permit)


8145


1. 3.


A TRUE COPY ATTEST: Charles it mackie City Registrar


1


PLACE OF DEATH


Suffolk Conyty) Boston (C'ity or Town)


No.


BOSTON CITY HOSPITAL


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 Åpent


Registered No.


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


PHYSICIAN - IMPORTANT


[ (W'as deceased a {C. S. War Veteran. lif so specify WAR)


(a) Residence. No. ( l'sual place of abode)


1.ength of stay :


In place of death.


...


.years .. ....


months.


.. days.


In place of residence


.. years ...


.. months ..


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


August


17


1961


8 SEX Lemale


9 COLOR


white


10 SINGLE


Juste the wordy


MARRIED/Manuel


WIDOWED


or DIVORCED


4 I HEREBY


CERTIFY,


Aug ....... 14


19.


61


to


August


17


1961


/10a If married, widowed, or divorced HUSBAND of


(Give maiden nood of wife if full)


(or) WIFE of


Husband's name in full


(a)


Due


b. Cachoxia


1 to 2 y


Due Iv


(c)


Reticulum coll sarcoma, gororali


OTHER


SIGNIFICANT


CONDITIONS


2 to 3


B Social Security No.


022-10-5990


Winthrop


Was autopsy performed?


What test confirmed diagnosis?


Autopay


5 Was disease or injury


If so, specify


inany way related to occupation of deceased?


(Signed)


M. D.


M. WINTHROP ... O' CONNELL. .... D.


(PRINT OR TYPE SIGNATURE)


BOSTON CITY HOSPITAL!


AUGUST 17


19


61


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


Gebed 13. Stanchi


ADDRESS


174 Winthrop St Winthro


C


AUG 22 1967 arles H. Mackie". ( Registrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


...


(State or country)


(mais.


19 MAIDEN NAME


OF MOTHER


Lavina Emma true


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


21


Informant


(Address)


mabel T Williams.


205 329 Pleasant 29 Wirdvia


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)


(Official Designation)


(Date of Issue of Permit)


T


R-301A -


TIONS


RTIFICATE


ring DEATH enter n one r each and (c)


nai mean of dying, " failure. It means or compli- h caused


if any, rise to se (a), under- se last. as contrib- th but not e terminal tion given ,001 hapter 137, 4. requires to print or cause or death on ficates, and 8, Acts of ires Physi- int or type signature.


27 196


8145


2 FULL NAME


Graco Loring Ci ---


( First Name) (Middle Name)


(Last .Came)


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


329 Pleasant Stroot


St.


Winthrop, Mass.


( If nonresident, give city or town and State)


1


death is said to


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Bronchopneumonia


have occurred on the date stated above, at


iWILL.VAL


DETWEEN


10:15AM


ONSET AND


I1 IF STILLBORN, enter that fact here.


DEATH


3 0 03


12


AGE 70


Years.


Months.


Days


Occupation :


(Kind of work done during most of working life)


zecidustry


or Business :


Bundet College


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Herbert Wendel Piece ofany


Winthrop


Southport


6


Place of Duriel or Cremation


aurait 19


19


If under 24 hours


Hours.


Minutes


(Month)


(Day)Loro provient.


'A TRUE COPY ATTEST: Charles it Mackie City Registrar


X PLACE OF DEATH


SUFFOLK


(County)


DOSTON


(City or Town)


The Comenmuralth 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 Ageot.


02907


Registered No.


S(If death occurred in a hospital or institution, St. 7 give its NAME instead of street and number)


PHYSICIAN - IMPORTANT ( ( Was deceased a U. S. War Vetetao.


{if so specify WAR)


Mass.


(a) Residence. No.


( l'sual place of abode)


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


white


9 COLOR


10 SINGLE


(write the word)


DEATH


(Month)


(Day)


(Year)


'Auf:


HEREBY


CERTIFY


Augat vegyended deceased


.


61


19


welast saw h ...


Imive on AUG. 20,


19.


death is said to


12:35a.m.


have occurred on the date stated above, at


INTERVAL


BETWEEN


ONGET AND


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Basilar Artery Occlusion


(a)


Due To (b)


Due To (c)


OTHER


Diabetes Mellitus


SIGNIFICANT


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


clinical


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


If so, specify


(Signed)


M. D


Charles.L ... Clar, .! '.D.


