Town of Winthrop : Record of Deaths 1963, Part 9

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 9


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


IST OR TYPE SIGNATURE)


.. 19 .. 63


6 St. Joseph's West Roxbury (City or Town)


Place of Burial or Cremation


February ...... 7,


19


63


7 NAME OF FUNERAL DIRECTOR Arthur J. O' Maley


Winthrop, Mass


ADDRESS ...... 7-1963


........... 19


ri.


( Registrar)


8 SEX


M


9 COLOR


w


10 SINGLE


MARRIED


WIDOWED MARRIED


or DIVORCED


10a If married, widoMargaret Molloy HUSBAND of


(or) WIFE of


(Husband's name in full)


II IF STILLBORN, enter that fact here.


12


AGE.


.6.5.Years.


Months ..


.Days


If under 24 hours


Hours


.Minutes


13 Usual


Occupation :


BuyerDomestics


(Kind of work done during most of working life)


14 Industry


or Business :


Jordan Marsh Co


15 Social Security No.


013-07-90.58


Worcester


16 BIRTHPLACE (City)


(State or country)


Mass


17 NAME OF


FATHER


Michael Shea


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Ellen Crowley


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


Ireland


21 Margaret Shea Informant (Address) 63 Paine St., Winthrop


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


(Signature of Agent of Board of Health or other) 2-6-63


B15047


(Official Designation) (Date of Issue of Permit)


V


TRUCTIONS FOR L CERTIFICATE


giving OF DEATH not enter than one e for each (b) and (c)


does not meon de of dying, heart failure. etc. It means se, or compli- which caused


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


ditions contrib- deoth but not o the terminal ondition given 12.2. 2.3


: - Chapter f 1954. requires ians to print df the of


cause death on certificates, and er 48. requires


ts bysi to print on type ander signature.


5 1963


PLACE OF DEATH


M R-301A 1


SUFFOLK (County) BOSTON (City or Town)


The Commonwealth of Massachusetts. JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH


Registered No.


1295


2 FULL NAME


( First Name )


(Middle Name )


(Last Name)


PHYSICIAN -- IMPORTANT


... . .. St.


15


INTERVAL BETWEEN ONSET AND DEATH 2 yrs


15 days


or ( Address) STElex Date 2/4


PARENTS


DATE OF BURIAL


(Give maiden name of wife in full)


RECEIVED


TO !!


OF


11.1.2


1


.LERK


il;


WINTHROf


6


VASE.


APR =51963 AM


1


The Commonwealth of Massachusetts KEVIN H. WHITE


SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD


CERTIFICATE OF DEATH


Registered No.


01513


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


PHYSICIAN - IMPORTANT


2 FULL NAME ..


COLBERT MASON


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


(a) Residence. No ...


7 Somerset Terrace, Winthrop, Massachusetts


(Usual place of abode)


(If nonresident, give city or town and State)


Length of stay: In place of death ......... years ......... month _......


days. In place of residence. 31


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


male


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


single


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


(or) WIFE of.


( Husband's name in full)


12


AGE BO.Years. 9 ...


Months. 12 Days


lf under 24 hours


Hours ........ Minutes


13 l'sual


Occupation :


( Kind of work done during most working life)


14 Industry


or Business:


American Mutual Ins.Co.


15 Social Security No ...


16 BIRTHPLACE (City)


(State or country )


England


17 NAME OF


FATHER


Frederick Mason


18 BIRTHPLACE OF


FATIIER (City).


(State or country)


England


19 MAIDEN NAME


OF MOTHER


Virginia Allen


20 BIRTHPLACE OF


MOTHIER (City)


0x ord


(State or country)


England


6


Woodlawn Creamatory.


Everett, lass


Place of Burial or Cremation


(City or Town)


DATE OF XOREN Creamation Web 12, 1963


7 NAME OF


FUNERAL


I


alfred B. March


ADDRESS


Received and filed


FEB 14 1963


7% Winthrop St. Winthrop quanla .... 19 Charles it Mackie


( Registrar)|


A TRUE COPY ATTEST:


21 Informant


Miss. Ella Lason


( Address )


7 Somerset Terrace Winthrop HEREBY CERTIFY that a satisfactory standard certificate of death Ha blanwith me BEFORE the burial of transit poripit was issuedy


12126


Official Designation)


(Date of Issue of Permit)


(Signature of Agent of Board of Health or other) 12- 62


I VBV


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


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


oes not mean le of dying, heart failure. esc. It means se, or compli- which caused


ons, if any, gave rise to cause (a), she under . cause last.


litions contrib- death but not the terminal ondition given


nc.


