USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 20
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19
( Registrar)
57
(If death occurred in a hospital or institution, } give its NAME instead of street and number) )
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, ho. so specify WAR)
221 Landow
. ....
St.
Wood. (Specify whether)
years
months 11 days.
In this community 40
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
100m-0-44-14955
PLACE OF DEATH No.
Suffolk (County)
Boven. Motifud
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.
M R-301 A 1 1 Winthrop (City or Towy Winthrop Luigi adriani (If deceased is a married, widowed or divorced woman, give also maiden name.)
Community Hoop.
St.
E. Boots
(If nonresident, give city /or town and State)
10.650 m.
Place of Burian, Cremation of Removal.
(City of Town)
47
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall fortbwitb, 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, wben last seen alive by the physician or othcer 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 hest 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 Fehruary fourteenth, eighteen bundred 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. Cbap. 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 110 undertaker or other person shall exhume a buman 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 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 bave 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 deatb 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 witbin the commonwealth cannot be obtained early enough for the purpose, tbe 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 bas been sooner obtained bereunder. If the death certificate contains a recital, as required
by section ten of chapter ionty-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 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, Cbap. 38, Sec. 6.
No undertaker or other person shall bury a human body or the asbes thereof which have been brought into the commonwealth until be has re- ceived a permit so to do from the board of bealth or its agent appointed to issue such permits, or if there is no suchi 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 sucb deatbs 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 sucb 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 pby- 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 wbich 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 bad retired from business, report the usual occupation prior to retirement. Children not gainfully employed may be returned as at school or at bome. 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-botel, etc. For a person who bad no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
ORM R-302
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.) resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
PLACE OF DEATH
Suff.o.l.k. (County)
1
Boston
(City or Town)
No.
Mass .Men , Hospt
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.
231158
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
2 FULL NAME
Baby Boy Costa
(If deceased is a married, widowed or divorced woman, give also maideu name.)
(a) Residence. No.
95 .. Marshall
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
1
days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
M
4 COLOR OR RACE|
W
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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 faot here.
8 AGE. Years .Months. Days
If less than 1 day
G.Hours
.Minutes
Usual
9 Ocoupation :
Industry 10 or Business :
11 Social Security No ..
12 BIRTHPLACE (City)
(State or country)
Boston .. Ma.ss.
PARENTS
50m. (b) .6.44. 14607
A TRUE COPY
Mikael Planning
ATTEST :
(Registrar of city or town where death occurred) March 13
47
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 I HEREBY CERTIFY,
That I attended deceased from
·March .... 7 ....... , 19.4.7 ..... , to
March ... 8.
19.
4.7
1 last saw h ....... 1m .. allve on .....
March ... 8
19.4.7, death Is said to
have ocourred on the date stated above, at.
3 .;. 15.P.
m.
Immediate oause of death.
Respiratory failure
23 Hrs
Due to.
Prematurity
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings:
Of operations
Date of.
which death should be charged sta- tistically.
Of autopsy
What test confirmed diagnosis?
No
20 Was disease or Injury In any way related to oooupation of deceased?
If so, speolfy.
HM Lennon
M. D.
(Address)
7.50 Harrison Ave. Date
3-819
47
21 PLACE OF BURIAL,
CREMATION OR REMOVEt Michael's Cen-Boston
(Cemetery )
(City or Town)
DATE OF BURIAL
March 12/47
19
22 NAME OF
FUNERAL DIRECTOR
P Rapino
ADDRESS
East. Boston Mass
Received and flied MAR 31-1947 19
(Registrar of City or Town where deceased resided)
DATE FILED
Father (
Relation, if any
17 Informant (Address)
Winthrop Mass.
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston Mass.
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Annita Mulone
(Signed)
Underline the cause to
13 NAME OF
FATHER
Ramond Costa
14 BIRTHPLACE OF
(If U. S.
War Veteran,
spoolfy WAR)
Winthrop Mass.
March 8/47
Duration 6"Hï's
MB-301
If deceased was a U. S. War Veteran, G. L., Chap. 48, Sec. 10, requires physicians to Insert a recital to that effect PARENTS
100m- (1)-1-45-15510
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the Burial or transit permit was issued: Walter & Bakers
(Signature of agent of Board of Ifealth or other) Theatthe prices Oficial Designatlot) (Date of Issue of Permit)
3/18 /47
MEDICAL CERTIFICATE OF DEATH
47
(Month)"
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
PhiCivi maiden name of life in full)
(or) WIFE of
(Husband's name in full)
-years
7 IF STILLBORN, enter that fact here.
8
72
4
AGE
Years
Months
25 Days
If less than 1 day
Hours_
Minutes
Usual
9 Occupation:
Housewife
Industry
10 or Businesa:
Own Home
11 Social Security No.
None
12 BIRTHPLACE (City)
Houlton
(State or country)
Maine
13 NAME OF
FATHER
Edourd Millman
Major findings:
Of operations
Date of.
