USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1944 > Part 66
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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 certificate, shall forthwith countersign It and transmit it to the clerk of the town for registration. The person to whom the permit ls so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary Information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chop. 114, Sec. 45, G. L., (Tercentenary Edition).
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 hls 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.
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 80 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 he held, or from a person appointed to have the care of the cemetery or burial ground In which the Interment Is made. . . . Chop. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as thoss 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 physician ls 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 septicemia), and hy the actlon 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 dylng, 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 la very Important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he 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
1
M R-302
PLACE OF DEATH
Middlesex (County)
The Commonfocalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
TEWKSBURY STATE HOSPITAL and INFIRMARY TEWKSBURY, MASSACHUSETTS (City or town making return)
Registered No.
282 191
No. Tewksbury State Hospital and Infirmary
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Theodore E. Crocker
(If deceased is a married, widowed or divorced woman, give also maiden name.)
10 Woodside Park
St.
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution.
(Before death)
(Specify whether)
years
months
6
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
5a If married, widowed,pr civorgeearned
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 fact here.
8
AGE.72
Years
4
Months
24,
Days
If less than 1 day
Hours ..
Minutes
Usual
9 Occupation :
Janitor
Industry
National Fireworks,
10 or Business :
Boston ....... Mass.
11 Social Security No ...
015-01-9580
12 BIRTHPLACE (City)
(State or country)
"Mas's:
13 NAME OF
Ebenezer S. Crocker
FATHER
PARENTS
14 BIRTHPLACE OF
Not learned
FATHER (City)
(State or country)
West Bridgewater
15 MAIDEN NAME
OF MOTHER
Mary Robinson
16 BIRTHPLACE OF
MOTHER (City)
Not learned
(State or country)
West Bridgewater
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
August 16
Fairhaven, Fairhaven
(City or Town)
44
19
22 NAME OF
Maurice W. 'Kirby
FUNERAL
DIRECTOR
A TRUE COPY.
C. Winthrop Houghton m.D.
'Supt.
ADDRESS
210 Winthrop St., Winthrop
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
August 13
19
44
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
August
13
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Aug ..
7
19 44, to
AUF. 13
19
44
I last saw h .... j.m. .... alive on
Aug. 13
1944,
death Is sald to
have occurred on the date stated above, at
8 P.
m.
Duration
Immediate oause of death.
Cerebral Thrombosis with
Right Hemiplegia
Un
known
Due to
Arteriosclerosis
"Yrs.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Underline the cause to which death
should be
charged sta- tistically.
Of autopsy Clinical
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?
If so, specify
Nils E. Svibergson
M. D.
(Address)
T. S. H. and I., Tewksbury
Date
8-1319.
44
Informant
(Address)
17 Hospital Records Relation, if any
DATE OF BURIAL
Received and filed.
OCT .... 2.3 ...... 1944
19
(Registrar of City or Town where deceased resided)
X
50m (e)-1-41-4667
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-802 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
1
Tewksbury, Mass (City or Town)
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
Winthrop
(If U. S.
War Veteran,
specify WAR)
1944
That I attended deceased
from
c
Bridgewater
Major findings :
Of operations
Date of
(Signed)
M R-302
Essex
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
1
PLACE OF DEATH
(County)
Danvers
Registered No.
192
.....
-
No.
.Dar.v.e.r.s .... State ..... ]ospital
{ give its NAME instead of street and number)
Anna M. Little
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
117 Loring Road
St.
winthrop
(Usual place of abode)
Length of stay : In hospital or institution.
(Before death)
(Specify whether)
years
2 months
1 days.
in this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACEI
female white
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
cannot be le rned.
(Husband's name in full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
AGE
Years
Months.
Days
if less than 1 day
.Hours
Minutes
Usual
unable to work
11 Social Security No ..
none
12 BIRTHPLACE (City )May's Landing,
(State or country)
N. J.
13 NAME OF
FATHER
Benjamin Abbott
14 BIRTHPLACE OF
May's Landing
16 BIRTHPLACE OF
MOTHER (City)
Bridgeton
(State or country)
J. J .
17 M. K.I.cPhillips ( Relation, if any
DSH
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
9 /11/44
.. 19
DATE FILED
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sep. 2, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
J.r.l ................. , 19 ... 4.4 ...
to.
Sep ...
2, 19 44
I last saw h ....... ] ..... allve on.
S.e.p.
........... , 19.44.4 death Is said to
have occurred on the date stated above, at 11.354
m
Immediate oause of death.
Chronic ..... my.o.c.ard.j.t.i.s ...
