USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 20
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100m-10-'39. No. 8427-e
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual 9 Occupation:
1 (or) WIFE of 8 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 Industry 10 or Business:
2 FULL NAME
armie Heichman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
......
6 Age of husband or wife if alive 7 IF STILLBORN, enter that iact here.
AGE 70 Years Months. .Days
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 helief the name of the deceased, his supposed age, the disease of which he died, defined as required hy 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, Scc. 9.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not heen huried, until he has received a permit 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 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 hoard of health or its agent aforesaid or from the clerk of the town where the hody is huricd. No such permit shall be issued until there shall have heen de- livered to such hoard, agent or clerk, as the case may he, a satisfac- tory written statement containing the facts required hy law to he returned and recorded, which shall he 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 certificate cannot he obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed hy it or hy the selectmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy violence, the medical exam- iner shall make such certificate. If such a permit for the removal of a human hody, 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 hody 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 hody 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 heen 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 ohtained 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 hody or the ashes thereof which have been hrought 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 he hurled or the funeral is to he held, or from a person appointed to have the care of the cemetery or hurial 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 hedside 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 disahled hy recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy traumatism (including resulting septice- mia), and hy 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 heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husi- ness, report the usual occupation prior to retirement. Children not gainfully employed may he 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 Aji
PLACE OF DEATH
Suffolk
(County)
(City or Town)
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.
59
Registered No (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Martha Hamlin (DeMond) Shorey
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay : In hospital or institution ...
17 Tewksbury
St.
........
years
months
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Thite
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
Or DIVORCED
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Charles Eldon Sumner Shorey
(Husband's name in full)
6 Age of husband or wife if alive. .years
7 IF STILLBORN, enter that fact here.
8
AGE.8.5.
.Yecrs
Months
2.Days
If less than I day
Hours.
Minutes
Usual
9 Occupation:
At home
(State or country)
massachusetts
13 NAME OF
FATHER
Anthony De Mond
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Unknown
15 MAIDEN NAME
OF MOTHER
Sabra Hamlin
Unknown
Relation, if any
son
Informant .
Ralph. V. Shorey.
(Address) 12 Cottage ave Winthrop
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 of other))
3/28/40
Health Officer (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
march 26
(Month)
(Day)
19 I HEREBY CERTIFY.
That I attended deceased from
april 17
1939, to March 26, 1940
I last saw ben alive on march 26, 1940, death is said
to have occurred on the date stated above, at.
7.10p.m.
Immediate cause of death
generalized arteno selemais
Duration IMPORTANT 1930
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 ?
Clinical
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury in any way related to occopation of deceased? no
Sudie de Dickinson
M. D.
(Address)
21
Winthrop Cemetery Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL ..
March
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed
APR 1 1940
19
(Registrar)
100m-10-'39. No. 8427-e
BYTY IMMANENT ALLUND. Every item of
1 winthrop 3 SEX Female 11 Social Security No ... 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) 17 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 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 Industry 10 or Business: none
No 17 Tewksbury
St. 1
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If nonresident, give city or town and state)
In this community 6 Oyrs.
mos.
days.
1940
(Year)
12 BIRTHPLACE (City)
Boston
If so, specify ..............
(Signed)
00 milisop Mas Date mar 28 1940
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical offiear 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 secn 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 buricd, 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 hoard. 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 de- livcred to such board, agent or clerk, as the case may be, a satisfao- tory 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 physiclan, if any, as required by law, or in lieu thereof a certincate 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 pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused by violence, the medical 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 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 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 ohtaincd 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 shal! thereafter fur- nish 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., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thercof which have been brought into the commonwealth until 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, Seo. 46. G. L., (Tereenteuary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Altending physicians will certify to such deaths only as these 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 Iloalth 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 dicd without recent medleal 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 ahortion, but also deaths from disease resulting from injury or infacilon 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, c. g., heart fallure, asphyxia, asthenia, etc. As principal cause namc the disease causing death. As related causes, name earlier morbid 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 discase causing death, report the usual occupation prior to lliness. If the deceased had retired from busl- ness, report the usual oceupation prior to retirement. Children not galnfully employed may be returned as at school or at home. For a woman whose only oceupatlon 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 howsekceper-private family. cook-hotel, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 AJ
PLACE OF DEATH
(County)
(City or Town)
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.
Registered No
(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) Length of stay: In hospital or institution ...
(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE | 5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) uran
HUSBAND of
id Arrived . Sim Rean (Give maiden name of wife in full) Created
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here ..
8 68 Years X Months.
If less than 1 day
.. Days
Hours.
Minutes
Usual 9 Occupation:
Returd Printer
Industry 10 or Business: ....
II Social Security No.
Lamedead Leçons Head
12 BIRTHPLACE (City) (State or country) Norra Jeda
13 NAME OF FATHER James Hewitt
14 BIRTHPLACE OF FATHER (City)
(State or country) nova Scotia
15 MAIDEN NAME OF MOTHER Ellenon . Macmillan
16 BIRTHPLACE OF MOTHER (City) (State or country)
Hugh Meldensie Awa Relation, if any
17 Informan ... 15 cura 8h Winichop mas
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE De burigy or transit permit was issued: Nau. S. Childress (Signature øy Agent of Board of Health fr ader) Health Officer 3/ 30/ 40 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from
last saw himlive onf.
19 .... XDdeath is said to have occurred on the date stated above, nt 8,20Pm. Immediate cause of death .........
Duration IMPORTANT
5 MM
5 M/s
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings : Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deceased?
If so, specify.
(Signed)
+Wilson Date 5/30 1946
(Address).
21 Winter of Man
(City or Town)
Place of Burial, Cremationfor, Rodove
DATE OF BURIAL
13/31 1940 Whichis)
719
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
mas
Received and filed. 19
(Registrar)
100m-10-'39. No. 8427-e
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 is very important. See instructions and extracts from the laws on back of certificate.
1
15@nast No ......
Hugh. Macmillan Hewitt
St.
2 FULL NAME
deceased is a married, widowed or divorced woman, give also maiden name.) # 15- Cara St Withes
(If nonresident, give city or town and state)
18 DATE OF
march 29
1940
193 5 ...... ,
19
.years
AGE
Due to antena siluri
. M. D.
PARENTS
HEIN IN A IEMMANENT REVUND. Every Item of
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 anthorized person or of any member of the family of the deceased, furnish for regls- 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 onc. where same was contraetcd, the duration of his last illness, when last seen alive hy the physician or officer and the date of his death ... Gen. Lates, 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 pe:mlt 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 person died; and no undertaker or other person shall exhumc a human body and remove It from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomh 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 huried. No such permit shall be Issued until there shall have been de- livered to such hoard, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required hy law to be returned and recorded, which shall be accompanled, In case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lleu thereof a certificate as hercinafter 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 hy 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 medical exam- iner shall make such certificate. If such a permit for the removal of human body, not previously Interred, from one town to another within the commonwealth 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 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 anch hody has been sooner obtained hereunder. If the death certificate contains a recital, as required by sectlon 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- nlsh 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, Soc. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thercof which have been brought Into the commonwealth untlì he has received a permit so to do from the board of health or Its agent appointed to issue auch 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 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 these of persons to whom they have given bedside care during a fast 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 hy recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy traumatism (including resulting septice- mia), and by the actlon 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 endden 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 cansing death. As related causes, name earlier morhld con= ditions, if any, related to the principal cause and any important complication of the principal cause.
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