USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1948 > Part 45
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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 hody is to be huried or the funeral is to be held, or from a person appointed to have the care of the cemetery or hurial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The Tuffilment 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 hy 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 traumatism (including resulting septicemia), and hy the action of chemical (drugs or poisons)," thermal, or electrical agents, and deaths following ahortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disahled hy 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 important, 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 husiness, 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, 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-302
PLACE OF DEATH
Suffolk (County)
Chelsea
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
2682.1
S (If death occurred in a hospital or inetitution, give ite NAME instead of etreet and number)
2 FULL NAME
Mrs. Emily (n) Anderson
(If deceased ie a married, widowed or divorced woman, give aleo maiden name.)
(a) Residenoe. No.
70 Pebble Ave
St.
Winthrop.
Mass
(Usual place of abode)
Hosp
years
months
daye.
in this community
yrs.
moe.
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
4 COLOR OR RACE
5 SINGLE
(write the word)
May 16, 1948'
Female
White
MARRIED
WIDOWED
or DIVORCED
Married
(Month)
(Day)
(Year)
5a If married, widowed, or divoroed
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if allve years
7 IF STILLBORN, enter that fact here.
8
AGE 50 Years Months Days
If less than 1 day .Hours. Minutes Due to.
Usual
9 Ocoupation :
Housewife
industry
10 or Business :
none
11 Soolal Seourity No.
12 BIRTHPLACE (City)
Marlboro
(State or country) N .H.
Major findings:
Of operations.
Date of.
should be charged sta- tietically.
14 BIRTHPLACE OF
FATHER (City)
(State or country)
England
Of autopsy What test confirmed diagnosis?
20 Was disease or Injury in any way related to oooupation of deceased ?.
If so, speolfy
Thos . J . Mathieu
M. D.
(Address)
USNH
5/16/48 Date
19
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 PLACE OF BURIAL,
CREMATION OR REMOVAL
Evergreen Leominster
(Cemetery)
(City or TownMass
19
DATE OF BURIAL
6. 19 48
A TRUE COPY.
Joseph & Tyrrell
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
5/17/48
19
Received and filed 19
AUG 2
19.4.8
(Registrar of City or Town where deceased resided)
50m-(b)-6-44-14607
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-302 to the clerk 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
15 MAIDEN NAME
OF MOTHER
Hannah Morrison
immedlate oause of death Hypertensive Heart
Disease MyocardialInfarction
Due to.
Other conditions
(Include pregnancy within 3 months of death)
Physician
Underline the cause to which death
13 NAME OF
FATHER
Orlando Morrison
18 DATE OF
DEATH
19 I HEREBY CERTIFY,
April15
19 ... 4.8 .. , to.
May .... 16
194.8
That I attended deceased from
last saw h
er alive on May 16
19.48 death Is said to
have occurred on the date stated above, at 6:35P m.
Duration
61
1
No.
(City or Town)
U. S. N. H.
St.
(If U. S.
War Veteran,
speolfy WAR)
no
(If nonresident, give city or town and State)
Length of stay : In hospital or institution ...
(Before death)
(Specify whether)
22 NAME OF
FUNERAL DIRECTOR
Reynolds Funeral Parlor
ADDRESS
Winthrop St., Winthrop, Mass
17 InformantJohn L. Anderson
I Relation in any
(Address)70 Pebble Ave., Winthrop
(Signed)
Copies of returns of deaths recorded during the previous month which occurred in your city or town in case the deceased
50m (e)-1-41-4667
17 Francis C. Obler
Informant
(Address)
31 College Ave. , Medford.
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
19 48. DATE FILED June 10
MEDICAL CERTIFICATE OF DEATH
18 DATE OF
June 9, 1948
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
Sept. 6.
19 .... 4.7
to.
That I attended deceased from
June9,
19.
4.8
I last saw h.
er
alive on
June 7,
19 40 death is said to
have occurred on the date stated above, at
2. P.M.
.m.
Duration
Immediate cause of death
Arteriosclerosis
10 Yrs.
Due to ..
Generalized Arteriosclerotic
heart disease
10 Yrs.
Due to.
Pulmonary edema
2 Days
Other conditions
None
(Include pregnancy witbin 3 months of death)
Major findings:
Of operations
Physician Underline the cause to
Of autopsy.
