USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 17
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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 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 fulfillment 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 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.
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.
PACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
ANK, RATING ORGANIZATION AND OUTFIT.
ERVICE NUMBER
NORFOLK
(County) PROOKLINE
(City or Town)
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS
COPY OF CERTIFICATE OF DEATH
Registered No.
124
50
No. Brentwood Convalescent Home
f(If death occurred in a hospital or institution.
St. [ give its NAME instead of street and number)
2 FULL NAME
Minetta F. Griggs
(If deceased is a married, widowed or divorced woman, give also maiden name.)
21 Harbor View Avenue
St.
Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months ..
14 days.
In place of residence
60
.. years
months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
George Griggs
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
81
Years
6
Months
27
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :.
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :..
Own home
15 Social Security No ......... no.ne
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF FATHER Cannot be learned
18 BIRTHPLACE OF
FATHER (City).
(State or country) Cannot be learned
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Cannot be learned
etts
21
Informant
Edward S. Coombs
(Address)
70 Salem St., Malden, Mass.
7 NAME OF
FUNERAL DIRECTOR. Alfred ... B ..... Marsh
ADDRESS
174 Winthrop St., Winthrop, Mass.
Received and filed.
MAN 16
19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased ?. ..... no
(Address).
Brookline, Mass
Date Feb. 12" 19 54
6 Evergreen Cemetery ,.Brighton Massachus Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
February 15
19.51
A TRUE COPY
ATTEST:
(Registrar of-City or Town where death occurred)
DATE FILED
February 18
1954
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
50m-(e)-10-48-24658
m.S.
PLACE OF DEATH
M R-302 1
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February.
12
1951
(Month)
(Day)
(Year)
19
have occurred on the date stated above, at .
1:10 8.
.. m.
DISEASE OR CONDITION
DIRECTLY LEADING
Coronary Artery Disease
TO DEATH (a)
with heart failure
CEDENT (b)
CAUSES
Due To
Arteriosclerosis and
(c)
Senility
OTHER
SIGNIFICANT
Malnutrition
CONDITIONS
Major findings:
Of operations
Date of operation
What test confirmed diagnosis?
Electrocardiogram
If so, specify
A W-Contratto
(Signed)
1180 Beacon St
WRITE THAINET, WITH VERTALING BLACK IAN - THIS DAPERMANENT RECORD
ANTE
Due To
Coronary Artery Disease
4 I HEREBY CERTIFY,
That I attended deceased from
April
52
to
February 12
19
54
I last saw h .......... alive on
February 11 1954, death is said to
INTERVAL BE-
TWEEN ONSET
AND DEATH
3 wks
4 yrs
10 yrs
4 mos.
Was autopsy performed ?.
no
M. R.
BROOKLINE (City or town making return)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
(write the word)
Boston:
MAR1
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,
PLACE OF DEATH
Essex (County)
Danvers
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)
51
Registered No.
(City or Town)
Danvers State hospital, Hathorne No.
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
Evangeline Nelson (Getchell)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
39 Grovers Ave.
St.
(If nonresident, give city or town and State)
.. months
9
days. In place of residence. ....... .. years ..
.months
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
February
18,
1954
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED Married
or DIVORCED
4.I HEREBY CERTIFY,
Feb. 9
54
19
to
death is said to
have occurred on the date stated above, at
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING.
TO DEATH (a)
Generalized
Arteriosclerosis
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
Year
12
AGESO
10
Months.
.Days
If under 24 hours
Hours
Minutes
Housewife
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
New Portland
OTHER
SIGNIFICANT
CONDITIONS
Acute Enteritis
1 day
Major findings:
Of operations.
Date of operation.
Was autopsy performed?
What test confirmed diagnosis?
Clinical & Laboratory
5 Was disease or injury in any way related to occupation of deceased? If so, specify ... Andrew Nichols 3rd M. D.
(Signed).
Hathorne, Wass. Date 2/10/"
(Address).
Lewiston, Maine
G. A.R. Ce. etery 6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL. February 22
15%
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS
Winthrop, Hass.
Received and filed
AR 8 1954
19
(Registrar of City or Town where deceased resided)
Informant.
(Address)
21
Mary
Sheehan
ffathorne, Mass
A TRUE COPY
Chthis Way
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
February
23
19
54
X
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
PARENTS
17 NAME OF
FATHER
Andrew Getchell
18 BIRTHPLACE OF
Madison
FATHER (City)
(State or country)
naine
19 MAIDEN NAME
OF MOTHER
Sarah Sawyer
20 BIRTHPLACE OF
Madison
1954:
MOTHER (City)
(State or country)
25M-3-53-909098
(Month)
That, I attended
Feb. 18
deceased , from
34
KHUSBAND OK
10a If married, widowed, or divgred i am Springall
(Give maiden name of wife in full)
I last saw h
er
Feb.
