USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 53
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Winthrop Community Hospital
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
204 Shirley Street
St
Winthrop, Mass.
(If nonresident, give city or town and State)
(Give maiden name of wife in full)
INTERVAL BETWEEN ONSET AND DEATH 10min 12.77
Due To
(b)
tended deceased, from 63
lee3
1963 death is said to
No.
-
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
RECEIVED
TOWI
OFFICE O
71 12.
In.
MIN
CLERK
W
MAS
R
1964 PM
JAN 3 ·
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.
I
PLACE OF DEATH
SUFFOLK
(County)
BOSTON
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
270
(City or Town making this return)
11643
Registered No. [(If death occurred in a hospital or institution, .St. ( give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
Guy Frizzi
(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 .... 10 .... Locust .... Street.
(Usual place of abode)
St .... Winthrop, ... Mass ..
(City of 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
8 SEX
male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
widowed
Il If married, widowed, or divorced
HUSBAND of
(or) WIFE of.
Jennie Bonfiglio
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET ANO DEATH
4 hour
S AGE.
... ..... Years.
Months.
Days
If under 24 hours
Hours ........ Minutes
-
(b)
Arteriosclerotic ... heart
disease
Due To
(c)
OTHERChronic bronchitis and
SIGNIFICANT emphysema
CONDITIONS
Diabetes mellitus
Was autopsy performed ? .... no
What test confirmed diagnosis ? clinical
S Was disease or injury in any way related to occupation of deceased?
If so, specify .
@@.@low
M. D.
(Signature)
.Charlas.L.Clay, M. D.
(Print or Type Name)
(Address) Aar.t. Dir .. Mens, Gon'l, Hosp. Date.Nov .19 9 63
6
St. Michael Cemetery Boston
Place of Burial or Cremation
Nov. 22,
1963
.........
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Vincent R. Rapino
ADDRESS 9 Chelsea St. EastBoston Mass
NOV-2-97-1963 Received and filed Williamf. Kane.
PARENTS
17 NAME OF
FATHER
Angelo Frizzi
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Victoria Bonasera
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Italy
21 Informant
Sarno Frizzi (som)
10 Locust St. Winthrop, Mass
......
(Addres
I HEREBY CERTIFY that a satisfactory standard certificate of death way filed with me BEFORE the byristor transit permit was issued:
Signature of Agent of Board of Health or orbey)
19362 11/21/63
..... (Registrar)|| (Official Designation)
(Date of Issue of Permit)
1
M R-301
burial permit of Health gent. TIONS R RTIFICATE
R TYPE CAUSES ATH enter an one or each ) and (c)
of dying, ort failure, :. It means or compli- ich caused
, if any, e rise to use (.).
As contrib- th but not he terminal ition given
20.1 81 170
16 1964 recten se only Ink.
(City or Town)
-
NOMASSACHUSETTS GENERAL HOSPITAL
Gaetano
.........
3 DATE OF
DEATH
November
19
1963
(Month)
(Day)
(Year)
4 THERENY CERTIFY , That Heattended deceased from
November .17 , 19 63
to .. November .... 19.
19 .. 63
Wel last saw himlive on .. November ..... 19 ........... 1963, death is said to
have occurred on the date stated above, at .. 2:15 ... a .. m.
(a) Acute myocardial infarction
12
74
13 Usual
Occupation :
Retired
(Kind of work done during most of iworking life)
14 Industry
or Business:
*****
15 Social Security No.
025-09-0148
20 years 16 BIRTHPLACE (City)
20 year
(Husband's name in full)
Due To
6 years
(State or country ) Italy
-
933404
wse last.
TRUE COPY ATTEST:
Williaml. Kane. City Registrar
MF TOW;
1
CLERK
6 5
!THROP MA
JAN 1 61964 AM
R-301 1
urial permit of Health gent. ONS
IFICATE
TYPE AUSES TH ter one each nd (c)
ol mean dying, failure, It means compli- caused
1 amy, rise to (a), under- last .
contrib- but not terminal os given
67. 0)
16 1964 rector
only Ink.
