Town of Winthrop : Record of Deaths 1963, Part 45

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 45


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


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


B18489 10-25-63


(Date of Issue of Permit)


T. V.B. V


A TRUE COPY ATTEST:


23


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY 10/20 19 63 ... to.


That I attended deceased


10/23


19


from


63


I last saw hunglive on


10123, 1963 heath is said to


have occurred on the date stated above, at


00.30 AM


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL BETWEEN ONSET AND DEATH


A (a) CARDIAC ARREST


Due To


(b)


? MASSIVE PULM. EMBOLISM3minutes


Due To


? MYOC. INFARCT


(c)


OTHER


SIGNIFICANT


CONDITIONS


St. post hip arthroplasty 4 day


Was autopsy performed ?


No


What test confirmed diagnosis ?


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


If so, specify


.....


(Signature)


M. D.


(Print or Type Name) RAPHAEL ADÄR


19


WINTHROP CEINETERY WINTHROP. 6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL Oct. 25


19.


7 NAME OF FUNERAL DIRECTOR


MAURIS+ MAURis


ADDRESS .......


man 48 So. Common St. LYan


Received and filed


OCT 2 9 1963 19.


William)


(Registrar) || (Official Designation)


1


Registered No.


10819


2 FULL NAME


155


PLEASANT


S


WINTHROP, MASS.


(('ity or town and State)


3 DATE OF


DEATH


10


8


(Address) ..... 330 BROOKLINE. QUE. 10/23


......


PARENTS


(Address)


A TRUE COPY ALITEST:


r


OF TON


CLERK


5


THRON


DEC - 41963 AM


X


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.


229


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


PHYSICIAN - IMPORTANT


2 FULL NAME.


Wilbur Herbert Freeman


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


125 Washington Avenue


St


(If nonresident, give city or town and State)


Length of stay: In place of death. 1 lyear ......... months ........ days. In place of residence + years.


... months .......... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


November


3


1963


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY


, That I attended deceased from


DE0. 29, 1961, 10%.


Nov 3


I last saw himlive on


Nov.


2 16 death is said to


have occurred on the date stated above, at


93 Am


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


GLIOMA


INTERVAL BETWEEN ONSET AND DEATH 8 MO


Due To


(b)


Due To (c)


OTHER


HYPERTENSION & HYPER-


SIGNIFICANT


CONDITIONS


TENSIVE HEART DIS


3yrs


Was autopsy performed? YES OF HEAD


What test confirmed diagnosis ?


AUTOPSY.


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


(Signature)


myronhiking


M. D.


MYRON N. KING MED


(Address)


222 PLEASANT 51 Date.


11/4/ 1963


Winthrop Cemetery


6


Winthrop, Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL November 5, 1963


7 NAME OF


FUNERAL DIRECTOR


alfred B. Marsle


ADDRESS


174 Winthrop St. Winthrop,


Received and filed


NOV 4 - 1963


19


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


(write the word)


MARRIED married


WIDOWED


DIVORCED


UNKNOWN


male


white


11 If married, widewed, or divorced


Margaret Dawson


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGE 69 Years 5


.Months ... 29. Days


If under 24 hours


Hours ......


Minutes


13 Usual


retired auditor


Occupation :


(Kind of work done during most working life)


14 Industry


or BusinessFirst .... Natural Bank


15 Social Security No ..


031-09-2401


Dorchester


16 BIRTHPLACE (City)


(State or country )


Massachusetts


17 NAME OF


FATHER


Edward Farster Freeman


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Caledonia


(State or country)


Nova Scotia


19 MAIDEN NAME


OF MOTHER


Flora Annie Wheelock.


20 BIRTHPLACE OF


MOTHER (City)


.Torbrook. ..


(State or country)


Nova Scotia


Mrs. Wilbur H. Freeman


19 ...


21 Informant


(Address)


125 Washington Ave. Winthrop


HEREBY CERTIFY that a satisfactory standard certificate of death T .: ass filed with me BEFORE the burial or transit permit was issued: Ralph E. Sirianni (+B)


(Signature of Agent of Board of Health or other)


Health Officer


Nav. of, 1963


(Registrar) || (Official Designation)


(Date of Issue of Permit)


TVR


A TRUE COPY ATTEST: RUE C


......


