USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1952 > Part 73
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BOSTON
(City or town making return)
Registered No.
8758215
J(If death occurred in a hospital or institution, XXI give its NAME instead of street and number)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20 Center
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
months.
.. days.
In place of residencel. i.f.@ars
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
6,
1952
(Month)
(Day)A
(Year)
8 SEX
M
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY ,
10/5
19
to
10/6
19.
52
10a If married, widowed, or divorced
Annie E McGrath
HUSBAND of.
(Give maiden name of wife in full)
I last saw
h
alive on
19
death is said to
have occurred on the date stated above, at 2.758 .. m.
INTERVAL BE-
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a)Pneumonitis rt upper
and middle lobes
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
55
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:
House Painter
15 Social Security No.
031-12-0024
16 BIRTHPLACE (City)
(State or country)
Mass .
Boston
17 NAME OF
FATHER
Charles Edwards
18 BIRTHPLACE OF
Farmington
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Gertrude
NovaScotia
Cem
Winthrop.
(City or Town)
Winthrop ..
Place of Buriaf or Cremation
Uct. 8,
52
19
7 NAME OF
FUNERAL DIRECTOR
D O'Brien
ADDRESS
ATTEST:
Cambridge, Mass.
Received and filed.
19
21
Informant
(Address)
Hospital Records
DATE OF BURIAL
Was autopsy performed ?.
Yes
Date of operation
What test confirmed diagnosis?
Autopsy
NO
5 Was disease or injury in any way related to occupation of deceased? If so, specify
M. D.
(Signed)
J ... Fornald
(Address).
VAH
Date.
10/6 19 52
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
A TRUE COPY Charles H. Mack.
(Registrar of City or Town where death occurred)
DATE FILED
Oct. 9
52.
19
(Registrar of City or Town where deceased resided)
Painter
ANTE
Due ToPulmonary congestion
CEDENT (b)
CAUSES
and edema
Due ToPulmonary Infarct
(c)
left lower lobe
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
PARENTS
-302 1
No.
Veterans Administration Hospital
GEORGE E EDWARDS
(Was deceased a
U. S. War Veteran.
if so specify WAR)
Winthrop Mass
WW I
(a) Residence. No.
(Usual place of abode)
That A
attended
deceased from
(or) WIFE of.
(Husband's name in full)
RECEIVE
DATE OF ENTERING MILITARY SERVICE
5/28/17
DATE OF DISCHARGE
9/24/20
31
RANK, RATING
ORGANIZATION & OUTFIT
6
SERVICE NUMBER
OCT2299 006
-
X
PLACE OF DEATH
SUFFOLK BOSTONI (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No. 8773 216
J(If death occurred in a hospital or institution, XXXXX \ give its NAME instead of street and number)
2 FULL NAME NANCY E BROWN
(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. (Usual place of abode)
2 ... Upland. .. Road,
XXXXX Winthrop ..... Mas
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years
months. 1 .days. In place of residence. 1 .. years .. .... months. 19 .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
F
10 COLOR OR RACE
W
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
3 DATE OF
DEATH
October 7, 1952
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Acute meningitis
Meningococcomis
5 Accident, suicide, or homicide (specify).
Date and hour of injury 19
Where did Injury occur? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
Injury
Manner ofCollapsed .... at .... home;di.denrout
(How did injury occur?)
Nature of
to hospital
Injury
While at work?
Was autopsy performed? N.
6 Was disease or injury in any way related to occupation of deceased? ....
If so, specify
(Signed)
W Brickley
M. D.
(Address) Boston
Date 10/7, 58
Winthrop Com.
Winthrop
7 Place of Burial, or Cremation. Oct. 8,
52
DATE OF BURIAL
19
8 NAME OF
FUNERAL DIRECTOR
E Boston
ADDRESS
OCT 20 1952
19
Received and filed.
(Registrar of City or Town where deceased resided)
PARENTS
18 NAME OF FATHER Ernest C Brown
19 BIRTHPLACE OF
East Boston
FATHER (City)
(State or country)
Mass.
