USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 36
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SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. 94 Washington Ave.
The Commonmralth 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.
116
Registered No
§ (If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
Elizabeth Goetz
bort Krauss
...
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
94 Washington Ave.
St
Length of stay: In hospital or institution.
nane
(Specify whether)
years
months
days.
In this community 10yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
OF DIVORCED/idowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Karl Goetz
(Husband's name in full)
.years
7 IF STILLBORN. enter that fact here.
AGE
61
ears
Months
Dayı
If less than 1 day Hours Minutes
9 Occupation:
At Home
11 Social Security No ...
none
Germany
13 NAME OF
FATHER
John Krauss
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Barbara Dietel
16 BIRTHPLACE OF MOTHER (City). (State or country) Germany
Informant
Louis Goetz
Relatlon, if any son
(Address)
94 Washington Ave., Winthe
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other)
agent June 14/40
.... (Official Designation] (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
13
1940
(Month)
(Day)
(Year)
19 NEHERERY CERTIFY. 19 24 to
That I attended deceased from June 3, 1940
I last saw h 3 alive on plfue 13. 19 40 death is said to Duration m. IMPORTANT have occurred on the date stated above, at 11.308 Immediate cause of death ......... Myocardialfacture
T
Due to. Coronary Atrombares
Due to. Diebita Jurelitus
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Underline the cause to which death should be charged sta- tlstically.
20 Was disease or injury in any way related to occupation of deceased ?.....
If so, specify ......
(Signed)
Vigilio Noparingentes
. M. D. (Address) )/ early19 Normering Date 10/12/ 190
21 Mt. Hope, Boston
Place of Burial, Cremation or Removal. OFDATE OF BURIAL June
......
......
(City or Town)
17.1940 19 .........
22 NAME OF FUNERAL DIRECTOR ... ADDRESS Boston
Received and filed. .19
(Registrar)
Major findings:
Of operations.
Date of.
Of autopsy.
no
What test confirmed diagnosis ?.
6 Age of husband or wife if alive
1 3 SEX Female 8 Usual 12 BIRTHPLACE (City) (State or country) PARENTS 17 is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry 10 or Business :........ none
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
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 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 receiv- ing tomb to another in the same cemetery, until he has received a permit from the board of healthi 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 disease, and those of persons found dead.
Dr. Fimmerty,
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 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
A R-301 A
Suffolk County)
BOSTON NOTIFIED
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
2 FULL NAME.
marylyn Mccarthy
(Af deceased isa manned, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ..
Hospital
(Specify whether)
years
months
17 days.
In this community
yrs.
mos.
17 days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced HUSBAND of.
(Give maiden name of wife in full)
(Husband's name in full)
years
7 IF STILLBORN, enter that fact here.
8
AGE
Years
Months.
17 Days
If less than 1 day Hours Minutes
12 BIRTHPLACE (City).
(State or country),
Ninthup
mars
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
mass
15 MAIDEN NAME
OF MOTHER
Helen G. Mª dennes
16 BIRTHPLACE OF MOTHER (City) .... (State or country)
East Boston
mass
¥17 Joseph hom Carthy
Relation, if any (Ficathe)
Informant. (Address) 44 SA- Undreis Per 2.3.
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)
The atthe Oficer 61/5/40
(Official Designation) ( (Date of Issue of Permity
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
una.
14.
(Month)
(Day)
(Year)
15
I HEREBY CURTIRY. 19 70 ....
That I attended deceased from
to have 19.
I last sawh ir alive on Juan 14, 1940, death is said to have occurred on the date stated above, at 2:159 Immediate cause of death ... Strappocream Schwierig
Duration IMPORTANT 3 Days
9 days
Due to
Kinthe abnormality
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
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 Mit Schwart (Signed) (Address) .. 19 quesin St EB .. Daté ....
0/14
M. D.
19 40
Thatdin
Place of Bunal, Cremation or Removal. (City or Town)
DATE OF BURIAL.
