USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1946 > Part 76
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6
Yr's
PIus
Due to.
Usual
9 Ocoupation :
Postal Clerk
Industry 10 or Business :
U.S.Postal ServiceDue to
11 Soolal Security No.
None
12 BIRTHPLACE (City)
(State or country)
Boston Mass
13 NAME OF
FATHER
John McCollom
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
15 MAIDEN NAME
OF MOTHER
Cannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannot be learned
17 informant. (Address)
Wife ( Relation, if any
A TRUE car chael
ATTEST!
(Registrar of city or town where death occurred) Oct.25 19/16
22 NAME OF
FUNERAL DIRECTOR
J FOIMaley
ADDRESS
Winthrop Mass.
.19
Reoolved and filed NOV 19 1945
(Registrar of City or Town where deceased resided)
=
7 Yrs Physician
(Include pregnancy within 3 months of death)
Major findings:
Of operations
None
Of autopsy
as above
What test confirmed diagnosis?
autopsy
20 Was disease or Injury in any way related to oooupation of deceased ?.
If so, specify.
C.L Clay
(Signed)
(Address)
Mass . General Host. 10-23
M. D.
46
21 PLACE OF BURIAL,
Winthrop Cem-Winthrop
CREMATION OR R
DATE OF BURIAL
oct. 25/
(Cemetery)46
(City of
""är Town)
19
50m-(b)-6-44-14607
3 of the city of town in which the deceased resided. (See Chap. 48, Sec. 12, G. L.) PARENTS
DATE FILED
1
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
(if U. S.
War Veteran,
speolfy WAR)
Oct.
22/46
18 DATE OF
DEATH
(Month)
(Day)
(Year)
det !. ¿ tended deceased from
19 | HEREBY CERTIFY,
oct.
19
40to
19
I last saw h
allve on.
im
Oct.22
19 ..
40 death is said to
have ooourred on the date stated above, at
12:40PM
Duration
7 IF STILLBORN, enter that faot here.
AGE
8 67 Years Months Days
If less than 1 day .Hours Minutes
Other conditions
Diabetes mellitus
Date of
Underline the cause to which death should be charged sta- tistically.
MARRIED
WIDOWED
or DIVORCED
......
(City or Town) Mass.General Hospital No.
R-305
PLACE OF DEATH
JUKHULK (County) BOSTON
(City or Town)
Petor Bent
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return) t
Registered No.
933210
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
William J Ferguson
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
29 Crystal Ave.
- OVE
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
montha
days.
In this community
40 yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full)
6 Ags of husband or wife If allve years
7 IF STILLBORN, enter that fact here.
AGE
8 66 Years Months. Days
If less than 1 day
Hours.
.Minutes
Usual
9 Occupation :
Painter
Industry
10 or Business :
Retired
11 Social Security No.
None
12 BIRTHPLACE (City)
(State or country)
St John N.E.
13 NAME OF
FATHER
Andrew Ferguson
PARENTS
14 BIRTHPLACE OF
FATHER (City)
Scotland
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary McKentrie
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
17 Informant (Addregs)
Brother ( ....
Relation, if any
A TRUE Cobrachanel
ATTEST : ..
(Registrar of city or town whe Now: why death occurred) 19
DATE FILED
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Oct/31/46
(Month)
(Day)
(Year)
19 | 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 was involved, state fully.) Broncho Pneumonia Alcoholism
20 Accident, sulolde, or homlolde (specify)
Date of occurrence
19
Where did
Injury occur ?
(City or town and State)
Did Injury ooour in or about the home, on farm, In Industrial place, or In publlo place? (Specify type of place)
Manner of
Injury
Nature of
InJury
While at work ?.
Was there an autopsy ?....... O
21 Was dissase or Injury In any way related to occupation of deceased?
If so, specify
Richard Ford
(Signed)
(Address)
25 Shattuck St
Date.
10-3 19 46
Woodlawn Crem-Everett Mass
22
-
23 NAME OF
FUNERAL DIRECTOR
Kirby Bros.
ADDRESS
Winthrop Mass,
Received and filed.
NOV 10 1945
19
(Registrar of City or Town where deceased resided)
25m. (d)-6-43.12056
of the city or town in which the deceased resided as soon as possible after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
1
No.
EPigham Hospital
(If U. S.
War Veteran,
spoolfy WAR)
Winthrop
Mass.
(Usual place of abode)
St.
M. D.
Place of Burial, Cremation or Removal.
DATE OF BURIAL
Nov. 2/416
(City or Town)
19
301 A Suffolk
1
.....
(City of town) Winthrop Community Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permil with Board of Health or its Agent.
Registered No.
211
§ (If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN . IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
( If deceased is a married sidowed or divorold woman, give also graiden name. ) 503 Elleneanol
St.
