Town of Winthrop : Record of Deaths 1963, Part 6

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 6


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


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


ditions contrib. death but not o the terminal condition given


PLACE OF DEATH


X Suffolk (County)


3-7-63


LIBERTATE


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


(City or Town making this return)


STANDARD


CERTIFICATE OF DEATH


Registered No.


25


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


James D . Hoy


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


(a)


(Usual place of abode)


1


Length of stay: In place of death years 6 months


days. In place of residence ......... .years .......... months .. .... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


White


10 SINGLE


(write the word)


MARRIED


WIDOWED


DIVORCED


EMARRIed


HUSBAND of


MARC ARet New Hook


(Give maiden name of wife in full)


12 (or) WIFE of. 76 AGE/ INTERVAL BETWEEN ONSET AND DEATH 2/6/69 Years .. Months .. .. . Days


(Husband's name in full)


If under 24 hours


Hours ........ Minutes


13 Usual


CustodiÁN


Occupation


(Kind of work done during most of iworking life)


14 Industry or Busine U.S. Postal Service


Ret.


15 Social Security No.


16 BIRTHPLACE (City) (State or country) BOSTONMASS


17 NAME OF FATHER DANIEL Hoy


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


LYNN


MASS.


19 MAIDEN NAME


OF MOTHER


ANNie Kennedy


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


Boston MASS


MARGARET HOY


(Adres 16 Lexington Ave, E, Bostony


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


(Signature of Agent of Board of Health or other) Wraith Officer 3/4/63


......


62-933404


A TRUE COPY ATTEST:


(Registrar)|| (Official Designation)


(Date of Issue of Permit)


X


(Month) (Dây)


4 IHEREBY CERTIFY


May 20, 19 62


to


Feb- 71


That I attended deceased from


I last saw himalive on


Jan


26


..... 19 69 death is said to


have occurred on the date stated above, at


€.15pm


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Coronary Thrombosis


(a)


Due TeGeneralmed Arteriosclerosis


(b)


Due To


Hipertensión


(c)


OTHER SIGNIFICANT CONDITIONS


Diabetes Mellitus


Was autopsy performed? What test confirmed diagnosis ? Cemal Eran


5 Was disease or injury in any way related to occupation of deceased ? 221 If so, specify


(Signature) Louis Ssalyfta M. D. LOUISE SCHROFFA


(Address


Holy Cross MALden


Place in Burial or Cremation


(City or Town)


DATE OF BURIAL


Feb 9


63


7 NAME OF


Frederick JIMAGRATH


ADDRESS East Boston


Received and filed


FEB 8 1963


19


male


St


(Was deceased a


U. S. War Veteran,


(if so specify WAR)


No.


JO LexINGtory St Ave


E. Boston


(City or town and State)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF DEATH feb 6 1963 (Year)


1963


10 um


10 you


Name) 19 Bennington ST. 1(Primer ET) 2-7 19 63


PARENTS


1


Winthrop (City or Town)


Mounts Convalescent Home N


2 FULL NAME


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE


RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE FEB -81963 FM


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) Medieal 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.


ORM R-301


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)


oes not mean e of dying, heart failure, etc. It means se, 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


2-932382


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


Female white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


(write the word) widowed


11 If married, widowed, or divorced HUSBAND of


(or) WIFE of ....


Joseph Tecovvero


(Give maiden name of wife in full)


(Husband's name in full)


12


84


3


13


Months.


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housewife


(Kind of work done during most working life)


14 Industry


or Business:


at Home


15 Social Security No ....


16 BIRTHPLACE (City)


(State or country}


Italy


17 NAME OF


FATHER


nicholas Buscale


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Maria Lucchese


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


Italy


Mrs Mancy De Giacomo


21 Informant ( Address) 47 Wilshire St Winthrop


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


...... ....


ASignature of Agent of Board of Health or other)


Devitt officer


7. 1. 12. 1963


(Registrar) | (Official Designation)


(Date of Issue of Permit)


1 X


3 DATE OF


DEATH


(Month)


(Day)


10


19623


(Year)


4 IHEREBY CERTIFY , That I attended deceased from


19 4.2


19 64


I last saw h ..... lalive on


Feb


196 3, death is said to


have occurred on the date stated above, at


9:5-5pm.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Carcinomaturis


(b)


Due To (c)


OTHER


Chronic Valvular


CONDITIONS


heart disease


Was autopsy performed?


