USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 34
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Statement of Oooupation .- Precise statement of occupation la 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 illness. If the deceased had retired from husineaa, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa at school or at horne. For a woman whose only occupatiou waa that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terma, aa housekeeper-private faniily, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
1
PLACE OF DEATH
Suffolk (County) Winchnit (City or Town) 1058 Shirley
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. 102
( { If death occurred In a hospital or institution, St. ¿ give its NAME instead of street aud number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give
(a) Residence. No. 1058 Schuley SI-
(Usual place of abode)
Length of stay : In hospital or institution.
( Before death)
(Specify whether)
years months
days.
In this community /0 yrs.
-
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX desuale
4 COLOR OR RACEĮ
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
widow
Sa If married, widowed, or divorced HUSBAND of
(or) WIFE of
Frank Henry Willians
( Thishand's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN. enter that fact here.
AGE
8
76
Years
6
Months
13
Deys
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
And at- Home
Industry
10 or Business :
none
11 Social Security No.
12 BIRTHPLACE (City)
(State or country )
new Hampshire
13 NAME OF
FATHER
William. Davison.
14 BIRTHPLACE OF
unable x oflaw
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
lc
4
16 BIRTHPLACE OF
MOTHER (City)
4
(State or country)
€
€
r
17 Eva, Lo. Pulcoder
Informant
( lildress) 1068 Shuty PK
Relation, if any ( daughter)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit parmit was Issued : Wm. Flchildress
(Signature of Agent/4] Board of Health or other)
Ho 3/19/44
(Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
May
18
1944
(Month )
(Dar)
(Year)
19 1
HEREBY CERTIFY
Jan 10 1944
to
May 18
19.
That I attended deceased from
44
....
I rast sammen alive on
Thay If, 1944, death Is said to
have occurred on the date stated above, at.
8:15 A:
m.
Immediate cause of death
Carcinoma of Reclin
Due to
General Carcinomatores
6 mas
Due to. arteriosclerosis
Other conditions.
(Include preguancy within 3 months of death)
1 year
IMPORTANT
Major findings :
Of operations
none
Date of
Of autopsy
none
What test confirmed diagnosis ?
clinical x X-Ray large
Iistically.
20 Was disease or injury in any way related to occupation of deceased 60.
-
so, s
(Signed ) Jacob, atrans MU.D.
(Address 562 Hurley ST, Winfrey
M. D.
3/19944
l'lace of Burial, Cremation or Removal.
(City of Town)
DATE OF BURIAL
may
2/17
1944
22 NAME OF
FUNERAL DIRECTOR
Charles RBensin
ADDRESS
24. 000
19
X
100m (d) .1.41-4667
extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to Insert a recital to that effect. PARENTS
Registered No.
No.
Hattie anna Williams
Davidon
also maiden name.)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, "so specify WAR).
St.
(If nonresident, give city or town and State)
Duration
Physician l'mlerline the cause to which death should be
......
(Registrar) X
Received and filed.
MAY 22 1944
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died. defined as re- quired hy section Que. 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 cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six atul forty-seven of said chapter one hundred and fourteen, the word "war" shall inclinte the China relief ex- pedition and the Philippine insurrection, which shall, for sail purposea, he deeincd 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. Chiap. 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 boily is buried. No such permit shall he 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 internient, 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 aelectmen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused hy 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 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 auch removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such reinoval, 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 aection ten of chapter forty-aix, that the deceased aerved In the army, navy or marine corps of the l'uited States in any war in which it has hren engaged. such recital shall appear upon the permit. The board of health. or its agent, upon receipt of such statement anul 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 neces- sary information which can be obtained as to the deceased, or as to the manner or canse of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45, G. L .. (Tercentenary Edition).
No undleriaker or other person shall bury a human hndy or the ashes thereof which have been hronght into the commonwealth until he has re- ceived a permit so to do front 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 hodies 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 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 auch 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 physicians will certify to such deaths only as thoae of persons who, though disabled by recognized disease unrelated to any form of injury. have died without recent medical attendance or whnse physi- 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 aepticemia), 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 discase, 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 out 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 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
R-301 A
- PLACE OF DEATH r
Suffolk (County) Nunchuck
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or its Agent.
103
12 Pleasant S. Hinthul st { { If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.}
12 Pleasant It Worthit
(a) Residence. No. (Usual place of abode)
Length of stay: In hospital or Institution.
( Before death)
(Specify whether)
....
