USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 44
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SPACE FOR ADDITIONAL INFORMATION
M R-301 A
PLACE OF DEATH
(County)
1
Tinthrop
(City or Town)
No. 16 Enfield Road
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
ZSE.
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
anie (gomes) Hollingsworth
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S. War Veteran, specify WAR)
(a) Residence. No ...
( Usual place of abode)
Length of stay: In hospital or institution.
16 Infield Road
.......
.... St.
(If nonresident, give city or town and state)
months
days.
In this community
11
yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE |
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Tidowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full) worth
(or) WIFE of
Thomas
..
Hollings eath
(Husband's name in full)
.years
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
8
AGE 80 Years Months 12 Days
Hours
.Minutes
Usual
9 Occupation:
it home
Industry 10 or Business:
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
England
13 NAME OF
FATHER
Unable to obtain
14 BIRTHPLACE OF
Unable to obtain
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Unable to obtain
16 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain
100m-10-'39. No. 8427-e
I7
Relation, if any
Informant ..
Levis ", Hollingsworth son)
(Address) 16 Enfield
Road winthrop Lass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buri I o: Atransit permit was issued: Www. D. Couldrisk Signature of Agent of Board of Health or other) Healthe Officer 7/23/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jul
(Month
(Day)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from
I fast saw 'h
.alive on ... 1940, death is said ... m. to have occurred on the date stated above, at ....?..... 7 .... Immediate cause of death Edema 7. Jungs
Duration IMPORTANT 3 Days
Due to
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
.Date of ..
Of autopsy
What test confirmed diagnosis ?
20 W'as disease or Injury lo any way related to occupation of deceased?
If so, specify.
.....
Hurry Cuteet
(Signed)
, M. D.
(Address)
Date Tinthrop
21 'inthron Cemetery
Place of Burial, Cremation or Removal. DATE OF BURIAL JULY 20.
7 City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS.Winthrop .... Less.
Received and filed 19
(Registrar)
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact staten:ent of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state .
is very important. See instructions and extracts from the laws on back of certificate.
PARENTS
If less than I day
Cerchial Humanlige
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
7/22.19.40
21
40
19.3 ....
anh 21
19 40
years
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- tratlon a standard certificate of death, stating to the best of his knowledge and bellef the name of the deceased, his supposed are, 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. Laics, 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- llvered 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 lleu thereof a certificate as herelnafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed 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 medleal exam- iner shall make such certificate. If such a permit for the removal of & human body, not previously Interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and In the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recltal, 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 recltal 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 la 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., (Tercenterary Edition.)
Ne undertaker or other person shall bury & human body or the ashes thereof which have been brought Into the conunonwealth until he has received a permit so to do from the board of health or its agent appointed to issue sueli permits, or If there is no such board. from the clerk of the town where the body Is to be burled or the funeral le 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., (Tereantenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calla 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 bedelde care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Haalth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease an- 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.
(8) Biedleal 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 related to ocrupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Canse of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, s. g., heart fallure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earller morbid con- ditlons, if any, related to the prinelpal cause and any important complleation of the prinelpal cause.
1. Statement of Occupation .- Precise statement of occupation Is very Important, so that the relative healthfulnesa of various pursults 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 buzi- ness, report the usual oceupatlon prior to retirement. Children not rainfully 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 nons.
SPACE FOR ADDITIONAL INFORMATION
VI R-301 A
AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. is very important. Sec instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent./ st
Registered No .. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Marion ( Kirkland ) Hughes
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
94 Main
(Usual place of abode)
Length of stay : In hospital or institution ....... h.o.s.p.i.tal.
years
months
day
Though this community1 7 yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Thomas ..... Hughes
(Husband's name in full)
.Years
6 Age of husband or wife if aliva. 7 IF STILLBORN, enter that fact here. 8 77
AGE Years 13 Days
Hours
Minutes
Usual
At home
9 Occupation:
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City}
Glasgow
(State or country) Scotland
13 NAME OF
FATHER
James Kirkland
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Jessie Jarden
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
100m-10-'39. No. 8427-e
17 Informantennie Hughes
Relation, if any
1.
daughter
(Address) 94 Main St Winthrop Mass
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Chil dress (Signature of Agent of Board of Health of other ) Le alte aparecer (Official Designation) (Date of Issue of Permit) 7/29/40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
July
2)
1940 (Year)
(Month)
KDay)
ThatI attended deceased from
19 I HEREBY CERTIFY top 920, 1940
19 .........
last salv h ......
