Town of Winthrop : Record of Deaths 1963, Part 27

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 27


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


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54


MAS


No undertaker or other person shall bury of other rise 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, tbe-clerk of the town where the person died; and no undertaker or other puton shapekomme a human body and remove it from a town, from one cemeteryu another om one grave or tomb other than the receiving tomb to another .inthe 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 lieu 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 whichit 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 dierk 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 injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.


Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.


Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


4


No. 455 Shirley Street


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


2 FULL NAME Phyllis Alexandra Savino (Kennedy)


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


(a)


Residence. No.


455 Shirley Street


(Usual place of abode)


Length of stay: In place of death .......... years .......... months ......... days. In place of residence .... years .......... months .......... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


married


female


white


11 If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


Carl Savino


(Husband's name in full)


12


AGE 60 Years 3


.. Month:2.9


.Days


If under 24 hours


Hours ... .


Minutes


13 Usual


Occupation :


retired waitress


(Kind of work done during most working life)


14 Industry


or Business :


restaurant


15 Social Security No ....


034-20-7876


16 BIRTHPLACE (City)


(State or country)


Massachusetts


17 NAME OF


FATHER


Frank Alexander Kennedy


18 BIRTHPLACE OF


FATHER (City)


Rouses .... Point


(State or country)


New York


19 MAIDEN NAME OF MOTHER Bernice May Oakes


20 BIRTHPLACE OF


MOTHER (City)


Charlestown


(State or country)


Massachusetts


6


Winthrop Cemetery


Winthrop,


Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


19 July 6 1963 afeel B Marche


ADDRESS


....


174 Winthrop St. Winthrop


Received and filed JUL 8 - 1963 19


(Registrar)|


A TRUE COPY ATTEST:


PARENTS


21 Informant


Carl Savino


(Address) 455 Shirley St. Winthrop, Mass.


I HEREBY CERTIFY that a satisfactory standard certificate of death 1.1&& led with me BEFORE the burial or transit permit was issued: Falak


(Signature of Agent of Board of Health or other) (MB)


Health Office


July 51963


(Official Designation) (Date of Issue of Permit)


V.I.


1


1


R-301


- 1


PLACE OF DEATH


Suffolk (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)


Registered No.


133


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


NO.


St


(If nonresident, give city or town and State)


3 DATE OF


DEATH


July


4


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


October 1933


to ......


July 4


1963


I last saw hexalive on


July


2 1, 1963, death is said to


have occurred on the date stated above, at 9:50 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Coronary Occlusion.


Due Totypertensive Arterioselevatic


(b)


Due To


Heart Disease


(c)


OTHER


SIGNIFICANT


CONDITIONS


Diabetes Mellitus


2 yrs


Was autopsy performed?


No


What test confirmed diagnosis? (@fini


5 Was disease or injury in any way related to occupation of deceased? NO If so, specify


(Signature)


Charles


Liberman


M. D.


CHARLES


FIBERMAN


(Print or Type Name) (Address) WINTHROP MAZS Date


East Boston


contrib- but not erminal given


VotER (R) 267 wash AVE


ial permit Health nt. IS


ICATE


YPE USES 1


r ne ich (c)


mean dying, failure, means compli- caused


any, e to (a), nder- last.


182


INTERVAL


BETWEEN


ONSET AND


DEATH


1 day


8yrs.


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RECEIVED


OF TOWA


OFFICE (


11.12 1


CLERK


WII


5


6


MASC


HROP


JUL #81963 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 fromn 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 bad been given up or changed, or if the deceased bad 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.


Y


PLACE OF DEATH


SUFFOLK


(County)


. IN HALUP (City or Town)


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.


134


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


PHYSICIAN - IMPORTANT


2 FULL NAME


Bernard Baldassaro


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


(a)


Residence. No ..


84 Orient Ave., E.Foston


St.


(If nonresident, give city or town and State)


Length of stay: In place of death .......... years .......... months


35


days. In place of residence.


2


as.


.. months ..


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


male Achite


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWA


(write the word) Inarried


11 If married, widowed, or divorced EstherStalazzo HUSBAND of


(Give maiden name of wife in full)


(Husband's name in full)


If under 24 hours


.. Hours ...