2382
PLACE OF DEATH
MITT - AND - TOWN SUFFOLK
(County)
1
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
271
(City or Town making this return)
11892
Registered No.
[(If death occurred in a hospital or institution, .. St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
no
U. S. War Veteran,
if so specify WAR)
85 Quincy Avenue, Winthrop Massachusetts
(a)
Residence. No ...
(Usual place of abode)
(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
Malo
9 COLOR
White
10 SINGLE
MARRIED
(write the word)
WIDOWED Married
DIVORCED
UNKNOWN
11 If married, widowed, or divorced.
HUSBAND of
Flávia Pino
(or) WIFE of.
(Husband's name In full)
12
AGE
Years.
Months ...
.. Days
If under 24 hours
Hours ........ Minutes
contractor
13 Usual
Occupation :
(Kind of work done during most working life)
14 Industry
PROof's
or Business :
016 26 0423
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Dominico
MANdiLe
18 BIRTHPLACE OF
FATHER (City).
Italy
(State or country)
9 MAIDEN NA
OF MOTHER
Margarita Mandilo
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Italy ...
Mrs. Flavia Mandile
21 Informant
(Addresi)
85 Quincy Avo. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: R.K. Jamon
(Signature of Agent of Board of Health of other)
19455
11/29/63
(Date of Issue of Permit)
(Registrar)|| (Official Designation)
Williamg.
YEARS
Was autopsy performed ?
What test confirmed diagnosis ?
Autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify .
(Signature)
-cella
M. D.
-Charles. L. Clay, M.D.
(Print or Type Name)
(Address) Ass's. Dis., Mass .. Con.L. Hosp .... Date .: Winthrop.
Winthrop Cemetery
6
Place of Burial or Cremation
Nov 30.
(City or Town) 63. DATE OF BURIAL
19 ....
7 NAME OF
FUNERAL DIRECTOR Maurice W. Kirby.
210 Winthrop St. Winthrop.
ADDRESS
Received and filed
DEC 2 1963 /auce
INTERVAL BETWEEN ONSET AND DEATH WBoks
Due To (b)
Due To (c)
OTHER
SIGNIFICANT MYOCARDIAL INFARCTION
CONDITIONS
OLD HEALED
That Iwstended deceased from
19. November 26 6 last saw hh.Mlive November 26 . 16 3., death is said to have occurred on the date stated above, at 7.50pm
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE PANCREATITIS
(a)
3 DATE OF
November 26,
1963
(Month)
(Day)
(Year)
NI HEREBY vomber f & 6.3
DEATH
No
Massachusetts General Hospital BAKER MEMORIAL
Antonio Mandilo,
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
.....
11-27-63
PARENTS
(Give maiden name of wife in full)
A TRUE COPY ATTEST'!
City Registrar
REDE YED
OF TOWN
11. 12.
-19 1
LERK
6 5
JAN 1 61964 AM
OUT - OF - TOWN
SUFFOLK
....
(County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
272
(City or Town making this return)
Registered No.
12103
[(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number) ...
PHYSICIAN - IMPORTANT
2 FULL NAME
Cabina Stocco
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20
(a) Residence. No ...........
££Harvard St.
St
Winthrop
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months. ... days. In place of residence. 9
... years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
married
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of.
(Give maiden name of wife in full)
Frank Stocco
(Husband's name in full)
12
50
Years.
Months.
.. Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :.
Stitcher
(Kind of work done during most working life)
14 Industry
or Business :
Crown Dress M&g. Co.
15 Social Security No. 011-05-5020
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Frank Aloi
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria Ligotti
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
Frank Stocco (husband)
21 Informant
(Address)
20 Haward St., Winthrop, Mass.
I HEREBY CENTIEY that a tyisfactory standard certificate of death was filed withme BEFORE the Burial or transit permis
.........
Simsturdy Agent of Bord
1952
(Registrar)|| (Official Designation)
(Date of Iagde of Bermit)
1 X
A TRUE COPY ATTEST:
1963
(Day)
(Year)
4 I HEREBY CERTIFY , That Iwettended deceased from
Dec. 2,
.63
Dec. 2,
63
OF last saw
bralive on Dec .... 2,
163., death is said to
have occurred on the date stated above, at } ...... 2} ............. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) -Subarachnoid Hemorrhage
Due To (b)
Due To (c)
OTHER
SIGNIFICANTron ... Deficiency Anemia
CONDITIONS
3 years
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
@c.Clar
(Signature)
M. D.
. Charles L. Clay, M.D.