13,
,54
alive on
1:10 P.
m.
yrs
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
(or) WIFE of
2. Leon Nelson
(write the word)
(a) Residence. No. (Usual place of abode) Length of stay: In place of death. ........... years.
Winthro if so specify WAR)
(Was deceased a
U. S. War Veteran,
Maine
: (
12
6
MIÅR1C
COPY OF CERTIFICATE OF DEATH
CERTIFICATE OF DEATH STATE OF NEW HAMPSHIRE
TOWN OR CITY CLERK'S NO.
52
1. NAME OF
DECEASED
(Type or Print)
Francia
a. (First)
b. (Middle)
c. (Last)
(Month)
(Day)
(Year)
2. DATE
OF
DEATH
Feb
19 1954
3. PLACE OF DEATH
a. COUNTY
Hillsboro
4. USUAL RESIDENCE (Where deceased lived. If institution; resid-
a. STATE
b. COUNTY
ence before admission). Suffolk
b. CITY
OR
TOWN
c. LENGTH OF
STAY (in this place)
c. CITY (Give actual town of residence, NOT mailing address).
OR
TOWN
Winthrop
(If rural, give location)
d. FULL NAME OF (If not in hospital or institution, give street address or location)
HOSPITAL OR
INSTITUTION
d. STREET
ADDRESS
200 Revere
9. AGE (In years) IF UNDER 1 YEAR last birthday) Months! Days
IF UNDER 24 HRS
Hours
Min.
10a. USUAL OCCUPATION (Kind uf work
done during most of working life, even if retired)
Store
Singer Sevi
Mass.
13. FATHER'S NAME
Machine Co.
001 & Farrell
15. WAS DECEASED EVER IN U. S. ARMED FORCES?
(Yes, no, or unknown) | (If yes, give war or dates of service)
16. SOCIAL SECURITY 17. INFORMANT
NO.
015-09-2307
Mrs. Francis Gunn
MEDICAL CERTIFICATION
18. I. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH This does not mean (a) .. the mode of dying, such as heart failure. asthenia, etc. It means the disease, injury, or complication which caused death.
Acut
Pulmo ary Eceme
DUE TO
(b)
Acute Myocardial Decompensation
3 hrs.
ANTECEDENT CAUSES
Morbid con-
ditions, if any, giving rise to the above cause
(a) stating the underlying cause last.
DUE TO
(c)
Cerebral Hemorrhage
3 hrs.
II. OTHER SIGNIFICANT CONDITIONS Conditions contributing to the death but not related to the disease or condition causing it.
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)
OF
INJURY
m.
21e. INJURY OCCURRED
NOT WHILE
WHILE AT
WORK
AT WORK
21f. HOW DID INJURY OCCUR?
22. I hereby certify that I attended the deceased from ... 2-19
alive on 2-19, 19
Ghid that death occurred at
19.54 to. .. 2-13, 19 5 that I last saw the deceased 1 : 54) from the causes and on the date stated above.
( Degree or title)
23b. ADDRESS
23c. DATE SIGNED 1 2-20-54
24a. BURIAL. CREMATION, 24b. DATE
ENTOMBMENT, REMOVAL
Burial
( Specify)
2-22-54
24c. NAME OF CEMETERY OR CREMATORY 24d. LOCATION (City, town, or county ) (State)
St. Patrick
Lowell, Mass.
IF ENTOMBED
24e. PLACE OF BURIAL
( Name of Cemetery)
LOCATION (City, Town, County ) ( State)
DATE
25. FUNERAL DIRECTOR
Jones O'Donnell
ADDRESS
COUNTERSIGNED - AGENT (City Bd. of Health) Marie Anne Char at
DATE 2-20-54
DATE REC'D BY TOWN OR CITY CLERK
Feb. 25. 1954
CLERK'S OWN SIGNATURE
Lowe a S. LeBlanc
CLERK OF
Nechua, N. H.
A true copy, Attest:
Gward S. LeBlanc
Clerk of ..... . Nashua, M.H. Dated .... 3-9
... 19
54
V. S.17
1-53-50M
5. SEX
Male
Memorial dosp.
6. COLOR OR RACE |7. MARRIED, NEVER MARRIED. 8. DATE OF BIRTH
whit
WIDOWED, DIVORCED (Specify) vid.
10-17-1895
58
10b. KIND OF BUSINESS OR IN- 11. BIRTHPLACE (State or foreign country)
DUSTRY
12. CITIZEN OF WHAT
COUNTRY?
14. MOTHER'S MAIDEN NAME
Della Hackett
INTERVAL BETWEEN ONSET AND DEATH 3 hrs .
