USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 4
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Bannot be learned
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
austria
17 Informant Mary k. M'Yhalling Relation, if any (Address) Hallhorne Maso;
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Jan.
20
1947
19/h HEREBY Oct.29 ...
CERTIFY,
1946
to
That I attended deceased from
8
194/
I last saw h.
.allve on
Jan 08, 1947 death la said to
Duration
Secondary anemia
6 dias.
Intestinal hemorrhage
..........
6 dias
Due to.
Underline the cause to
13 NAME
OF
HERJoseph Tannenbaum
14 BIRTHPLACE OF
FATHER (City)
(State or country)
austria
Of autopay
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
(a) Residence. No.
(Usual place of abode)
Winthrop
(If U. S.
War Veteran,
spoolfy WAR)
2 FULL NAME,
CERTIFICATE OF DEATH
ORM R-302
SUFFOLK BOS (County)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
1
PLACE OF DEATH
(City or Town)
Beth Israel Hospital No.
(If death occurred in a hospital or institution,
St.
give its NAME instead of street and number)
M/rs Rae Elfman
2 FULL NAME
(If deceased io a married, widowed or divorced woman, give also maiden name.)
20 Beach
st
Winthrop
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay : In hospital or Institution .. hospital
(Before death)
yeare
months 1 7 7days.
In this community
yTS.
mos.1 77 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
Famale
4 COLOR OR RACE|
White
5 SINGLE
(write the word)
18 DATE OF
DEATH
January 9 1947
(Month)
(Day)
(Year)
5a If married, widowed, or divorced HUSBAND of
(or) WIFE of
Tours
,(Give maiden name
gepf wife in full)
(Husband's name in full)
6 Age of husband or wife If allve 47
years
7 IF STILLBORN, enter that faot here.
8 46 Years Months. Days
If less than 1 day
.. Hours ....
......
.. Minutes
Usual
9 Ocoupation :
Housewife
Industry
10 or Business :
11 Soolal Security No .....
none
Other conditions
(Include pregnancy within 3 months of death)
Physician
12 BIRTHPLACE (City)
(State or country)
Canada
13 NAME OF
FATHER
Louis Greenfield
Major findings :
Of operations
Date of
should be
charged sta- tistically.
What test confirmed diagnosis ?All.t.o.ps.y.
20 Was disease or Injury In any way related to oooupation of deceased ?.. NO ..
If so, spoolfy
Laurice Kaufman
M. D.
(Address)
BIH
Date 1/9 19/17
17
Informant.
Louis ..... Elfman
Relation. & Any
(Address)
20 Beach Rd Winthrop
A TRUE COPY
ATTEST :
Michael I Ma
(Registrar of city or town where death occurred)
DATE FILED
Jan 13 1947
19
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
of the city or town in which the deceased resided. (See Chap. 46, Sec. 12, G. L.)
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
15 MAIDEN NAME
OF MOTHER
Anna Markowitz
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ... Tifareth ..... Israel
(Cemetery) E.grettscip. arstewn)
Jan IC 1917
19
DATE OF BURIAL
....
22 NAME OF
FUNERAL DIRECTOR
Penj F Solo
ADDRESS
Brookline 8889
Received and filed. JAN 221917
19
(Registrar of City or Town where deceased resided)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-808 to the clerk
30m-(b)-6-44-14607
Pemphigus
72 mos ....
Due to
Due to.
Duration
Immedlate cause of death.
19 I HEREBY CERTIFY,
Oct 15
19116.
to.
That I attended deceased from
Jan 9
1947
! last saw h ............. alive on
Jan ..
9
197
death Is sald to
have ooourred on the date stated above, at
10:30P
m.
Montreal
Underline the cause to which death
Of autopsy
As above
(Signed)
Registered No.
262
(If U. S.
War Veteran,
spoolfy WAR)
no
(Specify whether)
MARRIED
Married
or DIVORCED
ORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD 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
50m . (b).6-44-14607
A TRUE COPY.
