USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 32
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MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
1
9 COLOR
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word) Widowed
11 If married, widowed, or divorced
HUSBAND of
John
(Give maiden name of wife in full)
Tobin,
(or) WIFE of ..
(Husband's name in full)
12
AGE
101 Years
.Months.
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
AT HOME
(Kind of work done during most working life)
14 Industry
or Business :
AT HOME
15 Social Security No ..
NONE
16 BIRTHPLACE (City)
(State or country )
FRANKLIN, MASSI
17 NAME OF
FATHER
Walsh
18 BIRTHPLACE OF
CBL
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
CEL
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
CRL
Miss
CRANE
21 Informant
63 ( Address)
(Granddaughter) 1726 Esacon It.
Bricklings
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph & Sirianni (3)
(Signature of Agent of Board of Health or other)
Health of five
august 16,1963
(Registrar) (Official Designation)
(Date of Issue of Permit)
X
A TRUE COPY ATTEST:
15
1963
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY
That I attended deceased from
aug. 9
1963
to ..
aug
15
19
63
I last saw h .. Elalive on
aug
95, 1963, death is said to
have occurred on the date stated above, at
2:58 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
Due To
(b)
arteriosclerosis
Due To
(c)
generalized
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased No
If so, specify
(Signa
res Papa Gregorio
M. D.
Joseph GREGORI
(Address)
(Print or; Type Name)
194 Washingtonand Date.
aug15 963
Ridgelawn Cemetery, Watertown 6
Place of Burial 01 ( fes
RigeLAWN (WATER TOWN)
DATE OF BURIAL
1 Mc Donald Funeral
NAME OF
FUNERAL DIRECTOR
McDonald Funeral !
f. Home
FRANK, & McDONALS)
401 COMMONWEALTHTAVO
ADDRESS
Received and filed
AUG 1.6. 1963
19
$2
R-301
1 permit Tealth
CATE
PE ISES
.
le :h ( c)
mean dying, ašlure, means ompli- caused
ny, : 10 (a), der- ast.
mtrib- it not minal given
1
8-26,63
No
Winthrop Community Hospital
PHYSICIAN - IMPORTANT
(Usual place of abode)
3 DATE OF
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
myocardial Heart Disease
(a)
-
PARENTS
.
(City or Town)
August 17
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RECEIVED
TO!
OF
1 1/ 12
19
LLERK .
5
6
IN
THROP M
AUG 1 61963 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 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.
R-301
al permit Health t.
NS
FICATE
YPE USES H
er one ach d (c)
mean dying, failure, means compli- caused
any, se to (a), inder- last . contrib- but not erminal given
AMYLOIDOSIS OF
2 MOS.
Was autopsy performed ?
no
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? no If so, specify
(Signature)
Louis 7. Salerno
M. D.
LOUISE SALERNO
(Address)
(Print or Type Name)
175 Pleasant Str
Plus 1 8 1963
6
WOODLAWN
EVERETT.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
AUG 20
1963
7 NAME OF
FUNERAL DIRECTOR
MAURICE W KIRBY
ADDRESS
WINTHROP-
Received and filed
AUG 20 1963
19
( Registrar)
A TRUE COPY ATTEST:
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
MARRIED
11 If married, widowed, or divorced
HUSBAND of
VIOLET
NEVINS
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE 77 Years ...
Months.
Days
If under 24 hours
Hours . ... Minutes
13 Usual
Occupation :
BANKER
(RETIRED
(Kind of work done during most of iworking life)
14 Industry
or Business :
BANJY
15 Social Security_No ..
012-16-5819
16 BIRTHPLACE (City)
(State or country )
MYASS
17 NAME OF
FATHER
ALBERT E LOW
18 BIRTHPLACE OF
FATHER (City) .....
ESSEX 1
(State or country)
MASS
19 MAIDEN NAME
OF MOTHER
EMMA VENISON
20 BIRTHPLACE OF
MOTHER (City) ..
BOSTON
(State or country)
MASS
21 Informant
NIRS VIOLET LOW
(Address 200 BARTLETT RD WINTHROP.