20 MAIDEN NAME OF MOTHER Mary E O' Leary
Boston
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
22
Informant.
(Address)
Father
A TRUE COPY.
ATTEST:
A L (Registrar of City or Town where death occurred)
DATE FILED
Oct. 10,
52
......
19
X
305
1
(City or Town)
enroute to Children's Hospital No.
of death should be transmitted on Form R-305 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-(c)-11-49-900.475
11a If married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full)
... (or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
.1
13
AGE
Years.
4
Months.20 ... Days
If under 24 hours
Hours ...
.Minutes
14 Usual
Occupation:
At hom
(Kind of work done during most of working life)
15 Industry or Business:
16 Social Security No.
17 BIRTHPLACE (City).
(State or country)
Cambridge , Mass.
(City or Town)
R Kirby
Single
RECEIVEY
TOW
6
THROP.
OCT20
AM
-
- -
of Death. See reverse side for extracts from the laws relative to the return of certificates of death. If deceased was a U. S. War Veteran, G.L. Chap. 46, Section 10, requires physicians to insert a recital to that effect.
25M (8).8-50-902.592
PLACE OF DEATH
Suffolk (County)
The Commonwealth uf Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
To bo filed for burial permit with Board of Health or Its Agent.
217
Registered No.
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
(Was deceased a U. S. War Veteran, if so specify WAR).
15 Williams St. Hunctrop
.. St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
21
months.
.. days.
In place of residence
.years
.months ..
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Oct-9-1952
(Month) (Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Senelita arterio Sten to Heart Disease: Recent Fracture RT. tenir
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Female
White
10 COLOR OR RACE
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDred
11a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
William
Burke
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE.8.2 Years.
Months.
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
15 Industry
or Business:
Own .... Home
16 Social Security No ...
17 BIRTHPLACE (CityFastBoston
(State or country)
Mass
18 NAME OF
Charles Hayes
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
20 MAIDEN NAME
OF MOTHER
Mary A. Kenney
21 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Mass
22
InformantLillian Martin
(Address)
15 Williams St
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed/with me BEFORE the burial or transif permit was issued:
Watter &. Bakery.
(Signature of Agent of Board of Health or other)
Health Officer 10/10/52
(Official Designation) (Date of Issue of Permit)
(Registrar)
PARENTS
6 Was disease or injury in any way related to occupation of deceased? ....
If so, specify !!
(Signed)
M. D.
Coast-9-
12/20
(Address) Holy Cross Malden
7 Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL ..
1952
8 NAME OF
FUNERAL DIRECTOR
ADDRESS Winthrop
OCT 14 19
Received and filed ...
accidental
Date and hour of injury ..
Yata 30 - 1952
Injury occur?
Where did
Kauttrop.
{City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Specify type of place)
Sell accidentally on her batt
Injury
(How did injury occur?)
Nature of
Injury
Novou Jula - 30-1952
While at work?
Was autopsy performed?
200
-303 A 1
(City or Town)
May Kower Couval, Home Sauver av Mary J. Banke (If deceased is a married, widowed or divorced woman, give also maiden pame.)
