USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 17
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SPACE FOR ADDITIONAL INFORMATION
ORM R-305
1
Danvers (City or Town)
No. Danvers State Hospital, Hathorne, Mass
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers (City or town making return) 42
Registered No.
(If death occurred in a hospital or institution, give its NAME instead of street and number)
Calvin Thomas
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(If U. S.
War Veteran,
specify WAR)
(a) Resldenoe. No.
Cliff Avenue
(Usual place of abode)
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
12 days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Feb.
10
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.)
Fracture of right hip and Myocardial failure
20 Acoldent, sulclde, or homicide (specify)
accident
Date of ocourrencon or about 1 /29 19 43
Where did
Winthrop, Mass.
Injury oocur?
(City or town and State)
Did Injury occur In or about the home, on farm, In Industrial place, or In
publlo place?
.Nursing .... home
(Specify type of place)
Manner of Fell to floor Injury
Nature
Fractured right hip
Injury
While at work?
no
Was there an autopsy ?...... O
21 Was disease or Injury In any way related to oooupatlon of deoeased ?. no
If so, speolfy.
(Signed).
J. W. P .Murphy
(Address)
Peabody
Date.
2/19 43
M.
22Woodlawn Cemetery,Everett Mass.
Place of Burial, Cremation or Removal.
(City or Town)
23 NAME OF
Metropolitan run'l Serv.
FUNERAL DIRECTOR
Boston, Mass.
ADDRESS
Reoelved and filed
Feb. 12
19
.43
(Registrar of Clty or Town where deceased resIded)
(gILIal vi Vit) vi VwH wiHelC urrascu icblueuזי)
=
=
3 SEX 8 AGE 83 PARENTS of the city or town in which the deceased resided as soon as possible after the close of the month in which the death 10 or Business :
25m (h)-1-41-4667
A TRUE COPY.
ATTEST :
...
(Régis the daily thrown where death occurred)
DATE FILED
Feb. 12
19
43
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
occurred. (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.305 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
4 COLOR OR RACE)
5 SINGLE
(write the word)
male white
MARRIED
WIDOWED
or DIVORCED
wid.
5a If married, widowed, or divorcedMabel- ---
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 faot here.
Years Months. Days
If less than 1 day Hours .... .Minutes
Usual
9 Occupation :
Handyman
Industry
Yacht Club
11 Soolal Security No .... cannot ..... be .... Learned
Belfast
12 BIRTHPLACE (City)
(State or country)
Ma ine
13 NAME OF FATHER Calvin Thomas
14 BIRTHPLACE OF
FATHER (City)
(State or country )cannot be learned
15 MAIDEN NAME
OF MOTHER
Nickerson
16 BIRTHPLACE OF
MOTHER (City)
(State or country)cannot be learned
17 InformantMary K. McPhillips( (Address) Hathorne, Mass,
Relation, if any
DATE OF BURIAL
Feb .... 12
19.43
1943
PLACE OF DEATH
Essex (County)
RM R-302
Suffolk
(County)
Boston
(City or Town)
Boston Floating Hospital
No.
2 FULL NAME
Kathleen Griffin
(If deceased is a married, widowed or divorced woman, give also maiden namc.)
(a) Residence. No.
57 Paine St
St.
Winthrop Mass
(If nonresident, give city or town and State)
months
days.
In this community
yrs.
mos.
days.
17 hrs
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Feb 13, 1943
(Month)
(Day)
(Year)
19
19 | HEREBY CERTIFY,
2/12/43
...
That I attended deoeased from
to.
2/13/43
19
[ last saw her
alive on
2/13/43
.. , 19
death is sald to
have occurred on the date stated above, at
3:450
m.
Immediate cause of death
Congenital heart disease
55 hrs
Due to
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Atelectasis
It lung
Physician
Major findings :
Of operations
Date of.
should be charged sta- tlstically.
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury In any way related to oooupation of deceased?
If so, specify.
(Signed)
C.Hollis
M. D.
(Address) .. Boston
Date.
2/1/293
21 PLACE OF BURIAL,
Holy Cross Cem
CREMATION OR REMOVAL
(Cemetery) Malden((fag gown)
Relation, If any
( ..... father ......
