USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1941 > Part 81
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87 | Part 88
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attendance or whose 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 septice- mia), 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 occupa- tion, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .-- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name carlier morbid con- ditions, 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 busi- ness, 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, designatc 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-302
1
PLACE OF DEATH
Essex (County)
Danvers
(City or Town) Danvers State Hospital
The Commontucalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No. 240
S (If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Ada B. Stimpson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
years
1
months
11
days.
In this community
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sep. 30, 1941
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
1
19.53.7 .....
to ...............
412
I last saw h ...... e.m.alive on ..
Dep. 30 ..... , 1941.
have occurred on the date stated above, at ......... 57.
m
death Is sald to
Immediate oause of death
Generalized ... arteriosclerosis Chr. myocarditis
4
Byrs yrs
Due to
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings : Of operations.
Date of
should be
charged sta-
tistically.
What test confirmed diagnosis ?
20 Was disease or Injury In any way related to occupation of geoe)sed ? If so, speolfy.
(Signed)
Mycr-zsekoff
M. D.
(Address)
Date 11/20041
21 PLACE OF BURIAL,
CREMATION OR REMOVALthrop
Winthrop
DATE OF BURIAL
(Cemetery)
Oct. (file or Town) ]
.19
22 NAME OF
FUNERAL DIRECTOR
Charles A. Bennison
ADDRESS
winthrop
Received and filed PIC : 1 1.
19
DATE FILED
19
Relation, if any
A TRUE COPY
ATTEST :
(Registrar 12/1/41
here death occurred)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
2 FULL NAME
(a) Residenoe. No.
85 Crest Ave.
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
3 SEX
4 COLOR OR RACE
MARRIED
female
WIDOWED
or DIVORCED
white
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
7 IF STILLBORN, enter that fact here.
8
82
AGE
Years.
Months.
Days
Usual
housewife
9 Occupation :
Industry
10 or Business :
Il Social Security No. ..
HOHE
Union, N.H.
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
Daniel Burrows
FATHER
14 BIRTHPLACE OF
FATHER (City)
N.H.
15 MAIDEN NAME
OF MOTHER
PARENTS
16 BIRTHPLACE OF
N.H.
MOTHER (City)
(State or country)
HaryK.HePhillips
17
DSH
Informant
(Address)
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk
(State or country)
Hannah Stackpole
5 SINGLE
(write the word)
idowed
(or) WIFE of
william Mallenty Stimpson
6 Age of husband or wife if alive years
If less than 1 day
Hours.
Minutes
50m (e)-1-41-4667
(If U. S.
War Veteran,
specify WAR)
Winthrop
St.
(If nonresident, give city or town and State)
That I attended deceased from
Duration
Of autopsy
clinical
Underline the cause to which death
(Registrar of City or Town where deceased resided)
1
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH
State File No.
Registrar's No.
State of NEW HAMPSHIRE
1. PLACE OF DEATH:
(a) County
Carroll
(a) State
Mass
(b) County
Unk.
(b) City or town
Conway
(c) Name of hospital or institution:
(If outside city or town limits, write RURAL)
(If outside city or town limite, write RURAL)
(d) Street No.
41 Buckthorn Terrace
(If not in hospital or institution, write street number or location)
(If rural, give location)
(d) Length of stay: In hospital or institution
In this community
about 5 months
(Specify whether
years, months or days)
3. (a) FULL NAME
Edward H. Scribner
20. Date of death: Month
oct.
16
3. (b) If veteran,
name war
3. (c) Social Security No.
21.
I hereby certify that I attended the deceased from
19
4. Sex
Male
5. Color or
race
White
divorced _M.
that I last saw h
alive on
19
Duration
Immediate cause of death
sudden
7. Birth date of deceased
July
15
1873
(Month)
(Day)
(Year)
8. AGE:
Years
68
Months
Days
If less than one day
hr.
min.
9. Birthplace
North Attleboro,Mass.
10. Usual occupation
retired
(City, town, or county)
(State or foreign country)
11. Industry or business
Other conditions.
