USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 45
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To be filed for burial permit with Board of Health or its Agent.
Registered No .. 147
Nicholas La Pena 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
20 Read St
St. .
(If nonresident, give city or town and State) 9
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Marreul
4 I HEREBY CERTIFY.
-
19
to
19 -
10a If married, widowed, or divorced
HUSBAND of.
EILEEN
M.
ARSENault
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12
AGE
41 Years
Months .. . Days
If under 24 hours Hours ... Minutes
13 Usual
Occupation :
Tool + Die Maker
(Kind of work done during most of working life)
14 Industry
or Business:
Tool May
15 Social Security No. 070-16-8976
16 BIRTHPLACE (City)
(State or country)
new Haven bonn
17 NAME OF
FATHER
Julius La Dennã
18 BIRTHPLACE OF FATHER (City) (State or country)
France
19 MAIDEN NAME Maria Giovanni Rosato OF MOTHER
20 BIRTHPLACE OF MOTHER (City) (State or country) France
ÈricÈ
21 Informant Mrs Certaine La Penna
Hi Reaust Winthrop Mans
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buriakor transit permit was issued: Walter J. Haken (Signature of Aient of Board of Health or other),
(Official Designation)
(Date of Issue of Permit)
X
...
19
., death is said to
have occurred on the date stated above, at
4 P.
m.
INTERVAL BE- TWEEN ONSET AND DEATH
ANTE
Due To
to Presumably
CEDENT (b)
CAUSES
Coronary Occlusion
Due To
(c) ..
OTHER
SIGNIFICANT
CONDITIONS
Hypertension
5yrs
Major findings:
Of operations ..
Date of operation ...
Was autopsy performed? no
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? no
If so, specify
(Signed)
inthis @ Murray
M. D.
(Address) Winthrop Board of Hate 4 July 1953
6 Place of Harial or Cremation
DATE OF BURIAL.
7 NAME OF
FUNI
Ernest / Gaggiano
ADDRESS 147 Winthrop St Honderd
Received and filed JUL 7 1953 19
(Registrar)
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) IV
JCTIONS OR CERTIFICATE
iving F DEATH t enter han one or each ) and (c)
oes not mean dying, such ure. asthenia, s the disease, tions which
conditions. g rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
:50M (B)-12-49-900722
C
4 1 1953 (Year)
3 DATE OF
DEATH
July (Monthy
(Day)
That I attended deceased1
from
I last saw h -........ alive on
DISEASE OR CONDITION
DIRECTLY LEAD Natural Causes
TO DEATH (a)
6 hrs
PARENTS
Health dintrey (City or Town)
105 3
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death years 9 months . days. In place of residence years
Healthe office
7.6.53
(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 of 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-sever. 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, bet 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 exhumne 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 sooncr 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 inarine corps of the United States in any war in which it has been engaged, such recital shall appear upon the perinit. 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).
Medieal examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence. or by the action of chemical. [thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. - General Laws Chap. 3%. Sec. 6., as amended by Chap. 6.32. Sec. 4. Acts of 1945.
Noundertaker or other persons shall bury a human body of 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 is the funeralis to be held, or from a person appointed to have the care of the centetermet burial ground in which the interment is made.
:'Chap. 114 Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
nt of the purpose of these laws calls for the observance of the follow-
aptice: tending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of Jesam Tho, though disabled by recognized disease unrelated to any form of mydry. have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation. the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during inost 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
Tel. 0
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-302 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. 148
[(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL NAME.
Samuel Alton Phinney
(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. 141 Loring Rd.
St.
Winthrop
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death. ] ....
.years ....
Q ... months ..
.4 ... days. In place of residence.
.......... years ..
.. months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July
1953
(Month)
(Day)
(Year)
8 SEX
Nale
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
4IHEREBY CERTIFY,
That I attended deceased from
June 30
1952 to July 4,
19.53
I last saw him alive on July 4
19 .. 5.3, death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
interiosclerotic
heart disease
11 IF STILLBORN, enter that fact here.
12
AGE ..
74 Years 7 Months 13 Days
If under 24 hours
.Hours
Minutes
ANTE
Due ToGeneralized Arterio
CEDENT (b)
CAUSES
sclerosis
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation.
.Was autopsy performed?
What test confirmed diagnosis ?.
Clinical& .... Laboratom
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ... Andrew Nichols 3rd. M. D.
(Signed).
(Address)
Denvers Joana Date
7/201 1953
6
.Pivorside ... Co .... Place of Burial or Cremation DATE OF BURIAL July 7
(City or Town)
19
5B
21
Informant
(Address)
Mary E. Shechan
Hathorne, Para
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
Winthrop. Mass.