ORM R-301


for burial permit rd of Health s Agent. UCTIONS FOR CERTIFICATE


OR TYPE OR 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


62-932382


1


No ... 125 Washington Avenue


(Was deceased a


U. S. War Veteran,


if so specify WAR).


NO.


(a) Residence. No ..


(Usual place of abode)


19.


63


·,


(a)


(Print or Type Name)


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 bad 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 TOW


LERK


. Fr


6


5


NOV - 41963 PM


RM R-301


I


PLACE OF DEATH -


Suffolk (County)


winthrop. (City of Town)


No ... 76 Lowell Road


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


WINTHROP


(City or Town making this return)


Registered No. 230


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


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


NO.


(a)


Residence. No.


76 Lowell Road


(Usual place of abode)


Length of stay: In place of death3.6 .. years.


.. months. .. days. In place of residence3.6 .. years ......... months ... ... days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


November


8


1963


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY , That I attended deceased from


75


1953


to ......


oct


30


19


1.3


Nlast saw h. .. Alive on


6c+ 3:


19 ........ , death is said to


have occurred on the date stated above, at


7.00 AM m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


myocardial infarction


INTERVAL BETWEEN ONSET AND DEATH


(a)


(b) Arterio seleratic heart disease


2yrs


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS .


Failure - Savona


Was autopsy performed?


What test confirmed diagnosis ?


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


If so, specify



(Signature)


H.B. Greenfield


M. D.


447 Shirley Printor Type Name)


(Address)


Winthree Mass Date ..


11-9


1963


Mass


Winthrop Cemetery Winthrop,


6


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Nov. 12,1963


19.


7 NAME OF


FUNERAL DIRECTOR


alfud B. March


ADDRESS 1.74 Winthrop St . Winthrop,


Received and filed


NOV 12 1963


19


( Registrar)


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the. word)


married


male


white


11 If married, widowed, or divorsed


Ethel Margaret Edwards


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12


AGE


82Years.


2


Months


26


Days


If under 24 hours


Hours ......


.. Minutes


13 Usual


retired traffic manager


Occupation :


(Kind of work done during most working life)


14 Industry


or Business: wholesalewoolsales


15 Social Security No. 023-03-9002 Chelsea


16 BIRTHPLACE (City)


(State or country)


Massachusetts


17 NAME OF


FATHER


Abbott Aidan Wilder


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Vermont


19 MAIDEN NAME


OF MOTHER


Margaret Alexander


20 BIRTHPLACE OF


MOTHER (City) ..


Chelsea


(State or country )


Massachusetts


M.


Mrs ..


John L. Wilder


21 Informant


(Address)


76 Lowell Road, Winthrop


Į HEREBY CERTIFY that a satisfactory standard certificate of death MasSssfiled with me BEFORE the burial or transit permit was issued: laeph 16 Seranne (3) (Signature of Agent of Board of Health or other) Heaith Officer Jetzt 16-1963


(Official Designation)


66


(Date of Issue of Permit)


TV. 13- V


· burial permit 1 of Health Agent. CTIONS R ERTIFICATE


R TYPE CAUSES ATH enter an one or each ) and (c)


not mean of dying, art failure, ;. It means or compli- ich caused


, if any, e rise to use (a), e under- use last.


ons contrib- ath but not he terminal lition given C.


932382


2 FULL NAME


John Merton wilder


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


St


(If nonresident, give city or town and State)


2yrs


Congestive her ..


NO


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 galls 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 wNOViin 21003cats 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.


M R-301


burial permit of Health gent. TIONS I RTIFICATE


TYPE CAUSES ATH enter in one r each and (c)


not mean of dying, ut failure, . It means or compli- ch caused


if any, e rise to se (a), e under- se last.


ns contrib- th but not se terminal ition given C.


PLACE OF DEATH


X SUFFOLK (County)


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)


231


Registered No.


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


2 FULL NAME


JOHN MARMINNO


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


(a) Residence. No


85 QUINCY AVE


WINTHROP


St


(City or town and State)


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


days. In place of residence 50 years


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


NOV.


10.