FranceNO Hanff
ATTEST :
( Registrar of city or town, where death occurred)
DATE FILED
January 1,
147
19
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
9,
1947
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY, March 27
1942
January
to
That I attended deceased from
1 last saw h ..
im
Jan. 9
19 47
alive on
death Is said to
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife If allve 63 years
7 IF STILLBORN, enter that faot here.
8
60
3
Months
Days
1
If less than 1 day Hours Minutes
Usual
9 Occupation :
Shipper
Industry
Standard Oil Co.
10 or Business:
11 Soolal Security No ..
None
12 BIRTHPLACE (City)
Roxbury
(State or country) Mass.
13 NAME OF
FATHER
Thomas Patten
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
Norah McCartly
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
17 state San. Records
Relation, if any
(Gity or Town)
DATE OF BURIAL
December
13,1948
19
22 NAME OF
FUNERAL DIRECTOR
Jefferson, Muss"
Frank ". Miles Co.
ADDRESS
Received and filed FEB 4 1947 19
(Registrar of City or Town where deceased resided)
1
RUTLAND
(City or Town),
Rutland State Sanatorium
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
RUTLAND
(City or town making return)
10
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
2 FULL NAME
John Joseph Patten
(If deceased is a married, widowed or divorced woman, give also maiden name.)
90 Sagamore Ave.
St.
Winthrop, Mass.
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institutbanatorium
4 years 9 months 13 days.
(Before death)
(Specify whether)
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4 COLOR OR RACE|
White
5 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
1
5ª If married, widowed, or dlvoroed
Margaret Greaves
HUSBAND of
(Give maiden name of wife in full)
have ocourred on the date stated above, at
3:15 A .M
Immediate cause of death
Pulmonary tuberculosis
Duration 13 year:
Due to
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
Date of
should be charged sta-
tistically.
What test confirmed diagnosis ?
Lab.& x-rays
20 Was disease or Injury in any way related to oooupation of deceased? Unknown
If so, speolfy
Armand Laroche
(Address) [t] and State Wall. Date1/9
1947
21 PLACE OF BURIAL,
MtBenedict, Doston, Mass
CREMATION OR REMOVAL
Underline the cause to which death
Of autopsy
(Signed)
M. D.
Informant.
(Addresa)
hutland , lass.
No.
PLACE OF DEATH
V. ORCESTER
(County)
Registered No.
(If U. S.
War Veteran,
spoolfy WAR)
In this community
4 yrs. 9
mos. 03
days.
AGE
Years
FORM R-305 + Casex (County)
1
PLACE OF DEATH
Danvers (City or Town) No Envers State Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers (City or town making return)
Registered No.
11
St. (If death occurred in a hospital or institution, give its NAME instead of street and number)
Bridget B. Mc neil
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of ahode)
15 Summit
St.
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
/
months
3 days.
In this community
yra.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Jan.
11
1947
(Month)
(Day)
(Year)
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
AlorGive Maiden many of wife in till
(Husband's name in full)
19 | HEREBY CERTIFY that I have Investigated the death of the person above-namsd and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Broncho Joneumonia associated with fracture right him
6 Age of husband or wife If allvs years
7 IF STILLBORN, enter that fact hers.
8
AGE.
81
.Years
Months
Days
If less than 1 day
.Hours.
Minutes
Usual
9 Occupation :
Houseurje
Industry 10 or Business:
11 Soolal Security No.
none
12 BIRTHPLACE (City)
(State or country)
Canada
13 NAME OF
FATHER
William Fenton
PARENTS
15 MAIDEN NAME
OF MOTHER
Bridget O'Donnell
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
17
Mark. Inc Philliat
Relation, if any
DATE OF BURIAL
Jan. 15
1947
(Address) Hathorne maso.
A TRUE COPY.
2
ATTEST :
(Registrar of city or town where death occurred)
DATE FILED
Jan. 20
19 47
20 Accident, suicide, or homicide (specify) Accident
Date of coourrenoo.
Jan. 6
1947
Where did
Danvers
mass
(City or town and State)
Did Injury occur In or about the home? on farm, In industrial place, or In
publlo
Danvers State Hospital
(Specify type of place)
Manner of
Fell out of bed
Injury
Nature of
as above
Injury
While at work ?.
