USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 5
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DATE FILED
January
26,
19
53
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
RALPH MCCARTHY
M. D.
(Address) Peabody, Mass. Date]/16/1953
7
Cedar Grove Cen.
Durchoster
Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL January 24.
53
8 NAME OF
FUNERAL DIRECTOR Marjorie Johnson
ADDRESS Roxbury ..... Mass ..
Received and filed. FEB 19 1553 19
25m-(c)-11-49-900.475
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)
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed?
10 COLOR OR RACE
(write the word)
3 DATE OF
DEATH
Pharyngitis
Bronchopneumonia
(Usual place of abode)
Registered No.
M R-305 1
No. Danvorstate Hospital, Hathorne
12
6
FEB10
R-302 1
T.
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.)
PLACE OF DEATH
SUFFOLK BOSquTYNN
(City or Town)
Veterans Administration Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
604
15
§(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
CHARLES E BURRILL
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
WW I
Winthropfy WARIs.S.
St.
(If nonresident, give city or town and State)
life
days. In place of residence.
........... years.
.months.
... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M-
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a
If married, w
Puntired Allen
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
1
65
Months.
13
Days
If under 24 hours
Hours.
Minutes
Supt. - water Dept.
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
Winthrop,
Mass.
15 Social Security No.
winthrop , Mass.
17 NAME OF
FATHER
Frank Burrill
winthrop,
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
19 MAIDEN NAME
OF MOTHER
Hannah Mann
20 BIRTHPLACE OF
MOTHER (City)
Maine
Surrey
V À Hospital Records
Informant.
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Jan 22
.19 ..
53
......
(Registrar of City or Town where deceased resided)
PARENTS
Date
1/19, 53
M.
winthrop,
Mass.
(State or country)
5/3 21
7 NAME OF
FUNERAL DIRECTOR
A Marsh
ADDRESS
Winthrop Mass.
Received and filed
ALB 1 6 1:53
19
25M.(B) -11-51-905807
No.
2 FULL NAME.
365 Winthro p
(a) Residence. No.
(Usual place of abode)
2
months
9
Length of stay: In place of death.
.years
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
18
1953
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
11/9
19
5.2
to
1/18
19
I last saw h
.alive on
19.
death is said to
have occurred on the date stated above, at.
9:00p.
m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ....
hepatic coma
ANTE
CEDENT (b)
Due To
cirrhosis
CAUSES
post-infectious
yrs.
Due To
(c)
gastro-intestinal
hemorrhage
days
OTHER
SIGNIFICANT
esophageal varices
yrs.
Major findings:
Of operations
porto-caval anastomosis
Date of operation
1/10/53,
autopsy performed ?.
yes
What test confirmed diagnosis ?.
autopsy
5 Was disease or injury in any way related to occupation of deceased?
no
If so, specify.
(Signed)
H Achenbach
(Address)
VAH.
6
Winthrop Cem.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Jan .21
19
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,
CONDITIONS
bronchial pneumonia days
INTERVAL BE- TWEEN ONSET AND DEATH hrs.
ThatVà attended deceased
from
53
HUSBAND of
(Give maiden name of wife in full)
16 BIRTHPLACE (City)
(State or country)
DATE OF ENTERING MILITARY SERVICE - 5/24/17 DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
4/28/19 Pvt Mach Gun Co 101st Infantry 62880
1.
0
FEB1G PM
CONNECTICUT STATE DEPARTMENT OF HEALTH Bureau of Vital Statistics - Hartford, Connecticut, U. S. A.
Certificate of Death
1 PLACE OF DEATH:
New Haven
( ) State of Connecticut: (b) County.