20.1


$70 18 1963 Directon use only K Ink.


2-932382


PLACE OF DEATH


SUFFOLK


(County)


BOSTON


(City or Town)


NO.MASSACHUSETTS GENERAL HOSPITAL


42


OUT - OF - TOWN


(City or Town making this return)


1


Due 'lo (c)


OTHER


SIGNIFICANT


CONDITIONS


Vos


Was autopsy performed ?


What test confirmed chagnosis?


autopsy


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


If so, specify ..


-elClay


(Signature)


M. D.


Chariss.L ... Cloy .. M. D.


(Print or Type Name)


(Address) s'9. Dir .. Most .. Gen'l. Howp ....... Date. Feb 9 10 63


3 DATE OF


DEATH


February 9, 1963


(Month)


(Dãy)


(Year)


4IHEREBY CERTIFY , That Wattended deceased from


2-7.


.. , 19


63


... to


2-9


1º. 63


q last saw h ...... alive on


2-9-63


19


., death is said to


have occurred on the date stated above, at


1:100.


INTERVAL


BETWEEN


ONSET AND


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


Pulmonary odoma


(a )


Due To


Coronary heart disas?


(1))


Tink


Years


retired draftsman


PARENTS


(write the word)


( Was deceased a


U. S. War Veteran,


if so specify WAR)


ORM R-301


TRUE COPY. ATTEST: Parles it Mackie City Registrar


RECEIVED


TOW


OF


17 12 1


201410


1


4.


.


CLERK


B


WIN


6


120


APR = 81963 AM


1


I


R-301A


1


PLACE OF DEATH


Suffolle (County)


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


STANDARD


CERTIFICATE OF DEATH


Registered -----


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


NEPONSET MAYOR HOSPITAL Catherine F. Ellis


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


Waldemar AVE


(a) Residence.


No.56 (L'sual 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 20 years months ......... days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


IO SINGLE


MARRIED


(write the word)


Widowed


or DIVORCED


10a If married, widowed, or divorced IIUSBAND of


(or) WIFE of ..


Harry Ellis


(Ilusband's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE / Years


Months


Days


If under 24 hours


Ilours ...... Minutes


13 L'sual


Occupation :


Retired Practical Nurse (Kind of work done during most of working life)


14 Industry


or Business :.


Nursing


15 Social Security No ...


16 BIRTIIPLACE (City)


(State or country)


BOSTON Mass


17 NAME OF


FATHER


Charles Coakley


PARENTS


18 BIRTHPLACE OF


FATHER (City) (State or country)


Ireland


19 MAIDEN NAME


OF MOTIIER


Nova Ring


20 BIRTHPLACE OF MOTIIER (City) .. (State or country) ireland


21 Catherine Verry


Informant


(Address) Al Waldemar And Wentbrek


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


(Signature of Agent of Board of Ilealth or other)


Received And filed


EL8 211 1963


(City or Town)


DATE OF BURIAL


Feb 23


19


7 NAME OF FUNERAL DIRECTOR Arthur J. OMaley Winthrop- Mass ADDRESS


(Registrar)


INTERVAL BETWEEN ONSET AND DEATH Echange


(a) - Cerebral Thrombosis with buff sidre nemefare.


Due To


Generalized


(b)


Arterie -seloresi!


iwith Meat i Diri


Due To (c) .


OTHER SIGNIFICANT CONDITIONS


pro


Was autopsy performed?


What test confirmed diagnosis ?..


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


(Signed)


MYRON


Monte Posen Thal


M. D. (Address) (4) Mortoist Date 2/19 196 3


6 Winthrop


Winthrop ...


Place of Burial or (ffemation


19 1963 (Year)


(Month) (Day)


4 I HEREBY CERTIFY,


That I attended deceased from


- 18 , 19 4 2. , to.


19.


