USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1942 > Part 6
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-
years
months
days.
In this community +2 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
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of ..
Jeannette Miller
(Give maiden name of wife in full)
(or) WIFE of ...
(Husband's name in full)
62
6 Age of husband or wife if alive .. years
7 IF STILLBORN, enter that fact here.
8
AGE.
66 Years
2
Months
17 Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Bookkeeper
10 or Business:
11 Social Security No ...
022-07-9669
12 BIRTHPLACE (City)
Nest Dennis
(State or country)
Mass.
13 NAME OF
FATHER
Browling K Baker
14 BIRTHPLACE OF
FATHER (City) .....
West Dennis
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Abbie T Baxter
16 BIRTHPLACE OF
MOTHER (City)
West Dennis
(State or country)
Mass.
Relation, if any wife
Informant.
(Address)
142 Pleasant 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 . Childrens & (Signature of Agent of Board of Health or other)
Health Officer 1/26/42
(Official Designation) (Date of Issue of PermitY
19 I HEREBY CERTIFY, That I attended deceased from
law
19 42
to.
1942
Mast saw he alive on.
Low 23, 199-2 death is said to
6
have occurred on the date stated above, at.
G .m. Duration
IMPORTANT
Due to.
Certing - Schoon
2
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
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 ..
mart
(Signed)
(Address) 74 Cescu St. Lynn Date Ate 26 1942
South Denn.
21
South Dennis
Place of Burial, Cremation or Removal.
January 28
19
(City or Town) 42
DATE OF BURIAL
22 NAME OF
Howard S quenaldo
FUNERAL
ADDRESS
Winthrop Mari
Received and filed .. 19.
......
(Registrar)
is very important. See instructions and extracts from the laws on back of certificate.
100m-2-'40-D-729-a
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 N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of
1
(If U. S.
War Veteran,
specify WAR)
(a) Residence. No
(Usual place of abode)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH.
Jan
24
1942
Immediate cause of death.
Industry
Furniture Store
PARENTS
n
Underline the cause to which death should be charged sta- tistically.
Jan, M. D.
17 Jeannette Baker
1
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 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 scction 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 hury or otherwise dispose of a human body in a town, or remove therefrom a human hody which has not been huried, until he has received a permit from the board of hcaith, 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 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 original interment, hy a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as herelnafter provided. If there Is no attending physician, or if, for sufficlent 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, unless a permit in the usual form for the re- moval of such body has been sooner obtaincd 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 cnzagcd, 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 cierk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shail thereafter furnish 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 .- 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 issue such permits, or if there is no such board, from the clerk of the town where the body is to be huricd 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 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 iliness 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 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, but also deaths from disease resulting from Injury or infection related to occupation, 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 principai 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 principai 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.
RM R-301 A
PLACE OF DEATH
Suffolk XCounty)
(City_or Towny 56. Washington ava
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.
15
{ {If death occurred in a hospital or Institution, St. ( give its NAME instead of street and number)
Elinfect, Bracket
If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
56. Washington are much
(Usual place of abode)
· years
months
days.
in this community 45 yrs.
- mos.
-
days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
OF Jan
24
(Month )
(Day)
1942
( Year)
19 1 HEREBY CERTIFY,
That I attended deceased from
3
1941.
Jan
24
1942
1 last saw h .............. alive on ..
194 death Is said to
have occurred on the date stated above, at.
9 Pm.
Immediate cause of death IMPORTANT Hyperstatic Brummen Jan 23 1942
Due to ...:
Generalized Internal Delucia
1930
Chateauinte
Due to
D intetra Mellitus
mon
Du. 31 $1. Nee 3:41
11:42
IMPORTANT
Major findings:
Of operations
none
Date of
Of autopsy
What test confirmed diagnosis ?.
Clinical.
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify.
wir w, pickinson
M. D.
(Signed)
(Address) Olmayan notar
Date form 25 1947
l'lace of Burial, Cremation or Alemoyal. ( (City or Town) DATE OF BURIAL Zuelita Lan 27 luncheon 1942
22 NAME OF
FUNERAL DIRECTOR ......
B.R. Benson
ADDRESS
Received and flied
19
KOfficial Designation) (Date of Issue of Permit)
21
Relation, if any
Informant (Address) 56 - washita we will
I HEREBY CERTIFY that a satisfactory standard certificate of death was a. filed with me BEFORE the burlar or transit permit was Issued : Nau. D. Children 9- (Signature of Agent of Board of Health or other> Healthe Officer 1/26/42
100m (d)-1-41-4667
1
....
No.
2 FULL NAME
Length of stay : In hospital or Institution ..
( Before death)
( Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE|
thunde White
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
......
