USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1943 > Part 48
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19
DATE OF BURIAL
Syrs.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Underline the cause to which death
I last saw h
alive on
to
June 22
.. ,
.f.t ..
19 ..
death Is sald to
have occurred on the date stated above, at.
11:30p.
Im.
Immediateycause of death1 ....... oumon1&
Duration
ladas.
Due to.
Ulcerative colitis
19 | HEREBY ERTIFY That I attended deceased from
(Give maiden name of wife in full)
(Specify whether)
St.
(If U. S. War Veteran,
(City or. Town) Chelsea Memorial hospital No.
-302
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
Carney Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
t
St.
§ (If death occurred in a hospital or institution,
give its NAME instead of street and number)
Frederick H. Tape
(If deceased is a married, widowed or divorced woman, give also maiden namc.)
(If U. S.
War Veteran,
speolfy WAR)
(a) Residence. No.
(Usual place of abode)
145 Main
St.
Winthrop
.Ma.s.s.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
4 days.
In this community
yrs.
mos. 4
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced
HUSBAND of
Margaret Murphy
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
45
years
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
8
AGE
.Years.
Months.
50
Days
-
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
Embalmer
Industry
10 or Business :
Undertaker
11 Social Security No ..
----
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
James W. Tape
14 BIRTHPLACE OF
St. John
FATHER (City)
(State or country) New Brunswick
15 MAIDEN NAME
OF MOTHER
Ellen Murphy
16 BIRTHPLACE OF
-
MOTHER (City)
Framingham, Mass.
(State or country)
17
Informant
( Address)
Relation, if any .wife
A TRUE COPY ..
ATTEST :
Francis
(Registrar of city of town where death occurred)
DATE FILED
18 DATE OF
DEATH
June
27
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
June 24
19 .... 4.3, to.
June .... 27
19.43.
I last saw h ... im ...... alive on ..
June ... 2.7
19 .... 4.3death Is said to
have occurred on the date stated above, at
7.55
P.m.
Duration
Immediate cause of death
Acute cardiac failure
10 days r
Due to.
Hypertensive cardio
10 yrs
vascular disease
Due to
Other conditions
(Include pregnancy within 3 months of death)
Physician
T
Major findings :
Of operations.
Date of
Underline the cause to which death should be charged sta- tlstically.
What test confirmed dlagnosis?clinical signs
20 Was disease or injury In any way related to occupation of deceased ?.... ]Q.
If so, speolfy
(Signed)
S. C. Carter
M. D.
(Address)
.Carney .... Hos.p.
Date ..
6-27 1943
21 "PLACE OF BURIAL,
Winthrop Town Cem.
CREMATION OR REMOVAL
(Cemetery)
(Cfty or Town)
June 30
43
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
W. J. Cassidy
ADDRESS
Boston, Massa
Received and filed
19
Registrar of
realded )
50m (e)-1-41-4667
1
Registered No.
6257
No.
2 FULL NAME
death oc
June 30
19 43
PARENTS
South Boston
Of autopsy.
Winthrop ... Mass.
19
-302
1
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
No.
Palmer ... MemorialHospital
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
Mary Barry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
281 ... RiverRoad
St.
Winthrop,
Mass.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
3
days.
In this community
yrs.
mos.
3
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
June
28
1943
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
9-22
That I attended deceased from
19.
4.2.,
June .... 28
19.
.. 4.3.
I last saw h.
er
.. alive on
June 28
19.43, death Is sald to
have ooourred on the date stated above, at.
3.40
p.
Duration
Immediate oause of death
Carcinoma
of cervix uteri - with
Metastases .... to .... liver
8 AGE. 66 .Years. Months. Days
If less than 1 day Hours. Minutes Due to
Usual
9 Ocoupation :
Housewife
Industry
10 or Business :
own home
11 Social Security No ..
none
Bo.s.t.on, .... Ma.s.s ..
Other conditions.
(Include pregnancy within 3 months of death)
Physician
T
Major findings :
Of operations
Date of
11-12-42
Underline the cause to which death should be charged sta- tistically.
Of autopsy
Bionsy
What test confirmed diagnosis?
20 Was disease or Injury In any way related to oooupation of deceased ?
If so, speolfy
(Signed)
T. J. Anglem
M. D.
(Address) 1.71 Bay State Rd
21 PLACE OF BURIAL, Holyhood
CREMATION OR REMOVAL
(Cemetery)
(City or Town)
DATE OF BURIAL
July .... 1.
