Town of Winthrop : Record of Deaths 1961, Part 9

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 9


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


11 IF STILLBORN, enter that fact here.


12


53


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Meat Checker


10 mof Industry


First National Stores


or Business :


15 Social Security No.


16 BIRTHPLACE (City)


(State or country )


Cty. Calway, Ireland


17 NAME OF


FATHER


Patrick Kennedy


Was autopsy performed?


yes


What test confirmed diagnosis ?


Biopsy.


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


BARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country) Cty . Galway, Ireland


(Signed)


Francis F. Smith


M. D.


(Address )


85 Otis St. Camb ...


har. 30


winthrop


20 BIRTHPLACE OF


MOTHER (City )


State or cou


Cty. Galway, Ireland


Nora Burke


Informant


( Address )


9 Atlantic ~ Es Winthrop


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


ADDRESS


79 Atlantic St. inthrop


Received and filed


APR 11 1961


19


ATTEST :


(Registrar of City or Town where death occurred)


DATE FILED


Mar. 7,


19 61


V. B.V


(b) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)


IM R-302


THIS IS A PERMANENT RECORD


()


50M-9-59-926111


( Registrar of City or Town where deceased resided )


10a If married, widowed, or divorcedr


19


HUSBAND of


ilora Kennedy


(Give maiden name of wife in full)


(or) WIFE of.


( Husband's name in full)


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) CerebellarMetastases


10 MDAGE


Irs


.Months .......... Days


Due To


Carcinoma of the Lung ..


( Kind of work done during most of working life)


OTHER


SIGNIFICANT


CONDITIONS


19 MAIDEN NAME


OF MOTHER


Kate Mellody


Winthrop Cemetery 6


Place of Burial or Cremation DATE OF BURIAL


March 6, 19


(City or Town)


A TRUE COPY Frades. ( ,,


1


Michael Burke


( Was deceased a


U. S. War Veteran.


(if so specify WAR,


RECEIVED


6


SPACE FOR ADDITIONAL INFORMATION


APR-2-44961 .. 001


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


X PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


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


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


41


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Anna .... C ....... Campbell


( First Name)


(Middle Name)


(Last Name)


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


(a) Residence. No.


156.Somerset .... Ave


(L'sual place of abode)


Length of stay :


In place of death.


years.


months ..


8


days. In place of residence ..


10 ...


years


months.


.. days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


March3, 1961


(Month)


(Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


or DWANGowed


4 I HEREBY CERTIFY,


That I attended deceased from


19 ..


..... , to ......


Marin


19.67


I last saw h.s.k.alive on


manche 3 1961


death is said to


have occurred on the date stated above, at


7:40 Pm.


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Archibald F. Campbell


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


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.


16 BIRTHPLACE (City)


(State or country)


East ..... Boston


Mass


17 NAME OF


FATHER


Olaus Olson


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Sweden


19 MAIDEN NAME


OF MOTHER


Carlotta Krona


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Sweden


21


Informant


....


Hazel ..... Mac.Donald


(Address) 150 Somerset Ave., Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E, Serianni ( Signature of Agent of Board of Health or other) atte 3/6/6/


HO


1 ......


(Official Designation)


(Date of Issue of Permit)


CTIONS OR ERTIFICATE


iving F DEATH : enter an one or each ) and (c)


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


is, if any, Je rise to use (a), te under- use last.


ns contrib- ith but not he terminal 'ition given


Chapter 137, 54. requires s to print or cause or death on ificates, and $8, Acts of aires Physi- rint or type per signature.


1


ADDRESS


Received and filed


MAR 6 1961


19


(Registrar)


PARENTS


Glenwood


6 Place of Burial or Cremation


Everett Mass.


(City or Town)


DATE OF BURIAL


March 7


19.61


7 NAME OF


FUNERAL DIRECTOR


Arthur J. 0'Maley


Winthrop Mass


M. D


(Signed)


Joseph GRIGORIE


(PRINT OR TYPE SIGNATURE)


(Address)


194 Washusten 26 Date.


9/4


1961


Was autopsy performed?


