USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 11
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100m-10-'39. No. 8427-e
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www.D. Childrens (Signature of Agent of Board of Health or other) Health Officer Official Designation (Date of Issue of Permit}
2/11/42
MEDICAL CERTIFICATE OF DEATH
18 DATE OF DEATH. Feh
1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
1942, to 19 42 I last saw her alive on Feb 8 19 .. 27 death is said to have occurred on the date stated above, at ... 6% .. m.
Years) Immediate cause of death ..
Duration IMPORTANT
لسير
Due to
Vilenlace Kuch
(4 months premature)
Due to
Other conditions (Include pregnancy within 3 months of death)
Major findings : Of operations
Date of ..
Of autopsy
What test confirmed diagnosis ?
tistically.
20 Was disease or injury In any way related to occupation of deceased?
If so, specify (Signed)
M. D.
(Address) 2362
Date 2/11 19.462
(City or Town)
Place of Burial, Cremation or Removal DATE OF BURIAL SuUt !! 10/2.
22 NAME OF FUNERAL DIRECTOR ADDRESS 978Sanat80.666600
4942
19
(Registrar)
8
If less than I day
AGE Years Moniks.
Days
.Hours. Minutes
Usual 9 Occupation:
Industry 10 or Business:
11 Social Security No.
12 BIRTHPLACE (City) (State or country)
13 NAME OF FATHER
14 BIRTHPLACE OF FATHER (City) (State or country)
Mass
15 MAIDEN NAME OF MOTHER
Julia Pragaro
Gast Follow
16 BIRTHPLACE OF MOTHER (City) . (State or country) Mass.
17 Daniel Mastromarino Fin Ley
Informant 14 Jayden St. Cast Boots
The Commonfocalth 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.
29
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 or divorced woman, give also maiden name.)
14 Leyden
(a) Residence. No ... (Usual place of abode)
Length of stay: In hospital or institution. .... (Specify whether)
.......... years
months
days.
In this community
yrs.
mos.
days.
2 3 SEX Female Photo
4 COLON OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Stingte
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.
PLACE OF DEATH
RM R-301 A; Suffolk
BOSTON NOTIFIED 3/8/425
(County)
1
&Cittor Rown)
Hanthinh Community Arepitas
No ...
Conby (Gul) SMastromarino
.St. 1
(If U. S. War Veteran, specify WAR) Caso (Boston,
........ St.
(If nonresident, give city or town and state)
PERSONAL AND STATISTICAL PARTICULARS
PARENTS
Winthrop, Mass.
Daniel Mastromarino
PHYSICIAN Underline the cause to which death should be charged sta-
.
Received and filed
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registored 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 scetlon one, where came 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 hody is buricd. No such permit shall be issued until there shall have been de- livered to such board, agent or clerk, as the case may be, a satisfac- tory written statement containing the facts required by 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 licu 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 physiclan 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 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 thercafter 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, See. 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 burled 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 observ- ance 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 Ill- ness 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 un- related to any form of injury, have died without recent medical attendance or whoxe 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 polsons), thermal, or electrical agents, and deaths following abortlon, 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, c. g .. heart fallure, asphyxla, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morhid con- ditions, If any, related to the principal cause and any important complication of the prinolpal cause.
Statoment 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 husl- ness, report the usual occupation prior to retirement. Children not galnfully 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-302
1
PLACE OF DEATH
SURGAL K BOSTOLLI (City or Town) Peter Bent Bricham Hospital
The Commontocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
BOSTON
(City or town making return)
30
Registered No.
1254
S (If death occurred in a hospital or institution, St. give ita NAME instead of street and number)
Margaret L
Rockett
(If deceased ia a married, widowed or divorced woman, give also maiden name.)
(a) Residenoe. No.
(Usual place of abode)
82 Waldemar Ave
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
in this community
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Feb 9 1942
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deoeased from
1/23/42
19
.......
to
2/9/42
19.
i last saw h ...... O.m ... alive on.
