USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 31
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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 anotber, 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 tbe clerk of the town where the body is buried. No such permit shall be issued until tbere shall have been delivered to sucb 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, bis 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 tbe certificate required of the attending physician. If death is caused by violence, tbe 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 witbin the commonwealth cannot be obtained early enough for the purpose, the certificate of deatb made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for sucb removal; provided, that sucb body sball 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 bereunder. 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 tbe United States in any war in which it has been engaged, such recital sball appear upon tbe permit. The board of health, or its agent, upon receipt of sucb statement and certificate, shall forthwith countersign it and transmit it to tbe clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death sball thereafter furnisb for registration any otber necessary information which can be obtained as to tbe deceased, or as to the manner or cause of tbe deatb, which tbe clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
SPACE FOR ADDITIONAL INFORMATION
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until be 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 beld, 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 qf the purpose of these laws calls for tbe observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they bave 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 tbose of persons wbo, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from bome wben the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. Tbcse include not only deatbs caused directly or indirectly by traumatism (including resulting septicemia), and by tbe action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from Injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., beart failure, asphyxia, astbenia, etc. As principal cause name tbe disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of tbe principal cause.
Statement of Occupation .- Precise statement of occupation is very important, so that the relative bealthfulness 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 cbanged on account of tbe disease causing death, report the usual occupation prior to illness. If the deceased bad retired from business, report tbe usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wbose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, bowever, designate the occupation by tbe appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person wbo had no occupation whatever write none.
F
R-302
PLACE OF DEATH
Denvers (City or Town}
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
(If death occurred in a hospital or institution, St. 1
give its NAME instead of street and number)
2 FULL NAME
Fila.A ... Paine
(If deceased is a married, widowed or divorced woman, give also maiden name.)
116 ... Boudoi ... o.
.........
St.
........
Minthron
· (If nonresident, give city or town and state)
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE 5 SINGLE
(write the word)
female white
MARRIED
WIDOWERingle
or DIVORCED
18 DATE OF
DEATH.
May 26. 1940.
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
19 | HEREBY CERTIFY.
NOM.
Cxhy 19
That I attended deceased from
May
1930
I last saw h.
Umalive on
May 26. 40
death is said
to have occurred on the date stated above, at.
.. m.
Duration
Immediate cause of death
Chr. myocarditis
2 yrs
AGE
Years
.. Months.
Days
If less than 1 day .Hours Minutes
Usual
9 Occupation:
none
Industry 10 or Business:
11 Social Security No .....
none
12 BIRTHPLACE (City)
(State or country)
Mathsop
13 NAME OF
FATHER
Benjamin Paine
14 BIRTHPLACE OF
FATHER (City)
New Hampshire
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary Tewksbury
16 BIRTHPLACE OF
MOTHER (City)
Winthrop
(State or country).
Lephillips
Relation, if any
17 Informant (Address)
A TRUE COPY.
ATTESTI
(Registrar of city or town where death occurred)
DATE FILED 6/5/40
19
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Underline the cause to which death
Of autopsy ..
What test confirmed diagnosis ?.
28 Was disease or lojory In any way related to occupation of deceased ?
If so, specify
(Signed)
Melvin Goodman
. M. D.
(Address).
Date
5/8119-40
21 PLACE OF BURIAL,
CREMATION FOR REMOVAL
(Cemetery) throp
(City or Town)
DATE OF BURIAL
5/00/40
19
22 NAME OF
FUNERAL DIRECTOR
Charles.R ..... Bennison
ADDRESS
Winthrop
Received and fled
1.1
19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
No. Dunvor
.....
(If U. S. War Veteran, specify WAR)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ..
(Specify whether)
year
months days
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
.years
7 IF STILLBORN, enter that fact here.
8
76
Generalized arteriosclerosis 5 yrs
Due to
Due to
Date of.
should be charged sta- tistically.
....
PARENTS
VMVy wt utttascu icstucu in another city of town at the time
LECHVED
TOWN
OFFICE OF
GLEN
-L
20
JUN101940
1 R-301 AJ Suffolk.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
Registered No. 101
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
Hanthrop
(If nonresident, give city or town and state)
In this community
40yrs.
mos.
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
may
28
1940
(Month)
(Day)
(Year)
IMĮ HEREBY CERTIFY That I attended deceased from
19.20
last saw h.k ........ alive on May 28 1940 death is said
to May 28 ..... , 19. m. to have occurred on the date stated above, at 3:15 Pm Immediate cause of death ... acute Heart- Block
Duration IMPORTANT
(adams-Stokes)
Due to
Disease
Due
asternaglerosis
Hypertension
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
Of autopsy
What test confirmed diagnosis!
Elnucal $
20 Was disease or Injury in any way related to occupation of deceasod? If so, specify) ... (Signed) Jacob Chaves (Address) 562 Hanley Date.
