USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 51
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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-301 A
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 Agents wir
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME Carrie .... Estelle ..... (.Bra.cke.t.t.).cook
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5.6 .... Washington Avenue
à
(If nonresident, give city or town and state)
months
days.
In this community
15
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Frank P. Cook
(Husband's name in full)
6 Age of husband or wife if alive 7 IF STILLBORN, enter that fact here.
8
AGE 83 Years Months. Days
Hours.
Minutes
Usual
9 Occupation:
At home
Industry 10 or Business:
II Social Security No.
12 BIRTHPLACE (City)
Rumford
(State or country) Maine
13 NAME OF FATHER Peter Brackett
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country) Maine
OF MOTHER Betsy Abbott
16 BIRTHPLACE OF MOTHER (City) (State or country) Maine
Relation, if any
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 permit was issued: Www.8. Childress 0 (Signature of Agent of Board of Health ofother) Health Officer 9/7/40
{Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept
5
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY .. That I attended deceased from
Qua 10 19.40, tothe
Left
5
19 40
I last saw h IN alive on sept 5. 13.4 .. 0, death is said to have occurred on the date stated above, at 8:35 pm. Immediate cause of death. Concur Dilu Lives
Duration MMIPORTANT 3 months ·
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 ?
Clinical
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deccased? to -
If so, specify
M. D. (Signed).
(Address)
21 Newport Maine
Place of Burial, Cremation or, Removal. (City_or Town)
September8 1940
19
22 NAME OF
FUNERAL DIRECTOR
Charles ..... R ....... Bennison
ADDRESS.
Winthrop Mass
19
Received and filed SED 10 1940
(Registrar)
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.
1
No. 56 Washington Avenue
St.
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ....
(Specify whether)
years
.. years
If less than 1 day
......
Date Seft 6 1940
17 Mrs.Louise E. Field sister (Address) 56 Washington Ave Winthrop MassPATE OF BURIAL.
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 famlly of the deceased, furnish for regle- tration a standard certificate of death, stating to the best of hls knowledge and bellef the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where game 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, Scc. 9.
No undericker or other person sball hury or otherwise dispose of a human hody In a town, or remove therefrom a human body whleh has not heen buried, until he has received a permit from the board of bealth, 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 czhume a human body and remove it from a town, from onc cemetery to another, or from one grave or tomh other than the receiving tomb to another in the same cemetery, until he has received a perinit from the board 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 dc- livered to such board, agent or clerk, as the case may he, a satisfac- tory written statement contalning the facts required by law to be returned and recorded, which sball 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 Insufficient, a physician who is a member of the board of health, or employed by it or by the selectmien for the pur- posc, shall upon application make the certificate required of the at- tending physician. If death is caused by vlolence, 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 remova! ; 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 hody has been sooner obtained 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 been engaged, such recital shall appear upon the permit. The board of healtb, 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, See. 45. G. L., (Tercentenary Edition.)
No undertaker or other person shall hury 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 iswue such permits, or if there is no such board, from the clerk of the town where the body Is to be burled or the funeral is to 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, Soc. 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) Atlending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last Ill- ness from disease unrelated to any form of injury.
(2) Board of Health physiclan, will certify to such desths 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 Anpposably due to Injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septice- mia), 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 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 fallure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhld con- ditions, if any, related to the principal cause and any important complieatlon of the principal eause.
Statement of Occupation .- Precise statement of occupation is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing deatb, report the usual occupation prior to illness, If the deceased had retired from husi- ness, report the usual occupation prior to retirement. Children not galnfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged In domestic service for wages. however, designate the occupation by the appropriate terms, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write nons.
SPACE FOR ADDITIONAL INFORMATION
R-301 A Suffolk County) Winthrop 1 (City or Town)
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.
CERTIFICATE OF DEATH
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Lizzie Dawirtz
(19 deceased is a married, widowed or divorced woman, give also maiden name.) ,
16 Cross It.
St.
(If U. S. War Veteran, specify WAR) Winthrop mars
(If nonresident, give city of town and state)
Length of stay: In hospital or institution.
(Specify whether)
PERSONAL AND STATISTICAL PARTICU !. ARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
female
4 COLOR OR RACE
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widow
5a If married, widowed, or divorced
HUSBAND of
Benjamin
. (Give maiden name of wife in fu),
Jewish
(Husband's name in full)
Years
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
8
68%
Years
Months
Days
Hours
Minutes
Housewife
Il Social Security No.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER Joseph Rosenzweig
14 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
15 MAIDEN NAME
OF MOTHER
cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Henry Dewirtz
Informant
(Address)
16 choes 200 Winthrop
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 or other)
health Officer
9/9/40
(Official Designation) (Date of Issueof Permit)
18 DATE OF
DEATH
Sept
(Month)
(Day)
19 I HEREBY CERTIFY - That I attended deceased from
19.Y .. L.,
to.
Selt8
19
40
I last saw
her alive
Left 8
19.40, death is said
to have occurred on the date stated above, at.
11:45m.
Duration IMPORTANT
6 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 ?
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related te occupation of deceascd?
