USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1950 > Part 56
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(a) Residence.
No.
230 Lincoln St.
St.
winthrop, Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
.... years ..
.months
2
days. In place of residence.
......
... years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
September
7
1.9.5.0
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
of DIVORCED . idowed
4 I HEREBY CERTIFY,
Sept. 5, 19 50
to
Sept. 7,
195.0
I last saw
h
im
alive on
Sept. 7, 1950, death is said to
(Give maiden name of wife in full)
have occurred on the date stated above, at
6: 50 Am.
INTERVAL BE-
(or) WIFE of.
(Husband's name in full)
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
79 years.
6
Months.
29
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
Hetired .... Grocer
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
Unknown
16 BIRTHPLACE (City)
(State or country)
vaine
17 NAME OF
FATHER
Frank F. Swett
18 BIRTHPLACE OF
FATHER (City)
Belfast
(State or country)
laine
19 MAIDEN NAME
OF MOTHER
Eliza Pendleton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
maine
North Port
winthrop Cemetery,
Winthrop Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
September 9,
19.5.0
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Harsh
ADDRESS.
Winthrop, Mass.
19
Received and filed
OCT 13 1950
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
Andrew Nichols III
M. D.
(Signed)
(Address)
Hathorne LasS Date
9/13/1950
6
25m-(b)-11-49-900,475'
PLACE OF DEATH
ORM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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
ANTE
CEDENT (b)
CAUSES
Due To
Gastric Ulcer
?
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Parkinson's Disease
Yrs.
Major findings:
Of operations ..
No
Date of operation
Was autopsy performed?
What test confirmed diagnosis ?.
Clinical
21
Informant
(Address)
Hathorne Mass.
Mary E. Sheehan
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
September 14.
50
.19
(write the word)
That I attended deceased from
10a If married, widowed, or divorced
HUSBAND of.
Gretta L. Kinear
DISEASE OR CONDITION
DIRECTLY LEADING,
TO DEATH (a)
Hemorrhage of
Stomach
4- 5daysGE
belfast
(Was deceased a
U. S. War Veteran,
if so specify WAR)
RECEIVES
ROP.
OCT 131950 AM
1
Suffolk
(County) Chelsea
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or town making return)
Registered No.
5407 2
(City or Town) soldiers' Home Hospital No.
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
Maury H.MacDonald
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
105 Ocean View Ave:
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
3 DATE OF
DEATH
Sent.10,1950
(Month) (Day)
(Year)
8 SEX
female
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
singlo
4 I HEREBY CERTIFY,
Sept.1
50
That I attended deceased from
Dept.10
50
19
50
I last saw
h
alive on.
19
death is said to
1.55p.
INTERVAL BE- TWEEN ONSET AND DEATH ?mos
11 IF STILLBORN, enter that fact here.
12
AGE
Years
73
1.0
Months
25
Days
If under 24 hours
Hours ....
Minutes
ANTE
Due To
Arterio sclerotic
CEDENT (b)
CAUSES heart disease
?yrs.
Due ToGeneralized arterio sclerosis
?yrs.
OTHER
Chronic nephritis
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
no
clinical
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify .... ]sudore raplan
M. D.
(Address).
winthrop Cen., winthrop, Dass. 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Sept. 13, 1950
19
7 NAME OF
Alfred B. Marsh
FUNERAL DIRECTOR Anthrop St. Winthrop
ADDRESS
Received and filed.
OCT 11 1950
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Garrick, Scotland
19 MAIDEN NAME
OF MOTHER Elizabeth MacDonald
20 BIRTHPLACE OF
50
MOTHER (City)
(State or country)
Garrick, Scotland
21 Mrs. Jennie Roberts (Niece )
Informant
(Address)
A TRUE COPY Joseph G. Tyrrell
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Sept.10,1950
.19
25m-(b)-11-49-900,475
PLACE OF DEATH
RM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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
cr
19
to ...
Sept.10
10a 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
m.
DISEASE OR CONDITION
DIRECTLY LEADING rnicious anemia
TO DEATH (a)
Hurso
R.N.
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Nursing
15 Social Security No.
none
16 BIRTHPLACE (CityHalifax N.S. (State or country)
?yrs.
17 NAME OF
FATHER
Alexander W.