2/9/42
19
death is said to
have occurred on the date stated above, at ..... 3. 1OP
m.
Duration
Immediate cause of death. pulmonary ..... omb.o.1.1 .. sm
term
... thrombo ..... phlebitis ..... of ...
......... 0
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings : Of operations
Of autopsy
What test confirmed diagnosis ?.
autopsy
20 Was disease or injury in any way related to oooupation of deceased? If so, specify
(Signed)
H.Benjamin
M. D.
(Address) Boston
Date 3/7019 42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop Mass
(Cemetery)
(City or Town)
DATE OF BURIAL
Feb 12 1942
19
22 NAME OF
FUNERAL DIRECTOR
J Kelly
ADDRESS
Boston
Received and filed ATT 9 7942
19
(Registrar of City or Town where deceased resided)
<
2 FULL NAME
3 SEX
female
(or) WIFE of
8
61
Usual
9 Occupation :
10 or Business :
PARENTS
(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-802 to the clerk
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
11 Social Security No.
50m (e)-1-41-4667
A TRUE COPY francis
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
2/12/42
19
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
5a if married, widowed, or divorced
HUSBAND of
( Giva maiden name of Rije in fullt t
(Husband's name in full)
6 Age of husband or wife if allve years
4.8
7 IF STILLBORN, enter that fact here.
AGE
Years
Months.
Days
if less than 1 day
Hours
Minutes
Due to ..
Loft ..... Jeg
Industry
at home
12 BIRTHPLACE (City)
(State or country )
Gloucester Lass
13 NAME OF
FATHER
Alfred Schiveree
14 BIRTHPLACE OF
FATHER (City)
Prince Edward Is
(State or country)
15 MAIDEN NAME
OF MOTHER
Judith Peters
16 BIRTHPLACE OF
MOTHER (City)
PE I
(State or country)
17
informant.
husband
(
Relation, if any
Date of
Underline the cause to which death should be charged sta- tistically.
No.
(if U. S.
War Veteran,
speolfy WAR)
4 COLOR OR RACE
white
M R-301 A
Every item of 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. D .- WRITE PLAINLI, WIIn UNFADING BLACK INK-THIS IS A PERMANENT RECORD. PARENTS
PLACE OF DEATH
Suffolk .. (County)
1
Winthrop.wass ... (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
31
No.15 ... George ... StreetWinthrop ...
St.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number) -
2 FULL NAME Mary J. O' DONNELL
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. Nol.5 ... G.e.org.o ... Street ...
(Usual place of abode)
St
(If nonresident, give city or town and state)
Length of stay: In hospital or institution.
(Specify whether)
years
months
days.
In this community '74 yrs.
- mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white.
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of Dennis F. O' Donnell
years
7 IF STILLBORN, enter that fact here.
8 AGE.7.4 ... .Years. ~Months ...
If less than 1 day
Hours.
Minutes
Usual
9 Occupation Housework ..
Industry 10 or Business :... A.t ...... Home ...
11 Social Security No. None;
12 BIRTHPLACE (City)
(State or country)
Roxbury . Mass.
13 NAME OF
FATHER
Patrick Carey
14 BIRTHPLACE OF FATHER (City) (State or country} Treiand.
15 MAIDEN NAME
OF MOTHER
Catherine Glynn.
16 BIRTHPLACE OF MOTHER (City) (State or count Ireland .
17
Relation, if any Informant Mr Joseph O' Donnell, Son. (Address) 15 George Straat Vintiray
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Wm. 2 Gheldress
(Signature of Agent of Board of Health or other)
all 2/13/42
....... (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
February 10
1942
(Month)
(Day)
(Year)
19 May 30, 1939, to
That I attended deceased from I HEREBY CERTIF Fel 9, 19 ... 42
I last saw hralive on February9, 1942, death is said to have occurred on the date stated above, at. 10 20 P m.