If so, specify ...................
Fraux 7 Sandla
M. D.
(Signed)
(Address).
........ Date ...
Perus mars
9/8
19 40
21
Winthrop Cem Everest, mais
Place of Burial, Cremation or Removal.
City or Town)
19:40
Relation, if any son) DATE OF BURIAL. sept.
Manuel Stanetsky
22 NAME OF
FUNERAL DIRECTOR
ADDRESS 10 Wash,
It. Dor trade
Received and filed SEP 10 1940
19
(Registrar)
100m-10-'39. No. 8427-e
(or) WIFE of AGE Usual 9 Occupation: PARENTS 17 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: is very important. See instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
Winthrop Community Hook.
St. 1
(a) Residence. No ...
(Usual place of abode)
Spital
Idalje years
months
5
days.
In this community / Fyrs.
mos.
days.
81940
(Year)
Immediate cause of death.
Coronary thoulouis
If less than I day
Rua
Russia
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith. after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for regis- tration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was 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 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 obtaincd hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war In which It has been engaged, such recital shall appcar upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thercafter fur- 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, Sec. 45. G. L., (Teroentenary Edition.)
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth untll he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition)
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observ- ance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last ill- ness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical 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 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 Cause of Death .- Cause of death means the disease, or complication which causes death. not the mcde of dying, e. g., beart 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 deccased had retired from busi- ness, report the usual occupation prior to retirement. Children not gainfuily employed may be returned as at school or at home. For a woman whoze 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 oceupatlon whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No. 304 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.
1 (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
Ceruttrop
(If nonresident, give «ty or town and state)
months
days.
In this conimunity 30 yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
1940
(Month)
(Day)
(Year)
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
George Edwin Furber
(Husband's name in full)
years
7 Ir STILLBORN, enter that fact hore.
8 AGE 73 Years 7 Monthz 26Days
If less than 1 day
Hours.
Minutes
at Home -
II Social Security No.
12 BIRTHPLACE (City) Fast Boston
(State or country)
Massachusetts
FATHER Charles Edward Browne
14 BIRTHPLACE OF
FATHER (City)
Portland
(State or country) Maine
15 MAIDEN NAME
OF MOTHER
Mary Caroline Morrill
16 BIRTHPLACE OF MOTHER (City) (State or country) Maine
Portland
Date Met 10 10.40 (Address) 2/ Ways tob Pd.
17 Alice M. Browne
Relation, if any sister
Informant (Address) 304 Pleasant St Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bitial or transis permit was issued: Im& Children (Signature of Agent of Board of With or other) a sept. 13/40.
(Official Designation)
(Date of Leghe of Permity
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Of operations
PHYSICIAN Underline the cause to Of autopsy ...... wat Date of. which death should be charged sta- What test confirmed diagnosis Qual classico istically.
20 Was disease or injury in any way related to occupation of deceased? To.
(Signed)
If so, specify ...
Marjorie Euros duse
M. D.
21
Place of Aidt, Cremation or-det.
DATE OF BURIAL .....
September 14 1940
19
FUNERAL DIRECTOR
22 NAME OF
Charles R. Bennison
ADDRESS
Winthrop Mass
19
(Registrar)
Health
Prin Cem. (8 - 25-4)
. asker buried
19 I HEREBY CERTIFY.
June 15, 1070
.... , to .....
That Lattended deceased froma
Lept 10 19. ...
40
I laat saw h. LAG .. alive on .... Set 5, 19.550 death is said to have occurred on the date stated above, at ....... m.
Duration IMPORTANT
Immediate cause of death ... Cardiac Facture De compensation suro
May 1940 .
Due to
Cardio Renal Doseu
Due to Several your.
100m-10-'39. No. 8427-e
3 SEX Female (or) WIFE of Usual 9 Occupation: Industry 10 or Business: PARENTS is very important. See instructions and extracts from the laws on back of certificate. inforniation should be cereially supplied. aut should be staicu LaAviet. PITIDiviANS should state 13 NAME OF CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION
2 FULL NAME
Mabel Morrill Furter
(If deceased is a married, widowed or divorced woman, give also maiden name.) 304 Pleasant St.
(a) Residence. No .. (Usual place of abode) Length of stay: In hospital or institution ....
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
18 DATE OF
DEATH.
Sept
10
White
Widowed
6 Age of husband or wife if alive.
4 COLOR OR RACE
years
St. 3
Received and Eled. SEP 2-5 1940
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 hest of his knowledge and belief the name of the deceased, hls supposed age, the disease of which he died, defined 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 body in a town, or remove therefrom a human hody which has not been huried, 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 hody and remove it from a town, from one cemetery to another, or from one grave or tomh 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 huried. 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 hy law to be returned and recorded, which shall he accompanied, in case of an original . interment, by 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 insufficient, a physician who is a member of the board of health, or employed hy it or hy the seleetmen for the pur- pose, shall upon application make the certificate required of the at- tending physician. If death is caused hy 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 he 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 fconstitute a permit for such removal ; provided, that such body shall he returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner 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 fur- nish for registration any other necessary information which can he 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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