(Was deceased a
WWI
U. S. War Veteran,
if so specify WAR)
Nurse
(a) Residence. No. (Usual place of abodetal
11
Winthrop, flass.
(write the word)
(Signed). Soldiers' Done Date2/10 19 ..
Enlisted Nov. 5, 1918 Discharged feb.12,1919 Nurse, USA Nursing Corps
ORM R-302 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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
+
PLACE OF DEATH
"Middle seanty)
Cambridigor Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
COPY OF CERTIFICATE OF DEATH
Registered No.
1302135
No. Holy Ghost Hospital
2 FULL NAME.
(If dede Gatefx hatfled, malWed or divorced woman, give also maiden name.)
(a) Residence. No.
(Usual place of abode)
46-Washington Ave
.....
St.
Winthran .. Ma
br town and State)
Length of stay: In place of death ..... .. years 5.months ... ].6 ... days. In place of residence .. 38
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX 9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
3 DATE OF
DEATH
Saptimber 27 a1950
(Year)
4 I HEREBY CERTIFY,
That
attended deceased from
19
19.
.... "death is said to
have occurred on the date stated above, at.
.m.
INTERVAL BE- TWEEN ONSET AND DEATH
yrs.
12
AGE. 75
.Years 2
Months
Q .. Days
If under 24 hours
.Hours ..... .. Minutes
13 Usual
Occupation:
We work done during most of working life)
14 Industry
or Business:
at ... home
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Boston ,Mass.
Major findings:
Of operations.
Date of operation .Was autopsy performed? yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
M. D.
19
6
Holy Ghost Hosp Mandarpor Cemation inthrop, Mas(City of Town) DATE OF BURIAL
Sept. 30, 1950 19
7 NAME OF FUNERAL DIRECTOR ·Howard-S ... Reynolds
ADDRESS Winthrop Hasa.
Received and filed.
OCT 2 050
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
Patrick Keleher
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Margaret Friel
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informar
(Address)
Wallace.A.Pratt
A TRUE COPY
Frederick Ht. Burke
ATTEST:
(Registrar of City or Town where death occurred) .
DATE FILED
Sept. 28. 1950
.. 19.
X
married
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Wallace (Auband Alame in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Multiple sclerosis
ANTE
Due To CEDENT (b) CAUSES
Carcinoma of uterus.
about 4 yrs
OTHER
SIGNIFICANT
CONDITIONS
Due To (c) Pulmonary embolism
50m-(e)-10-48-24658
Cambridge (City or town making return)
.
J(If death occurred in a hospital or institution. St. ¿ give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
-
white
"July 1;
50
19
to ...
Sept. 27,
50
I last saw h.
er
alive on ...... Sept . 27,
2.40 A.
11 IF STILLBORN, enter that fact here.
(Address) Richard M. Uart Date. 9-27 50
RECEIVED
1
1
4
5
RO
OCT211950 AM
1
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or ite Agent.
Registered No.
J(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME.
Arthur R. Montferrand
(If deceased is a married, widowed or divorced woman, give also maiden name.)
26 ... Beal ... St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death . years. 2 months. days. In place of residence1 5 years .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
(Month)
(Day)
1 1950 (Year)
8 SEX Male White
10 SINGLE
(write the word)
MARRIED WIDOWED or DIVOMarried -
4 I HEREBY CERTIFY,
may
1948
to
That
Oct
1
1950
I last saw h wn alive on
9/30
1050
., death is said to
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET ANO DEATH 11 IF STILLBORN, enter that fact here.
12
AGE
72
Months
Days
If under 24 hours
Hours
Minutes
13 Usual
Engineer
(Kind of work done during most of working life)
14 Industry or Business:
Laundry
15 Social Securit021 -- 09 -- 1697
16 BIRTHPLACE (City) (State or country)
Mass
17 NAME OF FATHER Cannot be learned
18 BIRTHPLACE OF FATHER (City) (State or country)
Canada
19 MAIDEN NAME OF MOTHER Florence Tramp
20 BIRTHPLACE OF MOTHER (City) (State or country)
Canada
21 Informant (Address)
Frances Montferrand 26 Beal St
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Watter S- Ballers
19
OCT 3
1950
(Registrar)
9 yrs.
ANTE CEDENT (b) CAUSES
Due To (c)
moolite
Residual Polic myletter to play?
