USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 41
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At home
Industry
none
10 or Business :
11 Social Security No.
none
Tryon County
12 BIRTHPLACE (City)
( State or country)
Prince Edward Island
13 NAME OF
FATHER
David MacWilliams
14 BIRTHPLACE OF
FATHER (Clty)
Tryon County
(State or country)
Prince Edward Island
15 MAIDEN NAME
OF MOTHER
Jane Enman.
16 BIRTHPLACE OF
MOTHER (City)
Charlottetown
(State or country)
Prince Edward Island.
inthrop
17 William ... O ....... W.o.o.d.
Husband
Informant ( Address ) 9
I HEREBY CERTIFY that a satisfactory standard certificats of death was fled with me BEFORE the burial or trangit permit was Issued :
{Signature of Ageft of Board nf Hearth or othery
6/19/45 ( Date of Issue of Permity
(Omclal Designation)
18 DATE OF
DEATH
J.una
.1.7
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
april 25, 1945, to.
Jerne 17
45
I last saw han.
alive on gerne
17
.19 4), death Is said to
have occurred on the date stated above, at.
230 p
m.
Duration
Immediate cause of death.
IMPORTANT
Carcinoma of Rectum
G mas
Due to
Due to
Other conditions
( Include pregnancy within 8 montbe of death)
2 days 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, speolfy.
Louis 7 Salerno
. M. D.
(Address) 175 Pleasant St
Data Jamal 8 1945
21 Winthrop .... Cemetery ..
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
ROEtier.
TiaquiFy
DATE OF BURI
June 19,1945
19
22 NAME OF
FUNERAL DIRECTOR
Maurice & Aby
ADDRESS
210 Winthrop St.
. A.
Raoalved and Alad
JULY 1_
1943
19
( Registrar)
100m. (g) - 1.45-15510
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Seotion 10, raquiras physicians to insert a recital to that affect. extracts from the laws on back of certificate. ferma, so that it may be properly classified. Exact statement of LuorATION is very important. See instructions and PARENTS
Major findings:
Of operations
Data of
Of autopsy
What test confirmad diagnosis?
( Signed) ..
PHYSICIAN · IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
MEDICAL CERTIFICATE OF DEATH
1945
That I attended deceased from
80.
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 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 hy the preceding section or hy 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 ariny, navy or marine corps of the United 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 hoth 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 hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican horder service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen 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 hoard, from the clerk of the town where the person died; and 110 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 tomh tc another in the same cemetery, until he has received a permit from the hoard of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall he issued until there shall have been delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy law to he returned and recorded, which shall be accompanied, in case of an original interment, hy 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 he obtained early enough for the purpose, or is insufficient, a physi- cian who is a member of the board of health, or employed hy it or by the selectmen 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 he 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 hody shall he 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 United States in any war in which it has heen engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt 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 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 cause of the death, which the clerk or registrar may require .- Chap. 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 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 and take charge of the same; .. . - General Laws, Chap. 38, Sec. 6.
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 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 hody is to he huried 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. . .. Chap. 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 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 hy recognized discase unrelated to any form of injury, have died without recent medical attendance or whose phy- sician 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 indirectly hy traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut 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 morhid 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 he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen 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, how- ever, designate the occupation hy the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
-
R-301 A
PLACE OF DEATH
Suffolk (County)
Winthrop
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.
119
Registered No. st & (If death occurred in a hospital or institution, give its NAME instead of street and number)
Edward M. Goodim
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
230 Pleasant
SŁ
( If nonresident, give city or town and State)
months
days.
In this community / yra. - mos. - days.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
June
19
1945
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deceased from
Lovely 25 1942
to
June 19
19:45
1 last saw h ..
alive on.
Chuck 18, 1945 death Is said to
have occurred on the date stated above.
11:45 AM
Immediate oause of death ...
acute Coronary Thrombosis
Due to
auguia Pectoris
Due to
arteriosclerosis
Other conditiona.
200ml
( Include pregnancy within 3 months of death)
Mejor findings:
Of operations
none
Date of
Of autopsy
What test confirmed diagnosis Clinicalx
Kali
Physician Underline the cause to which death should be charged sta. tistically.
20 Was disease or injury in ony way related to occupation of deceased ?...... )
If so, spacity ....................
(Signed) Jucob Letraus
. ..
0/19/7
D.
(Address) 562
sully 750ats
21 Toallaun Werthup
Place of Burial, Cremation or Removal.
DATE OF BURIAL
fume
(City of Town) Quevery
2%,
1945
22 NAME OF
albert 7 Douglass
FUNERAL DIRECTOR
ADDRESS 2.42
Washington Que,
Relin
Received and Aled.
JUN 26 1945
............
19.
( Registrar)
100m. (g) - 1-45-15510
1
(City or Town)
Pleasant
No.
