USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1953 > Part 76
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17 NAME OF
FATHER
Peter Campbell
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Nova Scotia
19 MAIDEN NAME OF MOTHER Sarah Cosmon
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21
Informant.
(Address)
A Campbell
7 NAME OF
FUNERAL DIRECTOR
H Reynolds
Winthrop Mass
Received and filed.
NOV 16 142
19
(Registrar of City or Town where deceased resided)
8 SEX
M
9 COLOR OR RACE
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of.
Alice malen TOod wife in full)
(or) WIFE of.
(Husband's name in full)
Due To CEDENT (b) ...... coronary .... sclerosis CAUSES
40yrs
Due To (c) ...... general arterio.
OTHER
sclerosis
40yrs
SIGNIFICANT
Post-op ...... intestinal.
Major findings:
Expl. fapar
18HRotomy
Of operations. ·appendectomy
Date of operation.
11-1-53
What test confirmed diagnosis?
Was autopsy performed?
clinical
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed).
C. Clay
M. D.
(Address). MGH
Date.3.
195.3.
Woodlawn .... Com
Place of Burial or Cremation
Everett
(City or Town)
DATE OF BURIAL.
Nov 10
19.53
PARENTS
A TRUE COPY
ATTESTarles & Mackie
(Registrar of City or Town where death occurred)
DATE FILED
Nov 12
19.53
L
1
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).myocardial infarction
-10days
7days
25m-(b)-11-49-900,475
ANTE 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 CONDITIONS
x
....
No. . Mass .... General ... Hospital
ADDRESS.
1
.
6
HROB
NOV16 IM
R-301 1
PLACE OF DEATH
Suffol
(County)
Winthrop
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
(City or town making return)
STANDARD CERTIFICATE OF DEATH
Registered No.
246
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME Frederic H Everbeck
(If deceased is a married, widowed or divorced woman, give also maiden name.)
140 River Rd.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death 23 years.
months .. .days. In place of residence .. 2.3.years ....
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF November 7,
DEATH
(Month)
(Day)
1953
(Year)
8 SEX
Male
9 COLOR OR RACE
White
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDHarried
1
4 I HEREBY CERTIFY,
That I attended deceased from
18 lec 19.49
to 7 November 19.5.3.
I last saw him alive on.
7 November ,53, death is said to
10a If married, w
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE52
Years 6
Months.
14 Days
If under 24 hours
Hours ......
. Minutes
13 Usual
Occupation:
Fireman
retired
(Kind of work done during most of working life)
14 Industry
or Business:
Winthrop fire department
15 Social Security No ...
Lone
16 BIRTHPLACE (City) ........
(State or country)
Mass.
17 NAME OF
FATHER
Arthur Everbeck
18 BIRTHPLACE OF
FATHER (City).
East Boston
(State or country)
r.ass.
19 MAIDEN NAME
OF MOTHER
Ella Freeman
20 BIRTHPLACE OF
Albany
MOTHER (City)
(State or country)
New York
21 Florence & Everbeck
Informant. (Address) 140 Rover Rd. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter S. Hakrig Signature of Agent of Board of Health or other) Healthy Office 11.9.53
(Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
(Registrar)
PARENTS
M. D.
winthrop /
Minthron
(City or Town)
6 Place of Burial or Cremation
DATE OF BURIAL. Nov. 10
19.5.1
7 NAME OF
FUNERAL DIRECTOR
Howard SO Funnell
ADDRESS
Winthrop mw.
Received and filed.
NOV10 1953
......
19
1 yr
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Myocardial Infantion
4 yrs
Major findings:
Of operations.
Date of operation
Was autopsy performed? 200 What test confirmed diagnosis? clinical-
TWEEN OHSET AND DEATH 2 hrs.
have occurred on the date stated above, at 3:50 A. m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADINO
TO DEATH (a)
Cerebral Hemorrhage
ANTE Cerebral Arteriosclerosis.
CEDENT (b) CAUSES
TIONS R ERTIFICATE
ving DEATH enter an one r each and (c)
es not mean dying, such e, asthenia, -> the disease, ions which
conditions, rise to the (a) stating ing cause
os contrib- ath but not disease or sing death.
50M .(A)-11-51-905807
No. .
(City or Town) 140 River Rd.
(a) Residence. No. (Usual place of abode)
(Was deceased a U. S. War Veteran, if so specify WAR)
no
L
East Boston
5 Was disease or injury in any way related to occupation of deceased ?.
MO
If so, specify the COmurray
(Signed)
Winthrop Mass Date 7 0nov
.19.5.3 ..