2 ..... y.r.s ..
Due to.Cerebral .... vascular ..... accident
11 days
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operatione
Underline the cause to which death Date of should be charged sta- Of autopsy. What test confirmed diagnosis@ ...... ini cal
20 Was disease or injury in any way related to oooupation of deceased ?.
........
If so, specify.
(Signed) Leo Maletz
M. D.
(Address)
DSH
Dat.9/ 8
1944
Camden, N.J.
DATE OF BURIAL
21 PLACE OF BURIAL, Tarleigh
CREMATION OR REMOVAL
(Ce
gr/5/44
(City or Town)
19.
22 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop.
Received and filed
001 1-0-4944
.19
(Registrar of City or Town where deceased resided)
2 FULL NAME
3 SEX
8
74
9 Ocoupation :
Industry
10 or Business :
FATHER (City)
PARENTS
Informant ..
(Address)
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 returna of deaths recorded during the previous month which occurred in your city or town in case the deceased
(State or country)
50m (e)-1-41-4667
(City or Town)
5
(If death occurred in a hospital or institution,
St.
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and State)
Duration
tistically.
15 MAIDEN NAME
OF MOTHER
Harriet Blue
RM R-302
PLACE OF DEATH r
SUFFOLK BOUTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
POSTON
(City or town making return)
Registered No.
7.765 193
....
203 W. Newton Supleath occurred in a hospital or institution, St.
{ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
no
(If deceased is a married, widowed or divorced woman, give also maiden name.)
227 Shirley St.
Winthrop
St.
(If nonresident, give city or town and State)
12 hrs 30 min
In this community
yrs.
mos. days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sept 4, 1944
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Feb.
1944
19
....
to,
That I attended deceased from
9/4/44
19
[ last saw h
er
9/4/44
alive on
19
death Is sald to
S
Immediate cause of death.
Acute cardiac
failure
Due to.
Other conditions. (Include pregnancy within 3 months of death)
Physician
Pregnancy
term
Major findings:
Of operations
Date of
should be
charged sta-
tistically.
Of autopsy. What test confirmed diagnosis ?.
20 Was disease or injury in any way related to oocupation of deceased ?.
If so, specify
J. F. Deich
(Signed)
(Address) .4.75.Comm ..... Ave
M. D.
Date
9/4/48
Winthrop Cem. Winthrop
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
(Cemetery)
1944
(City or Town)
19
22 NAME OF
FUNERAL DIRECTOR
Charles R. Bennison
ADDRESS
Winthrop
Received and filed
OCT 1 0 1944
.19
(Registrar of City or Town where deceased resided)
Y
Evelyn Gims
2 FULL NAME
(a) Residenoo. No.
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
F
4 COLOR OR RACE|
Black
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
Chaffesnadimoment wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
30
7 IF STILLBORN, enter that fact here.
8
27
AGE
Years.
5
Months.
Days
9
Usual
9 Occupation :
Housewife
industry
None
10 or Business :
Il Social Security No ..
.no
12 BIRTHPLACE (City)
(State or country)
Winthrop, Mass.
13 NAME OF
FATHER
John R. Sandiford
14 BIRTHPLACE OF
Barbadoes
FATHER (City)
15 MAIDEN NAME
OF MOTHER
Minnie E. Blair
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
Antigna
(State or country)
British West Indies
17
Informant ...
(
(Address)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
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
(State or country)
British West Indies
5 SINGLE
(write the word)
Married
years
If less than 1 day
Hours ..........
.Minutes
50m (e)-1-41-4667
A TRUE COPY The Marcin
ATTEST :
(Registrar of city or tow'n 'where death occurred)
DATE FILED
Zept .... 7.,.1944
19
ʻ
Relation, if any
Husband
DATE OF BURIAL
Sept.
Underline the cause to
which death
Due to
Duration
1
(City or Town)
Evangeline Booth Hosp
No.
12 hrs 30 min
months
days.
have occurred on the date stated above, at.
1:15 p.
m.
C
RM R-302
1
PLACE OF DEATH
SUFFOLK BOSTON
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City /or town making return)
Registered No.
813394
No.
( give its NAME instead of street and number)
Baby Girl Annis
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
9 Almont st.
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
(Before death)
Hosp
years
months
1Qyshrs
ẩys.
In this community
yrs.
mos.
10 hrs.
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 Single
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
years
7 IF STILLBORN, enter that fact here-
8
AGE
Years ..
.Months.
