USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 36
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ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
A TRUE COPY
Jennio Lo Carroll
ATTEST:
DATE FILED
(Registrar of City or Town where death occurred)
Sept. 20, 1963
19
M.C.I.Bridgewater, Mass.
21 Informant
(Address)
(Registrar of City or Town where deceased resided)
3 DATE OF
September14 1963
19
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
9/20/1917
DATE OF DISCHARGE
6/12/1918
RANK, RATING
Private
ORGANIZATION AND OUTFIT
Battery C, 301st Field Artillery
1662912
SERVICE NUMBER.
0 sốt
HAND
SEP 2 41963 AM
10%
.40
7
-
INTHRON
SEP 2 41963 AM
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS W3 STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 178
S(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number) No. ... Winthrop Community Hospital ...........
2 FULL NAME
Elizabeth ..... Cone .... (Knox.).
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. 63.Harbor View Avenue
St.
Winthrop , Mass
(Usual place of abode)
65
Length of stay: In place of death.
............. years.
......
months.
.6 ..... days. In place of residence.
.. years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
white
10 SINGLE
(write the word)
DEATH
(Month)
(Day)
(Year )
4 I HEREBY CERTIFY, That I attended deceased from
June.,
50
19
19
to .... Sept ...... 15,
63.
I last saw her.
.alive on
Sept. 15,
63
death is said to
have occurred on the date stated above, at
.. m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Cerebro ... vascular .... Hemorrhage
Due To
Arteriosclerosis, generalized
(b)
years
Due To
(c)
Hypertension, .... essential
years
OTHER
Diabetes Mellitus
SIGNIFICANT
CONDITIONS
Hydrops of Gallbladder
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
(Signed) Graphe thegare M. D.
Joseph Gregorie, M.D. (PRINT OR TYPE SIGNATURE)
(Address) 194 Washington Av Sat Date
Winthrop, Mass
inthrop
6
winthrop
Place of Burial or Cremation
(City or Town)
Sept. 18
63
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS inthron Lass.
Received and filed
SEP 17 1963 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
Paisley
FATHER (City)
(State or country) Scotland
19 MAIDEN NAME
OF MOTHER
Emma Tewksbu. y
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lass.
winthrop
Frank: A Baumeister
21 Informant (Address) 24 Perkins St. Winthrop, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was jfiled with me BEFORE the Burial .or transit permit was issued: Ralph Serianni (3)
"Signature af Agent of Board of Hearth or other) Health officer (Official Designatym)
Sept 17,146.3
(Date of Issue of l'ermit)
T
TRUCTIONS FOR L CERTIFICATE
giving OF DEATH not enter e than one e for each , (b) and (c)
does not mean de of dying, heart failure, ,etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), s the under- cause last.
ditions contrib- death but not to the terminal condition given
· Chapter 137. 1954. requires ans to print or ne cause or of death on ertificates, and : 48, Acts of quires Physi- print or type der signature.
C
-11-59-926662
11 IF STILLBORN, enter that fact here.
12
67
6
17
3 days AGE
Years ..
Months
Days
If under 24 hours
Hours.
Minutes
Housewife
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No.
None
Everett
16 BIRTHPLACE (City)
(State or country)
mass .
17 NAME OF
FATHER
Alexander Knox
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John Iv Cone
(Husband's name in full)
INTERVAL
BETWEEN
ONSET AND
DEATH
4:20P
MARRIED
WIDOWED
or DIVORCED. idoW
3 DATE OF
Sept. 15, 1963
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, [if so specify WAR)
(If nonresident, give city or town and State)
DATE OF BURIAL
Sept. 15, 63
M R-301A 1
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.
RECEIVED
TOW,
OFFICE O
13.12. 1
10.
4
MIN
CUM
CLERK
Se
WII
7 65
ITHROP MASS.
SEP 1 71963 PM
X
BUTPOLK
MENS
(City or Town) ' CHROF
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD U CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No. 1.79
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
Cee Ardith Johnson (Jones )
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR) NO.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 34 Senfoam Ave., Winthrop, Mass. St.
(a) Residence. No.
(Usual place of abode)
1
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years ....
.......
.months.
days. In place of residence
2
.years .............. months .............. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
DEATH
(Month)
(Day)
(Year)
4 I HEREBY
DOC .
CERTIFY
That I attended deceased from
16
I last saw h.
Stalive on
Sept. 16
65
19
, death is said to
have occurred on the date stated above, at
10:3080 m.
INTERVAL
BETWEEN
ONSET AND
2 clBEATY.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Coronary Occlusion
(a)
Coronary Artery Heart
Due To
Disease.
(b)
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
None chat
Was autopsy performed ?
YES
What test
confitmed diagnosis? Clicca120.
5 Was diseasefor Allery ragy way helping me ogpayation of deceased? If so, specify WINTHROP, MASS /21/6 330
(Signed)
(PRINT OR TYPE SIGNATURE)
(Address) Date. 19
6
Winthrop Cemetery, Winthrop, Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
September 19,1963
19.
