USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 5
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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 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
Suffolk
(County) Stunthrob
(City or Town)
100 Versace are No .....
2 FULL NAME.
(If deceased is a married,
wjudred or divorced wonian, give also maiden name.) 100 Terrace area
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution ....
have
"(Specify whether)
years
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DivoraDelante
Sa If married, widowed. HUSBAND of Margaret Seeley (Give maiden naine 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 ... 90 00
„Months ........... .. Days
If less than 1 day Hours .. Minutes
Usual 9 Occupation :
Retired Certiet
10 or Business: Scenic
11 Social Security No. Dane
12 BIRTHPLACE (City)
(State or country)
3.2%
3.3. City
13 NAME OF
FATHER
John a Thompson
14 BIRTHPLACE OF FATHER (City) . (State or country) S.V.
15 MAIDEN NAME
MOTHER langex be learned
16 BIRTHPLACE OF MOTHER (City) nu City (State or country)
17 Relation, if any
Informant Jours. @ magnagoof Law) (Address) 100 Versace Der Vaart
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial of transit permit was issued: Wan. D. Children Signature of Agent of Board of Health or other) /Realite Officer 1/10/41
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
1
(Day)
(Year)
19 .I HEREBY CERTIFY.
2
19 ..
, to.
That I attended deceased from
1944
I last saw h .............. alive on
death is said to
have occurred on the date stated above, at .....?..
Immediate cause of death
m.
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?
Was disease or injury in any way related to occupation of deceased ?.
If so, specify
>
M. D.
(Signed)
(Address) .................
Of ......... Date]
19
21 twitteraf
Place of Burial, Cremation of Removal.
(City or Town)
BURIAL Je211
O
22 NAME OF
FUNERAL DIRECTOR
ADDRESS.
Received and filed.
19
(Registrar)
Keley - see death CheDit
M R-301 Ą
8 PARENTS 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 is very important. See instructions and extracts from the laws on back of certificate. 100m-2-'40-D-729-& N. B .-- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry
PLACE OF DEATH
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.
13
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
......
Salm a Thambern
$
(If U. S.
War Veteran,
specify WAR) ....
(If nonresident, give city or town and state)
60
1140
Underline the cause to which death should be charged sta- tistically.
....
Į
Kellie.
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 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 hody which has not heen huried, until he has received a permit from the board of health, or its agent appointed to issue such perinits, or if there is no such hoard, from the clerk of the town where tlie 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 huried. No such permit shall he issued until there shall have heen 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, 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 board of health, or em- ployed by 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 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 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 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 shail 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 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 hy 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 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 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 morbid conditions, if any, related to the principal cause and any important complication of the principai 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 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.
SPACE FOR ADDITIONAL INFORMATION
M R-301 A |
1
PLACE OF DEATH
Suffolk. (County) Winthrop
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
Registered No.
( (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced wordan, give also maiden name.) 28 Trident ave.
St.
Winthrop
(If nonresident, give city or town and state)
months days.
In this community O yra.
mog.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
white
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
So If married, widowed, or divorced HUSBAND of.
(Give malden name of wife in fuli)
(or) WIFE of John
Papp
(Husband's name in figi)
spot.
6 Age of husband of wife if alive.
years
7 IF STILLBORN, enter that fact here.
AGE
If less then 1 day
Hours
Minutes
Usual
9 Occupation :..
Industry
10 or Business:
ou
home
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Vasilior Valahogy
14 BIRTHPLACE OF
FATHER (City) ....
(State or country)
15 MAIDEN NAME
OF MOTHER
Sanoula Kolo Riches
16 BIRTHPLACE OF
MOTHER (City) ...
(State or country)
17 William Papper Relation, if any San
Informant
(Address)
15 - Carol Que Wund
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 Health or other )
Health Mulder 1/10/41
(Official Designation) (Date of Issue of Permits
18 DATE OF
DEATH
January
9
1941.
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY. Decanter 10 1932
That I attended deceased from
to January 9 ... ,
1941
I last saw her alive on January 8, 194, death is said to have occurred on the date stated above, at 12:304. ... m.
Immediate cause of death .... Ucule Cormary Mecantons
Duration LUPORTANT 3 days
.... 2 years
Due to
Senility
2 years
Other conditions.
Congestive Heart Disease 3 zes
(Include pregnancy witnn 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations.
none
Date of
Of autopsy chu malt
What test confirmed diagnosis ?.. caviracing
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify A
(Signed) .....
(Address) 562 Stanley Date 1/9
19461.
21.
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL ...
January
10
1941
22 NAME OF
FUNERAL DIRECTOR
arthur 3. Nacisti
ADDRESS
1654 Washington (Boston)
Received and filed
19
(Registrar)
100m-2-'40-D-729-8
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 is very important. Sen instructions and extracts from the laws on back of certificato.
No ....
(City or Town) 28
Trident Owe. angelika Pappas.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
MEDICAL CERTIFICATE OF DEATH
Due to ... arteriosclerosis
8 70 Years Months. Days
PARENTS
Underline the cause to which death should be charged sta- tistically.
M. D.
CERTIFICATE OF DEATH
(If U. S. War Veteran, specify WAR)
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. defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the 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 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 re- 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).
