USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 22
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... St.
Take thatth, Cassidy Eastman
(If deceased is a married, widowed or divorged woman, give also maiden name.) 180 (Cottage Tack Rd
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution aapitar
years
months
V
days.
In this community /4 yrs. 4
mos. ( days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
7
(Month)
(Day)
1940.
(Year)
19 I HEREBY CERTIFY October 14. 19.2.7 .... april 7 19.
That I attended deceased from
40
I last saw het alive on. april 6, 1040, death is said
to have occurred on the date stated above, at. 1:100 m. Immediate cause of death, Cerebral Hemostige
Duration IMPORTANT 4/5/40
1939 1939 1939
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to tccopatlod of deceased?
lf so, specify !!
J. D.
(Signed) ...
(Address) 562 Fluidey Date
21 Place of Burial, Cremation or Removal. DATE OF BURIAL Wordtum Sity Or Fax) /9/ 1940
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and filed 19
(Registrar)
1
(City or Town)
No ..
2 FULL NAME
(Specjis whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
termal
MARRIED
WIDOWED
or DIVORCED
(Give maiden nande of wife in full)
(or) WIFE of
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
92%
Years
4
AGE
Months.
29 Days
Usual
9 Occupation:
Industry
-
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Retand
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
Biddeford
MOTHER (City)
(State or country)
17
M. Florence Cassidy
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. See instructions and extracts from the laws on back of certificate.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
100m-10-'39. No. 8427-e
N. D .- WRITE ILATTEI, WITIT ONI AVINO WHAVE THIS TITI WU A TEAMANENI RECORD. Every item of
13 NAME OF
FATHER
Thomas Cassidy
5 SINGLE
(write the word)
Widow
5a If married, widowed, or divorced
HUSBAND of
Rw. Cyrus. Lemail. lastman
(Husband's name in full)
years
If less than 1 day
Hours.
Minutes
Pask Borth
Informant
(Address)
180 Collage Park Rd VinTherit
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ima lechildress (Signature of Agent of Board of Health, or other)
14.8 april 8/40 (Date of Issue of Permit)
Relation, if any
Kizue . )
(Official Designation)
Due to
Arteriosclerosis
Lenilito
Due to
consective treatfacture
Other conditions zone (Include pregnancy within 3 months of death)
Major findings :
Of operations
none
Of autopsy
nor dine
What test confirmed diagnosis? Clinical x
.Date of ........
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran. specify WAR)
St.
(If nonresident, give city or town and state)
PLACE OF DEATH
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical ofacer 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 famlly of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of hls knowledge and belief the name of the deceased, hls supposed age, the disease of which he died, defined as required by section one, where same was contraeted, 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, See. 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 hoard of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permlt shall be issued until there shall have heen de- livered to such board, agent or elerk, 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, by a satisfactory certificate of the attending physician, if any, as required by law, or In lieu thercof a certificate as hereinafter provided. If there is no attending physielan, or If, for sufficient reasons, his certificate cannot be obtained carly 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 selcetmen 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 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 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 appcar 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 physiclan certifying the cause of death shall thereafter fur- alsh for registration any other necessary Information which can be ohtained as to the deceased, or as to the manner or cause of the death, which the elerk or registrar may require .- Chap. 114, Sse. 45, G. L., (Tercentenary Edition.)
No undertaker or other person shall bury a human body 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 be burled or the funeral Is to he held, or from a person appointed to have the care of the cemetery or burlal ground in which the Interment is made .... Chap. 114, Sec. 46, G. L., (Tarcentenary 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 last fil- ness from disease nnrelated 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 physiclan is absent from home when the certificate of death Is needed.
(3) Medieal 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 septlce- mia), and by the action of chemical (drugs or polsons), thermal, or electrical agents, and deaths following abortlon, 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 Canso of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, c. v., heart fallurc, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbld con- ditions, if any, related to the principal eause 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 deccased had retired from busl- ness, report the usual occupation prior to retirement. Children not galnfully 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, sooke-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A|
PLACE OF DEATH
....
Suffolk (County)
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)
2 FULL NAME
Mary ( Sinnicks)
Jones
(If deceased is a married, widowed or divorced woman, give also maiden name.)
55
Washington Ave.
St.
(If nonresident, give city or town and state)
years
months
days.
In this community
9 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
(Give maiden name of wife in full)
(Husband's name in full)
years
If less than I day
Hours.
Minutes
(State or country)
Canada
(State or country)
Canada
Relation, if any
Informant
Mary R Goodwin
1.
