USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1962 > Part 36
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
(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 froin 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 fursuits can be @ nowal Make some entry in this section for every person aged 10years 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
CIM R-302
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 THIS IS A PERMANENT RECORD
PLACE OF DEATH
Essex
1
(County)
Danvers
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or Town making this return)
Registered No.
180
(City or Town) Danvers State Hospital Hathorne S(If death occurred in a hospital or institution, .St. { give its NAME instead of street and number)
Maude B. Tewksbury
(If deceased is a married, widowed or divorced woman, give also maiden name.)
98 Bellevue Ave.
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 .......... years .......... months ........
.. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
TIF
That
attended deceased gym
19
I last saw h ...... alive on
4:25ª
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET ANO
DEATH
Due To (b)
Due To (c)
OTHER
Bronchopneumonia
SIGNIFICANT
CONDITIONS
Was autopsy performed ?
yes
What test confirmed diagnosis ?
by autopsy
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
Andrew Nichols III
(Signed) Androw Nichols III
M. D.
(Address) Hp thorne, Mass. Date 10/5/ .. 62 19.
Winthrop Cemetery, Winthrop 6 Place of Burial or Cremation
DATE OF BURIAL
19
7 NAME OF
Reynolds Funeral Home
FUNERAL DIRECTOR
Winthrop, Mass.
ADDRESS
Received and filed
NOV 1 1962
.19
(Registrar of City or Town where deceased resided)
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN'
(write the word)
single
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of.
(Husband's name in Iull)
12
75
6
6
If under 24 hours
Hours .......
Minutes
13 L'sual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :..
15 Social Security No.
.. Winthrop
16 BIRTHPLACE (City).
Mess ..
(State or country)
17 NAME OF
FATHER
Herman Douglas Tewksbury
18 BIRTHPLACE OF
FATHER (City) ..
(State or country)
Winthrop
Mass
19 MAIDEN NAME
OF MOTHER
June Gammon
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Yarmouth, N.S.,
Canada
M. ry, E. Sheehan
21 Informant
Hathorne, ....... ass ..
(Address)
A TRUE COPY
ATTEST:
Posil Toonly
(Registrar of City or Town where death occurred)
DATE FILED
10/11/
1962
(Was deceased a
U. S. War Veteran,
if so specify WAR
(a) Residence. No.
(Usual place of abode) 6
4
14
October
5,
1962
(Year)
C 19.Octto 5,
62
death is said to
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Generalized Arteriosclerosis
(a)
PERSONAL AND STATISTICAL PARTICULARS
(Give maiden name of wife in full)
AGE
Years.
Months.
Day:
none
PARENTS
Oct. 6(City or Town)
62
50M - 10-61-931673
No ....
2 FULL NAME
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
IT:
ARK
ROR
NOV 1 1962 AM
1X PLACE OF DEATH
SUFFOLK (County) WINTHROP (City or Town) 97 GROVER'S AVE No. Peter
The Commonwealth of Massachusetts EDWARD J. CRONIN 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. 1.81
[ (If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
97 GROVER'S AVE
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years months days. In place of residence
5
.years
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR OR RACE
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) MARRIED
4 I HEREBY CERTIFY .
19
-
to
19
10a If married, widowed, or divorced
HUSBAND of .......
(Give maiden name of wife in full)
(or) WIFE of
AGATHA
. ZINO
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
8%
11
Months
22
Days
If under 24 hours
Hours .
Minutes
13 Usual
Occupation :.
BRICKLAYERS.T.
14 Industry
15 Social Security No. 034-18-0305A
16 BIRTHPLACE (City) (State or country) ITALY
OTHER
SIGNIFICANT
CONDITIONS
none
-
Major findings:
Of operations
Date of operation.
Was autopsy performed? no
What test confirmed diagnos
Post-mortem judgement
5 Was disease or injury in any way related to occupation of deceased? no If so, specify Arthur C. Murray, M.D. (Signe)ichne mun ay M. D. (Address) Winthrop Board of Heavy 16 Oct 1962.