.19.43.
22 NAME OF
FUNERAL DIRECTOR
E. J. Burke
ADDRESS
Boston ..... Mas.s.
Received and filed JUL .1.2 ... 1043
19
DATE FILED
G
A TRUE COPY.
ATTEST :
Francis
(Registrar of city or town where death-ereurred)
July 1
19 43
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered . No.
6311
.t
50m (e)-1-41-4667
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
U.S.A.
15 MAIDEN NAME
OF MOTHER
Hannah Reardon
16 BIRTHPLACE OF
MOTHER (City)
Bangor
(State or country)
Maine
17 Informant. (Address)
Relation, if any (husband
Due to.
12 BIRTHPLACE (City)
(State or country)
years
7 IF STILLBORN, enter that fact here.
5a If married, widowed, or divorced
HUSBAND of
(Give majden name of wife in full)
(or) WIFE of Joseph ... A ...... Barry
(Husband's name in full)
6 Age of husband or wife If alive
6.8
T
(Registrar of City or Town where deceased resided)
1
13 NAME OF
FATHER
Michael Garrigan
no
Date
6-28 19 43
Brookline, Mass.
(If U. S.
War Veteran,
speolfy WAR)
-302
1
PLACE OF DEATH
SUPTOLK ) BOSTON (City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON (City or town making return)
Registered No.
6319
-
No.
Mass General Hospital
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Pearl L. MacQueen
(If deceased is a marrfed, widowed or divorced woman, give also maiden name.)
spoty WAR)
(a) Residence. No.
29 Charles
St.
Winthrop.
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
years
months 2
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
John w maven mme og wife in full)
(Husband's name in full)
6 Age of husband or wife if alive 59
years
7 IF STILLBORN, enter that faot here.
8
AGE
Years
65
2
2
Months
Days
If less than 1 day Hours Minutes Due to.
infarction
4 days .....
Usual
9 Occupation :
At home
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Mass.
13 NAME OF
FATHER
Luke Flood
PARENTS
14 BIRTHPLACE OF
FATHER (City)
North Adams , Mass.
(State or country)
15 MAIDEN NAME
OF MOTHER
Julia Lincoln
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Adams , Mass.
17
Informant.
(Address)
Relation, if any
( ..... husband .....
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
July 25
. 194.3
22 NAME OF
FUNERAL DIRECTOR
C. R. Bennison
ADDRESS
Winthrop Mass.
Reoelved and filed JUL 1-2 -1943 19
(Registrar of City or Town where deceased resided)
T
Major findings :
Of operations ..
none
Date of
Underline the cause to which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis ?.
Autopsy
20 Was disease or Injury In any way related to occupation of deceased?
If so, specify
(Signed)
G ...... F ...... Houser
M. D.
Boston
Date ..
6-3019.43
(Address)
21 "PLACE OF BURIAL, Winthrop Cem
CREMATION OR REMOVAL.
(Cemetery)
(City or Town)
Winthrop .... Mass.
DATE OF BURIAL
July 2
19
43
50m (e)-1-41-4667
18 DATE OF
DEATH
June
30
1943
19 | HEREBY CERTIFY,
June 28
19
43
June 30
19.43
That I attended deceased from
to
i last saw her
.alive on
June 30
19 ..... 4,3death is said to
have ocourred on the date stated above, at.
5.09
immediate cause of death
Arteriosclerotic
Duration
? yrs.
Heart Disease
T
... Coronary .... thrombosis ... with ... myocardial
Due to.
Other conditions.
Diabetes mellitus
& IT'S Physician
(Include pregnancy within 3 months of death)
North ... Adams
(Specify whether)
it
(If U. S.
War Veteran,
01 A
Suffolk
(County)
Winthrop
(City or Town)
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.
Registerad No.
148
§ ( If death occurred in a hospital or Institution, St.
( give ita NAME instead of street and number)
2 FULL NAME.
Edward Franklin Bell
( If deceased is a married, widowed or divorced woman, give aiso maiden name.)
(a) Residence. No.
8 Vine Ave. Winthrop
(Usual place of ahode)
Hosp.
yeara
months
days.