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued: Ralph /6. Seriamn (3) (Signature of Agent of Board of Health or other)
Health Otherin
Ciugust .20 1963
(Oficial Designation)
(Date of Issue of Permit)
TJB
104
X 1
PLACE OF DEATH
SUFFOLKT (County) WINTHROP. (City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD . QVIEL
CERTIFICATE OF DEATH
Registered No.
157
§(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
EVERETT R, LOW
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ...
200 BARTLETT PD
St
(Usual place of abode)
Length of stay: In place of death 50 years.
.. months .......... days. In place of residence: 30.
years
months ......
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
august 17 (Day)
1963 (Year)
(Month)
4 I HEREBY CERTIFY
That I attended deceased from
Jan 3 19.60 to ...! Cinquit M 63
I last saw hupalive on
august 17
19 ..... .. , death is said to
have occurred on the date stated above, at ....
2.39 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
CORONARY HEART DISEASE
INTERVAL BETWEEN ONSET AND DEATH
142
Due To
(b)
MYOCARDIAL INFARCTION
148
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
LARGE BOWEL
EAST BOSTON
PARENTS
(City or Town making this return,
No
200 BARTLETT PD
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
(City or town and State)
(write the word)
MALE
2.3 ajeno
(a)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE.
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
Or TO !!
10: " D
11
6" 1 %
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.
AUG 2 01963 AM
X
PLACE OF DEATH
Suffolk
62-92-8
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.
.158
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Baby Girl Gerardi
(If deceased is a married, widowed or divorced woman, give also maiden name.)
180 Waldemar Avenue
St
East Boston
(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
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
August
19
1963
(Month)
(Day)
(Year)
19
4 IHEREBY CERTIFY , That I attended deceased fromfemale
KAULUST
1963
to ...
I last saw hC.falive on
19AUGUST
123 ... , death is said to
have occurred on the date stated above, at
1:40 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
PREMATURITY
INTERVAL
BETWEEN
ONSET AND
DEATH
3h.
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify .
Labut Bornstein
(Signature)
(Print or Type Name)
Date
(Address)
190 PLEASANT ST
15 AUGUSTO 63
6
Holy Cross Cemetery
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
August 21
63
7 NAME OF
FUNERAL DIRECTOR
Vincent R. Kapino
ADDRESS
9 Chelsea Street, Cast Boston, Ma
Received and filed
AUG 20 1963
19
8 SEX
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN Single
(write the word)
11 If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
AGE.
Years ............ Months ...
Days
3
If under 24 hours
.Hours ....
Minutes
13 Usual
Occupation :
none
14 Industry
or Business :
****
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Winthrop, Mass.
17 NAME OF
FATHER
John Gerardi
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Veronica. Rapino
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Boston
Mass.
John Yerardi (father)
21 Informant
(Address)
180 Waldemar Hve., East. Doston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kaiph & Liveanna (6)
(Signature of Agent of Board of Health or other)
Health officin
Cinqueto 20, 1963
(Registrar)|| (Official Designation)
(Date of Issue of Permit)
X
A TRUE COPY ATTEST:
382
R-301
rial permit Health ent. ONS
FICATE
TYPE AUSES H ter one ach nd (c)
ot mean dying, failure, t means compli- caused
f any, ise to (a), under- last.
contrib- but not terminal n given
1
(County)
Winthrop (City or Town)
No ..
Winthrop Community Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(a) Residence. No ...
(Usual place of abode)
(a)
(Kind of work done during most working life)
PARENTS
WINTER!
M. D.
1
1
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE ROD
DATE OF DISCHARGE RANK, RATING
AUS .201963 PM
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.
X
A 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. 159
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Helen Beattie
(If deceased is a married, widowed or divorced woman, give also maiden name.)
8 Siren Street
St
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months .......... days. In place of residence.
20
ears ..
...... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
August ..... 201963
(Month)
(Day)
(Year)
4.
June
19.
I HEREBY CERTIFY
46
; That I attended deceased from
1963
to ...
QUE 20
death is said to
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE CORONARY OCC.
INTERVAL BETWEEN ONSET AND DEATH 275
(a)
Due To ARTERIOSCLEROTIC AND
(b)
Idue To
HYPERTHYROID ITEART
(c)
DU EAURICULAR FIBAHAD
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
No
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased! If so, specify
(Signature)
myron b. King
......
