USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 26
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
(3) Medical Examiners will investigate and certify to all deaths sup- posably due to injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, hut also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized diseaso, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the moile of ilying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, naine earlier morbil conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some 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 discase 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
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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state MARGIN RESERVED KUROBINWIE
PLACE OF DEATH
Suffdok
(County)
I
Winthrop
(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.
10
Registered No S (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 woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or institution
95
Main Street
St
(If nonresident, give city or town and state)
months 2 days.
In this community
yrs.
- mos.
2 days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDSingle
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,
8
AGE Years .Months.
2 Days
If less than I day Hours. Minutes
Usual
9 Occupation :.
Industry 10 or Business:
1I Social Security No ...
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
John Walsh
PARENTS
14 BIRTHPLACE OF
East Boston
FATHER (City)
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Marion Gentle
16 BIRTHPLACE OF MOTHER (City) ...... (State or country) Mass.
17 John Walsh
Relation, if any Father
Informant. (Address)
95 Main Street Winch
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mm. S. Ofuldrestx (Signature of Agent of Board of Health or other) Health Officers 4/10/42
(Official Designation) (Date of Issue/of Permit)
18 DATE OF
DEATH
april
9
(Month)
(Day)
(Year)
19 IHEREBY CERTIFY. 1942 to Referee 9
That I attended deceased from
194-2 I last saw her alive on (2/2hey, 19:47 death is said to have occurred on the date stated above, at. 1
Immediate cause of death.
Duration IMPORTANT
....
2019
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings:
Of operations.
QueTojon
Of autopsy
What test confirmed diagnosis ?. autojasii
20 Was disease or injury in any way related to occupation of deceased ?..
If so, specify
C. H. Konrad.
(Signed).
transição. ilmas
M. D.
(Address)
270 Comit the Date 4/2
19442
winthrop
21 ..
Winthrop commun
Place of Burial, Cremation or Removal.
April 10
(City or Town) 42
19
DATE OF BURIAL ....
22 NAME OF
FUNERAL DIRECTOR Coward
ADDRESS,
Received and filed 19
(Registrar)
100m-2-'40-D-729-a
No. Winthrop Comr mity Hospital
..... Baby Girl Walsh
(If U. S.
War Veteran,
specify WAR)
1942
m.
„Date of.
4/9/42
Underline the cause to which death should be charged sta- tistically.
Dorchester
winthrop
years
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shail forthwith, after the death of a person whom he has attended during his last iliness, 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 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 shail 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 shail exhume a human body 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 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 hy 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 hy it or hy the selectmen for the purpose, shail 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- movai of such hody 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 recltal shali appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be ohtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the cierk of the town where the body is to be buried or the funeral is to he heid, or from a person appointed to have the care of the cemetery or hurlai 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 calis 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 ali deaths supposably due to injury. These include not only deaths caused directly or indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from dlsease resulting from Injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
6
INTERI
APR131: 2W
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 discase causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very 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 iliness. 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
FRM R-302
1.
PLACE OF DEATH
SUFFOLK BOSTON
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.
3264
(If death occurred in a hospital or institution, St.
give its NAME instead of street and number)
Arthur LEO
Mc Fague
(SEE ATTACHED)
(If U. S.
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
39Fairview
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
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced
HUSBAND of
GertrudeW Howlev
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
AGE
Years.
Months.
.Days
If less than 1 day
Hours ....
.. Minutes
Usual
9 Oocupation :
trunk .... maker.
Industry
leather factory
11 Social Security No.
012-07-8415
12 BIRTHPLACE (City)
(State or country)
Ch. rlestown Mass
13 NAME OF
FATHER
James Mc Fague
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Charlestown Mass
15 MAIDEN NAME
OF MOTHER
Mary Quinn
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Charlestown Mass
Relation, if any
(
A TRUE COPY.
Y. Francis
× 4ans
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
4/14/42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
April 11 1942
(Month)
(Day)
(Year)
19
HEREBY CERTIFY,
to
2/5/42
19
4/11/42
19
That I attended deceased from
I last saw h.1.m
.. alive on.
4/11/42
19
death Is sald to
have ocourred on the date stated above, at
2/47P
m.
Duration
Immedlate cause of death
.pneumonia,.lobar
Due to ...... carcinoma .... o.f ...... stomach
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Underline the cause tu which death should
charged sta- tistically
Of autopsy
What test confirmed diagnosis ?.
20 Was disease or Injury in any way related to occupation of deceased ?.
(Signed)
If so, speolfy
John Gowell
M. D.
(Address)
Enston
Date+/11/19 42
21 PLACE OF BURIAL,
Winthrop Mass
CREMATION OR REMOVAL.
