USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 39
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MOTHER (City)
Ansonis
(State or country)
Conn.
17 Informant. Vernon Skillings any (Address) 68 Washington Are., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : William D. Childress
(Signature of Agent of Board of Ilealth or other)
agent June 32/4
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June 25. 1942
( Month )
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
June 24, 1942 19.
June 25, 1942
19
to
I last saw him
alive on
June 24, 194219
death Is sald to
have occurred on the date stated above, at.
9:00
A.
Immediate cause of death.
Chr.
Lyelorenous Leukemia
Due to.
Due to.
Other conditions.
Albuminuria
(luclude preguancy within 3 months of death)
IMPORTANT
Major findings :
Of operations ..
Tonsillectomy: Chronic
Tonsillitis
Date of
June 24'42
Of autopsy
What test confirmed diagnosis ?
Blood smear
Physician I'mderline the cause to which death -Iwould be charged sta. iistically.
20 was disease of injury in any way related to occupation of deceased ? . O If so, specify.
(Signed)
(Address) 28 N.
Washington ive. Date Jun 20, 19
Winthrop
M, .P.
21
Winthrop
l'lace of Burial, Cremation or Removal. June 1942 (City or Towu)
... 19
22 NAME OF
FUNERAL DIRECTOR
Richard HolThuis
ADDRESS
147 Winthrop St ., Winthrop ....
Received and filed. JUN 3 0 1942
19
(Registrar)
100m (d)-1-41-4667
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 see attached cest.
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect. PARENTS
No.
......
Robert V. Skillings
68 Washington
Ave
St.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
- years
months
2
days.
In this community
12 yrs.
mos.
days.
Registered No.
DATE OF BURIAL
Duration IMPORTANT
Months 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 forthwith. after the death of a person whom he has attetaled during his last illness. at the request of an undertaker or other authorize 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 decreased, 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 aeen alive by the physician or officer and the date of his death ... Gen. Laws, Chap. 46. Sec. 9.
A physician or officer furnishing a certificate of death as required hy 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 I'nited 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 saine. 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 inchole the China relief ex- pedition and the Philippine insurrection, which shall, for sail 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 bury or otherwise dispose of a human body in a town, or remove therelrom 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, froin 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 atotlier, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit fromn the board of health or its agent aforesaid or froin the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to 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 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 hy it or by the aelectmen for the purpose, shall upon application make the certificate re- quired of 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, not previously interred, from one town to another within the commonwealth cannot be obtained carly 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 forin 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 aerved in the army, navy or marine corpa of the United States in any war in which it has been engaged. such recital shall appear upon the jurinit. The board of health. or its agent. upon receipt of such statement atul 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 nece+ sary information which can be obtained as to the deceased, or as to the manter or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. L., (Tercentenary Edition ).
No ulklertaker 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 he held, or from a person appointel to have the care of the cemetery or burial ground in which the interment is made. ... Chap. 114. Sec. 46. G. L., (Tercentenary Edition).
Medical examiners shall inake examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a inelical examiner has notice that there is 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, Chiap. 38, Sec. 6.
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 thoae of persons who, thengh disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyai- cian is absent from home when the certificate of death is needed.
(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 aepticernia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, aud 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. Aa principal cause name the disease causing death. As related causes. name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very 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 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 wnges, however, designate the occupation by the appropriate terins, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none:
SPACE FOR ADDITIONAL INFORMATION
ORM R-306
?
Winthrop
(City er Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS AFFIDAVIT AND CORRECTION OF A RECORD OF DEATH
WINTHROP
(City or town making return)
Registered No. 115
5 (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Robert V. Skillings
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of ahode)
68 Washington Ave St.,
Ward,
(If nonresident give city or town and state)
Length of stay: In hospital or institution
Hospital
years "months
2
days.
In this community 12yrs. _ mos. __ days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE| 5 SINGLE
White
(write the word)
MARRIED
WIDOWED
Or DIVORCED
Single
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Hushand's name in full)
6 Age of husband or wife if alive. years
7 IF STILLBORN, enter that fact here.
8 AGE 17 Years 5 Months. 18 Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation:
Scholar
10 or Business:
Industry
High School
ISocial Security No.
026-16-0666
12 BIRTHPLACE (City)
Worcester
(State or country)
Mass.
13 NAME OF
FATHER
Vernon Skillings
14 BIRTHPLACE OF
FATHER (City)
Oakland
(State or country)
Me.