M. D.
MYRON N. K ING (M.D)
2:2 p. (Print or Type Name)
(Address) MINDFULD MAG „Date. QUE 2163
6
Winthrop Cemetery
Winthrop
....
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
August 23,
19.63
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass.
ADDRESS
Received and filed
AUG 2.2 1963
19
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORMarried
UNKNOWN
11 If married, widowed, or divorced
HUSBAND of
Charles .... Beattie
(or) WIFE of.
(Husband's name in full)
12
AGE ... 59 Years
Months ..
.Days
If under 24 hours
Hours ........ Minutes
4uns
Occupati
13 Usual
Switchboard ... Operator
(Kind of work done during most working life)
14 Industry
or Business :
Telephone
15 Social Security No ..
16 BIRTHPLACE (City) (State or country) Somerville
Mass
PARENTS
17 NAME OF
FATHER
Ben jamin Robbins
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Elizabeth Runey
20 BIRTHPLACE OF
MOTHER (City)
Somerville
Mass
(State or country)
2I Informant
Charles Beattie
(Address)
8 Siren St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: j'aiph & Serianni (S) (Signature of Agent of Board of Health or other) Health Officer august 22, 1963
(Registrar) | (Official Designation)
(Date of Issue of Permit)
TVP
A TRUE COPY ATTEST:
2382
urial permit of Health gent. IONS
TIFICATE
TYPE CAUSES TH nter one each and (c)
not mean f dying, failure, It means compli- caused
if any. rise to e (a), under- e last.
s contrib- but not terminal ion given
No ...
8.Siren Street
L
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a)
Residence. No.
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
(Give maiden name of wife in full)
I last saw helalive on
QUE-16
063
have occurred on the date stated above, at 600Am.
.....
1 YR
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
12
.1
5
6
THROP
AUG 2 21963 PM
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.
R-301
rial permit Health ent. ONS
IFICATE
TYPE AUSES CH ter one each nd (c) ot mean dying, failure, t means compli- caused
f any, rise to (a), under- last.
contrib- but not terminal n given
PLACE OF DEATH
Suffolk
BOSTON 8-26-63
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
160
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME ....
Angelina (Diorio) Ceruolo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
no
(a)
Residence. No .... 49Bayswater St.
(Usual place of abode)
St.
East .Boston, Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ......... years ......... months 5 days. In place of residence 5 years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Divorced
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of
Nicholas Ceruolo
(Husband's name in full)
12
AGES6
Years.
Months.
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
or Business:
7. W. Woolworth Co.
15 Social Security No ....
unknown
025-12-1914
16 BIRTHPLACE (City)
(State or country)
Chelsea M 11.
17 NAME OF
FATHER
Domenic DiOrio
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Susie Tontodonato
20 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
21 Informant
Susie DiOrio (mother)
(Address)
49 Bayswater St., East Doston, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
Health Officer
august 2.2.1963
(Official Designation)
(Date of Issue of Permit)
IT X
A TRUE COPY ATTEST:
20
1963
(Month)
(Day)
(Year)
4 IHEREBY CERTIFY,
7/26
19 63
to ...
8 - 20.
19
That I attended deceased from 63
I last saw h&kalive on
8-20-
1963
death is said to
have occurred on the date stated above, at
... m.
9A
INTERVAL BETWEEN ONSET AND DEATH
(a) CEREBRAL HEMORRHAGE
1/2 tur years
Due To
(b)
HYPERTENSION
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signature)
M. D. Pasquale Costanza MB
238
Maverick
(Print or Type Name)
8/21
63
(Address)
Last Poston Date.
19
Holy Cross Cemetery
Malden
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
August 24
19 63
7 NAME OF
FUNERAL DIRECTOR
Vincent Rasino
ADDRESS
9 Chelsea St., East Doston
Received and filed
AUG 2 2 1963
19.
(Registrar )|
2382
I
(County)
Winthrop
(City or Town)
NO ... WINTHROP COMMUNITY HOSPITAL
(City or Town making this return)
PARENTS
Pasquale Cortana a
Salesgirl
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
3 DATE OF
DEATH
August
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 Operson 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.
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