7 NAME OF
FUNERAL DIRECTOR
asfeel B. Marche
ADDRESS 174 .Winthrop St Winthrop,
SEP 19 1963
Received and filed 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Rockland
NO (State or country) Maine
19 MAIDEN NAME
OF MOTHER
Ermina Greenlaw
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Deer Isle
Maine
Robert Johnson
Informant (Address) 34 Seafoam Ave . Winthrop,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or Lansit permit was issued
Mass. Ralph 6 Jerianne (B) (Signatur of Agent of Board of Howlth or other)
Health officer
Lipt 191963
(Official Design;Aynı) (Date of Issue of Permft) X
1
(Give maiden name of wife in full)
(or) WIFE of
Carleton Johnson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
Years.
AGE.6.6.
8
Months.
.1.2 .. Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation :
practical nursing
(Kind of work done during most of working life)
14 Industry
or Business :
self employed
15 Social Security No.
021-07-8043
16 BIRTHPLACE (City)
(State or country)
Maine
Rockland
ditions contrib- death but not to the terminal condition given
Chapter 137, 1954. requires ns to print or e cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
-11-59-926662
PLACE OF DEATH
1 R-301A -
RUCTIONS FOR . CERTIFICATE
giving OF DEATH
not enter : than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means se, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
2 days.
10a If married, widowed, or divorced
3 HUSBAND of
MARRIED
WIDOWED
or DIVORCED
widowed
50 pt
-
3 DATE OF
sept
16
1963
2 FULL NAME
No.
17 NAME OF
FATHER
C, Frank Jones
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT.
SERVICE NUMBER
0
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.
SEP 191963 PM
ORM R-301
or burial permit rd of Health s Agent. UCTIONS FOR CERTIFICATE
OR TYPE R CAUSES DEATH ot enter than one for each (b) and (c)
oes not mean e of dying, heart failure, etc. It means e, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib- death but not the terminal ondition given
C
2-932382
PLACE OF DEATH
Suffolk (County)
I
Winthrop (City of 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.
180
S(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Francis E.Dacey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
101 Johnson Ave
St
(If nonresident, give city or town and State)
.. months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDMarried
DIVORCED
UNKNOWN
LIHEREBY CERTIFY , That I attended deceased from
June15, 1963,
Sent
63
I last saw het alive on
Sept 11
194 3 death is said to
have occurred on the date stated above, at 6.A.m.
INTERVAL BETWEEN ONSET AND. DEATH
(or) WIFE of.
(Husband's name in full)
Years
Months.
Days
13 Usual
Occupation :
Self- Employ=1
(Kind of work done during most working life)
Due Acute Cardiac failure & Chili 4 Industry
(c)
OTHER
Coronary insufflencse
CONDITIONS
13 MAS
Was autopsy performed?
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signature).
Lean w. lesochett
M. D.
com W. Crockett
(Print or Type Name)
(Address 3 2 mon 3, Chash Date
9/18 1963
Holy Cross Cemetery , Malden
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Sept. 21, 1963
19
7 NAME OF
FUNERAL DIRECTOR
Joseph P.Murphy
322 Bunker Hill St.Charlestown
ADDRESS
Received and filed
SEP 19 1963
19
17 NAME OF
FATHER
William T.Dacey
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston
19 MAIDEN NAME
OF MOTHER
Mary Cummings
20 BIRTHPLACE OF MOTHER (City) (State or country)
Boston
21 Informant
Helen F.Dacey
(Address)
101 Johnson Ave. inthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kaiph &
Signature, of Agent of Board of Health or other) Health officer depit 19,1969
(Registrar) | (Official Designation)( C
(Date of Issue of Permit)
A TRUE COPY ATTEST:
or Business :
Screen and Shade Co
15 Social Security No.
014-18-2371
16 BIRTHPLACE (City)
Chelsea
(State or country)
If under 24 hours
Hours ........ Minutes
DEAHWAS CAUSED BY: IMMEDIATE CAUSE
Hypostatic Congestion
(a)
OfLung
(b)
11 If married, widowed, or divorced
HUSBAND of
Helen F. Murphy
(Give maiden name of wife in full)
3 DATE OF
Sept . 18,1963
DEATH
(Month)
(Day)
(Year)
(Was deceased a
U. S. War Veteran,
(if so specify WAR).
No
(a)
Residence. No.
(Usual place of abode)
Length of stay: In place of death ..
.. years .......... months .......... days. In place of residence
6
.. years.
No ... 101 Johnson Ave
PARENTS
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 thSEP 1 91963 PM 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.
15M-6-60-928241
-
PLACE OF DELIVERY No.
Suffolk (County ) Winthrop Mass
(City or Town)
Winthrop Community Hospital
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
181
(If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVERY
9
19
63 (Year)
4 SEX
Male .. ... Female.
XUndetermined.
5 COLOR (if In fetermined) .
6 THIS BIRTH (Check one) Single. ATwin. . Triplet
7 IF MULTIPLE BIRTH, BORN :
1st. .. ... 2nd ... . 3rd.