2 FULL NAME.
(a) Residence. No. (Usual place of abode)
40
5 Accident, suicide, or homicide (specify)
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 leath of a person whom he has attended during his last illness, at the request f an undertaker or other authorized person or of any member of the family of he deceased, furnish for registration a standard certificate of death, stating to the est of his knowledge and belief the name of the deceased, his supposed age. the isease of which he died, defined as required by section one, where same was ontracted, the duration of his last illness, when last seen alive by the physician f 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 receding section or by section forty-five of chapter one hundred and four- een, shall, if the deceased, to the best of his knowledge and belief, served in the rmy, navy or marine corps of the United States in any war in which it has been ngaged, insert in the certificate a recital to that effect, specifying the war, and hall also certify in such certificate both the primary and the secondary or imme- iate cause of death as nearly as he can state the same. For neglect to comply rith 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 f said chapter one hundred and fourteen, the word "war" shall include the China, elief expedition and the Philippine insurrection, which shall, for said purposes, bel leemed to have taken place between February fourteenth, eighteen hundred and .! inety-eight and July fourth, nineteen hundred and two, and the Mexican border ervice 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 n a town, or remove therefrom a human body which has not been buried, until he as received a permit from the board of health, or its agent appointed to issue uch permits, or if there is no such board, from the clerk of the town where the erson died; and no undertaker or other person shall exhume a human body and emove it from a town, from one cemetery to another, or from one grave or tomb ther than the receiving tomb to another in the same cemetery, until he has eceived a permit from the board of health or its agent aforesaid or from the clerk f the town where the body is buried. No such permit shall be issued until there hall have been delivered to such board, agent or clerk, as the case may be, satisfactory written statement containing the facts required by law to be eturned and recorded, which shall be accompanied, in case of an original inter- nent, by a satisfactory certificate of the attending physician, if any, as required by aw, 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 nough 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 pplication make the certificate required of the attending physician. If death is aused by violence, the medical examiner shall make such certificate. If such a ermit for the removal of a human body, not previously interred, from one town o 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 he undertaker desiring to make such removal shall constitute a permit for such emoval; provided, that such body shall be returned to the town from which it was emoved within thirty-six hours after such removal, unless a permit in the usual orm 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. as amended by Chap. 48, Acts of 1927 and Chap. 414, Acts of 1931. No undertaker or other person 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 funcral 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., as amended.
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 resultingfrom 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.
.The medical examiner certifies the cause and manner of death to the best of i
Is knowledge and belief.
11.12
RULES OF PRACTICE
The Juffillment of the purpose of these laws calls for the observance of the follow- ng rules of practice!
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
Board of Health physicians will certify to such deathsonly as those of who though disabled by recognized disease unrelated to any form of
ETSOWA ury. Tato ed without recent medical attendance or whose physician is absent ome when the certificate of death is needed.
Medical Examiners will investigate and certify to all deaths supposably due towhom ( These include not only deaths caused directly or indirectly by trauma sm (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 personi found dead. Af
STATEMENT OF CAUSE OF DEATH
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a steam railway accident.""Pistol shot wound of the chest with associated hemorrhage, hom- icidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1)Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)'
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
-302 1
PLACE OF DEATH
WORCESTER
(County) GRAFTON. (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
GRAFTON.
(City or town making return)
Registered No. ..
218
No.
Grafton State Hospital
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME. Mary .M ...... Barry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 411 Shirley Street
..... St.
Winthrop, Mass
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.9 ..
.years ..?.
19
.days. In place of residence.
......
... years
Not learned
mont
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
(write the word)
WIDOWED Widowed
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
.Nov ....... 20 ....
19 ...
50.
to.
Oct ...... 10
19.52
I last saw h.@ ....... alive on
Oct ...... 10
19.52 death is said to
have occurred on the date stated above, at ..
2:40 .P.m.
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
William Barry
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ...
69. Years
Months
Days
If under 24 hours
Hours .....
.. Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :.
At .... Home
15 Social Security No.
Not ... learned
16 BIRTHPLACE (City).
(State or country)
Mass
Boston
OTHER
SIGNIFICANT
None
Of operations.
None .... performed
Was autopsy performed ?. No
Date of operation.
What test confirmed diagnosis? Clin & Lab
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
Bernard Brass
M. D.
(Address) .... No. ... Grafton
6
Holy Cross
Melden Mass
Place of Burial or Cremation
DATE OF BURIAL ..
Oct. 14. 1952
19
7 NAME OF
FUNERAL DIRECTOR
M ...... J ........ Kelly
ADDRESS.
East Boston Mass
Received and filed
NOV 3 1952
19
(Registrar of City or Town where deceased resided)
PARENTS
18 BIRTHPLACE OF
FATHER (City).
Not .... learned
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Xxxx Mary O' Connor
20 BIRTHPLACE OF
Date ... 1.0. 10 19 ... 52 MOTHER (City) Not .... learned
(State or country)
Ireland
21 Inform (Address) Grafton State ..... Hospital Rcds North Grafton Mass
A TRUE COPY
ATTEST:
raymond D. Indan
(Registrar of City of Town where death occurred)
DATE FILED
October 13, 1952
.19
3 DATE OF
DEATH
ANTE
CEDENT (b)
CAUSES
Major findings:
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, Ser 12, G. L.)
