USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 52
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No undertaker or other person shall bury a human body or the ashes thereof which have been hrought 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 he hurled 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 ohserv- 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 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 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 failure .. 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 Occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can he 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 husi- 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 d no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-305
- PLACE OF DEATH
(County) HAVERHILL (City or Town)
6 Downing av
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
HAVERHILL (City or town making return)
Registered No. ( (If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Esther B. Levine
(If deceased is a married, widowed or divorced woman, give also maiden name.)
111 Locust
........................ St.
Winthrop
(If nonresident, give city or town and state)
no
years
months
days.
In this community
yrs.
mos.
14 days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE 5 SINGLE
MARRIED
WIDOWED
(write the word)
I DIVORCED Married
5a lf married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Harry .Levine
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
About 44
years
If less than 1 day
Hours
Minutes
Housewife
12 BIRTHPLACE (City)
(State or country)
Russia
Eli Berger
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Sarah Sandler
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
Informant
Arthur Berger
(.
Relation, if any
(fAddress)
6 Downing av
A TRUE COPY.
Bernard H. Doratura
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
Sept 12
40
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
September
10
1940
(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.) Chronic myocarditis Contrib :..... Bronchial asthma
20 Accident, suicide, or homicide (specify)
no
Date of occurrence.
Where did
Injury occur?
None
(City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in
public place?
None
Manner of
(Specify type of place)
Injury
None
Nature of
Injury
None
While at work ?.
no
. Was there an autopsy?
no
21 Was disease or lojury la any way related to occupation of deceased ?.
no
If so, specify
(Signed)
John L .O !Toole
M. D.
(Address)
Haverhill
DaSeptla, 40
22
Hebrew
Everett
Place of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
September 10
19
40
23 NAME OF
FUNERAL DIRECTOR
William J Comeau
ADDRESS
Haverhill
Received and äled 19
(Registrar of City or Town where deceased resided)
1
No.
........
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ...
3 SEX
Female!
White
7 IF STILLBORN, enter that fact here.
8
About
Usual
9 Occupation:
Industry
10 or Business:
11 Social Security No.
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
PARENTS
17
25m-10-'39. No. 8427-g
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible
AGE
44 Years
-
Months .........
.Days
(If U. S. War Veteran, specify WAR)
19
OCT107 9 AM
R-301 Al
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)
2 FULL NAME
Hannah Flavia Grady
(If deceased is a married, widowed or divorced woman, give also maiden name.)
53 Crest Ave
St.
(If nonresident, give city or town and state)
years
months
days.
In this community 28yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCEDSingIr
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Years
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
If less than 1 day
8
AGE 5.
Years.
Months
Days
Hours
Minutes
Usual
3 Occupatio
Housework
Industry
10 or Business:
Own
Home
11 Social Security No.
12 BIRTHPLACE (City)
Clinton
(State or country) Mass
13 NAME OF
FATHER
Michael Grady
PARENTS
17
Informant
Annie Grady
Relation, if any
Sister)
(Address)
53 Crest Ave
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William D. Childress (Signature of Agent of Board of Health or other)
agés gent Sept. 15-140
(Official Designation)
(Date of Issue of Pe mit)
(Registrar)
1
Winthrop
(City or Town)
No 53 Crest Ave.
St.
(If U. S. War Veteran, specify WAR) ...
(a) Residence. No ...
(Usual place of abode)
Length of stay: In hospital or institution ....
(Specify whether)
............
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sint
(Month)
(Day)
13 1440 (Year)
19 I HEREBY CERTIFY. That b attended deceased from 1713, 1940
13
19 40 to.
I last saw h ...... alive on .. 1/1/3 1942 death is said to have occurred on the date stated above, at ....... Y.S.Q .... m. Immediate cause of death Duration
Due to
1 000 ........
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 lajury in any way related to occupation of deceased? no
If so, specify.
(Signed)
(Address).
M. D.
9/14/1940
21
St.
Johns Clinton
Place of Burial, Cremation of Removal
DATE OF BURIAL
sept
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Winthrop
.........
SEP 201940
Received and filed
19
O'Malit
100m-10-'39. No. 8427-e
PLACE OF DEATH
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.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary Hoban
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
(write the word)
Female
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer sball 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, furnisb 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, ocfined 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 deatb ... 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 buman body wbich 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 sball 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 easc may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, wbicb 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 tbe pur- pose, shall upon application make the certificate required of the at- tending physician. If deatb 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 witbin the commonwealth cannot be obtained early enough for tbe purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)
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., (T'ercentenary 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 wben the certificate of death Is needed.
(3) Medleal 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 Causo of Death .-- Cause of death means the disease, or complication which causes death, not the mode of dying, c. 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 gainfuliy 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
-----
(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. 1.80
Registered No (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Helen Medora (Yaw) Floyd
(If deceased is a married, widowed or divorced woman, give also maiden name.)
I39 Somerset Ave
.....
.St.
(If nonresident, give city or town and state)
In this community48
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Herbert Wilson Floyd
(Husband's name in full)
6 Age of husband or wife if alive
Years
7 IF STILLBORN, enter that fact here.
AGE
Yoars
7
Months.
Io Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Housewife
10 or Business:
Own Home
11 Social Security No.
12 BIRTHPLACE (City)
Halifax
(State or country)
Vermont
13 NAME OF
FATHER Frederick Yaw
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
15 MAIDEN NAME
OF MOTHER
Lerinia Sargent
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Vermont
17 Informant ... (Address) 13, Somerset Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Comis Childrens
(Signature of Agent of Boardof Health or oth
HO.
4.2% Left : 7/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
9
(SIonth)
15
(Day)
(Year)
19 I HEREBY CERTIFY,
9 13
19.40,
19.4.0
That I attended deceased from
I last saw had ...... alive on.
9/15
19 ... 6.4 death is said
to have occurred on the date stated above, at ..................... m.
Immediate cause of death ...
Duration IMPORTANT
Due to
Due to
Other conditions
divorce tus condites
(Include pregnancy within 3 months of death
PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was elseass or Injury la any way related to occupation of deceased?
If so, specify.
(Signed)
Huren
M. D.
(Address)
21
Winthrop
winthrop
Place of Burial, Cremation of Bemoval. 1 8
DATE OF BURIAL
(City or Town)
1940
....
22 NAME OF
FUNERAL DIRECTOR Howard S Rurales
ADDRESS
Received and filed
SEP 201940
19
....
(Registrar)
100m-10-'39. No. 8427-e
1 3 SEX 8 84 is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry
PLACE OF DEATH
Suffolk (County)
No 139 Somerst Ave
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
months
days.
MUL sivuIu De statcu information" should ve carviuity suppileu. VIDITE DIAINTV WITH INFANING RI ACK INK.THIS IS A PERMANENT RECORD PARENTS
....
Major findings :
Of operations
.Date of.
Of autopsy
What test confirmed diagnosis ?
Date
9/16/2020
Herbert W Floyd
Relation, if any
(Husband
.. )
.....
40
Female
White
82
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 physiclan, or if, for sufficient reasons, his certificate cannot be obtained early cnough 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- incr 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 reeital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appcar upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith 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 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 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 ef 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) Medieal 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- mla), 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 mode of dying, c. 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 .- Preeise 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, ete. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
₹-302
PLACE OF DEATH
... SUFFOLK BOS TO
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return) {
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