(Cemetery)
(City or Town)
DATE OF BURIAL
Ampil 14 1942
19
22 NAME OF
FUNERAL DIRECTOR
W P Carley
ADDRESS
Boston
Received and filed
MAY 8
1942
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
3 SEX
male
(or) WIFE of
8
61
PARENTS
17
Informant.
( Address)
of the city or town in which the deceased resided. (See Chap. 16, 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
10 or Business :
InIJ IS A TEAMMANCINI NEUVAU
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
MARGIN RESERVED FORODINOWY
WRIIG PLAINLI, WIIN UNTAUING ULAUN ITA
(City or Town)
No.
Mass General Hospital
copy
( werly WAR)
-
7 mb
Major findings :
Of operations
Date of.
72 hr
51
FORM R-301
To be filed for burial permit with Board of Health or its Agent. INSTRUCTIONS FOR MEDICAL CERTIFICATE
PRINT OR TYPE CAUSE OR CAUSES OF DEATH do not enter more than one cause for each of (a), (b) and (c)
This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, or compli- cations which caused death.
Conditions, if any, which gave rise to above cause (a), stating the under- lying cause last.
Conditions contrib- uting to death but not related to the terminal disease condition given iR (a).
Original Copy 5-8-42 MAR 6 1963
100M-6-62-933404
8 SEX
Male
9 COLOR
White
10 SINGLE MARRIE WIDOWE DIVORCI UNKNOV
11 If married, widowed, or divorced
HUSBAND of
Gertrude .... W ...... How.
(Give maiden name of wil (or) WIFE of.
(Husband's name in
12.5161
AGE.
Years.
Months.
.Days
13 Usual
Occupation:
Trunk maker
(Kind of work done during mosl
14 Industry
or Business:
Leather factory
15 Social Security No 012-07-8415
16 BIRTHPLACE (City) ..
Boston ictvay
(State or country )
Mass
17 NAME OF
FATHER
James McFague
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Charles.tow.
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Mary Quinn
Charlestown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass
21 Informant
Mrs ...... G ..... McFague,
(Address)
39 Fairview .... St.W.
I HEREBY CERTIFY that a satisfactory stand was filed with me BEFORE the burial or transi'
(Signature of Agent of Board of Health o
I
BOSTON
(City or Town)
KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
BOS?
(City or Town ....
STANDARD CERTIFICATE OF DEATH
Registered No. ..
Mass. General .... Hosp
f(If death occurred in a hospit St. ¿ give its NAME instead of st
PHYSICIAN - IMPO:
Arthur Leo McFague 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a U. S. War Vetera if so specify WAI
(a)
Residence. No ..
39 Fairview
.St.
Winthrop
Length of stay: In place of death .......... years ....
2 months 6
days. In place of residence .......... years .......... months .......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
April 11, 1942
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY , That I attended deceased from
Feb 5
,42
April 11
19.
12
I last saw
im
19.
to
live on
April 11
19.
42
-death is said to
have occurred on the date stated above, at
1;47p
.... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
INTERVAL BETWEEN ONSET AND DEATH
(a)
Pneumonia, lobar
(b)
Due
Carcinoma of stomach
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
no
What test confirmed diagnosis ?Exploratory , laparo
5 Was disease or injury in any way related to_occupation of deceased?
If so, specify
tomy Je junostomy
(Signature)
J. Gorrell
M. D.
(Brint or Type Name)
(Address)
Mass.
Gen. HOSPDate.
4/11
42
Winthrop Cem. Winthrop
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April 14
142.
7 NAME OF
FUNERAL DIRECTOR
W. P. Carley
ADDRESS
Allston
Mass
Received and filed April 14, 1942 19
A TRUE COPY ATTEST:
PLACE OF DEATH
SUFFOLK
(County)
No.
(Usual place of abode)
(City or 1
PERSONAL AND STATISTICAL PARTI
(Registrar)| (Official Designation)
(Date of Issue of
If 1
RM R-302
Auffolic
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
72
No. Peter Bent .... Brigham .... Hospital § (If death occurred in a hospital or institution, St. give its NAME instead of street and number) r
2 FULL NAME
William J
Campbell
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
93 Locust
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
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE|
white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
married
5a If married, widowed, or divorced HUSBAND of
Catherine G Daley
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve
years
7 IF STILLBORN, enter that fact here.
8 AGE 68 Year Months. ..... Days
If less than 1 day
.Hours.