15 MAIDEN NAME
OF MOTHER
Ruth Hoyt
16 BIRTHPLACE OF MOTHER (City) (State or country) Conn.
Ansonia
17
Informant
Vernon Skillings
Esther
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
William D. Childress
(Signature of Agent of Board of Health or other) Agent June 27, 1942
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
25
1942
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
June 24
19
I last saw h
im
alive on
June 24, 142,
death is said
to have occurred on the date stated above, at
9: 00am.
Duration
Immediate cause of death
Chr. Mvelogenous Leu-
?
kemia
Due to
Due to
Other conditions
Albuminuria
(Include pregnancy within 3 months of death)
Major findings:
Of operations
Tonsillectomy : Chroni
Tonsillitis
Date of 6/24/42
Of autopsy
What test confirmed diagnosis?
Blood smeartistically.
20 Was disease or injury in any way related to occupation of deceased ? No.
If so, specify
(Signed),
Ora H. Wagman
M. D.
(Address)
winthron' Mass.Date6/26
1942
[City or Town)
Place of Burial, Cremation or Removal.
DATE OF BURIAL
June 28
19 42
22 NAME OF
FUNERAL DIRECTOR
Richard H. White
ADDRESS
147 Winthrop St.
June 30/ 194anthrop
Received and filled Donald S. Myhead
A TRUE COPY ATTEST: (Registrar)
Corrected com
20m-(a)-6-'40-3181
PLACE OF DEATH
Suffolk (County)
No. Winthrop Community Hospital
Ward
N.B .- WRITE PLAINLY WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of information should be carefully supplied. AGE should be stated EXACTLY. See reverse side for affidavit.
to State
MARGIN RESERVED FOR BINDING
PARENTS
Physician Underline Ce cause to which death should he charged sta-
(Address)
68 Washington Ave.
L
winthrop
21
Winthrop
Winthrop
Relation, if any
20
Washing
42, to_
June 25
19
42
DEPOSITION WRITE LEGIBLY WITH DURABLE BLACK INK
The Commonwealth of Massachusetts
County of. Suffolk
ss. :
The undersigned, being duly sworn, depose s and say s that the record relating to the death of ........ Robert V. Skillings in the .... Town ....... of Winthrop
(Give name of decedent exactly as recorded on the original record) (City or town) (Name of city or town)
does not fully and correctly state all the facts relating to said death, and that the true statement of
facts omitted or incorrectly stated in said record has been supplied by .. her on the
(Him or her)
form of certificate on the other side of this blank.
SIGNATURE Huth H. Stillings
RESIDENCE (City or town, street and number, if any) 68 Washington Give
Relation to decedent, if any
mother
Minikrop
FURTHER, The written evidence submitted to substantiate the affidavit was:
Birth certificate of deceased. Date of birth, Jan. 7, 1925. ......
Date, ......... July 20, 1942
Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by. ...... her are true.
Name
Edich @ Petraeus
Official designation ......... Ass't Town Clerk
(City or town clerk or assistant clerk)
MARGIN RESERVED FOR BINDING
A R-301 S
Suffolk Winthrop county)
(City or Towny
Fintheir Community Hospitals.
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 raportul
years
months
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
Male Mite
5 SINGLE
(write the word)
MARRIED
WIDOWED
OF DIVORCED
5a If married, widowed, or divorced HUSBAND of. (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 here.
Stillborn"
.years
AGE Years Months
Days
If less than 1 day .Hours .Minutes
11 Social Security No .....
12 BIRTHPLACE (City).
(State or country)
Andhusk mars
13 NAME OR
FATHER
Paul Salvaggio
14 BIRTHPLACE OF FATHER (City) (State or country) eltuly
15 MAIDEN NAME
OF MOTHER
Eleanor argentina
16 BIRTHPLACE OF MOTHER (City) ...... (State or country)
0 Botox
masa
17 Paul Salvaggio (Mache) Relation, if any
Informant. (Address) 137 Jamacha St & Bota
10M · A· 1-42 - 8511
I HEREBY/CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: m. D. Children x ........ (Signature of Agent ef Board of Healthy or other) Healthe Officer 7/1/42
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
26
(Month)
(Day)
(Year)
19 rus 26
I HEREBY CERTIFY,
That I attended deceased from
19/2
Fuer 26
1922
have occurred on the date stated above, at. 58. .m.
Immediate cause of death ..
Steel fora
Due to.
High Loroch detines delive
Due to.
utwere inert"
Other conditions.
(Include pregnancy within 3 months of death)
Major findings: Of operations ...
.Date of
Of autopsy.
What test confirmed diagnosis ?..