What test confirmed diagnosis?


INTERVAL


BETWEEN


ONSET AND


DEATH?


1/sur


12


AGE ..


78


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Acute let + Ventric


(a)


....


ular Failure


Due To


(b)


arterioscleratic


gros


Due To


Heart Disease


(c)


arteriosclerosis -gen


yr


OTHER SIGNIFICANT CONDITIONS


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


If so, specify


Mi


Registered No.


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


(if so specify WAR) NO


St.


(If nonresident, give city or town and State)


(write the word)


028145


R-301A 1


No. Winthrop Community Hospital


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 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.


OF


TOW


Er


MAR - 61961 FM


1


Winthrop


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


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


Registered No.


42


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


2 FULL NAME


Samuel Weiner


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


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


if so specify WAR)


No


(a) Residence. No. ..


(Usual place of abode)


246 Shore Drive


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.


14 years


months.


... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


March 3rd 1961


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


That I attended deceased from


October, 1952


to


March 3


1966 L.


I last saw himlalive on


March 2, 1961, death is said to


have occurred on the date stated above, at


9:10 A. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Coronary


Occlusion


aculté


Du


Coronary Artery Heart


(b)


Diseasel.


Due To


Arteriosclerosis,


(c)


OTHER


SIGNIFICANT


None


CONDITIONS


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 .....


Charles Liberman


No


(Signed).


Charles Liberman


M. D.


WinthropMosDate 3/3/196


Bessarabian Cem 6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March 5th


19.61


7 NAME OF


FUNERAL DIRECTOR


Philip Briss


ADDRESS


470-


arvard Street, Bkln Mass


Received and filed


3-3-61


19


(Registrar)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


(write the word)


MARRIED


WIDOWEDmarried


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of Tina Halpern


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


DEATH


I bank.


Years


66


Months


Days


If under 24 hours


.Hours ....... Minutes


13 Usual


Occupation :


retail meats


(Kind of work done during most of working life)


14 Industry


or Business:


retired.


15 Social Security No ...


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


Morris Weiner


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Russia


19 MAIDEN NAME


OF MOTHER


Hinda (unknown)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Russia


21


Informant


Mrs Tina Weiner


(Address) 246 Shore Drive, Winthrop I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E. Spercannes (Signature of Agent of Board of Health or other)


HO 3/3/6/


(Official Designation)


(Date of Issue of Permit)


UBV


-THIS IS A ENT RECORD. e only APPROVED nk or black iter ribbon.


UCTIONS FOR CERTIFICATE


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


oes not mean of dying, heart failure, tc. It means or compli- which caused


s, if any, ve rise to ause


(a), the under- ause


last.


ons contrib- cath but not the terminal Audition given


hapter 137, 54, requires to print or cause or death on ficates.


2. 46, šť 9 & 2. 114 §§ 45, .P. 38 $ 6.)


-58-923886


PLACE OF DEATH


Suffolk (County)


No.


246 whore Drive, Winthrop


INTERVAL BETWEEN ONSET AND


10yrs


5 yrs.


PARENTS


(Address)


Everett Mass


[ R-301A


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 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.


(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 occupation. 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 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.


IM R-304


1 giving USE OF AL DEATH not enter e than one se for each (a), (b) and (c)


or maternal ion causing death (do use such as stillbirth maturity. ) and/or ma- conditions, . which gave to above (a), stating nderlying last.


utions of fetus Other which ave contrib- to fetal t but, in so · is known. e not related cuse given ().


15M-6-60-928241


Suffolk (County ) PLACE OF DELIVERY No. Winthrop Community Hospital


The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)


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


Registered No.


43


(If death occurred in a hospital or institution, -


give its NAME instead of street and number)


3 DATE OF


DELIVERY


3/5/61


(Month )


(Day)


(Year)


4 SEX X


Male .... Female ...... Undetermined


5 COLOR (if


determined) .


W


6 THIS BIRTH (Check one)


Single.X.