2
Days
If less than 1 day
Hours ............ Minutes
Usual
9 Occupation :
None
Industry
10 or Business :
None
Il Social Security No .. none
12 BIRTHPLACE (City)
(State or country)
Chelsea, Mass.
13 NAME OF
FATHER
Theodore Annis
14 BIRTHPLACE OF
FATHER (City)
S. Boston, Mass.
(State or country)
15 MAIDEN NAME
OF MOTHER
Josephine Horner
16 BIRTHPLACE OF
MOTHER (City)
.E ...... Boston, .... Mass ..
(State or country)
Relation, if any
(Cemetery)
(City or Town)
DATE OF BURIAL
Sept .... 18., ..... 19.44
19
22 NAME OF
FUNERAL DIRECTOR
C. H. Treaner
ADDRESS
£ ..... Boston., .... Mass.
Received and filed
OCT-1 0-1944
19
(Registrar of City or Town where deceased resided)
50m (e)-1-41-4667
A TRUE COPY.
Francis J. Hay
66
Father
ATTEST :
(Registrar of city or town where death decurred)
DATE FILED
.CITY.REGISTRAR
Sept 20, 1944
19
IS DATE OF
DEATH
Sept 16 1944
(Month)
(Day)
(Year)
19 I HEREBY
Sept 16/44
19
CERTIFY,
That
attended deceased from
....
Sept 16/44
19
I last saw h .... er
alive on.
Sept 16/44, 19.
..... , death Is said to
have occurred on the date stated above, at.
10:50 pm
Duration
Immediate cause of death.
Intracranial hemorrhage
2
days
Due to.
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings:
Of operations.
Date of
should be
charged sta-
tistically.
What test confirmed diagnosis ?
20 Was disease or injury in any way related to oooupation of deceased?
If so, specify
no
(Signed)
Đ ...... H ...... P.r.u.gh ....
M. D.
(Address) 300 Longwood Ave.
Date.9./17/44
21 PLACE OF BURIAL,
Winthrop, Winthrop, Mass.
CREMATION OR REMOVAL
which death
PARENTS
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
(City or Town)
Infants Hospital
(If death occurred in a hospital or institution, St.
(If U. S.
War Veteran,
specify WAR)
(a) Residenoe. No.
(Usual place of abode)
(Specify whether)
(Give maiden name of wife in full)
rn
Underline the cause to
Of autopsy.
17
Informant
(Address)
RM R-305
1
PLACE OF DEATH
Essex (County)
Dan.v.e.r.s. (City or Town) Danvers State Hospital
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
1.95
(If death occurred in a hospital or Institution, give its NAME instead of street and number)
Ella May Thompson
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo.
No.
104 Highland Ave.
St.
winthrop
(If nonresident, give city or town and State)
(Usual place of abode)
Length of stay: In hospital or Institution
(Refore death)
(Specify whether)
1
years
7
months24
days.
In this community
yrs.
mos.
daya.
PERSONAL AND STATISTICAL PARTICULARS
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDL do we d
5a If married, widowed, or divorced
HUSBAND of
Archibald Thompson
(Give maiden name of wife in full)
(Husband's name in full)
6 Age of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
8 91
AGE
Years
Months.
Days
If less than 1 day
Hours.
Minutes
Usual
9 Occupation :
at home
11 Soola! Security No.
none
12 BIRTHPLACE (City)
( State or country )
.. cannot .... he ..... learned
13 NAME OF
FATHER
cannot be learned
14 BIRTHPLACE OF FATHER (City) cannot be learned (State or country)
15 MAIDEN NAME
OF MOTHER
cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
cannot be Learned.
17
Mary K. McPhillips , Relation, if any
( Address)
DSH
V
A TRUE COPY.
ATTEST :
(Registrar of city of town where death occurred)
DATE FILED
10/1/44
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Sep. 27, 1944
(Month)
(Day)
(Year)
1. Cannot be learned 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 waa involved, state fully.) Arteriosclerotic heart disease with myocardial failure. Senile psychosis Fractured left hip
20 Acoldent, sulolde, or homicide (specify) ....... accident
Date of ocourrenoe.
Max 10 1944
Where didDanvers State Hospital
Injury ooct
(City or town and State)
Did Injury occur In or about the home, on farm, In Industrial place, or In
oubllo place?
public place
Manner of
Fell to floor
Injury
Nature of
Fracture of left hip
Injury
While at work?
Was there an autopsy ?.
no
no
21 Was disease or Injury In any way related to occupation of deceased? no
If so, speolfy
(Signed)
Ralph ........... F.o.s.s
M. D.
(Address)
Peabody.
