USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 41
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
:
R-301A 1 Winthrop (City of Town)
Bay View Nursing Home No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
annie millman 2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. 121 Hawthorne (Usual place of abode)
Length of stay: In place of death.
0 years 1 months 14
.days.
In place of residence.
.years
0
.months
0
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
4 I HEREBY CERTIFY
That I attended deceased from
I last saw
alive on
Wlan as 19 / death is said to
have occurred on the date stated above, at .... .m.
DISEASE OR CONDITION
DIRECTLY LEADING Y
TO DEATH (a)
(
INTERVAL BE- TWEEN ONSET ANO DEATH 4 dy
ANTE CEDENT (b) CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify ...... (Signed) (Address)
M. P.
Liberty Progressive Place of Burial of Cremation (City or Town)
DATE OF BURIAL
may 26
1.5%
7 NAME OF
FUNERAL DIRECTOR.
Hyman &, Jorf
ADDRESS 15/ Washington alu c/eua
Received and filed. 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
(CBK)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant.
(Address)
/2/ Havvitore et chelsea
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or/transit permit was issued: J ater De Fraper
(Signature of Agent of Board of Health or other) Thatha Mile 526/54
(Official Designation) (Date of Issue of Permit)
X
CTIONS 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
ns contrib- ath but not disease or sing death.
50M-10-52.908091
PLACE OF DEATH Suffolk (County)
Chelsea 6/8/54
The Commonwealth of Massachusetts DVITTENT 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.
120
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran.
if so specify WAR)
St. Chelsea mass
(If nonresident, give city or town and State)
40
10a If married, widowed, or divorced HUSBAND of .. Jacob
(Give_maiden name of wife in full)
millman
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
74 Years
0
Months.
0
Days
If under 24 hours
Hours . ..... Minutes
13 Usual
Houseunfe
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
own home
15 Social Security No ..
nome
16 BIRTHPLACE (City).
(State or country)
Russia
17 NAME OF
FATHER
David Rothstein
109/2
3 DATE OF
DEATH
MAY
25
(Month)
(Day)
1954 (Year)
19
44
to.
May 25.
19 54
2º
(or) WIFE of
Philip Mullinan
Date 15/25 1954
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 imine- 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-cight and July fourth, nineteen hundred and two, and the Mexican border' service of nineteen hundred and sixteen and nincteen 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 hody, 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 T 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 dierk 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 Mindre have died without recent medical attendance or whose physician is absent Tomhome 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 cheinical (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
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time after the close of the month in which the death occurred. (See Chap. 46. Sec 12, G. L.)
PLACE OF DEATH
SUFFOLK (County)
BOS TON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
CERTIFICATE OF DEATH
BOS TON
(City or town making return)
Registered No:
1214623
J(If death occurred in a hospital or institution. XXSCX give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Trident Ave.,
xx
Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death ..
years.
months
days. In place of residence.
.. years ..
.months.
.... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR OR RACE
W
(write the word)
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
That
I
attended deceased from
5/26
10a If married, widowed, or divorced
19
5! HUSBAND of
Mary Goldstein
I last saw h ...... i.m .. alive on.
5/26
19
5/death is said to
(or) WIFE of.
(Give maiden name of wife in full)
have occurred on the date stated above, at 8:308
.m.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ....
congestive heart
failure
INTERVAL BE- TWEEN ONSET AND DEATH wks
11 IF STILLBORN, enter that fact here.
84
12
AGE
Years.
Months.
Days
If under 24 hours
Hours
.Minutes
13 Usual
Occupation :
Tanner
14 Industry
or Business:
retired
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Harry Babson
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Sarah
-
- -
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
M Babson
7 NAME OF
FUNERAL DIRECTOR
A Golov
ADDRESS
Brookline Mass
Received and filed.
7 1954
19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify .....
(Signed).
J Slosberg
M. D.
(Address).
330 Brkl Ave
Date
5/26.1954
Everett (City or Town)
DATE OF BURIAL.
May 27
19.54
21
Informant
(Address)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
May 28
54
......
... 19 ......
25M-10-53-910621
2 FULL NAME
(a) Residence.
No.
(Usual place of abode)
3 DATE OF
DEATH
(Month)
(Day)
4 I HEREBY CERTIFY,
5/20
19
to
CEDENT (b)
Due To
(c)
Major findings:
Of operations.
