USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 10
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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
1
Winthrop
(City or Town) 68 Taft Avenue
The Commonmoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or Its Agente
Registered No.
( if death occurred in a hospital or Institution, St. [ give its NAMIE instead of street and number)
2 FULL NAME
Rose Marion (Fearon) Jordan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
68 Taft Avenue
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
( Before death )
X years
months days.
In this community
4
yrs.
X
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
1943
3 SEX Female -
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
John Henry fordan
(Tlusband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
8 AGE 65
Years 6 Months 6 Days
If less than 1 day
.Hours.
Minutes
Usual
9 Occupation :
At home
Industry
10 or Business :
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Ireland®
13 NAME OF
FATHER
Michael Fearon
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Mary Hagen
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
Relation, if any
17 Edwin E Jordan .8.0n Informant ( Address) 68 Taft Ave, Winthrop Mass
100m (d)-1-41-4667
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or Transit permit was Issued : Man. D. Childreny (Signature of Agent of Board of Health or other)
/health Office 2/6/43
(Official Designation) (Date of Issue of Permity
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
jan 29
1993
...
That I attended deceased from
I last saw h.
.alive on
Wr-3
19 73 death Is said to
have occurred on the date stated above, at
11 00
m.
Duration
Immediate cause of death.
IMPORTANT
Due to
6MUSI
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
Major findings :
Of operations
Date of
Of autopsy.
What test confirmed diagnosis ?.
Physician Underline the cause to which death should be charged sta- Listically.
20 Was disease or injury in any way related to oooupation of deceased ?.
If so, specify
('Signed).
(Address) quanapon
Date
2-5
19.00
M. D.
21 Holy Cross Cemetery Malden
l'lace of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIALFebruary 8
.1943
19
22 NAME OF
Charles R ..... Bennison
FUNERAL DIRECTOR
ADDRESS
Winthrop .... Mass
Received and filed 1943
19
(Registrar)
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. PHYSICIANS should state CAUSE OF DEATH in plain
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect. extracts from the laws on back of certificate.
PLACE OF DEATH
Suffolk (County)
No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
(Specify whether)
.
to
19
45
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 nr 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, bis 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 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 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 l'uited 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 canse of death as nearly as he can state the saine. For neglect to comply with any provisinn of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion aiul 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 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 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 huried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay 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 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, 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 form for the reinoval 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 I'nited States In any war in which it has heen engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt nf 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 urces- 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 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 hoard, from the clerk of the town where the body is to he 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 only 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 alıd 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 physi- cian is ahsent from home when the certificate of death is needed.
(3) Medioal Examiners will investigate and certify to all deaths sup- posably due to injury. These include nnt 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, 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 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 bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FORM R-301 1
MARGIN RESERVED FOR BINDING
1 PLACE OF DEATH 3 SEX * 19 HUSBAND of 8 GF 54 AGE. 9 Occupation: 17 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 10 or Business:
Informant ....
Crl = Good 3en1"
Relation, if any ??
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed Ath me BEFORE the burial or transit permit was issued: Www. D. Children
Signature of Artny of Board of Health of other ) Health Office
2/5/43 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
4
1943
(Dan)
(Year)
19 | HEREBY CERTIFY. That I attended deceased from 19 .... , to ... ... 19
I last saw h ............ alive on ..
19.
death is said
to have occurred on the date stated above, at .................... m.
Duration
Immediate cause of death ........
... ...
puna itistra ....
Due the Branch
Due to
Other condit
comparte 1325 36h
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of. ....
Of autopsy
What test confirmed diagnosis ?
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.
(Signed)
HW shapes un Date 2/5
M. D.
(Addı
21
(City or Town) Place of Burial, Cremation of Removal. DATE OF BURIAL .. .... 19
22 NAME OF
FUNERAL DIRECTOR
John JO Knaller
ADDRESS
110
Received and filed ...
19
A TRUE COPY ATTEST:
(Registrar)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of PARENTS 200m-10-'39. No. 8427-d
STON NOTIY
No. Inthron community
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registered No.
26
(If death occurred in a hospital or institution, S
.St. { give its NAME instead of street and number)
2 FULL NAMEAnt Yr F. Peers
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No Valley St Faat
a.A.t ... Boston
St.
