USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 56
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SPACE FOR ADDITIONAL INFORMATION
R-301 A :
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No 16 Thornton Park
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. 1.91
Registered No
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Fred .... Greenwood ... Curtis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Thornton Park
(If nonresident, give city or town and state)
In this community 40yrs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
12
1940
(Month)
(Day)
(Year)
5a If married, widowed og diroce HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
62
years
If less than 1 day
8 AGE.68 Years 10 Months .9. . .Days
Hours. Minutes Due to
Usual
9 Occupation:
Manager
Industry
10 or Business!
W. E. Clarke Iron & Steel Mgg
11 Social Security No.
031- 03 - 2897
12 BIRTHPLACE (City)
Worcester
(State or country) Massachusetts
13 NAME OF
FATHER
Marcus Curtis
14 BIRTHPLACE OF
FATHER (City)
Worcester
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Helen Greenwood
16 BIRTHPLACE OF MOTHER (City) (State or country)
Unable to obtain
100m-10-'39. No. 8427-c
17 Dorothy C. Hoyt (daughter) (Address45 Trevor Court Rochester N. Y
1 HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the barigt ox transit/permit was issued:
(Signature of Agent of Board of Health or other)
Healthe Officer 10/14/40
(Official Designation) (Date of Issue of Permit)
19 I HEREBY CERTIFY, That I attended deceased from
aug. 18
19 .: 2.9.
to.
12- 1940
I last' saw h., AM .... alive on.
Oct 11,
104.0., death is said
to have occurred on the date stated above, at ............... @m.
Duration
IMPORTANT
Immediate cause of death
Concer of Stomach
Cancer a viver
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings : Concert Stomache
Of operations
Of autopsy
no autopay.
i tistically.
20 Was disease or injury In any way related to occupation of deceased? no
If so, specify ......
Fyrolie 1 Dickinson
. M. D.
(Signed).
(Address) Muntert mass
Date .......... 1.2, ... 19.450.
14.
Place of Burial, Cremation or Removal.
DATE OF BURIAL
October
19
(City & Town)
40
22 NAME OF
Charles R. Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
Roceived and filed. 19
14
(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.
Male
4 COLOR OR RACE
Whit
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ..
years
months
days.
may 19.30
.
PHYSICIAN
Underline the cause to which death should be charged sta- What test confirmed diagnosis? Rattological
21
Winthrop Cemetery Winthrop
Date of Saft 25, 39
PARENTS
Relation, if any
1
3 SEX
Rogers
(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. 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 lilness. 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 lg 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 onc 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 buricd. 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 ati original interment, by a satisfactory certificate of the attending physician, if any, as regulred by law, or in lieu thereof a certlacate 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 irsufficient, a physician who is a member of the board of health. or employed hy 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 certificatc. 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 ay above provided and In the possession of the undertaker desiring to make such removal shall constitute & permit for such removal ; provided, that such body shall be returned to the town from which it was removed within thirty- slx 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 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 permlt 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, Soc. 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 these of persons to whom they have given bedside care during a last Il1- 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 physiclan 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- inla). and by the action of chemical (drugs or polsons). thermal. or electrical agents, and deaths following abortion, but also deaths from disenso 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 fallurc, asphyxia, asthenia, etc. As principal cause namc the disease causing death. As related causes, name earlier morbid con- ditions, if any, related to the principal eauss and any important complication of the principal cause.
Statement of Occupatien .- Precise statement of occupatlon 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 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, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write nons.
SPACE FOR ADDITIONAL INFORMATION
IR-301 A
PLACE OF DEATH
Suffolk
(County)
Wruttrop
(City or Town)
78 Crystal Love Que.
No.
nellie m. Ellis (Knball)
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.
192."
Registered No ..... § (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) 78 Crystal come Que. St.
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community
3
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
Female/ White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Hesse M. Ellis
(or) WIFE of.
(Husband's name in full)
6 Age of husband or wife if alive. .years
7 IF STILLBORN, enter that fact here.
8
81
AGE
Years
0
Months.
Days
4
If less than 1 day
Hours.
