USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 26
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MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
widowed
11 If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Alfred Roy Paro
(Husband's name in full)
12
AGE5.8 .. Years. 1
Months.
23
Days
If under 24 hours
Hours ........ Minutes
13 Usual
saleslady
Occupation :
(Kind of work done during most working life)
14 Industry
or Business :
retail merchandise
15 Social Security No ..
019-23-7263
16 BIRTHPLACE (City)
Winthrop
(State or country)
Massachusetts
Doane
17 NAME OF
FATHER
Benjamin Stanwood
18 BIRTHPLACE OF
FATHER (City).
East Boston
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Frances Agnes
Donahue
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 Inforinant
Mrs. Edward C. Feeney
( Address)
218 Court Road, Winthrop, Mass.
Falah 6° Vivian
(Signature of Agent of Board of Health or other)
Health Officer
July 2, 196 3
2
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
$2
R-301
al permit Health t. S
CATE
PE JSES
1e ch (c)
mean dying, aslure , means ompli- caused
iny, : to (a), der - last.
- ontrib- ut not minal given
-
Que to acute coronary
(c)
Due
occlusion on basis of history
OTHER
Winthrop Board of Health
SIGNIFICANT
CONDITIONS
Charles Liberman, mill.
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signature)
Pleaseles
Libe man
M. D).
CHARLES
LIBERMAN
(Print or Type Name)
(Address) WINTHROP, MASS Date.
7/1/1963
Winthrop Cemetery Winthrop, Mass 6
l'lace of l'urial or Cremation
(City or Town)
DATE OF BURIAL
July 3, 1963
19
7 NAME OF
FUNERAL DIRECTOR
alfred B. Marche
HEREBY CERTIFY that a satisfactory standard certificate of death ADDRESS /4 Winthrop St. Winthrop, Massas filed with me BEFORE the burial or transit permit was issued.
Received and filed
JUL 2 -1963
19
(Registrar)
1963
3 DATE OF
DEATH
July
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
19
to.
I last saw h ...... alive on
have occurred on the date stated above, at 2:40A .r.
death is said to
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Death, presumably due to
INTERVAL
BETWEEN
ONSET AND
DEATH
Due
Thatural causes, probably
(b)
9 COLOR
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
NO.
(a)
Residence. No.
(Usual place of abode)
I
No
587 Pleasant Street
Registered No.
PARENTS
TL
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
OF
TOWN
1 .!
OFF
5
WINTHRO
6
KLERK
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of 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 persons who, though disabled by recognized disease unrelated to any forJUL 2 1963 PM 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.
R-301
I
PLACE OF DEATH
JUFFOLK (County) WINTHROP (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return,
129
No. 106 PUTNAM ST §(If death occurred in a hospital or institution, St. ? give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
VITO PETRALIA
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
106 PUT NAM ST
St
WINTHROP.
(City or town and State)
Length of stay: In place of death 23
.years.
.months.
days. In place of residence 50 years.
.......
months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
.
WHITE
10 SINGLE
MARRIED
WIDOWED
DIVORCED
(write the word)
UNKNOWN MARRIED
11 If married, widowed. or divorced
ANGELA LAMPASONA
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of 4
(Husband's name in full)
12
AGE 74 Years
Months .. ..... Days
If under 24 hours
Hours ..
Minutes
13 Usual
BARBER. (RETIRED)
(Kind of work done during most of iworking life)
Occupation :
14 Industry
or Business :
BARBER SHOP
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
ITALY
17 NAME OF
FATHER
PAUL PETRALLIN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
ITALY
19 MAIDEN NAME
OF MOTHER
JOSEPHINE LOLONGENIO
20 BIRTHPLACE OF
MOTHER (City).
(State or country )
ITALY
21 Informant
PAUL PETRALLIA
(Address)
106 PUT NAM ST WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Falch 6, Liviana (Signature of Agent of Board of Health or other) (HB) Health Officer July 3, 1963
(Official Designation) (Date of Issue of Permit)
V. TV
A TRUE COPY ATTEST:
3 DATE OF
DEATH
JULY
/
1943
(Year)
(Month)
(Day)
4 IHEREBY CERTIFY , That I attended deceased from 19 to ... 19
I last saw h.'Malive on
VLLY
1
19 % Sdeath is said to
have occurred on the date stated Above, at
5:50 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Death presumably due to
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
Due T
natural causes, probably
(b)
acute coronary occlusion
Ion basis of history.
(c)
Winthrop Board of Health
OTHER
SIGNIFICANT
CONDITIONS
Clearlos Liberman Mal
Was autopsy performed? What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signature)
0 balles
Libe una
. D.
CHARLES
LIBERMAN
(Print or Type Name)
(Address
WINTHROP, MASDate 7/3/1963
6 WINTHROP
WINTHRUM
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL .
JULY 6
1943
7 NAME OF
FUNERAL DIRECTOR
MAURICE N. KIRBY
ADDRESS
WINTHROP
Received and filed
JUL 3 - 1963
19
( Registrar )
al permit Health t.
S
CATE
PE JSES
T ne ch (c) mean dying, ailure, means ompli- caused
any, e 10 (a), der - last. contrib- ul not rminal given
PARENTS
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR) NO
(Usual place of abode)
MALE
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 TOVA
MIN
6
THROP
JUL .3 1963 AM
R-301
any, e 10 (a), der- last. ontrib- ut not rminal given
Was autopsy performed?
NO TRANSAMINASE
What test confirmed diagnosis ?
TRANSAMINASE-ENG. L.D.H.
5 Was disease or injury in any way related to occupation of deceased ? Y ... If so, specify
(Signature)
Stoffer
M. D.
D. Thomas
STAFFIER
(Address)
(Print or Type_ Name) 21 BREENSTRO .. Date
19 13
Holy Cross Cemetery Malden 6 Idade of burial or Cremanon Sty or Town)
DATE OF BURIAK
Forly 40
1963
7 NAME OF
FUNERAL DIRECTOR -
* Freterick lefaso
ADDRESS 65 Clark St Cover
Received and filed JUL 2 -1963 19
(Registrar)
A TRUE COPY ATTEST:
8.7-X
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
130
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME. Emilio
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
17 Chisholm St.
(Usual place of abode)
Length of stay: In place of death .......... years .......... months .......
1
days. In place of residence >years. ....... months ........ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
.
8 SEX
male Tribute
9 COLOR
10 SINGLE
(write the word)
.
MARRIED
WIDOWEDG
DIVORCED
Married
1 17 TY married, widowed, or divorced
HUSBAND
Tomel Bonotti
(or) WIFE of
(Husband's name in full)
12
AGE 65 Years.
Months .....
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation :
Cleance
Kind of work done during most working life)
14 Industry
or Business :
Self Employed
15 Social Security No ...
6028-10%-9906
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Luigi +Staffieri
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Santa Famiglietti
20 BIRTHPLACE OF MOTHER (City). (State or country)
Italy
21 Informant
( Address)
17 Chisol Sr Coverto
Į HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph / Serianni()
§Signature of Agent of Board of Health or other)
Health Officer
Julep 2 1963
(Official Designation) (Date of Issue of Permit)
82
PLACE OF DEATH
Suffolk (County)
1
Winthrop
(City or Town)
al permit Health it. IS
ICATE
'PE USES
r ne ch 1 (c) mean dying, failure, means ompli- caused
0
I last saw
hl&.alive on
July
1
13
death is said to
have occurred on the date stated above, at
1200
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
acute CoronARY ThRou boris
(a) ....
Due To
(b)
Chy. Coronary ARTERY DISEASE
1049 S
l)ue To (c)
OTHER SIGNIFICANT CONDITIONS
. That I attended deceased from
yan. 1955
to.
JULY
1
19.0
3
(Month)
(Day)
(Year)
IHEREBY CERTIFY
Everett Mass
St
(Was deceased a
U. S. War Veteran,
(if so specify WAR) .....
(If nonresident, give city or town and State)
3 DATE OF
DEATH
JULY
1
1963
Staffieri
Winthrop Community Hospital
No.
Bell
(City or Town making this return)
PARENTS
.
(Give maiden name of wife in full)
INTERVAL BETWEEN ONSET AND DEATH 24°
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 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.
OF
TO:
'301.
11 72 .
CLERK
00
IM
6
ITHROP MAS
JUL 2 1963 AM
R-301
PLACE OF DEATH
I SUFFOLK (County) WINTHROP (City or Town)
TATE
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS (City or Town making this return)
STANDARD CERTIFICATE OF DEATH
Registered No.
131
S(If death occurred in a hospital or institution, .. St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
12 PLEASANT ST.
(a) Residence. No.
(Usual place of abode)
length of stay : In place of death. .. years ..
months 6 days. In place of residence. 5
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
MALE WHITE
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED WIDOWER
UNKNOWN
11 If married, widowed, Advised Cambria
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE
89
Pars.
Months.
Days
If under 24 hours
Hours ... . Minutes
13 Usual
Occupation
Contractor TREtiREdy
( Kind of work done during most of iworking life)
14 Industry
or Business :
Retired
GENERal CONTR.