Immediate cause of death. Cerchal The
montage
Duration IMPORTANT 2 years
Central hemland
Due to. Arterconciencia
tues
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
Underline the cause to which death
Of autopsy.
-
should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed
Francis/s. Higgins
M. D.
(Address) 520 Commondelletitre Date
2/12 1942
21 .. New .... Calvert,
Boston, han
Boston-Masa Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL February .... ... ... 29942
22 NAME OF FUNERAL DIRECTOR DR. Martin e. Kelley
....... ADDRESS 109 R chung of Holary 19
Received and filed
1942
(Registrar)
Date of.
What test confirmed diagnosis?
Registered No.
(If U. S.
War Veteran,
specify WAR)
Female,
6 Age of husband or wife if alive
.Days
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwitb, 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 bis last illness, when last seen allve by tbe physician or officer and the date of bis death . .. Gen. Laws, Chap. 46, Sec. 9.
No undertaker or other person shall hury 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 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 huinan 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 huried. No such permit shall he issued until there sball 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 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 he obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the hoard of health, or em- ployed hy it or hy the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused hy violence, the medical examiner shali 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 perinit for such removal; provided, that such body shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the re- moval of such body has been sooner obtained hereunder. If the deatb 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 heen engaged, such recital shall appear upon the permit. The hoard of health, or its agent, upon receipt of sucb 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).
No undertaker or other person shall bury a human body or the ashes thereof which have heen 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 hoard, 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 tbe observance of tbe 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 disahled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahiy due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), therinal. 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 dlsease, 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 been given up or cbanged 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
. .
M R-301 A
- PLACE OF DEATH
Suffolk. (gunty ) Winthrop (City of Town 238 Therley No.
The Commonforalth 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.
32
Registered No.
{ ( If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Bennety.
(thing
(If deceased is a married, widowed or divorced toman, give also maiden name.)
(a) Residence. No. 238 Shirley St.
(Usual place of abode)
Length of stay : In hospital or Institution
(Before death)
(Specify whether)
years
months
days.
In this community 2 / yrs.
mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE!
Male White
5 SINGLE (write the word) MARRISO WIDOWED KOR Malower or
5& If married, widowed or divorced HUSBAND of
(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
8 82 Years Months. Days
If less than 1 day .Hours Minutes
Usual 9 Occupation :
Hebrew tracker
Industry
For Himself
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
Cuma
13 NAME OF
FATHER
Jevac atkins
PARENTS
14 BIRTHPLACE OF FATHER (City) (State or country)
15 MAIDEN NAME OF MOTHER Sarah Comment be learned)
16 BIRTHPLACE OF MOTHER (City) (State or country) Органи
17 Joseph Letters
Relation if any
Informant, (Address) 2318 Landey SX
Winthrop Was
I HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE the burial or trans permit was issued : Mm. D. Chil dress (Signature of Agent of Board of Health or other)
Health Murer 2/12/42
(Official Designation) (Date of Issue of Permit)/
18 DATE OF
DEATH
(Month) 11 1942 (Day) ( Year)
19 | HEREBY CERTIFY,
19.
42
Fl 4
That I attended deceased from
to Feb 11 19
YL
I last saw h
we allve on
Feb 11
194, death Is said to
have occurred on the date stated above, at.
10 20,1
Immediate cause of death.
Duration IMPORTANT
........
Due to
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
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 infury in any way related to ocoupation of deceased ?) ... If so, specify
(Signed)
Jaublotie
M. D.
(Address) Ist Member St Date 111
Death Jesturm
Place of Burial, Cemation or Removal.
(City or Town) 1946
DATE OF BURIAL
Feb. 12
22 NAME OF
FUNERAL DIRECTOR
Manuel
Stanetiky
ADDRESS
10 Washington St. Not.
Received and filed
1 1942
(Registrar)
100m (d) -1-41-4667
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoltal 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. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain ...
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