Fears - months -days.
In this community
50 grs. ~ mos.
- days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE|
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
( Ilushand's name in full)
0
6 Age of husband or wife if alive
7 IF STILLBORN. enter that fact here.
8
81
Years
7
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
of Home
Industry 10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( State or conutry)
Reading
13 NAME OF
FATHER
Richard Ponsonly
14 BIRTHPLACE OF
FATHER (City)
unable to obtain
(State or country)
n
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Freland
17 huis may. E. Rogers. Relation, if any
Informant. (Address) 157 Frebin Pr- Owalle
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was Issued : Vi .... D. Childress
(Signature of Agent of Board of Health or other) Health Click 3/24/44
('Official Designation) VU (Date of Issue of Permit)
18 DATE OF
DEATH
22 1944
(Months
(Das)
(Year)
19 | HEREBY CERTIFY,
100 15
1943,
to
May 22
1944
I last saw her
alive on
May ro
.1944, death Is said to
have occurred on the date stated above, at. 3:30 P.m.
years Immediate cause of death ....
Duration IMPORTANT 1 year
.....
20 years
RHEUMATIC.
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings :
Of operations.
Date of
Of autopsy
What test confirmed diagnosis? Clinical Signs
l'indlerline 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 Daniel J. OBrien ..... M. D.
('Signed) (Address) - Winthrop mass Date May 23 1944
21 Windhund Geometry
l'lace of Burial, Cremation or Removal.
DATE OF BURIAL
may
(City or Towu)
25
194
22 NAME OF
FUNERAL DIRECTOR Parco R. Densucom
ADDRESS
wencheof
Received and filed MAY 26-1944 19
( Registrar) .....
100m (d) -1-41-4667
extracts from the laws on back of certificate. terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recitai to that effect. PARENTS
1
No.
Mary Kearney
(Ponsonly)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR)
...
(It nonresident, give city or town and State)
That I attended deceased from
alle .... mache da nated wife in full) carnes
AGE
Thematic Heart Disease
IMPORTANT Physician
......
Registered 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 sn umlertaker or other authorized person or of ans 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 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 hia 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 I'nited States in aus 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, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one bundred 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 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 uineteen bundred 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, fromn 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 oue 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 bave 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 of the attending physician. If death is caused by violence. the medi- cal examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained 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 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 l'nited States in any war in which it has been engaged. such recital shall appear upon the permit. The board of health, or its agent. upon receipt of such statement and certificate, shall forthwith counter-ign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other nece+ sary information which can be obtained as to the deceased, or as to the matiner or canse of the death, which the clerk or registrar may require .- Chap. 11+. Sec. 45, G. L., (Tercentenary Edition).
No undertaker or other person shall bury a human hody or the ashes thereof which have heen brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issne 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 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 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 obaervance 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 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 death« 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 ahortion, 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 bomte. For a woman whose only occupatiou was that of honie 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 occupatiou whatever write none.
SPACE FOR ADDITIONAL INFORMATION
R-301 A
1
PLACE OF DEATH
(County) Winthrop
(City or Town) 45 Highland Ave.
The Commonwealth 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. 105
Registared No.
§ (If death occurred in a hospital or institution, St give its NAME instead of street and number)
2 FULL NAME
Rose grulfeld
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
45 Highland Ave.
(Usual place of abode)
St.
Winthrop
( If nonresident, give city, or town and State)
13
Length of stay: In hospital nr Institution
( Before death)
( Specify whether )
years
months
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 married
or DIVORCED
Sa If marrled, widowed, or divorced HUSBAND of
(or) WIFE of
Aaron .** Krappe fife in full)
( Husband's name in full)
6 Age of husband or wife if aliva
5.7
years
7 IF STILLBORN, enter That fact here.
8 52
AGE
Years
Months
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupetion :
House .ife
Industry
10 or Business :
At home
11 Social Security No.
none
12 BIRTHPLACE (City)
( Siale or country )
Russia
13 NAME OF
FATHER
Max Lezar
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Mollie (unknown )
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Aaron Krulfeld
Kdyvahay
( Address )
45 Highland ive, Winthrop
I HEREBY CERTIFY that a/satisfactory standard certifioste of death was filed with me BEFORE the burial or fransit permit was Issued ? Ma-S. Children
(Signature of Agents of Board of Health or other)
Really Aplicar 5/24
( Date of Issue of Permit) 14.4
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