(Include pregnancy within 3 months of death)
PHYSICIAN
12. Name
Horace M. Scribner
13. Birthplace
Boston. Mass.
14. Maiden name
Jennie D. Crab tree
Of operations
Underline the cause to which death should be charged sta- tistically.
16. (a) Informant's own signature
Mrs. Ernestine Scribmen
(b) Address_4] Buckthorn Terrace ,Winthrop I'm 22; If death was due to external causes, fill in the following:
17. (a) Burial
(b) Date thereof Oct. 19, 1942 (a) Accident, suicide, or homicide (specify)
(Burial, cremation, or removal)
(Month) (Day) (Year
(c) Place; burial or cremation Everett ,Mass. wood]_will (b) Date of occurrence Cemetery
Where did injury occur?
(City or town) (County) (State)
(d) Did injury occur in or about home, on farm, in industrial place, in public place?
(Specify type of place)
While at work? (e) Means of injury
23. Signature C. M. wiggin
Conway, N.H.
(M. D. or other) 1.D. Date signed 10/16/
(Date received local registrar)
(Registrar's signature)
Address
8-6917
U. S. GOVERNMENT PRINTING OFFICE 16-13493
41
day
hour
minute
6. (a)Single, widowed, married,
19
to
6. (b) Name of husband or wife
Ernestine Scribner
6. (c) Age of husband or wifeif | and that death occurred on the date and hour stated above.
alive
years
Acute Coronary occlusion
Due to Arterio Sclerosis
Due to
MOTHER FATHER
(City, town, or county)
(State or foreign country)
Major findings:
15. Birthplace
C'est Falmouth, Ne.
(City. town, or county)
(State or foreign country)
Of autopsy
18. (a) Signature of funeral director Cecil R, Lead
(b) Address
Conway. N.H.
19. (a) Oct. 17 1(4] Leslie_C. Hill
2. USUAL RESIDENCE OF DECEASED:
(c) City or town
Winthrop
Il (e)) If foreign born, how long in U. S. A .?
years.
MEDICAL CERTIFICATION
year
1941
3
1
DEC171341 1
9
R-302
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible was with you in test tue deccestu resided in another city of town at the time
50m-10-'39. No. 8427-f
Jutfolk
PLACE OF DEATH
(Connty)
Ronton
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return) ....
Registered No.
916742
(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Sarah
Simon
(If U. S. War Veteran, specify WAR)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
160 Shore Drive
St.
Win.thr.o.p.
(If nonresident, give city or town and state)
years
months
days.
In this community
yrs.
Inos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ..
Nov 2 1941
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(Giye maiden name of wife in full)
(or) WIFE of
Arthur ..... Simon ..
(Husband's name in full)
6 Age of husband or wife if alive. 78
years
7 IF STILLBORN, enter that fact hero.
AGE
8
65
Years
Months ..
Days
If less than I day
Hours ......
Minutes
Usual
9 Occupation:
a.t ..... home
Industry
10 or Business:
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Julius Alpert
14 BIRTHPLACE OF
FATHER (City)
(State of country)
Russia
15 MAIDEN NAME
OF MOTHER
Fannie -
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17
Informant.Anna .... Aronson.
(Address)
Relation, if any (dau .....
A TRUE COPY.
ATTEST:
frances
8 Tay
(Registrar of city of town where death occurred)
DATE FILED
11/5/41
19
Other conditions
(Include pregnancy within 3 months of death)
PHYSICIAN
Major findings :
Of operations
Date of.
Of autopsy ........ s.ame .... a.s .... ah.o.v.e
What test confirmed diagnosis ?...
autopsy.
20 Was disease or Injury In any way related to occupation of deceased ? If so, specify
(Signed)
S Stearns
M. D.
(Address).
.. Date
19.
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
DATE OF BURIAL .. 19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and fled
19
(Registrar of City of Town where deceased resided)
x
-
---
PARENTS
1
(City of Town)
-
No ... .......