June 15
19 ... 0
22 NAME OF
FUNERAL DIRECTOR Frederick X Diagrade
ADDRESS
East Botn
Received and filed
19
(Registrar) 1
100m-2-'40-D-729-a
1 3 SEX Female (or) WIFE of PARENTS is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual 9 Occupation : Industry 10 or Business:
PLACE OF DEATH
...
(City or Town
anthrop Community Itospitale No.
.St.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
4 4 th andrews Road St
East
(If U. S. War Veteran, specify WAR) Boston
(If nonresident, give city or town and state)
1940
Major findings: Of operations.
.Date of
Of autopsy
What test confirmed diagnosis ?.
Due to.
Spina Bifidalite
6 Age of husband or wife if alive
11 Social Security No ...
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 hest 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 hody in a town, or remove therefrom a human body whichi 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 hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human hody and remove it from a town. from one cemetery to another, or from one grave or tomh other than the receiv- ing 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 he 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 hy law to be 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 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 hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy 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 he obtained early enough for the purpose, the certificate of death made as ahove 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 re- moval 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 been engaged, such recital shall appear upon the permit. The hoard 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 hody Is to be buricd 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 deathis only as those of persons who, though disabled by recognized disease unrelated to any form of injury, liave 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 supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), 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 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., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid 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 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 A
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) No. 207 Pleasant
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)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
207 Pleasant
St
(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
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
HUSBAND of.
Elizabeth & Manning
(Give maiden pame of wife In full)
(Husband's name in full)
6 Age of husband or wife if alive ....
years
7 IF STILLBORN, enter that fact here.
AGE ... 63 Years Months Days
If less than 1 day Hours Minutes
Usual
9 Occupation :..
Pharmacist
10 or Business:
11 Social Security No 049-01-3692
13 NAME OF
FATHER
Daniel Smith
14 BIRTHPLACE OF
FATHER (City) ....
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Ellen Driscoll
16 BIRTHPLACE OF MOTHER (City) ... 1
(State or country) Ireland
17 Juro Elizabeth Smith Wife
100m-2-'40-D-729-a
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: War. S. Children.
(Signature of Agent of Board of Health or other) 06/18/40 Healthe Officer
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
6
17
40
(Month)
(Day)
(Year)
19
I HEREBY CERTIFY.
That I attended deceased from
15, 1940
1
nume 17
19 40
I last saw h . alive on
Fahre 1), 19 ff } death is said to
have occurred on the date stated above, at ....
Immediate cause of death.
Duration IMPORTANT
Com
Thrombosis
.... 230
Due to
Due to.
Other conditions Jen. Interno Silivri (Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations.
Date of ....
Of autopsy
What test confirmed diagnosis ?..
20 Was disease or injury in any way related lo occupation of deceased ?.
If so, specify ...
200
(Signed) ....
wem M. D.
21. Stowar Hills
Date 6/16 1920 Boston
Place of Burial, Cremation or Removel. (Clty or Town)
DATE OF BURIAL.
June
20
19.40
22 NAME OF FUNERAL DIRECTOR ... Q.C. Kirby ADDRESS 17 Bennington Sr., Broton
Received and filed
19
(Registrar)
Y
Underline the cause to which death should be charged sta- tistically.
Relation, if any (Address) 207 Pleasant St., Winthrop
1 2 FULL NAME ... 3 SEX male widowed, o (or) WIFE of 8 12 BIRTHPLACE (City). (State or country) PARENTS is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Industry Drug
St.
(If nonresident, give city or town and state)
.m.
61
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 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, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human hody which has not been buried, 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 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 receiv- ing 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 huried. No such permit shall be issued until there shall have been delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required hy law to he returned and recorded, which shall be accompanied, in case of an original interment, hy a satisfactory certificate of the attending physician, if any, as required hy law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed by it or hy 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 he obtained early enough for the purpose, the certificate of death made as ahove 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 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 re- moval of such hody has heen sooner ohtained hereunder. If the death certificate contains a recital, as required hy 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 furnish 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).
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