USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 30
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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 of 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.
96
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)
(a) Residence. No.
235 Washington Ave
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years months. days. In place of residence
5.5.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDO WED
or DIVORCIddowed
4 I HEREBY CERTIFY.
That I attended deceased from
...
......
...............
19 ...
to 225
19
I last saw him alive on
19 ......... death is said to
have occurred on the date stated above, at.
2: 19 % m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ....
1
Due To (c)
OTHER
SIGNIFICANT ...
CONDITIONS
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)
(Address)
1
M. D.
Date -
19.J.
6 Calvary Place of Burial or Cremation
Boston
tygr Town)
DATE OF BURIAL
19
7 NAME OF
FUNERAL DIRECTOR
John J. Ochaley
ADDRESS
AAnthrop Mass
Received and filed APS 29:52
....... 19
(Registrar)
10a
If married,
Mary KeEfe
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
INTERVAL BE- TWEEN ONSET ANO DEATH 11 IF STILLBORN. enter that fact here.
12
AGE 87.
Years
Months
.Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Retired
(Kind of work done during most of working life)
14 Industry
or Business:
Wine Merchant
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Ireland
17 NAME OF
FATHER
Daniel
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary Ann Regan
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Harrison Bergin Informant (Address) 26 Crystal St Elmont N. Y.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burialor transit permit was issued: Walter f Haber.
(Signature of Agent of Board of Health or other)
The alla Officer 4.29.53
(Official Designation)
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, ans the disease, cations which th.
id conditions, ing rise to the se (a) stating rlying cause
tions contrib- e death but not the disease or causing death.
A R-301A 1
1.
1
2 FULL NAME
J
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Registered No.
No.
50M-5-52.907046
ANTE
Due To
CEDENT (b)
CAUSES
1
May 1, 1953
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. REC
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 purposess.bb deemed to have taken place between February fourteenth, eighteen hundred and's ninety-eight and July fourth, nineteen hundred and two, and the Mexican borden service of nineteen hundred and sixteen and nineteen hundred and seventec 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 person died; and no undertaker or other person shall exhume a human body e ) 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 oceupation, 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 Isd 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. See. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rAles of practice:
EDAttending physicians will certify to such deaths only as those of persons on they have given bedside care during a last illness from disease unrelated any form of injury.
INTHIRDD.
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.
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 ocupa- 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
1
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS - STANDARD
CERTIFICATE OF DEATH
Registered No.
97
(City or Town) Mounts ConvalesCENT Home 104 Highland Ave ..
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Katherine A ( Smith) McLeod
(If deceased is a married, widowed or divorced woman, give also maiden name.)
19 Lewis Ave. (a) Residence. No. (Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ...... years 8 months. days. In place of residence .years months days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
1953
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widow
4 I HEREBY CERTIFY,
That I attended deceased from
19-77
to
af2 29, 1953
ath is said to
have occurred on the date stated above. at
1.08 A
m.
INTERVAL BE.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
TWEEN ONSET AND DEATH
ANTE
CEDENT (b)
CAUSES
Due To
Central Hemostunge
Du (c)
sys.
OTHER
SIGNIFICANT
CONDITIONS
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? ha
If so, specify.
-
(Signed)
Ittelseat ST Date
(Address)
M. D.
4,20 1950
rt Auburn Cambridge
6 Place of Burial or Cremation (City or Town) 2
May
19 .5
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Howard S Quenuldo
ADDRESS
Received and filed. MAY I 1953 19
(Registrar)
11 IF STILLBORN, enter that fact here.
12 81 7
26
AGE
Years
Months
Days
If under 24 hours
Hours . . Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
At home
15 Social Security No.
none
South Brookfield
16 BIRTHPLACE (City)
(State or country)
nova Scotia
17 NAME OF
FATHER
Joshiah Smith
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Fraser
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21 Informant Robert McLeod
(Address)
19 Lewis Ave. winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filedwith me BEFORE the burial ør transit permit was issued: Walter . Haber (Signature of Agent of Board of Health or other)
Health Affiell
5.1.53
(Official Designation)
(Date of Issue of Permit)
UCTIONS FOR CERTIFICATE
giving OF DEATH t enter than one for each b) and (c)
loes not mean f dying, such ure, asthenia .. ns the disease, ations which h.