(If nonresident, give city or town and State)
In this community
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
4 COLOR OR RACE
Male Minuto
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
( write the word)
Single
Se 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
7 IF STILLBORN, enter that fact here. Stillborn years
8
AGE
-
Years
Months
Days
If less then 1 dey Hours .Minutes
Usual
9 Occupation :
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( Siste or country)
Manthus Mass:
13 NAME OF
FATHER
George Biampa
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Masse:
15 MAIDEN NAME
OF MOTHER
16 BIRTHPLACE OF
MOTHER YCity)
(State or country)
17 George Beampa q
Informant S ( Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE/the burlal or transit permit was Issued : Walter A. Paulto.
(Signature of Agent of Board of Health or other) / flatter Affiche 11/12/16
(Official Designationy (Date of Issue of Permit)
18 DATE OF
DEATH
november
7
1946
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY.
nor 7 / 406.
,
Thet I attended deosased from
Ło
por. 7/4
I last saw h ...
......
allve on
19
death Is sald to
have occurred on the date stated above, at. m.
Immedlate oause of death. Stillborn (mos)
IMPORTANT
...........
Due to
Fall down stairs
Due to
Other conditions.
none
( Include pregnancy within 8 months of death)
IMPORTANT
Physician
Underline the cause to which death should be charged s14- tistically.
20 Was disease or injury in any way related to occupation of deceased ?.
If so, specify TO
....
( Signed
(Address) 562
Date 11/12/16
M. D.
Place of Burial, Cremation or Removal. (City or Town)
DATE OF BURIAL
1986
22 NAME OF
FUNERAL DIRECTORZ.
ADDRESS 778 Junto 28.6./2020
Received and fled
19
15
(Registrar) y
Jatresty from the laws on back of certificats. IY deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physicians to insert a recital to that effeot. PARENTS
100m-(g)-1-45-15510
PLACE OF DEATH
(County)
Baby Boy) Ciampa
2 FULL NAME
(a) Residence. No.
(Usual place of abode)
Length of stay : In hospital or Institution
( Before death )
(Specify whether )
years
months
days.
What test confirmed dlegnosis ?.
Duration
76
Mejor findings:
Of operations
une
Date of
Of autops
21
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 as 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 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 iu 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 bury 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 no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomh 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, 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 hy 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 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 permit for such removal; provided, that such body 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 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 hy violence. If a medical examiner has notice that there is within his county the hody of such a person, he shall forthwith go to the place where the hody 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 hody 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. . .. 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 hy 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 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 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
-302
Essex
(County)
Danvers
(City or Town) Danvers State Hospital No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
212
(If death occurred in a hospital or Institutlon, st. give Ite NAME instead of street and number)
2 FULL NAME Margaret Adelaide Leonard
(If deceased ie a married, widowed or divorced woman, give also maideu name.)
27 Crystal Cove Ave.
St.
(a) Residenoe. No.
(Usual place of abode)
Length of stay: In hospital or Institution ..
(Before death)
(Specify whether)
years
months
daye.
In this community
yrs.
moe.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE|
white
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
.. Charles ..... Leonard
(Husband's name in full)
6 Age of husband or wife If allve Unknown years
7 IF STILLBORN, enter that faot here.
AGE.4 Years Months. Days
If less than 1 day .Hours ...... Minutes
Usual
9 Occupation :
Housewife
Industry
10 or Business :
11 Social Security No. .. none
12 BIRTHPLACE (City)
Brooklyn
(State or country )
New York
13 NAME OF
FATHER
Ferdinand Lehnert
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
15 MAIDEN NAME
OF MOTHER
Rebecca
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17 M.K.McPhillips
Relation, if any
A TRUE COPY. ATTEST: el restauchiar
DATE FILED
(Registrar of city or town where death occurred) November 12 19 46
MEDICAL CERTIFICATE OF DEATH
DEATH
(Month)
(Day)
(Year)
19 | HEREBY, CERTIFY, That I attended deocased from
November
19
to November 2, 1916
I last saw h
alive on
er
November
7
19
death Is said to
have occurred on the date stated above, at
3:15 p
.m.
Duration
Immediate oause of death
...
Bronchopneumonia
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- tietically.
What test confirmed dlagnosis?
20 Was disease or injury in any way related to occupation of deceased ?.
no
If so, speolfy
(Signed)
Fracis a. Sullivan
M. D.
(Address)
DAHI
Date ..
11/8/1946
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Winthrop
Winthrop
(Cemetery)
November
19
(City or Town)
DATE OF BURIAL
22 NAME OF
FUNERAL DIRECTOR
howard J. Reynolds
ADDRESS
Winthrop
Received and filed
DEC 7 1946
19
V
(Regietrar of City or Town where deceased resided)
9,
46
Informant.
(Address)
DSH
50m. (b).6-44-14607
1
PLACE OF DEATH
-
(If U. S.
War Veteran,
specify WAR)
Winthrop
(If nonreeldent, give city or town and State)
18 DATE OF
November 7,
1946
Underline the cauee to which death
Of autopsy Clinical
R-302
Suffolk
(County)
Boston
...
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
955621.3.
(If death occurred in a hospital or institution,
St.
give ite NAME instead of street and number)
Nathan Levine
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maideu name.)
(a)
Residence. No.
