USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 11
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PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, (if so specify WAR) NO.
(a) Residence. No.
(Usual place of abode)
55 Min.
(If nonresident, give city or town and State)
Length of stay: In place of death.
............ years.
months.
Hex* In place of residence ..
3.0 ... years.
months. .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
white
10 SINGLE (write the word) MARRIED married WIDOWED or DIVORCED
10a If married, widowed, or divorced HUSBAND of Barbara Cameron
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
II IF STILLBORN, enter that fact here.
12
1 10 -15 um GE 62
Years
.4.
Months.
.2.0.Days
If under 24 hours
Hours. Minutes
13 Usual
Occupation :
Photo engraver
(Kind of work done during most of working life)
14 Industry
or Business :
Boston Newspapers
15 Social Security No.
011-01-2409
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
Charles Wilox Hunter
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country) Massachusetts
19 MAIDEN NAME OF MOTHER Ida May DeMerrit
20 BIRTHPLACE OF MOTHER (City) Boston
(State or country)
Massachusetts
6
Winthrop Cemetery' Winthrop, Mass Place of Burial or Cremation (City or Town) DATE OF BURIAL March 30,1962
7 NAME OF FUNERAL DIRECTO
acked B. March
ADDRESS 174 Winthrop St.Winthrop .....
Received and filed
.19
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Joseph Za bella Joseph Zambella, MD .. , M. D.
PRINT OR TYPE SIGNATURE)
(Address) 327 Summer Salkostim 7-26.62
Charles W. Funter
Informant (Address) 84 Lincoln St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued :
Mass ..
(Signature of Agent of Board of Health or other
health Officer (Official Designation)
3/29/62
(Date of Issue of Pernny)/
VE
3 DATE OF
DEATH
March
26
1962
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
March 26
1902
to .....
4411024 26
19.
62
I last saw h.l.Malive on
March 26 1962, death is said to
have occurred on the date stated above, at
1.45pm.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Coronary Occlusion
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?
What test confirmed diagnosis ?
INTERVAL BETWEEN ONSET AND DEATH
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hospital No.
2 FULL NAME
Charles Wilox Hunter
(If deceased is a married, widowed or divorced woman, give also maiden name.) 84 Lincoln St
Winthrop
St.
That I attended deceased from
Gardner
ng
Y
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
TOW:
ORGANIZATION AND OUTFIT
SERVICE NUMBER
V
6
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 thors to whom they have given bedside care during a last illness froMARS1962 AM 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
Suffoll. (County)
inthrop (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.
54
No. inthron Community Hospital
E.
2 FULL NAME Vier ce xxxxxxxxourad (Moore )
(If deceased is a married, widowed or divorced woman, give also maiden name.)
7 In Isside Ave, inthrop
St.
(If nonresident, give city or town and State)
.years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
8 SEX
female
white
10 SINGLE
(write the word)
MARRIEDwidowed
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Alexander M. Murad MouRid
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
Years
AGE7.7
3
Months ..
9
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Hospital Maid
(Kind of work done during most of working life)
14 Industry
Winthrop Community Hospita or Business :
15 Social Security No.
010-07-8712-D
Bermingham
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
Henry Moore
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
Mrs. Lawrence T. Burns
21 Informant (Address) 5 Ingleside Ave. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued: Halkle E Miriane
(Signature of Agefft of Board of Health or other) Health Offices 3/29/62
(Date of Issue of Permit).
(Official Designation)
(Registrar)
PARENTS
Imyron bo King M. D. OF MOTHER Elizabeth Roath
(Signed) MYRON NUKING M.D
(PRINT OR TYPE SIGNATURE)
3/27 1962
Rock Ridge Cemetery 6
Place of Burial or Cremation (City or Town)
7 NAME OF FUNERAL DIRECTOR
DATE OF BURIAL March 30,1963 Chud B, March
ADDRESS 174 Winthrop St. Winthrop, Mass.
Received and filed
19
TVI.
ISTRUCTIONS FOR O AL CERTIFICATE
In giving UE OF DEATH ) not enter nre than one cise for each ). (b) and (c)
h does not meon code of dying, sos heart failure, ez, etc. It means leose, or compli- os which caused A
o'itions, if ony, hh gove rise to bie couse (a), asg the under- i couse last.
nditions contrib- H'o deoth but not ti to the terminol a condition given
c :- Chapter 137, af 1954. requires r:ians to print or e the cause or of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.
MAR 2 9 1962
M-6-59-925686
3 DATE OF
March 27. 1:02
DEATH
(Month)
(Day)
(Year)
4 THFREBY CERTIFY,
Jan
2%
1962 to.
