Town of Winthrop : Record of Deaths 1947, Part 18

Author: Winthrop (Mass.)
Publication date: 1947
Publisher:
Number of Pages: 544

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 18

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(b) Address 20 ... Marlboro ... S.t .. , Keene, N.H. 17. (a) Entombment (Burial, Cremation, Entombment. Removai)

RuaAlnido ComAtAmi

2. USUAL RESIDENCE OF DECEASED :

(a) State

Massachusetts

(b) County Suffolk

Winthrop

(d) Street No.

40 Washington Avenue

(If rural, give location)

(e) If foreign born, how long in U.S.A .?

.. years

MEDICAL CERTIFICATE

20. DATE OF DEATH: Montfebruary day

year

hour

min

that I last saw h .... alive on

19.

and that death occurred on the date and hour

stated above.

Immediate cause of death

Traumatic Shock

Hours

Due to

Fractures Multiple

& Rupture of Bladder

Due to

Other conditions

(Include pregnancy within 8 months of death)

Major findings:

Of operations

Fracture left Lower Leg

Of autopsy

Pelvis & Rupture of Bladder

22. If death was due to external causes, fill in the follow-

DURATION

Suddon

PHYSICIAN

Underilne the cause to which death should be charged statistically

Please write the causes of death clearly and legibly

CAD

WITH UNFADING INK. Every item of information should be carefully supplied. The correct age is especially important.

MOTHER

Florence Thompson

1947

07 A.

PLEASE WRITE PLAINLY

Form V. S. 19A

6-46-10M

8458

(b) Place: USUI BUVAULUD VOILIV VOSY (If entombed or buried, write name of cemetery) Chester, Vermont (City, Town, County) (State or Country)

If Entombed

(Month)

(Day)

(Year)

(d) Place of burial Landgrove

(Name of Cemetery)

Land grove

Vermont

(City, Town, County)

(State)

(e) Date

18. (a) Signature of funeral

(Month)

(Day)

(Year)

director

Charles ... F ... Fletcher

(b) Address

Keen e, .. New ... Hampshire.

Countersigned

Lena F. Warren

(Agent City Board of Health)

19. (a) March 1,1947

(b) March 1,1947

(Date rec. by City Bd. of Health)

(Date rec. by Town or city clerk)

...

Signature of Town or City

M.D. or other

M.D .. ... Date signearch 1 1947

Clerk

Lena .. F.Warren city

Clerk of

Keene, New Hampshire

Address

Keene, New Hampshire

A true copy, Attest:

Zware

City

Clerk of

Keene, New Hampshire

ing: (a) Accident, suicide, or homicide (specify) Accident

(b) Date of occurrence

February 27,1947

(City or Town) (County) (State)

(d) Did injury occur in or about home, on farm, in

industrial place, in public place ? .... Main .. Street

(Specify type of place)

Keene, N. H.

While at work?

(e) Means of injury

Pedestrian struck by Automobile

...

23. SIGNATURE

Walter.H.Lacey.

Dated

March 3

19.47

...

March 2, 1947

PLACE OF DEATH

County)

(City or Town)

No. 47

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. 5.3

Registered No.

{ {If death occurred in a hospital or institution. { give its NAME instead of street and number)

Mandant Gronna

( If deceased Is a married, widowed or divorced woman, give also maiden name.)

(a) Residenca. No.

(Usuat place of abode)

047Emple Gonais

Length of stay: In mnepital or Institution

( Before death)

( Specify whether)

years

months

days.

In this community to yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

march

( Month)

( Day )

( Year)

19 | HEREBY CERTIFY,

That f attended deosased from

Inly 7

March 3

1947

I last few h 2'L aliva on

March 3, 1947 death is cald to

hava occurred on tha date stated above, at.

3 30 4

Immediata cause of death.

Coronary Thrombose

Due to

Other conditions

1 Martis Completeura

( Include pregnancy within 3 months of death)

Major findings:

Of oparations

Data of

Of autopsy

........... .........

What test confirmed diagnosis ?

clinical

IMPORTANT

Physician Underline the cause to which death should be charged st.i. tistically

20 Was discesa or injury in any way related to occupation of deceased ?

if so, spaolfy

. M. D.

Paul Marinesaty

( Signad)

(Address) 235 Show Devie

Data

3/2 1977

Place of Burial, Cremation or Removal.

DATE OF BURIAL.

(City er Town)

. 19

...

22 NAME OF

FUNERAL DIRECTOR.,

ADDRESS

1409 dach I 200

Reosived and Alad

212 10 1947

( Registrar)

100m-(g) -1-45-15510

2 FULL NAME

3 SEX

(or) WIFE of

AGE

Usual

9 Occupation :

Industry

10 or Business :

PARENTS

informant

( Address)

If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a reoital to that effect.