Minutes
Usual 9 Occupation : antreten
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Nova Scotia
13 NAME OF
FATHER
Michael Campbell
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Margaret Joyce
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
17
John Campbell
Relation, if any
(Address)
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
4/17/42
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
April 14 1942
DEATH
(Month)
(Day)
(Year)
19 1HEF
3/25/45
19
CERTIFY,
attended deceased from
last saw h.
im
4/14/42
19.
.alive on
death Is sald to
have occurred on the date stated above, at
7/20A
m.
Duration
immediate cause of death. thrombosis,rt ilieac vein
6 dys
pulmonary infarction
unk
Due to carcinoma of bladder and prostate
3 vrs
Due to.
Other conditions.
pulm tbc old
VIS Physician
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date
of
3/27/42
Underline the cause to which death should be charged sta- tistically.
Of autopsy
autopsy
What test confirmed dlagnosis?
20 Was disease or injury in any way related to occupation of deceased ?...........
If so, specify
(Signed)
H.Benjamin
M. : D.
(Address)
Boston
Date
4/14/19
42
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
(City or Town)
DATE OF BURIAL
April 16 1942 19
22 NAME OF
FUNERAL DIRECTOR
Kirby
ADDRESS
winthrop
Received and filed 19
"1942
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
......... 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 ...
PLACE OF DEATH
(County)
RostOD
(City or Town)
Registered No.
3369
(If U. S.
War Veteran,
speolfy WAR)
Winthrop
14/42
19
(Give maiden name of wife in full)
67
PARENTS
Informant
-
A IRUL LUFI ABIL ...
CRM R-301 A
1 3 SEX male (or) WIFE of Usual 9 Occupation : PARENTS 17 : Informant ... ( Address) If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. extracts from the laws on back of certificate. should be carefully supplied. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain N. B .- WRITE PLAINLY, WIIM UNFADING BLACK INK-THIS IS A PERMANENT ACCORD. EVERY TIME OF MOVIMENTO industry 10 or Business :
PLACE OF DEATH
Suffolk (County) Brottanthrop
Wenchang Comments Hep No. Male Waire
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.
3
Registered No.
§ (If deeth occurred in a hospital or institution, St. { give its NAMIE instead of street and nuniber)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. Wer Veteran,
if so specify WAR)
(If nonresident, give city or town and Stete)
Length of stay: In hospital or Institution
( Before death)
(Specify whether)
years
months
days.
In this community
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
april 24
1942
( Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
Mymail 24
to.
That + attended deceased from
last saw h.
afive on
19
...... , death Is sald to
have occurred on the date stated above, at.
m.
Immediate cause of death Heltom
Due to. Cause Lundi Med
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Pertina
140 TO Date of
Of autopsy ....
Putrefaction
IMPORTANT Physician Underline the cause to which death should be charged sta- Listically.
20 Was disease or injury in any way related to occupation of deceased ?......
if so, specify
(9)RAH. WARBaymax
FAMWASHINGTON AVENUE
Date apr. 25
1. 2 1942
M. D.
WINTHROPQMASSACHUSETTS
21 Neschop Tematy, Vendar A
Plece of Burial, Cremetion or Removel.
(City or Town)
DATE OF BURIAL
for 28
19:
22 NAME OF
FUNERAL DIREOTOR.
AD
210 Newbury Lt Windloop
Received and filed.
/19
(Registrar)
100m (d)-1-41-4667
2 FULL NAME
(a) Residenoe. No. .
352
(Usual place of ebode)
4 COLOR OR RACE|
White
5a If married, widowed, or divorced
HUSBAND of
(Husband's name in full)
8
AGE
Years
Months.
Deys
11 Social Security No. .
12 BIRTHPLACE (City)
Winthrop
(State or country)
mass.
14 BIRTHPLACE OF
FATHER (City)
Chelsea
Worcester
Andlung Naitt
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
(State or country)
Mars
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
ungle
(Give meiden name of wife in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here. Billbom'
If less than 1 day
Hours
.Minutes
13 NAME OF
FATHER
Anthony Waitt
15 MAIDEN NAME
OF MOTHER Elizabeth Lucey
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
mas
Rention, Many (facher)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial of transit permit was issued : Man. D. Childrenfx (Signature of Agent of Board of Health-orother) Health Officer 4/28/42
(Official Designstion) (Date of Issue of Permit)/
What test confirmed diagnosis?
19
Duration IMPORTANT
(If deceased is a merried, widowed or divorced woman, give also meiden 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 umulertaker or other anthorized 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 his last illness, when last seen alive by the physiciau or officer and the date of his death ... Gen. Laws, Chap. 46, Scc. 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 belicf, 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 immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief ex- pedition and the l'hilippine 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. Clap. 46, Sec. 10.
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.