Beth .... Israel .... Hospital
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(write the word)
3 SEX
fem
4 COLOR OR RACE| 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCEDmarried
19 I HEREBY CERTIFY.
to ..
10/2/41
19.
11/2/41
19
That I attended deceased from
I last saw h .......... alive on
Duretion
11/2/41
.19.
., death is said
to have occurred on the date stated above, at .... ] .. 1 .... A .... z.
Immediate cause of death.
acute myocardial infarct
recent ... myocardial .... inf.al.c.t
4 wks
Dueto ... congestive .... failure
bilateral ... hydrothorax
4 wks
2 ... dys
Due to
Underline the cause to which death should be charged sta- tistically.
(Cemetery) (City or Town)
R-302
Suffolk
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
ROSTON (City or town making return)
Registered No.
9.39143
(If death occurred in a hospital or institution, St. ( give its NAME instead of street and number)
2 FULL NAME
Thomas
Brugman
(If deceased is 2 married, widowed or divorced woman, give also maiden name.)
64 Plummer Ave
St.
Winthrop
(If nonresident, give city or town and state)
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
Or DIVORCED
(write the word)
married
5a If married, widowed, or divorced HUSBAND of
Theresa .... A .... Ahearn ....
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
.Years
6 Age of husband or wife if alive. 53
7 IF STILLBORN, ontor that fact hore.
ÄGE
8
53
Years
Months.
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation:
truck driver ....
Industry
10 or Business:
Il Social Security No.
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
Dirk Brugman
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Holland
15 MAIDEN NAME
OF MOTHER
Catherine Ferron
16 BIRTHPLACE OF
MOTHER (City)
Ireland-
.......
(State or country)
17
Informant
(Address)
Frank Brugman
( .....
Relation, if any .s.o.n
A TRUE COPY.
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED 11/13/41
19
18 DATE OF
DEATH.
Nov 8 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
11/6/41
19.
11/8/41
to ...
19.
...
to have occurred on the date stated above, at ....
Duration
I-last~saw h.i.m .... alive on.
19.
death is said
9/45Pm
Immediate cause of death
cerebral hemorrhage
hrs
Due to
Due to
PHYSICIAN
Major findings :
Of operations
Of autopsy
What test confirmed diagnosis?
20 Was disease er lajury in any way related to occupation of deceased !
If so, specify
(Signed)
M W O'Connell
M. D.
(Address).
Boston
Date
19
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ..
Winthrop
Mass
(City or Town)
DATE OF BURIAL
Nov 11 1941
.15
22 NAME OF
FUNERAL DIRECTOR
C H Treanor
ADDRESS
Boston
Received and fled.
19
(Registrar of City or Town where deceased resided)
50m-10-'39. No. 8427-f
PLACE OF DEATH
(County)
1
(City or Town)
No.
Boston .... City ..... Hospital
(If U. S.
War Veteran,
spocify WAR)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. I .. ) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible Vy WW# is cot the deceased resided in another city of town at the time
PARENTS
Other conditions
(Include pregnancy within 3 months of death)
.Date of.
Underline the cause to which death should be charged sta- tistically.
(Cemetery)
That I attended deceased from
..
I R-302
dutfolk
PLACE OF DEATH
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No. 9351 .
244
(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
2 FULL NAME
George .... E
Park.e.p
(If deceased is a married, widowed or divorced woman, give also maiden name.)
201 Main
St.
Winthrop ... Mas.s
months
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
male
4 COLOR OR RACE 5 SINGLE
MARRIED
white
WIDOWED
or DIVORCED
(write the word)
married
5a lf 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.
years
7 IF STILLBORN, enter that fact here.
ÅGE.84
.. Years .. LO ...... Months .. 2.7 Days
If less than I day
Hours
.Minules
Usual 9 Occupation:
switchman
Industry
18 or Businessl
B & A retired
II Social Security No.