ADDRESS
Received and filed
8/10/53
19
(Registrar of City or Town where deceased resided)
S
=
11
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
N. S. Canada"
17 NAME OF
FATHER
James Phinney
18 BIRTHPLACE OF
FATHER (City)
(State or country)
N. S. Can da
19 MAIDEN NAME
OF MOTHER
Priscilla Daniels
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
N. S. Canada
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July
19 53
25M .(B)-11-51-905807
PLACE OF DEATH
Essex (County)
No.
Danvers State Hospital, Hathorne
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 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.)
1
9 COLOR OR RACE
(write the word)
10a If married, widowed, or divorced
HUSBAND of
Bertha Gale
(Give maiden name of wife in full)
have occurred on the date stated above, at. 11:30 P INTERVAL BE- TWEEN ONSET AND DEATH
years
· 13 Usual
Occupation :
Retired Mailer
(Kind of work done during most of working life)
Years
PARENTS
-
RECEIVAS
TO:
AUG10
-
PLACE OF DEATH No.
Suffolk (County) Winthrop (City or Town)
66 Loring Road
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.
149
[(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME Harvey Elias Sleeper
(If deceased is a married, widowed or divorced woman, give also maiden name.)
66 Loring Road
. St.
60
(If nonresident, give city or town and State)
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
July 5, 1953
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
4 I HEREBY CERTIFY,
That I attended deceased from
11/8/50
19
to ..
7/5/53
19
I last saw himG ...
alive 007/5/53
19 death is said to have occurred on the date stated above, at 10: 25 am +NTERVAL BE- TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Carcinoma recto-
sigmoid junction.
ANTE
Due To
CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Adenocarcinoma of colon
Date of operation ...
14/11/50 Was autopsy performed?
no
What test confirmed diagnosis.
Pathological
no
5 Was disease or injury in any way related to occupation of deceased?
If so, spec
Syndie w. bushm
(Signed)
M. SD.
(Address)Canthrow mo-13
Winthro p
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
July 7
1953
7 NAME OF
FUNERAL DIRECTOR ..
Howend S Runabb
ADDRESS Colinanis mus
Received and filed 1. JUL 2 1953. 19
(Registrar)
C
11 IF STILLBORN, enter that fact here.
12
11/8/ 5 DAGE 76
Years
1
24
Months
Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation:
Accountant
(Kind of work done during most of working life)
14 Industry
or Business:
Boston Produce Exchange
15 Social Security No ...
023-10-6702A
16 BIRTHPLACE (City)
(State or country)
Maine
17 NAME OF
FATHER
George T Sleeper
PARENTS
18 BIRTHPLACE OF
FATHER (City)
South Thomaston
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Ella K Martin
20 BIRTHPLACE OF
South Thomaston
21 Lillie D Sleeper
Informant
(Address)
66 Loring Rd. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the Curjal or transit permit was issued: Walter &- Bakers
(Signature of Agent of Board of Health or other)
Health Oficer 7.7.53
(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 (B)-1-51 903586
R-301A 1
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
No
U. S. War Veteran,
( if so specify WAR)
(a) Residence. No.
(Usual place of abode)
40
Length of stay: In place of death
years ..
.months
days. In place of residence
.years
.months
days.
10a If married, widowed ...
Life D Bloomfield
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
South Thomaston
.Date W
6
1953
MOTHER (City)
(State or country)
Maine
Winthrop
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or officer furnishing a certificate of death as required by their 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 inher Men
1Ma undertaker or other persons shall bury a human body or the ashes thereof Thynich Have been brought into the commonwealth until he has received a permit soto dią from the board of health or its agent appointed to issue such permits, or if there Is no such board, from the elerk of the town where the body is to be buried engaged insert in the certificate a recital to that effect, specifying Theme, filingor thesmeral is to be held, or from a person appointed to have the care of the shall also certify in such certificate both the primary and the secondary cemetery or burial ground in which the interment is made. diate cause of death as nearly as he can state the same. For neglect toreply Chap. 114. Sec. 46, G. L., (Tercentenary Edition). with any provision of this section, such physician or officer, shall forfelt te dos For the purposes of this section and of sections forty-five, forty-six and f. 5 of said chapter one hundred and fourteen, the word "war" shall include RULES OF PRACTICE relief expedition and the Philippine insurrection, which shall, for said pict ASS. deemed to have taken place between February fourteenth, eighteen hundre THROP 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.
JUL -7
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 c rtifving 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).
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 Medical examiners shall make examination upon the view of the dead bodies chemical, thermal or electrical agents or following abortion, or from diseases „resulting from injury or infection relating to occupation, or suddenly when not of an undertaker or other authorized person or of any member of the famnfryroff: I of persons as are supposed to have died by violence, or by the action 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 frisabled 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.
or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
11.
be fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will eertify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any fun of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits ean 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
D
X
Suffolk
(County) Boston
(City or Town) Mass. General Hospital
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