MAR 27
That I attended deceased from
162
I last saw h. 6 live on
MAR.
27, 1962, death is said to
have occurred on the date stated above, at
INTERVAL
BETWEEN
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ONSET AND
DEATH
(a) GENERALIZED CARCINOMATESIS
CARCINOMA OF STOMACH
(b)
....
3 MIO
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
GENERAL ARTERIOSCLEROSIS
Was autopsy performed ?
No
What test confirmed diagnosis ? BIOPSY CLINICAL, OPERATION
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Address) 222 PLEASANT. ST ...... Date .. Sharon, Mass
Registered No.
f(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)
Length of stay : In place of death.
.... .. ... years.
2
months
.days. In place of residence.
40
Imor
CINSE LE TIT ULA
OM R-301A 1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
FECE VED
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
TOW: .1
19
I
2 :
0
RULES OF PRACTICE MAR 2 91962 AM
The fulfillment of the purpose of these laws calls for the observance of the following ritles 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)
Winthrop
(City or Town)
No.
475 Shirley St
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. 55
S(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Albert F. Beddeos
( 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.
119 Terrace Avenue
St
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months.
days. In place of residence.
4.0 years
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
March 28. 1962
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY ,
to
19.
That I attended deceased from
19
I last saw h ........ alive on
19 ...
death is said to
have occurred on the date stated above, at
4.40 P.m.
INTERVAL BETWEEN ONSET AND DEATH
Due To
(b)
Causes presumably due to
Due To
(c)
acute coronary occlusion
OTHERAte arteriosclerotile heart SIGNIFICANT CONDITIONS disease
Winthrop Board of Health
Was autopsy performed?
What test confirmed di
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
I. D CHARLES LIBERMAN, M.D
(PRINT OR TYPE SIGNATURE)
(Address) WINTHROP Date 3/28/ 1962
6
Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Mar.c.h ..... 3.1 .. , ... 19 ... 62.
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop Mass
Received and filed MAR 30 1962
19
(Registrar)
PARENTS
17 NAME OF
FATHER
Earl Beddeos
18 BIRTHPLACE OF
FATHER (City)
Arlington
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Frances Brown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
Mass
21 Helene Beddeos
Informant (Address)
119 Terrace 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 C. Piriannex (Signature of Agent of Board of Health or otber)
Health Officer 3/30/62
(Official Designation)
(Date of Issue of Permit) TUE. V
ITRUCTIONS FOR DIAL CERTIFICATE
n giving JE OF DEATH I not enter fre than one ci se for each (), (b) and (c)
hi does not mean ode of dying, s heart failure, en, etc. It means azase, or compli- which caused
ositions, if any, hit gave rise to c
cause (a), lig the under- il cause last.
(nditions contrib- go death but not e to the terminal as condition given a
Ne :- Chapter 137, cfof 1954. requires icians to print or p the cause or us of death on a certificates, and hiter 48, Acts of 5 requires Physi- a to print or type under signature.
MI-60-928145
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED ed
(write the word)
10a If married, widowed, or divpresthe Ezekiel
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 ... 5.3 ... Years ...
Months ..
Days
If under 24 hours
Hours ..
.Minutes
13 Usual
Occupation :
Gas Sta Proprietor
(Kind of work done during most of working life)
14 Industry
or Business :
Automobile
15 Social Security No.
Somerville
16 BIRTHPLACE (City)
(State or country)
Mas's
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Death due to natural
(Usual place of abode)
OM R-301A 1
SPACE FOR ADDITIONAL INFORMATION
TOWI
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
9:
ORGANIZATION AND OUTFIT
0
SERVICE NUMBER
MAR 3 01962 KM
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)
ONSE PI
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.
56
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Lillian J. Laidlaw
(First Name)
(Middle Name)
(Last Name)
[ (Was deceased a U. S. War Veteran,
{if so specify WAR) No
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death.
.years.
months
.days. In place of residence. LO .... years.
... months ...
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEMarried
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frederick W. Laidlaw
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DEATH
15 MIL
12
AGE
69
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.
Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
George Johnson
18 BIRTHPLACE OF
St. Johng
FATHER (City)
(State or country)
N. B.
19 MAIDEN NAME
OF MOTHER
Annie McNamara
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
St. John$
N. B.
21 Loretta Gallagher
Informant (Address) 177 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: Halflifereally
(Signature of Agent of Board of Health or other) Healthe Officer
4/2/62
(Official Designation)
(Date of Issue of Permit)V 1
....
