Town of Winthrop : Record of Deaths 1963, Part 26

Author: Winthrop (Mass.)
Publication date: 1963
Publisher:
Number of Pages: 574


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 26


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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