. HOLY CROSS CEMETERY, MALDEN Place of Burial or Cremation (City of Town) MASS
DATE OF BURIAL. OCT. 19 196.2L
7 NAME OF
LAWRENCE BRUNO
FUNERAL DIRECTOR
ADDRESS
291 REVERE ST. REVERE
MASS
19
Received and filed.
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
PHILOMENA UNKNOWN
20 BIRTHPLACE OF MOTHER (City) (State or country)
ITALY.
AGATHA CERBONE (WitA)
21 Informant (Address) 97 DRIVER'S AVE, WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificateof death was filed with me BEFORE the burial or transit permit was issued: Rekli 8. tireama
(Signature of Agent of Board of Health or other)
10/15/65
(Official Designation)
(Date of Issue of Permit)
T.JCTIONS OR VI ERTIFICATE
n iving OF DEATH it enter shan one u or each ) and (c)
is oes not mean ef dying, such faure, asthenia. reis the disease, olutions which e.1.
t' conditions. i1g rise to the (a) stating deying cause .C
dons contrib- Il death but not Die disease or tusing death.
Chapter 137. .954, requires us to print or tause or causes 2 on death ca.
50M-3-54-911687
AR-301A 1
2 FULL NAME.
(a) Residence. No. (Usual place of abode)
(Month)
(Day)
That I attended deceased from
-
I last saw h ........
alive on
19 ........ , death is said to
have occurred on the date stated above, at
3 P. m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) Natural Causes
INTERVAL BE- TWEEN ONSET AND DEATH -
ANTE
Due Topresumably Coronary
CEDENT (b)
CAUSES
Occlusion
Sudden
Due To Arteriosclerotic
(c)
Heart Disease
15
years
(Kind of work done during most of working life)
or Business:
CONSTRUCTION
17 NAME OF FATHER ANTHONY CERBONE
Registered No.
Cerbone
(Was deceased a U. S. War Veteran, if so specify WAR) No
3 DATE OF
DEATH
October
16
1962
(Year)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall. if the deceased. to the best of his knowledge and belief. served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five. forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person ‹lied; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied. in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in heu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose. the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the-interment is made.
. . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
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 in jury, 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 resultingble bled united disease, and those of
the sudden deaths of persons nou TOif irdun ofinfection related to occupation, 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
R-301 1
TI CTIONS
PLACE OF DEATH
Suffolk (County)
AKSEPFTI
-11
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) No. Mayflower Nursing Home,Winthrop ....
2 FULL NAME WILLIAM GILLIS (First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No356 Beach Street (Usual place of abode)
...........
St.Revere ...... 5.1 ............ Un.S.S ..
(If nonresident, give city or town and State)
Length of stay: In place of death 3 .. years. 7 .months. days. In place of residence. .years ... ...... .months ............ days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 CITIZEN
OF U.S.
YES
NO
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
lla If married, widowed, or divorced
HUSBAND of
Anna ..... Walsh
(or) WIFE of
(Husband's name in full)
12 DATE OF BIRTH
13
AGE
87 Years.
.Months.
.. Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :
retired.
(Kind of work done during most of working life)
15 Industry
or Business :
C. N. B. L.
16 Social Security No.
Cambridge, Mass
17 BIRTHPLACE (City)
(State or country)
18 NAME OF
FATHER
Peter Gillis
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown.
20 MAIDEN NAME
OF MOTHER
Isabella Patterson
21 BIRTHPLACE OF Unknown
MOTHER (City)
(State or country)
22 Catherine Gillis
Informant
(Address)
18 Reservoir Ave, Revere,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Halfle o Pereanne x
(Signature of Agent of Board of Health or other) Keabete Officer
10/15/62
(Official Designation)
(Date of Issue of Permit) /
A TRUE COPY ATTEST:
(Registrar)
PARENTS
Bast Boston, Dass
Everett
Place of Burial or Cremation
DATE OF BURIAL
oct.
