USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 51
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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 injuryst.
(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 &d be some) 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
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 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
25m-(b)-11-49-900,475
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
Bostan
(City or town making return).
6175
145
Registered No. J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Irwin St
Winthrop
Mass .
St.
(If nonresident, give city or town and State)
months.
days. In place of residence.
.years.
.months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
June ... 20 .. , 19 ...
.5.2
July 4
19
10a If married, widowed, or divorced Margaret Hines
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 ...
79
Years
Months
Days
Floor Layer
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
Construction
15 Social Security No.
None
16 BIRTHPLACE (City).
(State or country)
Prince Edward Island
17 NAME OF
FATHER
Donald Matthews
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Prince Edward Island
Date of operation
6-20-52
Was autopsy performed?
Cystoscopy , xray, E K G
No
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
P. B Metcalf Jr.
(Address)
Boston ... Mass ........
.Date .
7-4
19.52.
Winthrop em-Winthrop Mass.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
July 7/52
19
7 NAME OF
FUNERAL DIRECTOR
Winthrop Mass.
ADDRESS
Received and filed.
JUL.2.1.1552
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Sarah Rogers
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ruth Brothers
101 Eim St Somerville
A TRUE COPY
ATTESTharles 2. Mackie
(Registrar of City or Town where death occurred)
DATE FILED
July 9/52
..... 19 X
ANTE
CEDENT
(b)
Due To
Arterio sclerotic
CAUSES
heart disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
bladder
Papilloma of urinary
1 Yr.
Major findings:
Of operations
Papilloma
No
What test confirmed diagnosis ?.
5 Days
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Broncho pneumonia
INTERVAL BE-
have occurred on the date stated above, at.
12;30P
m.
19
death is said to
IMlast saw h ...
im ... alive on
July 4
52
to
That I
attended deceased
from
52
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence. No.
(Usual place of abode)
Length of stay: In place of death
........
.years.
14
3 DATE OF
DEATH
July 4/52
(Day)
(Year)
(Month)
John W Matthews
Mass .Memorial Hospt.
No.
JF O Maley
M.
England
21
Informant
(Address)
2-302 1
If under 24 hours
Hours
Minutes
10 Yrs
PLACE OF DEATH
SUFFOLK BOSTON (County)
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.
6115 146
{(If death occurred in a hospital or institution, SEX /give its NAME instead of street and number)
2 FULL NAME.
IRVING MOORE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
179 Pauline
(Was deceased a
U. S. War Veteran,
if so specify WAR).
No
(a) Residence. No.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years.
.. months.
1.7.days. In place of residence
5.years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
6/17
19.
.52,
to .
7/4
That I attended deceased from
19
52
10a If married, widowed, or divorced
HUSBAND of.
Katherine A .Smith
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
67 Years 6
Months 23 Days
If under 24 hours
.Hours
.Minutes
Mesenteric thrombosis ANTE Due To CEDENT (b) infarctionof ..... cecum
CAUSES
and terminal ileum
Arteriosclerosis
(c) Coronary artery dis ease
OTHER Diabetes Mellitus-pulm. T.B. SIGNIFICANT (arrested ) old CVA-Jack- CONDITIONS Sonian epilepsy-oldas Facture
Major findings:
Of operations ..
Infarctionof cecum & termin
Date of operation.
.. Was autopsy performed ?- Y.ES
What test confirmed diagnosis ?.
Autopsy Operation
PARENT
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Hannah Sullivan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
-unable to learn-
K Moore
DATE OF BURIAL
July 7,
19
512
7 NAME OF
FUNERAL DIRECTOR
H Reynolds
ADDRESS
Winthrop. Mas.s.
Received and filed.
JUL 21 1952
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 8.
.....
19.
52
X
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, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25M.(B) -11-51-905807
(Signed).
MGH
(Address)
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify ...
E Dunn
M. D.
Winthrop
Place of Burial or Cremation
(City or Town)
Date
7/4.19 52
winthrop
Jobber
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
Industrial Rubber
or Business:
15 Social Security No. 011-10-1573
16 BIRTHPLACE (City)
(State or country)
Mass
Boston
17 NAME OF
FATHER
Irving
Moore
6/30/52
ondary
to as-
piration of
vomitus
6days
3 DATE OF
DEATH
July
4,
19.52
(Month)
(Day)
(Year)
I last saw
h .... m .... alive on.
7/4
19 .. 52 death is said to
have occurred on the date stated above, at 4:50a .. m. INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION -Pneumonia , sec- DIRECTLY LEADING
TO DEATH (a)
No.
(City or Town)
Mass ...... General .... Hospital.
1
302
21
Informant
(Address)
St.
Winthrop, Mass.
PLACE OF DEATH
Suffolk (County)
Boston
(City of 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)
6158
Registered No.
J(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5 Irwin St
St.
(Was deceased a
U. S. War Veteran,
[ if so specify WAR)
Winthrop Mass.
