USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 21
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SPACE FOR ADDITIONAL INFORMATION
-
M R-301 A |
PLACE OF DEATH
Suffolk (County)
Uhr 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.
59
Registered No. § (If death occurred in a hospital or institution, St.
2 FULL NAME
SarahJane Collver
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
48Winthrop Shore Drive
St
(If nonresident, give city or town and state)
In this community4 1
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
.March
17
1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. That I attended deceased from December 28 1940 to March 14 1941
I last saw h ........... alive on March 14 194.1 ... , death is said to
have occurred on the date stated above, at 51.00
A .m.
Immediate cause of death
Arteriosclerotic Heart Disease
Auricular fibrillation
7 days
Due to.
Generalized Ateriosclerosis
Due to.
Other conditions. (Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations
Date of.
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?: NO
If so. specify
(Signed)
(Address) .... W.AGMAN ... M.D.
Date.
3/18 94/
26 WASHINGTON AVENUE
Exeter
N. H.
21 ....
Place of Burial, Crema
"HUSKEToval
DATE OF BURIAL
Larch 20.
1941
19
22 NAME OF FUNERAL DIRECTOR Charles R. Bennison ADDRESS.Winthrop .... Mass.
Received and filed
19
(Registrar) X
Winthrop 1 (City or Town) 3 SEX Female 4 COLOR OR RACE White 6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here. 8 AGE. .81 Years 3 .. Months. 1.6 .. Days Ueual 9 Occupation :... At home Industry 10 or Business: 11 Social Security No. 12 BIRTHPLACE (City). St. Johns (State or country) New Brunswick 13 NAME OF 14 BIRTHPLACE OF FATHER (City) (State or country) England PARENTS MOTHER (City). (State or country) Newfoundland 17 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 100m-2 -* 40-D-729-a N. B .- WRITE PLAINLI, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of FATHER Emanuel Collyer
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
Sa If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
years
If less than 1 day
Hours
.Minutes
15 MAIDEN NAME
OF MOTHER
Mary Jane Crocker
16 BIRTHPLACE OF
Harbor Grace
Relation, If any
Informant. Mary T. ... Collver sister) (Address) 48 Winthrop Shore Drive
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued:
Um. Dehuldreso
(Signature of Agent of Board of Hean for other)
a Mai- 19/41
(Official Designation) (Date of Issue of Permits
No .. 48 Winthrop Shore Drive .....
{ give its NAME instead of street and number)
(If U. S.
War Veteran,
epecify WAR)
years
months
days.
Duration IMPORTANT 20 vrs
Underline the cause to which death should be charged sta- [tistically.
M. D.
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 deatlı, stating to the best of his knowledge and helief 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 hy 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 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 tomh 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 hody is buried. No such permit shall he issued until there shall have been delivered to such hoard, agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy law to he 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 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 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 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 80 given and the physician certifying the cause of death shall thereafter furnish 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).
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 he huried or the funeral is to he 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 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 hy traumatism (including resulting septicemia), and by 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 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 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 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
RM R-301 A
Every item of
1
PLACE OF DEATH
Suffolk (County Winter (City or Town) Quitter
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Hospitali
To be filed for burial permit with Board of Health or its Agent.
60
(If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR) Levere
(If nonresident, give city or town and state)
Length of stay: In hospital or institution. (Specify whether)
years
nonths days.
In this community yrs.
mos. days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Wiele
4 COLOR OR RACE white
5 SINGLE
MARRIED
WIDO WED
or DIVORCED
(write the word) single
5a If married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8 AGE Years .. Months Days
If less than 1 day Hours .... Minutes
Usual 9 Occupation: Industry 10 or Business:
........
11 Social Security No .. Winthrop,tues
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Samuel Friese
14 BIRTHPLACE OF
FATHER (City) .....
(State or country) Salem mess.
15 MAIDEN NAMEO OF MOTHER Othel Goldstein
16 BIRTHPLACE OF MOTHER (City) .... Boston, wess (State or country)
.17 Sammel Friese (Fottre)
Informant (Address) 146- Slisten Gue,
I HEREBY CERTIFY that a satisfactory standard certificat ordeath was filed with me BEFORE the burjal or transit permit was issued: Www. D. Children
(Signature of Agent of Board of Health or other)
Health Officer 3/28/41
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
March 28
(Month)
(Day)
1941 (Yeaf)
19
I HEREBY CERTIFY,
19
., to
That I attended deceased from
I last saw h ............. alive on. 19. death is said to
......
