USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 56
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SERVICE NUMBER
PLACE OF DEATH
(County)
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
Registered No. 162.
J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
EDITH LILLIAN DOREY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
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
9 COLOR OR RACE
10 SINGLE MARRIED WIDOWED or DIVORCED
(write the word)
CERTIFICATE OF DEATH FLORIDA
13155
STATE FILE NO.
REGISTRAR'S NO.
CODE NO. 62-11
a. STATE
Massachusetts
Suffolk
CTY ! omtatde emparste bulls, prins RURAL
c. LENGTH OF STAY to the pleen!
E. CITY OR TOWN
Winthrop
St. Anthony's Hospital
b. Middle
& ILet
4. DATE
(Month)
(Day) (Year)
Lillian
Deroy
DEATH May 19, 1952
7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED Nudy widowed
Mar. 3, 1871
81
BON. KIND OF BUSINESS OR IN-
I. BIRTHPLACE Mtale of
12. CITIZEN OF WHAT
oun home
Boston, Massachusetts
14. MOTHER'S MAIDEN NAME
Whitney
& WAS DECEASED EVER IN U. S. ARMED FORCES? |16. SOCIAL SECURITY no none
NO.
ADDRESS
MEDICAL CERTIFICATION
INTERVAL BETWEEN
I. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH"(a)
carcinoma
of the Brest
E meterturis to the Lungs
12 mas.
the mode of dying Morbid conditions, if any, giving
ring to the shore cause (a) stabs
DUE TO (c)
II. OTHER SIGNIFICANT CONDITIONS Conditione contributing to the darth but not related to the disrass or condition Mataing death.
19a. DATE OF OPERA- 19. MAJOR FINDINGS OF OPERATION
20, AUTOPSY?
Carcinoma of the event ( text) (Dr. Owen)
216. PLACE OF INJURY
21c. (CITY OR TOWN
(COUNTY
(STATE)
210. INJURY OCCURRED
TI HOW BID INJURY OCCUR
WORK
1/10/46
5/19/52
22. I hore ; certify that I attended the deceased fram_'
,10
and that death occurred at 11:50 Pm. from the carmes and on the date
2. milton Rojus
M.D
11-4# 8 2
23c. DATE S GNED 5/20152
Mc NAME OF CEMETERY OR CREMATORY Md. LOCATION (City, town, er etr ) (State
Winthrop Winthrop, Mass.
25. FUNERAL DIRECTOR'S SIGNATURE ADDRESS
7 NAME OF - FUNERAL DIR 5-21-52
Emily B Knew Jake B Marting, St. Petersburg, Fla.
ADDRESS
Received and filed. itv9. 25, 1952
19
(Registrar of City or Town where deceased resided)
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
.. 19 .. ...
50m-(e)-10-48-24658
No. 2 FULL NAME (a) Residence. No. (Usual place of abode) 3 DATE OF DEATH May 19 4 I HEREBY NON RESIDENT BINTH NO PLACE OF DEATH I last saw h Pinellas . COUNTY have occurred on t TOWN OR St.Petersburg DISEASE OR CO. FUL NAME OF HOSPITAL OR INSTITUTION DIRECTLY LEAI TO DEATH (a) Edith 3. NAME OF DECEASED (Tym w Fm B. SEX 4. COLOR OR RACE ANTE Due To 00. USUAL OCCUPATION: Bisa bad of which female white (b) CEDENT CAUSES housewife J FATHER'S NAME Charles Due To (c) 10. CAUSE OF DEATH Zater osly cee cade OTHER SIGNIFICANT ANTECEDENT CAUSES CONDITIONS por Une for (n), (h), RDd (a) · This dụng net moon Duch es keurt forhire Major findings: Of operations. com phcution which Date of operation ... What test confirmed Dxc. 62- 1950 TION 11: ACCIDENT 5 Was disease or in ju BUICHE If so, specify (Month) Tar (Signed) INJURY (Address) 21d. TIME OF afire on 5/19/52 6 Da. SIGNATURE Place of Burial DATE OF BUR TION, REMOVAL 18pmk) Ma. BURIAL. CREMA-24b. DATE Removal 5-22-52 DATE REC'D BY LOCAL REGISTRAR'S SIGNATURE REG. 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 retums of deathis wiser occanica is your city of towns att case tie uctcescu icoluce af angelica city of twit at this tillie asthenta, cta. It meansjing the underlying ouuse iset. after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
n name of wife in full)
b. COUNTY
"porse Limite, write RURAL
od's name in full)
7 mos.