Clinical
What test confirmed diagnosis ?. Findings
No
le
(Signed)
366 Broadway, Som
Date
6/1019 48
21 PLACE OF BURIAL,
CREMATION OR REMOVAL ..
Holyhood Cem. , Brook-
Relation if any
line, Mass.
(Cemetery)
(City or Town)
DATE OF BURIAL
June 11, 19.
22 NAME OF William II. McKenna
FUNERAL
DIRECTOR
390
Medford St. , Somerville.
ADDRESS
Received and filed 19
JUL 13 1948
(Registrar of City or Town where deceased resided)
X
RM R-302
Middlesex
The Commonturalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Somerville
(City or town making return) 1
44$25
1
Somerville
(City or Town)
No.
8. Fairview Terrace ( Somerville Sanatorium) Helen J. Kohler
( If death occurred in a hospital or institution, St.
( give its NAME instead of street and number)
(If U. S.
War Veteran,
specify WAR)
(If deccased is a married, widowed or divorced woman, give also maiden name.) 17 Irwin St., Winthrop, Mass
Length of stay: In hospital or institution.
(Before death)
(Specify whether)
years
10 months
days.
In this community
mog.
days.
PERSONAL AND STATISTICAL PARTICULARS
2 FULL NAME
(a) Residenoe. No.
(Usual place of abode)
3 SEX
F
4 COLOR OR RACE
W
(or) WIFE of
7 IF STILLBORN, enter that fact here.
8
AGE
77
Years
Months.
-
Days
Usual
9 Occupation :
Retired
10 or Business :
11 Social Security No.
12 BIRTHPLACE (City)
Boston
(State or country)
Mass.
14 BIRTHPLACE OF
FATHER (City)
PARENTS
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
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-302 to the clerk
(State or country)
Germany
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)
(Husband's name in full)
6 Age of husband or wife if alive years
If less than 1 day Hours. Minutes
Industry
N. E. Tel.& Tel.Co.
13 NAME OF
FATHER
Joseph Kohler
15 MAIDEN NAME
OF MOTHER
Regina Cast
20 Was disease or injury in any way related to oooupatlon of deccased?
if so, specify
Edward T. Downey
(Address)
Date of
which death
None
should be charged sta- tistically.
PLACE OF DEATH
(County)
Registered No.
St.
(If nonresident, give city or town and State)
Rest Home
RM R-302
Suffolk
(County)
Boston
(C'ity or Town) Palmer Memorial Hospital ( N E D H)
St.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
12 Sunset Road
Winthrop Mass.
(Usual place of abode)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
7 Hrs
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE
5 SINGLE
(write the word)
Married
MARRIED
WIDOWED
or DIVORCED
18 DATE OF
DEATH
June 29/48
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
June .... 28
19 .. 118.
to.
19
That
1 attended deceased
June
29
48
(or) WIFE of
(Give maiden name of wife in full)
(Husband's name in full;
6 Age of husband or wife If alive
70
years
7 IF STILLBORN, enter that faot here.
8 AGE ... 68. .. Years .. Months. .Days
If less than 1 day Hours.
Minutes
Usual
9 Oocupation :
Housewife
Industry
10 or Business :
Un Home
11 Social Security No.
Ireland
12 BIRTHPLACE (City)
(State or country)
13 NAME OF
FATHER
John Butler
PARENTS
14 BIRTHPLACE OF
Ireland
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Barett
If so, specify.
No
(Signed)
M. D.
(Address)
81 Bay State Rd.
Date .. 6-29 .... 19.
...... 48
Winthrop Cem-Winthrop Mass.
17
Informant.
(Address)
W ... S. Burrill ( Relaisband)
A TRUE COPY.
22 NAME OF
FUNERAL DIRECTOR
J F O' Maley
ATTEST:
(Registrar of city or town where death occurred)
DATE FILED
July.
2/48
19
Received and filed 19
JUL 12 1948
(Registrar of City or Town where deceased resided)
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.)
25M-(f)-11-12 10746
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
1
PLACE OF DEATH
No.
The Commonforalth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
Registered No.
5846 26
Wa
(If U. S.
War Veteran,
speolfy WAR)
St.