20. AUTOPSY?
YES
L
NO
23a. SIGNATURE Charles I. Umna
Lowell, Mais.
Ferrell
Nashua
1
MAR 2 . 1.04
R-305 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.)
25M.5.52-907046
PLACE OF DEATH
Middlesex (County)
Everett
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
EVERETT
(City or town making return)
53
Registered No.
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
26 Ingleside Ave.
- St.
Winthrop
(a) Residence. No. (Usual place of abode)
6
81
months
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February 25, 19.54
(Month) (Day)
(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.) Gen. Arteriosclerosis
... Broncho pneumonia Fracture Rt. Hip
accident
5 Accident, suicide, or homicide (specify)
Date and hour of injury.
Feb.17,
.19.5.4
Where did
Winthrop, Mass.
Injury occur?
(City or town and State)
Did injury occur in about home, on farm, in industrial place, or in public
place?
(Specify type of place)
Manner of
Fell at home and
Injury
(How did injury occur?)
Nature of
injured rt. hip
Injury
While at work?
no
Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased ?.
If so, specify G.S.MITes
(Signed)
Somerville
2=25
195.4.
(Address) Winthrop
.. Date ..... winthrop
7
Place of Burial, or Cremation.
Town) 1954
8 NAME OF
FUNERAL DIRECTOR
Winthrop
ADDRESS
Received and filed
March 15, 1954
195.4
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
f
10 COLOR OR RACE
Wht
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
11a
If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
81
13
AGE
.Years
.Months
Days
13
If under 24 hours
.. Hours ....
.. Minutes
14 Usual
Occupation :
Revefe Pubfre Binoof Dept.
15 Industry
or Business:
16 Social Security No .......
Winthrop
17 BIRTHPLACE (City)
(State or country)
Mas's
18 NAMEON onn W. FATHER
19 BIRTHPLACE OF
FATHER (City)
Mass ..
(State or country)
20 MAIDEN NAMELovicy White OF MOTHER
21 BIRTHPLACE OF
MOTHER (City)
Vermont
(Stat
Roland E. Davison
Winthrop
22 Informant. (Address)
A TRUE COPY.
ATTEST:
(Registrar of/City or Town where death occurred)
DATE FILED
3-1-
19
54
m.S.
(City or Town)
No. . Whidden Hospital
Winnie E. Davison
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(If nonresident give city or town and State)
Length of stay: In place of death
... years
months
days. In place of residence.
.years.
13
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
DATE OF BURIAL
Alfred B. Marsh
M. D.
no
PARENTS
Retired School Teacher
HIARELS
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 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
Essex
(County) Danvers
(City or Town)
Danvers State Hospital, Hathorne No.
¡(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Eva Zaks (Parker)
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
16 Nevada St.
Winthrop
so specify WAR)
(a) Residence. No.
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
2
.years ..
7
months.
ths.
8
days. In place of residence.
... years ..
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
Female
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
DEATH
(Month)
(Day)
(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.)
General Arteriosclerosis
Fracture ræght håp
12 IF STILLBORN, enter that fact here.
13
74
AGE
Years
Months.
.Days
If under 24 hours
Hours ..
Minutes
14 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
15 Industry
or Business:
16 Social Security No.
17 BIRTHPLACE (City) ....
(State or country)
Austria
18 NAME OF
FATHER
Louis Par er
19 BIRTHPLACE OF
FATHER (City).
(State or country)
Austria
20 MAIDEN NAME
OF MOTHER
Martel Weiss
21 BIRTHPLACE OF
MOTHER (City)
Austria
Tefereth Israel of winthrop, Everett (State or country) 7 Place of Burial, or Cremation. (City or Town) 22
Mary E. Sheehan
DATE OF BURIAL
February
26
5
19
8 NAME OF
FUNERAL DIRECTOR
Chelsea, Mas3.
ADDRESS
Received and filed MAR 18 1954 19
(Registrar of City or Town where deceased resided)
X
but
A TRUE COPY.
arthur W Say
ATTESTS
(Registrar of City or Town where death occurred)
DATE FILED
March
1
19
54
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
51
I R-305 1
25M.5.52-907046
6 Was disease or injury in any way related to occupation of deceased ?... If so, specify.
(Signed)
Ralph C. Foss
(Address)
Peabody, Mass.
Date
2/26/
M. D. 1054 10 ....
PARENTS
La. If married, widoyed, optirotd Becker
HUSBAND of.
(Give maiden-name of wife in full)
2. Harry
(or) WIFE of
(Husband's name in full)
5 Accident, suicide, or homicide (specify)
Accident
Date and hour of injury
July
19
53
Where did
Danvers State Hosp
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public
place?
Public Place
Manner of
Fell onto ffyge of place)
Injury
Nature of
(How did injury occur?)
Injury
Fracture rt. hip
While at work?