FATHER
8
FULL
NAME
John Leone
14
MAIDEN NAME
MOTHER Anna Navarro
PRESENT NAME
Anna Leone
9
RESIDENCE, NO 42 Gove St. CITY OR TOWN East Boston
STREET
STATE Mass
10 COLOR ORWhite
11 AGE AT TIME OF
THIS DELIVERY
34 (Years)
16 COLOR OR
RACE.
White
17 AGE AT TIME OF
THIS DELIVERY
25 .(Years)
12 PLACE OF
BIRTH
East Boston (City or Town )
Mass
(State or country
18 PLACE OF BIRTH Italy
(City or Town)
(State or country )
13 Shoe Worker
OCCUPATION
20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus) None
(a) How many children are
now living?
None
(b) How many children were born aliv dead ?
but are now
(c) How many previous fetal deaths of ANY gestation age ?
21 LENGTH OF
PREGNANCY
9 .completed weeks
77 WEIGHT OF FETUS 6 Lb. 11 Oz Grams )
23 WHEN DID FETUS DIE? Before Labor
24 AUTORSY
Yes
No
25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Unknown cause
Due To (b) Term Delivery antepartum death Due To (c)
OTHER SIGNIFICANT CONDITIONS
None
26 HOLY CROSS Place of Burfal of Cremation
DATE OF BURIAL 9-23-63 19
27 NAME OF FUNERAL DIRECTOR VINCENT RAPINO ADDRESS / CHELSEAST. A. Boret SEP 20 1963 Received and filed 19
A TRUE COPY ATTEST :
I HEREBY CERTIFY that this delivery occurred on the date stated above at m .. and product of conception was not a live birth.
Signaturef Attending Physician or Medical Examiner : Dohowar Sloffen
M.D.
D. T. Staffier, M.D. (PRINT OR TYPE SIGNATURE)
Address
21 Breed Street
Date
9/19 19. 63
E. Boston, Mass
I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued :
Leiph E. Jewanne Signature of Agent of Board of Health or other)
Hearth Offices
Official Designation )
7/20/63
( Date of Issue of Permit )
Y
RM R-304
1
2 NAME OF FETUS (if given)
Baby Girl Leone
St.
(Month )
( Day)
STREET
CITY OR TOWN
42 Gove St
East Boston
STATE Mass
RACE ..
In giving AUSE OF AL DEATH o not enter re than one use for each f (a), (b) and (c)
1 or maternal ition causing 1 death (do use such s as stillbirth rematurity. ) 1 and/or ma- al conditions, y, which gave : to above e (a), stating underlying e last.
ditions of fetus nother which have contrib- d to fetal h, but, in so as is known. not related ause given a ).
MALDEN (City or Town)
Registrar
During Labor
or Delivery
Y Unknown
Husband
19 INFORMANT
15
RESIDENCE, NO.
- : FETAL DEATH
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48. ACTS OF 1960.
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, .. . shall not be permitted except ... ".
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muschEphe physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
X
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No
S(If death occurred in a hospital or institution, Winthrop Community Hospital
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Verdi, Andrew E.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
91 Fremont St., Winthrop
St
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months
days. In place of residence.
Lyears
... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Sept.
26. 1963
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
Supr
1940, to 1201.26
1963
I last saw haplive on
Jepi 25°
19.4: death is said to
have occurred on the date stated above, at
3:00 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
myocardial Heart Disease
(b) arteriosclerosis-gjen
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased:0 If so, specify
ature) parce Quegane M. D.
Joseph @ RUEGORIE (Print or Type, Name)
(Address)
194 Washington Cer 2 Date.
9/27/1963
6
Winthron
winthrop Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
19.
7 NAME OF
FUNERAL DIRECTOR
Ernest P Caggi no
ADDRESS
147 inthron St
Winthrop
SEP 30 1963
Received and filed
19
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
widowed
11 If married, widowed, or divorced
Helen G. O'Reilly
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
88
10
9
AGE.
Years.
Months.
Days
If under 24 hours
Hours .... ..
Minutes
13 Usual
Occupation :
Storekeeper
(Kind of work done during most working life)
14 Industry
or Business:
Variety Store
15 Social Security No .....
021-26-8165
16 BIRTHPLACE (City) ..... e ymouth (State or country) england
17 NAME OF
FATHER
George Verdi
PARENTS
18 BIRTHPLACE OF
FATHER (City) ..
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Helen Talepartria
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Greece
Mrs. Dilli n Froder
21 Informant
(Address)
34 Sunset La, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Raph & de cann
{Signature of Agent of Board of Health or other)
Health Hier.V
9/28/63
(Date of Issue of Permit)
TV .. V
A TRUE COPY ATTEST:
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)
182
Registered No.
for burial permit ard of Health ts Agent. RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)
does not mean le af dying, heart failure, etc. It means se, or campli- which caused
ions, if any, gave rise ta cause (a), the under- cause last.
ditions contrib- death but nat a the terminal condition given I. C .
62-932382
(Registrar) | (Official Designation)
(Was deceased a U. S. War Veteran, (if so specify WAR).
No
(a) Residence. No.
(Usual place of abode)
13
(write the word)
Male
INTERVAL BETWEEN ONSET AND DEATH up
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