(PRINT OR TYPE SIGNATURE)


Aug. 20, 61


(Address) Ass't. Dle, Maas .. Gan'l. Harp. Date.


Winthrop Cemetery


Winthrop


6


I'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


August 23


1.67


7 NAME OF


FUNERAL DIRECTOR


Frederick J. Magrath


ADDRESS


East Boston


AUG 2 3 1961 Charles & Mackin


(Kegistrar)


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Julia Turke


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21


Serveret Driscoll


Informant


(Address)


20 Pico AVE. Winthroo


IFREBY CERTIFY that a satisfactory standard certificate of death hled with me BEFORE rAsit permit was issued:


(Signature of Agent of Board of Health or other)


A 19233


aug 21, 4161


(Official Designation)


(Date of Issueof Permit)


CTIONS R ERTIFICATE


ving DEATH enter an one r each and (e)


not mean of dying. ut failure. . It means or compli- ch caused


if any. e rise ro use (0). e under. se last.


as contrib- th but nat e terminal tion given


32


hapter 137. 54. requires to print or cause or death on hcates, and 8, Acts of ires Physi- int or type r signature. C. rector · only Ink. 27 196


18145


11 IF STILLBORN, enter that fact here.


AGE.69


„Years.


Months.


Days


If under 24 hours


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


13 Usual


Occupation :


Purchasing Agent


(Kind of work done during most of working life)


14 Industry


or Business :


retired


013-45-3845


East Poston


16 BIRTHPLACE (City)


(State or country)


Lass.


17 NAME OF


FATHER


Florence Priscoll


8 yings Social Security No.


10a If married, widowed,& diverssd o' Donnell


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


St


( If oonresident, give city or town and State)


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


3 DATE OF


August


20


1961


MARRIED


WIDOWED married


or DIVORCED


19


to.


61


TOWN


R-301A 1


No. .MASSACHUSETTS.GENERAL .. C.OSPITAL


2 FULL NAME John L. Driscoll ( First Name) (Middle Name) ( Last Name) (If deceased is a married, widowed or divorced womao, give also maideo name.) 28 Pico Avenue, Winthrop


(Husband's name in full)


A TRUE COPY ATTEST: Charles it mackie City Registrar


-


X


PLACE OF DEATH


SUFFOLK (County) BOSTON (City or Town)


Che Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH


OUT - O


To be hled for burial permit with Board of Health er ila Agent. fy


Registered No.


§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) No. 87 Faywood Avenue, East Roston


2 FULL NAME


FRANK L HEALY


(First Name)


(Middle Name)


(Last Name)


PHYSICIAN - IMPORTANT


[(Was deceased a


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


18 Tileston Road,


St.


Winthrop, Massachusetts


(a) Residence No.


( L'sual place of abode)


Length of stay: In place of death


years.


months.


.days. In place of residence ..


30


years


months


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


August


25,


1961


(Month)


(1)ay)


(Year)


9 SEX


10 COLOR


Male


White


MARRIED)


WIDOWED


or DIVORCE Maried


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.)


lla If married, widowssordist ......


(Schwarz).


Coronary .... occlusion


(or) WIFE of


(Husband's name in full)


12 IF STILLBORN, enter that i ct here.


13


AGE 58 Years 1 Months. 3


... Days


If under 24 hours


Hours ..........


Minutes


IF ACCIDENTAL, was injury causally related to the death?


14 Usual


Occur tion:


(Kind of work done tuning most of working life)


15 Indu try


or Bo ness :


Morze1 ... Meat Packers


Social Security No.


013-01-3076


17


RTHPL.\CE (City)


East Boston


te or cont y)


18 NAME OF


FATHER


Joseph T. Healy


19 BIRTHPLACE OF


FATHER (City)


New Jersey


(State or country)


20 MAIDEN NAME


OF MOTHER


Lillian Tanner


21 BIRTHPLACE OF


MOTHER (City)


(State or country)


East .... Boston


(Address) Boston


Date


7 Winthrop Cem. Winthrop Mass Place of Burial, or Cremation. (City or Town)


DATE OF BURIAL


August .... 2.9


1967


Ar ..


8 NAME OF


FUNERAL DIRECTOR


Richard C .. .. Kirby Inc


ADDRESS917 Bennington


t. E.B.