I8
19
7 NAME OF FUNERAL DIRECTOR Lopresti Funeral Ser.
Inc
ADDRESS
262 Pearl St. Malden
Received and filed
OCT .19 1962
19
10-16 1960
(Address)
821 Gratora Strate.
M. D.
(Signed)
e Chapter 137, 954 requires ns to print or e cause
or B of death on 1 ctificates, and te 48, Acts of quires Physi- print or type vier signature.
-
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
INTERVAL BETWEEN ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Generalized arteriosclerosis DEATH
15yrs
5 Was diseage or injury in any way related to occupation of deceased? If so, specify ....
John F. com, !).
(Print or Type Name)
6 Woodlawn
(City or Town) 62
RE
2
Winthrop (City or 'Town)
Registered No.
182
PHYSICIAN - IMPORTANT
f(Was deceased a U. S. War Veteran,
[if so specify WAR) NO
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
October
16, 1962
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY, That I attended deceased from
Sept.11.
19 ...
52 toOctober
15
62
I last saw Wallhalive on
October
15.050 62
death is said to
(Give maiden name of wife in full)
have occurred on the date stated above, at
D.m.
n iving F DEATH r .: enter e lan one Je or each ,p) and (c)
ds not mean od of dying, cart failure, c. It means a: or compli- ich caused
tus, if any, ve rise to use (a), & he under- use last.
nd ons contrib- cath but not to'he terminal codition given
3-930213
X
Peter-Gillis
L ERTIFICATE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1 ..
OCT 191962 AM
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 froin 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.
i 1 1 1 ( 1
1 1
E €
( 1 t t T
1
f
6
] ] 1 (
c
X
SUFFOLK
1
(County) WINTHROP
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
WINTHROP
(City or Town making this return)
Registered No.
183
En route to Winthrop Community Hospita,If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number) No.
2 FULL NAME
JACOB
PASTAN
(( Was deceased a
¿ U. S. War Veteran,
{if so specify WAR)
NO
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death.
.years.
months
......
.days. In place of residence.
30
.years ..
.... months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 17, 1962
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR
white
11 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word )
Married
4 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.) Pcclusive coronary arteriosclerosis
12 If married, widowed, or divorced
Miriam M. Ceder
HUSBAND of
and
(Give maiden name of wife in full)
WIFE of
(Husband's name in full)
5 Accident, suicide, or homicide (specify)
Accident.
Date and hour of injury
10/14
62
IF ACCIDENTAL, was injury causally related to the death ?
Yes.
15 Usual
Occupation
Dealer
(Kind Owork done during most of working life)
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm,. in industrial place, or
public place ?
Market building
(Specify type of place)
Manner of
Accidental fall downstairs.
Injury
(How did injury occur ?)
Nature of
Injury
While at work? Was autopsy performed ?
Yes.
6 Was disease or injury in any way related to o rup tmn& deceased ?
If so, opeof ....
(Signed)
M. D.
Michael (Print or Type Name)
Luongo .M.D. 10/18 ,62
(Address)
Date
Sharon Memorial Park 7
Sharon
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL
October
18
19.62
8 NAME OF
FUNERAL DIRECTOR
PaulR .... Levine
ADDRESS 470 Harvard St., Brookline
Received and filed OCT 19-1962 .. 19 ..
A TRUE COPY ATTEST:
(Registrar)
PARENTS
20 BIRTHPLACE OF
FATHER (City)
(unknown)
(State or country)
21 MAIDEN NAME
OF MOTHER
Rose (unknown)
22 BIRTHPLACE OF MOTHER (City) (State or country)
Mrs. Miriam Pastan
23
Informant
(Address)
154 Sewall Ave., Winthrop
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)
1 10/19/62
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER VI
DEATH in plain terms, so that it may be properly classified under the International Classification of Causes
of Death. See reverse side for additional information. See also Chap. 38, §§ 6, 20; Chap. 46, §§ 9, 10; Chap. 114,
§§ 44-48.
50M-9-61-931348
PLACE OF DEATH
R-303 burial permit 1 of Health Agent.
If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.