25M (E)-6.50.902253
Copics of itturns us acquis with detunica if your city of cowar iii case this delcasco febluca if allglici city Of town at the WHITE
CONDITIONS
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH (a)
Arteriosclerotic.
Heart Disease #420.0
Due To
Due To
(c)
TWEEN ONSET AND DEATH
Sev.
(Month)
October
10
1952
(Day)
(Year)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
No
17 NAME OF FATHER Patrick Crowley
RECEIVED
OF
TOWN
3:31
11 12
1
11)
OF
9
NIVY
ULEMA
B
*
WI
6.5
ASS.
NOV-3
AM
PLACE OF DEATH
Winthrop (County)
Suffolk
(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 pormit with Board of Health or its Agent.
219
Winthrop Community Hosp. No.
[(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Leo Coriani (If deceased is a married, widowed or divorced woman, give also maiden name.) 94 BeachST. Revere
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, no if so specify WAR)
(a) Residence. No. (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ....... .. years. .months. 3 days. In place of residence. .years .. .months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day) 11 1952 (Year)
8 SEX
Male
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
4 I HEREBY CERTIFY,
That I attended deceased from
Geb 1,
19 52.
to
Oct 11
1912
I last saw him, alive on
have occurred on the date stated above, at. 187 .. m.
INTERVAL BE- TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here.
OV11/52 AGE.
81
Years
Months. .. .
Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation:
Self employed
(Kind of work done during most of working life)
14 Industry
or Business:
Retired
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Lino Coriani
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
Date of operation
.Was autopsy performed?
no
What test confirmed diagnosis ?.
Ekly & X-Rays
5 Was disease or injury in any way related to occupation of deceased? Me
If so, specify)
(Signed)
(Address) 17BA
M. D.
6
St. Michael Cemetery
Place of Burial or Cremation
DATE OF BURIAL Oct. 15 - 52
Boston
(City or Town)
19
7 NAME OF
FUNERAL DIRECTOR
Vincent ... Rappno
ADDRESS
9 .Chelsea St .... East ... Boston
Received and filed. OCT 14 196/ 19
(Registrar)
10a If married, widowed, or divorced
HUSBAND of ..
Catherine Tassinari
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
Thrabais
ANTE CEDENT CAUSES
Due To Tell ventiladores heard
(b)
Due
(c)
OTHER SIGNIFICANT CONDITIONS
Chyta Chronic
50M (B)-1-51 903586
-301A 1
IONS TIFICATE
DEATH ter 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.
Major findings:
Of operations.
19 MAIDEN NAME
OF MOTHER
Anna
( unknown )
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21
Florence DeSimone
Informant
(Address)
94 Beach St.
Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A. Maker (Signature of Agent of Board of Health or other) Heartin Seine (Official Designationy (Date of Issue of Permit) 10/14/52
Tel 1850
Cocl11
1955
. death is said to
Registered No.
HEViKE 11/6/52
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 leath 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 he deceased furnish for registration a standard certificate of death. stating to the best of his knowledge and belicf the name of the deccased, his supposed age, the lisease of which he died, defined as required by section one, where same was ontracted, the duration of his last illness. when last seen alive by the physician r 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- een, shall, if the deceased, to the hest of his knowledge and belief, served in the irmy, 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 hall also certify in such certificate both the primary and the secondary or imme- iate cause of death as nearly as he can state the same. For neglect to comply ith 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 f said chapter one hundred and fourteen, the word "war" shall include the China elief expedition and the Philippine insurrection, which shall, for said purposes, be leemed to have taken place between February fourteenth, eighteen hundred and nety-cight and July fourth, nineteen hundred and two, and the Mexican border ervice of nineteen hundred and sixtecn and ninetcen hundred and seventeen. . L. Chap. 46. Sec. 10.
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