200
Was there an autopsy ?.
no
21 Was disease or Injury In any way related to ccoupation of deceased ? 0
If so, speolfý.
(Signed)
H. N.P. Murphy
M. D.
(Address) Meatray Mas Date 1-12 1947
22
St Patrick's Com
Place of Burial, Cremation or Removal,
(City or Town)
23 NAME OF
FUNERAL DIRECTOR
John 7. 0' maler
ADDRESS
Winthrop maso
Received and filed.
FEB 7 1947
19
(Registrar of City or Town where deceased resided)
25m-(J).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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD occurred. (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-805 to the clerk Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased MARGIN RESERVED FOR BINDING
r
2 FULL NAME
3 SEX
Female
4 COLOR OR RACE
White
5 SINGLE
(write the word)
Medrived
MARRIED
WIDOWED
or DIVORCED
(Fenton)
(If U. S.
War Veteran,
speolfy WAR)
Winthrop
Lowell
14 BIRTHPLACE OF
FATHER (City) ..
(State or country)
Canada
Injury ocour ?
RM R-301 A
Y Suffolk
147
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.
2 FULL NAME Dale Seit Mailor .........
(If deceased is a married, widowed or divorced woman, give also maiden name.)
2x7 maverick
....... .St
(If nonresident, give city or town and state)
(Specify whether)
years 1 hr 12 min
months days.
In this community
yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
Januari
1447
(Month)
(Day)
(Year)
19 1/HEREBY CERTIFY.
Jan 11
That I attended deceased from
197, to /4kl.
1917
I last saw han alive on
11,
19 ..... , death is said to
have occurred on the date stated above, at.
Immediate cause of death.
4:50 am
Duration- IMPORTANT
Due to.
Chimature Bath
Due to.
Other conditions.
(Include pregnancy within 3 months of death)
IMPORTANT
PHYSICIAN
Major findings: Of operations.
Date of.
Of autopsy
What test confirmed diagnosis?
20 Was disease or injury in any way related to occupation of deceased ?. .......
If so, specify ..
M/ S, M. D.
Canada (Address) ... I. Michaels
21. Place of Burial, Cremation or Removal. (City or Town)
22 NAME OF
FUNERAL DIRECTOR
al tany Di Pietro ADDRESS of Mavencao
Received and filed JAN 111947
19
.........
(Registrar)
4 COLOR OR RACE
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVOROLD
Boringle
5a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of. (Husband's name in full)
6 Ago of husband or wife if alive ..
years
7 IF STILLBORN, enter that fact here.
8 AGE. Years. .Months. Days[.
If Iese than I day
Hours/ 2 Minutes
II Social Security No ...
12 BIRTHPLACE (City). (State or country)
13 NAME OF
FATHER
George Mailor
IL BIRTHPLACE OF Waterford
FATHER (City) (State or country) M.c.
15 MAIDEN NAME
OF MOTHER
FER Jenine Dupeux
16 BIRTHPLACE OF MOTHER (City) ... Casas 1 montreal (State or country)
Relation, if any
George
I HEREBY CERTIFY that a satisfactory etandard certificate of death was filed with rye BEFORE the burial or transit permit was issued : Walter . Saker
(Signature of Agent of Board of Health or other)
Health Officer 1/13/47
(Official Designation) (Date of Issue of Permity
I Usual 9 Occupation :. Sper hosp. 1/28/47 PARENTS Informant ... 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 information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state 3 .... N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Industry 10 or Business: 100m-2-'40-D-729-1
PLACE OF DEATH
(County) Distin Mentler (City or Town)
No enthrop (Immunity Josh
.St.
Registered No.
§ (If death occurred in a hospital or institution, ¿ give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
(a) Residence. N (Usual place of abode) Length of stay: In hospital or institution.
...
3-BEX
Female White
............ m.
Underline the cause to which death should be charged sta- tistically.
(Signed)
23F Proverite do
Dato ....
1/11 /4719.
Boazai
....
DATE OF BURIAL ..
