USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 20
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death certificate contains a recital, as required by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. 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 obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go to the place where the body lies and take charge of the same; . General Laws, Chap. 38, Sec.6.
No undertaker, or other persons 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 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 follow- ing 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 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 traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation. the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, 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 occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, 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
+
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
1
No. Winthrop Hospital
¡(If death occurred in a hospital or institution, .. St. [ give its NAME instead of street and number)
2 FULL NAME ..
Louis E.Witter
(If deceased is a married, widowed or divorced woman, give also maiden name.)
37 Lawrence Road
St.
Medford
(If nonresident, give city or town and State)
Length of stay: In place of death years. months. days. In place of residence 8
14
.. years .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(fonth)
17 (Day)
1950 (Year)
8 SEX
Male
9 COLOR OR RACE
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
4 I HEREBY CERTIFY.
That I attended deceased from
cepar 3
19
50
to
apr 17
50
19.5.0., death is said to
have occurred on the date stated above, at 6:38 A. INTERVAL BE- TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Thrombosis
17 days
12
AGE65
.. Years
Months
Days
If under 24 hours
.Hours . Minutes
ANTE
Old Coronary
CEDENT (b)
CAUSES
Due To
Coronary Sclerosia
(c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation.
.Was autopsy performed?
What test confirmed diagnosis ?.
EKG
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
D. D Patito
(Signed)
M. D.
(Address) 176 Benning Ton St. Bace 4113
19 50
Oak Grove
Medford
(City or Town)
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
42 Green St. Boston
Received and filed 19
APR 24 1950
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City) (State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Antonette-unknown
20 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
21 Mrs.Alfreda Witter
Informant (Address) 37 Lawrence Rd. Medford
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter du thaler
(Signature of Agent of Board of Health or other)
4/18/50
(Official Designation)
(Date of Issue of Permfit)
STRUCTIONS FOR AL CERTIFICATE In giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean de of dying, such failure, asthenia. means the disease, plications which death.
orbid conditions. giving rise to the ause (a) stating derlying cause
nditions contrib- the death but not to the disease or n causing death.
50M-2-19-25666
RM R-301A 1
Amedford 5/8/50
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
To be filed for burial permit with Board of Health or its Agent.
63.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. no if so specify WAR)
or divorced
10a If married veda Forzese
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
13 Usual
Occupation :
Photographer
(Kind of work done during most of working life)
14 Industry
or Business :.
Selg
5 mois
15 Social Security No. none
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF FATHER Andrew Witter
6
Place of Burial or Cremation DATE OF BURIAL April 19 Jusso
1950
oct 28 1949.
I last saw him alive on
(a) Residence. No.
(Usual place of abode)
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 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 four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the arrny, 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 imme- diate 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 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 permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and 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 permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original 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 permit 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 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 registra- tion. 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 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 cxaminers shall make examination upon the view of the dead bodies of persons as are supposed to have died by violenec. or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws, Chap. 38. Scc. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
No undertaker or other persons 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 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 follow- ing 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 deathsonly 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 traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .-- Precise statement of occupation is very import- ant, 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 occup :.- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, 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
RM R-302 1
PLACE OF DEATH
Middlesex (County) Arlington
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Arlington
(City or town making return)
Registered No.
149 61
Ring Sanatorium & Hosp. - 163 Hillside Avemaudeath occurred in a hospital or institution. No.
St. { give its NAME instead of street and number)
2 FULL NAME
Charles L. Hazelton
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 245 Cottage Park Road
St.
Winthrop .... Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death .. years. 1 months 28
lays. In place of residence. 1.5.years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased from
Feb. 21
19.
50
to.
April
18
19
50
10a If married, widowed, or divorced
HUSBAND of
Mae .... Clair ..... Berry
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
TWEEN ONSET AND DEATH
5 dys
63
Months
22
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Stevadore
(Kind of work done during most of working life)
Unknown
14 Industry
or Business :.
Business
15 Social Security No ...
034-24-4519
16 BIRTHPLACE (City)
(State or country)
Canada
NovaScotia
Left .... Hemiplegia
2 yrs
Was autopsy performed ?.
No.
Clinical
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify.
Charles E. White
M. D.
(Signed).
(Address) 163 Hillside AveDate 4-18-1950
6 .HolyCross
Place of Burial or Cremation
(City or Town)
Malden
DATE OF BURIAL. April
2.0
150
7 NAME OF
FUNERAL DIRECTOR
Richard C. Kirby
ADDRESSLA .... Bennington .St .... E.Boston
Received and filed 19
MAY S 1950
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Charles L. Hazelton
18 BIRTHPLACE OF
FATHER (City)
Digby
(State or country)
Nova Scotia, Canada
19 MAIDEN NAME
OF MOTHER
Mary Ellen Ross
20 BIRTHPLACE OF
New Brunswick
MOTHER (City)
(State or country)
Nova Scotia, Canada
21 Informadae Clair Berry Hazelton-Wife (Address P)5 Cottage, Park Rd. Winthrop
A TRUE COPY X Golden
ATTEST:
(Registrar of City of Town where death occurred)
DATE FILED
April
20
19
50
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
(Usual place of abode)
3 DATE OF
April
(Month)
DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
Broncho pneumonia
CEDENT (b)
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
What test confirmed diagnosis ?.