JAN
19.60
to. MAR30
I last saw h.Ellalive on
MAR 30, 1962, death is said to
have occurred on the date stated above, at
8.35 Pm.
INTERVAL BETWEEN ONSET AND
(a)
....
ACUTE CORONARY OCC
Due To
(b)
ARTERIOSCLERETIC HEART
DIS
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
No
What test confirmed diagnosis?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased: N.a. If so, specify
Muren n. Kui
(Signed)
222 PLEASANT ST QUINTARIA
(PRINT, OR TYPE SIGNATURE)
MYRON N-KING
Date ..
3 31 1962
(Address)
Holy Cross
6
Place of Burial or Cremation
Malden, Mass
(City or Town)
DATE OF BURIAL April2, 19.62
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass
Received and filed APR 2 - 1962 19
(Registrar)
5-60-928145
OM R-301A 1
ISTRUCTIONS FOR O AL CERTIFICATE
In giving UE OF DEATH · not enter pre than one c se for each 1), (b) and (c)
k does not mean ode of dying, i s heart failure, er, etc. It means cease, or compli- 01 which caused th
oitions, if any, h' gave rise to be: cause (a), asg the under- cause last.
Unditions contrib- go death but not le to the terminal a: condition given a
Ne :- Chapter 137, cl of 1954. requires hiicians to print or p the cause or us of death on a certificates, and hiter 48, Acts of 5 requires Physi- a to print or type ar under signature. 1.C.
3 DATE OF
DEATH
MAR
30
1962
(Year)
(Month)
(Day)
4 I HEREBY
CERTIFY, That I attended deceased from
1962
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
2 YRS
PARENTS
Registered No.
No. 177 Somerset Avenue
177 Somerset Avenue
.St.
(If nonresident, give city or town and State)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
TO !!
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
6
RULES OF PRACTICE APR 2 1962 AM
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.
JE
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.
57
Winthrop Community Hospital 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, lif so specify WAR)
NO
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(L'sual place of abode)
147 Winthrop St. Winthrop Mass ,St.
(If nonresident, give city or town and State)
Length of stay: In place of death
. years.
1
months
.days. In place of residence
15
.years.
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
March
3.1 1962. (Year)
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEmarried
4 I HEREBY CERTIFY,
3/22
62
3/3/
That I attended deceased from
,62
I last saw henalive on
3/31
19.6 V, death is said to
have occurred on the date stated above, at
7SP
.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here
12
60
AGE
Years
8
Months
11
.. Days
If under 24 hours
Hours .........
Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
at home
15 Social Security No.
Messina
16 BIRTHPLACE (City) (State or country) Italy
17 NAME OF
FATHER
Frank Ferrara
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
Messina
19 MAIDEN NAME
OF MOTHER
Maria Velardo
20 BIRTHPLACE OF MOTHER (City) (State or country)
Ernest P. Caggiano
21 Informant (Address) 147 Winthrop St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the/ burial or' transit permit was issued: Herequilla
(Signature of Agent of Board of Health or other)
4/3/62
(Official Designation)
(Date of Issue of Permit)
TVA
TRUCTIONS FOR DIAL CERTIFICATE
n giving JE OF DEATH not enter ure than one dse for each 0, (b) and (c)
hi does not meon ode of dying, heart failure. en, etc. It means @bose, or compli- . which caused
mitions, if ony, h'i gave rise to be: couse (a), a'g the under- couse last.
(nditions contrib- go deoth but not te to the terminal acondition given
o :- Chapter 137, sf 1954. requires sians to print or e the cause or of death on tlcertificates, and [:r 48, Acts of requires Physi- to print or type a inder signature.
KM-6-59-925686
(Registrar)
PARENTS
(Signed)
Minson b. King
M. D.
MYRON IN. KINGDOM.D
(PRINT OR TYPE SIGNATURE)
(Address) LVLPLEASANT Date APRIL 2 19 62
6
Winthrop Cemetery,
Winthrop
Place of Burial or Cremation DATE OF BURIAL April 4, 19 62
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Marsh
ADDRESS 174 Winthrop St., Winthrop.
Received and filed APR 3 - 1962 19
1YR
Due To (c)
OTHER SIGNIFICANT NONE CONDITIONS
Was autopsy performed?
YES
What test confirmed diagnosis CLINICAL + PATHOLOGICAL
5 Was disease or injury in any way related to occupation of deceased ? N c. If so, specify
- (b) ....
ADENOCARCINOMA CF
UTERUS
2MO
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Ernest P ...
Caggiano
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
GENERAL CATRE IN OMATOSIS
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