Daughter
(Address)
I Winthrop Place Beverly
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with the BEFCHE the burial or transit permit was issued: W.m. D. Guildrelax (Signature of Agony of Board of Healey of other) Health Office 4/12/40
(Official Designation) (Date of Issue of /Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April
10
1940
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
2.6
19.3.4, to Anie 10
19. Y O
I last saw h ........... alive on ....
9
1940
death is said
to have occurred on the date stated above, at. ?..
.A
.. m.
Immediate cause of death.
Duration IMPORTANT
6 years.
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
(State or country)
Canada
13 NAME OF
FATHER
Samuel Sinnicks
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis? Cheten
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury lo any way related to occupation of deceased?
If so, specify
(Signe
(Address) Winter Man
Da Chil 11 1940
Beverly.
M. D.
21
entral Cemetery
Place of Burial, Cremation or Rethoyal.
(City or Town)
19.40
DATE OF BURIAL.
April
I3
22 NAME OF
Howard S Punoles
FUNERAL DIRECTOR
ADDRESS
Winthrop meus.
Received and filed.
19 ......
(Registrar)
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ...
(Specify whether)
1
Winthrop
(City or Town)
3 SEX
4 COLOR OR RACE
Female
White
5c: If married, widowed, or divorced
HUSBAND of
(or) WIFE of
William K Jones
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE .86
Yours .. 5.
Months27
Days
Usual
9 Occupation:
Housewife
Industry
10 or Business:
Own Home
II Social Security No.
12 BIRTHPLACE (City)
Labrador
14 BIRTHPLACE OF
FATHER (City)
Labrador
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Labrador
17
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
is very important. Sec instructions and extracts from the laws on back of certificate.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
100m-10-'39. No. 8427-e
N. D .- WRTIL PLAINLY, WEIT UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
15 MAIDEN NAME
OF MOTHER
Almira Keats
No. 55 Washington Ave.
St. ¿
Date 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 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 eontracted, 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 elerk 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 faets required by law to be returned and recorded, which shall be accompanied, in ease 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 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- iner shall make sueh 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 shali 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 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 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 thereof 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, 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- mia), 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 relaled to occupa- tion, the sadden deaths of persons not disabied 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 prineipal cause name the disease causing death. As related eauses, name earlier morbid con- ditions, if any, related to the principal cause and any important complieation 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 seetion 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- nesa, report the usual oceupation 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, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffol (County)
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)
2 FULL NAME
Frank Allen Thomas
(If deccased is a married, widowed or divorced woman, give also maiden name.)
80 Hermon St
........................... St.
months
days.
In this community 40
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
Years
If less than 1 day
Hours.
Minutes
(State or country) canada
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of/tra; sit permit was issued: Wm. D. Children (Signature of Agent of Board of Health of other) Health Offices 4/11/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
4
Month)
10
(Day)
(Year)
19 | HEREBY CERTIFY.
41.
19.3 ... , to
That I attended deceased from
19.4-0.
...
I last saw h ... ....... alive on ...
110
194.
death is said
to have occurred on the date stated above, at ..
........... m.
Duration
IMPORTANT
Immediate cause of death.
7 ....
Stomach
1gr
Due to
Due to
Other conditions Gen. Culino Selever (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 disoase or Injury in any way related to occupation of deceased?
If so, specify
(Signed)
Hume
/. .. M. D.
(Address) Vrathing
21 Winthrop Place of Burial, Cremation or Removal. DATE OF BURIAL
Winthrop
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
for !! finOmaley
Winthrop
.........
Received and filed.
19
(Registrar)
....
Date 4/19 940
Relation, if any Son
Wirwur
St. {
(If U. S. War Vetoran, specify WAR)
(If nonresident, give city or town and state)
years
Winthrop
(City or Town)
No. 86 Hormon St
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
3 SEX
4 COLOR OR RACE
Male
Thite
(or) WIFE of
57
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE 7.O.
Years
Months
Days
10 or Business:
Electrical!
1I Social Security No.
12 BIRTHPLACE (City)
Montreal
13 NAME OF
FATHER
PhillipThomas
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Elizabeth Holly
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Canada
17
Informant
John Thomas
(Address)
86 Hermon St
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
Usual
9 Occupation:
Electrforan
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
(write the word)
40
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 dcatb, 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 scen 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 cxbume 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 case of an original interment, by a satisfactory certificate of tbe 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 cnough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the sclectmen 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 inake 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 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 be obtaincd 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.)
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