DATE OF BURIAL
2/16/43
19
22 NAME OF
FUNERAL DIRECTOR
R.C. Kirby
ADDRESS
Boston ... Ma.s.s
Received and filed
Feb 18, 1943
19
(Registrar of City or Town where deceased resided)
1
Boston
(City or town making return)
1
PLACE OF DEATH
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
(Usual place of abode)
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
White
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
7 IF STILLBORN, enter that fact here.
8
55 hrs
AGE
Years
Months.
.Days
Usual
9 Occupation :
None
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Boston Mass
14 BIRTHPLACE OF
FATHER (City)
(State or country)Chelsea Mass
15 MAIDEN NAME
OF MOTHER
Elizabeth Howley
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
(State or country)
Boston Mass
17
Informant
(Address)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
13 NAME OF
FATHER
William K Griffin
4 COLOR OR RACE: 5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Single
years
If less than 1 day
Hours.
Minutes
50m (e)-1-41-4667
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED 19
1
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
years
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Registered No.
157043
(If U. S.
War Veteran,
specify WAR)
Duration
Underline the cause to which death
ORM R-305
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Boston
(City or town making return)
45
Registered No.
...
1949
(If death occurred in a hospital or institution, 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.
207 Cottage Park rd
St.
Winthrop Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
months
days.
2 mrs
In this community
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
Feb 22, 1943
DEATH
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Fractured distocation cervical
6 Age of husband or wife If alive years spine
7 IF STILLBORN, enter that faot here.
8
AGE 16 Years
- Months 27 Days
If less than 1 day
Hours
.Minutes
Usual
9 Occupation :
Student
Industry
10 or Business :
Junior ..... High
11 Soolal Security No.
12 BIRTHPLACE (City)
(State or country)
Winthrop Mass
13 NAME OF
FATHER
Cornelius J Donovan
14 BIRTHPLACE OF
FATHER (City) (State or country)East Boston Mass
15 MAIDEN NAME
OF MOTHER
Mary J Fraser
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Gysboro Nova Scotia
17 Informant (Address)
(.
A TRUE COPY.
ATTEST :
(Registrar of' city or town where death occurred)
DATE FILED 19
20 Accident, suloide, or homicide (specify)
Accidental
Date of occurrence
Feb 22/43
19
Where did
Boston
Injury oocur ?
Dld Injury occur In or about the home, on farm, In Industrial place, or In
publlo place?
(Specify type of place)
Ship
Manner of Fell accidentally into hold of
Injury
Nature of
a boat at & Boston 2/22/43
Injury
While at work?
7
Was there an autopsy ?...... nQ
21 Was disease or Injury in any way related to occupation of deceased ?..?
If so, speolfy
(Signed)
W J Brickley
M. D.
(Address)
B.o.s.ton
Date 2/23/93
22
Winthrop
winthrop lass
Place of Burial, Cremation or Removal.
(Clty or Town)
DATE OF BURIAL
Feb 25, 1943
19
23 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS
Bostonukas.s.
Received and filed.
Feb 26, 1943
.19
(Registrar of City or Town where deceased reslded)
occurred. (See Chap. 46, Sec. 12. G. L.)
PARENTS
25m (h)-1-41-4667
of the city or town in which the deceased resided as soon as possible after the close of the month in which the death
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-305 to the clerk
1
Boston
(City or Town) Mass General Hospital
St.
No.
Joseph X Donovan
(If U. S. specify WAR)
3 SEX
4 COLOR OR RACE|
5 SINGLE
(write the word)
Male White
MARRIED
WIDOWED
or DIVORCED
Single
16 yrs.
19 | HEREBY CERTIFY that I have Investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state_fully.) Fractured base of skull
(City or town and State)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
11
1
1
IR-301 A
Muro Elizabet Snook. 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 If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoltal to thall effect. PARENTS
100M-G - 2-42-8855
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or trajalo bernat was Issued: Him. halchildress
140
(Signature of A
Ceny Board of Health or other
mar. 5/43
(Omclal Designation) (Date of Immue of Permit)
18 DATE OF
DEATH
march
2
(Month)
(Day)
(Year)
19 1 HEREBY CERTIFY,
Den 10
That I attended deceased from
1942, to.
march
2
1943
I last saw h.A .....
..... alive on
march
2
1943, death is said to
have occurred on the date stated above, at.