No
Was autopsy performed?
No
4
Informant
(Address)
Hathorne, Hass.
Tori
Married
3 DATE OF
February 26, 1954
(Was deceased a
U. S. War Veteran,
-
..
6
MAR16
IR-301A 1
PLACE OF DEATH
Suffect (County)
Chelsea +/7/54
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No ..
55
No.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
Pwscott fre
(a) Residence. No. (Usual place of abode)
Length of stay: In place of death ....... years .... months. 1/2 days.
In place of residence.
... years ..
months
.... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Dáy)
2,
1952x
(Year)
8 SEX
m
9 COLOR OF RACE
White
10 SINGLE
MARRIED
WIDOWEL
(write the word) Married Granghelli
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
62 Years
Months.
Days
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation:
Shoe Maker
(Kind of work done during most of working life)
14 Industry
or Business:
Shoe Business
15 Social Security No.
029-24-0910
16 BIRTHPLACE (City).
(State or country)
Stala
17 NAME OF
FATHER
Joseph Spinelli
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Staly
19 MAIDEN NAME
OF MOTHER
Could not be laved
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Stali
21
Informant
(Address)
3 presidi Que chalna
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Hakers (Signature of Agent of Board of Health or other) Health place 3.2.5€
(Official Designation) (Date of Issue of Permit)
X
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
does not mean of dying, such lure, asthenia, ns the disease, ations which h.
d conditions. ing rise to the e (a) stating lying cause
ions contrib .- death but not he disease or ausing death.
50M-5-52-907046
7 NAME OF
FUNERAL DIRECTOR,
Hmm to Walsh
ADDRESS
318 By way Chalice
/3/3/54 19
Received and filed
til 2010
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation.
. Was autopsy performed ?. -272
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? 25
If so, specify.
(Signed) $22:
M. D.
(Address) / 6/2 2
Holy Cross MALDEGEM
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL. march 5 195$
PARENTS
(Registrar)
10a If married, widowed of divorced
HUSBAND of
werea
pive maiden name of wife in full)
I last saw
hi malive on
19
5 4 death is said to
have occurred on the date stated above, at
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
TWEEN ONSET
ANO DEATH
Prin.I/s
ANTE
Due To receive A
CEDENT (b)
CAUSES
4 Į HEREBY CERTIFY,
That I attended deceased
from
Afet-25-
1953
to Mueve 2
19
54
St.
R/C.
12€
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. if so specify WAR) 72.
no
(If nonresident, give city or town and State)
To be filed for burial permit with Board of Health or its Agent.
(City or Town)
(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Rocco Spinelli
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 ath of a person whom he has attended during his last illness, at the request an undertaker or other authorized person or of any member of the family of e deceased, furnish for registration a standard certificate of death, stating to the st of his knowledge and belief the name of the deceased, his supposed age, the sease of which he died, defined as required by section one, where same was ntracted, the duration of his last illness, when last seen alive by the physician 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 eceding section or by section forty-five of chapter one hundred and four- en, shall, if the deceased, to the best of his knowledge and belief, served in the my, navy or marine corps of the United States in any war in which it has been gaged. insert in the certificate a recital to that effect, specifying the war, and all also certify in such certificate both the primary and the secondary or imme- ate cause of death as nearly as he can state the same. For neglect to comply th any provision of this section, such physician or officer, shall forfeit ten dollars. or the purposes of this section and of sections forty-five, forty-six and forty-seven said chapter one hundred and fourteen, the word "war" shall include the China lief expedition and the Philippine insurrection, which shall, for said purposes, be emed to have taken place between February fourteenth, eighteen hundred and nety-eight and July fourth, nineteen hundred and two, and the Mexican border rvice of nineteen hundred and sixteen and nineteen hundred and seventeen. L. Chap. 46. Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body a town, or remove therefrom a human body which has not been buried, until he s received a permit from the board of health, or its agent appointed to issue ch permits, or if there is no such board, from the clerk of the town where the rson died; and no undertaker or other person shall exhume a human body and move it from a town, from one cemetery to another. or from one grave or tomb her than the receiving tomb to another in the same cemetery, until he has ceived a permit from the board of health or its agent aforesaid or from the clerk the town where the body is buried. No such permit shall be issued until there all have been delivered to such board, agent or clerk, as the casc may be, satisfactory written statement containing the facts required by law to be turned and recorded, which shall be accompanied. in case of an original inter- ent, by a satisfactory certificate of the attending physician, if any, as required by w. or in lieu thereof a certificate as hereinafter provided. If there is no attending ysician, or if, for sufficient reasons, his certificate cannot be obtained early ough for the purpose, or is insufficient, a physician who is a member of the board health, or employed by it or by the selectmen for the purpose, shall upon plication make the certificate required of the attending physician.
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