138 Highland St
St.
Winthrop
Mass.
(Ususl place of abode)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
2
monthe
10
days.
in this community
yre.
mos .-
10
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX M
4 COLOR OR RACE|
W
5 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
5a if married, widowed, or divorosd
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wifs if alive 42
years
7 IF STILLBORN, enter that faot here.
8 AGE 42 Years Months. Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation :
Pharmacist
Industry
10 or Business :
11 Soolal Seourity No ..
022-22-8135
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Benjamin Levine
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Ida S
Russia
17
Informant
(Addreee)
Wife ( Relation, if any
A TRUE CO
ATTEST :
Registrar of eity or town where death occurred) NOT/13/46 19
A
22 NAME OF
FUNERAL DIRECTOR
B Birnbach
ADDRESS
Dorchester Lass.
Rsoeivsd and filsd
19
DATE FILED
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
Nov.9/46
(Day)
(Year)
19 | HEREBY CERTIFY,
August ... 31 19
46
Nov.9/46
19.
to
I last saw h .**
.. alive on
19
death Is said to
have occurred on the date stated above, at
1:30AM
m.
Duration
Immediate cause of death
Malignant brain tumor
2 irs
Due to.
Broncho pneumonia
14 Das.
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations.
Partial removal of brain
tumor
Date of
9-16-46
Underline the cause to which death should be charged sta- tistically.
Of autopsy What test oonfirmed diagnosis ?.
20 Was disease or injury in any way related to oooupation of deosased ?.
If so, speolfy.
M W O' Connell
(Signed)
M. D.
(Address)
Boston City Hospt Da. 11-9
19
46
21 PLACE OF BURIAL,
CREMATION OR REMOVALTefereth Israel Everett
(Cemetery)
(City or Town)
Mass.
DATE OF BURIAL
Nov. 10/46
19
50m-(b)-6-44-14607
PLACE OF DEATH -
1
No.
(City or Town)
Boston City Hospital
(If U. S.
War Veteran,
specify WAR)
(If nonresident, give city or town and State)
2
/ 19 1946
(Registrar of City or Town where deceased
resided)
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
1 Sarah Cooperstein
That I attended deceased from
PLACE OF DEATH
Sufall.
(County )
1
...
Sin of Town
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.
Registered No.
214.
S (If death occurred in a hospital or institution, SŁ { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
Erdamit fm 600 Shirley ff
St.
(Usual place of abode)
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
male
4 COLOR OR RACE
While
5 SINGLE
( write the word)
DEATH
November
10
1946
MARRIED
WIDOWED
or DIVORCED
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 allve years
7 IF STILLBORN, enter that fact hera.
8 AGE 66 Years Months Days
If less than 1 dey
Hours
Minutos
Usual
9 Occuoetlon :
Confectionery Business
Industry
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
( Siate or country)
13 NAME OF
FATHER
Francis le Park
14 BIRTHPLACE OF
FATHER (City)
(State or country)
m.g.
15 MAIDEN NAME
OF MOTHER
Trabella Sing
16 BIRTHPLACE OF
MOTHER (City)
(State or country}
M.J.
Minutach Folge of Ele (. Relation, if any
17
Informent.
( Address)
I HEREBY CERTIFY that a satisfactory standard certificata of death was fled with me BEFORE the burial or transit permit was Issued :
22 NAME OF
FUNERAL DIRECTOR
Suply Brage
ADDRESS
Received and Aled. NOV 1 21946
.19
(Omcial Designation)
(Date of Issue of Permit)
1
18 DATE OF
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, Thet I attended deocased from
Januar, 1 -.
1946.
November 9-, 1946
I last saw h Im alive on Molimare
9
194.5 ... , death is sald to
hava occurred on the dato stated above, at
735
a.m.
Immediato osuse of death
.
Coronar
Thrombosis
IMPORTANT
1/2 1240
...
1
years
IMPORTANT
Mejor findings : Of operations
Date of
Of autopsy
What test confirmed dlagnosis?
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 ? NO If so, spaolfy
. M. D.
(Signed)
(Address) 200 Martin top en
Date 11-11-
19 H.C
21
Place of Burial, Cremationgor Removal.
DATE OF BURIAL /av 12
1946
100m-(g)-1-45-15510
If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, raquires physiolans to insert a reoltal to that effect. PARENTS
2 FULL NAME
No. Naklace L le tante
(If deceased is agmarried, widowed or divorced) woman, give also
maiden name.)
(If nonresident, give city or town and State)
years
2
months
- days.
In this community 23 yra.
mos.
dayı.
MEDICAL CERTIFICATE OF DEATH
Duration
Dua to
Due to
Other conditions.
Chronic Bronchitis + Asinma
( Include pregnancy within 3 months of death)
(City or Town)
(Signature of Agent of Board of Health or other) 11/12/46
( Registrar)
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwith, after the death of a person whom be 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 bis 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, wben last seen alive by the physician or officer and the date of bis death ... Gen. Laws, Cbap. 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 bundred 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 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.
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