VA 11
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
......
.years
months
5
days. In place of residence
1
.years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 7/52
(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,
July 2,
19
52
That I attended deceased
July 7
19
19.
death is said to
have occurred on the date stated above, at
8;45A.
m. INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
44
AGE
Years
11
3
Months
Days
If under 24 hours
.Hours
Minutes
13 Usual
Occupation:
Lawyer
(Kind of work done during most of working life)
14 Industry
or Business:
Himself
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Boston Mass.
17 NAME OF
FATHER
Morris Fleischer
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Austria
19 MAIDEN NAME
OF MOTHER
Ada Ferrar
20 BIRTHPLACE OF
MOTHER (City)
Austria
(Address)
American Austrian Woburn?
(City or Town)
DATE OF BURIAL
B Birnbach
ADDRESS
Received and filed.
JUL .... 2.1.1552
19
(Registrar of City or Town where deceased resided)
21
Informant
(Address)
Clinical Records
77 Warren St Brighton ....
A TRUE COPY
21 Mackie
(Registrar of City or Town where death occurred)
DATE FILED
July 9/52
.. 19 ..
25m-(b)-11-49-900,475
ANTE
CEDENT (b)
CAUSES
Due To
Arteriosclerosis
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
No
Major findings:
Of operations.
Craniotomy-negative
Date of operation
7-4-52
. Was autopsy performed?
Yes
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
M D Manning
(Signed)
U. S. Public Health Serv. HosbtD.
PARENTS
10a
married, widowed, or divor
Mary Dasey
(or) WIFE of
from
52
HUSBAND of
(Give maiden name of wife in full)
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
Cerebral thrombosis
TO DEATH (a)
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
-302 1
No.
U.S.Public Health Service Hospt.
Philip Fleischer
·
(State or country)
6 Place of Burial or Cremation July 8/52 19
7 NAME OF
FUNERAL DIRECTOR
Dorchester Mass.
to
I last saw h
imlive on
July 7
52
Entered Service 10-28-42 Dis char ged 10-27-1945 Cpl. 160th AAF Service No. 11114675
-302
1
PLACE OF DEATH
SUFFOLK BOSTON (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOST
(City or town making return)
Registered No
6185
148
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 56 Locust
St.
Wint hrop, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death.
... years.
.. months 17
days.
In place of residence.
3
years.
.months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July.
7.
1952
(Month)
(Day)
Year)
4 I HEREBY CERTIFY ,
That I attended deceased from
6/20
1952.
to
..... ,
7/7
19
52
I last saw h .. el ....... alive on ..
7/7
19 ... 52 death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
acute leukemia
INTERVAL BE- TWEEN ONSET AND DEATH 11mos.
11 IF STILLBORN, enter that fact here.
12
AGE
Years
3
10
Months.
4 Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation:
At home
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ...
16 BIRTHPLACE (City).
(State or country)
Mass
17 NAME OF
FATHER
Robert F Mckeon
18 BIRTHPLACE OF
FATHER (City)
Bost.on
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER Mildred Stanton
20 BIRTHPLACE OF
MOTHER (City)
Winthrop
(State or country)
Mass.
Place of Burial or Cremation
Winthrop
(City or Town)
DATE OF BURIAL.
July 9,
1958
7 NAME OF
FUNERAL DIRECTOR
R C Kirby
ADDRESS
Boston
Received and filed
JUL -2-5-1952
19
A TRUE COPY
ATTEST:
CA Rodina of Ci
(Registrar of City or Town where death occurred)
DATE FILED
July 10,
..........
19
.52 ...
(Registrar of City or Town where deceased resided)
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
S.
ingle
Due To
CEDENT (b)
CAUSES
ANTE
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Was autopsy performed?
Yes
Date of operation.
What test confirmed diagnosis ?.
Bone marrow
5 Was disease or injury in any way related to occupation of deceased? No
If so, specify ....
(Signed)
A COX
M. D.
(Address)
300 LongwoodAve
Date 7/7
19
58
6
Winthrop
PARENTS
25m-(b)-11-49-900,475
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.)
(City or Town)
The Children's Hospital No.
J(If death occurred in a hospital or institution.
Xit. [ give its NAME instead of street and number)
BARBARA E MC KEON
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
have occurred on the date stated above, at
4:30a.
.m.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Boston
21
Informant
(Address)
Mrs. Mckeon
RECEIVER
2
31
٠٠٠
6
JUL 25
-302
1
PLACE OF DEATH
SUFFOLK BOSTON
*
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOST ..
(City or town making return)
Registered No.
6189 149
XXXxx (If death occurred in a hospital or institution. give its NAME instead of street and number)
2 FULL NAME
STEPHEN FLANNERY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
17 Cliff Ave.
XXX
Winthrop, Mass
(a) Residence.
No.
(Usual place of abode)
(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.
7hrs-15mins.