AUG 29 1961


Received and filed


27 19 Charles 21 Mache


(Registrar)


r


1


OM R.303 A


information should be careful!, supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF


DEATH in plain terms, so that it may be properly classified under the International Classification of Causes


11 44-48.


SOM-6-50-928145


In.C.


0.1


of Death. See reverse side for additional information. See also Chap. 38. 11 6. 20; Chap. 46, 11 ), 10; Chap. 114,


6 Was disease or injury in any way relase


patiני


Jeceased ?


......


M. D.


(Signed)


Michael A. Luongo,


(Print or Type . natt


)


8/20


.19.61


PAREN


22


Informant


Mrs. Doris E. Healy


(Address)


18 Tileston Rd. Winthrop


1 HEREBY CERTIFY that a satisfactory standard certificate of death (was filed with me BEFORE the burial or transf perprit was issued: Dufth Ven Histas (Signature of Agent of Board of Health or other ),


Q19 352


8/27/61


(Official Designation)


(Date of Issue of Fermny


T VI/


S Accident, suicide, or homicide (specify)


Date and hour of injury


19


Did injury occur in or about home, on farm, in industrial place, or in


public place ?


(Specify type of place)


Manner of


Injury


(How did injury occur ?)


Nature of


Injury


While at work ?


Was autor sy per


Where did


Injury occur ?


(City or town and State)


HUSBAND of


(Give maiden name of wife in full)


(lf nonresident, give city or town and State)


11 SINGLE


(write the word)


U. S. War Veteran. (if so specify WAR) No


ALLUAV. Every item ot


If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.


A TRUE COPY ATTESTI Charles it Mackie City Registrar


1


f(If death occurred in a hospital or institution, XX) give its NAME instead of street and number)


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.


( l'sual place of abode)


Length of stay: In place of death. 0 years. O. months 3 days. In place of residence


years.


months ..


.Iva.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL, PARTICULARS


8 SEX


9 COLOR


Whito


10 SINGLE


(write the word)


MARRIED YAcc


WIDOWED


or DIVORCED


IOa If married, widovilcoy 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 73 Years 7 Months


11Days


If under 24 hours


Hours .... ..


.. alinutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


15 Social Security No. .


1021-20-2208


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Ciriaco Lucilla


18 BIRTHPLACE OF


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Maria Baresso


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


21


Informant


V. A. Hospital Records, 150 S.


(Address) Huntingera la Bais Sa


I HEKERY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permir was issued: vequelana varato (Signature of Agent of Board of Health or other) 3624 9/14/61


(Official Designation) (Date of Issue of Permit)


A:TIONS . ERTIFICATE


ving F DEATH H enter an one for each () and (e)


@ mot mean 'e of dying, lut failure, e. It means se or compli- och caused


if any. sup rise to ( se (a). · under. Ose last.


it's contrib. di & but mot e terminal option given


20.1


Chapter 137. 14. requires ar to print or he cause or o death on ricates, and . Acts of ·gres Physi- Int or type d' signature. C.


27 196


PLACE OF DEATH


Suffol': (County) Boston .


(City or Town)


No. Votosama hinatrenden Dospital


Che Onuamiralth 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 15


Registered No.


PHYSICIAN - IMPORTANT


[ ( Was deceased a


U. S. War Veteran. lif so specify WAR, LAI


Winthrop, Mass.


( If nonresident, give city of town and State)


DEATHI


(Month)


(Day)


7


(Year)


4I HEREBY


CERTIFY ..


61


19


to ..


19


, death is said to


have occurred on the date stated above, at


122:20m.


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


Acute myocardial infarction


(a)


Due Tos


(b)


ght lower loto peumonia


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


Actor


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


(Signed)


(Ad


VAH DOLCI, .. .- 3.


Date Li JN. 23 19 67


Winthrop Com., Winthrop, Inc. 6 Place of Burial or Cremation (City or Town)


DATE OF BURIAL


Sort. 16


61


19


7 NAME OF


FUNERAL DIRECTOR


Jecoph Langers, Jr.