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 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 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 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 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 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
RM R-301 A
100m-10-'39. No. 8427-e N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS
17 Relation, if any
Informant
89 Cliff and Winthisp
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE. the Burial or fransit permit was issued: Im. 8. Chil dress (Signature of) Agent of Board of Heath or other) Vrealthe Officer (Official Designation) (Date of Issue of Permit) 1/11/41
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jan.
9
1941
(Month)
(Day)
(Year)
19 J HEREBY CERTIFY.
That I attended deceased from
December 20 1939 to January 9
19.5.6.( ..
I last saw hel alive on January 19, 1041, death is said
to have occurred on the date stated above, 508:30911.
Immediate cause of death ...
acute Coronary Thrombosis
Duration IMPORTANT 3 days 13 year
Due to
acqua Pectoris
1 year
Other conditions.
none
(Include pregnancy within 3 months of death)
Major findings :
Of operations
une
PHYSICIAN Underline the cause to which death
Of autopsy"
une
should be
What test confirmed diagnosis
clinical klak charged sta-
"tistically.
20 Was disease or Injury In any way related to occupation of deceased?
If so, specify ...
Jacob hau R.D.
(Signed
, M. D.
(Address) 562 Sunday 1 Date 1/10
1941
21
Winthis
Winthis
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL Ofan
11
19.41
22 NAME OF
FUNERAL DIRECTOR Richard 96. chito
ADDRESS ..
147 Winthup Mass
Received and filed 19
(Registrar)
1 3 SEX Female 8 65 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 Industry 10 or Business:
(County) PLACE OF DEATH Suffolk Winthrop (City or Town) 60 Chiff are Winthey Areso No Elizabeth Downing Hiller
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
To be filed for burial permit with Board of Health or its Agent
15
Registered No
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
(If U. S. War Veteran, specify WAR)
(If nonresident, give city or town and state)
years
months
days. to In this community / 5 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
(write the word)
MARRIED
WIDOWED
Manuel
5c If married, widowed, or divorced
HUSBAND of
Theodor& Hiller
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
71
years
6 Age of husband or wife if alive. 7 IF STILLBORN, enter that fact here.
AGE
Years.
6
Months.
30 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
at 16 ome-
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
New York City
new york
13 NAME OF
FATHER
John Downing
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Not Known
15 MAIDEN NAME
OF MOTHER
not Known
16 BIRTHPLACE OF MOTHER (City) (State or country) /01 /5 9own
STANDARD CERTIFICATE OF DEATH
2 FULL NAME
( deceased is a married, widowed or divorced woman, give also maiden name.) 60 Cliff are ........................ St.
(a) Residence. No.
( Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
4 COLOR OR RACE
White
Due to
arteriosclerosis
.Date of.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan or registered hospital medical officer sbail fortbwith, fter the death of a person whom he has attended during his last Iness, at the request of an undertaker or other authorized person r of any member of the family of the deceased, furnish for regis- 'ation a standard certificate of death, stating to the best of his nowledge and belief the name of the deceased, his supposed age, ne discase of which he died. defined as required by section one, here game was contracted. the duration of his last illness, wben last een alive by the physician or officer and the date of his death ... en. Laws. Chap. 46, Sec. 9.
No undertaker or other person sball bury or otherwise dispose of a uman body In a town, or remove therefrom a human body which as not heen buried, until be has received a permit from the board [ health, or its agent appointed to issue such permits, or if there no such board, from the clerk of the town where the person died : nd no undertaker or other person shall crhume a human body and emove it from a town, from one cemetery to another, or from one rave or tomh other than the receiving tomb to another in the same smetery, until he bas received a permit from the board of health or s agent aforesaid or from the clerk of the town where the body is uricd. No such permit shall be issued until there sball have been de- vered to such board, agent or clerk, as the case may be, a satisfao- ry written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an riginal interment, by a satisfactory certificaic of the attending hysician, if any, as required by law, or in lieu thercof a certificate s hereinafter provided. If there is no attending physician. or if, for ufficient reasons, his certificate cannot be obtained carly enough for he purpose, or is insufficient, a physician who is a member of the oard of health, or employed by it or hy the selectinen for the pur- ose, shall upon application make the certificate required of the at- ending physician. If death is caused by violence. the medical exam- er shall make such certificate. If such a permit for the removal of human hody, not previously interred, from one town to another ithin the commonwealth cannot be ohtalned early enough for the urpose, the certificate of death made as above provided and in the ossession of the undertaker desiring to make such removal shall onstitute a permit for such removal ; provided. that such body shall e returned to the town from which it was removed within thirty- ix hours after such removal, unless a permit in the usual form for ne removal of such body has been sconer obtained hereunder. If the eath certificate contains a recital, as required by section ten of hapter 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 ngaged. such recital shall appear upon the permit. The board of ealth, or its agent, upon receipt of such statement and certifcatc. hall forthwith countersign it and transmit It to the clerk of the own for registration. The person to whom the permit is so given od the physician certifying the cause of death shall thereafter fur- isb for registration any other necessary information which can be btained as to the deceased, or as to the manner or cause of the eatb, which the clerk or registrar may require .- Chap. 114, Sec. 45, . L., (Tercentenary Edition.)
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