Boat - "Thomas H. Teti"
(If not in hospital give street no. or location) (e) Name of Hospital New Haven Hospital or I titution
8. NAME O
(First)
(Middle)
D CEAS D
Type or pri t) George
PERSONAL AND STATISTICAL PARTICULARS
5. SEX M
6. RACE wh
MARRIED, OSOB
S. IF MARRIED. WIDOWED OR DIVORCED, GIVE MAIDEN NAME OF WIFE OR HUSBAND
Ann J. Brogan (Day)
(Month)
9. DATE OF DEATII JAN
20
(Year)
153
10. DATE OF BIRTH
AGE (in years last birthday)
If under 1 year
If under 1 day
3/31/97 55
11. BIRTHPLACE (City or town)
(State or foreign country)
wast Boston Mass
12. (a) USUAL OCCUPATION (Give kind of work done during most of working life even if retired) Inspector U. S. A. Engineer (b) Industry or Business
U. S. Army
13. (a) WAS DECEASED A VETERAN? Yes or No
(b) If yes, Hive-wat. 45 Army Corps of Engineers Unit or Ship
FATHER
14. NAME Frederick Adams
(City or town) (State or foreign country)
15. BIRTIIPLACE St. John New Brunswick
MOTHER
16. NAME
MAIDEN Elizabeth Dunn (City or town) (State or foreign country)
17. BIRTIIPLACE East Boston Mass.
18. INFORMANT'S NAME
John F. O'Maley (Funeral Director)
19. BURIAL, CREMATION OR REMOVAL Date.
Jon. 24 10 53
Cemetery or Crematory_ winthrop Place Winthrop , Mass.
20. NAME OF EMBALMER IF BODY WAS EMBALMED Edvard L. M~Dermott
1410
21. SIGNATURE OF LICENSED EMBALMER OR LICENSED FLYERAL DIRECTOR Keenan Funeral Home Marylose Fueran
Address 06 H ward' Ave. New Haven, Conn.
THIS CERTIFICATE RECEIVED FOR RE, ORD ON
JAN 21 1953
BY
Last)
Adams
MEDICAL CERTIFICATION
22, CAUSE OF DEATH (Enter only bue cause per line for (a). (b) (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 DEATH
arteri Heart Disease
ANTECEDENT CAUSES. Morbid conditions, if any, giving rise to the above cause (a) staling the underlying cause last.
DUE (b) TO. io
ris
DUE (C) TO. ...
23. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing death
24. OPERATION, DATE AND MAJOR FINDINGS
AUTOPSY (Yes or No)
25. IF DEATH WAS DUE TO EXTERNAL CAUSES, FILL IN THE FOLLOWING: (b) Date of occurrence
(a) Accident, suicide. homicide (specify)
(c) City or Town and State Where injury occured
(d) Did injury occur in or about home. factory. (e) While at work?
farm, office, street, etc .?.
(f) How did it occur?
26. I HEREBY CERTIFY, That I attended the deceased from
that I look now the deceased ative on
and that death is said to have occurred on
1/20133 9:30R
27. SIGNATURE OF PHYSICIAN terling
Ceylon
Address 1/4/53
REGISTRAR Audru- Carolina
Registrar.
Andrew Gasolina I certify that this is a true copy of the certificate received for record. --
Attest :
Form VS-4 (5-60)30M
2. USUAL RESIDENCE OF DECEASED
State- MASS
(b) County
(dy Lon th of stay in town c) Town) winthrop
() (City or Buthigh)
(e) Street Number
(If rural, give location) 209 River Road
4. SOCIAL SECURITY NUMBER
Months | Days
Hours | Mins.
Active Service
License number
COPY
6
FEB1Q
"This copy of Certificate received for record at
4his day of
Registrar"
M R-302 1
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,
25M-(B)-11-51-905807
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or town making return)
675
17
Registered No.
J(If death occurred in a hospital or institution,
St. \ give its NAME instead of street and number)
2 FULL NAME
(If deceased is a morneuedat wead) andi
woman, give also maiden name.)
(a) Residence.
No.
(Usual place of abode)
122 Washington.Ave.
Length of stay: In place of death.
.years.
months .... ] ... days. In place of residence ...
23
.. years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
Jan/26/53
(Year)
4 I HEREBY CERTIFY.
That
I attended deceased from
Jan/13"
19.
53
to
Jan. 21
...
19.
53
I last saw h
.. alive on
er
Jan/21 ...... 19.5.3, death is said to
have occurred on the date stated above, at ...