Duration IMPORTANT
Due to
Due to.
Other conditions. (Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
Date of
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify (Signed)
Place of Burial, Cremation or Removal. DATE OF BURIAL.
(City or Town) 28
19.
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
10- West H DA
Maure Struct
Received and filed APR 3 1941
(Registrar)
100m-2 -* 40-D-729-a
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
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. is very important. See instructions and extracts from the laws on back of certificate.
No ..
2 FULL NAME
Baby
Joe
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
146 - Stanley Que St
19
have occurred on the date stated above, at. 12 300 m.
Immediate cause of death .................. Dead Felus
PARENTS
Underline the cause to which death should be charged sta- tistically.
21
Relation, if any
Registered No.
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 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 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 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 hody is buried. No such permit shall he issued until there shall have heen delivered to such board, agent or clerk, as the case may he, 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 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 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 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 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 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 he ohtained 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).
SPACE FOR ADDITIONAL INFORMATION
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 hody is to he huricd 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, 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 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 supposahly due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and hy 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 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 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 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 hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
RM R-301 A1 1
stelt
(Cpunty) Mütterof (City or Towny
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.
61
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 for divorced woman, give also maiden name.)
115 Sunnit Que
......
.. St.
(If nonresident, give city or town and state)
Length of stay : In hospital or institution ....
years
months
days.
In this community 5 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
Female White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED.
Harley
18 DATE OF
DEATH
March
30
(Month)
(Day)
1941
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give malden Mame of wie ja foul)
Randolph leur
(or) WIFE of
(Husband's name in full)
45
years
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
If less than 1 day
8 55 Years 9 AGE Months Days
5
Hours.
Minutes
9 Occupation:
Forlady
Industry
10 or Business:
Tavaly Mfg 60
1I Social Security No.
021-05-9341
12 BIRTHPLACE (City)
Saint John's,
(State or country)
Granada.
13 NAME OF
FATHER
John In. Knight
14 BIRTHPLACE OF
FATHER (City)
Viverbool,
(State or country) England.
15 MAIDEN NAME
OF MOTHER
Martha English
Vierpool,
17 Jurs Melkille Harrington Friend. 1
Informant.
(Address)
115 Summit ine. Winthrop Mas
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the Burial oy transit permit was issued: Www. D. Childress
(Signature of Agent gf Board of Health or other)
Healthe Officer
4/1/4/
(Official Designation) (Date of Issue of /Permit)
18 I HEREBY CERTIEY november
That I attended deceased from Maury 30 1941
19 .... I last saw ha. er March 20 1941 to have occurred on the date stated above, at 50 .m.
Immediate cause of death ...... acute Coronary Thrombosis
Duration IMPORTANT 3 days.
1 year
1year
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Of autopsy
Clinical x
What test confirmed diagnosis ?
lauracory
20 Was disease er Injury In any way related to occupation af deceased?
200
1
14:00M.
D.
If so, specify. 1 (Signed) (Address) 562 Plunder Pate 3/31/19%. New Galvery Cemetery W. Roy, Mas. Place of Burial, Cremation or Removal. City or Town) 19 41
DATE OF BURIAL Gebzel
2
22 NAME OF
FUNERAL DIRECTOR
John Auchan
ADDRESS.
35) Maindy, Medford, mas.
Received and filed
APR-3- 1941
19
(Registrar)
1 3 SEX PARENTS information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION deceases was thought to bemarried, Nellachies N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Usta 100m-10- 39. No. 8427-e
PLACE OF DEATH
No. 115 Summit ave.
Josephine m=Knight
(If U. S. War Veteran, specify WAR)
(a) Residence. No ...
(Usual place of abode)
(Specify whether)
St.1
0
alive on death is said
...
Due to artevinateros
Due to
Hypertension
Date of.
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
21
16 BIRTHPLACE OF MOTHER (City) (State or country) England.
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 cxhume 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 sball be issued until there shall have been de- livered to such board, agent or clerk, as the casc 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 carly 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 carly enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such reinoval 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.)
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