(Print or Type Name) (Address) Ass's .. Dis., Mass. Gen'] .. Hosp ..... Date .. Dec ...... 2.,.19 ... 63.
6
St. Michael Cemetery Boston
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 5,
19 63
7 NAME OF
FUNERAL DIRECTOR
Anthony P. Kapino
ADDRESS
9 Chelsea St, East Boston, Mass
Refined Diane Lane.
I .... DEC. ..... 5 1963
X I
ORM R-301
for burial permit rd of Health s Agent. RUCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (e)
Does 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
330 70
V 24 1964 Directen uso caly CK Ink.
ogera
was issued:
.
hay /4163
2-932382
PLACE OF DEATH I
No. MASSACHUSETTS.GENERAL .. HOSPITAL Catena
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
3 DATE OF
DEATH
Dec ...... 2,
(Month)
to ....
INTERVAL BETWEEN ONSET AND DEATH 2 hour
PARENTS
A TRUE COPY ATTEST:
Williamf. Kance. City Registrar
TOM
6
5
INT
JAN 2 41964 AM
X
PLACE OF DEATH
Suffolk
(County)
Revere
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF GVILT CERTIFICATE OF DEATH
Revere
273
(City or Town making this return)
Registered No.
f(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME.
George N. Dracos
(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
40 Sea View Ave.
(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
2.
.years .......... months .......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December
5,
1963
DEATH
(Month)
(Day)
(Year)
4 LHEREBY CE)
July 27
19
to.
66 TIFY,
That I attended deceased from
Dec.
19
63
I last saw himmive on
Dec.
4. 6 death is said to
. 19.
have occurred on the date stated above, at
12:35 Pm ..
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Arteriosclerotic Heart
Disease
(a)
Due To Arteriosclerosis
(b)
generalized
5yrs.
Due To (c)
OTHER
Idiopathic
SIGNIFICANT
CONDITIONS
Parkinsonism
5yrs.
16 BIRTHPLACE (City)
(State or country)
Greece
17 NAME OF
FATHER
Nicholas Dracos
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Greece
19 MAIDEN NAME
OF MOTHER
Margaret Spelios
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Greece
Mary Dracos
21 Informant
( Address)
40 Sea View Ave., Winthrop
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
December
9,
19.63 '
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.)
6
Place of Burial or Cremation
(City or Town)
63
19
DATE OF BURIAL
December
7,
7 NAME OF
Paul K. Babalas
FUNERAL DIRECTOR
ADDRESS
336 Broadway, Cambridge
Received and filed
JAN 15 1964
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE MARRIED WIDOWED DIVORCED UNKNOWN
(write the word)
Married
11 If married, widowed,
Mawy Rodes
HUSBAND of
(Give maiden name of wife in full)
INTERVAL
BETWEEN
ONSET AND
(or) WIFE of
DEATH
12
2yrs.
Years.
Months ............ Day3
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation :
Grocery Store
(Kind of work done during most working life)
14 Industry
or Business :
Retired
15 Social Security No.
013-28-7332
Was autopsy performed?
No
Clinical findings
NO
......
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
John F. Collins
M. D.
27 Bennington St. 12/6
63
(Address)
Revere
Date.
19
Winthrop Cemetery Winthrop
PARENTS
50M · 10-61-931673
M R-302
1
400 Revere Beach No
(a) Residence. No ..
Winthrop
(Husband's name in full)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
IF TON
1
6
TI
JAN 1 5 1964 AM
PLACE OF DEATH
Suffolk 1 - TOMAS
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
274
(City or Town making this return)
1.2226
Registered No.
f(If death occurred in a hospital or institution, .. St. ( give its NAME instead of street and number) PHYSICIAN -- IMPORTANT
2 FULL NAME
Irene T. Norris
(If deceased is a inarried, widowed or divorced woman, give also maiden nagle.)
