USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1951 > Part 78
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To be filed for burial permit with Board of Health or its Agent.
No. 5. Somerset Terrace
......
j(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME George Sinclair Ellis
(If deceased is a married, widowed or divorced woman, give also maiden name.)
117.Buchanan Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years ...
.months. 1.6 .days. In place of residence.
38
years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF DEATH October YMonth)
5 1951
(Day)
(Year)
4 I HEREBY CERTIFY,
That
I attended deceased from
19
to
19
I last saw h. ... ... alive on
19
death is said to
have occurred on the date stated above, at.
4 . A.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE 38 Years
1
Months .. 2. .. Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Carpenter
(Kind of work done during most of working life)
14 Industry
or Business:
Local Contractor
15 Social Security No ... 028-05-0416
16 BIRTHPLACE (City) ..
Somerville
(State or country)
MASS.
17 NAME OF FATHER George Harvey Ellis
18 BIRTHPLACE OF
FATHER (City)
Baltimore
(State or country)
Md.
19 MAIDEN NAME
OF MOTHER
Mary Anderson
20 BIRTHPLACE OF
MOTHER (City)
Glasgow
Scotland
(State or country)
21 George ... H ..... Ellis
Informant (Address) 117 Buchanan St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter &. Baker
(Signature of Agent of Board of Health or other) A
Health Office (Official Designation) A
10/8/51
( Date of Issue of/Permit)
SOM (B). 1-51 903586
5 Was disease or injury inany way related to occupation of deceased? mo
arthur C. murray
(Signed)
(Address) Winthrop Board of Health,
M. D.
Not
19.5 %
6 Winthrop Cemetery Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL October 8. 1951 19
7 NAME OF
FUNERAL DIRECTOR
alfred Vb. March
ADDRESS
174 Winthron St. Winthrop, Mass.
Received and filed .19
OCT 9 1951
(Registrar)
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
male
white
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Pulmonary
ANTE
CEDENT (b)
CAUSES
Due To
Tuberculosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
20 years
R-301A 1
TIONS RTIFICATE ing DEATH enter n one each and (c)
not mean ying, such , asthenia. the disease. ons which
onditions, rise to the a) stating cause
s contrib- th but not disease or ing death.
PARENTS
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(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 registercd 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 deccascd, furnish for registration a standard certificate of death, stating to the best of his knowledge and belicf the name of the deceased, his supposed age, the disease of which he died, defined as required by section onc, 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, eightcen 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 casc 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, Scc. 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 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 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
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
218
No.
Winthrop Community Hospital
J(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME
Leslie Everett Griffin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
187 Bartlett Rd.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
......... years.
months. 1 days. In place of residence. 46
.months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
White
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowed
4 I HEREBY CERTIFY,
Jan ?
19
40
That ,I attended deceased from
Get. 5
195/
to ....
Get. 1
1957, death is said to
10a If married, widowed, or divorced
HUSBAND of.
Lucy F Riley
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE
73 Years
.6 . .. Months
12Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation :
Commision Merchant (Kind of work done during most of working life)
14 Industry
or Business:
Meats
15 Social Security No. 031-03-319
Livermore
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
Frank Griffin
PARENTS
18 BIRTHPLACE OF FATHER (City) Brunswick
(State or country)
Maine.
19 MAIDEN NAME
OF MOTHER
Clara Morse
20 BIRTHPLACE OF
MOTHER (City)
Livermore
(State or country)
Maine
21 Informant (Address) ett Ra. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issuedl: Watter & Baker
(Signature of Bucal of Bund of Health or other)
4.0 Oct. 8161
(Official Designation)
(Date of Issue of Permit)
Received and filed 19
OCT 9 1951
(Registrar)
2 yrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Coronary Thrombosis
10 yrs
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
cif Louis 7 Salerno
(Signed)
M. D.
(Address) 175 Paliasset 17
Date Get 5. 19.2 2
6 Winthrop
Winthrop
: Place of Burial or Cremation
DATE OF BURIAL
(City or Town) October 8
1915
7 NAME OF
FUNERAL DIRECTORY
ADDRESS Mintha mano.
50M-2.19-25666
3 DATE OF
DEATH
6ct
(Month)
(Day)
5 1951 (Year)
I last saw h Y alive on
have occurred on the date stated above, at
8 26 Am.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Flucascais
INTERVAL BE- TWEEN ONSET AND DEATH 1 day
ANTE
CEDENT (b)
CAUSES
Due To
Hypertension
conditions. rise to the (a) stating me touse
ns contrib- eath but not disease or sing death.
ving F DEATH enter an one r each )and (c)
es not mean dying, such re, asthenia .. the disease. ions which
CTIONS R ERTIFICATE
(a) Residence. No. (Usual place of abode)
Registered No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, ( if so specify WAR)
(Give maiden name of wife in full)
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, 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 shallexhume 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 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 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
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. Ser 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
SUFFOLK B(County) N
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return) 8743 219
Registered No.
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
Richard P Howard
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 65 Beal
St.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
Winthrop Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death ... years .. .. months. 35
50
days. In place of residence
years
.. months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Oct. 5/51
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
Aug.31
19.51
That I attended deceased
Oct.5
from
51
19
19.
death is said to
have occurred on the date stated above, at
8:05P
m.
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH (a)
Uremia
TWEEN ONSET
AND DEATH
35 Days
11 IF STILLBORN, enter that fact here.
AGE
50
Years
1
2
Months
Days
If under 24 hours
.Hours.
Minutes
ANTE
CEDENT (b)
Due To
Malignant hypertension
CAUSES
9 Mos.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
No
Date of operation.
None
Was autopsy performed?
What test confirmed diagnosis ?.
Clinical
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed).
(Address) 889, em. Hospt.
Date
10-5
19
M.
31
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. Oct.8/51
19
7 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS Boston Megg.
Received and filed. 19
OCT15 1951
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
Boston Mass.
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Sarah Robicheau
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
St Johns N.B.
Wife
21 Informant (Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred) " .(
DATE FILED
Oct.
8/51
19
Praftsman
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
General Electric Co.
15 Social Security No.
027-07-5109
16 BIRTHPLACE (City)
(State or country)
Winthrop Mass.
17 NAME OF
FATHER
Richard I Hav ard
25M (E)-6-50-902253
R-302 1
Mass.Memorial Hospital
No.
(Usual place of abode)
to.
Oct. 5
51
I last saw h .... ]MA ... alive on
10a If married, widowedMididred M Brittain
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12
P. Bonnet
Winthrop Cem-Winthrop Mass.
PLACE OF DEATH
Suffolk ACounty)
112 Winthrop (City or Town) Pleasant It
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
220
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