5/28/9/40
M. D.
21 Temple Tomali.com. DATE OF BURIAL .. may 20 19.40
22 NAME OF FUNERAL DIRECTOR ADDRESS 394 Warum on St. Dochelys
Received and filed.
19
(Registrar)
100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit pormit was issued:
William S. Childrens (Signature of Agent of Board of Health or other)
Cegent
may 29/40
(Date of Issue of Permit)
(Official Dengnation)
(write the word)
Massied
Years
Days
Hours
Minutes
15 MAIDEN NAME
OF MOTHER
Rosalie (Milonown)
V
57 Crystal Love ave James alland.
CERTIFICATE OF DEATH
.St. S
(If deceased is a married, widowed or divorced woman, give also maiden name.) 57 Crystal Cave av.
years
months
days.
PLACE OF DEATH
(County) Winthrop 1 (City or Town) No. ......... 2 FULL NAME (a) Residence. No ... (Usual place of abode) Length of stay : In hospital or institution ... (Specify whether) PERSONAL AND STATISTICAL PARTICULARS 3 SEX Male 4 COLOR OR RACE White 5 SINGLE MARRIED WIDOWED 5a If married, widowed, or divorced . HUSBAND of sache albon ive maiden name of wile in full) (or) WIFE of (Husband's name in full) 6 Age of husband or wife if alive. 49 7 IF STILLBORN, enter that fact here. 8 AGE 75 Years. .. Months If less than I day Industry 10 or Business: Il Social Security No. 012-10-2298 12 BIRTHPLACE (City) (State or country) Poland 13 NAME OF FATHER Charles. B. alland 14 BIRTHPLACE OF FATHER (City) Poland. (State or country) PARENTS 16 BIRTHPLACE OF MOTHER (City) (State or country) Poland. 17 Sadie Illand Relation, if any Informant. 57 Conptal Cove care gold (Address) information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual 9 Occupation: Retail Millinery 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.
2 weeks
Izear 1year
PHYSICIAN Underline the cause to which death should be charged sta- tistically. no
.Date of.
Jacob.t. Ferme
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 discase of which he died, defined as required by section one. where same was contracted, the duration of bis 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 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 bas 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, Sce. 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 burlal 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 Ilealth 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, but also deaths from disease resulting fromn 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 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 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
R-303 B
PLACE OF DEATH
Suffolk (County) youthof (City or Town) No Matterof Gourmet Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or ito Agent.
Registered No .....
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Irving washoff neuhoff
(a) Residence. No ... (Usual place of abode) Length of stay: In hospital or institution (Specify whether)
Hospital
years
months
17 days.
In this community 21
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Mala
4 COLOR OR RACE; 5 SINGLE
(write the word)
MARRIED
WIDOWED
Or DIVORCED Marscard
Sa If married, widowed, or arequite Popplehower HUSBAND of (Give maiden name of wife In full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. Years
7 IF STILLBORN, enter that fact here.
8 AGE 52 Years Months Days
Hours.
Minutes
Usual
9 Occupation:
Salesman
Industry
Cleaning products
10 or Business:
11 Social Security No .... ana
12 BIRTHPLACE (City)
new york,
(State or country)
n.y.
13 NAME OF
FATHER
Simon neuhoff
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country) Russia
15 MAIDEN NAME
OF MOTHER
Eva glichman
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Margarita Neuhoff Relation. if any (Address) 276 Tiver Road Dinthink
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit/was issued:
Brückley
(Sanature of Agent of Board of Health for other
Healthe Officer 53140
7 (Official Designation)
(Date of Issue of Permit)"
0 - Childress
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
May - 30-1940
DEATH.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows; (If an injury was involved, state fully.) Tojenua due to Flame Burns y Extremities & Body.
Clothing accidentally ignited at
his nande april -13-1946
accidental
Was there an autopsy ?.
no
(See reverse side for description for unknown person)
20 Where did
injury occur ?.
Mutterof
(City & town and State)
21 Was discass or Injury In any way related to occupation of deceased ?.
If so, specify
Hm.Brickley
M. D.
(Signed).
(Address)
Braten
Obavy 30 1980
22
Michkan Jefila West Pathway Place of Burial, Cremation or Removal. (City or Town) DATE OF BURIAL June 2 1940 ......
23 NAME OF
FUNERAL DIRECTOR Denjamint. Solomon.
ADDRESS
420 HARVARD ST., BROOKLINE. MASS.
Received and filed 19
(Registrar)
5m-10-'39. No. 8427-j
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. DEATH in plain terms, so that it may be properly classified under the International Classification of Causes information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
2 FULL NAME.
(If geteased)is'a married, widowed or divorced woman, give also maiden name.) 276 Rue Read Northrop ... St.
(If U. S. War Veteran. specify WAR)
(If nonresident, give city or town and state)
White
50
If less than 1 day
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan 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 regls- 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 underlaker 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 zame 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 he 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 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 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., as amended.
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