USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1947 > Part 71
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301 A
7 Suffolk County)
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.
211
St. { (If death occurred in a hospital or institution. { give its NAME instead of street and nun.ber) !
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran if so specify WAR) None
"(If nonresident, give city or town and State)
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR' OR RACE
White
5 SINGLE
write the word) .
MARRIED
WIDOWED
Marked
5a if married, widowed or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
68 yrs
years
6 Age of husband or wife if alive
7 IF STILLBORN, enter that fact here.
00 AGE
74
Years
Months
Getrid
Days
It less than 1 day
Hours
Minutes
Industry
10 or Business:
advertising
11 Social Security No.
12 BIRTHPLACE (City) (State or Country)
13 NAME OF
FATHER
George T. Abely
PARENTS
15 MAIDEN NAME OF MOTHER
Johanna Driscoll
16 BIRTHPLACE OF MOTHER City) (State or Court Five Ellen IT. Ality
17
Intormant (.1 1dres .) 87 Wordside And Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was tiled with me BEFORE the burial of transit permit was issued
Board of Hoch had his) Health Office
(Official D)- ignation) ( Date of l'une 10/29/47
19 1 HEREBY CERTIFY,
Sept. 13 , 1947 . to
That I attended deceased from 00/28 , 19
47
I last saw him
alive on
Oct. 27
. 197 /, death is said to
have occurred on the date stated above, at 9:00 Am.
Immediate cause of death
Bronchopneumonia
Due to Cerebral thrombosis
Due to
Other conditions
(Include pregnancy within 3 months of death)
Major findings: Of operations
Date of
Of autopsy
What test contirmed diagnosis? Clinical
20 Was disease or injury in any way related to occupation ot deceased? If so, specity
(Signed Mintlub napas Date Oct 28 1947
(Address'
Wanthurt . Mais .
21 Place of Burial. Crespou yr Kemal (('Hy or Town)
DATE OF BURIAL les. 90 . 19 Michael J. barnen
22 NAME OF FUNERAL DIRECTOR ADDRESS 978 Sauloga ST E. B.a.
Received and Filed
19
OCT 3 1 1947
(Registrar)
V
See instructions and extracts from the laws on back of certificate. If deceased was a U. S. War Veteran, G. L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
PLACE OF DEATH
(City or 87 Hoodaide
No. .
Abely
2 FULL NAME
(If deceased is a married, wolowed or divorced woman, give also maiden name.) 87 Hooderve
(a) Residence.
No.
(Usual place of abode)
Length of stay: In hospital or institution (Before death) (Specify whether)
years
months days. In this community 25 yrs.
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH
October
28
(Day)
(Month)
1947
(Year)
Duration IMPORTANT
1 day 1 week
IMPORTANT
Physician Underline the cause to whichdeath should be charged sta- tistically.
14 BIRTHPLACE OF FATHER (City) (State or Country)
Salen, Mais.
Boston,
"Mass.
(
100M - 7-46-19068
1
. MD
Usual 9 Occupation:
por DIVORCED Ellen J. Chiley
St.
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, See. 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 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 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 hody in a town, or remove therefrom a human hody which has not been buried, 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, from the clerk of the town where the person died; and 10 undertaker or other person shall exhume a human hody and remove it from a town, from one cemetery to another, or from one grave or tomh other than the receiving tomb to another in the same 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 buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may he, a satisfactory written statement containing the facts required hy 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- eian 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 body, not previously interred, from one town to another within the commonwealth cannot he obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall he returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as required
by section teu of chapter forty-six, tuat the deceased served i:" 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 he 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 hodies 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 hody lies and take charge of the same; ... - General Laws, Chap. 38, Sec. 6.
No undertaker or other person shall bury a human hody or the ashes thereof which have heen brought into the commonwealth until he has re- ceived a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the hody is to be buried or the funeral is to he held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made. . . . Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disahled 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, 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, ete. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause.
Statement of Occupation .- Precise statement of occupation is very im- portant, so that the relative healthfulness of various pursuits can he known. Make some entry in this section for every person aged 10 years or over. If the occupation had heen given up or changed on account of the disease causing death, report the usual occupation prior to illness. If the deceased had retired from business, report the usual occupation prior to retirement. Children not gainfully employed may he returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, how- ever, designate the occupation hy the appropriate terms, as housekeeper- private family, cook-hotel, etc. For a person who had no occupation whatever write gone.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
No. 87 Upland Road
St.
§ (If death occurred in a hospital or institution give its NAME instead of street and number)
2 FULL NAME. Angie Lena(Fifield) Young (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
87 Upland Road
(Usual place of abode)
St
(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
30 years
months
days·
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
4 COLOR OR RACE
female
white
5 SINGLE (write the word)
MARRIED
WIDOWED
or DIVORCEDWidowed
5a If married. widowed, or divorced
HUSBAND OF
(Give maiden name of wife in full)
(or) WIFE OF
William. S. Young
(Husband's name in Full)
6 Age of husband or wife if alive years
7 IF STILLBORN, enter that fact here.
8 AGE 83 Years 10 Months 6 Days
If less than 1 day
Hours .
Minutes
Usual
·9 Occupation:
At home
Industry
10 or Business:
none
11 Social Security No.
none
12 BIRTHPLACE (City)
(State or country)
Stoneington
Maine
13 NAME OF
FATHER
John Fifield
14 BIRTHPLACE OF
FATHER (City)
(State or country)
Stoneington
Maine
15 MAIDEN NAME OF MOTHER Sarah Tyler
16 BIRTHPLACE OF MOTHER (City) (State or country)
Chelsea
Mass.