OTHER SIGNIFICANT CONDITIONS Inguinal hernia - left.
Major findings:
Of operations.
Carcinoma of perus
Date of operation 2 yrs ago. Was autopsy performed? no :
What test confirmed diagnosis? Biopsy
5 Was disease or injury in any way related to occupation of deceased? no.
If so, specify
(Signed)
(Address) 25 Sturges St.
Date Oct 2 . M. D.
1950
Winthrop]
WinthropTown)
Octa 4 1950
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
oh@maley Winthrop
ADDRESS
Received and filed.
(Signature of Agent of Board of Health or other) Healthe Office (Official Designation) (Date of Issue of Permit)
10/2/50
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving JSE OF DEATH do not enter more than one ause for each (a), (b) and (c)
This does not mean node of dying, such art failure, asthenia, t means the disease, implications which d death.
Morbid conditions, y, giving rise to the cause (a) stating underlying cause
Conditions contrib -- to the death but not d to the disease or tion causing death. inquiet
/50M (8)-12-49-900722
Carmona of perio
Due To
TO DEATH (a)
general carcinomatoris
10 45 A
m.
10a If married, widowed, or divorced
HUSBAND of.
Francis
02
Sheeran
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
arterio-salentia Heartis
m
Lowell
PARENTS
6 Place of Burial or Cremation
No.
Winthrop Convalescent Home
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR)
(a) Residence. No. (Usual place of abode)
I attended deceased from
9 COLOR OR RACE
ORM R-301A 1
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 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 imme- diate cause of death as ncarly 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. Scc. 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 perinit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may bc. 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 eaused 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 registr .- 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 of 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 persons as are supposed to have died by violence, 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, Sec. 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: sec 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 no.ic.
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. Winthrop Community Hospital
(If death occurred in a hospital or institution.
St. Į give its NAME instead of street and number)
Baby Boy Berkowitz 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
35 Jefferson Avenue
St.
Chelsea
(If nonresident, give city or town and State)
Length of stay: In place of death . years . .. months 6 days. In place of residence. years .months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October (Month)
5 (Day)
1950 (Year)
8 SEX
Lale
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED.
of DIVORPEbng le
4 I HEREBY CERTIFY.
9-29-
50
...
to
10- 5 -
1950
I last saw h &M alive on 10-5
.. 19 50, death is said to
have occurred on the date stated above, at 9:55 Pm.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Prematurity
ANTE Due To CEDENT (b) CAUSES
Due To (c) ..
OTHER
SIGNIFICANT
CONDITIONS
atilistasis
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? If so, specify. person (Signed) (Address) 19 2 5 honderd St clubred H. athin
M. D.
Date 10-5- 1950
Holy Cross Cemetery Place of Burial or Cremation (City of Town)
DATE OF BURIAL
October .. 9,
15.0
7 NAME OF
FUNERAL DIRECTOR
William F. Welsh
ADDRESS 721 Broadway Chelsea, lass.
Received and filed 19
OCT 10 1950
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City) Chelsea
(State or country) Mass.
19 MAIDEN NAME OF MOTHER Barbara Burke
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lass.
Chelsea
21 Informant Barbara Barkowitz(mother) 35 Jefferson Ave. Chelsea
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter M . Baker (Signature of agent of Board of Health or other) Healthe Officer 10/9/50
(Official Designation)
(Date of Issue of Permit)
10a If married, widowed, or divorced HUSBAND of . (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months
6
ays
If under 24 hours
Hours
.Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
Winthrop
16 BIRTHPLACE (City)
(State or country)
Lass.
17 NAME OF FATHER Samuel Berkowitz
·50M (B)- 12-49-900722
RM R-301A 1
ISTRUCTIONS FOR AL CERTIFICATE
In giving SE OF DEATH o not enter ore than one use for each ), (b) and (c)
his does not mean de of dying, such t failure, asthenia, means the disease, aplications which death.
orbid conditions. giving rise to the cause (a) stating nderlying cause
ditions contrib- the death but not to the disease or on causing death.
Cheesea 11/9/50
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
177
Registered No
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, { if so specify WAR)
(a) Residence. No. (Usual place of abode)
That I attended deceased from
... Malden. Mass.
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 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 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, Scc. 10.
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