..... alive on
..... 13 ........ Death is said to have occurred on the date stated above, at 12.00 Immediate cause of death
Duration IMPORTANT
Due to
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings : Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury in any way related to occupation et deceased? If so, specify ..
(Signed)
4 Comments on Date /18
, M.
D.
19 .. N
(Gity or Town)
21
Winthrop Cemetery
Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL July 29",
.1.940
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop Mass
Received and filed 19
(Registrar)
(If U. S.
War Veteran,
specify WAR)
...........
.St.
(If nonresident, give city or town and state)
(or) WIFE of
7
Months
If less than 1 day
PARENTS
(Address)
Winthrop Community Hospital No.
St.
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 Hilness, 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 hy section one, where game was contracted, the duration of his last illness, when last seen alive by the physician or offleer and the date of his death ... Gen. Laws, Chap. 46, Scc. 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 heen 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 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 untll there shall have been de- livered to such hoard, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be acconpanled, 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 regulred of the at- tending physician. If death is caused by violence, the medical exam- iner shall make such certificate. If such a permit for the removal of human body, not previously interred, from one town to another within the commonwealth cannot be obtained carly enough for the purpose. the certificate of death made as abovo provided and in the possession of the undertaker desiring to make snch 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 npon 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 certifylng the cause of death shnii thereafter fur- nish 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 clerk or registrar may require .- Chap. 114, Seo. 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 perniit so to do froin the board of heaith 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 l'unerai 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. ... Chep. 114, Sec. 46, G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fuifilimert of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given hedside care during a last Ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to snch deaths only as those of persons who, though disabled hy recognized disease un- related to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deathis caused directly or indirectly by traumatism (including resulting septice- inia), and hy the action of chemical (drugs or poisons), thermal, or electrical agenty, and deaths following abortion, hut aiso deaths from disease resulting from injury or infection related to occupa- tion, the sudden deaths of porsons 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 faliure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid con- ditions, if any, related to the principal cause and any Important complication of the principal cause.
Statement of Ocenpatien .- Precise statement of occupation is very Important., so that the relative heaithfuiness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the cecupation had been given up or changed on account of the disease causing death. report the usual occupation prior to iliness. If the deceased had retired from busi- ness, report the usnai 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, ete, For a person who had no occupation whatever write nons.
SPACE FOR ADDITIONAL INFORMATION
A 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)
(If U. S. War Voteran, specify WAR)
37 Bartlett Road
.St.
(If nonresident, give city or town and state)
In this community Py yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
7
(Month)
30
(Day)
(Ýear)
19 I HEREBY CERTIFY.
5-13
19.440, to.
That I attended deceased from
-
36
1944
I last saw hnen ...... alive on
7-30
10.40, death is caid
to have occurred on the date stated above, at ... ............. m.
Duration IMPORTANT
5/5/40
Due to
Due to
Other condition
(Include pregnancy within 3 months of death)
Major findings : Of operations
PHYSICIAN Underline the cause to Date of. Of autopsy which death should be charged sta- What, test confirmed diagnosis ?
20 Was disease er Injury in any way related to occupation of daceased?
li so, specify.
, M. D. (Signed) (Address) Withup Dato .. 7/11 19 40
17 Walter Lyany Relation, if any 21 Place of Burial, Comolion OF Removal. (Citpor Town)
SON
Informant (Address) 21 Park Que, Port Washington
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: WM.D. Children 8. (Signature of Agent of Board of Health or other)
He althe Office (Official Designation) (Date of Issue 'of/Permit)
7/31/40
(write the word)
manuel
Clivece
(Husband's name in full)
20 yoars Immediate cause of death .. Cerebral Humanhage
If less than 1 day
Days
Hours.