.... Minutes


13 Usual


Occupation :


(Kind of work done during most working life)


14 Industry


or Business :


laity of Boston


15 Social Security No.


024-03-3187


Bailen


16 BIRTHPLACE (City)


(State or country)


mars


17 NAME OF


FATHER


Pasquale Baldassaro


18 BIRTHPLACE OF U


FATHER (City).


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Maria Martignetti


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Maly


Esther Baldassaro


21 Informant


(Address)


84 Orientave.E.B.


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph 6.


(Signature of Agent of Board of Health or other)


Winter Officer


July 6 1943


(Date of Issue of Permit)


X


A TRUE COPY ATTEST:


3


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


6/1


19.63


to ...


7/5


That A attended deceased, from


1969


I last saw h/4.alive on


7/


19 death is said to


have occurred on the date stated above, at


3KP.


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) CIRRHOSIS OF LIVER


Due To WITH JAUNDICE AND (b) ASCITES


1 MO


Due To (c)


LEUKEMIA -CHRONIC


2YRS


Was autopsy performed?


What test confirmed diagnosis ?


CLINICAL


5 Was disease or injury in any way related to occupation of deceased 0 If so, specify


(Signature) myron n. 15mg M. D. MYRJON N. KIN @ MAT (Print or Type Name)


7/5 1063 (Address) VIL PLEASANT ST cuma InThe Date ..... Holy Cross Cemetery malden 6


I'lace of Burial or Cremation (City or Town)


DATE OF BURIAL


July - 8


63


19.


7 NAME OF


FUNERAL DIRECTOR


ADDRESS


374 Broadway Som, Mass


Received and filed


JUL 8 -1963


19


(Registrar) || (Official Designation)


12


R-301


al permit Health t.


5


CATE


PE JSES


h (c) mean dying, ailure, means ompli- caused


ny, to (α), der- ast. ontrib- ut not minal given


1


No ...


WIN HELP COMMUNITY HUSETTAL


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


no


(Usual place of abode)


JULY


3 DATE OF


DEATH


INTERVAL


BETWEEN


ONSET AND


(or) WIFE of


DEATH


12


56


6.210.


Years


Months


Days


Steam Fitter


OTHER


SIGNIFICANT


CONDITIONS


MYELOGENIUS


10


PARENTS


Lillian Cataldo


CAMARGO


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER.


TOWI


OFFICE OF


2. 1.12


GLERK


MIN


-


00


MASS


THROP


JUL 81963 PM


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.


01


ermit th


I


WINTHROP


(City or Town)


5 Summit ave


The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH · OVIETEM


(City or Town making this return)


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.)


(a) Residence. No ..


5 Summit are


(Usual place of abode)


St


(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


July


9/ 1963


(Month)


(bay)


(Year)


4 IHEREBY 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


7:10 A.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Death presumably due to


INTERVAL


BETWEEN


ONSET AND


DEATH


Due To natural


(b)


CAUSES


probably acute coronary


Due To


(c)


Occlusion on basis of


history. Winthrop Board ofHealy SIGNIFICANT CONDITIONS Charles Hiberna, Lung


Was autopsy performed?


What test confirmed diagnosis ?


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


If so, specify


(Signature)


Oleartes Liberman


M. D.


CHARLES


LIBERMAN


(Print or Type Name)


(Address)


WINTHROP


Date ...


7/10/


19 63


Wintherif


Winthrop


6


Place of l'urial or Cremation


(City or Town)


July 11


63


7 NAME OF


FUNERAL DIRECTO Comnest lGaggiano


ADDRESS


147 Wattherch St Maarthorin


Received and filed


JUL 10 1963


19.


( Registrar)


PERSONAL AND STATISTICAL PARTICULARS


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Married


11 If married, widowed, or divorced


Margaret Sitek (Dolan)


(or) WIFE of.


(Husband's name in full)


12


AGE53


Years


8


Months ..


29 Days


If under 24 hours


Hours ...


Minutes


13 Usual


Electrical Tester


Occupation


(Kind of work done during most working life)


14 Industry


or Business :


Electric Motors


15 Social Security No.


16 BIRTHPLACE (City)


(State or country )


man


PARENTS


18 BIRTHPLACE OF


FATHER (City)


C'est Breton


(State or country)


Mass


19 MAIDEN NAME


OF MOTHER


Delie Connolly.