In this community
16 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Married
5a If married, widowed, or divorced Melissa Moore
HUSBAND of
(Give maiden name of wife in fuli)
(or) WIFE of
( Husband's name in full)
6 Age of Muchand or wife if alive
years
IF STILLBORN. enter that fact here.
AGE
8 69 Years Months 23 Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Leather Cutter
Industry
Factory (Hat Bandg)
10 or Business :
11 Social Security No.
030-14-8632
12 BIRTHPLACE ( City)
EastBoston
( Siate or country)
Mass.
13 NAME OF
FATHER
John E Bell
14 BIRTHPLACE OF
Thomston The .a.C.
FATHER (City)
(State or country)
Maine
15 MAIDEN NAME
OF MOTHER
Flora Burk
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Prince Edward Isle.
17 Melissa Bell
Relation, if any Wife
I HEREBY CERTIFY that a satisfactory standard certificata of death was filed with ma BEFORE the burial or transit permit was Issued: William 8. Children
(Signature of Agent of Board of Health or other)
agent July 6 th 1943
.......
(Omcja) Designation) ( Date fof Issue of Permit)
18 DATE OF
DEATH
7 (Month)
(Day)
2
19/3
(Year)
19 I HEREBY CERTIFY,
That L attended deceased from
19/3.
to.
2
19.
43
I last saw h.
salve on
2. 19 2 death Is said to
have occurred on the date stated above, at 1115#
m.
Immediate cause of death.
Duration 1
IMPORTANT
Due to
Due to
atemorplus
Other conditions.
(Include pregnancy within 3 months of death)
Major findings: Of operations.
Date of
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, spaolfy ...........
(Signed) ..
(Address) The stranglers Date 2-3-
M. D.
21 ..
Woodlawn Crematory Everett
(City or Town)
...
l'lace of Burial, Creniation or Remoyal ..
July 6
43
DATE OF BURIAL
19.
22 NAME OF
Forward Skinnold)
FUNERAL DIRECTOR
ADDRESS
Winthrop mars
Raoalvad and Aled ..... JUL 6 1943
19
( Registrar)
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS
100M-F -2-42-8855
1
PLACE OF DEATH
No.
Winthrop Community Hospital
........
St.
PHYSICIAN - IMPORTANT
U. S. War Veteran,
if so spoolfy WAR)
(If nonresident, give clty or town and State)
Length of stay: In hospital or Institution
(Before death)
(Specify whether)
MEDICAL CERTIFICATE OF DEATH
...
IMPORTANT Physician
Of autopsy.
What test confirmed diagnosis ?
19% 6.3
Informant
8 Vine Ave. Winthrop
42
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 illneaa, at the request of an undertaker or other authorized person or of ans meniber of the family of the deceased, furnisb 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 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 helief, 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 aec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bumlred 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. Chisp. 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 otber person ahall exhume a human body and remove it fromn a town. from one cemetery to another, or from one grave or tomb other thau the receiving tomb to another In the same cemetery, until he has received a permit from the board of health or its agent aforexaid 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 sucb board, agent or clerk, as the case may be, a satisfactory written statement containing the facta 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. o1 in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate carmot be obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed by 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. tbe medl- cal examiner shall make such certificate. If such a permit for the removal of a human 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 ot the undertaker desiring to make such removal shall constitute a permit for much 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 hody has been sooner ohtalned hereunder. If the death certificate contains a recital, as required
by section ten of chapter forty-six, that the deceased served in the army, bavy or marine corps of the United States in any war In which It has been engaged. sucb 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 Is so given and the physiciau certifying the cause of death shall thereafter furnish for registration any other nece+ sary information which can be obtained as to the deceased, or wa to the manner of cause of the death, which the clerk or registrar may require .- Cbap. 114. Sec. 45. G. L., ( Tercentenary Edition).
No undertaker or other person shall bury a human body or the ashea 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 be buried or the funeral is to he held, or from a person apointed to have tbe care of the cemetery or burial ground in which the interment is made. .. . Cbap. 114. Sec. 46. G. L., (Tercentenary Editiou).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by 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 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 rulea of practice :
(1) Attending phyalciana will certify to such deatha 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 phyalolans will certify to such deaths only as those of persons who, though disahled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whose phyaf- cian is ahsent from home when the certificate of death is needed.