Minutes
Usual
at theme
9 Occupation :..
Industry
10 or Business:
,
11 Social Security No .......
12 BIRTHPLACE (City) ..
(State or country)
13 NAME OF
FATHER
abel
Kinhwill
14 BIRTHPLACE OF Cannot be Banned FATHER (City) (State or country)
PARENTS
15 MAIDEN NAME
OF MOTHER
Hanet Rackun
Dockrem
16 BIRTHPLACE OF MOTHER (City). Cannot Be Learned (State or country) ·
0
VI
17 Ww. Clemles Mr. Lewicy dag with Reiation, if any Informant (Address) 18 Capital Come Que Winters
I HEREBY CERTIFY that a satisfactory standard certificate of death wag filed with me BEFORE che bumal or transit permit was issued : I M. D. Guldrest (Signature of Agent of Board of Heaith or other) Health Applier 10/14/40 (Official Designation) V (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
October 13,
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I, attended deceased from
I last saw h in alive on.
(a)12, 19 4 p death is said to
have occurred on the date stated above, at 3.30 P
.m.
Immediate cause of death.
Duration IMPORTANT
Due to.
Due to.
Varicose
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
(Signed)
M. D.
(Address) Y Undum Mon Date /10-141940
21.
u
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL ..
Getalien 16,
1940
....
22 NAME OF
FUNERAL DIRECTOR
A Ettendeson Co.W. R.grant
ADDRESS.
Received and filed 19
(Registrar)
100m-2-'40-D-729-a
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
St.
:
(If U. S.
(specify WAR )
(If nonresident, give city or town and state)
19 .... O to.
Centra 13 1940
Of autopsy.
What test confirmed diagnosis ?.
Major findings: Of operations.
Date of
.......
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwitb, after the death of a person whom be has attended during bis 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, tbe duration of bis last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body wbich has not been buried, until he has received a permit from the board of health, or its agent appointed to issue sucb 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 health or its agent aforesaid or from the clerk of the town wbere 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 pbysician 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 sucb 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 sball constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed witbin thirty-six bours after such removal, unless a permit in the usual form for the re- moval of such body bas been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of tbe 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 furnisb for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of tbe deatb, wbicb 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 bealth 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 tbose 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 boine 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 deatbs 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.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not tbe 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 bealtbfulness 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 tbe usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman wbose only occupation was that of bome bousework, 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 wbo bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
AR-301 A Suffolk
PLACE OF DEATH
(County) intimp (City or Town) 423 Wanthurts At
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. 193
Registered No.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
423 Vindurch
St.
(If nonresident, give city or town and state) In this community / 3 yrs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) Widowa
Sa If married, widowed, or divorced - 6 XYalak HUSBAND of Iluhunnit
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
.years
7 IF STILLBORN, enter that fact here.
AGE ..
8
80
Years
Months.
Days
If less than 1 day Hours Minutes
Usual
9 Occupation:
Oye Maker
Industry
10 or Business:
Retired
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
cheland
13 NAME OF
FATHER
Patrick For
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country)
cheland
15 MAIDEN NAME
OF MOTHER
ME Ellen Mc Shane
16 BIRTHPLACE OF MOTHER (City). (State or country)
cheland
17 James Flat
Relation, if any
Informant (Address) 423 anthrop IL Senthuli
I HEREBY CERTIFY that a satisfactory standard certificate of death wasfiled with me BEFORE the burial or transit permit was issued : Www. D. Children . (Signature of Agent of Board of Health or other) Malthe Office 10/18/48
(Official Designation) (Date of Issue of PermitY
18 DATE OF
DEATH
17 1940
(Month)
(Day)
(Year)
+1 19 I HEREBY CERTIFY That, Iattended deceased from 1940
.... alive on. BETTIS 194 death is said to m. have occurred on the date stated above, at 1,305. Immediate cause of death ...........
Duration IMPORTANT
Due to.
Chironis heplinit
190€
1936
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations.
Of autopsy.
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?..... ). If so, specify ...
(Signed)
624 305Oct/2 040
malden
Holy Cross
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
WIT 20
19.40
22 NAME OF Huderick I magrack ADDRESS 64 Moulian IEast/ Botão FUNERAL DIRECTOR ..
Received and filed.
19
(Registrar)
100m-2-'40-D-729-a
CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and extracts from the laws on back of certificate.
2 FULL NAME
John
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
St.
(If U. S.
War Veteran,
specify WAR)
MEDICAL CERTIFICATE OF DEATH
(general)
Due to.
Date of.
Underline the cause to which death should be charged sta- tistically.
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 helief 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 body in a town, or remove therefrom a human body which 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 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 hody 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 hy law to he 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 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 hy 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 heen 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).
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