Town of Winthrop : Record of Deaths 1953, Part 59

Author: Winthrop (Mass.)
Publication date: 1953
Publisher:
Number of Pages: 600

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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 nbtained 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 nf the dead bodies of petsdps 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. nr suddenly when not disabled-by recognizable disease, or when any person is found dead. . - General Laws, Chup. /38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.

· Xo 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 such board, from the clerk of the town where the body is to be buried or the (pneist is to be held, or from a person appointed to have the care of the cemetery it burial ground in which the interment is made.

Chap. 11,4. Seg. 46, G. L., (Tercentenary Edition).

RULES OF PRACTICE

fruitment of the purpose of these laws calls for the observance of the follow- ing rules id practice: (1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated

AUG337

fard 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 can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT

SERVICE NUMBER

DH-VS-5a-15M-52

1. FULL NAME OF DECEASED (First)

Irving

(Middle)

(none)

(Last)

2. DATE OF DEATH

(Month)

(Day)

(Year)

August 28, 1953

3. PLACE OF DEATH

a. COUNTY

Orange

4. USUAL RESIDENCE (If institution-residence before admission)

a. STATE

Massachusetts

Suffolk

b. COUNTY

c. CITY OR TOWN (If rural, please state)

Winthrop

d. STREET ADDRESS (If rural, give R. F. D. number)

d. NAME OF HOSPITAL OR INSTITUTION (If not in hos- pital, give street address)

Gifford Memorial Hospital, Inc.

12 Seafoam Avenue

5. SEX

Male

6. COLOR OR RACE | 7. MARITAL STATUS

(Check one)

S M

W D

8. DATE OF BIRTH

Unknown

9. AGE (In years

last birthday)

unknown

If under 1 year

Months

Days

If under 24 hrs.

Hours

Mins.

10a. USUAL OCCUPATION (Kind of work done most of working life)

10b. BUSINESS OR

INDUSTRY

Chemistry

11. BIRTHPLACE

Winthrop,

Mass.

12. CITIZEN OF WHAT

COUNTRY ?

USA.

13. FATHER'S NAME

Aaron Osvar

15. MOTHER'S MAIDEN NAME

Rose Kachelnick

Russia

17. WAS DECEASED EVER IN U. S. ARMED FORCES? | 18. SOCIAL

(Yes, no, unknown) | (Give war & dates of service)

Unknown

SECURITY NO.

Unknown

19. INFORMANT'S NAME (Person giving this information) Arthur R. Jones for Aaron Osvar

Medical Certification

DURATION

DUE TO

(b) Probable fractured skull

DUE TO (c)

II. OTHER SIGNIFICANT CONDITIONS (Contributing to the death but not related to disease or condition causing it)

21. DATE OF OPERATION | 21a. MAJOR FINDINGS OF OPERATION

22. AUTOPSY

Yes

23a. ACCIDENT, SUICIDE,

HOMICIDE (Specify)

Accident

23b. PLACE OF INJURY (In home, farm, factory,

street, etc.)

23c. CITY OR TOWN

COUNTY

STATE

Warren, Washington Co., Vermont

23d. TIME OF INJURY (Month, day, year) (hour) 8-28-1953; About3:30₽

23e. INJURY OCCURRED

While at work

Not at work

23f. HOW DID INJURY OCCUR?

Climbed to edge of waterfall and fell

from edge.

8-28- 19 53, to

8-28- 19 53, that I last saw deceased alive on 8-28- 19.53

24. I hereby certify that 7ª10ªpende

and that death occurred at m, from the cause and on the date stated above.

25a. SIGNATURE /s/ Wilmer W. Angell,

(Degree or Title)

M.D.

25b. ADDRESS

Randolph, Vt.

25c. DATE SIGNED

8-29-1953

26a. BURIAL, CREMA- TION, REMOVAL (Specify) Burial

26b. DATE

Aug. 30, 195B

26c. NAME OF CEMETERY OR CREMATORY StaRow_Memorial Park .Beth Isreal

26d. LOCATION (Town or County)

thaRow

Everett,

Massachusetts.

27. DATE REC'D BY

28. CLERK'S SIGNATURE

29. FUNERAL DIRECTOR'S SIGNATURE ADDRESS

TOWN OR CITY CLERK -09-1052 SEPT. 3. -1953

Hyman J. Torf.

Chelsea. Mass. sea.

20.

I. DISEASE OR CONDITION DIRECTLY LEAD- ING TO DEATH. This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury or complications which caused death.

ANTECEDENT CAUSES. Morbid conditions, if any, giving rise to the above cause (a) stating the under- lying cause last.

16. MOTHER'S BIRTHPLACE

(Town)

(State or Country)

14. FATHER'S BIRTHPLACE (Town)

Russia

(State or Country)

Osvar

Certificate No. 190

STATE OF VERMONT

cept write fading ord.

ball

b. CITY OR TOWN (If rural,

please state)

Randolph

c. LENGTH OF STAY (In

this place)

55 minutes

white

Professor

t be in. id cause [c). t of very

attended the deceased from

(State)

At waterfall in country

(a) Multiple injuries Ribs, Rt. Elbow

State definitely the cause of death.