ADDRESS 58 Morrirac St., Doston, Mass. SEP 15 1967 ..... ....... 19 Charles & Mack


PARENTS


MR-301A 1


-9:145


PUCILLO


3 DATE OF


Soptontor


13


1952


That L,attended deceased from


61


DET .. CEN


C" __ T AND


Retirer


(PRIMA OR TYPE SIGNATURE)


A TRUE COPY ATTEST: Charles it. Mack City Registra


X PLACE OF DEATH


Suffolk (County)


Boston


(City of Town)


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


OUT - OF - TOWI


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


Registered No.


[(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. IL {if we specify WAR;


2 FULL NAME . SAMUEL ABRANCON ( First Name) (Middle Name) (Last Name) ( If deceased is a married, widowed or divorced woman, kive also maiden name.)


24 Dolphin Acro


Ix Winthrop, Mass.


( If nonresident, give city or town and State)


Length of stay:


In place of death


. years .....


.. months. ... days.


In place of residence.


Lifpars.


.months.


day's.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


September


17


1951


DEATH


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY


Th


atterded deceased


from


September 17 19 61


61


19


., to ....


........... , death is said to 1


have occurred on the date stated above, at


5:00 2


... m.


L


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) Subarachnoid he-or -: 00


GIATH curs


Due To


(b)


Diabetos.


Due To


(c)


Coronary Artery Disease.


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed? No. What test confirmed diagnosis? Clinical Pardines


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


(Signed)


M. D


(PRIN. OR TYPE SIGNATURE)


37 10 67


Tiforoth


6


Place of Burial or Cremation (City or Town) .


DATE OF BURIAL


Contombor 20


7 NAME OF


FUNERAL


DIRECTOR


ARNOLD GULOV


1658 Beacon Sso


ADDRESS


De cive) and filed


J ... A: NOT


O .. .19,


(Registrar)


¿Y PARENTS


21 VA Hospital Records, 150 South


Informant


(Address) Huntington -Con Particolare


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


(Sjanpaure of Agent of Board of Health of other) 2653


9/18/


FICTIONS


L ERTIFICATE


Ving F DEATH n enter an one for each ) and (c)


not mean of dying. ut failure. . It means For rompli- ich caused


if any, e rise to se (a), e under- se last.


'Uns contrib. Ath but not ole terminal Dition given


Tiapter 137. 54. requires . to print or cause or death on ficates. and 8. Acts of Sires Pbysi- nt or type ir signature.


01 for fod


0 8145


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


Thito


10 SINGLE


MARRIEIL


WIDOWEMarried


or DIVORCED


10a If married, widowed, or divorced.


HUSBAND of


Rose .... Moff


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


ACE.


ars .. en.


Months.


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


Pharmacist


(Kind of work done during most of working life)


14 Industry


or Business :


BISHOP DRUG BUSTON


15 Social Security No. ..


010-03-3986


16 BIRTHPLACE (City)


(State or country)


Facocchusotto


17 NAME OF


FATHER


Morris


ABRAAISON


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


Eva Shanker


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


.....


(Official Designation) (Date of Issue of Pr-


VR-30IA -


Veterans Administration Hospital No.


(a) Residence No. ( l'sual place of abode)


(write the word)


12


1,8.


1.


Days


(Address) VIH BOSTON. 1 200 Date


.. ..


A TRUE COPY ATTESTI Charles it Mackie City Registrar


X PLACE OF DEATH


SUFFOLK


(County)


COSTON


(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 of us Aprot.


No. MASSACHUSETTS .. GENERAL.HOSPITAL


......


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


2 FULL NAME Giovanni Freccero ( First Name) (Middle Name) ( Lası Namr)


[ ( Was deceased ] U. S. War Veteran.


lif so specify WAR) non


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


(a) Residence. No. ( l'sual place of abode)


39. Grovers Avenue


.St


Winthrop, Massachusetts


(lf nonresident, give city or town and State)


Length of stay: In place of death ..


years ... . ...


months.


.. days. In place of residence.


years.


months.


days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Mala


9 COLOR


10 SINGLE


MARRIED


WIDOWED


(write the word)


( Month) (1)ay)


(Year)


4I HEREBY CERTIFY,


That :"attended deceased from ptember 24 19 61 September 25 61


welast saw h.


imive on ..


September 25 61


death is said to


have occurred on the date stated above, at 11:30am.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


BETWEEN


ONSET AND


DEATH


Due To (b) CORONARY HEART DISEASE


10 YEARS


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performed?


What test confirmed diagnosis?