. STREET ADOR
Ir rutal, gl . loration
90 Cottage Avenue
If under 24 hours Hours Minutes
ys
. DATE OF BIRTH
, ACE
DUSTRY
one during most of working life)
17. INFORMANT'S SIGNATURE
Mary Dunbar Chart Hewhitney Winthrop, Massachusetts
DUE TO (b)
ves D
1 Dagrwe er title) 216. ADDRESS
-302 1
(Was deceased a U. S. War Veteran, if so specify WAR)
1952
2. USUAL RESIDENCE (Where dotraged livet If Institution torterose befude
CONNECTICUT STATE DEPARTMENT OF HEALTH Bureau of Vital Statistics - Hartford, Connecticut, U. S. A.
COPY
Certificate of Death
1. PLACE OF DEATH:
2. USUAL RESIDENCE OF DECEASED:
(a) State
Massachusetts (b) County Suffolk
c) Town) Winthrop
(If rural, give location)
(e) Street
Number 31 Cross Street
3 Y'AME OF
(Fir t)
(Middle)
LACEASI D ( Type or print) Julia
PERSONAL AND STATISTICAL PARTICULARS
5. Sı x female G. RA
MARRIF , DIVORVED
8. IF MARRIED, WIDOWED OR DIVORCED, GIVE MAIDEN NAME OF WIN O HUSBAND a } Bro
(Month)
(Day)
9 DATE OF DEATH
July 12
10. DATE OF BIRTH
AGE (In years last birthday)
If under 1 year
If under 1 day
Months | Days { Hours Mins.
77
11. BIRTH LACO (City or town) (State of for . s country)
Ir land
L.S. ( ) USI AL OCEL ATION (Give kind of work d ne durs mit of wirki I fe even if an red)
(1 In iu try or Bu + e
23. OTHER SIGNIFICANT CONDITIONS
Conditions contributing to the death huit not related to the disease or condition causing death
1 (-) W DE EISED A VETERAN? Yes or No no
(b) If ye . Five war Unit or Sh
24. OPERATION, DATE AND MAJOR FINDINGS
AUTOPSY (Yetjor No)
25. IF DEATH WAS DUE TO EXTERNAL CAUSES, FILL IN THE FOLLOWING:
(b) Date of occurrence
(a) Accident, suicide. homicide (specify).
MAIDEN Trident ?
16. NAME
(City or town)
(State or foreign country)
17. BIRTHPLACE
18. INFORMANT'S NAME
MEDICAL CERTIFICATION
22. CAUSE OF DEATH (Enter only one cause per fine for (a), (b) and (c)
(a) DISEASE OR CONDITION DIRECTLY LEADING TO DEATH This does not mean the mode of dying. such as heart failure, asthenia, etc. It means the disease, injury or complication which caused death
INTERVAL BETWEEN ONSET AND DEATII
Bronx
trà to schule !
130
ANTECEDENT CAUSES. Morbid conditions, if any, giving rise to the above cause (a) stating the underlying cause last.
DUE (b). TO.
DUE C) TO.
14. NAME
PATH
Michael Rogers (City or town) (State or foreign country) Ir land
15. BIRTHPLACE
MOTHI R
(c) City or Town and State Where injury occured
(e) While at work?
(d) Did injury occur in or about home, factory, farm, office, street, etc .?. How did it occur?