.. m.
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGBIS
Years
Months.
Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation:
Housework
(Kind of work done during most of working life)
14 Industry
or Business:
At Home
15 Social Security No.
None
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Israel Kaplan
18 BIRTHPLACE OF
FATHER (City)
Russia
(State or country)
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
Russia
(State or country)
6
Place of Burial of Chel Jacob Woburn Mass City of Town)
DATE OF BURIAL
Jan 23/53
19
7 NAME OF
FUNERAL DIRECTOR
B Birbach
ADDRESS
Dorchester Mars
19
Received and filed
REB 1 6 1953
(Registrar of City or Town where deceased resided)
8 SEX
F
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Ldowed
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Louis Solomon
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Intra abdominal
neoplasm
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Arteriosclerotic
cardio vasc.disease
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?
No
If so, specify
(Signed).
J. F .Griffin
M. D.
(Address)
Jewish tiem finan Date
1-21
53.
21
Informant
(Address)
Myer Krim
TRUE COPY Les
ATTEST:
(Registrar of City or Town where death occurred)
Jan.26/53
DATE FILED
.19 ...
Boston
(City or Town)
No.
Jewish "Smorial Hospt.
St.
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
and State )
PARENTS
1
6
FEBİG PM
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-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
X
PLACE OF DEATH
SUFFOLK (County) BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return)
875 18 ....
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
2 FULL NAME
Christopher Molloy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
(Usual place of abode)
465 Winthrop
St.
Winthrop Masa
(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
9 SEX
M
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
11a If married, widowed, or divorced
HUSBAND of.
Maria .. Lennon
(or) WIFE of.
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 82
... Years
Months.
Days
If under 24 hours
Hours.
Minutes
14 Usual
Occupation :.
Retired ... U ... S .Army ..
(Kind of work done during most of working life)
15 Industry
or Business:
16 Social Security No.
None
17 BIRTHPLACE (City)
(State or country)
Ireland
18 NAME OF FATHER Andrew Molloy
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
20 MAIDEN NAME
OF MOTHER
Ann Heavey
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
(Address) Date .... ]-27 ...... 19.53
7
St Joseph's Boston Mass.
Place of Burial, or Cremation.
(City or Town)
.
DATE OF BURIAL
Jan.29/53
19
8 NAME OF
FUNERAL DIRECTOR
J ........ OMaley ..
ADDRESS
Winthrop Massi
Received and filed.
FEB 241:00
19
(Registrar of City or Town where deceased resided)
(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.) Generalized arteriosclerosis
prostatiam ....
pyelonephritis
fracture of hip accidental
fall on sidewalk at Winthrop
5 Accident, suicide, or homicide (specify)
Date and hour of injury
12-29-52
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?
Manner of
(Specify type of place)
Injury
(How did injury occur?)
Nature of
Injury
While at work?
Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased? ...
If so, specify.
(Signed)
Richard Ford
M. D.
PARENTS
22
Informant
(Address)
Anna Foley ...... Daughte
A TRUE COPY.
ATTESTAViles H. Mackie
(Registrar of City or Town where death occurred)
Jan. 29/53
DATE FILED 19
(write the word)
3 DATE OF
DEATH
(Month)
Jan.26/53
(Day)
Veteran's Adm.Hospt.
No.
M R-305 -
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
Spanish
... World .f ....
(Give maiden name of wife in full)
1 %?
6
FEB24
Entered Service 11-15-1913 Discharged 11-14-1920 Sgt. C.A.C. U S Army Service No. 14:8608
1
X
SUFFOLK
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
METON
(City or town making return)
Registered No.
844
19
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
RALPH P WOOD
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
22Siren
St.
winthrop. ..... Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death.
......
ears ............ month&
....... days. In place of residence ...
....... years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Monanuary
(Day
27
1953
8 SEX
M
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4I HEREBY CERTIFY.
That we attended pdeceased from
1/27 19. ... to
1/27
153
I last saw h
........
.. alive on
19
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)
have occurred on the date stated above, at ... 1.2:30p .m.
