USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 24
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St.
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
Harriet (Brown) Confrau
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Queensbury
.....
.....
St.
(If nonresident, give city or town and state)
months
28
days.
In this community
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
hite
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
idowed
Sa If married, widowed, or divorced
HUSBAND of
(Give maiden name, of wife in full)
George Hallett Godfrey
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
.years
8
69
Years
7
Months.
3
Days
If less than 1 day
Hours.
Minutes
Usual
House work
9 Occupation:
10 or Business:
Own home
Il Social Security No.
12 BIRTHPLACE (City)
Eastport
(State or country)
aine
13 NAME OF
FATHER
jarren Brown
14 BIRTHPLACE OF
Lastport
FATHER (City)
(State or country)
ITaine
15 MAIDEN NAME
OF MOTHER
Harriet Molleil
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Laine
17 Ladolin Godfrey
Relation, if any daughter
Informant. (Address)
19 queensbury St Boston Tags
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Childrenfix. (Signature of /Agent of Board of Hearth Jor other) Health Officer 4/17/40
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
1
(Month)
(Day)
40
(Year)
19 I HEREBY CERTIFY. 2/11
19.40, to.
4-15
1940
I last saw h .... 1 ... alive on
4-16
10.4 ... 9, death is said
to have occurred on the date stated above, at ......
Duration
Immediate cause of death .. I enterre Lymph a deuses
IMPORTANT
Due to
Due to general arterio Silenzio ?
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
PHYSICIAN Underline Date of .... the cause to which death should be charged sta- What test confirmed diagnosis@ ................. Braga None Te htistically.
20 Was disease or Injury In any way related to occupation of deceased?
(Signed)
If so, specify
Haure aFeel
,
M. D.
(Address)
21
Hillside Cemetery Jastport Fe.
Place of Burial, Cremation or Removal.
DATE OF BURIAL ...... DT11
1 9%y or Town)
19
22 NAME OF
FUNERAL DIRECTOR
Charles ?. Bennison
ADDRESS
inthron wass
19
(Registrar)
AGE should be stated EXACTLY. PHYSICIANS should state
information should be carefully supplied.
1 AGE - 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
100m-10-'39. No. 8427-e
PLACE OF DEATH
No.
(If U. S.
War Veteran,
specify WAR)
Boston Mass
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ...... hospital
years
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
MEDICAL CERTIFICATE OF DEATH
15
That I attended deceased from
Of autopsy
Eastport
Date ...
4/16
1940
Received and filod.
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 belicf the name of the deceased, his supposed age, the discase of which he died, defined as required by section one, where same was contracted, the duration of bis 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 hury or otherwise dispose of a hunan 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 cxhume 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 buried. No such permit shall be issued until there shall have been de- Ilvered to such board, agent or clerk, as the case inay be, a satisfac- tory written statement containing the facts required hy 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 eannot 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, shail 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 obtained hereunder. If the death certificate contains a reeital, 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 counteraign It and transmit it to the clerk of the town for registration. The person to whom the permit is so glven and the physician eertifying the cause of death shall thereafter for- nish for registration any other necessary information which can be obtained as to the deceased. or as to the manner or eause of the death, which the clerk or registrar may require .- Chap. 114, Ses. 45. G. I .. , (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 hurled or the funeral is to be held, or from a person appointed to have the care of the ceinctery 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 eertify 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 llealth 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 suppomably 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 clectrical 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 Causo of Death .- Cause of death means the disease, or complication wbich causes death, not the mode of dying, s. o .. heart failure, asphyxia, asthenia, etc. As prineipal cause name 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 eause.
Statement of Occupation .- Precise statement of occupation la 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 buni- 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 domestie service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, oooh-hotel, ete. For a person who had no oceupation whatever write nons.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
CAUSE OF DEATH in plain terms, so that it may be properly classified. is very important. See instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
Suffolk
(County)
1
Tinthrop
(City or Town)
No 54 Highland Ave
The Commonwealth of Mussarhusetta 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
ยง (If death occurred In a hospital or institution, St. { give its NAME instead of street and number) - (If U. S. War Veteran. specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
91 Marshall St.
St
(If nonresident, give city or town and state)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
rried
5a If married, widowed, or divorced L'alto Buckley
HUSBAND of ..........
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
68
6 Age of husband or wife if alive .. ... years
7 IF STILLBORN, enter that fact here.
AGE
8 74 Years Months ... Days
If less than 1 day
.Hours
.. Minutes
Due to.