What test confirmed diagnosis ?


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


If so, specify)


(Signature)


M. D.


Joseph GREGORIE


(Print or Type Name)


(Address) Holy Cross 6 I'lace of furial or Cremation


Malden Mass


(City or Town)


DATE OF BURIAL


Feb 13


,63


7 NAME OF


FUNERAL DIRECTOR


Ernest Plaggique


147 Winthro/ St Winthrop


ADDRESS


Received and filed


FEB 12 1963


19


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)


1


PLACE OF DEATH


County) Winthrop


(City or Town)


Mayflower Leat Home Nursing Maria Tesorero (Curiale)


2 FULL NAME ..


(If deceased is a married, widowed or divorced woman, give also maiden name.) 48 Wilshire St


(a) Residence. No ..


(Usual place of abode)


3


.days. In place of residence. 13


St


(If nonresident, give city or town and State)


.. years .......... months .......... days.


26


Registered No.


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


PHYSICIAN - IMPORTANT


(Was deceased a U. S. War Veteran, if so specify WAR)


no


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


MEDICAL CERTIFICATE OF DEATH


to.


1.2b


10


INTERVAL


BETWEEN


ONSET AND


DEATH


monsieur


AGFO 7 Years


Due To areimeine of liver


110


PARENTS


16


Y Suffolk


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 medicali 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.


PLACE OF DEATH


SUFFOLK. (County) WINTHROP (City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATHOME


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


27


MOUNTS REST HOME CONVALESCENT. No ADELAIDE E COLEMAN 2 FULL NAME


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


69 JOHNSON AVE St


(If nonresident, give city or town and State)


Length of stay: In place of death ............ years .. months. 14 days. In place of residence 3 years. months ......... ... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


9 COLOR


FEMALE WHITE


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


SINGLE


10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


If under 24 hours


Hours ......


Minutes


13 Usual


Occupation :


CLERIT.


(RETIRED)


(Kind of work done during most of working life)


14 Industry


or Business:


MACHINERY MFG,


15 Social Security No ....


010-03-8534


16 BIRTHPLACE (City) (State or country) MASS


AMHERST


OTHER


SIGNIFICANT


CONDITIONS


Diabetes Mellitus


10 yrs.


Was autopsy performed?


No


What test confirmed diagnosis?


Clinical


No


(Signed)


Charles Liberman


M. D.


(Address) Winthrop, mass Date 2/12/1962


GUT BRIDGETS


ANTERST MASS


Place of Burial or Cremation (City or Town)


DATE OF BURIAL


FEB 14


943


7 NAME OF


FUNERAL DIRECTOR


MAURICE W KIRBY


ADDRESS WINTHROP


Received and filed.


FEB 13-1963


19


(Registrar)


PARENTS


17 NAME OF


FATHER


MATHEW COLEMAN


18 BIRTHPLACE OF


FATHER (City).


IRELAND


(State or country)


19 MAIDEN NAME


OF MOTHER


ANNE GLEASON


20 BIRTHPLACE OF


MOTHER (City).


(State or country)


IRELAND


21 AUGUSTINE CAMPONOVO


Informant


(Address)


CY JOHNSON AVE WINTHROP


1 HIEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Purple to Seriana 131 (Signature of Agent of Board of Health or other)


Health officeri


Feb 13,1963


(Official Designation)


(Date of Issue of Permit)


1


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Feb


(Month)


(Day)


12


1963


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


Nov. 4,


1962, 0


February 12, 1963


I last saw h.CY .. alive on


Feb


11


19.63, death is said to


have occurred on the date stated ahove, at


6:45 A.m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Arteriosclerosis cerebral


Due To Arteriosclerosis generalized


(h) ...