Minutes
Each Baston-
12 BIRTHPLACE (City)
(State or country)
Mas
13 NAME OF
FATHER
Joseph. MCClanam
Steward
FATHER (City)
Buslow
(State or country)
Mars
amanda
15 MAIDEN NAME / OF MOTHER abbie Canada Courses
100m-10-'39. No. 8427-c
Received and filed. Que 2 19kg ....
(Registrar)
tistically.
DATE OF BURIAL aug /s
22 NAME OF FUNERAL DIRECTOR Blad. Buna ADDRESS Muchof It wuchsMate
1 (Cityor Town) No. 2 FULL NAME (a) Residence. No ... (Usual place of abode) Length of stay: In hospital or institution 3 SEX Female 4 COLOR OR RACE white 5a If married, widowed, or divorced HUSBAND of (or) WIFE of Charles 6 Age of husband or wife if alivo .. 7 IF STILLBORN, enter that fact hero. 8 69 AGE Years Months. 9 Occupation: Industry 10 or Business: Il Social Security No. 14 BIRTHPLACE OF 16 BIRTHPLACE OF PARENTS MOTHER (City) (State or country) information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state Usual at home 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. ,Per Imr. Benman
Josephine. Sewall (Steward) ELwell (If deceased is a married, widowed or divorced woman, give also maiden name.)
years
2
months 2 days.
40
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(Give maiden name of wife in full)
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. fter the death of a person whom he has attended during his last liness. at the request of an undertaker or other authorized person r of any member of the family of the deceased, furnish for regls- ration a standard certificate of death, stating to the best of his nowledge and belief the name of the deceased. hls supposed age, he disease of which he died, defined as required by section ene, here same was contracted, the duration of his last illness, when last een alive by the physician or officer and the date of his death ... en. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a uman body In a town, or remove therefrom a human body which as not been buried. until he has received a permit from the board f health. or its agent appointed to issue such permite, or if there s no such board, from the clerk of the town where the person died ; nd no undertaker or other person shall exhume a human body and emove it from a town, from one cemetery to another, or from ons rave or tomb other than the receiving tomb to another in the same emetery, until he has received a permit from the board of health or ts agent aforesaid or from the clerk of the town where the body is urled. No such permlt shall be issued until there shall have been de- vered to such board, agent or clerk, as the case may be. a satisfac- ory written statement containing the facts required by law to be eturned and recorded, which shall be accompanled, in case of an riginal interment, by a satisfactory certificate of the attending physician, If any, as required by law, or in lieu thereof a certificate s hereinafter provided. If there is no attending physiclan, or if, for ufficient reasons, hls certificate cannot be obtained early enough for he purpose, or is Insufficient, a physician who is a member of the oard of health, or employed by it or by the selectmen for the pur- ose, shall upon application make the certificate required of the at- ending physician. If death is caused by violence, the medical exam- ner shall make such certificate. If such a permit for the removal of human body. not previously interred, from one town to another Althin the commonwealth cannot be ohtalned early enough for the purpose, the certificate of death made as above provided and In the ossession of the undertaker desiring to make such removal shall onstitute a permit for such removal ; provided. that such body shall e returned to the town from which it was removed within thirty- ix hours after such removal, unless a permit in the usual form for he removal of auch body has been sooner obtained hereunder. If the eath certificate contains a recital, as required by section ten of hapter 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 ngaged, such recital shall appear upon the permit. The board of ealth. or its agent, upon receipt of such statement and certificate, hall forthwith countersign it and transmlt it to the clerk of the own for registration. The person to whom the permit is so given nd the physician certifying the cause of death shall thereafter fur- ich for registration any other necessary juformatlon which can be btained as to the deceased. or as to the manner or cause of the eath, which the clerk or registrar may require .- Chap. 114, Sec. 45, . L .. (Tercentenary Edition.)
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