USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1945 > Part 47
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In this community 50 yrs.
mos.
days.
6 Age of husband or wife if aliva
100m-(g)-1-45 15510
(Official Designation)
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 armny, 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 forfcit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-scven 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 have 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 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 tomh to 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 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, tbe 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 aud 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 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 causcd 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 can he 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 housework. For a person engaged in domesti. 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
M R-301 A
PLACE OF DEATH
Buffelk
(City or Town)
No .. 125 Cliff 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.
134
[ (If death occurred in a hospital or institution, St. (give its NAME instead of street and number)
2 FULL NAME ... Ada ... L ... Hoff
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
125 Cliff .. Av.s ....
St
(If nonresident, give city or town and state)
(Usual place of abode)
Length of stay: In hospital or institution
years
months
days.
In this community
23/rs.
mos.
days.
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
July.
....... 10.
19.45
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive.
years
7 IF STILLBORN, enter that fact here.
8 AGE .. 73 Years 3 Months. 18 Days
If less than 1 day Hours .. Minutes
9 Occupation :.
At Home
11 Social Security No .......
none
12 BIRTHPLACE (City)
Uni.cn ... Spring.s
13 NAME OF
FATHER
James B. Hoff
14 BIRTHPLACE OF
FATHER (City).
(State or country)
N. Y.
Union Springs
Sarah Creque
16 BIRTHPLACE OF
MOTHER (City) ....
Union .... Springs
* (State or country}
N. Y.
Relation, If any
Informant ... Welfare Dept Recorde (Address) Town Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial er transit permit was issued:
(Signature of Agent of Board of Healthor other) Health Aktivit
61
is
(Official Designation) (Date of Issue of Permit}
Due to.
Chronic hypertensive
heart lie
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT PHYSICIAN
Underline the cause to which death should be charged sta- tistically.
20 Was disease er injury in any way related to occupation of deceased ?. 200
If eo, specify.
(Signed)
Winthrop, Mas Date
July 11,1945
21.Chestnut ... Hill ...... Uni.on .... Spring.s ..... N ...... Y .. Place of Burial, Cremation or Removal. (City of Town)
DATE OF BURIAL ........ July :.... 13 ..... 1.945
19
22 NAME OF
FUNERAL DIRECTOR ...
Buchard 16 toute
ADDRESS.
147 Winthrop St . , Winthro
Received and filed 19
JUL 13 1945
(Registrar)
N. B .- WRITE PLAINLY, WITH ONFADING DLAVA INN ETHIS IS A SANITY information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state
..... (County) 1 Winthrop 3 SEX Female Usual (State or country) 18 MAIDEN NAME OF MOTHER PARENTS 17 is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION Industry 10 or Business :. none.
100m-2-40-D-729-a
4 COLOR OR RACE
White
(write the word)
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
19 I HEREBY CERTIFY. That I attended deceased from October 15, 1944, to Jeely 9, 1945
I last saw her alive on
July 9, 1945, death is said to
have occurred on the date stated above, at ..
6,00 4 m.
Immediate cause of death ..
CaronAry Thrombosis
Duration
IMPORTANT
Judder
3 years
Major findings:
Of operations.
220ml
Date of.
Of autopsy.
What test confirmed diagnosis ?.
Clinical pois
M. D.
(Address)
Registered No.
(If U. S. War Veteran, specify WAR)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physiclan 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 hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dled, defined as required by section one, where same was contracted, the duration of hls last illness, when last seen alive hy 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 hody which has not been huried, until he has received a permit from the hoard 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 hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiv- Ing tomh to 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 hody Is huried. No such permit shall be Issued untll there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement contalning the facts required hy law to be returned and recorded, which shall he 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 herelnafter provided. If there Is no attending physician, or if, for sufficlent reasons, his certificate cannot be obtained early enough for the purpose, or Is in- sufficient, a physlclan who Is a member of the hoard of health, or em- ployed by It or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human hody, 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 perinlt 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 re- moval of such hody has heen sooner ohtalned hereunder. If the death certificate contalns 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 hoard 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 he ohtalned 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).