(8) Medloal Examiners will investigate and certify to all deaths sup- posably due to Injury. These include not only deaths caused directly or in- directly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agenta, and deaths following abortion, but also deaths from dlacasa resulting from injury or Infection related to occupation, the sudden deatha of persona not disabled by recognized dlacase, and those of persons found dead.
Statement of Cause of Death .- Cause of deathi means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. Aa principal cause name tbe disease caualng 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 disease causing death, report the usual occupation prior to Illuese. If the deceased bad retired from businesa, report the usual occupation prior to retirement. Children not gainfully employed may be returned aa at school or at boine. For a woman whose only occupatiou waa that of home housework, write bousework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301
1 PLACE OF DEATH 3 SEX Female AGE ... esrady Industry AGE should be stated EXACTLY. PHYSICIANS should state (or) WIFE of
CAUSE OF DEATH in plain 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.
iniurination should be carefully supplied.
200m-10-'39. No. 8427-d
14.0
(Signature of Agent of Board of Health or other) at July 7 143
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
(write the word)
DEATH
July-
7 -
18 DATE OF
1943
(Month)
(Day)
(Year)
19
1 HEREBY CERTIFY. That Vattended deceased from
.......
JUNE
1
19.43. 10 ..
July 7
1943
I last saw h ... £ .. ..... alive on.
....
July.Le , 1943
death is said
to have occurred on the date stated above, at. 7. 98A.
Immediate cause of death ............
Cerebral HEnimorhage.
10 days
Due to
Due to
Other conditions
Coronaria Thrombosis
4€
(Include pregnancy within 3 months of death)
Major findings :
Of operations
PHYSICIAN
Underline
the cause to
which death
Of autopsy
What test confirmed diagnosis ?..
-
should be charged sta- tistically.
20 Was disease or Injury In acy way related to occupation of deceased ? No
If so, specify
Edward A. Fraunger
V. Franger.
M. D.
(Signed).
(Address).
200 Washington, Avendo dupy 7, 1943
21 Holy Cross, Walden
Place of Buurt, Cremation dr Remysal. DATE OF BURIAL July 9 (City of Town)
1943
22 NAME OF
was Kelly
FUNERAL DIRECTOR
ADDRESS
11 Mondial St., E. OB.
1
Received and filed.
JUL 8
1943
A TRUE COPY ATTEST:
(Registrar)
19
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
Ja If marred, widowed, or divorced HUSBAND of
-
.....
(Husband's name, in full)
6 Age of husband or wife if alive ..
years
7 IF STILLBORN, enter that fact here.
8
89-851
....... )
Years
Months
.Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation:
Retired
House wife
10 or Business: own home
11 Social Security No. none
12 BIRTHPLACE (City)
Prince Edward Island
(State or country)
Canada
13 NAME OF
FATHER
John Peters
14 BIRTHPLACE QÉ
FATHER (City)
Prince Edward Island
(State or country)
Canada
15 MAIDEN NAME
OF MOTHER
Victoria Bourque
16 BIRTHPLACE OF
MOTHER (City)
...
Prince Edward Island
(State or country)
Canada
17 Mrd. Edmund 6. Grady Informant ...
Relation, MD_ pny
daughter (Address) 183 Lencola Sty Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with mo BEFORE the burial or transit permit was lasued:
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Winthrop (City or town making return)
Registered No. ....
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
O'DONNel Margaret
of divorced woman, give also maiden name.)
(If U. S.
War Veteran.
specity WAR)
No-
(If deceased is a married, widowed
183 Lincoln
St.
(a) Residence.
No ...
(Usual place of abode)
length of stay: In hospital or institution
(Specify whether)
stospital
...
(If nonresident, give city or town and state)
years
months
7
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
PARENTS
Date of.
.......
Duration
...
Suffolk (County) Winthrop (City of Town) Winthrop Community Hospital so No.
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 issuc 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 tomh 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 aforcsaid or from the clerk of the town where the body is buricd. 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 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 physician who is a member of the board of health, 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 carly 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 obtained hereunder. If the death certificate contains a recital, as required by scction ten of chapter forty-slx, that the deceased served in the army, navy or marine eorps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of healtlı, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the elerk of the town for registration. The person to whom the permit is so ziven and the physician certifying the cause of death shall thereafter fur- nish for registration any other necessary information which can be
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