5yrs


Due To (c)


100M.11.55.916145


-301A 1


TIONS R ERTIFICATE


ving · DEATH enter an one r each and (c)


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


, if any, e rise to 15€ (a), e under- se last. -


ns contrib. th but not he terminal lition given


hapter 137, 4, requires to print or cause death on ficates. C


Registered No.


or ir


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 .. (Usual place of abode)


INTERVAL 12 BETWEEN ONSET AND DEATH 400ks. AGE 91 Years. .Months ........... .Days


-


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


EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE


RETURN OF CERTIFICATES OF DEATH


T


A physician or registered hospital medical officer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of deathy stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician. or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.


A physician or officer furnishing a certificate of death as required by the, preceding section or by section forty-five of chapter one hundred and four- te n, shall. if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifyingct herwar. and Ohnery or burial ground in which the interment is made.


shall also certify in such certificate both the primary and the secondary of imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall. for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.


No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the


death certificate contains a recital, as required by section ten of chapter forty-six, ~that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).


Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General "Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.


No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried nos the funeral is to be held, or from a person appointed to have the care of the


Chap. 114, Sec. 46, G. L., (Tercentenary Edition).


RULES OF PRACTICE


The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:


(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.


(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.


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


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


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


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT


SERVICE NUMBER


.....


ORM R-301


for burial permit ard of Health ts Agent. RUCTIONS FOR CERTIFICATE


OR TYPE OR CAUSES DEATH not enter : than one e for each (b) and (c)


laes nat mean de of dying, heart failure, etc. It means se, or campli- which caused


ions, if any, gave rise to cause (a), the under- cause last.


ditians contrib- death but nat o the terminal canditian given C .


PLACE OF DEATH


Suffolk (County) Winthrop (City or Town)


19 CORAL


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


CERTIFICATE OF DEATH Ave


Registered No.


28


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.


(Usual place of abode)


Length of stay: In place of death.


.. years .......... months .......... days. In place of residence.


.. years.


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


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


Feb


15.


1963


(Month)


(Day)


(Year)


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


1: 25 pm.


INTERVAL BETWEEN ONSET AND DEATH


(a) Death occurred of 4:25 AM


(b)


Due


Of Feb. 15, 1965. Death apparently


Due


(c)


Todue to natural causes, presumably


acute coronary occlusion basert


SIGNIFICANTON history and medical record


OTHER


CONDITIONS


Winthrop Board of Health.


Was autopsy


What test confirmed diagnosis darles Lebenau hin


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


(Signature) Cluster Lete way M. D. CHARLES LIBERMAN (Print or Type Name) (Address) WINTHROP, MASS Date 2/15/1963


6 MONTIFIORE SOC,


EVERETT


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


7 NAME OF


FUNERAL DIRECTOR


TORF funeral Service


ADDRESS 151 Washingtonrtve Chelsea


Received and filed FEB 18 1963 19.


(Registrar ) ||


A TRUE COPY ATTEST:


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Male


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCEDMARRIED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


SARAH


GOLDMAN


(Give maiden name of wife in full)


(or) WIFE of


(Husband's name in full)


12


AGES 2 Years


Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


CLERKS


(Kind of work done during most working life)


14 Industry


or Business :


RETAIL FOODS


15 Social Security No 034-03-8103


16 BIRTHPLACE (City)


(State or country )


MALDEN MASS


17 NAME OF


FATHER


DAVID MILLER


PARENTS


18 BIRTHPLACE OF


FATHER (City)


Russia


(State or country)


19 MAIDEN NAME


OF MOTHER


BESSIE MILLER, OR)


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


RUSSIA


21 Informant


SARAH MILLER


(Address)


19 CORAL Ave Winthrop


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


&Signature of Agent of Board of Health or other)


Health Efecin


til-15 1163


(Official Designation)


(Date of Issue of Permit)


TV


I


No


JACOB


MILLER


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


19 CORAL


Ave


St.


(If nonresident, give city or town and State)


8


(City or Town making this return)


2 FULL NAME


62-932382


11


firiania (2)


.....


FEB


17


1963


(write the word)


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


SPACE FOR ADDITIONAL INFORMATION


DATE OF ENTERING MILITARY SERVICE


DATE OF DISCHARGE RANK, RATING


ORGANIZATION AND OUTFIT


SERVICE NUMBER


RULES OF PRACTICE FEB 1. 81263 AM


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.




Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.