Avoid as far as possible all terms classified as "causes ill-defined."

When any item called for cannot be obtained fill in the blank space "unknown."

Write the name of deceased in full; initials only are not acceptable.

EXTRACTS FROM THE PUBLIC LAWS OF VERMONT

Certificate furnished family ; burial permit. The physician, or person filling out the certificate of death, within thirty-six hours after death, shall deliver the same to the family of the deceased, if any, or to the undertaker or per- son who has charge of the body ; and such certificate shall be filed with the person issuing the certificate of permission for burial, entombment or removal obtained by the person who has charge of the body, before such dead body shall be buried, entombed or removed from the towny WHen such certificate of death is so filed, such officer or person shall immediately issue a certificate of permission for burial, entombment or removal of the dead body under legal restrictions and safeguards.

Unauthorized burial or removal; penalty. A person who buries, entombs, transports or removes the dead body of a human being without the certificate of permission so to do, or in any other manner or at any other time or place than as specified in such certificate, shall be imprisoned not more than one year or fined not more than five hundred dollars nor less than ten dollars, or both.

Use separate form for filing fetal deaths (stillbirths).

These forms may be obtained from the State Health Department, Burlington.

I hereby certify that the foregoing is a true copy. RANDOLPH TOWN CLERK'S OFFICE

Sept. 1, 1953

(Town or City Clerk)

DUTY OF TOWN CLERK Vermont Statutes, Revision of 1951

Sec. 219. On the first day of each month, he shall make a certified copy of all births, marriages and deaths filed in his office during the preceding month, except births of illegitimate children, whenever the parents of a child born, or a bride or a groom or a deceased person was a resident in any other town at the time of such birth, marriage or death, and shall transmit such certified copy to the clerk of such other town who shall file the same.

PLACE OF DEATH

Suffolk (County)

Winthrop. (City or Town)

The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

To be filed for burial permit with Board of Health or its Agent.

Registered No. 1.91

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.

(Usual place of abode)

Length of stay: In place of death.

years.

months.

days. In place of residence

St.

(If nonresident, give city or town and State)

.years

.months

.days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF

DEATH

August 29 1953.

(Month)

(Day)

(Year)

4 I HEREBY CERTIFY,

That I attended deceased from

I last saw h

alive on

., death is said to

have occurred on the date stated above, at

INTERVAL BE- TWEEN ONSET AND DEATH

DISEASE OR CONDITION

DIRECTLY LEADING

DI Natural Causes

TO DEATH (a)

Herumably due to

ANTE

CEDENT (b)

CAUSES

Cerebral hemorrhage

Due To (c)

OTHER SIGNIFICANT CONDITIONS

Major findings:

Of operations,

Date of operation.

.Was autopsy performed?

What test confirmed diagnosis?

Clinical.

5 Was disease or injury in any way related to occupation of deceased

If so, specify

leadles Fiberway.

Winthrop Boardof Headrate 8/29/1953 Winthrop

Place of Burial or Cremation (City of Town)

DATE OF BURIAL

Sept

153

7 NAME OF

FUNERAL DIRECTOR ..

Winthrop Mass

Received and filed.

August 31. 1954

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Male

9 COLOR OR RACE

White

10 SINGLE

MARRIED

WIDOWED

or DIVORCEbdowed

(write the word)

10a If married, widowed, or diygreed Eddy

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

AGE

.8.3Years

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:

Hotel

15 Social Security No ..

16 BIRTHPLACE (City)

(State or country)

Nova Scotia

17 NAME OF

FATHER

John Gillis

18 BIRTHPLACE OF

FATHER (City)

(State or country)

Nova Scotia

19 MAIDEN NAME OF MOTHER Margaret

20 BIRTHPLACE OF

MOTHER (City)

(State or country)

Nova Scotia

Informant

(Address)

Mary .Ta

.. Gillis

83 Waldemar Ave Winthrop

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: walter 6. Raken

HiO

(Signature of Ass

Efter Board of Health or other)

Lug. 31 -1953

(Official Designation)

(Date of Issue of Permit)

TIONS RTIFICATE ing DEATH enter n one each and (c)

s not mean ying, such e, asthenia, the disease, ons which

onditions, rise to the a) stating ng cause

s contrib- th but not disease or ing death.

S 50M-10-52-908091

29. 5.

R-301A 1

83 Waldemar Ave. No.

John W. Gillis

2 FULL NAME ..

(If deceased is a married, widowed or divorced woman, give also maiden name.)

83 Waldemar Ave.

thay.