Usual
9 Occupation :
Industry
10 or Business:
11 Social Security No ... C
12 BIRTHPLACE (City)
(State or country)
Ttolv
13 NAME OF
FATHER
Joseph Placco
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ital-
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Cannot be learned
17 Irs, William Ike ( daughter
(Address) 97 Revere St Tinthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: UNMED. Meldelser (Signature of Agent of Board of Health or other)"
Healthe Officer 4/17/40
(Date of Issue of Permit) :
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
april
16
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY That I attended deceased from
7.29 1939, to april 16 19 410 I last saw hame alive on april 15, 1940 death is said to have occurred on the date stated above, at ... 8.35 a. m.
Immediate cause of death ... Broncho pneumonia
Duration IMPORTANT 11 days
IMPORTANT PHYSICIAN
Major findings:
Of operations ...
none
Date of.
Of autopsy.
none
What test confirmed diagnosis ?.
Clinical
20 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed) ..
(Address)
Date ...... 4/16 M. D. 1940
21 Pintaron inc ... 'Op
Place of Burial, Cremation or Removal. April 19
(City_or Town)
1940
............ 19
DATE OF BURIAL.
22 NAME OF FUNERAL DIRECTOR ... ADDRESS Whether
John F., O Maxey
Received and filed.
.19
(Official Designation)
(Registrar)
100m-2-40-D-729-a
Relation, if any
Informant ..
(Retire)
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Underline the cause to which death should be charged sta- tistically.
2 FULL NAME
Joseph Placco
(a) Residence. No ..
(Usual place of abode)
Length of stay: in hospital or institution.
years
months
days.
In this community to yra. mos. days.
Exact statement of OCCUPATION
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 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, definded 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 dicd; 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 receiv- ing 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 satisfactory 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 in- sufficient, a physician who is a member of the board of health, or em- ployed 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 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 re- moval 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 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., (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 observance 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 septicemia), 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 dlsease, 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, naine earlier morbid conditions, 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 business, 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
R-301 A Suffolk ""County) Winthrop
No. 64 Orlando
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD
CERTIFICATE OF DEATH avenue
To be filed for burial permit with Board of Health or its Agent.
Registered No. 120
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
none
(If deceased is a married, widowed or divorced woman, give also maiden name.) 6 4 orlando avenue se
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or institution ..
(Specify whether)
years
months
days.
In this community
6 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
Sa If married, widowed, or divorced Julia t. Washfrun. HUSBAND of
(Give melden name of wife in full)
(Husband's name in full)
Years
If less than 1 day
Hours
Minutes
12 BIRTHPLACE (City)
(State or country)
maine
13 NAME OF
FATHER
Benjamin F Waite
14 BIRTHPLACE OF
FATHER (City)
Huffandstone
(State or country)
mass.
15 MAIDEN NAME
OF MOTHER
Hannah Todd
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
maine.
17 mis Grace W. Jenings Relation, if any
64 Orlando Bir. mintha
I HEREBY CERTIFY that a sansfactory standard certificate of death was Eled with me BEFORE the burial of tymasit permit was issued: Chuldress
Signature of Agent of Board team) or other) Nealthe Officer 4/16/40
(Official Designation) (Date of Issue of Perfait)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
(Day)
(Year)
(Month)
DEATH
april
16
1440
19
J HEREBY CERTIFY. That I attended deceased from
april
12
19.20 .. , to .......
1L
19.Y .
...
Wlast saw h .. W ....... alive on ......
15, 1940, death is said
to have occurred on the date stated above, at .!......... A.
... m.
Immediate cause of death ...
Duration IMPORTANT
Due to
Chemin Lago candenti
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
Of autopsy
200
What test confirmed diagnosis ?!
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or lajury in acy way reisted ta occupatioc of deceased? If so, specify
M. D.
Datataal 16 19 40
(Address) Writing In
21 Forest Hills
Boston, main
(City of Town)
20
40
19
Place of Buriel, Cremation or Remera !!
DATE OF BURIAL
april
J. S. Waterman+ Sono;
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Boston, mais.
Received and Eled 19
(Registrar)
100m-10-'39. No. 8427-e
1 3 SEX m. 8 Usual AGE should be stated EXACTLY. PHYSICIANS should state (or) WIFE of
information should be carefully supplied.
(City or Town)
4 COLOR OR RACE
6 Age of husband or wife if alive
7 IF STILLBORN, erter that fact here.
AGE
91
Years
Months
6 Days
Broker
9 Occupation:
10 or Business:
11 Social Security No.
none
Calais
PARENTS
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
Industry
Real Estate.
is very important. See instructions and extracts from the laws on back of certificate.
1
w
.St.
2 FULL NAME
Horace
waite
(If nonresident, give city or town and state)
PLACE OF DEATH
Eastport,
(Signed).
QB Paka
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 hc 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 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 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 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 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 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 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.)
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