I last saw h.'. walive on 14, 1965, death is said to have occurred on the date stated above, at 9150m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


3 DATE OF


DEATH


L


Boston (City or Town)


Neponset Manor Hospital


OUT - OF - TOW3


.THIS IS A ENT RECORD. e only APPROVED nk or black iter ribbon.


UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each b) and (c)


oes not mean dying. heart failure. te. It means . or compli- which caused


I.C.


. if any, ause (a). the under. ause last


ons contrib -- > each but not the terminal adition giren


Chapter 137, 54, requires s to print or cause or on death on ificates. P. 46.99 9 & P. 114 :45, ΑΡ. 3816.) 8.1963 021.


3


...


2 FULL NAME_


PHYSICIAN - IMPORTANT


(Was deceased a


U. S. War Veteran,


NO


if so specify WAR).


winthrop


15.270


2 20 63.


(Official Designation)


(Date of Issue of Permit) V


To be filed for burial permit with Board of Health or its Agent. 01869


MEDICAL CERTIFICATE OF DEATH


yrs


(Give maiden name of wife in full)


RECEIVED


OF


TOW:


12 12 1


1110


CLERK


WINTHROP


6


APR -81963 AM


1


-


DICTION WAIVED


ORM R-301


or burial permit rd of Health Agent. UCTIONS FOR CERTIFICATE


OR TYPE OR CAUSES DEATH ot enter than one for each (b) and (c)


Does not mean e af dying. heart failure. etc. It means e, or compli- which caused


ons, if any, gave rise to ramse (a), the under. cause last.


itians contrib. death but mat the terminal ondition given nc.


8 1963


PLACE OF DEATHO


1 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


OUT - OF - TOWN14


(City or Town making this return)


1864


f(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, Cif so specify WARI ....


No


(a) Residence. No. 187 Shore Drive


(Usual place of abode)


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


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


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Mait


9 COLOR


White


10 SINGLE


MARRIED


WIDOWED


DIVORCED


UNKNOWN


( write the word)


Married


HUSBAND of


Derithy Lorcet. 7.


(Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


12


AGF.


Years


Months


Days


If under 24 hours


Hours


Minutes


13 l'sual


Occupation


Executive Director


( Kind of work done during most of iworking life)


14 Industry


or Business:


M.T. A.


15 Social Security No.


16 BIRTHPLACE (City).


(State or country )


Mass.


17 NAME OF


FATHER


Domenic Massucco


18 BIRTHPLACE OF


FATHER (City) .


Besten


(State or country)


Massi


19 MAIDEN NAME


OF MOTHER


Susan Biggi


20 BIRTHPLACE OF


MOTHER (City)


(State or country )


Massi


21 Informant


Dorothy Massucco


187 Shore Drive, Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 1. vornan


(Signature ol Agent of Board of Health or other)


15240


2 20 63.


(Official Designation)


(Date of Issue of Permit)


KVA.V


A TRUE COPY ATTEST:


(Day )


( Year)


4 1 HEREBY CERTIFY


Oct 13


150


to


February


19.1963


I last saw h& malive on


February /& . 163. death is said to


have occurred on the date stated above, at . 6:20 An.


INTERVAL


BETWEEN


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


ONSET AND


DEATH


YES


PULMONARY EMPHYSEMA


(a)


CORONARY THROMBOSIS


Due To (b)


Dne To


SECONDARY POLYCYTHEMIAYRS


OTHER


DIABETES MELLITUS YRS


CONDITIONS


Was autopsy performed?


What test confirmed diagnosis? PHYSICAL EXAM EKG


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


Caram Pelas


M. 1).


CAREY .M. PETERS


(Print or Type Name)


(Address) 1180 Beaconist Date 19 Debe 1963


St. Michael Cern. Boston


6


Place of Burial or Cremation


Feb, 27, 1967


DATE OF BURIAL


7 NAME OF


Arthur S. Porcella


FUNERAL DIRECTOR


ADDRESS


10 N. Bennett St Bestin


Received ajul filed FEB. 2.1 1953 19 Charles it Inak


( Registrati


No .. New England Deaconess ... Hospital


2 FULL NAME Walter


Massucco


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


St.


Winthrop


Mass.


(('ity of town and State)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


February


19


1963


(Month)


That I attended deceased from


Z DAY'S


Besten


PARENTS


Boston


(City or Town)


2-933404


Registered No


-


RECEIVED


TO!Vi


OF


21 32 1


11-10


CLERK


6


THROR.