DEATH


1963


(Month)


(Day)


(fear)


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 4/115 Pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


INTERVAL BETWEEN ONSET AND DEATH


(a) Death presumably due


Due To


(b)


to natural causes,


Due Toprobably acute coronary (c)


OTHER


occlusion on basis of


History Winthrop Boardof Health


Was autopsy performed ?


What test confirmed diagnost


Charles Libermantin


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


(Signature)


Charles Liberman


M. D.


CHARLES


LIBERMAN


(Print or Type Name)


(Address)


WINTHROP, MAS Date 11/12/


. 19 63


6


WINTHROP


WINTHROP


I'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


NOV 13


1963


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS


WINTHROP.


Received and filed


NOV 12 1963


19


( Registrar )|


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


WHITE


(write the word)


MALE


11 If married, widowed, or divorced


HUSBAND of


DOMENICA


PINO


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


I2


AGE 79 Years ..


Months ..


Days


If under 24 hours


.Hours ...


Minutes


13 Usual


WAITER


(RETIRED)


Occupation :.


(Kind of work done during most of iworking life)


14 Industry


or Business :.


RESTAURANT


15 Social Security No ....


010-09-3245-4


16 BIRTHPLACE (City) ..


(State or country )


ITALY


17 NAME OF


FATHER


STEFANO MARMINO


PARENTS


18 BIRTHPLACE OF


FATHER (City) ....


(State or country)


ITALY


19 MAIDEN NAME


OF MOTHER


CATERINA BATTAGLIA


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


ITALY


21 Informant


MIRS PAULINE FALCO


1.Adress) 123 QUINCY AVE WINTHROP.


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 (B)


(Signature of Agent of Board of Health or other) , Health Officer


november12, 63


(Official Designation (Date of Issue of Permit)


T. V.B.V


A TRUE COPY ATTEST:


933404


I


WINTHROP (City or Town)


No. 85 QUINCY AVE


(Usual place of abode)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


NO


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


WIDOWED


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE.


DATE OF DISCHARGE.


RANK, RATING


ORGANIZATION AND OUTFIT


TONY:


SERVICE NUMBER


..


ERK


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 fast illness from disease un- related to any form of injury. (2) Board of Health physicians will certifa to such deaths only as those of persons who, though disabled by recognize disease unterated 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.


X


M R-302


1


Hingham


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


Hingham


(City or Town making this return)


Registered No.


232


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


Edward Patrick White


(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.


(Usual place of abode)


72 Sargent


St.


Winthrop


(If nonresident, give city or town and State)


Length of stay: In place of death .. 2.


... years .......... months .......... days. In place of residencel.,2.years .......... months .......... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word)


Widowed


11 If married, widowed, or divorced


HUSBAND of


Susanna


Harrington White


(Give maiden name of wife in full)


(or) WIFE


(Husband's name in full)


12


4 hrs


AGE


8.6.ears.


-


Months ......


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Retired Dentist


Occupation :


(Kind of work done during most working life)


14 Industry


or Business:


Dentist


15 Social Security No.


-


16 BIRTHPLACE (City)


Cambridge


(State or country )


Mass.


17 NAME OF


FATHER


Edward P. White


18 BIRTHPLACE OF


London


FATHER (City)


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Catherine Dollard


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Currick on Sur


Ireland


6 St. Pauls


Arlington, Mass.


l'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


November 15, 1, 63


7 NAME OF


FUNERAL DIRECTOR


Arthur J. O'Maley


Winthrop, Mass.


ADDRESS


Received and filed


NOV 1-8 1963


19


William Russell


681 Main Street


Hingham, Mass.


A TRUE COPY William X. Noward.


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


November 14, 1963


/


/


THIS IS A PERMANENT RECORD


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)


PLACE OF DEATH


Plymouth (County)


(City or Town)


1192 Main Street


No


2 FULL NAME


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


November 12, 1963


DEATH


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That I attended deceased from


I.une .......


19


56


to.


Nov. 12


19


63


I last saw h.l .. lalive on


12, 19 6, Bleath is said to


have occurred on the date stated above, at


7:15 pm


INTERVAL


BETWEEN


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


ONSET AND


DEATH


(a) Cerebral Vascular Accident


Due To


(b)


Hypertension


yrs.