10-Pm
6 Age of husband or wife if alive
65
years
IF STILLBORN. enter that fact here.
8
75 Years
AGE
- Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Salesman
Industry
10 or Business :
clicking
11 Social Security No. move
'2 BIRTHPLACE (City)
( Siate or country)
1' NAME OF
CATHER
Nulenacon"
Major findIngs :
Of operations
14 BIRTHPLACE OF
FATHER (Clty)
m.4
(State or country)
15 MAIDEN NAME
OF MOTHER
Antonette young
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
17
Informant
( Address )
Hullnon In
tawn lubche ( wife
Relation, If any
DATE OF BURIAL
mars 6
1943
22 NAME OF
FUNERAL DIRECTOR ..
ADDRESS
Reosived and Aled.
19
( Registrar)
1
PLACE OF DEATH
County (County)
(City or Town) 3) Semble Are
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 .:
Registered No.
$ { If death occurred in a hospital or institution, St. [ give its NAME Instead of street aud nuniber)
PHYSICIAN · IMPORTANT
2 FULL NAME
Jason &
leopard Knock
( If deceased Is a maryted, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
37 Temple Que
(Usual place of abode)
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 2 3
yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
Married
Sa If married,
HUSBAND of
Curabile Mc Quillian
(Give maiden name of wife In full)
(or) WIFE of
( Husband's name In full)
Immediate oause of death
Carcinoma of color
Due to
Due to.
Other conditions
( Include pregnancy within 3 months of death)
IMPORTANT
Physician
Underline the cause to which death should be charged sta- tistically.
20 Was disease orinjury in any way related to oooupation of deceased ?. -
If so, spoolfy
Thin Lyhummer
. M. D.
('Signed)
(Address)
1786 Sacataja Sf
Date ch 4, 19/3
New York
21
Place of Burial, Cremation or Removal.
(
(City of Town)
Date of
Of autopsy.
.....
........
What test confirmed diagnosis? Jalkation
......
Duration IMPORTANT ....
No. .
r
(Was deceased a
U. S. War Veteran,
if sg specify WAR)
1943
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiolan or registered hospital medloal officer shall forthwith, after the death of a person whoin he has attemuled during his last illness, at the request of an undertsker or other authorized person or of any meniber of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and behef the name of the deceased, his supposed age, the disease of which he died. defined as re- quired hy section one. where ssme wss contracted. the duration of his last illness, when Isst seen allve by the physician or officer and the date of his death ... Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certifleste of death as required by the preceding section or by section forty five of chapter one hundred and four- teen, shall, if the decessed, to the best of his knowledge and helief, served in the army, navy or marine corps of the I'nited Ststes in any war in which it has been engaged, insert in the certificate s recitsl to that effect, speci- fying the wsr, sud shall slso certify in such certificate both the primary and the secondary or immediste cause of death ss nearly as he can state the ssine. For neglect 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 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. Chsp. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to lasue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertsker or other person shall exhume a human body and remove it fromn a town. from one cenietery to another, or from one grave or tomb other than the receiving tomh to another In the same cemetery, until he has received a permit from the bosrd of health or its agent aforesaid or from the clerk of the town where the hoily is buried. No such permit shall be issued until there shall have been delivered to such hoard, agent or clerk, as the case tnay he, 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. 01 in lieu thereof a certificste as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the bosrd of health, or employed by it or hy the selectmen for the purpose, shall upon application niske the certificate re- quired of the attending physician. If death is csused 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 esrly enough for the purpose, the certificate of desth made as ahove provided and in the possession ot the undertaker desiring to make such removal shall constitute a permit for such removal; provided, thst 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 ususl form for the removal 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 recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificste, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other neces sary information which can be obtained as to the deceased, or as to the manner of cause of the death, which the clerk or registrar unay require .-- Chap. 114. Sec. 45, G. L., ( Tercentenary Edition).
No undertaker or other person shall hury a hunisn hody or the ashes thereof which have been brought Into the commonwealth until he has re- ceived a permit so to do from the hoard 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 be buried 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 internient is made. .. . Chap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall mske examination upon the view of the dead hodies of only such persons ss are supposed to have died by violence. If a medical examiner hss notice that there is within his county the body of such a person, he shall forthwith go to the place where the body fiea aud 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 deatha only an those of persons to whom they have given hedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physiolans will certify to such deaths only as those of persons who, though disahled hy recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is absent from home when the certificate of death is needed.
