USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1936 > Part 86
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RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the ob- servance 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 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 septi- cemia), 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.
STANDARD CERTIFICATE OF DEATH
10984 DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
1. PLACE OF DEATH
County
Elijitou
Township
Champlain
City
No.
or Village
Q Sabes Point
or
St. Ward
(If death occurred in a hospital or institution, give ita NAME instead of street and number) __ mos.22ds. How long In U. S. If of foreign birth? -yrs. .. mos. _____ ds.
2. FULL NAME
Click&
C
Savvio
(a) Residence: No.
(Usual place of abode)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
21. DATE OF DEATH (month, day, and year)
Feb. 10, 1936
22.
I HEREBY CERTIFY, That I attended deceased from 19 19. ., to
5a. If married, widowed, or divorced
HUSBAND of
(or) WIFE of
Hast saw h ____. alive on. 19 ; death Is sald
to have occurred on the date stated above, at m.
6. DATE OF BIRTH (month, day, and year) Har 31, 1868
Years
Months
Days
If LESS than
1 day, ____.
hrs.
67
11
or _____ min.
Lancer of stermach
4 mes.
8. Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc. Iner Foco Cinqueer
9. Industry or business In which work was done, as silk mill, saw mill, bank, etc.
10. Date deceased last worked at
this occupation (month and
11. Total time (years)
spent in this
occupation
Other contributory causes of Importance:
Heart failure
15 das
12. BIRTHPLACE (city or town).
(State or country)
13. NAME
Name of operation Date of
What test confirmed diagnosis ?.
Was there an autopsy?
23. If death was due to external causes (violence) fill In also the following:
Accident, suicide, or homicide? Date of injury 19
Where did Injury occur ?. (Specify city or town, county, and State) Specify whether inJury occurred In industry, In home, or In public place.
FUJIINFORMANT (Address)"
18. BURIAL, CREMATION, OR REMOVAL
Date
19.
24. Was disease or Injury In any way related to occupation of deceased?
19. UNDERTAKER {Address)
If so, specify
(Signed).
A. S. Plavid
M. D.
20. FILED 19
Registrur.
(Address)
State New york
Registered No.
Length of residence In city or town where death occurred
_yrs.
St.,
Ward.
Winthrop Muss.
(If nonresident give city or town and State)
o 11-10031 3. SEX 7. AGE OCCUPATION MOTHER FATHER Place: OCCUPATION is very important. See Instructions on back of certificate. state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should year).
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of V. B. NO. BO
14. BIRTHPLACE (city or town) (State or country) "1
TAIOn 15. MAIDEN NAME
BIRTHPLACE (city or town)
109A State or country)
Canada
Manner of Injury Wat Mature of injury
The principal cause of death and related causes of importance were as follows:
Date of onset
4. COLOR OR RACE | 5. SINGLE, MARRIED. WIDOWED. |
OR DIVORCED (write the word)
Wichowed
..
UNITED STATES STANDARD CERTIFICATE OF DEATH
Statement of occupation .- Precise statement of occupation is very important, 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 deceased had retired from business, report the occupation prior to retirement. 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 housewife in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as servant-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the particular kind of work done and return that, as spinner, weaver, etc.
In stating the industry or business, avoid the use of such general terms as "store," "factory," "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic," but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the discase, injury, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease or injury causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under other contributory causes of importance, name other important diseases or injuries. Examples:
Example I
Example II
The principal cause of death and related causes of importance were as follows:
Date of onset
The principal cause of death and related causes of importance were as follows:
Date of onsel
Arteriosclerosis
1915
Attack of epilepsy.
1 weck ago
Chronic interstitial nephritis
1921
Run over by street car
1 week ago
Cerebral hemorrhage
July 5, 1927
Peritonitis
3 days ago
Other contributory causes of importance:
Other contributory causes of importance:
Gallstones
May 1, 1923
Gastroenteritis
1 year
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
U. S. GOVERNMENT PRINTING OFFICE: 1930
c11-3184
OM R-305
PLACE OF DEATH
SUFFOLK (County)
BOSTON
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No ... 9169.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Samuel Broner
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No
(Usual place of abode)
69 Locust
St.,
.Ward, ...
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Marr.
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Pauline Ginsburg
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 AGE 40 Years Months Days
If less than 1 day
Hours
Minutes
OCCUPATION
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Agent
9 Industry or business in which work was done, as silk mill, Metropolitan Ins. Co. saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
10/36
spent in this occupation .. yr.8.
