USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 19
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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 huried, 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 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 board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he 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 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 hy 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 hody, not previously interred, from one town to another within the commonwealth cannot he obtained early w. 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 auch 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 ohtalned 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 certifylng the cause of death shall thereafter furnish for registration any other necessary information wlilch can be obtained as to the deceased, or as to the manner or cause of the death. which the clerk or registrar may require .- Chop. 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 issuc 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 heid, 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 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 supposably 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 disahled hy 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 morhld condltlong, if any. related to the principal cause and any Important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation Is very Important, so that the relative healthfulness of various pursuits can be known. Make some entry In this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to Illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation hy the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FORM R-301
1 PLACE OF DEATH 3 SEX male per Death Cert. Usual 9 Occupation: PARENTS Informant. (Address) 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 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: 200m-10-'39. No. 6427-d
Suffolk (County) Winthrok
(City or Town) 18 Cliff ave No
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
51
-
(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
Walter G Sharkey
(If deceased is a married, widowed or divorced woman, give also maiden name.)
No. 14 Cliff avc
St.
(If nonresident, give city or town and state)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
mar
9
1942
(Month)
(Day)
( Year)
19 | HEREBY CERTIFY. That I attended deceased from
Jan22
19 42, to mar 9
19.9.2
I last saw b ... alive on
9
19.5.3 .. , death is said
to have occurred on the date stated above, at ......
P. m.
Duration
6 Age of husband or wife if alivo
years
7 IF STILLBORN, enter that fact here.
AGE 76 Years. Months .Days
If less than 1 day
Houra.
Minutes
Retired
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
4.13.
13 NAME OF
FATHER
Edward Sharkey
14 BIRTHPLACE OF
FATHER (City)
Ireland
(State or country)
15 MAIDEN NAME
OF MOTHER
Marguet Power
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
17 Walter a Sharkey
Relation, if any
)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Www. D. Children
(Signature of Agent of Board of Health or other) Realthe officer 3/11/462
(Official Designation) (Date of Issue of Permit)
PHYSICIAN
Underline the cause to which death should he charged sta- tistically.
20 Was disease or Injury In any way related to occupation of deceased ? 25
If so, specify .....
Bichade Inteatt
(Signed)
M. D.
(Address)
148 Winthrop 940
Date
3/9
1942
21
Hinchrop
Place of Burial Cremation or Removal,
DATE OF BURIAL
Marx
(City or Town)
19512
22 NAME OF
ADDRESS
Targus may
Received and filed. NTR I. S 1947 19
A TRUE COPY ATTEST:
(Registrar) /
MARGIN RESERVED FOR BINDING
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
What
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widerced
5a If married, widowed, { Elizabeth mcdermott
HUSBAND of
(Giz maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
Immediate cause of death.
Coronam
12hs
Due to
Corona
Due to
Chi Hypertensive Conduce Des
2 ...
Other conditions
aqua Saleves
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of.
-
Of autopsy
What test confirmed diagnosis ?.
3 war Veteran.
specify WAR)
(a) Residence.
(Usual place of ahode)
length of stay: In hospital or institution
years
months
days.
In this community 5 yrs .~ mos. days.
2 FULL NAME
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 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 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 lleu 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- nlsh 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 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 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 earlier morbid con- ditlons, 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, 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
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information extracts from the laws on back of certificate.
PLACE OF DEATH
Suffolk
(County)
1
Winthrop
(City or Town)
5 Lincoln S
The Commonturalth 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.
52.
{ (If death occurred in a hospital or Institution, St. { give its NAME instead of street and number)
2 FULL NAME
Robert Gillies Zeppernick
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
5 Lincoln St
St.
(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 9
yrs. - mos .-
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACEJ
White
5 SINGLE
(write the word)
MARRIED Married
WIDOWED
or DIVORCED
5a If married, widowed, or, divorced
Mcintyre
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at
2:30 A
.m.
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here.
8
59
AGE
.Years
Months.
.Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Letter Carrier
Industry
U. S. Postal Service
11 Social Security No.
Liverpool
13 NAME OF
Carl L. Zepnernick
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Isabella C. Gillies
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
England
17 Edna. ". Zeppernick
Informant ...
Relation, if any (Address) 5 Lincoln St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burial or transit permit was Issued : Www. D. Clubdress
Signature of Agent of Board of Health or other)
3/10/42
(Official Designation) (Date of Issue of Permit) /
18 DATE OF
DEATH
March
9
(Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
That ! attended deceased from
January -
1940.
March -
1942
to ..
I last saw h Come alive on
Anarch 8, 1942, death is said to
Duration
Immediate cause of death
IMPORTANT
/ Meat
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findIngs :
Of operations.
Carcinoma of stomach
Date of 11/28/41
Of autopsy
What test confirmed diagnosis? X-ray-Operation
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to ocoupatlon of deceased ?........ R. =
(Signed) Arthur C. Murray
M. D.
(Address)
Winthrop
21
Tinthron
winthrop
Place of Burial, Cremation or Remoyal.
(City or Town)
DATE OF BURIAL.
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
lathrop Massachusetts
2.19
Fol 10 malen
Received and filed. MAR 1 8 1942
19
( Registrar)
100m (d)-1-41-4667
do per street list 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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect. PARENTS
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so speolfy WAR)
1942
Due
Carcinoma ol stomach
10 or Business :
12 BIRTHPLACE (City)
(State or country )
England
IMPORTANT Physician
Date 2/9
1942
No.
(Usual place of abode)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan or registered hospital medical officer ahall 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 atandard 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 hia last illness, when last seen alive by the physician or officer and the date of hia 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 army, 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 and the secondary or inunediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, sucb 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 hury 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 he 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 sn 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 nf 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. unt 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 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 haa 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 neces- sary 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 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 the town where the body is to be buried or the funeral is to be held, or from a person appointed to have tbe care of the cenietery or burial ground in which the interment ia made. . . . Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there ia within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; ... - General Laws, Cbap. 38, Sec. 6.
RULES OF PRACTICE
The fulfillment of the purpose of these lawa calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deatha only as those of persona to whom they have given bedside care during a last illneas 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 disahled by recognized disease unrelated to any forni of injury, have died without recent medical attendance or whose physi- cian is absent from home when the certificate of death is needed.
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