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


(Signed)


M. D


Charles L. G.m .. .. D. (PRINT OR TYPE SIGNATURE) (Address) Aus's Dir., Loss Gen'L Hasp. Date Sent. 25 6


It michael C meter 6 Place of Burial or Cremation (City or Town)


DATE OF BURIAL


19.


7 NAME OF


S.


ADDRESS 58 SEP 28 600


PARENTS


16 BIRTHPLACE (City) (State or country)


17 NAME OF


FATHER


Lawrence Vaccaro


18 BIRTHPLACE OF FATHER (City) (State or country)


19 MAIDEN NAME E Catherine Dabou


OF MOTHER


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mary


Italy


21 Informant (Address)


I HEREBY CERTIFY that satisfactory standard certificate of death was filed /with me BEFORE the burial or dansit permit was med. acqueline Dosolo .... (Signature of Agent of Board of Health or other) A 3784 9/26/61


Received Charles 21-Mach (Registrar) (Official Designation) (Date of Issue of Permit)


R:TIONS IR RTIFICATE


1/Ing C· DEATH center jan one ir each and (c)


a Not mean & of dying. Art foilure. e It means Cor compli- och caused


if any, rise to se (a). à under- ase lass.


Gis contrib- &h but not e terminal Ciom given 20.1


hapter 137. 14. requires to print or cause or death on ricates, and , Acts of gres Physi- int or type d


signature.


Lector i only Kink. 27 195!


91145


S


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


.Ilours ..


Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


Retired


15 Social Security No. 012-07-3170


of DIVORCEALONG


3 DATE OF


DEATH


September 25


1961


Registered No.


AR-301A I


A TRUE COPY ATTEST: Charles it Mackie City Registrar


X Suffolk (County )


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


OUT - OF TOWN To be hled for burial permit with Board of Healths # 01 :ts Agent.


CERTIFICATE OF DEATH


Registered No.


09170


No.


2 1.011. NAME


S(If death occurred in a hospital or institution. St. ¿ give it« NAME instead of street and number) Stolpe PHYSICIAN - IMPORTANT MRS Minerva f ( Was deceased a ( First Name) ( Middle Nanie) JU S War Arteian. (Last Name) ( If deceased is a married, widowed or divorced woman, give also maiden name.) lif wo specify WAR) 10 PROSPECT Ave


WINTHROP


( If nonresident, give city of town and State)


months.


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


SEDI


27


1961


(Month) (Day)


(Year)


41 HEREBY CERTIFY


That I attended deceased from


.27 19 61 to. SEPT 2)


61


I last saw h. W.Valive on Sept. 27 19 of death is said to


have occurred on the date stated above, at 2:15Pm.


DEATH, WAS CAUSED BY : IMMEDIATE CAUSE


(a) Acute Myocardial IntereTio


Due To


(b) ARTERIOSClerotic HA. Disease


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


NO


What test confirmed diagnosis?


EKG


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


(Signed)


Lucian n. Balucian


M. D


(Address)


CARNey


Winthrop - BisHara 6


Place of Burial or Cremation


DATE OF BURIAL Sept. 30 1961 21 Informant (Address)


7 NAME OF


FUNERAL DIRECTOR


Housed S.Tioned's


LINUS Rop, MASS


ADDRESS


Received And/hled Charles St.


(egistrar)


8 SEX


9 COLOR


Female


White


10 SINGLE


MARRIED)


WIDOWED


or DIVORCED


(write the word)


MARCI


10a If married, widowed, or divorced HUSBAND of


(or) WIFE of


Albert V. Brolpe


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


10


AGE ...


Years ...


/


Mor


12


.Days


If under 24 hours


Hours ...... ..


hiinutes


13 Usual


Occupation :


House Wife


(Kind of work done during most of working life)


14 Industry


or Business :


OWN Home


15 Social Security No. NONE


16 BIRTHPLACE (City) SE-JOHN,


(State or country)


HeuFour ClAnd


17 NAME OF


FATHER


PAYRick Scott


18 BIRTHPLACE OF FATHER (City) (State or country) NewFoundland


19 MAIDEN NAME


OF MOTHER


Elizabeth Condy


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


NewFoundland


Albert V. Stolpe


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed With me BEFORE the burial or transit permit was issued: Jacqueline Dorata (Signature of Agent of Board of Health or other) A3821 9-28-61




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