Twin


Triplet


7 IF MULTIPLE BIRTH, BORN :


1st.


.2nd


.. 3rd.


FATHER


MOTHER


14


MAIDEN NAME


Florence Buonopane


PRESENT NAME Florence Buonopane


RESIDENCE, NO.1115 Saratoga St., CITY OR TOWN E. Boston


STATE


Mass ..


STREET


15


RESIDENCE, NO. 1115 Saratoga St.,


CITY OR TOWN E. Boston


STATE ... Mass ..


10 COLOR OR


RACE White


11 AGE AT TIME OF


THIS DELIVERY


40


(Years)


16 COLOR QR


RACE White


17 AGE AT TIME OF THIS DELIVERY 40 (Years)


12 PLACE OF


BIRTH


(City or Town)


Italy


(State or country)


18 PLACE OF


BIRTH


(City or Town)


Italy


(State or country)


19 INFORMANT Alberico Buonopane


20 PREVIOUS DELIVERIES TO MOTHER


(Do not include this fetus )


6


(a) How many children are


now living?


6


(b) How many children were born alive but are now dead ? 0


(c) How many previous fetal deaths of ANY gestation age ?


21 LENGTH OF PREGNANCY


abmit 20 completed


weeks


(or


...


Grams )


23 WHEN DID FETUS DIE? Before Labor


24 AUTOPSY


Yes


No


25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE


DIED in UTERO- Cause Unknown.


(a)


Due To (b) Due To (c)


OTHER SIGNIFICANT CONDITIONS


26 Holy Cross Cemetery Malden


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March .8,


27 NAME OF FUNERAL DIRECTOR Vincent Rapino ADDRESS 9 ChelseaSt., East Boston


Received and filed


MAR 8 1961


19


A TRUE COPY ATTEST :


(Registrar )


I HEREBY CERTIFY that this delivery occurred on the date stated above at 6.2 m., and product of conception was not a live birth.


Signature of trending Physician on Medical Examiner: D. Thomas Stoffer


M. D.


D. Thomas Staffier (PRINT OR TYPE SIGNATURE)


Addres


19 Breed St., East Boston


19


I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued : 7 Ralph E Siwann


CHCISignature of Agent of Board of Health or other) H.O 3/8/6/


(Official Designation )


(Date of Issue of Permit ) >


1


1 Winthrop (City or Town)


2 NAME OF FETUS (if given)


Paby Poy Buonopane


St.


8


FULL


NAME


Alberico Buonopane


.


STREET


13 OCCUPATION Candy Maker


22 WEIGHT OF FETUS


Lb. 10 /2 Oz.


During Labor


or Delivery.


Unknown


FETAL DEATH


TO!


EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.


Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, . . . shall not be permitted except ... ".


Section 9A. When a child is born dead, after a period of gestati MAR # 81961 PM ot less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.


Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."


Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.


X PLACE OF DEATH


Suffolk (County)


Winthrop (City or Town)


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


CERTIFICATE OF DEATH


Registered No.


44


No. Winthrop Community Hospital


2 FULL NAME


Mary J. Cardoza


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


62 Cottage Avenue, Winthrop


St.


(If nonresident, give city or town and State)


Length of stay: In place of death.


years.


.months ..


5


days. In place of residence .. 32.


.. years


.........


.months ..


.........


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


(write the word)


WIDOWED Widowed| or DIVORCED


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


Matthew E ...... Cardoza


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE82


Years ..


4


Months ..


9 ... 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.


No


16 BIRTHPLACE (City)


Azores


(State or country)


Portugal


17 NAME OF


FATHER


Manuel Benavidz


Azores


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Portugal


19 MAIDEN NAME


M. D.


OF MOTHER


Anna DeRego


20 BIRTHPLACE OF


MOTHER (City)


Azores


(State or country)


Portugal


21


Miss Mary H ....... Cardoza-dau.


Informant


(Address)


62 Cottage Ave. Winthrop


I HEREBY CERTIFY that a satisfactory Standard certificate of death was filed with me BEFORE the burial or-transit permit was issued: Palkh &


(bignatyfe of Agents of Board of Health or other)


H.O.