12 BIRTHPLACE (City)
(State or country)
E-Hartford Conn
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Delaware Co NY
15 MAIDEN NAME
OF MOTHER
Emily J-
18 BIRTHPLACE OF
MOTHER (City)
(State or country)
Wilmington Del
17 Mrs Violet PentletonR ation, if any Informant (Address) friend
A TRUE COPY.
ATTESTI
Francis
(Registrar of city or town where death occurred)
DATE FILED 11/13/41
19
18 DATE OF
DEATH.
Nov 8 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
10/23/41
19
That I attended deceased from
I last saw h ... i.m .. alive on ..
11/41
.... , 19.
death is said
to have occurred on the date stated above, at ... 3.2.0A. m.
Duration
Immediate cause of death
carcinoma of rectum
3 yrs?
Due to
Due to
metastases to bone & lungs
PHYSICIAN
Major findings :
Of operations
.Date of.
Of autopsy
ca of rectum
What test confirmed diagnosis ?
20 Was disease er Injury In any way related to occupation ef deceased ?
no
If so, specify.
(Signed)
C C Franseen
Boston
M. D.
(Address)
Dat
11/9/19 41
21 PLACE OF BURIAL.
(City or Town)
CREMATION OR REMOVAL
Woodlawn Crem Everet
(Cemetery)
NOV 12 1941
19
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR ..... E .... Parker
ADDRESS
Boston
Received and Ned.
19
(Registrar of City or Town where deceased resided)
1
1
Other conditions
(Include pregnancy within 3 months of death)
13 NAME OF
FATHER
Edmund A Parker
50m-10-'39. No. 8427-f
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible · @tuwie ruitu neturitu lu yuui chy or town in case the deceased resided in another city or town at the time
1
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No ......
(Usual place of abode)
Length of stay: In hospital or institution.
(Specify whether)
years
(If nonresident, give city or town and state)
.... , to ..
12/8/41
, 19 ......
Underline the cause to which death should be charged sta- tistically.
No. Palmer MemorialHospital
٠٫٠٠
مـ
مر
M R-305
1
PLACE OF DEATH
(County) Roston (City or Town)
No. St Elizabeth's Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
ton (City or town making return)5
Registered No.
939.2
(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 ma.den name.)
(a) Residence. No ..
(Usual place of abode)
Length of stay: In hospital or institution.
115.Main
.St.
Winthrop
(If nonresident, give city or town and state)
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE' 5 SINGLE
MARRIED
WIDOWED
(write the word)
widowed
white
or DIVORCED
Sa If married, widowed, or divorced
HUSBAND cf
Mary J.Quinlan
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if alive.
7 IF STILLBORN, enter that fact bere.
AGE 35 Years Months Days
If less than 1 day
Hours ..
Minutos
Usual 9 Occupation: truck driver
II Social Security No.
12 BIRTHPLACE (City)
Boston Mass
13 NAME OF
FATHER
Frederick S Adams
14 BIRTHPLACE OF FATHER (City)
(State or country) New Brunswick
15 MAIDEN NAME OF MOTHER Elizabeth A Dunn
16 BIRTHPLACE OF MOTHER (City)
Boston Mass
(State or country)
17 George Adams
Relation, if any bro . ........ ·)
Informant. (Address) A TRUE COPY Chiraneis & Tay
DATE FILED
19
MEDICAL. CERTIFICATE OF DEATH
13 DATE OF
DEATH
Nov 9 1941
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) traumatic intracranial hemorrhage continued around occipital scalp fracture dislocation left knee
5
23 Accident, suicide, or homicide (specify) ....... 001.dental
Date of occurrence.
Nov ....... 194119
)
Where did Injury occur? Boston (City or town and State)
Did injury occur in or about the home, on farm, in industrial place, or in public place ? .Highway. Manner of said to havebeen injured by an Injury auto at Boston Nov 8 .... 1941 Nature of Pedestrian
Injury
While at work ?.
............