95 Loring Road, Winthrop, Mass.
(Usual place of abode)
St
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years ....
9 months ........ days. In place of residence 22 years.
.......
.. months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
6
1963
(Month)
(Day)
(Year)
4
19
6.3
I HEREBY CERTIFY,
That I attended deceased from
Fe.b. ....... 2.5.,. 19 .... 6.3.
.. , to.
December 6.
I last saw h.e.Mve on December ..... 6 ...... , 19 .... 6, Death is said to
have occurred on the date stated above, at
3:45am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Bilateral Lobar Pneumonia
(a)
INTERVAL BETWEEN ONSET AND DEATH
probably tuberculous
Due To
Arteriosclerotic Heart
(b)
Due To
(c)
Disease with old antero- ... septal ..... myocardial/infarct and acute myocardial
OTHER
SIGNIFICANT
CONDITIONS
extension.
Was autopsy performed ?
....
Yes
What test confirmed diagnosis ?
......
5 Was disease or injury in any way related to occupation of deceased ?
If so, spesify
Print or Type Name) Dand S. Sherman M. D. PARENTS
(Addres 2 49 Rue Sie mattabaDate
Dec 6 19 63
6 ...
WIKITHR WA WINTHROP- .....
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
DEC
9
945
7 NAME OF
FUNERAL DIRECTOR
MAURICE W. KIRBY
ADDRESS
WINTHIRUP.
DEC 1-0 1963 tilham. Kay 311614
(Registrar)| (Official Designation)
A TRUE COPY ATTESTI
8 SEX
10 SINGLE
(write the word)
FEMALE
9 COLOR
WHITE
MARRIED
WIDOWED
DIVORCED
UNKNOWN'
NIDINED
11 If married, widowed, or divorced HUSBAND of
(or) WIFE of.
JOHN M. NORRIS
(Husband's name in full)
12
AGE 76 Years
Months ..
........
... Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation:
HOME MAKER
(Kind of work done during most working life)
· 14 Industry
or Business :
HUME
15 Social Security No.
NONE
16 BIRTHPLACE (City)
(State or country)
MASS.
17 NAME OF
FATHER
GILBERT MORRISON
18 BIRTHPLACE OF
FATHER (City)
(State or country)
SCOTLAND.
19 MAIDEN NAME
OF MOTHER
ANNE T LONG
20 BIRTHPLACE OF
MOTHER (City)
ST. JOHNS
(State or country)
N.B.
MAS CATHERINE CURRAN
21 Informant
(Address)
72 TREATON ST MELROSE MASS
I HEREBY CERTIFY that a satisfactory standard certificate of death fed with me BEFORE the buri Poyr transit permit waa Issued: Frank P-fraca
(Signature of Ageat { Board of Health or other) Dec, 8,1963 ..... (Date of Issue of Permit)
X 1
M R-301 -115
burial permit of Health Agent. TIONS
TIFICATE
TYPE CAUSES ATH enter in one r each and (c)
not mean of dying, ut failure, . It means or compli- ch camsed
, if any, e rise to se (.), e under. se last.
as contrib- th but not" se terminel ition given
20.1 81 20 274984
32382
No ....
Boston Sanatorium
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
NO
(a) Residence. No ....
(Give maiden name of wife in full)
NUTH BROOKFIELD
(Signature)
SHERMAN
A TRUE COPY ATTEST:
Williamf icane. City Registrar
5
THEOP
JAN 2 41964 AM
ORM R-301
for burial permit ard of Health ta Agent. UCTIONS FOR CERTIFICATE
OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure. etc. It means e, or compli- which caused
ons, if any, gave rise to cause (), the under. cause last.
itions contrib- death but not the terminal ondition given
33, 10
124 1964
62-934553
PLACE OF DEATH
Suffolk
(County)
-
Boston
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
275
(City or Town making this return)
12422
Registered No.