(If nonresident, give city or town and State)
30
mos.
dayo.
years
months
days.
In this community
yrs.
19
death Is sald to
have occurred on the date stated above, at
1;30AM
m.
Duration
Inimedlate oause of death
Uremia
4 Das.
Due
Pyelonephritis, chronic bilateral
with inactive rt.kidney
10 Years
Due to.
Other conditions
Diabetes mellitus
"It"Yrs Physician
(Include pregnancy within 3 months of death)
arterio sclerosis,gener alized (Y
Underline the cause to
Major findings :
Of operations.
None
which death
Date of
should be
charged sta-
Of autopsy
as a bove
tistically.
What test confirmed diagnosis ?
Autopsy and tests
20 Was disease or injury in any way related to occupation ALQaeda& urine
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 PLACE OF BURIAL,
CREMATION OR REMOVAL.
(Cemetery)
July 2/48
(City or Town)
19
DATE OF BURIAL
A Marks
ADDRESS
Winthrop Mass.
Katherine Burrill
5a If married, widowed, or dlvoroed HUSBAND of
I last saw h ...... er ..... alive on
June 29
L8
RM R-302
Suffolk
(County)
1.
Boston
(C'ity or Town)
No.
Jewish Memorial Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
5872~
Registered No.
(If death occurred in a hospital or institution,
give its NAME instead of street and number)
Sarah Abramovitz
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
5 Wave Way Ave.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In hospital or Institution.
(Before death)
(Specify whether)
years
3 months
28
days.
In this community
yrs.
3
mos.
28 days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
F
4 COLOR OR RACE
W
5 SINGLE
(write the word)
Widowed
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(or) WIFE of
(Give maiden Hams of tig in full)
(Husband's name in full)
6 Age of husband or wife If alive --
years
7 IF STILLBORN, enter that faot here.
8 AGE 75 Years Months.
.. Days
if less than 1 day Hours .. ..... .Minutes
Usual
9 Oooupation :
Housewife
Industry
10 or Business :
At Home
11 Social Security No ...
None
12 BIRTHPLACE (City)
(State or country)
Russia
13 NAME OF
FATHER
Charles Goldman
PARENTS
14 BIRTHPLACE OF
Russia
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Mary
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
17 Informant (Address)
C Abrams
Relation, if any Son. changed
A TRUE COPY. Michael Planning
ATTEST :
.....
(Registrar of city or town where death occurred)
DATE FILED
July ......... 6/48
19
18 DATE OF
DEATH
June
30/48
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
March ... 2
19.
48
That I attended deceased from
June .. 30
19
48
[ last saw h.
er ..... alive on.
June 30
1948
, death Is said to
have occurred on the date stated above, at.
1:20P
.m.
Duration
Inimedlate cause of death. Cerebral thrombosis
(recurrent)
3 Das.
Due Gen. arterio sclerosis
? Yrs.
Due to.
Other conditions
Left hemiplegia
(Include pregnancy within 3 months of death)
Major findings :
Of operations
Date of
Underline the cause to which death should be charged sta-
Of autopsy.
tistically.
What test confirmed diagnosis?
Clinical
20 Was disease or injury in any way related to oocupation of deceased?
If so, specify
(Signed)
L. D. Jacobs
M. D.
(Address)
....
Boston ... Mas.s
Date 6-30 19
18
21 "PLACE OF BURIAL,
Mto Lebanon Baltimanzer
DATE OF BURIAL
(Cemetery )
July 1/48
19
22 NAME OF
FUNERAL DIRECTOR
ADDRESS
Henry Levine
Dorchester Mass:
Received and filed. JUL 12 048 .19
(Registrar of City or Town where deceased resided)
25M-(f)-11-42 10746
PLACE OF DEATH
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
6 MOS.
Physician
No
...
CREMATION OR REMO
.. West ... Rox.
(City or Town)
Name legally
St.
giv
(If U. S.
War Veteran,
speolfy WAR)
Winthrop Mass.
St.
to.
RM R-302
PLACE OF DEATH
Suffolk (County)
Boston
(City or Town).
