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Born in Little Italy, New York, Serio got the nickname "Donnie Bags" because of the colostomy bag he needed since the time his wife shot him in the gut. He was a cousin of Nick Geraci and was known to be a very skilled driver. In the early 1960s, he distanced himself from his treacherous cousin and started reporting to Thomas Neri. He gained enough trust to become Michael Corleone's personal driver.