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REGISTRY DIVISION OF _.TH~ CITY OF 60STON
CoutiTlt OR SUFFOLK. COMMOt1wEAt.TN OF MASSACMV9Etr8. gNtTEO ljTATE.tf OF AMERICA
.off Certificate p ~1TQ 2545? `
1, the utldersigned, hereby certify that 1 hold the o,~ce of
City-12epiatrar of tha City of $oston and I certify the following fact8 appear on the ~ •
records ~ Birtha, Marriages ^:•.,~..~alhs ksp! in said City as required by law.
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/ a / ~ ~ } 1, ~il~r ~~a:auua»s~saittf ~f ~tt~~ur~u~:lt,~
JOHN F. X. OAVOREN~ -
Suttolk ~
~ " •tC11tTARY OI? 'tM[ .COM(NONWlAtrTM
' OIVIRIhN OI VITAt. YTATIiTIC9 t[:rlr er T.trw arc?iss tkia Men)
A (Cwaw)
, - 1 0 Doston - STANDARD ~,?r p(`
1• .
u ' l(:uy w Tvtra) CERTIFICATE OF' DEATH Rrwb+eted Ktr.
~ • . --1~ ~ p~. ST.~- • ~ ~ tit deatk w~wrred is a Iww.ital er iwiat3.a.
t _ sire is :1i(l'AtE iwstrVd .1 .trey asd aataket)
FORM R-~301
TIIYti1ClAN._ IMPORTAPrI'
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~ .t°~ire. k~t l f 2•H (1 F . r R l l ntl i n i ur areefeti) .
a< w ARas. i FULL NAVE _ - ~li. S. Mat Yeteras.
tl!~r a
111 deceased is • ararrted. trtdord or.dirtrreed sNttu. srre ala. assrdes aura) , • y WAR)
INSTavenara pet..K.t Reai~eaee_ Nw 1436 River.. SL _..li~?rie..•Pttr. rl?iass.
AiEDICAL ($ir1FICA18 ((:its w tn~s ad Solt)
PRI\? OtA nlB hrED1CAL. CE1t77FICAT6 O! DBA'fH PBRSONAL AND STATISTI(:AL PARTICULARS
CAUb'E OR CAUSBi , A B OF Yr - , r~~~~ 10 LORD I l SI:~Ci.k (write Ike trot 1
OF DBATH DEATH .u ........:.....t~.~..........l..l...~Yeu..._.......:............... kfARRIk;D
WIDUWED•
~ ..t .ae. a l t~ }At a T c a R r I F T. ~ 1 dearted 11fa l e 1Yh i t s ~ uDNt~owr rte rri e d
wwtitt
~ eaett I isst taw k alitre os lo......., death i. said ~ESiI~ ShRrt R
Darn oooumed oa tke date gatad akore, at ..............a. IM?ERYAI (Chre"asatdes oasre d trt(e to ttrU)'
TAis lsror sst ¦setrs W CAUSED STt D~IM6DIA USIC [4ETwEEN (a) WIPE d
t.~e war+dst ~~1 1~~nrel. "'t' ~ OMiET AIO Iritsshand't sasse is relit
a.eArnis. cte. le .eewa ~'~R'"'~- cii~ .........~1.......S1'... ok.......... oun t0 ~ Ir oeaee.2a iroers
tk a diwatti er ceas~f- AGE - ..Yews 1[oatlt _ Ihyt Hoer iaW
~ationa srkieJt eaearl ~ Dne ro ~ ~ la Used N ~
death. v ~i1V~ Oa..rp.t:ae /'i11t0....~0(l,f- ~i.111 •
(b)...-.......__.~ lY..lQ. ..SR'.l.Sc ~ IKind ur vrgk t4rrr• au?iryt amt d v.erkintt li(e)
C.owditiowa. snL Due To 15 rndostry
arkitA NM siat t. (c) .~lt'. ...t.. vS a t)uoness: _ Sflllte•
above ave. ls1. 18 Sneial Seeority No.
~totiws tAe s+aJen O'fHBR
tyi¦Q ttttrtt Mat SiGAI[FiCAltT! .
coxDmonrs - 17 BIRTHPLAf:H (city) Frankl-in )1A8s-.-
. (State or orwwtryj ~
tis etstepp p(rfortnedt
4C AQ b lOatjt W la NAME OF
srlated eo eJYs escsra.r wk.t test eooerwed aiasrtotis? . ~ FATHER Lawrence Y11 lad ini
Qircas esatitMa tri«w .
i~ S Was dbeate oc iaftrry b soy wy redaled to oectrp.tios of aeeeasea I,,, reT~ ; OF I t $1 y -
if to. ~
~ ~ (State w avuntry)
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(sisoatureT l •cS- • 1/. D Y 40 \1AIpF.N NAAIB _
- ' .v~~.~-j. ~.,t~: ~~..t~ c)F samlF:rc ~f7tiltt7 F'r:1aCa
L 1 (P ' sr Tyle tiewse) ~
(l~ddnys 1'~ . ~ 1~ ~7 a 31 $IRTItI'LAt:B OF - -
_ Date - 111. 1,lOTHHR (City) .Italy .
~ dFairview Cprtetery: DoAton, I, } (st.te .,r e„W,tt,.) _
O Plsee or Betial or Ctemttioa ((Jly ae Tows) ~ I. HE EdY ~~R~'
Y that a satisfactory st+rduJ exrti5cate d datk
' ~ DATE OF BURIAL ...........Anri.l ...:...S.k 1~7 was ed ^FFORE tke hand a trash +-a:f~s ea.
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7 NADIB OF ' ~ (Sitp..?tare or Hoc Health
FtrIrBRAI DIRBCiOR . Francis ...E.. -.Kanney........~ ~ „ ~ : ~
ADDRESS 1445 River... St,IIyr18.....P1Tk.:~.. iixr~.i•i>~a~~..Mf ro. -...r'"i,:~;:~ «~-"P:•~a~
' - -
a Ire.Altred F Palla(lini (ttii'e~)Re~it _ _ lo'.....
1436 .-River St,l[~?d8....PArk,.~?ta.,,..ir..,_ , ~ ~Re~tttar)
(Address)
~.,u)1.1t-N-Nk7q _ ~79 ftW -9 ~ ~ I A TRUB COPY ATTEST:
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Pacr~A~"' 454285
RECOltO VERfftEO
I tttrtber certify that by annexation,
the Records of the tdlowio6-nsmrd cities WITNE86 my hand t?nd the SEAL ut tM CITY REGISTRAR
and lntvos are io tM custody of the City -
ReRistnr of B~too:- 12 ~ APRIL 1977 •
Axxsxso
East Botitoo ...1837 ~ ~-...:.......................Day ot............................................A. D. -19............
' Soutb Bastoo._ ...................................180! ~i~•%i~i~„~ , ^
Roxbury ..............................................1888 Y :
tt dfr
Dorebest~ ..........................................1870
CbarksWtro By Chap(er 314 d the Atts of 1802, "the certificates M attctations -
g~t,,,, ............................187 of the Assistant City Reaatrars shall have the atime frme and eNect ss 4 "
West Roxbttry that of t.ha City R~istrar." ~ ~ -
Hyds Parh ..........................................1912 ~1~~~ -
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