Reed Aug. 15,1952
Registrar.
that this is a true copy of the certificate received for record.
A
, (a) State of Connecticut: (b) County
Hartford
(c) Town Hartford
(d) Length of stay in town
(If not in hospital give street no. or location) (e) Name of Hospital or Institulion
Hartford
(Last) Brooks
(d) (City or Borough)
4. SOCIAL SECURITY NUMBER
(Y car 1952
MINS.
RECEIVED
OF
TOWA
1 .-
WI
6
THROP
AUG15 952 M
"This copy of Certificate received for record at ...
this day of 19 --.
Registrar."
"
PLACE OF DEATH
Essex (County)
1
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
164
No. Danvers State Hospital, Hathorne
j(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Herbert Morrill 2 FULL NAME.
(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.
53 Beal
(Usual place of abode)
St.
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
years
2
.months.
21
days.
In place of residence.
.. years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
16,
1952
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended
deceased from
April 25.
1952
to
July 16.
52
I last saw
h
im
alive on
July 16, 19 52
death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AG
74
Years
6
Months
2
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation:
Stage Hand
(Kind of work done during most of working life)
14 Industry or Business :.
15 Social Security No.
Chelsea
16. BIRTHPLACE (City)
(State or country)
MOSS.
17 NAME OF
FATHER
William T. Morrill
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Charlotte Stone
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ma"s.
21
Mary E. Sheehan
Informant ..
(Address)
Hathorne, Hass.
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop, Mass.
Received and filed
AUG 1 2 1952
19
(Registrar of City or Town where deceased resided)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Paget's Disease
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Was autopsy performed?
No
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
Andrew Nichols 3rd
M. D.
(Signed)
Danvers, Mass. Date 7/18/
.1952.
Franklin Cemetery
6
Place of Burial or Cremation
(City or Town)
Franklin
DATE OF BURIAL
July
19,
152
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Julv
.19 52
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)-11-49-900,475
1
-302
have occurred on the date stated above, 9:20 a. .. m. INTERVAL BE- TWEEN ONSET AND DEATH years
(write the word)
Date of operation
Clinical & Laborato
(Address) ..
RECEIVED
TOW
OFFICE OF
11 12
GLERK
9.
MIN
3
6
ASS
HROP.
-
AUG12
AM
--
-302
1
PLACE OF DEATH
SUFFOLK 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) 6794
Registered No.
165
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.)
102 Bayswater
East
Bostan'
(If nonresident, give city or town and State)
Length of stay: In place of death .years. months 2 days. In place of residence. 48
years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 27/52
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY. July 25 19 52
to
July 27
19
52
I last saw h .............. alive on
19
., death is said to
have occurred on the date stated above, at
3;35A
.m.
INTERVAL BE-
TWEEN ONSET AND DEATH WKS to Mos 48
11 IF STILLBORN. enter that fact here.
12
AGE
Years
1
Months
20
Days
If under 24 hours
Hours.
Minutes
ANTE
· Due To
CEDENT (b)
Cirrhosis of liver
CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:"
Of operations.
Was autopsy performed?
5 Was disease or injury in any way related to occupation of deceased? If so, specify. M.W.O. Comell
(Signed)
Boston City Hoopt Date
7-27 19
M. 52
(Address)
Winthrop Cem-Winthrop Lasso
6
Place of Burial or Cremation July 30/52
(City or Town)
DATE OF BURIAL
19
:21 Informant (Address)
C G Oakes Brother
A TRUE COPY;
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 30/52
...... .............. 19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Mary A Ryan
20- BIRTHPLACE OF
MOTHER (City)
(State or country)
Arashat N.S.
7 NAME OF
FUNERAL DIRECTOR
R C Kirby
Boston Mass.
ADDRESS
Received and filed.
AUG 1 2 1952
19
25M.(B) 11-51.905807
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.)
No.
John L Oakes
(Was deceased a U. S. War Veteran, if so specify WAR
W ₩ #2
(a) Residence. No. (Usual place of abode)
St.