No undertaker or other person shall bury a human body or the ashes thereof which have heen brought into the commonwealth until he has received 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 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 by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is ahsent 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 hy traumatism (including resulting septicemla), and hy the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, 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 dylng, e. g., heart failure, asphyxla, asthenla, etc. As principal cause name the disease causing death. As related causes, name earlier morhld 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 galnfully 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 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
R-301 A
PLACE OF DEATH
Suffolk ( caina ) Winthrop
(City or Town) 15- 4 euro
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. 135
Registared No. { (If death occurred in a hospital or institution, give its NAME instead of street and number)
SŁ
Freeman
( If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenca. No. 15 - nevada (Usual place of abode)
Length of stay: In ansoltal nr Institution
( Before death)
( Specify whether)
...
years
months
days.
In this community 30 yrs.
тов.
days.
PERSONAL AND STATISTICAL PARTICULARS
5 SINGLE
MARRIED
WIDAWED
or DIVORCED
( write the word) beidou
yaars
If less than 1 day Hours Minutes
12 BIRTHPLACE (City)
(Siste or country)
R
sia
13 NAME OF
FATHER
Abraham ly etcall
15 MAIDEN NAME
OF MOTHER
Gumof be learned
Rebecca Freeman 15-nevada
I HEREBY CERTIFY that a satisfactory standard sertifiosta of death was filled with me BEFORE they burlal or transit, parmoft was issued : com. D. lefuldrers
( Signature of Agent of Moird nf Realth or other) aff 7/6/43 ,
....... (Official Designation) ( Dete nf Trque/gf Permit)
MEDICAL CERTIFICATE OF DEATH
18 OATE OF
DEATH
July
15 1945
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, January 10, 1938 to
That A attended deceased from
last saw h.
ch
alive on ...
Julie
14, 19:45 death is said to
hava occurred on tha data stated above, at ..
10 A: M
Duration
Immediate cause of death .....
Cerebral Hemorrhage
Que to
Due to
arteripetersis
2 years
Other conditions
Peripheral Endarteritis iyear
(Include pregnancy within 8 montha of death) PERIPHERAL - NOARTERITI
Major findings:
Of operations
none
Date of
Of autopsy
none
What test confirmed diagnosis? Cenucal lah
IMPORTANT
Physician Underline the cause to which death should be L charged sta. tistically.
20 Was disease or injury in any way raiatad to oooupation of deceased ?..
if so, spoolfy ..............
(Signed) Lacet
M. P.
(Adam1) 562 Clientey Date July 15 1940
21 de of facili tem, wikof. l'hace of Burial, Cremation or Removal. DATE OF BURIAL July 175 19. (City or Town)
22 NAME OF
FUNERAL DIRECTOR
by anyel Stanelyhy
ADDRESS
10. Wash 58 4
....
Received and Alsd
JUL 19 1945
( Registrar)
100m. (g)-1.45-15510
1 No. 2 FULL NAME 3 SEX 4 COLOR OR RACE| female white Sa If married, widowed, or divoroed HUSBANO of (or) WIFE of 6 Age of husband or wife if allvs 7 IF STILLBORN, enter that fact hers. AGE Usual 9 Ocoupetion : Industry 10 or Business: 11 Social Security No. 14 BIRTHPLACE OF FATHER (City) (State or country) 16 BIRTHPLACE OF MOTHER (City) (State or country ) 17 Informant ( Address) If deceased was a U. S. War Vstsran, Q. L. Chap. 46, Section 10, requires physicians to Insert a reoltal to that effeot. PARENTS 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 8 74 Years Months - Oay
Quinie
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR) ...
St.
(If nonresident, give city or town and Stale)
July 15 19 55
IMPORTANT 24 hours
( Husband's name In full)
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 helief the name of the deceased, his 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 hy 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 hy 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 inarine 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 relicf expedition and the Philippine insurrection, which shall, for said purposes, he deemed to have taken place hetwecn 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 hody 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 hoard, 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 tom 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 may he, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall be accompanied, in case of an original interment, 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 hody, 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 ahove 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 hody has been sooner obtained hereunder. If the death certificate contains a recital, as required
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