Boston Lying In Hospital
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
St. (If death occurred in a hospital or institution, give its NAME instead of street and numher)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
275 Main
(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
yrs.
mos.
daye.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
5 SINGLE
(write the word)
Single
MARRIED
WIDOWED
or DIVORCED
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at
9:05AM
m.
Duration
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
...... Hours ....... Minutes
Usual
9 Oooupation :
Industry
10 or Business :
11 Social Security No.
Boston Mass.
13 NAME OF
FATHER
Edward A Sprague
PARENTS
14 BIRTHPLACE OF
Boothbay Harbor Maine
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Lillian Wigginton
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Wise Virginia
17 Informant. (Address)
Boston LyingatIn Hospt
A TRUE COPY
ATTEST :
Registrar of city or town where death occurred)
DATE FILED
.19
P
Other conditions
(Include pregnancy within 3 months of death)
Physician
Underline the cause to
Major findings :
Of operations.
which death
Date of
should be charged sta- tistically.
Of autopsy.
What test confirmed diagnosis?
20 Was disease or injury in any way related to oocupation of deceased?
If so, specify
D E Reid
(Signed)
(Address)
221 ... Longwood ... Ave.
Date.
6-30
19
18.
21 "PLACE OF BURIAL,
CREMATION OR REMOVAL
Calvary Cem-Waltham Mass.
DATE OF BURIAL
July 5/48
19
(City or Town)
22 NAME OF
FUNERAL DIRECTOR
G M Linehan
ADDRESS
Boston Mass.
Received and filed.
JUL 12 1948
.19
(Registrar of City or Town where deceased resided)
X
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.)
25M-(f)-11-42 10746
resided in another city or town at the time of death should be made forthwith and transmitted on Form R-802 to the clerk
No.
Baby Boy Sprague
(If U. S.
War Veteran,
speolfy WAR)
June 30/48
18 DATE OF
DEATH
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
June .... 30.
18
to
That I attended deceased
June 30
19
I last saw h ... im ..... allve on
June 30
,48
death Is said to
Inimediate cause of death Atelectasis
Due to rematurity
Due to.
12 BIRTHPLACE (City)
(State or country)
NO
1
Registered No.
59128
Winthrop Mass.
RM R-302
Suffolk
(County)
Boston
(C'ity or Town)
No.
Mass.General Hospital
The Commonmoralth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
(If death occurred in a hospital or institution, St. give its NAME instead of street and number)
2 FULL NAME
George C Wilfert
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residenoo. No.
600 Shirley
St.
Winthrop
Mass.
(Usual place of abode)
Length of stay: In hospital or institution
(Before death)
years
monthg O
days.
In this community
yrs.
mos.
10
days.
PERSONAL AND STATISTICAL PARTICULARS
MEDICAL CERTIFICATE OF DEATH
3 SEX
M
4 COLOR OR RACE
W
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
5a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
have occurred on the date stated above, at
7:22AM
m.
Duration
6 Ags of husband or wife If alive years
7 IF STILLBORN, snter that faot here.
8 AGE 71 Years 4 Months
17 Dayı
If less than 1 day Hours .. .Minutos
Usual 9 Oocupation :
Assembly Man Retired
· Industry
10 or Business :
General Electric
11 Social Security No.
12 BIRTHPLACE (City)
(State or country)
Germany
13 NAME OF
FATHER
John N Wilfert
14 BIRTHPLACE OF
Germany
FATHER (City)
(State or country)
15 MAIDEN NAME
OF MOTHER
Barbara Thierauf
16 BIRTHPLACE OF
MOTHER (City)
(State or country)
Germany
17
Informant
(Address)
G C Wilfert Jr.
Relation, if any
DATE OF BURIAL
July 3/48
19.
22 NAME OF
J S Waterman & Sons
FUNERAL DIRECTOR
ADDRESS
Boston Mass.
Rsoeived and filed.
JUL 12 1948
19
DATE FILED
18 DATE OF
DEATH
June 30/48
(Month)
(Day)
(Year)
19 | HEREBY CERTIFY,
That
- attended deceased
June
19
3
....
I last saw h
im ... alive on.
June 30
48
...
19.
death Is said to
Immediato cause of death
Leukemia,lymphatic
chronic
6 Yrs"
Due to
Due to
Other conditions.