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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).
Gastric ulcer
Irs.
13 Usual
Occupation:
Laborer
(Kind of work done during most of working life)
14 Industry or Business:
Road Construction
15 Social Security No.
None
16 BIRTHPLACE (City). (State or country)
East Boston "ass.
17 NAME OF FATHER Henry J Oakes
18 BIRTHPLACE OF FATHER (City) (State or country)
Arashat N.S.
Date of operation
What test confirmed diagnosis ?..... autopsy ..
.
Boston City Hospital
8 SEX
M
That
I
attended deceased
from
RECEIVED
TOW
OF
11 12
OFFICE
CLERK
NIW
5
AUG12
AM
..
Entered Service Aug.27,1942 Boston Mass. Discharged April 6,1943 Camp Beale California Private Co.D Quartermaster Bakery Battalion Service No. 11087495
.
PLACE OF DEATH
(County)
lestore Sep. 8/5
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.
Registered No. 166
[(If death occurred in a hospital or institution, mely/trapSt. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
{ if so specify WAR)
Hr. andrews RO
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ..... years. months. 20 days. In place of residence .. .. years .. months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
1952 (Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widow
HEREBY CERTIFY.
That I
attended deceased from
2
1935 death is said to
have occurred on the date stated above, at .
8:30 A .m.
INTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Pelicano
5 min
ANTE
Due To
Questa gange
CEDENT (b)
CAUSES
(c)
coletes Delletro
Jean
OTHER
SIGNIFICANT
CONDITIONS
artensacesso (gen)
security
yes
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
(Signed) Gegen Stre
.
(Address) 2200 Waslington Cup Date 8-18
&
M. D.
.1902.
6
Holy Cross Cemetery
Place of Burial or Cremation
(City or Town)
Malden
DATE OF BURIAL
Aug. 6, 1952
19
7 NAME OF
FUNERAL DIRECTORWilliam E. Pepi
ADDRESS
971 Saratoga St. East ... Boston,
Received and filed.
AUG -5 1952
19
(Registrar)
10a If married, widowed, or divorced
HUSBAND of ..
(Give maiden name of wife in full)
(or) WIFE of
Jack ... D' Ambrosio
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
81Years
Months
Days
If under 24 hours
Hours . .. Minutes
13 Usual
Occupation :
Home
(Kind of work done during most of working life)
14 Industry
or Business:
None
15 Social Security No.
Nono
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Giacchino(Clavella)
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Unknown
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Unknown
21
John D'Ambrosio
Informant
(Address)
109 St Andrew Rd.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter f. Bakery.
(Signature of Agefit of Board of Health or other)
8/5 /52
(Official Designation) (Date of Issue of Permit)
×
ONS IFICATE & EATH ter one ach d (c)
ol mean ng, such asthenia, disease, s which
ditions. se to the stating cause
contrib -- but not sease or g death.
50M (B)-1-51 903586
301A 1
(City or Town) Wedding Co No.
2 FULL NAME Maria W
" ambos
Af deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. /11 (Usual place of abode)
I last saw h ... alive on
1.
19 52
to
19
? 6MB
PARENTS
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 hest 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 imine- 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 deerhed 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 hody 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 ohtained 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 he 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 recognizahle disease, or when any person is found dead. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.
Na borfateVor @her 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 interinent 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 These fnofude not only deaths caused directly or indirectly by tablasmoncluding 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)
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.
Registered No. 16
2 FULL NAME ..
Mary Ann Mackenzie
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1 9 Thornton St
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years .... .months. days. In place of residence. 4
.years ..
months ..
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR OR RACE
(write the word)
Female
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDSingle
10a If married, widowed, or divorced HUSBAND of .. (Give maiden name of wife in full)
(or) WIFE of ..
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
75
Years
7
Months
6
Days
If under 24 hours
Hours
.. .. Minutes
13 Usual
Occupation :.
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