(3) Medloal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly hy traumatism (including resulting septicemia), and by the action of chemical ( drugs or poisons), thermal, or electrical agents, aml deaths following abortion, but also desths from dlacasa resulting from injury or infeotlon related to oooupation, the sudden deatha of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of deatlı 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 compliestion of the principal cause.
Statement of Oooupation .- 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 persou aged 10 years or over. If the occupation had been given up or changed ou account of the disease causing desth, report the usual occupation prior to illness. If the deceased hsd retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned an at school or at hoine. For a woman whose only occupatiou was that of honie housework, write bousework. For a person engaged in domestic service for wages, however, designste the occupation hy the appropriate terms, aa housekeeper-private fantily, cook-hotei, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
FI R-301 A
1
No. PLACE OF DEATH Auffalls County Winthrop ....
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.
Registered No.
( ( If death occurred in a hospital or institution, { give its NAME Instead of street and nuniber) PHYSICIAN - IMPORTANT
2 FULL NAME
( If deceased Is &married, widowed or divorced woran, give also maiden name.)
(a) Residence. No. 40 Sunnyside Que St.
(Usual place of abode)
(If nonresident, give elty nr town and State)
Length of stay: In nosoltal or Institution
(Before death)
(Specify whether)
years
months days.
In this community / yrs.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
5 SINGLE
( write the word)
MARRIED
WIDOWED
Widowed
5a If married, widowed, or divorced
HUSBAND of
.....
(or) WIFE of
( Husband's name Incfull)
6 Age of husband or wife if alive
years
IF STILLBORN. enter that fact here.
8 77 Years
Months
-
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
pone
.
Industry
10 or Business:
none
11 Social Security No. none
12 BIRTHPLACE (City)
( State or country )
Boston Mass
13 NAME OF
FATHER
Michael Fitzgerald
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Margare Charley
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Ireland
17 alice Bynes
Holatinn,
Informant
( Address )
40 Sunnyside ave
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with me BEFORE the burial or Trangt permit was issued ;
( Signature of ARgay of Board of Health ar other)
Health ..... Officer 3/6/47
7(Official Designation) ( Date nf faque of Permit)
18 DATE OF
DEATH
March
5
1943
( Jfonth)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
i last saw h.
alive on
3/4
1943, death is said to
have occurred on the date stated above, at
4
m.
Duration IMPORTANT 2.ym
Due to
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 ba charged sta- tistically.
20 Was disease or injury in any way related to oooupation of deceased ?. if so, specify
( Signed)
trend B. O TheSan
(Address)
3705Maloga Liv Date 3/6
. M. D.
196
21 Holy terass Maldin
Place of Burial Creniation or Removal.
(City or Town)
DATE OF BURIAL.
mar 8
1943
22 NAME OF
FUNERAL DIRECTOR
Charles H Treamer
ADDRESS
Each Boston
...
Reoaived and Alad 19
( Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoital to that offoot. extracts from the laws on back of certificate.
100M-6 .- 2-42-8855
of Information
WAIT PLAINET. WITH UNFADING BLACK INK -- THIS IS A PERMANENT RECUNO. ......... ... ......
terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
PARENTS
(City or Town) 40 Sunnyside ave Margaret T. SMeill
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
1942,
March -
1943
Immediate cause of death.
Chroni Myocardetes'
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
Female White
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 whoin he has attended during his last illness, at the request of an undertaker or other authorizeil person or of any member of the family of the deceased, furnisb for registration a standard certificate of death, stating to the best of his knowledge aud belief the name of the deceased, bis supposed age, the disease of which he died. defined as re- quired by section one. where ssme was contracted. the duration of his last illness, when last seen alive by the physician or officer aud the date of his death ... Gen. Laws, Clap. 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 decessed, to the best of his knowledge and belief, aerved 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 wsr. and shall slso certify in such certificate both the primary and the secondary or immediste cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, sucb physician or officer shall forfeit ten dollars. For the purposes of thla aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humilred and fourteen, the word "war" shall include the China relief ex- pedition and the Philippine insurrection, which shall, for said purposea, he deemed to have taken place hetween 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 bundred and seventeen. G. L. Cliap. 46, Sec. 10.
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