Of antopsy.
What test confirmed diagnosis?
20 Was disease or Injury in any way related to occupation of deceased ?__ If so, specify 200
(Signed)
Harva auf elle
M. D.
(Address) 200 gr Pendant bate 3/15
1947
21 Winthrop
Winthrop
(City or Town)
Place of Burial, Cremation or Removal.
March
18
DATE OF BURIAL
Howard Schinveld
19.47
ADDRESS
Received and filed. WAR 26 1947
19
A TRUE COPY ATTIST:
(Registrar)
-
St. § (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
2 FULL NAME
Nellie (Hillman) Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
121 Cottage Park Road
_St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution
Hosp.
(Before death)
(Specify whether)
years
months
7days.
In this community 34yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
19 I HEREBY CERTIFY,
That I attended deceased from
to
1977
March 13, 1947
I last saw hdp
alive on
Duration
IMPORTANT
3 mos
Iwant . 2. 19 4] death is said to
have occurred on the date stated above, at 930 PM.
Immediate cause of death
Aucunina y Lives
Due to.
Due to.
Other conditions.
Metastin y Jungs
(Include pregnancy within 3 monthsof death)
2 wks IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
15 MAIDEN NAME
OF MOTHER
Frances Atherton
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unable to Obtain
that it may be properly classified. Exact statement of OCCUPATION is very Important. See instructions and extracts from the laws on back of certificate.
PLACE OF DEATH
Winthrop
(City or Town)
No. Winthrop Community Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
Registrar's No.
59
PHYSICIAN-IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(Usual place of abode)
+
Suffolk
(County)
I Raistion in thy
17 Informant Philip J Smith (Addrear) 121 Cottage Park Rd. Winthrop
22 NAME OF
FUNERAL DIRECTOR
" Age of husband or wife if alive ...
13.
18 DATE OF
DEATH
mark
13
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 iu 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 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 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 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 tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case 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, 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 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 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 be 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 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 herennder. 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 ageut, 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- mary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registi ir 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 hody 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 hury 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 he buried or the funeral is to be held, cr 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 hedside 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 hy 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 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 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 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
RI R-301 A
If deceased was a U. S. War Veteran, Q. L. Chap. 46, Section 10, requires physiolans to Insert a recital 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
PARENTS
15 MAIDEN NAME
OF MOTHER
Matilda Peterson
16 BIRTHPLACE OF
MOTHER (City)
(State or country )
Kwerden
17 Informant ( Address)
I HEREBY CERTIFY that & satisfactory standard certificate of daath was filed with me BEFORE the busty or transit farmit was Issued,
maller Draker
(Signature of Aggat G Board of Health or other)
3/19/4
S
.....
(Oficial Destination) ( Date of Trouve of Farmit),
18 DATE OF
DEATH
march
16
1947
(Year)
(Month)
(Day)
19 4 HEREBY CERTIFY,
That I attandad deoaased from
Que 15.
1946, to
Imarch15 1947
I last saw h / mm alive on
March 15. 1947 death is said to
heve occurred on the date stated above, at
p.
m.
Immediate cause of daath.
IMPORTANT
8 AGENT 7 Years
Monthy
Dayı
If less than 1 day Hours Minutes Due to.
Usual
9 Occupation :
Multiograph operator
Industry 10 or Business :
United Business service
11 Social Security No. 022-10-3062
12 BIRTHPLACE (City)
(State or country)
Aureden
13 NAME OF
FATHER
Andrew
1
Major findIngs : Of operations
Data of.
Of autopsy
What test confirmed diagnosis?
Cleared Jegns
IMPORTANT
Physician Underline the cause to which death should be charged va- ristically .
20 Was disease or injury in any way related to occupation of deceased ? ()
If so, apsolfy ....
. M. D.
( Signed)
Address)
DABAR 18194)
Place of Burial, Cremationof Removal.
(City or Town)
DATE OF BURIAL ..
May 14
19.47 ......
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Received and Aled.
MAR 26 1947
19 ..
( Registrar) 1
1
-
(City.or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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