15 Social Security No.
None
16 BIRTIII.LACE (City)
( State of country )
Italy
17 NAME OF
FAILIER
Nunzio Bonaccorso
18 BIRTHPLACE OF
FATHER ((ny)
(State or country }
Italy
19 MAIDEN NAME
OF MOTHER
Mary Canna bucci
20 BIRTIIPLACE OF
MOTHER (City)
(State or country )
Italy
Lillian Pirroni
1.Addlı
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Vivianne
(Signature of Agent of Board of Health or other)
Health Officer
July 3, 1963
(Official Designation) (Date of Issue of Permit)
-TX
A TRUE COPY ATTEST:
(Day)
(Year)
4
I
April1
HEREBY CERTIFY _That I attended deceased from
1965, to Valy
2
1963
1 last saw hh alive
0752 335 Alin, 1963, death is said to
have occurred on the date stated above, at 345A ....
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CARCINOMA HEAD of PANCREAS
INTERVAL BETWEEN ONSET AND DEATH 6 mos
1)we (b)
ARTERIO - VASCULAR DISEASE
2-3 yrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
No
Was autopsy performed ?
What test confirmed diagnosis >
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signature)
G.
Jun
Guy/Grande.
(Print &.Type Name) 20 Sarat (Address) Magt .BOBton .. Date.
July 21,63
Winthrop.
WinthropMass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July
5
63
7 NAME OF
FUNERAL, DIRECTOR
Frederick J. Magrath.
ADD 325 Chelsea St. East Boston.
Received and filed
JUL 3-1963
19.
( Registrar)
404
rial permit Health nt. NS
FICATE
YPE USES H
er one ach d (c)
t mean dying, failure, means compli- caused
any, ise to (a), inter- last.
contrib- but not terminal " given
MOUNTS CONVALESCENT HOME No ... ANTONIO
BONACCORSO
St ..
WINTHROP
(City or town and State)
years .. ....... months ... ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
JULY
2
1963
Grande
M. D.
PARENTS
21 Informant
I2 Pleasant St. Winthrop
divorsed
(Was deceased a U. S. War Veteran, if so specify WAR) NO
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
TOW
ORGANIZATION AND OUTFIT
SERVICE NUMBER 0. 13) ERK
RU LES OT PRACT
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice: (1) Attending physicians will cont fy to such deaths only as those of persons
to whom they have given bedsideule Oblastifiness 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.
PLACE OF DEATH
Suffolk (County) WINTHROP (City or Town)
Boston 8-5-63
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
CERTIFICATE OF DEATH convalescent WINTHROP HAVING Home
f(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
No.
2 FULL NAME.
Emily LAPorta (SarNo)
(If deceased is /a married, widowed or divorced woman, give also maiden name.)
BALDWIN ACE
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
months
days. In place of residence year
.months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
2
1963
(Month
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
to
19
I last saw h _____ alive on
, 19_
____ , death is said to
have occurred on the date stated above, at
9:1.1m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Death presumably due to
natural causes, probably
Due To
(b)
cerebral vascular
occlusion on basis of
Due To history and previous
(c)
ailment
Winthrop Board of
Health
Was autopsy performed Paneles
What test confirmed diagnosis?
OTHER
SIGNIFICANT
CONDITIONS
Charles Listenin, Luca
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
Charles Letterwenn m. D.
(Signed) CHARLES
LIBERMAN
(Address) WINTHROPMAS Date 7/2/1963
6 St Michael's Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
July 6
1963
7 NAME OF
FUNERAL DIRECTOR
Ernest Caggiano
ADDRESS
147 Wenthul St Withrik
Received and filed
JUL 8 - 1963
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
Mute
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
10a If married, widowed, or divorce.
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Giacomo LA Porta
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
67 Year
3
Months
.Days
5
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
outof Home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Ota
taty
17 NAME OF
FATHER
David SarNo
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Sta 14
19 MAIDEN NAME
OF MOTHER
LOUISE ARICCA
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy.
21
Mrs Margaret Martusci
Informant
(Address)
125 Circuit Rd Winthrop
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Ralph 6: Serianni (Signature of Agent of Board of Health or other)
Health Officer
July 51963
(Official Designation)
(Date of Issue of Permit)
X
S
ICATE
CATH r ne ch L (c)
mean dying, Failure . means om pli- caused
any, e to (a), nder- last.
ntrib -- ut not rminal given
r 137, quires int or or
se th
50M-1-58-921976
1A
1
Registered No.
132
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No
1471 WINTHROP SF
St
BOSTON
PARENTS
AGE
HOUSEWIFE
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registercd 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 ncarly as he can state the samer For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section andiof sections forty five, forty- sivand forty-seven of said chapter one hundred and founteefi, the word "(war'! shall-include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, feighteen hundred and ninety-eight and July fourth, nineteen hut lied and two, and the Mexican border service of nineteen hundred and sixteenand frmeteen hundred and seventeen. G. L. Chap. 46, Sec. 10. WII 6
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