January 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 hest of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, definded as required 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.
No undertaker or other person shall hury or otherwise dispose of a human hody in a town, or remove therefrom a human body which has not heen 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 hoard, froin 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 receiv- ing tomh to another in the saine 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 until there shall have been delivered to such hoard, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to he returned and recorded, which shall he 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 in- sufficient, a physician 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 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 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 been sooner obtained hereunder. If the deatb certificate contains a recital, as required hy 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 forthwitb 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 necessary information which can be ohtained 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 buman body or the asbes thereof which have been brought into the commonwealth until be 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 he 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 ohservance 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 disahled hy 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 by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following ahortion, hut also deaths from disease resulting from injury or Infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Cause of death means the disease, or complication which causes death. not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier 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 important, 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 husiness, report the usual occupation prior to retirement. Children not gainfully employed may he returned aa 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
M R-301 A
PLACE OF DEATH -
(County)
... Minthop -
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.
13
Mary Ella (Jordin) Turkey ridon
( if deceased is a married, widowed or divorced woman, give also maiden name.)
067 Centre th
(a) Rasidence. No.
(Usual place of abode)
1
Length of stay: In hospital or Institution
( Before death)
( Specify whether)
years
months days.
In this community
35 yra.
mos.
dayı.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Adele White
4 COLOR OR RACE
5 SINGLE
( write the word)
MARRIED
WIDOWED
or DIVORCED
Sa If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
( Higband's' name in full)
6 Age of husband or wife if allva
years
7 IF STILLBORN, enter that fact hera.
If lass than 1 day
Hours
Minutas
Usual
9 Occupetion :
Thomas
11 Social Security No.
Hampden
12 BIRTHPLACE (City)
( Siate or country)
Meine
13 NAME OF
FATHER
Patrick Jardin
14 BIRTHPLACE OF
FATHER (Clty)
(State or country)
Ireland
15 MAIDEN NAME
OF MOTHER
DE anne Finnigan
16 BIRTHPLACE OF
MOTHER (City)
Hampton
(State of country) Maine
Relation, if any son
I HEREBY CERTIFY that a satisfactory standard certificata of death was Ated with me BEFORE the burial or transit parmit was Issued: walter 2 19.200202
( Signature of Agent of Board of Health ht other)
1/10/4
( Data of Inque of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
January
14
1947
( Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Thet i attended deocasad from
dec.
28
19 .. 4.6.
....
to
San. 14
19:47
....
I last sew her
.. allva on.
Jan 14
.. , 19 .. 2 ..... death Is said to
heve occurred on tha dato statad above, at ....
9: 45 Pm.
Duration
Immedlate oause of daath. Pulmonary edema.
Due to
Congestive heart failure
Due to
arteriosclerotic heart disease
year
Other conditions.
(Include pregnancy within 8 months of death)
Major findinga:
Of oparations
Data of
Of autopsy.
What test confirmed diagnoals?
IMPORTANT
Physician Underline the cause to which death should be charged sta. tistically.
20 Was diseasa or injury in any way ralated to occupation of daoaased ?......
If so, spaolfy.
arthur C. Murray
. M. D.
('Signed )
(3) INanthro, Mass Data Jun /6 1947
Banan Maine
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF
BURIAL Jan, 1601947
19
22 NAME OF
FUNERAL DIRECTOR
Terby Bras
ADDRESS
210 Mentherole of Hettak
19
Recalved and filed
JAN 20 7
( Registrar)
100m.(g) -1-45-15510
1 2 FULL NAME (or) WIFE of Industry 10 or Business : PARENTS 17 Informant ( Address)/ If deceased was a U. S. War Veteran, Q. L. Chap. 46. Section 10, requires physiolans to Insert a reoltal 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. ACE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain AGE 80 ears
(City or Town) 67 theatre th raneturk No.
Registared No.
§ (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).
St.
(If nonresident, give city or town and State)
(Oficial Designation)
IMPORTANT
6-house 1 week
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 ariny, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, speci- fying the war, and shall also certify in such certificate hoth the primary and the secondary or immediate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this sec- tion and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, 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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