USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1940 > Part 61
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SPACE FOR ADDITIONAL INFORMATION
AR-301 A
is very important. See instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
Suffolk
(County)
1
Winthrop
(City or Town)
No. 8 BillowsSt
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 207
Registered No. § (If death occurred in a hospital or institution, { give its NAME instead of street and number)
2 FULL NAME
Edward Joseph Reilly
(If deceased is a married, widowed or divorced woman, give also maiden name.)
8 Billowsst
St
(If nonresident, give city or town and state)
3
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDrried
5a If married, widowed, on
HUSBAND of
AfaceCH Donahue
(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.
8
AGED1
Years
Months.
.Days
If less than 1 day .Hours Minutes
Usual
9 Occupation:
Paper ... Ruler
Industry
Printing
10 or Business :.
11 Social Security No. 021-01-5074
12 BIRTHPLACE (City) Charlestown
(State or country)
massachusetts
13 NAME OF
FATHER
Thomas F. Reilly
14 BIRTHPLACE OF
Randolph
FATHER (City)
(State or country)
Massachusetts
15 MAIDEN NAME
OF MOTHER
Agnes O'Connell
16 BIRTHPLACE OF
MOTHER (City).
(State or country)
Canada
Relation, if any
Informant Alice. Reilly ( ... wife (Address) 8 Billow St Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health or other)
Realit Aplicar 11/13/40
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
November
11
1940
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, JEPT. 7
1920 ..... ,
I last saw h .. / .. 2%1 ... alive on.
NOV
11
19.90, death is said to
Duration
IMPORTANT
6 HRS
Due to ...
ESSENTIAL HYPERTEN-
VION
5 YRS
Due to.
Other conditions.
CARDIAC ENLI
MENT
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings:
Of operations ..
NONE
... Date of.
Of autopsy.
NONE
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 of deceased?
If so, specify ....
morvanM. D.
(Signed)
(Address) 28 with
La Date!
e NON 121990
21
inthron am Tetsthrop
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL.
November 14
1.40
.......
22 NAME OF
FUNERAL DIRECTOR
John F. OWales
ADDRESS
Winthrop, Massachusetts
Received and filed. 19
(Registrar)
-SALAJ EVACTIV
information should be carefully med that may be properly classined. Exact statement of OCCUPATION ACE .L .- IJ L
PARENTS
Montreal
17
100m-2-'40-D-729-8
St.
(If U. S.
Wer Ve WARS
World
(a) Residence. No
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
NOV. 11, to .. .m. 19 have occurred on the date stated above, at 3:15 Immediate cause of death. HYPERTENSIVE ENCEPHEL - OPATHY
That I attended deceased from
40
50
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human hody in a town, or remove therefrom a human hody 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 suchi hoard, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another. or from one grave or tomh other than the receiv- ing tomb to another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the body is 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 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 by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 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 re- moval 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 health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be huried 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 Ilealth physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia). and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled 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 morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very Important, so that the relative healthfulness of various pursuits can 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 business, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook -- hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
12-301 A
Suffolk Winthrop
(County) Winthrop Suffolk
(City or Town)
No. 83 Waldermar Ave
The Commonwealth of Mangarhugette OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Ager 2008
Registered No
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
2 FULL NAME
Hattie E Eddy Gillig
(If deceased is a married, widowed or divorced woman, give also maiden name.)
83 Waldermar Ave
St
(If nonresident, give city or town and state)
months
days.
In this community20
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Temald
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Marri
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
John W.Gillis
(Husband's name in full)
6 Age of husband or wife if alive ..
years
7 IF STILLBORN, enter that fact here.
8
AGE 70
Years
Months.
Days
Ifless than 1 day Hours Minutes!
Usual
9 Occupation OuSeuLife
Industry
10 or Business :.
Own Home
11 Social Security No ....
12 BIRTHPLACE (City)
(State or country)
Danoy
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Vermont
15 MAIDEN NAME
OF MOTHER
Cannot Be learned
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
Vermont
Relation, if any
17
John T. Gillis
(
Husband)
Informant
(Address)
83 Holderman
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 Heakh or other)
Health Officer 11/14/40
(Official Designationy (Date of Issue of Permit)
18 DATE OF
DEATH ..
November
13
(Month)
(Day)
(Year)
19 ^ I HEREBY CERTIF That I attended deceased from
19.60 to.