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
CAUSES
Disease
50m-(e)-10-48-24658
18
(Day)
1950
(Year)
I last saw h ... im ... alive ofA.pr.il
1.7
..... , 19 ... 5.0death is said to
have occurred on the date stated above, at 4:45A
m.
INTERVAL BE-
ANTE
Due To
Cardio vascular
11 IF STILLBORN, enter that fact here.
12
AGE
Years.
8
(Was deceased a
U. S. War Veteran.
( if so specify WAR)
None
×
PLACE OF DEATH
SUFFOLK (County)
Boston (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston (City or town making return)
Registered No.
3420.65
No.
Carney Hospital
f(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
James H. Jenness (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.
30 .... Cora
St.
Winthrop
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
months
4
days. In place of residence
30
.years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
April
18, 1950
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
DIVORCED
Widowed
4 I HEREBY CERTIFY,
That I attended deceased from
April
14
50
to
April 18
50
I last saw h
im alive on.
April 1819 ... 5 Death is said to
10a If married, widowed, or divorced
HUSBAND of
Julia Murphy
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINGUremia due to
TO DEATH (a)
renal failure
11 IF STILLBORN, enter that fact here.
12
AGE
84'ears.
.. Months
.Days
If under 24 hours
Hours. .. . . Minutes
13 Usual
Occupation:
Meter man
(Kind of work done during most of working life)
14 Industry
or Business:
Consolidated Gas Co.
15 Social Security No.
Boston Mass.
OTHER
SIGNIFICANT
CONDITIONS
Arterial thrombosis
approx 6 days
Major findings:
Of operations.
no operation
Date of operation
Was autopsy performed?
no
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?.... no.
If so, specify
James Ferrucci
M. D
(Signed)
Carney .... Hosp.
DateApril 18'
Malden
6
Holy Cross
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April ... 21,1950
19
7 NAME OF
FUNERAL DIRECTOR
John O'Maley
ADDRESS
Winthrop
19
Received and filed APR 2 % 1950
(Registrar of City or Town where deceased resided)
O PARENTS
17 NAME OF
FATHER
Samuel Jenness
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
19 MAIDEN NABElle Daly OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informant
Irene Jenness
(Address)
A TRUE COPY
DATE FILED
ATTEST:
Cho (Register of City of Town"where death occurred)
APRIL 24,1950
.19
..
25m-(b)-11-49-900,475
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible CAUSES
ORM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
ANTE
Due To
associated with
cardiac decompensation
Due To
(c)
arteriosclerotic ... heart
disease
have occurred on the date stated above, at.
1:30P
.m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
1 wk
16 BIRTHPLACE (City)
(State or country)
(Address)
M R-301A 1
County) No. 241 PLACE OF DEATH Suffolk Winthrop (City or Town)
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.
66
Registered No.
-
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran if so specify WAR) World /
(If deceased is a married, widowed of divorced woman, give also maiden name.) 241 Washington are
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years
months. days. In place of residence years. .months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR OR RACE
White
10 SINGLE (write the word) . MARRIED WIDOWED Or DIVORCEParmed
4 I HEREBY CERTIFY,
That I
attended deceased from
1950
I last saw h& M alive on april 18, 1918, death is said to
have occurred on the date stated above, at 7 00 A.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12 54
2 5years .Years
Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Currentun
Officier
(Kind of work done during most of working life)
14 Industry
or Business:
Penal hlep't
OTHER
SIGNIFICANT
CONDITIONS
augina Rectores
Major findings:
Of operations
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
(Address) 447 Sheilay St Dowithover 4-1% 1950
M. D.
6 Place of Burial or Cremation
(City or Town
DATE OF BURIAL.
april 21
19
7 NAME OF
FUNERAL DIRECTOR frederick & magath
ADDRESS East Butno
Received and filed APR 24 1950
19
(Registrar)
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country)
19 MAIDEN NAME OF MOTHER
Mary Slavin
20 BIRTHPLACE OF MOTHER (City) (State or country)
chiland
Edna m. O'Keefe
21 Informant. (Address) 241 Washington tex Win
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A. Bakero
(Signature of Agent of Board of Health or other) Health Affect 4/20/50
(Official Designation Y
(Date of Issue of Permit)
1
afarul
18
(Month)
(Day)
1950 (Year)
na 29.
19 ...
48.
to.
april
18
cana 10a If married, widoved, or divorced HUSBAND of (Give maiden name of wife in All)
m. Jist
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) Congestive heart failure
ANTE Due To CEDENT (b) CAUSES
Due To (c)
15 Social Security No. . East Boston mass
16 BIRTHPLACE (City)
(State or country)
17 NAME OF FATHER Timothy O' Keefe
chiland.
50
100M-(D)-10-46-24658
TRUCTIONS FOR AL CERTIFICATE
n giving E OF DEATH not enter e than one se for each , (b) and (c)
is does not mean e of dying, such failure, asthenia, eans the disease, plications which eath.
bid conditions. giving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or t causing death.
Washington are Daniel Joseph O' Keefe
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
(a) Residence. No. (Usual place of abode)
3 DATE OF
DEATH
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 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.
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