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify. ..............
Scorza. I Schumanti
(Signed) ......
M. D.
(Address) 19 Parcecal 82
0/29
.19 /2
Ar Michalka
Boston
Place of Burlal, Cremation or Removal, (City or Town) 42
DATE OF BURIAL ...
19 ... 7 ....
22 NAME OF
Tridenick + manuelle
FUNERAL DIRECTOR
ADDRES
64 meridian 14/E. Boston
Received and filed.
18
4
(Registrar)
1 3 SEX (or) WIFE of. 8 Usual 9 Occupation: PARENTS 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 Industry 10 or Business :.
PLACE OF DEATH
DOSTON NOTIFIED
The Commnumralth 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.
116
Registered No
§ (If death occurred in a hospital or institution, { give its NAME instead of street and number)
Salvaggio
(If U. S. War Veteran, specify WAR)
137 Saratoga It
.St.
East Bouton mass (If nonresident, give city or town and state)
In this community
yr8.
mos.
days.
1942 ...
13.20 death is said to
Duration IMPORTANT
IMPORTANT PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
=
M R-303A
Suffolk (County) Winthrop
PLACE OF DEATH ... (City or Town) Votat Banks Hospital
The Commonmealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
I
Registered No.
§ (If death occurred In a hospital or Institution,
St. { give its NAME instead of street and number)
2 FULL NAME ..
James 7 Calhours
(If U. S.
War Veteran,
specify WAR).
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Chloride kurMexico
(a) Residence. No ...
St.
(Usual place of abode)
(If nonresident, give city or town and state)
Length of stay: In hospital or institution ......
(Specify whether)
In this community
yr8.
years
months
days.
mo8.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
male
5 SINGLE
(write the word)
single
18 DATE OF
DEATH.
June- 29-1942
(Month)
(
(Day)
MARRIED
WIDOWED
or DIVORCED
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife In full)
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:
fractured- Sheet()
6 Age of husband or wife if alive.
.years
Laceration 1 6 3mai
(or) WIFE of.
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
8
35
20 Accident, suicide, or homicide (specify)
AGE
Days
Date of occurrence.
trave - 27-1942
then he mattknown
provato
19
Years
Monthe.
-
If less than I day
Hours ...
......
.. Minutes
Usual
9 Occupation :.....
Where did
Injury occur ?.
?
Aston, n.
(City or Town and State)
10 or Business:
U.S. army
11 Social Security No ...
Did injury occur in or about home, on farm, in industrial place, in public place?
12 BIRTHPLACE (City).
1 street
(State or country)
(Specify type of place)
new Mexico
Injury
Said to have fallen on street
13 NAME OF
Manner of
FATHER
unknown
Nature of
at Besten Je-27-1942
Injury ....
14 BIRTHPLACE OF
FATHER (City) .......
(State or country)
unknowns
While at work?
Was there an autopsy? yes
15 MAIDEN NAME
OF MOTHER
If so, specify
Editif (unbuon)
21 Was disease or injury in any way, related to occupation of deceased?
16 BIRTHPLACE OF
(Signed)
PARENTS
(Address)
unknown
Kultur
MOTHER (City).
(State or country)
M. D.
1942
17
Fort Back Hospita
Relatlon, if any
22
Chloride
new Mexico
Place of Burich Gromation or Removal.
1912
Informant.
(Address)
Within Ma
........
DATE OF BURIAL .......
june 30
(City or Town)
I HEREBY CERTIFY that a satisfactory, standard certificate of death
23 NAME OF
FUNERAL DIRECTOR ...
was filed with me BEFORE the burial or transit permit was issued:
M. D. Children.
ADDRESS
254 Seach St Renne
....
19
(Signature of Agent of Board of Health or other)
information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF
of Death. See reverse side for extracts from the laws relative to the return of certificates of death.
DEATH in plain terms, so that it may be properly classificd under the International Classification of Causes
Industry
Received and filed
Malthe Myver
6/10/42
.12 . 20 1942
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
Jose Dr. Brickwy
25m-2-'40-D-729-b
(Official Designation) (Date of Issue of ·Permit)
(Registrar)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where saine was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws. Chap. 46, Sec. 9.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there Is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiv- Ing tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an originalInterment, hy a satisfactory certificate of the attending physician, if any, as required by law, or In lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is in- sufficient, a physician who is a member of the board of health, or em- ployed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously Interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and In the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unleas a permit In the usual form for the re- moval of auch 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 la so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or aa 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 heaith 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).
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