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
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.