(or) WIFE of
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
8%
If less than 1 day
AGE
Hours
5 Months
18 Day's
Usuai
9 Occupation :
Industry
10 or Business :
11 Social Security No ...
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
Peter Brackett
FATHER (City)
(State or country)
mc
15 MAIDEN NAME
OF MOTHER
Betsy abbott
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
17
Trace Pettengill
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
extracts from the laws on back of certificate.
should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain
N. D .- WRITE PLAINLT, WITHT ONFADING BLACK INK-THIS IS A PERMANENT RECORD. Every Item of information
14 BIRTHPLACE OF
unable to obtain
5 SINGLE
(write the word)
widno
....
Give maiden name of wife is fully red
(Husband's name in full)
years
Minutes
Other conditions.
(Include pregnancy within 3 months of death)
Duration
(Registrar)
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
If so specify WAR)
(If nonresident, give city or town and State)
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 deaile of a person whoin he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the fanrily of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the naine of the deceased, his supposed age, the disease of which he died. defined as re- quired hy 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 bis death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death aa 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 immediate cause of death as nearly as he can state the same. For negleet to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of thia sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bundred and fourteen. the word "war" shall inchile the China relief ex- pedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetwcen 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. Cliap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a buman 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 ita 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 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 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 hoard of health, or employed by it or by the selectmen 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 liuman body, not previously interred, froin 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 renioval 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 ins agent, upon receipt of such statement atıl certificate, shall forthwith coumersign 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 canse of death shall thereafter furnish for registration any other neces- sary information which can be obtained as to the deceased, or as to tbe manner or canse 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 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 make examination upon the view of the dead bodies of ouly such persons as are supposed to have died hy violence. If a medical 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, Chap. 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 those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose pbyel- 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 aepticemla), and by the action of chemical ( drugs or poisons), thermal, or electrical agents, and deaths following ahortion, but also deathis from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized diseasc, and those of persons found dead.
Statement of Cause of Death .- Canse 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 conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation ia 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 illnesa. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at home. For a woman whose only occupation was that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, 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
Suffolk
(County)
No. 61
(City or Town) er Ton Orlando avE
The Commontoralth 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.
16
St.
( If death occurred in a hospital or Institution,
{give its NAMIE instead of street aud number)
r
Harry Wallace aiken
(If deceased is a married, widowed or divorced woman, give also maiden name.)
6/ Orlando avz
St.
(a) Residence. No.
(Usual place of abode)
Length of stay: In hospital or Institution.
( Before death )
(Specify whether)
years
months
days.
In this community 63 yrs. - mos. - days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE|
volute
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
marcel
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
years
7 IF STILLBORN. enter that fact here.
72
4
Years
Months.
15 Days
If less than 1 day Hours. Minutes
лечение
Somerville
12 BIRTHPLACE (City)
(State or country) massachusetts
William Q. Diken
14 BIRTHPLACE OF
Boston
Massachusetts
15 MAIDEN NAME
OF MOTHER
Enuna G. Underhill
16 BIRTHPLACE OF
MOTHER (City)
(State or country) Massachusetts
Boston
17 Harry, W. Cuken JR (Begon
Relation, if any
Informant. (Address) 61-Orlando Cere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transiy permit was issued : Man. D. Children
(Signature of Agent of Board of Health or other) Healthe Officer 1/27/42
(Official Designation) (Date of Issue/of Permit)
18 DATE OF
DEATH
1
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
to
1/25
194.2
I last saw h
.alive on
1/25
1944.2., death Is said to
have occurred on the date stated above, at.
93 a.m.
Immediate cause of death
angines
Pertonão
3 Tys
Due to.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Date of.
-
Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?......
If so, specify.
Hayven aut elle
('Signed)
M. D.
(Address)
Date .........
166
1942
Place of Burial, Crenintion or Removal. (City or Town)/
DATE OF BURIAL.
194L
22 NAME OF
GR. Bannon
FUNERAL DIRECTOR.
ADDRESS
Received and filed q 1043 19
( Registrar)
Physician
Of autopsy
What test confirmed diagnosis ?.
25
42
Elsauge S. Patrick
1
21/42
19 ..
.. ,
Duration IMPORTANT
64
100m (d)-1-41-4667
1 2 FULL NAME 3 SEX mare (or) WIFE of 9. 8 AGE . Usual 9 Oocupation : Industry 10 or Business : 3 11 Social Security No. 13 NAME OF FATHER FATHER (City) PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain 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 I. D .- WRITE PLAINTLI , WEIN ONTADING BLACK INK-InIS IJ A PERMANENT RECORD. Every trem of information (State or country) 20
PLACE OF DEATH
Registered No.
PHYSICIAN · IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident, give city or town and State)
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 anv meniher 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, bis supposed age, the disease of which he died. defined as re- quired hy 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 ... Cen. 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- teeu, 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 same. For neglect to comply with any provision of this section, snch physician or officer shall forfeit ten dollars. For the purposes of thia 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, he deemed to have taken place hetwcen February fourteenth, eighteen hundred and ninety-eiglit and July fourth. nineteen hundred and two, and the Mexi- can horder service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
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