Town of Winthrop : Record of Deaths 1947, Part 4

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


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 4


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41 | Part 42 | Part 43 | Part 44 | Part 45 | Part 46 | Part 47 | Part 48 | Part 49 | Part 50 | Part 51 | Part 52 | Part 53 | Part 54 | Part 55 | Part 56 | Part 57 | Part 58 | Part 59 | Part 60 | Part 61 | Part 62 | Part 63 | Part 64 | Part 65 | Part 66 | Part 67 | Part 68 | Part 69 | Part 70 | Part 71 | Part 72 | Part 73 | Part 74 | Part 75 | Part 76 | Part 77 | Part 78 | Part 79 | Part 80 | Part 81 | Part 82 | Part 83 | Part 84 | Part 85 | Part 86 | Part 87


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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