USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 19
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SPACE FOR ADDITIONAL INFORMATION
a
R-305
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
25m-10-'39. No. 8427-g
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Jennie Wapner
16 BIRTHPLACE OF
MOTHER (City)
New York
(State or country) N.Y.
17 Records-Nonson State Hospital
Informant.
(Address)
Palmen Massachusetts
A TRUE COPY.
Carlos N. Ball
ATTEST:
Carlos H. Ball
(Registrar of city or town where death occurred)
DATE FILED
March 18,
19
40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
March 19, 1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named sad that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
fractured skull as result of fall.
,
20 Accident, suicide, or homicide (specify) ... accident
Date of occurrence.
March 18, 1940
19
Where did
Injury occur ?.
Conson, Mass.
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
public place?
onson state Hospital
(Specify type of place)
Injury
Manner of Found unconcious on floor
Nature of
fractured skull of room
Injury
While at work ?
no
. Was there an autopsy ?
yes
21 Was disease or lajury In any way related to occupation of deceased ?
If so, specify
(Signed)
Thomas H. Keeley
M. D.
(Address).
Monson, Masi.
Date
3/199 40
2. Independence Pride of Boston, NOBUR.
Place of Burial, Cremation or Removal,
March 30,
DATE OF BURIAL
19
23 NAME OF
FUNERAL DIRECTOR
B. Schloscher
ADDRESS
1272 Blue Hill Avenue,
Received and filed.
March 18,
Mattapan
19
40
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME
Jacob Goldberg
(If deceased is a married, widowed or divorced woman, give also raaiden name.)
45 Sea Foam Avenue
.St.
WINTHROP Mass.
(If nonresident, give city or town and state)
Hospital
1 years
3 months 6 days.
In this community Lyrs. 3
mos. 6
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
white
single
5a If married, widowod, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
.Years
6 Age of husband or wife if alive 7 IF STILLBORN, enter that fact here.
AGE
8
32
Years
6
Months.2.4 .. Days
If less than 1 day .Hours. Minutes
Usual
9 Occupation:
none
Industry 10 or Business:
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Boston
PLACE OF DEATH
HAMP DEN
(County)
(City or Town)
No. Nonson -tate Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
(City or town making return)
Registered No ...
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ....
MONSON
Relation, if any
(City er Town) 40
,
(Registrar of City or Town where deceased resided)
13 NAME OF
FATHER
Laurice Goldberg
DECEIVE
TOWA
F
5
3
6
RO
APR-21940 PMf1
IR-301 Al
PLACE OF DEATH
Suffoly Winthrop (City or Town) Wetter No ........
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
@
STANDARD CERTIFICATE OF DEATH ty Hospitali
To be filed for burial permit with Board of Health or its Agent.
Registered No. 56
If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
Winthrop, la
(If nonresident, give city of town and state)
In this community 1 yrs. 6 mos. 21 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Tuale
4 COLOR OR RACE
1
5 SINGLE
MANTIED
WIDOWED
or DIVORCED
(write the word) Mamed
Sa If married, widowed on divorcedu train HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
If less than 1 day
Hours
Minutes
11 Social Security No ..
031-10-6015
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
abraham Block
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Pussig
15 MAIDEN NAME
OF MOTHER
Parola Carotte
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Idaly Block
Relation, if any wym)
Informant (Address) 41- Och
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with mo BEFORE the burial of transit permit was issued: Www. X. Children (Signature of Agent of Board of "ferth kr other) Alalite Officer (Official Designation)
3/22/40
(Date of Issue of Fermit)
18 DATE OF
DEATH
march
21
1840
(Month)
(Day)
(Year)
19 J HEREBY CERTIFY, That I attended deceased from 7 et 27, 1940, to March 21 19 40 I last saw by som alive on Inekof 2/ ... 19.40, death is said to have occurred on the date stated above, at. Duration 10.35 P. m. Immediate cause of death .. Lotar pneumonia ...
IMPORTANT 1940
(Type ITT)
Due to
Due to
Other conditions
cerebral embolism.
2 m/s. ....
(Include pregnancy within 3 inonths of death)
Major findings : Of operations
Date of
Of autopsy
..
What test confirmed diagnosis ?.
Lar.
20 Was disease or injury by any way related to occupation of Deceased?
If so, specify ... Frank Handle
Renie Mans
Date 3/22 . M. D. 19 40
(City of Town)
DATE OF BURIAL 190 70
22 NAME OF FUNERAL DIRECTOR Manuel
ADDRESS
10-Was
Received and fled.
19
.
2 FULL NAME
V
Block
(If deceased is a married widowed or divorced woman, gove also maiden name.)
...
- Odean
Que. St.
(a) Residence. No ...
(Usual place of abode)
Length of stay : In hospital or institution ...
(Specify whether)
years
months
21 days.
1 (or) WIFE of 8 Usual 9 Occupation: PARENTS 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 carerany supplied. HUL should be stated LAACILY. PHYSICIANS should state Industry 10 or Business:
100m-10-'39. No. 8427-6
(Registrat)
1
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
21
(Signed) (Address) Winthrop len. Place of Burial, Cremation ar Removal.
72623-30
AGE
68 Years.
Months.
.Days
white
63 years
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, 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 regis- tration a standard certificate of death, stating to the hest 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 hy 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 hody 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 hody 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 hoard of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issucd until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required hy law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificatc 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 pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the nicdical exam- iner 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 commonwealth cannot he 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 removal ; provided, that such body shall he 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 ohtained hereunder. If the death certificate contains a recital. as required 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 fur- nish for registration any other necessary information which can he 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., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought Into the commonwealth until he has received a permit so to do from the hoard 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 body Is to be burled or the funeral is to be held, or from a person appointed to have the carc of the cemetery or burial ground in which the Interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance 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 ill- ness 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 un- related 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 septice- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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 morhid con- ditions, if any, related to the principal cause and any important complication of the principal cause.