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

should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH In plain

Years

4 COLOR OR RACE

white

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(the word)

Sa if married, widowed, or divorced HUSBAND of

in hill )

( Husband's name in full)

6 Age of husband or wife if sliva

ysarsı

7 IF STILLBORN, enter that fact hera.

If less than 1 day

Hours

Minutes

11 Social Security No.

12 BIRTHPLACE (City)

( State or country)

Suland

13 NAME OF

FATHER

michael Kearney

14 BIRTHPLACE OF

FATHER (City)

(State or country)

Seland

15 MAIDEN NAME

OF MOTHER

Elizabich Si Ellegote

16 BIRTHPLACE OF MOTHER (City) ( State or country)

Theland

Relation, If any

I HEREBY CERTIFY that a satisfactory standard oartifloata of daath wary. filed with me BEFORE the burial or transit parmit was Issued ; Walter

(Signature of Agreat at Board of Health or other)

3/4/44

(bmclal Designation) ( Date of Toque of /Permit y

Duration

IMPORTANT

...

1 year

A R-301 A

.......

Cornette Gorz Can s.

PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR)

(If nonresident, give city or town and State)

1947

Months

Days

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 relicf 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 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 be, a satisfactory written statement containing the facts required by 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 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 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, tuat 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 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 can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at 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

R-301 A +

PLACE OF DEATH

Suffolk. (County)

Winthrop. (City or Town) 14 Forrest street.

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. Registared No. 51

St. § (If death occurred in a hospital or institution, give its NAME instead nf street and number)

2 FULL NAME

Arthur William Corkhum.

( If deceased is a married, widowed or divorced woman, give also maiden name.)

(a) Residence. No.

14 .... Forrest Street

St.

(Usual place of abode)

(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 42 yrs.

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

4 COLOR OR RACE

5 SINGLE

( write the word)

male white

MARRIED

WIDOWED

or DIVORCEDmarried

5a If married, widowed, or divorced

HUSBAND of

Emma .... Levina .... Parsons

(Give maiden name of wife in full)

( Husband's name in full)

6 Age of husband or wife if aliva 8.0

yaars

7 IF STILLBORN, enter that fact here.

8 AGE89 .. Years ... O ... Months .2 ..... Days

If less then 1 dey Hours Minutas

retired

carpenter

11 Social Security No. none

Chester

12 BIRTHPLACE (City)

( State or country)

Nova Scotia

13 NAME OF

FATHER

John Corkhum

14 BIRTHPLACE OF

FATHER (City)

Chester

( State or country)

Nova Scotia

15 MAIDEN NAME

OF MOTHER

Susan Richardson

16 BIRTHPLACE OF

MOTHER (City)

Chester

(State or country )

Nova Scotia

17 Informant William J. Corkhum ( Son

Relatlon, If any

( Address) 61 Shirley St Winthrop

I HEREBY CERTIFY that a satisfactory standard oartifonta of death was flod with me BEFORE the burial or transit parmit was Issued :

(Signature of Ageot of Board of Health nr other) Health offree

3/4/17

(Official Designation)

( Date of Imque of Permity

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

March

1947

( Month)

(Day)

(Year)

19 | HEREBY CERTIFY.

Feb 2

1947

march 4

I last saw h.

allva on

1947, de

Is sald to

hava occurred on tha data stated above, at 11:408 m.

Duration

Immedlate oause of death Cerebral Hemorrhage

IMPORTANT

Dua to

antonio saludo Next

Due to

have

Other conditiona

( Include pregnancy within 3 months of death)

Major findings:

Of operations

Date of

Of autopsy

Whet test confirmed diagnosis?

20 Was disease or injury in eny way ralatad to occupallon of deceased ? If so, spaolfy .. no

( Signed)

562 Saluley St

Data Man 5 198

21 WinthropCemetery Winthrop Place of Burial, Cremation or Removal. (City or Town) DATE OF BURIAL March 7, 1947 19

22 NAME OF

FUNERAL DIRECTOR

alfred 3 March

ADDRESS 1.74 Winthrop St, Winthrop

Received and Alad

MAR 10 :017

( Registrar)

100m(t)-1-44-13634

1 No. 3 SEX (or) WIFE of Usual 9 Occupation : PARENTS If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires phyelolans to insert a recital to that effect. extracts from the laws on back of certificate. terms, so fast if may be proparty classified. Exact statement of OCCUPATION is very important. See Instructions and Industry 10 or Business :

IMPORTANT

Physician Underline the cause to which death should be charged st .. tistically.

(Address)

PHYSICIAN - IMPORTANT

( Was deceased a

UL. War Veteran,

if sos specify WAR)

That 1 altendad deosased from

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 hest of his knowledge and helief 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 relicf expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place hetween 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 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 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 vi chapter torty-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 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 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.

Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at 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

M R-301 A

PLACE OF DEATH

Suffolk (County Balon notified 4/10/47

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Town of Winthrop : Record of Deaths 1947, Part 18

Author: Winthrop (Mass.) Publication date: 1947 Publisher: Number of Pages: 544

Author: Winthrop (Mass.)
Publication date: 1947
Publisher:
Number of Pages: 544