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) ... myocardial infarction
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.55 ... Years ... 5.
... Months1.3
... Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation :A.denworkdone during most of working life)
14 Industry
Sharpe & Dohme Inc.
15 Social Security No028-12-6361
16 BIRTHPLACE (City).
(State or country)
Everett, jass.
17 NAME OF
FATHER
George H Wood
18 BIRTHPLACE OF
FATHER (City)
East Boston
(State or country)
Nass.
19 MAIDEN NAME
OF MOTHER
Susan G Pierce
20 BIRTHPLACE OF
MOTHER (City)
Everett
(State or country)
Mass
21 Informant. Sister
(Address)
A TRUE COPY
3
ack
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed.
FED 1 6. 153
.19
(Registrar of City or Town where deceased resided)
hrs
Due To
ANTE
CEDENT (b)
CAUSES
"pulmonary congestion
edoma
Lahrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
. Was autopsy performed?
What test confirmed diagnosis?
autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
(Signed)
(Address)
MW O' Connell
M. D.
Date. 1/28-19-53
6 pR&d biliard Cremation Evaratt, Mass
DATE OF BURIAL
Jan 30 153
7 NAME OF
FUNERAL DIRECTOR
J & Henderson Co
ADDRESS. EverettWass
DATE FILED
Jan 30
19
53
25M-(B)-11-51-905807
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city of 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,
M R-302 1
T.
PLACE OF DEATH
Boston City Hospital No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
(write the word)
PARENTS
6
FEB1C
50M-(D)-6-51-904917
PLACE OF DEATH
Suffolk (County) Tinthrop (City or Town) 4 Paine Street
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.
20
Registered No.
j (If death occurred in a hospital or institution, . St. [ give its NAME instead of street and number)
2 FULL NAME
Mary V. McGillicudy
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 Paine Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ...... years. months. days. In place of residence 55 .years .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
female
9 GPLORIOR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That I attended deceased from
October 16. 1952
to
February 2
1953
I last saw h
alive on
February 2, 1953, death is said to
have occurred on the date stated above, at.
11:06 P
m.
DISEASE OR CONDITION DIRECTLY LEADING
TO DEATH
(a)
Metastatic Caranoin
abdminal
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Metastatic adenocarcinoma
Date of operation
Dec 2 1952 Was autopsy performed?
no
What test confirmed diagnosis ?.
Biopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ..
(Signed)
(Address) 197 Woodse de Gre
Dorothy
neu appleton
M. D.
Date Feb 3
1953
6
St. Paul's
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. February 5 1953
7 NAME OF FUNERAL DIRECTOR
ADDRESS
Winthrop Mass
FEB & 1953
19
Received and filed
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
Mass
19 MAIDEN NAME
OF MOTHER
Catherine Conley
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Mass
21
Informant
Annie McGillicuay
(Address)
4 Paine Street
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter A. Lakers (Signature of Agent of Board of Health of other)
Health Officer
31-4-53
(Oficial Designation)
(Date of Issue of Permit)
Rev.I.
M R-301A 1
T.
TRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH not enter e than one e for each , (b) and (c)
's does not mean e of dying, such failure, asthenia, eans the disease, lications which eath.
bid conditions. iving rise to the use (a) stating derlying cause
ditions contrib- the death but not o the disease or causing death.
15 Social Security No ... Boston
16 BIRTHPLACE (City).
(State or country)
Mass.
17 NAME OF
FATHER
Daniel E.McGillicudy
11 IF STILLBORN, enter that fact here.
12
AGE
70
Years
Months.
Days
If under 24 hours
Hours .. .. Minutes
13 Usual
Occupation : Retired ... Supervisor.
(Kind of work done during most of working life)
14 Industry
or Business:
Court House
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
INTERVAL BE-
TWEEN ONSET
AND DEATH
3 -mo.
3 DATE OF
DEATH
February 2, 1953.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
No.
Arlington
V
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 hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nincteen 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 heen 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 transinit 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. 4.5. G. L., (Tercentenary Edition).
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