(Include pregnancy within 3 months of death)
Physician
Major findings :
Of operations
None
Dats of
should be
charged sta- tistically.
What test confirmed diagnosis ?.. autopsy
20 Was disease or injury in any way related to oocupation of deceased?
if so, spsoify
J.S Lichty
(Signsd)
(Address)
Mass. General Hospt Date 6-30;
M.1-8
21 PLACE OF BURIALForest Hills Cem. Boston
CREMATION OR REMOVAL.
(Cemetery,
(City or Town)
A TRUE COPY.
ATTEST :
(Registrar of city or town where death occurred)
July 6,1948
1
19
(Registrar of City or Town where deceased resided)
:
1
PLACE OF DEATH
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
25M-(f)-11-42 10746
Of autopsy
Underline the cause to
which death
PARENTS
Barbara Mayer
June ... 20.
19 ... 18
to
(If U. S.
War Vstsran,
speolfy WAR)
(If nonresident, give city or town and State)
(Specify whether)
Registered No.
589329
1
[ R-301 A
See instructions and extracts from the laws on back of certificate. DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION is very important. If deceased was a U. S. War Vetaran, G. L. Chap. 46, Section 10, requires physicians to insert a racital to that effect.
PLACE OF DEATH
Suffolk (County) Winthrop (City or Town) 64 Moore Street.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be nica for bunlar perint with Board of Health or its Agent.
Registered No.
130
St.
{ (If death occurred in a hospital or institution, {
give its NAME instead of street and nun.ber)
PHYSICIAN - IMPORTANT
2 FULL NAME
Arthur James Glassett
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. 64 Moore Street St.
(Usual place of abode)
NO
years
months
days.
In this community
41yrs.
mos.
days.
PERSONAL AND STATISTICAL PARTICULARS
3 SEX
Male
4
COLOR OR RACE
White
5 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
18 DATE OF
DEATH
July
6
1948
(Year)
(Month)
(Day)
5a If married, widowed or divorced
HUSBAND of .. . Margaret O'Shea
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
6 Age of husband or wife if alive
41
years
7 IF STILLBORN, enter that fact here.
8
AGE
4.9 Years.
5
Months
24
Days
If less than 1 day
Hours
Minutes
Usual
9 Occupation:
Clerk
Industry
10 or Business:
Gasoline Station
11 Social Security No.
12 BIRTHPLACE (City)
(State or Country)
East Boston
13 NAME OF
FATHER
Thomas Glassett
PARENTS
14 BIRTHPLACE OF
FATHER (City)
(State or Country)
East Boston
15 MAIDEN NAME
OF MOTHER
Elizabeth Whelan
16 BIRTHPLACE OF
MOTHER (City)
(State or Country)
England
20 Was disease or injury in any way related to occupation of deceased?
Hermann IS Lava.
(Signed)-
(Address: 626 Huntablice Manden
Date./
M. D. 1940
21
Winthrop Com-tery
Winthrop
Place of Burial, Cremation or Removal.
(City or Town)
DATE OF BURIAL
July
.8.
19 4.8
22 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESS 17 Bennington St., E. Boston
Received and Filed
19
JUL 8 1948 (Registrar)
Duration IMPORTANT
Due to Coronary 1 trombosu
Due to
Coronary inter seckomoly.
Other conditions (Include pregnancy within 3 months of death)
Major findings:
Of operations
Date of
Of autopsy
Phys . Exam.
What test confirmed diagnosis?
17 days. 2 year.
IMPORTANT
Physician Underline the cause to which death should be charged sta- tistically.
Mrs. Margaret Glass( Relationif any)
17
Informant
(Address)
64 Moore St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial pr transit permit was issued: Walter & Maker (Signature of Agent of Board of Health of other) Health Officer 7/7/48 (Official Designation) (Date of Issue of Permit)
MEDICAL CERTIFICATE OF DEATH
19 From: 20 .
I HEREBY CERTIFY,
That I attended deceased from
19
I last saw h.alive on
July S . 1970, death is said to
have occurred on the date stated above, at 5.30% m. Immediate cause of death
100M-7-46-19068
1
No.
Length of stay: In hospital or institution
(Before death)
(Specify whether)
(If nonresident, give city or town and State)
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 kuowledge 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.
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