.. Was there an autopsy ?
no
21 Was disease or injury In any way related to occupaticu of deceased ?.
no
(Address)
32. St.Patrick's
Stoneham (City or Town)
Place of Burial, Cremation or Removal. DATE OF BURIAL Nov.121941 19
23 NAME OF
FUNERAL DIRECTOR
C H Treanor
ADDRESS
Boston.
Received and filed 19
(Registrar of City or Town where deceased resided)
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
WRITE PLAINLY WITH INFADING PURA
male (oz) WIFE of 8 Industry 10 or Business: PARENTS 25m-10-'39. No. 8427-g of death should be transmitted on Form R-305 to the clerk of the city or town in which the deceased resided as soon as possible (State or country) after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
Suffolk
CharlesF
Adams
(If U. S. War Veteran, specify WAR)
years
months
days.
In this community
yrs.
ATTEST:
( Registrar of city or town where death occurred)
11/13/41
years
)
If so, specify
(Signed)
W J Brickley
M., D.
Boston
Date 11/949 41
ORM R-301 |
.... 1 PLACE OF DEATH 3 BEX Male AGE 20 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
Suffolk (County)
Winthrop (City or Town)
Station Hospital, Fort Banks, Mass
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
246
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
ROBERT (NOHE
KENNEDY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
82 Greenwood Street
St. ..
Melrose. ... Mass.
(If nonresident, give city or town and state)
length of stay: In hospital or institution
(Specify whether)
years
3
months
5
days.
In this community
** yrs.
mos. 5 days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
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. -
.years
7 IF STILLBORN, enter that fact here.
Years
10
.Months
14
Days
If less than 1 day
- Hours
Minutes
Usual
Soldier
9 Occupation :.
10 or Business:
U. S. Army
1I Social Security No.
12 BIRTHPLACE (City)
Stoneham, Massachusetts
(State or country)
13 NAME OF
FATHER
John F. Kennedy
14 BIRTHPLACE OF
FATHER (City)
Malden. Massachusetts
(State or country)
15 MAIDEN NAME
OF MOTHER
Marguerite Fairfield
IS BIRTHPLACE OF
MOTHER (City)
Franklin Massachusetts
(State or country)
17 John F. Kennedy
Relation, if any Father
(Address)
82 Greenwood St., Melrose, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burial of transit permit was issued Www. D. Childrens
(Signature of Agent of Board of Health or other)
/ Realthe Officer 12/3/4
(Official Designation) (Date of Issue of Permit)
18 DATE OF
DEATH
December
2.
1941
....
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY.
That I attended deceased from
August 26,
19 ..
December 2,
10 47
...
I last saw h
im alive
December 2, 1941
to have occurred on the date stated above, at
11:058.
Duration
Immediate cause of death Appendicitis ,acute.
Peritonitis.acute.
Due to
Subphrenic abscess.
Pelvic abscess acute
Due to
Cholecystitis ,acute,suppura-
tive.obstructive.
"Fecal fistulae acute.
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations ...
Appendectomy -- Appendici
.....
.....
....
tis, acute. Cholecys .... Datg
Aug.26/41
...
totomy- Cholecystitis, acute.
Of autopsy ...
None
What test confirmed diagnosis ?
-
20 Was disease or Injury In any way related to occupation of deceased ? No
I so. specify thebull
(Signed)
Platt R. Powell Ist Lt. M.C.
M. D.
(Address).
Fort Banks . Mass.
Date.
Dec. 219 41
21 Wyoming Melrose
(City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
L'ec, 5.
1941
22 NAME OF
ADDRESS
254
Received and filed
DEC 5
1941
19
....
A TRUE COPY ATTEST: (Registrar)
..
....
Aug. 25
Aug. 30 Sept. 5 Aug. 30
Sept.10 Aug: 30
PHYSICIAN Underline the cause to which death should be charged sta- tistically.
Informant ..
8 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. Every item of PARENTS 200m-10-'39. No. 8427-d
(If U. S.
War Veteran.
specity WAR)
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
death is said
.,
to ..
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 exhume 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 shall be issued until there shall have been dc- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of 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 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 early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such a 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 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
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.