12 BIRTHPLACE (City) (State or country)
Russia
13 NAME OF
FATHER
Frank Broner
PARENTS,
14 BIRTHPLACE OF
FATHER (City)
(State or country) Russia
15 MAIDEN NAME
OF MOTHER
Sadie De Wolf
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
25m-2-'30. No. 7997-e
17 Informant (Address)
Wife
A TRUE COPY
Aceda Ofedition Tuink
. ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
10/27/36
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October 23/36
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully)
Ingestion of poison. Manner to be determined.
20 If death was due to external causes (VIOLENCE) fill in the following :
Accident,
Suicide or
Homicide ?
Date of injury.
19
Where did injury occur ?
(City or town and State)
Manner of
Injury
Nature of
Injury.
21 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
W J Brickley
M. D.
(Address)
Boston
Dat
.. 10/24/9.36
22 PLACE OF BURIAL
CREMATION OR REMOVAL
No Russell ....... Everett
(City or town)
DATE OF BURIAL
(Cemetery)
Oot .26
19.36
23 NAME OF
UNDERTAKER
1
Stanetsky:
ADDRESS
Boston
Received and filed
19
(Registrar of City or Town where deceased resided)
1
No. Highway, near E. Boston Racest., Track
Ward
(LE U. S.
War Veteran,
specify WAR)
203
.
11 Total time (years)
١
THU
R-302
Middlesex
(County) Tewksbury
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
State Infirmary Tewksbury, Mass.
(City or town making return)
Registered No.
502
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Edward Bakauskas
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Not learned
St.,
Ward,
Winthrop
(If nonresident, give city or town and state)
Length of residence in city or town where death occurred
yrs.
mos.
11
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7 22
AGE
Years 2 Months Days
21
If less than 1 day
Hours
Minutes
OCCUPATION|
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
C.C.C. worker
9 Industry or business in which
work was done, as silk mill,
saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years)
spent in this
occupation
12 BIRTHPLACE (City)
Brockton
(State or country) ass.
13 NAME OF
FATHER
James Bakauskas
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Not learned
(State or country) Lithuania
15 MAIDEN NAME OF MOTHER Olympier (not learned )
16 BIRTHPLACE OF
MOTHER (City)
Not learned
(State or country)
Lithuania
17 Informant (Address)
Hospital Records
A TRUE COPY
ATTEST:
comma XX. Shelley. M.s.
Supt.
(Registrar of city or town where death occurred)
Oct. 24,
DATE FILED
19
36
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct.
23,
1936
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
to ...
Oct. 20
1936
march 12
196
1 last saw him
alive on.
Oct. 23
150
death is said
to have occurred on the date stated above, at : 05
m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
Pulmonary tuberculosis
Not
tnown
Contributory causes of importance not related to principal cause:
Name of operation
None
What test confirmed diagnosis av. Gata
Was there an autopsy?
110
20 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Louis N. Stern
(Address)
State InfirmaryPate ..
10/23/19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Mit. Benedict
Hoston, .. 08
DATE OF BURIAL
Uct. 26.
(Cemetery)
(City or town)
19.3.6
22 NAME OF
UNDERTAKER
J. W. Lavery & Son
ADDRESS
04 A St., South Iston
Received and filed
19
7938
(Registrar of City or Town where deceased resided)
important.
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item or informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
1
PLACE OF DEATH
(City or Town) State Infirmary No.
.St.,
..... Ward
(If U. S.
War Veteran,
specify WAR)
204
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
(Give maiden name of wife in full)
50m-9-'31. No. 3385-p
Date of
-
M. D.
C
I R-302
Middlesex
(County) Tewksbury
(City or Town) State Infirmary No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
State Infirmary Tewksbury, Mass.
(City or town making return)
Registered No
007
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
396 Winthrop
.St.,.
Ward,
Winthrop
(If nonresident, give city or town and state)
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
hito
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
1
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
7
AGE 62
Years 4 Months
17 Days
If less than 1 day Hours
Minutes
OCCUPATIONI
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.
Dye Worker
9 industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at
this occupation (month and
year)
11 Total time (years) spent in this occupation
12 BIRTHPLACE (City)
Providence
(State or country)
13 NAME OF FATHER Thomas Yon
14 BIRTHPLACE OF
FATHER (City)
Not learned
land
15 MAIDEN NAME
OF MOTHER
Mary Spencer
16 BIRTHPLACE OF
MOTHER (City)
Not learned
(State or country) England
17 Informant (Address)
Hospital Records
A TRUE COP amenu XX. Xxellery. M. S.
Supt.
DATE FILED
ATTEST: (Registrar of city or town where death occurred) Nov. 7, 1936. 19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
AU. 31
1936 to Oct. 27
19
36
l last saw h.
.alive on ....