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 seven- teen. 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 heen 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 hy 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 registration. 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 only such persons as are supposed to have died by violence. If a medical examiner has notice that there is within his county the body of such a person, he shall forthwith go. to the place where the body lies and take charge of the same; . . General Laws, Chap. 38, Sec. 6.
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 clerk of the town where the body is to be · huried 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 following rules of 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 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 wben the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposahly 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, hut also deaths from disease resulting from injury or infection related to occupa- tion, 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
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
No.
54 Spafoam 4Vunuc
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. 247
2 FULL NAME Alexander L. Friedman
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 54 Beafvan Avenue
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
7
7
.years
months.
days. In place of residence
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
.ale
9 COLOR OR RACE
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCED Married
4 I HEREBY CERTIFY,
That I attended deceased from
July
1947
to
200.7
1953
I Cast saw
holly alive on.
Horaember 6, 1953, death is said to
5:30 A.m.
have occurred on the date stated above, at.
INTERVAL BE-
TWEEN ONSET
DISEASE OR CONDITION
DIRECTLY
DÍ elias dufonction
AND DEATH
11 IF STILLBORN, enter that fact here.
TO DEATH (a).
2 days
12
AGE
72
Years
Months.
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation:
Operator
(retired)
(Kind of work done during most of working life)
14 Industry
or Business:
otion Pictures
15 Social Security No.
XXXXXXXX NewYork, .... N.Y.
16 BIRTHPLACE (City).
(State or country)
17 NAME OF
FATHER
Juba Frid sn
18 BIRTHPLACE OF
FATHER (City) (State or country) Poland
19 MAIDEN NAME
OF MOTHER
Carch Solomon
20 BIRTHPLACE OF MOTHER (City) (State or country) England
21 Informanter Iu Erick (Address) ~ ~ VI Jaui . t., Info.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial br transit permit was issued:
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
ICTIONS OR ERTIFICATE
iving F DEATH t enter han one or each )and (c)
pes not mean dying, such re, 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.
OTHER
SIGNIFICANT
Quemrysun of liff eventuale 3 yrs.
CONDITIONSExpysnoO
Major findings:
Of operations.
Date of operation
What test confirmed diagnosis?
Was autopsy performed?
Clinical + lab.
5 Was disease or injury in any way related to occupation of deceased? 200
If So, specif findes Liberman
(Signed)
(Address) 238 Shone Drive Writese 11/7/ 1953
M. D.
6 Hand in Hand,Gat 20 xfar Place of Burial or Cremation (City of Town)
DATE OF BURIAL vember 5, .19 .....
7 NAME OF
FUNERAL DIRECTOR ..
Banj. 7. Solor now.
1
ADDRESS
450 Farvaru St., ar, Online.
Received and filed. NOV 10 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
no.
U. S. War Veteran,
if so specify WAR)
-
3 DATE OF
DEATH
200.
2
1953
(Year)
(Month) (Day)
10a If married, widowed, or divorced
HUSBAND of.
Raa.Kaufman
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
ANTE
Due To hypertension
CEDENT (b)
CAUSES
15 yrs.
Due To (c)
SOM-5-52-907046
M.S
PARENTS
Registered No.
(Usual place of abode)
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 belicf the name of the deceased, his supposed age, the disease of which he dicd, 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 ninctcen hundred and seventcen. 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 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, See.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 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).
RULES OF PRACTICE
The fulfilment of the purpose of these laws calls for the observance of the follow- ing rules of 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 fron disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deathsonly 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
R-301A 1
PLACE OF DEATH
X Suffolk (County ) Winthrop (City or Town) 209 Somerset ave No.
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.
248.
Margaret f. Love 2 FULL NAME.
PHYSICIAN - IMPORTANT
-
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death 10 .years. months. days. In place of residence.
10 years
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
10 1953 (Year)
8 SEX
7.
9 COLOR OR RACE
20.
10 SINGLE
MARRIED
WIDOWED
bingle
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
2 Day
12
59.
Months.
Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Spinner (Kind of work done during most of working life)
14 Industry
or Business:
Cotton Apill
15 Social Security No. 024-07-2232
16 BIRTHPLACE (City). (State or country) East Boston Mars
17 NAME OF
FATHER
James L. Love
18 BIRTHPLACE OF FATHER (City) (State or country)
freland
19 MAIDEN NAME OF MOTHER Margaret Stuart
20 BIRTHPLACE OF MOTHER (City) (State or country)
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