USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 25
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3 SEX
4 COLOR OR RACE
Female
White
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE69
Years
Months
5
Days
Usual
9 Occupation :
Proprieter
Industry
11 Social Security No ..
None
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
14 BIRTHPLACE OF
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
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.
information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
100m-2-'40-D-729-8
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
FATHER
James Coles
§ (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
St.
(If nonresident, give city or town and state)
48
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 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 hody in a town, or remove therefrom a human body which has not been buried, until lie 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 tomh 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 huried. 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 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 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 perinit 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 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 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 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).
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 inade. . . . 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 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 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 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 he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from husiness, 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
M R-301 A
PLACE OF DEATH
Suffalls - (County )
The Commontoralth 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.
73
f (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
tory-
(If deceased is a married, widowed or divorced woman, give also maiden nante.)
(a) Residence. No. 77 Triton Avenue St.
years months -days.
In this community/2
yrs.
-mos.
-- days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
4
20
41
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
19
...
to.
19
I last saw h.
alive on
19 ..
death Is said to
have occurred on the date stated above, at
6ft
m.
Duration
Immediate cause of death.
arteria.
IMPORTANT
Due to.
Due to
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Date of.
Of autopsy
What test confirmed diagnosis?
Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury in any way related to ocoupation of deceased ?........
so, specify . Harra att ell (Signed)
(Address) w.
wthump, MITuns Date 4/20 M. D.
19.4.1 ..
21
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIALabril 23
FUNERAL DIRECTOR Daniel J. Jullivan
ADDRESS 318 Shout Ave-Brata
19 ....
Received and filea APR 2 4 1941
(Registrar)
100m (d)-1-41-4667
I HEREBY CERTIFY, that a satisfactory standard certificate of deathuna b22 NAME OF filech with me BEFORE the burial er transit permit was issued : Nau. S. Culdrey f . ( Signature of Agent of Board of Health or other) 41 Seattle Officer 4172142 17
..... (Official Designation) (Date of Issue of Permit)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR) .. 10 diaso .
hone
Winther
(If nonresident, give city or town and State)
1 2 FULL NAME a rence (Usual place of abode) Length of stay: In hospital or Institution. ( Before death) (Specify whether) PERSONAL AND STATISTICAL PARTICULARS 3 SEX Male 4 COLOR OR RACE| White 5 SINGLE , (write the word) Widower MARRIED! WIDOWED idone Service a Place HUSBAND of (or) WIFE of (Give maiden name of wife in full) (Ilusband's name in full) 6 Age of husband or wife if alive years 7 IF STILLBORN, enter that fact here. 8 If less than 1 day Hours Minutes AGE 91 Years ( Week- Month's. Days Usual Inspector 9 Occupatiop: Industry 11 Social Security No .. home 12 BIRTHPLACE (City) (State or country) gestor non 13 NAME OF FATHER Mathen Hrey- 14 BIRTHPLACE OF Boston mass FATHER (City) (State or country ), 10 15 MAIDEN NAME Ek OF MOTHER Bostonchass 16 BIRTHPLACE OF PARENTS MOTHER {City) (State or country) 17 Fred Hrey- Relation if any Informant (Address) 77 Fut tvene Kultur If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoltai to that effect. extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain 10 United States nepiwo of Water
(City or Towp) No. 17 Tutowc venue -Ancheur t
Registered No.
malden
Physician
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 umulertaker 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, defined as re- quired by section one, where same was contracted, the duration of his last illness, when last seen alive by the physiciau or officer aud the date of lia death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the ariny, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate both the primary aud the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five. forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexi- can border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a towu, 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; aud no undertaker or other person shall exhume a human body and remove it from a town, fromn one cemetery to another, or from oue 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 delivered to such board, agent or clerk, as the case inay 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 insufficient, a physi- cian who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medi- cal 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 comunouwealth 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 obtained hereunder. If the death certificate contains a recital, as required
by aection ten of chapter forty-six, that the deceased acrved 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 certifylug the cause of death shall thereafter furnish for registration any other neces- saty 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 aahes thereof which have been brought into the commonwealth until he has re- ceived 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 tlic 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 juterment is made. .. . Chap. 114, Sec. 46, G. 1 .. , (Terecutenary Edition).
Medical examiners shall make examination upon the vlew of the dead bodies of ouly such persons as are supposed to have died by violence. If a inedical examiner lias notice that there is within his county the body of such a person, lie shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Chap. 38, Scc. G.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rulea 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 physiclans 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 receut medical attendance or wliose pbysi- cian is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deathis 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, c. g., licart failure, asphyxia, astheuia, etc. As principal cause name the discase 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 im- portant, so that the relative healthfulness of various pursuits can be known. Make some dutry 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 retiremcut. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of honie 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
M R-301 A
Suffolk
II8 Bartlett Rd
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)
(a) Residence. No TT8 Bon+]
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
..... Rd
St
(If nonresident, give city or town and state)
In this community
4
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Vidoma
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Euguene Sullivan
(Husband's name in full)
.years
If less than 1 day Hours ... Minutes
12 BIRTHPLACE (City).
(State or country)
Ireland
13 NAME OF
FATHER
Patrick I. Corcoran
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Ellen Good
16 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Ireland
Relation, if any
(Daughter)
(Address)
ITS Dont lett 02
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: William 8, Children
(Signature of Agent of Board of Health or other)
agent april 27/41
(Official Designation) (Date of Issue of Vermit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
(Month)
(Day)
(Year)
19
-
HEREBY CERTIFY,
That I attended deceased from
19 ........ , to.
19
I last saw h ...
... alive o
19
death is said to
have occurred on the date stated above, at.
Immediate cause of death
Duration IMPORTANT
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
my n netu
Major findings:
Of operations.
or ofcarry
Date of
Of autopsy.
What test confirmed diagnosis ?.
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) ..
4/20
19:41
21.
Holy Cross Halden
(City or Town)
Place of Burial. Cremation or Removal.
DATE OF BURIAL
/12/11/28
T040
22 NAME OF
FUNERAL DIRECTOR.
ADDRESS
Anthrop
JohnA@Mateu
Received and filed MAY 1 4941.
19
(Registrar)
100m-2-'40-D-729-8
PLACE OF DEATH
(County)
1
linti roo
(City or Town)
No.
2 FULL NAME
3 SEX
4 COLOR OR RACE
Female
Thite
5a If married, widowed, or divorced
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact here.
8
AGE59
Years
Months.
Daysl
Usual
9 Occupation :
House wife
11 Social Security No.
PARENTS
17
Informant
Ann Sullivan
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
Industry
10 or Business:
Own Home
years
months
days.
St.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
24
41
530 Pm
IMPORTANT
Technical
€
PHYSICIAN
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 helief 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 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 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 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 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 by law to he returned and recorded, which shall be 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 board of healthi, 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 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 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 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 hoard 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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