(If nonresident, give city or town and state)
(Usual place of abode)
ength of stay: In hospital or institution
(Specify whether)
years
months
I
days.
In this community
yrs. + mos
days
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDOWED
or DIVORCEDin
(write the word)
70
(Give maiden name of wife in full)
6 Age of husband or wife if alive. Years
If less than 1 day
Hours.
.Minutes
1I Social Security No.
030
03
7027
was ...
Suffolk
(County)
Vint on
(City or Towa)
4 COLOR OR RACE
Thite
5a If married, widowed, or divorced
(or) WIFE of
(Husband's name in full)
7 IF STILLBORN, enter that fact here.
Months
Days
Years.
Usual
Chaffeur
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Jine Eades
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Encl nö
(Address)
1.01.11:Av
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
Ach Collectir
Hognito?
(If U. S.
specify WAR)
1941
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 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 cxhume 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 thic 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 physician who is a member of the board of liealth, 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 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 engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificatc, 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- nish for registration any other necessary information which can be
obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, 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 beld, 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, bave 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 septicc- mia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deatbs 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., beart failure, asphyxia, astbcnia, etc. As principal cause name the disease causing death. As related causcs, name earlier morbid con- ditions, 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
ORM R-302
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-302 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
50ın (e)-1-41-4667
A TRUE COPY.
ATTEST :
Frances P. Hanff
(Registrar of city or town where death occurred)
DATE FILED
February 4,1943
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
February
4,
1943
(Month)
(Day)
(Year)
5a If married, widowed, or divorced Lda Vincent HUSBAND of
(or) WIFE of
(Husband's name in full)
55
years
7 IF STILLBORN, enter that fact here.
8
60
9
AGE Years. Months 8
Days
If less than 1 day Hours Minutes
9 Occupation :
Carpenter
Industry 10 or Business :
11 Social Security No.
021-07-7024
12 BIRTHPLACE (City)
(State or country )
Mass
13 NAME OF
FATHER
Marcus St.George
PARENTS
14 BIRTHPLACE OF
Worcester
FATHER (City)
(State or country)
Mass.
15 MAIDEN NAME
OF MOTHER
Clara Laviolette
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
Worcester
(Addressjutland State San . Date24
.43
21 PLACE OF BURIAL,
Notre Dame, Worcester
CREMATION OR REMOVAL
l'ebruary 6, 1943City or Town)
19
smetany)
5
22 NAME OF
Omer P.Lachapelle
ZEFSTOR
FUNERAL
Grafton St. , Worcester, Mass
Reoelved and filed. 19
(Registrar of City or Town where deceased resIded)
3
October 16
19.42
tofebruary
4
1943
I last saw him ..... alive on
February 4
43
19 death Is said to
have occurred on the date stated above, at
1 : 38 P.M
.₼.
Duration
Immediate cause of death.
Pulmonary tuberculosis
13
mos.
Tuberculosis of larynx
1 year
Due to.
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings : Of operations.
Date of
Underline the cause to which death should be charged sta- tlstlcally.
Of autopsy
What test confirmed diagnosisticroscopical
20 Was disease or Injury In any way related to oooupatlon of deceased ?. Unknown
If so, speolfy.
Heinz J.Lorge
M. D.
(Signed)
17 State San.Records
Relation, if any
Informant
( Address)
WORCESTER
(County)
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
RUTLAND
(City or town making return)
1
RUTLAND
CERTIFICATE OF DEATH
Registered No.
20
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME
Arrice Joseph St. George
(If deceased is a married, widowed or divorced woman, give also maiden name.)
22 Charles
(If U. S.
War
War Veteran,
specify WAR)
(a) Residence. No.
(Usual place of abode)
St.
Winthrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution Sanatorium
years 3
months 19 days.
In this community
yrs.
3 mos. 19 days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
19 1 HEREBY CERTIFY That 1 attended deceased from
(Give maiden name of wife in full)
6 Age of husband or wife if alive
Usual
PLACE OF DEATH
(City or Town)
Rutland State Sanatorium
No.
Worcester
DATE OF BURIAL
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