13
19 80
last saw ho alive on Nommen 13, 1944, death is said to have occurred on the date stated above, at. 10 hm .m.
dife cause of day rendition
Duration IMPORTANT 1936
0761
Door-to
Brandil Other
1856
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT PHYSICIAN
Major findings: Of operations ....................
Of autopsy ..
What test confirmed diagnosis? labs toute
.Date of
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? 200
If so. specify
Frank & Ra
(Signed)
(Address)
M. D.
Para quemDate na 13 1940
21.
winthrop Winthrop
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Nov
I5
(City or Town)
I940
18
22 NAME OF
FUNERAL DIRECTOR
them . Tweeler
ADDRESS
Tixthron
Received and filed .. 19
(Registrar)
100m-2-'40-D-729-a
stated EXACTI.Y AGF. should ha information should be carefully sunnlied. is very important. See instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
PHYSICIANG .hanld .teta
1
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
MEDICAL CERTIFICATE OF DEATH
1980
Chimie tabla Mychristian
13 NAME OF
FATHER
Benjamin Eddy
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, definded as required hy 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 hury or otherwise dispose of a human hody in a town, or remove therefrom a human hody 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 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 tomb other than the receiv- ing tomh to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he issued until there shall have been delivered to such hoard, 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 interinent, 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 be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed hy it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death Is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 hody shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner ohtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has heen engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the inanner 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 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 body Is to be buried or the funcral is to be held, or from a person appointed to have the care of the cemetery or hurial 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 hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated 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 supposahiy due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized discase, 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, asphyxla, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he 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
PLACE OF DEATH
1
(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. 209
105 Grovers are No anna m. Donovan
St.
§ (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 namc.)
105 Grovere
St
(If nonresident, give city or town and state)
none
years
months
days.
In this community /5 yrs. mos. days.
PERSONAL AND STATISTICAL PARTICULARS/ red
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
3h.
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
fuet
Sa If married, widowed, or divorced HUSBAND of. Jemachen Donovan (or) WIFE of (Husband's name in full)
6 Age of husband or wife if alive 56 .years
7 IF STILLBORN, enter that fact hero.
8 AGE 5Years
If less than 1 day
.. Hours
Minutes
Usual ar Norne
9 Occupation :.
Industry
10 or Business:
11 Social Security No. 22
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
adolf Hanenati
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER Unna no. Stosuenbad
16 BIRTHPLACE OF
MOTHER (City).
(State or country)
Germany
17 Vinothe Phone
Relatlon, if any
Informant (Address) 105 Elevera angebo
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. S. Childress Signature of Agent of Board of Health or other
Health Affiner 11/18/40
(Official Designation) (Date of Issue of Permit) (
18 DATE OF DEATH. November
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Nov2
19:40, to NY22 15
1940
I last saw hes alive on Nov 14, 1940, death is said to
have occurred on the date stated above, at. 15/5 a .m.
Immediate cause of death. Carcasa Jajest
Due to Toranach
A Breast
Due to.
Cancunacid
Other conditions ... Dabeste Velles (Include pregnancy within 3 months of death)
15 mm
IMPORTANT
PHYSICIAN
Underline the cause to which death should be
charged sta-
20 Was disease or injury in any way related to occupation of deceased? 220
If so, specify .. (Signed) Charles O Thompson .. , M. D.
(Address) ........ Mantan, Megaro ate 1 ca. 169 40
Place of Burial, Cremation Bemoval,
City of Town)
DATE OF BURIAL
...
22 NAME OF
៛ FUNERAL DIRECTOR
ADDRESS
Bostano
Received and filed
19
(Registrar)
Duration IMPORTANT
Major findings: & operations. Camargo Granada 0 .. Date of.
Of autopsy
-
What test confirmed diagnosis ?.
VR-301 A Suffoche County) Winthrop 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. 100m-2-'40-D-728- N. B .- WRITE PLAINLY, WITIT ONFADING DLAGN ING THIS IS A ILIANLit IL601. Vy 1CM V. PARENTS
Registered No ..
(If U. S. War Veteran, specify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution ....
(Specify whether)
"witte the word)
1940
Months .. Days
1
Betterby
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. definded as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- ing tomb to auother 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 delivered to such board, agent or clerk, as the case may be. a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the res moval of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required by section ten of chapter forty- six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
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