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
8,
1952
(Month)
(Day)
(Year)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCE Single
4 I HEREBY CERTIFY,
That I attended deceased from
7/7
19
5.2
to.
7/8
19
52
I last saw h ..... j.m ... alive on.
7/8
19.5.2. death is said to
have occurred on the date stated above. at.
1:00a. ... m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
1
12
AGE
Years.
Months
Days
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.
16 BIRTHPLACE (City).
(State or country)
Winthrop
Mass.
17 NAME OF
FATHER
Joseph Flannery
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Mass.
East Boston
19 MAIDEN NAME
OF MOTHER
Mary Doherty
20 BIRTHPLACE OF
MOTHER (City)
Winthrop,
(State or country)
Mass.
Place of Burial or Cremation (City or Town)
DATE OF BURIAL ... July ... 9.
1952
7 NAME OF
FUNERAL DIRECTOR
JO!Maley
ADDRESS Winthrop. Mass
Received and filed.
JUL -2-5-1952
19
(Registrar of City or Town where deceased resided)
PARENTS
21
Informant
(Address)
J ... Flannery
A TRUE COPY
TEST: Parler H. Znackie
(Registrar of City or Town where death occurred)
DATE FILED
July 10,
19 ...
52
25m-(b)-11-49-900,475
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
prematurity
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? N.o
If so, specify.
(Signed).
L Kruger
Date
19
M. D.
(Address) .... 300 LongwoodAve
Winthrop
Winthrop
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)
pneumonia
MEDICAL CERTIFICATE OF DEATH
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 after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
(City or Town)
Infants Hospital No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
RECEIVER
11 12
MIN
3
1 = 6
JUL 25
-301A 1
PLACE OF DEATH
Boston
8/6/5 a
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.
150
No.Winthrop Community Hospital
f(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME Lalla roster (If deceased is a married, widowed or divorced woman,
(Gardner) Burrill me) maldenhame.)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
84 St. Stephen St. Boston, Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death .. years months. 6 days. In place of residence 6 years months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWEDmarried
or DIVORCED
4 LHEREBY CERTIFY,
nule 3
19321
That I attended deceased from
to July
12
19
last saw her alive on Nulf /h, 196 death is said to
have occurred on the date stated above. at m.
6 P.
. .
INTERVAL BE- TWEEN ONSET AND DEATH 1 year
11 IF STILLBORN. enter that fact here.
DISEASE OR CONDITION
DIRECTL
TO DEATH (a)
cyst of
Multilocular
left ovary (malignant) GE
73Years
0
Months
11 Days
If under 24 hours
Hours .. ... Minutes
ANTE
Due To
. Several
CEDENT (b) CAUSES Carcino n atosis
Massive (c) ascites
OTHER SIGNIFICANT CONDITIONS Uremia
48 hs
Major findings:
Of operations. .
none
Date of operation
.. Was autopsy performed?
What test confirmed diagnosis?
clinical1
lab
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ..
(Signed)
8562 Lawley Dat Jeel 14 152
athrop Cemetery Winthrop,a
DATE OF BURIAL July 15. 1952 19 ..
21 Informant (Address)
Nelson G. Burrill
84 .St. Stephen St .. Boston I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Ageht of Board of Health or other)
7/15/52
(Official Designation) (Date of Issue of Permit)
50m-(b)-11-49-900,560
IONS TIFICATE 1g DEATH ater one each nd (c)
not mean ing. such asthenia, - e disease, s which
nditions. ise to the stating cause
contrib- h but not isease or ng death.
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Brooklyn
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Syretha McLeod
20 BIRTHPLACE OF
Brooklyn
MOTHER (City)
(State or country)
Nova Scotia
6 Place of Burial or Cremation
7 NAME OF
FUNERAL DIRECTOR
alfred B. March
ADDRESS
174 Winthrop St, Winthrop, Mass. Walter S Bakery.
Received and filed
JUL 1 5 1952
19
(Registrar)
1
1952
female white
10a If married, widowed, or divorced HUSBAND of .. (Give maiden name of wife in full) (or) WIFE of Nelson Gancelo Burrill
6 mois
13 Usual
Occupation :
housewife
(Kind of work done during most of working life)
14 Industry
or Business:
own home
4 mois 15 Social Security No. none
16 BIRTHPLACE (City)
(State or country)
Brooklyn
Nova Scotia
1 NAME OF FATHER Nathan Gardner
Suffolk (County)
Winthrop (City or Town)
Registered No.
(write the word)
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? ! our the funeral is to be held, or from a person appointed to have the care of the 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- Chap. 114, Sec. 46. G. L., (Tercentenary Edition). 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 RULES OF PRACTICE 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 The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice: deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border (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. 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's""" injury, have died without recent medical attendance or whose physician is absent has received a permit from the board of health, or its agent appointed to issue (, from home when the certificate of death is needed.
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 Mat 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
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