APR -81963 AM


RM R-301


1


PLACE OF DEATH


Suffolk .........


(County)


Winthrop


(City or Town)


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


CERTIFICATE OF DEATH


Winthrop Community Hospital No


[(If death occurred in a hospital or institution,


St. ¿ give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME


Rebecca


Kaminsky


Litner


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


Winthrop


St


(If nonresident, give city or town and State)


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


16


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX F


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED Widow


DIVORCED


UNKNOWN


11 If married, widowed, or divorced


HUSBAND of


(or) WIFE of Morris


(Give maiden name of wife in full)


hiTner


(Husband's name in full)


12


AGE 26 Years


.Months.


.Days


If under 24 hours


Hours ..


Minutes


13 Usual


Occupation :


House Wife


14 Industry


or Business :..


AT


Home


15 Social Security No ...


NONE


16 BIRTHPLACE (City)


(State or country)


Russia


17 NAME OF


FATHER


Herman Kaminsy


18 BIRTHPLACE OF


FATHER (City).


RUSSIA


(State or country)


19 MAIDEN NAME


OF MOTHER


ETTa (UNKNOWN)


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


Russia


Sharon Mem, Park Sharon 6


l'lace of Burial or Cremation


(City or Town)


DATE OF BURIAL


March 3


63


7 NAME OF


FUNERAL DIRECTOR


Henry Lavinge


ADDRESS


470 Harvard ST, Brookline


Received and filed


MAR 4 1963


19


Sidney H. LiTner


21 Informant


( Address)


330 Clinton Rd, BrookLINE


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


(Signature of Agent of Board of Health or other)


Health Office


Jarch 2, 1963


(Date of Issue of Permit)


TUR.V


A TRUE COPY ATTEST:


2


1963


DEATH


(Month)


(Day)


(Year)


4 [ HEREBY CERTIFY


APRIL


- 19 55


to ...


MARCH 2


19.


That I attended deceased from


I last saw h Elalive on


2 .--


19.1 2 death is said to


have occurred on the date stated above, at


DEATH WAS CAUSED BY: IMMEDIATE CAUSE (CEREBRAL VASCULAR ACCIDENT (a)


INTERVAL BETWEEN ONSET AND DEATH 5 DAYS


Due


(bX


TO ARTERIOSCLERITIC HEART DIS


I Ye.


Due (c)


FRACTURED LEFT HIP


16 DAYS


Ive 8 YRS


Was autopsy performed ?


Na


What test confirmed diagnosis? CLINICAL X-NY.


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


(Signature)


mukinh Rue


M. D.


MYRON 1


KING IJ


(Address)


222 DLCHSHET Si HINTERil Date.


(Print or Type Name)


3/2063


MEDICAL EXAMINER


2-932382


JURISDICTIONA.


or burial permit rd of Health Agent. UCTIONS OR


CERTIFICATE


OR TYPE R CAUSES EATH t enter han one for each b) and (c)


es not mean of dying, eart failure, tc. It means , or compli- hich caused


ns, if any, ave rise to ause (a), the under- ause last.


ions contrib- eath but not the terminal adition given 16


C.


RELETTPED


...


(City or Town making this return)


Registered No.


15


(Was deceased a


U. S. War Veteran,


(if so specify WAR).


NO


(a) Residence. No.


252 Shirley St


(Usual place of abode)


3 DATE OF


MARCH


(write the word)


( Kind of work done during most working life)


OTHER SIGNIFICANT CHRONIC LYMPHATIC LEUKEMIA CONDITIONS CHRONIC BRONCHIAL ASTHMA


PARENTS


(Registrar) | (Official Designation)


SPACE FOR ADDITIONAL INFORMATION


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


SERVICE NUMBER


36


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 fromn 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.


FORM R-301


d for burial permit Board of Health its Agent. STRUCTIONS FOR IL CERTIFICATE


T OR TYPE : OR CAUSES DEATH


not enter re than one se for each ), (b) and (c)


does not mean ode of dying, s heart failure, , etc. It means ease, or compli- which caused


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


nditions contrib- o death but not to the terminal condition given


X 1


PLACE OF DEATH


Suffolk ..... .