PARENTS

6 Winthrop

Phu. Otcalee

ADDRESS

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. THROP. 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 andAtlas of practicey

ninety-eight and July fourth, ninetren hundred and two, and the Mexican border service of nineteen hundred and sixteen and nincteen 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 hody which has not been buried, until he has received a permit from the hoard 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 hoard, 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 he 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 he 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:, {Tertentenary Edition).

Medical examiners shall make examination upon the view of the dead bodies of persons/ as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases ¿resulting from injury or infection relating to occupation, or suddenly when not . disabled by 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 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 derk 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).

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the follow-

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health physicians will certify to such 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.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE RANK, RATING. ORGANIZATION AND OUTFIT

SERVICE NUMBER

COPY OF CERTIFICATE OF DEATH

CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE

TOWN OR CITY

192

CLERK'S NO

1. NAME OF

DECEASED

(Type or Print)

Norma

a. (First)

b. (Middle)

c. (Last)

(Month)

(Day)

(Year)

2. DATE

DEATH

Aug. 16.

1953

3. PLACE OF DEATH

a. COUNTY

Belknap

4. USUAL RESIDENCE (Where deceased lived. If institution: resid-

a. STATE

Mass.

ence before admission).

b. COUNTY

Suffolk

b. CITY

TOWN

Lacon1

c. LENGTH OF

STAY (in this place)

few hours

c. CITY (Give actual town of residence, NOT mailing address).

-TOWN Winthrop

d. FULL NAME OF (if not in hospital or institution, give street address or location)

HOSPITAL OR

NSTITUTION

d. STREET

(If rural, give location)

ADDRESS

286 Revere Street

5. SEX

Female

6. COLOR OR RACE |7. MARRIED, NEVER MARRIED,

White

8. DATE OF BIRTH

4-28-1940

9. AGE (In years

last birthday)

IF UNDER 1 YEAR Months

Days

IF UNDER 24 HRS . Hours Min.

10a. USUAL OCCUPATION (Kind of work

done during most of working life, even if retired)

student

10b. KIND OF BUSINESS OR IN-

DUSTRY

11. BIRTHPLACE (State or foreign country)

Winthrop Mass.

12. CITIZEN OF WHAT

COUNTRY?

U.S.A.

13. FATHER'S NAME

Frank W. Meharg

14. MOTHER'S MAIDEN NAME

Gertrude Crosby

MEDICAL CERTIFICATION

Meningoovei meningitis cerebral type

INTERVAL BETWEEN

ONSET AND DEATH

36 hours

II. OTHER SIGNIFICANT CONDITIONS

Conditions contributing to the death but not

related to the disease or condition causing it.

Diabetes Mellitus

15 hrs

19a. DATE OF OPERA- 19b. MAJOR FINDINGS OF OPERATION

TION

21a. ACCIDENT

SUICIDE

HOMICIDE

(Specify)

21b. PLACE OF INJURY (e.g., in or about

home, farm, factory, street, office bldg., etc.)

21c. (CITY OR TOWN)

(COUNTY)

(STATE)

21d. TIME

(Month) (Day) (Year) [Hour)

INJURY

21e. INJURY OCCURRED

WHILE AT

WORK

NOT WHILE

AT WORK

22. I hereby certify that I attended the deceased from A.u.g.

alive on Aug .16, 19

Send that death occurred at

16 153 Aug. 16, 1953, that I last saw the deceased

6-30ml from the causes and on the date stated above.

23a. SIGNATURE

James S. Jessup

M.D.

23b. ADDRESS

23c. DATE SIGNED

724 Main St.Laconia N.H

8/16/53

24a. BURIAL. CREMATION,

24b. DATE

ENTOMBMENI, REMOVAL

removal& burdal 8/18/53

24c. NAMEOF CEMETERY OR CREMATORY 24d. LOCATION (City, town, or county ) [State)

Winthrop Cemetery

Winthrop Mass.

IF ENTOMBED

24e. PLACE OF BURIAL

( Name of Cemetery)

LOCATION (City, Town, County)

(State)

DATE

25. FUNERAL DIRECTOR

Howard Reynolds , Winthrop Mass.

ADDRESS

COUNTERSIGNED - AGENT (City Bd. of Health)

Arthur E. Simoneau

DATE

8/16/53

DATE REC'D BY TOWN OR CITY CLERK

Aug. 31 1953

CLERK'S OWN SIGNATURE

Chas.E.Lord

CLERK OF

Laconi a N.H.

A true copy, Attest:

flas 6 Ford

Clerk of ..

Laconi a N.H . Dated

Sept. 149 53

V. S. 17

1-53-50M

1953"

16. SOCIAL SECURITY 17. INFORMANT

NO.

15. WAS DECEASED EVER IN U. S. ARMED FORCES?

(Yes, no, or unknown) | (If yes, give war or dates of service)

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Town of Winthrop : Record of Deaths 1953, Part 59

Author: Winthrop (Mass.) Publication date: 1953 Publisher: Number of Pages: 600

Author: Winthrop (Mass.)
Publication date: 1953
Publisher:
Number of Pages: 600