230
2 FULL NAME
(Usual place of abode)
Length of stay : In hospttet or Institution
( Before death)
200
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
white
male
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
( Husband's name in full)
7 IF STILLBORN, enter that fect here.
8
AGE
81
Years
Months
Days
10 or Business :
11 Social Security No.
none
12 BIRTHPLACE (City)
South Boston
( Siate or country)
mass
14 BIRTHPLACE OF
FATHER (Chy)
Litchfield
( State or country)
maine
15 MAIDEN NAME
OF MOTHER
Chilena Springer
16 BIRTHPLACE OF
PARENTS
MOTHER (City)
Litchfield
(State or country)
maine
17 Mr. Grace B. Wiley
Informent
(Address) 230 Plamont St & winther
If deceased was a U. S. War Veteran, Q. L. Chap. 46. Seotion 10, requires physiolans to insert a reoltal to that effeot.
extracts from the laws on back of certificate.
terma, so that it may be properly classified. Exact statement of OCCUPATION is very important. See instructions and
should be carefully aupplied. AGE should be atated EXACTLY. PHYSICIANS should stato CAUSE OF DEATH in plain
Industry
atwood Mc Manus
( write the word)
kid
Se If
. widowed , or divor
ed Alvele a. Defplow
6 Age of husbend or wife if eliva yaers
If less then 1 dey
Hours
Minutes
Usual
9 Occupetion :
Corso maker (retired)
13 NAME OF
FATHER
Nehemiah Goodim
Robtion. VAL
I HEREBY CERTIFY that a satisfactory standard certificata of daath was Aled with me BEFORE the parlor transit bermit was Issued ;
( Signature of Arest of Board of Health or other) Away2 0/45
Ifeatile (Official Designation) (Date of Imque of Permit)
Dyrarign 1/2hour IMPORTANT
3 years ......
5 years
IMPORTANT
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, no if so specify WAR).
years
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 by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death . . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United 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 and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to bave taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nine- teen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and 10 undertaker or otber 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 bas received a permit from the board of bealth or its agent aforesaid or from the clerk of the town wbere the body is buried. No such permit shall be issued until there sball have been delivered to such board, agent or clerk, as the ease 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 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 board 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 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 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 cause of the death, which the clerk or registrar may require .- Chap. 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 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.
No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, 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).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose phy- sician is absent from home wben 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 indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits ean be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write bousework. For a person engaged in domestic service for wages, how- ever, 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
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
68-8-23 per M. Photo Paulito 6/3/4
PLACE OF DEATH
Suffolk (County)
ENREPETE
...
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. 120
Registered No.
St.
§ (If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
Anna .... Palvik.
(Wartko)
( If deceased Is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No.
123 Hermon St.
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 6 yrs. - mos. - days.
PERSONAL AND STATISTICAL PARTICULARS
1
Winthrop
(City or Town)
(Usual place of abode)
3 SEX
4 COLOR OR RACE
white
female
6 Age of husband or wife if aliva
7 IF STILLBORN, enter that fact hera.
68
Usual
9 Occupation :
At home
11 Social Security No.
„none
12 BIRTHPLACE (City)
( Siate or country)
Austria
14 BIRTHPLACE OF
FATHER (Clty)
Austria
(State or country)
15 MAIDEN NAME
OF MOTHER
Anna
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Austria
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot.
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
AGE
7.4Years
8.
Months
2.3 Days
5 SINGLE
( write the word)
DEATH
MARRIED
WIDOWED
Or DIVORCEWidowed
5a If married, widowed, or divorced
HUSBAND of
name of wife in full)
(or) WIFE of
John CH "a""""
( Husband's name In full)
yaars
If less than 1 day
Hours
Minutas
Industry
housewife
10 or Business :
Due to
·
Other conditions
arteriosclerosis generale
( Include pregnancy within 8 months of death)
IMPORTANT
Major AndIngs :
Of operations
Data of
Of autopsy
What test confirmad diagnosis ?.
Ckq. 2kg
20 Was disease or injury in any way ralatad to occupation of deceased ?
If so, spaoify
( Signed)
Stellen 8 Withus Data 6-22 1945
M. D.
(Address) 47
22 1 Michaelo
Clifton New Jersey
Piace of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
June 25 1945
19
22 NAME OF
FUNERAL DIRECTOR
Richard ... C Kirby
ADDRESS
Boston na
Racalved and Alad
JUN 20 1945
19
( Registrar)
100m. (g) 1-45-15510
I HEREBY CERTIFY that a satisfactory standard certificate of death was filled with me BEFORE the burialcos transit permit was issued : W Dfchildren
( Signature of Agent of Armed of Health or other) . June 22/4J
....... .... (Omelal 'Designation) ( Date of Those of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
que.
21
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That I attended deosased from
Det 19th
19 40.
to
1945
I last saw h .. Q.hun. allve on
June 15
19 45 death Is said to
have occurred on tha date stated abova, at.
11:30 A.m.
Immedlate oause of death,
Coronam
occlusion; Coronary sclerosis
IMPORTANT
Due to.
15 ..... ?
13 NAME OF
FATHER
John Wartko
0
Te af
(unknown)
17
Informant
( Address )
123 Hermon St. Winthrop
Peter PPalvik Relation If uny
No.
123 .... Hermon St ......... Winthrop
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
no
none
1945
Duration
Physician Underline the cause to which death should be charged sta. tistically.
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