(County)


Winthrop


(City or Town)


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


WINTHROP


(City or Town making this return)


STANDARD CERTIFICATE OF DEATH


Registered No.


(If death occurred in a hospital or institution,


.St. } give its NAME instead of street and number)


PHYSICIAN - IMPORTANT


2 FULL NAME


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


(a)


Residence. No ...


66 Shore Drive


St


Winthrop


(Usual place of abode)


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


1 .months .. 5 .days. In place of residence. 8


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


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


white


10 SINGLE


MARRIED


WIDOWED Widow


DIVORCED


UNKNOWN


(write the word)


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY, That I attended deceased from


JANUARY 24, 1963


MARCH 2


1963


I last saw H.R.alive on


MARCH 1


1963, death is said to


have occurred on the date stated above, at


7:45 A


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) HYPOSTATIC PNEUMONIA


INTERVAL


BETWEEN


ONSET AND


DEATH


Due To


(b)


CARDIAC DECOMPENSATION


(c)


Due To


ARTERIOSCLEROTIC HEART DISEASE


OTHER


FRACTURE SURGICAL NECK


SIGNIFICANT LEET HUMERUS CONDITIONS


OWAS


Was autopsy performed? .... NO


What test confirmed diagnosis ? EKG- X-RAYS


cal ExaminerVas disease or injury in any way related to occupation of deceased? NO ed jurisdiction iso specify


(Signature) Dorothy Chaney appleton M. D. DOROTHY Cheney APPLETON (Print or Type Name)


(Address) 197 Wood31de QUE Date MAR. 2 1963


6 Woodlawn Everett ..... Mass


Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


March 4 1963


7 NAME OF


FUNERAL DIRECTOR


Maley Funeral Home


ADDRESS


Received and filed


MAR 4 1963


19


(Registrar)


A TRUE COPY ATTEST:


11 If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE


Garret S. Voorhees


(Husband's name in full)


12


86


2DAYS


.Years


6


Months .. 1.3.


.Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Housewife.


(Kind of work done during most working life)


14 Industry


or Business :


Own Home


15 Social Security No ..


None


16 BIRTHPLACE (City)


(State or country )


New Jersey


17 NAME OF FATHER John Tobin


Newark


18 BIRTHPLACE OF


FATHER (City)


(State or country)


New Jersey


19 MAIDEN NAME OF MOTHER Laura Drake


20 BIRTHPLACE OF


MOTHER (City) ..


(State or country)


Newark


New Jersey


G. Coerte Voorhees


21 Informant


( Address)


1047 Amsterdam Ave New York 25 N Y


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 Their March 4-1963


(Official Designation)


(Date of Issue of Permit)


X


-62-932382


No.Winthrop Community Hospital


Mabel


T


Voorhees


(Was deceased a


U. S. War Veteran,


No


(if so specify WAR).


(If nonresident, give city or town and State)


3 DATE OF


DEATH


3


2 1963


2 WEEKS


VYRO


Newark


PARENTS


Arthur J.


O Maley


Winthrop Mass.


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 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.


ORM R-301


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


" FRESCOtt SX


OR TYPE R CAUSES DEATH ot enter than one for each (b) and (c)


Des nat mean e of dying, heart failure, etc. It means e, or campli- which caused


ms, if any, gave rise ta cause (a), the under- cause last.


itians contrib- death but not the terminal nditian given .C.


X 1 PLACE OF DEATH


Suffolk


(County)


Winthrop


(City or Town)


No ... 231 Court Road


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)


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


2 FULL NAME.


Madeline Frasso (Cioppa)


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


(a)


Residence. No.


231 Court Road


St


Winthrop


(If nonresident, give city or town and State)


Length of stay: In place of death 1 years 4 months days. In place of residence 1 years months days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


female


9 COLOR


white


10 SINGLE


MARRIED


(write the word)


WIDOWED married


DIVORCED


UNKNOWN


11 If married, widowed, or divorced HUSBAND of


(or) WIFE of.


Anselmo


Frasso


(Husband's name in full)


12


AGE 65 Years.


9 ... Months.


20


.Days


13 Usual


housewife


Occupation :


(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 Giovanni Cioppa FATHER


PARENTS


18 BIRTHPLACE OF


FATHER (City).


(State or country)


Italy


19 MAIDEN NAME


OF MOTHER


Angelina Graziano




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