17 Informantirs, Jessie C. Hawthorne halde (Address) 87 Upland Road Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burgal or transu grmit wpf natter Baker
Signature of Agent sont ( Health of other).
HO". nov. 1/ 1947
(Official Designation) (Daty of Isdue of Permit)
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
DEATH ...
7Days
October 30,1947
(Month)
(Year)
19 I HEREBY CERTIFY, That I attended deceased from
Oct 15
, 197, to Oct 30
19
47
I last sawh en
alive on
6 + 29.
19 7 /, death is said to
have occurred on the date stated above, at
1.55 P.M.
Immediate cause of death Hypostatic pneumonia Generalized arterio Sclerosis Due to Cerebral Hemorrhage
Due to
Other conditions
none
(Include pregnancy within 3 months of death)
Important
Physician Underline the cause to which death should be charged sta- tistically.
20 Was disease or injury in any way related to occupation of deceased? no .
If so, specify
(Signed)
M.D.
(Addr
Winthrop, mais
Date Oct. 31, 1947.
21
Woodlawn Cemetery, Everett
Place of Burial. Cremation or Removal.
(City or Town)
DATE OF BURIAL
Nov.1.1947
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
174 Winthrop St Winthrop
Received and filed
NOV 6
1947
19
(Registrar)
A TRUE COPY ATTEST:
If deceased was a U. S. War Veteran, C. L., Chap. 48, Sec. 10, requires physicians to insert a recital to that effect. PARENTS
on back of certificate.
100m-(r)-3-46-18278
1
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
Bal Winthrop (City or town making return)
.. .
212
Registrar's Number
PHYSICIAN-IMPORTANT
(Was deceased a
U. S. War Veteran.
(if so specify WAR)
NO
Duration Important 3 days 10 years from Sept 2,47.
Major findings:
Of operations
Date of
Of autopsy
none
What test confirmed diagnosis?
Clinical
alfred BB. March
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 meniber 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 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.
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 fourteen, 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, specifying 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 sanie. For neglect to comply with any provision of this section, such physician or officer shall forfeit ten dollars. For the purposes of this section 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 nineteen 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 perniit 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 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 perinit 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 inter- ment, 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 physician 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 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 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 perinit 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
of chapter forty-six, that the deceased served in the army, navy or marine corps of the I'nited States in uny 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 perinit is so/given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the (leceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114. Sec. 45. G. 1 ... (Tercentenary Edition).
Medical examiners shall make ex:unination 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 u person. he shall forthwith go to the place where the body lies and take charge of the same: . . . - General Laws, Chap. 38, Sce. 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 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 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 inade. . .. 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 toSuch deaths only as those of persons to whom they have given bedside cure 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 physician is absent 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 traumatismo (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 coniplication 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 : person engaged in domestic service for wages, however. 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
......
...
DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS
STANDARD CERTIFICATE OF DEATH PENNSYLVANIA
Stale File No. 22:03
Registrar's No.
213
State of
1. PLACE OF DEATH:
(a) County
DELAWARE
(a) State
mans
(b) County
Suffolk
(6) City or town
DARBY-
(If outside city or town hh
. write RURAL)
(c) Name of hospital or institution:
(If not in hospital or institution, write street number or location)
(d) Length of stay: In hospital or institution
In this community
years, months or day.)
(Specify whether
Çi If foreign born, how long in U. S. A .?
years.
3. (a) FULL NAME Francis lavid Cyp.
20. Date of death: Month
... day
77
Fear
1947
hour
5
minute
Pm
3. (b) If veteran,
name war
3. (c) Social Security
No. 030-09-6499 21 I hereby certify that I attended the deceased from
19 ____ , to
19_
:
19 ___:
and that death occurred on the date and hour stated above.
Duration
. years
Immediate cause of death
Corn
occlusion
F
8. AGE:
Years
. 50
Months
4
Days
19
If less than one day
-
hr.
min
9. Birthplace
Mars. (State or foreign country)
10. Usual occupation
Saluma
n
11. Industry or business
Stacks + Bondo
MOTHER FATHER =
12. Name Joseph Jeyr
13. Birthplace
Canada
14. Maiden name
Porathna
or foreign country)
15. Birthplace
Mada
(City, town, or county)
(Stata or foreign country)
16. (a) Informant's own signature.
Frances
Rau
(6) Address 100 Sumany Side And Winthing
22. If death was due to external causes, fill in the following:
(a) Accident, suicide, or homicide (specify)
(b) Date of occurrence
(c) Where did injury occur?
(City or town) (County) (Stata)
(+) Did injury occur in or about home, on farm, in industrial place, in public -place?
While at work?
(Specify type of place)
(e) Means of injury
23. Signature
(M. D. or other)
(Date received local registrar) (Registrado signature)
Address
Date signed
8-6917
6. (a)Single, widowed, married
divorced wid
6. (b) Name of husband or wife
Helen
0' Brian
6. (c) Age of husband or wife if
alive
16-1896
7. Birth date of deceased
(Month)
(Day) (Year)
Due to
9 ya
Due to
Other conditions (Influde pregnancy within 3 months of death)
PHYSICIAN
Major findings:
Of operations
Of autopsy
Underline the cause to which death should be charged sta- tistically.
(b) Date thereof
3-11-47
17. (a)
Burial
(c) Place; burial or cremation
(Burial, cremation, or removal) Winthrop
18. (a) Signature of funeral director
Chas. H. dr
(b) Address 920 mai St. well.
3-7-47 19. (a) (b) Sallie Breech
2. USUAL RESIDENCE OF DECEASED:
(c) City or town
(If outside city or town limita, write RURAL)
34 Jun
neide Are.
(d) Street No.
(If rural, give location)
MEDICAL CERTIFICATION
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