(c)


Due To


Arteriosclerosis


yrs.


OTHER


SIGNIFICANTCoronary Heart Disease


CONDITIONS


3 yrs


Was autopsy performed?


No


What test confirmed diagnosis ?


clinical


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


If so, specify


(Signed)


Donald M.Garland


M. 1).


(Address)


Hingham, Mass .Date


11/12/63


PARENTS


21 Informant


(Address)


50M - 10-61.931673


(Registrar of City or Town where deceased resided)


Male


SPACE FOR ADDITIONAL INFORMATION DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER


RECEIVED


GLER


WN


MASS


OF


MIN


THRI


OFFICE


WIN


INOM IN 1963 AM


X SUFFULIK (County) 1 WINTHROP (City or Town) 52 UPLAND PO.


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.


Registered No.


233


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


2 FULL NAME


PIC F. MARRUCHELLI


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


(a) Residence. No. 52 UPLAND RD


St.


WINTHROP


(Usual place of abode)


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


40 years.


.months ....


... days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


MALE


9 COLOR


WHITE


(write the word)


10 SINGLE


MARRIED


WIDOWED


or DIVORCED MARRIED


4 I HEREBY


CERTIFY


JAN 9


19


63


to


NOV


13


I last saw h.j Malive on death is said to


have occurred on the date stated above, at


935Pm.


INTERVAL


BETWEEN


ONSET AND


DEATH


3_MO


Due To METASTASIS TO BRAIN (b)


XCHEST


Due To (c)


OTHER


DIABETES MELLITUS


SIGNIFICANT


CONDITIONS


Was autopsy performed? No .


What test confirmed diagnosis ?


BIOPSY AT PRATT


Hos


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


NO


(Signed) Mysonb. King M. 1). MYRON NUKING M.T (PRINT OR TYPE SIGNATURE}


(Address) WUPLEASANT 51


WINNYED MAPS . Date. Nov 14 63


6 WINTHROP


WINTHROP (City or Town)


Place of Burial or Cremation DATE OF BURIAL MUL 14 1943


7 NAME OF


FUNERAL DIRECTOR


MAURICE W MIRBY


ADDRESS WINTHROP.


Received and filed


NOV 16 1963


19


(Registrar)


PARENTS


17 NAME OF


FATHER


RALFAELE HARRUCHELLi


18 BIRTHPLACE OF FATHER (City) (State or country) ITALY


19 MAIDEN NAME OF MOTHER VINCEMA DE SERNIA


20 BIRTHPLACE OF MOTHER (City) (State or country) ITALY


21 Informant (Address)


MARIA MARRUCHELLI


52 UPLAND RD WINTHROP


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Neph E Jerianne (3)


(Signature of Agent of Board of Health or other)


Health Officer


November 15, 1963


(Date of Issue of Permit)


T. V.B.V


-301A


TIONS


RTIFICATE


ing DEATH enter in one r each and (c)


not mean of dying, rt failure, It means or compli- h caused


if any, rise to se (a), , under- se last.


ns contrib- th but not e terminal tion given


apter 137. . requires o print or cause or death on cates, and Acts of es Physi- nt or type signature.


-925686


3 DATE OF


DEATH


Nov.


13


1963


(Year)


(Month)


(Day)


That I attended deceased


1963


10a If married, widowed, or divorced


HUSBAND of


MARIA N LALLÍ


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE 76 Years.


Months.


Days


If under 24 hours


Hours ...


Minutes


13 Usual


Occupation :


CLOTHING DESIGNERS.


(Kind of work done during most of working life)


14 Industry


or Business :


MENS CLOTHING


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


ITALY


4 WILS


PLACE OF DEATH


No.


PHYSICIAN - IMPORTANT [(Was deceased a


U. S. War Veteran,


[if so specify WAR)


(If nonresident, give city or town and State)


NOV 13 1963


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


UNDIFFERENTIATED


CARCINOMA OF MAXILLA


(a)


# WAS


(Official Designation)


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


OF TOW; ... 12 ..


ORGANIZATION AND OUTFIT


SERVICE NUMBER


IL.


NIN


1 RI


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 i .. clude 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.




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