I conditions, ng rise to the : (a) stating ying cause
ions contrib- death but not e disease or using death.
50M-2-19-25666
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
Crofton McLeod
(or) WIFE of
45
To be filed for burial permit with Board of Health or its Agent.
R-301A 1 Winthrop
No.
2 FULL NAME ..
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Husband's name in full)
3de yo
I last saw h ............ alive on
3.
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 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 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 clectrical agents or following abortion, or from discases 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. Scc. 6., as amended by Chap. 632, Sce. 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 Bagh 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).
ET RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- 10g tales of practice: Attending physicians will certify to such deaths only as those of persons hotmailve given bedside care during a last illness from disease unrelated form of Diury. Health physicians will certify to such deathsonly as those of persons yap though disabled by recognized disease unrelated to any form of injury 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 include not only deaths caused directly or indirectly by hatise (includingMresulting 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 occupi- 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
M R-302 1
3 DATE OF
DEATH
CEDENT (b)
CAUSES
Major findings:
Of operations.
6
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible
(Addressy
50m-(e)-10-48-24658
Apr.0,1953
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Max.25
1900
Apr. G
53
19
I last saw
h
alive on
19
death is said to
10:15A
m.
10a If married, widowed, or divorced
HUSBAND of.
Alexander
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
74
Years.
17
Months.
Days
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation :
At homo
(Kind of work done during most of working life)
14 Industry
or Business:
housewife
15 Social Security No ..
088-10-00486
16 BIRTHPLACE (City)
(State or country)
17 NAME OF
FATHER
Joseph I'ratus
18 BIRTHPLACE OF
Portugal
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Gloria M. Souza
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Portual
holy Cross, falcon, 433
Place of Burial or Cremation
Apr.9,1353
19
DATE OF BURIAL.
7 NAME OF
FUNERAL DIRECTOR.
Richard C.Kirby
ADDRESS
Received and filed
MAY 13 1953
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
Mhito
10 SINGLE
MARRIED
WIDOWED
Widowod
or DIVORCED
have occurred on the date stated above, a
INTERVAL BE-
TWEEN ONSET ANO DEATH
DISEASE OR CONDITION
DIRECTLY LEADING.
TO DEATH (a).
Carcinoma of
pancreas
ANTE
Due To
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
as above
Date of operatio
3/20/53
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 ....... Paul Forragopian (Signed)& Carry Live. Che
M. D.
(City or Town)
corre ROJO- son
21
Informant
(Address)
124 Hormon F.
..... finthrop, Lass
A TRUE COPY. * Couple & Tyrrell
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Apr.7,1953
19
2 FULL NAME.
Maria Adelaide Rose
(If deceased is a married, widowed or divorced woman, give also maiden name.)
124 Hormon
St.
HinthrcDIGud
if so specify WAR)
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.. years.
1
.months.
days. In place of residence ..
.years
months
... ....... days.
MEDICAL CERTIFICATE OF DEATH
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF
Cho Isca
(City or town making return) 209 08
CERTIFICATE OF DEATH
Registered No.
PLACE OF DEATH
Suffolk
(County) Chelsea
(City or Town)
No.
Cholcca Memorial Hospital
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
(Was deceased a
U. S. War Veteran,
(write the word)
(Give maiden name of wife in full)
er
Apr. 6
53
6 10 S o AGE.
Liston, Portugal
PARENTS
..... Date ... /. 1/6/53 19
WNIETHATALT. WIERT UNTALING BLACK ING - IND DAPERMANENT RECORD
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