Date 9/27 1941
22
Oak Grove
Medford
(City or Town)
Place of Burial, Cremation or Removal
9/29/44
DATE OF BURIAL
19
23 NAME OF
FUNERAL DIRECTOArd S. Reynolds
ADDRESS
Winthrop
Reoelved and filed.
OCT TO 1944
19
(Registrar of City or Town where deceased resided)
25m (h)-1-41-4667
No. r 3 .SEX (or) WIFE of PARENTS Informant of the city or town in which the deceased resided as soon as possible after the close of the month in which the death 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 deathw recorded during the previous month which occurred in your city or town in case the deceased Industry 10 or Business : occurred ( See Chap. 46. Sec. 12, G. L.)
St.
(If U. S.
War Veteran,
specify WAR)
female white
(Specify type of place)
-301 A
1
PLACE OF DEATH -
Suffolk (County) Winthrop (City or Town) 151- Shore No. Tillie Toits
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. 196
§ ( If death occurred in a hospital or institution, St. give Ita NAME instead of street and nuniber)
PHYSICIAN - IMPORTANT
2 FULL NAME
(If deceased Is a married, widowed or divorced woman, give, also maiden name.)
(a) Residence. No.
15withare Drive
(Usual place of abode)
Length of stay: In hospital or Institution
(Before death )
(Specify whether)
years
months
days.
In this community / _ yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX Female
4 COLOR OR RACE|
white
5 SINGLE
( write the word)
Widower
5a If married, widowed, or divorced HUSBAND of
(Give maiden name of File In full)
(or) WIFE of
( Husband's name in full)
6 Age of husband or wife if alive years
> IF STILLBORN. enter that fact here.
8 AGE 72 Years - Months Days
If less than 1 day
Hours.
Minutes
Usual
9 Dccuoation :
Industry
10 or Business :
11 Social Security No. none
'2 BIRTHPLACE (City)
( State or country)
13 NAME DF
FATHER
La Tarta (name
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russin
15 MAIDEN NAME
OF MOTHER
Dessie Tidus
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant ( Address} &Prille
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buffal or- transit permit was Issued : WasD. Culdress
(Signature of Agent of Board of Health or other) Health Officio 10/3/44
(Official Designation) (Date of Issue of Permity
18 DATE DF
DEATH
Oct
2
( Mfonth)
(Day)
(Year)
19 | HEREBY CERTIFY,
Jan
1940
aux 2
19.
That 1 attended deosased from
I last saw h ............... alive on.
out
2
19 4 /death is said to
have occurred on the date stated above, at
2 P.m
Immediate cause of death. Carcinoma 1 Pectina
Duration IMPORTANT
......
Due to.
Due to
Other conditions
( Include pregnancy within 3 months of death)
...
Major findIngs :
Df operations.
carcina
imma
Date of
Of autopsy
What test confirmed diagnosis ?
IMPORTANT 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)
(Address)
224 Wach Come Date 10.2 19 44
21KLIK 1
l'lace of Burial, Cremation or Removal.
DATE OF BURIAL
3,
1944
22 NAME OF
FUNERAL DIRECTOR Manuel
ADDRESS
Received and Aled.
OCT 2 1946
.19
(Registrar) Y
extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoltal to that effeot. PARENTS
100M-6 -2-42-8855
William Tanta
( Relation
Relation, If any
(City or Town)
. D.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
Win
(If nonresident, give city or town and State)
194Y
MARRIED
WIDOWED
or DIVORCED
Drive
Registered No.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physioien or registered hospital medical officer shall forthwith, after the desth of a person whoin he has atletuled during his last illness, at the request of sn undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of desth, ststing 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 ssme was contracted. the duration of his last illness, when last seen slive hy the physician or officer and the date of bia 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 ariny, wavy or marine corps of the I'nited States in any war in which it has been engaged, insert in the certificate s recital to that elect, speci- fying the war. and shall also certify in such certificate both the primary and the secondary or immeiliate 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 thie sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one humulred 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 aud 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 ita agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shell exhume a human body and remove it froin 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 aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case inay he, 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. 01 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 board of health, or employed by it or by the aelectinen for the purpose, shall upon application make the certificate re- quired of the attending physician. If death is caused by violence, the medl- cal examiner shall make such certificate. If such a permit for the removal of a humsu body, not previously interred, froin one town to another within the commonwealth cannot be obtained esrly enough for the purpose, the certificate of desth 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, unlesa a permit in the usual form for the removal of such hody has been sooner obtained hereunder. If the death certificate contains a recital, as required
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