[(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Pantonino
Carmelo
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of deathyears months L
days. In place of residence .......... years .......... months .......... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Married
11 If married, widowed, or divorced HUSBAND of
Concetta Alongi
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE
74
Years
5
Months
24
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Fireman, retired
Occupation
(Kind of work done during most of working life)
14 Industry
or Business
15 Social Security No ..
2 dayis BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Peter Carmelo
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Francis Busacco
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Informant
V ...... A ..... Hospital .. Records, .... 150 .......
Huntington Ave., Boston, Mass.
I HEREBY CERTIFY that
satisfactory standard certificate of death was issued:
with me BEFORE the portal quesiger 2 .
(Signature+ Agent of Board ( FHalth other)
19653
/12/13/63
(Date of Issue of Permit)
A TRUE COPY ATTEST:
INTERVAL BETWEEN ONSET AND DEATH 2 days
Due To (b)
Due To (c) .....
OTHER SIGNIFICANT
Pulmonary congestion and CONDITIONSedema and bronchopneumonia
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signature)
A&Weinstein
M. D.
...... (Print or Type Name) VAH/Boston, Mass.
Dec.12 ,63
19 ... ............
Winthrop Cem., Winthrop, Mass. 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 14
19.
63
7 NAME OF
FUNERAL DIRECTOR
Caggiano F. H.
ADDRESS
147 Winthrop St., Winthrop, Mass. was hled
Received and fled Williaml.
DEC 17 1953
Race strani (Oficial Designation)
........ ..........
St
Winthrop, Mass.
(City or town and State)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December
11
1963
DEATH
(Month)
(Day)
VA
(Year)
4 I HEREBY CERTIFY
Dec . 10
19
63
to
19 63
XXXXXXXXXXXXX death is said to have occurred on the date stated above, at .3.8.4.5P. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Pontine hemorrhage
(a)
That
Deo a ]attended deceased from
if so specify WAR).
(Was deceased a
U. S. War Veteran,
WWI
47 Lincoln
CERTIFICATE OF DEATH
Ix Veterans Administration Hospital
X OUT - 01
...
(Address)
PARENTS
(Address)
in
-
A TRUE COPY ATION.
Wichauf Kane. City Registrar
1
[
6
JAN 2 41964 AM
RM R-301
or burial permit rd of Health Agent. UCTIONS FOR CERTIFICATE
OR TYPE R CAUSES EATH ot e.iter than one for each (b) and (c)
es not mean of dying. heart failure. etc. It means e, or compli- which caused
Rs, if any, ave rise to camse (a), the under- cause last.
tions contrib- death but not the terminal ndition given
$20.0
2 4 106 Direction use only CK ink.
2-932382
PLACE OF DEATH
(City or Town)
OUT - OF - TOWN The Commonwealth of Massachusetts KEVIN H. WHITE SUFFOLK SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS L' (County) BOSTON STANDARD CERTIFICATE OF DEATH
276
(City or Town making this return) 12419
Registered No.
[(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.
Shore .... Drive.
St
Winthrop, Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years ..
1
months .......... days. In place of residence2 ... y
.years
months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
Temale White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
Singles
4 I HEREBY CERTIFY , That Iwettended deceased from
November 11 19 63
19
63
to ...
December 12
W last saw h.elflive on .. December ..... 12 .......
19 .... 63death is said to
have occurred on the date stated above, at
2:08 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Pulmonary Embolus
Due To
(b)
Atrial fibrillation
Due To (c)
OTHER
Coronary Heart Disease
SIGNIFICANT
CONDITIONS
unknow
Was autopsy perforined ?
Yes
What test confirmed diagnosis ?
Autopsy
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify .......
(Signature)
M. D.
-Charles.L ... Clay, M. D ....
(Print or Type Name) (Address) Aas's. Die., Mass .. Gen'L Hasp ...... Date ... Dec ...... 1219 .... 63
6 Wintherch Cemetery Wentworth .........
Place of Burial or Cremation
Dec
14
19.
63
.........
(City or Town)
DATE OF BURIAL
7 NAME OF FUNERA Ernest Plaggano 147 Winthrop ST Werkthron 1983 ADDRESS
Readyfor celiano Kauce
DEC 17-1963
8 SEX.
63
(Month)
(Day)
(Year)
11 If married, widowed, or divorced
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