3/6/61


(Official Designation)


(Date of Issue of Permit)


JCTIONS OR CERTIFICATE


riving OF DEATH


·t enter han one for each b) and (c)


's not mean of dying, heart failure, tc. It means , or compli- hich caused


is, if any, ve rise to zuse (a), he under- luse last.


ions contrib- ath but not the terminal dition given


hapter 137, 4. requires to print or cause or death on icates, and , Acts of res Physi- int or type signature.


(Signed)


Myron n. 1mg


MIRON N. KING M.D


(PRINT OR TYPE SIGNATURE)


(Address) 222 PLEASANT


·WINTER.


Date ...


3/5


, 61


Winthrop Cemetery,


Winthrop


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March


8th


19


61


7 NAME OF FUNERAL DIRECTO Richard C. Kirby, Inc. ADDRES 917 Bennington St. , E.Boston


Received and filed


MAR 6 1961


19


(Registrar)


5 YRS.


Due To (c)


OTHER


DIABETES MELLITUS- MILD


SIGNIFICANT


CONDITIONS


DECUBITUS ULCER


5 DAYS


Was autopsy performed ?


What test confirmed diagnosis ?


CLINICAL


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


PARENTS


3 DATE OF


MARCH


5


1961


DEATH


(Month)


(Day)


(Year)


4 I HEREBY


CERTIFY


That I attended deceased from


MAR 51


19%


I last saw he native on


MAR 5


, 1961


death is said to


have occurred on the date stated above, at


7:20 Am.


INTERVAL


BETWEEN


DNSET AND


DEATH


2 WKS.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


CEREBRAL VASCULAR ACCIDENT


WITH RT HEMIPLEGIA


Due To


(b)


ARTERIO-SCLEROTIC + HYPER-


TENSIVE HEART DIS


to ...


MAR 5


61


PHYSICIAN - IMPORTANT


[(Was deceased a


U. S. War Veteran,


lif so specify WAR)


No


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


[(If death occurred in a hospital or institution,


St. ? give its NAME instead of street and number)


(Benavidz)


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


R-301A 1


.59-926662


TOW ¡


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE. 3 DATE OF DISCHARGE.


: RANK, RATING THRC.R.


ORGANIZATION AND OUTFIT


MAR =6196T "AM 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.


X


R-301A


1


PLACE OF DEATH


SUFFOLK (County)


WINTHROP (City or Town)


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


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


Registered No. 45


[(If death occurred in a hospital or institution,


St ? give its NAME instead of street and number)


PHYSICIAN - IMPORTANT f(Was deceased a U. S. War Veteran, no


if so specify WAR)


(a) Residence. No.


218 Lincoln Street


(Usual place of abode)


St.


Winthrop


(If nonresident, give city or town and State)


Length of stay: In place of death ..


3


.. years.


months


.days. In place of residence.


.years ..


months ..


.days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


MARRIED


(write the word)


WIDOWED


or DIVORCED Widowed


4 I


HEREBY CERTIFY,


19.07, to Marele 8


That I attended deceased from


61


l last saw h.).Mfalive on .


march 3


, 19 61


death is said to


have occurred on the date stated above, at


1:50pm.


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE


Years


Months.


28


.Days


If under 24 hours


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


13 Usual


Occupation :


Contractor


(Kind of work done during most of working life)


14 Industry


or Business :


Building


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


Italy


17 NAME OF


FATHER


Anthony Delmonico


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


Salerno


19 MAIDEN NAMEouise Tetore


1 D. OF MOTHER


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Italy


Mrs. May G. Gaffny


DATE OF BURIAL ... March 13.


19.


61


7 NAME OF


FUNERAL DIRECTOR


Ernest P .Caggiano


ADDRESS


147 Winthrop St. Winthrop


Received and filed MAR 10-1961 19


(Registrar)


PARENTS


6 .Assumption Cemetery., Syracuse, .... N. Y.21 Place of Buffal or Cremation (City or Town)




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