19 ....
death is said
to have occurred on the date stated above, at. 2 ........ 3 The principal cause of death and related causes of importance in order of onset were as follows:
Date ofonset
Contributory causes of importance not related to principal cause:
Name of operation
Date of
What test confirmed diagnosis ?.
Was there an autopsy ?.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
C. winthrop Houghton
M. D.
(Address)
State Infirmary Date 10/209 36
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL
113,
(Cemetery) -a wsfity or town) 19
22 NAME OF
UNDERTAKER
Chapter
General
ADDRESS
Received and filed
1. 1936
19
(Registrar of City or Town where deceased resided)
1.
.St.,
Ward
(L U. S.
War Veteran,
specify WAR)
205
(a)
Residence. No.
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
7
mos.
days.
How long in U. S., if of foreign birth?
JTs.
N. B .- WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD. Every item of informa- OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very tion should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE
PLACE OF DEATH
1
important.
50m-9-'31. No. 3385-₪
(State or country)
PARENTS
(Give maiden name of wife in full)
d
HR-301
SUFFOLK
PLACE OF DEATH
(County)
(City or Town) Station Hospital, Fort Lanis, No.
ayer notified, 11/24/06 The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
206
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
EDT.IN WALTER PHELPS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
`(a) Residence.
No
(Usual place of abode)
Length of residence in city or town where death occurred
yrs.
mos.
days.
How long in U. S., if of foreign birth?
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 IF STILLBORN, enter that fact here.
If less than 1 dagS
Years Months Days
Hours Minutes
8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc ...
9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.
10 Date deceased last worked at this occupation (month and year)
11 Total time (years) spent in this occupation
Winthrop,
Massachucobisa (State or country)
13 NAME OF FATHER EDWIN ILRISAT FHELPS
14 BIRTHPLACE OF FATHER (City)
(State or country)
RUTH JANICE VAIITING
Dangor, Ha ine
17 REGISTRAR: Station Hospital, Fort,
Informant (Address) Barros, Winthrop, Massachusetts
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)
(Official Designation,
(Date of Issue of Permit )
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
October
30)
1930
DEATH
(Month)
(Day)
(Year)
CERTIF YothatIattended deceased from.
odtoho: 50
30
19.
I last saw h
......
alive on
5:4514 death is said
to have occurred on the date stated above, at. m.
The principal cause of death and related causes of importance in order of onset were as follows:
Date of Onset
Prematuro Birth (six months postation)
Contributory causes of importance not related to principal cause:
Name of operation What test confirmed diagnosis?
Date of
Was there an autopsy?
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
Fort
(Address)
Date
21 PLACE OF BURMAI CREMATION OR REMOL
Cemetery
(City or town)
DATE OF BURI
19
22 NAME OF UNDERTAKER
SSVW
CA!
ADDRESS
MY 9E6FC ZAON
VO WMO.1/ 30
CLERK
Received and filed
19
A TRUE COPY, ATTEST:
(Registrar)
100m-12-'32. No. 7070-h
2 FULL NAME 1 3 SEX male (or) WIFE of 7 AGE OCCUPATION 15 MAIDEN NAME OF MOTHER 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 12 BIRTHPLACE (City)
N. B .- WRITE PLAINLY, WITH UNFADING DLACA
Draout
Massachusetts.
OFFIC
0ct 30: M38 19
LNIM va
If U. S.
War Veteran,
specify WAR)
.St., ..
.............
.Ward,
(If nonresident, give city or town and state)
1
St.,
........ Ward
Revised United States Standard Certificate of Death
Statement of occupation .- Precise statement of occupation is very important, 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 occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. 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 in answer to Question 8 and own home in answer to Question 9. 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 what- ever write none.
To be complete, an occupation return must state:
8 .- The trade, profession, or particular kind of work done.
9 .- The industry or business in which the work was done.
10 .- The month and year the deceased last worked at the occupation.
11 .- The number of years the deceased followed the occupation.
In stating the occupation, avoid the use of such indefinite terms as "employee, " "worker. " "operative," etc. Find out the parti- cular kind of work done and return that, as spinner. weaver, etc.
In stating the industry or business, avoid the use of such general terms as store, " "factory, " "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.
Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter. painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.
Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.
Example
The principal cause of death and related causes of importance in order of onset were as follows:
Date of onset
Arteriosclerosis
1955
Chronic interstitial nephritis
1021
Cerebral hemorrhage
July 5, 1027
Contributory causes of importance not related to principal cause:
In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forth- with, 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 death, 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.
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 satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, 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 common- wealth 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 re- moval; 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 re- quired 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 registration. 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., as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931.
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