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 usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual 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. 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.
SPACE FOR ADDITIONAL INFORMATION
1 R-301 Al
SUFFOLIS
(County)
PLACE OF DEATH
40 WASHINGTON AVE
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. 57
Registered No.
St.
1
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
LESTER ADAMS TOMPKINS
(If deceased is a married, widowed or divorced woman, give also maiden name.)
40 WASHINGTON AVE
........
St.
(If nonresident, give city or town and state)
In this community 30 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
WIDOWED
HUSBAND of
igned RiduNeed GUNDERSEN
(Give maiden name of wife in full)
(Husband's name in full)
years!
If less than 1 day
Hours
Minutes
12 BIRTHPLACE (City)
(State or country)
NEW YORK
13 NAME OF
FATHER
Unable to oblaripping
(State or country)
NEW YORK
15 MAIDEN NAME
OF MOTHER
Unableto obtain
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
NEW YORK
Relation, if any
17 Informant HELEN TONIPKINS (daughter) (Address) YO WASHINGTON AVE WIN
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or bansit/permit was issued:
Guldrey f
(Signature of Ment of Board of Health ( th)
Le althe Officer 3/25/40
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
march
22
(Month)
(Day)
(Year)
19LHE! 5
HEREBY CERTIFY.
That I attended deceased from
March 22
40
193 8
to ..
19.
I last saw him alive on.
march 21
. 1920
death is said
to have occurred on the date stated above, at.
Immediate cause of death ........
Culminar Interculosis
Duration IMPORTANT 1939
Due to
Liga Tuberculose
1935
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
1935 Remme I Left Texte
Of operations
showed The. Zin
Date of.
1935
PHYSICIAN Underline the cause to which death should be
Of autopsy
Innoculation of
tistically.
charged sta-
What test confirmed diagnosis? You 1937.
20 Was discasa er Injery In any way related to occupation of decaased?
If so, specify.
(Signed)
(Address)
21
WINTHROP
WINTHROP
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
MARCH
25
19 ..... 0
22 NAME OF
olu F. O'malley
.........
FUNERAL DIRECTOR
ADDRESS
Recoived and filed
19
(Registrar)
....
M. D.
Date.
3/22
1940
.....
100m-10-'39. No. 8427-e
1
WINTHROP
(City or Town)
No ..
3 SEX
MALE
4 COLOR OR RACE
WHITE
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
Usual
9 Occupation:
PRINTER
10 or Business:
Il Social Security No.
None
14 BIRTHPLACE OF
FATHER (City)
PARENTS
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
Industry
PRINTING
years
months
days.
3
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay : In hospital or institution ...
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
9761
8.40 P
.. m.
AGE
67 Years
Months.
Days
POUGHKEEPSIE
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, 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 regis- tration 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 sueh board, from the elerk 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 de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in ease of an original interment, by a satisfactory eertifieate 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 seleetmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violenee. the medical exam- incr shall make such certificate. If such a permit for the removal of a liuman body. not previously interred. from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certifieate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; 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 required 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 eountersign it and transmit it to the elerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be obtained as to the dceeased, or as to the manner or eause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth untll he has received a permit so to do 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 body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46. G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance 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 ill- ness 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 un- related to any form of injury, have died without recent medical attendanee 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 septice- mla), 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
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, ete. As principal cause name the disease causing death. As related eauses. name earlier morbid con- ditions, if any, related to the principal cause and any important complication of the principal eause.
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 usual occupation prior to illness. If the deceased had retired from busi- ness, report the usual 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. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekecper-private family. cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 Al
PLACE OF DEATH
Suffolk (Count}) Winthrop (City or Town)
No. 36- Cutter
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health 58 or its Agent Registered No
St.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
36- Cutter
........
.St.
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ...
(Specify whether)
years
months
days.
In this community 2 Cyrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
2. SEX
Hierwalk
white
4 COLOR OR RACE |
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) widow
5a If married, widowed, or divorced HUSBAND of
Jos
(Give maiden name of wife in full)
ph H. Herchwas
(Husband's name in full)
yoars
Ii less than 1 day
Hours Minutos
14
works
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Austria
13 NAME OF
FATHER
abraham Turner
14 BIRTHPLACE OF FATHER (City) (State or country)
Questura
15 MAIDEN NAME OF MOTHER Cannot be learned
16 BIRTHPLACE OF MOTHER (City) (State or country)
17 Reo Deichman"
Relation, if any 21
Informant
(Address)
36-tutte FF
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Usu D. Childrenig (Signature of Agent of Board of Health or other)
Health Officer 3/ 25/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
march
24
(Month)
(Day)
1940 (Ycar)
19 I HEREBY CERTIFY. That I attended deceased from
19.YO to March24 19 50 to have occurred on the date stated above, at ... 90 .. m.
I last saw h .. La alive on. 19.Y, death is said
Immediate cause of death. circbral hemorrhage
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
.Date of.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury in any way related to occupation of deceased?
Ii so, specify ...
(Signed)
(Address) 108 Mendien ST 23 Dato 3 KW5
, M. D,
1940 Witterop they. Every la Place of Burial, Cremation or Removal. DATE OF BURIAL. dar
(City, or Town)
2.5
1940
22 NAME OF FUNERAL DIRECTOR
Manuel Stanitaly
ADDRESS
10-
West
Received and filed.
(Registrar)
1
Duration IMPORTANT
3/21/40 ....
/2/
PHYSICIAN Underline the canse to which death should be charged sta- tistically.
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