Town of Winthrop : Record of Deaths 1954, Part 17

Author: Winthrop (Mass.)
Publication date: 1954
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 17


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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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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