Boston


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Mass


21 Informant


Margaret Silch


(Address)


5 Summit Que Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Falak 6. Jirianne


(Signature of Agent of Board of Health or other) H.B


Health Officer.


July 10, 1963


(Official Designation)


(Date of Issue of Permit)


1


an


re.


li- ed


ib. sal en


PLACE OF DEATH


SUSfolk


(County)


No. Kenneth & SileK


Registered No.


135


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


22


8 SEX


HUSBAND of


U(Give maiden name of wife in full)


WINTHROP


17 NAME OF


FATHER


albert Silik


DATE OF BURIAL


A TRUE COPY ATTEST:


E


S


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE


RANK, RATING


TO:


ORGANIZATION AND OUTFIT


SERVICE NUMBER


8


16 5 C ..


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 certifyty such deaths only as those of persons to whom they have given bedside caulduring aflastillna'ss 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.


X 1 PLACE OF DEATH


Suffolk


(County)


Winthrop


(City or Town)


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


STANDARD CERTIFICATE OF DEATH


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


1


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


2 FULL NAME


Eva Alice (Mills) Knowlton


(If deceased is a married, widowed or divorced woman, give also maiden name.) 26 Amelia Ave


(a) Residence. No.


(L'sual place of abode)


Length of stay: In place of death.


............ years.


months


L.days. In place of residence


27


St.


(If nonresident, give city or town and State)


years


months.


davs.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


3 DATE OF


DEATH


JULY


13


1963


(Month)


(Day)


(Year)


8 SEX


Female


9 COLOR


White


10 SINGLE


(write the word)


MARRIEI)


WIDOWED


or DIVORCED: 1001


HEREBY CERTIFY


That I attended deceased from


JULY 1 1963 JULY 13/1963, 19


I last saw MEDlive on


JULY 13,, 1963, death is said to


have occurred on the date stated above, at 1.46pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


DEATH WAS CAUSED BY : IMMEDIATE CAUSE


(a) CARDIAC DE COMPENSATION


2 WKS


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


William Knowlton


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


79


10


12


Months.


Days


If under 24 hours


Hours.


Minutes


13 Usual


Occupation :


(Kind of work done during most of working life)


14 Industry


or Business :


At home


15 Social Security No.


021-18-1914


16 BIRTHPLACE (City)


stonington


(State or country) Laine


17 NAME OF


Butler Lills


18 BIRTHPLACE OF


FATHER (City)


Stonin ton


(State or country)


lainie


19 MAIDEN NAME


OF MOTHER


Laude Henderson


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


New Hampshire


21 Informant


Helen Malone


(Address) 2 11: ave inthevine


I HEREBY CERTIFY that a satisfactory standard certificate of death


was filed with me BEFORE the burial or transit permit was issued:


Ralph 6. Sirianni


....


(Signature of Agent of Board of Health or other)


Health Officer


Date 15, 1963


(Official Designation)


(Date of Issue of Permit)


TX


-


ean ing, ure, ans pli- sed


-


rib. not inal ven


37, res : or or on and of si- ype Ire.


(Signed)


912 Caplan


·M. CAPLAN MD


M. D.


(PRINT OR TYPE SIGNATURE)


Date ..


7-13-


19.


مرة


6 ..... intheu.s.


19


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


July 1


1 3


winthrop


7 NAME OF


FUNERAL DIRECTOR


Howard _ Reynold.


ADDRESS


Juntarop


Received and filed JUL 15 1963 19


(Registrar)


tyas


Due To (c)


OTHER


CARÁNUMATOSIS


IMD


SIGNIFICANT


CONDITIONS


COLOSTOMY


Was autopsy performed?


What test confirmed diagnosis ?


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


If so, specify


0


186 PRINCETONSTRAST


BOSTON


PARENTS


6


4


TE


TH


PHYSICIAN - IMPORTANT [(Was deceased a U. S. War Veteran, [if so specify WAR)


136


No.


Bay View Nursing Home


Registered No.


1


(b) ARTERIOSCLEROTIC


HEART DISEASE


AGE


Years.


Housewife


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 dertify to such deaths only as those of persons to whom they have given bedside tare during a last illness from disease un- related to any form of injury.




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