What test confirmed diagnosis ?.
6
Winthrop.Com
Place of Burial or Cremation
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,
CAUSES
heart disease
May
26
1954
(Year)
ANTE
Due To
arteriosclerotic
yrs
OTHER
? Addison's Disease
SIGNIFICANT
CONDITIONS hyponatremia, hypoglycemia -?
Date of operation
Was autopsy performed ?.
M R-302 1
Beth Israel Hospital No.
BEN JAMIN BABSON
(Was deceased a
U. S. War Veteran,
if so specify WAR)
6
(Kind of work done during most of working life)
M R-302 1
PLACE OF DEATH
SUFFOLK BOSTON
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
BOSTON
(City or town making return)
Registered No.
1678 122
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME ..
Dorothy E Sammartino
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(a) Residence.
No.
(Usual place of abode)
119 .... Povero ... St ...
.....
..........
St. Winthrop Mass
(If nonresident, give city or town and State)
Length of stay: In place of death.
years ..
months5
days. In place of residence ..
29 .. years
... months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That Iattended deceased from
5/23/54
19
to
5/27/54
19
WE last saw h.
er
alive on
19
death is said to
have occurred on the date stated above
7.0.1:00
m.
TO DEATH (a)
INTERVAL BE- TWEEN ONSET AND DEATH 5 days
11 IF STILLBORN, enter that fact here.
12
AGE.29 ..... Years2.
.Months3
Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation:
none
(Kind of work done during most of working life)
14 Industry
or Business:
at home
15 Social Security No ..
.none
16 BIRTHPLACE (City).
(State or country)
Bos.t.an
17 NAME OF
FATHER
Frank Sammartino
18 BIRTHPLACE OF
FATHER (City)
Boston
(State or country)
19 MAIDEN NAME
OF MOTHER
Theresa Amerina
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston
winthrop - winthrop
6
Place of Burial or Cremation
6/1/54
(City or Town)
DATE OF BURIAL. 19
7 NAME OF
FUNERAL DIRECTOR
Win throp
H S Reynolds
ADDRESS
Received and filed
MUN 7101
19
........
(Registrar of City or Town where deceased resided)
20 yrs
ANTE
CEDENT (b)
CAUSES
Due To
Epilepsy
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
none
no
Date of operation.
What test confirmed diagnosis ?.
PARENTS
21
Informant
(Address)
2a
Frank Sammartino
A TRUE COPY
Charles & Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
...... .19
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec 12, G. L.)
25M-10-53-910621
5 Was disease or injury in any way related to occupation of deceased?
If so, specify ... "Class
19
Date
5/2 8/54
M. D.
(Signed).
(Address)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING,tus epilepticus
Single
3 DATE OF
DEATH
May 27/54.
Mass Gen Hosp No.
123
(1949 Revision of Standard Certificate) CERTIFICATE OF DEATH
COPY
STATE OF MAINE
1. PLACE OF DEATH
a. COUNTY
Cumberland
2. USUAL RESIDENCE (If institution: residence before admission) Write RURAL, if so.
a. HOUSE ADDRESS
343 Stevens Avenue
b. TOWN
Write RURAL, if so.
Portland, Maine
c. LENGTH OF STAY
(in this place)
P. O.
State
Portland, Maine
d. FULL NAME OF (If not in hospital or institution, give House Address)
HOSPITAL OR
INSTITUTION
Maine General Hospital
Town
County
State
3. NAME OF
DECEASED
(Type or Print)
a. (First)
FRANCES
b. (Middle)
HILDA
c. (Last)
VAN HOOSEN
4. DATE·
OF
DEATH
(Month)
May 27,
(Day)
(Year)
1954
5. SEX
Female
6. COLOR OR RACE
White
7. MARRIED, NEVER MARRIED,
WIDOWED, DIVORCED (Specify)
Widowed
8. DATE OF BIRTH
June 10, 1883
9. AGE (In years
last birthday)
70
If under 1 Yr. | If under 24hrs. Mos. Hrs. Min. 11
10a. USUAL OCCUPATION (Give kind of work done during most of working life, even if retired) At Home
10b. KIND OF BUSINESS OR IN-
DUSTRY
11. BIRTHPLACE (Town & State or foreign country)
Boston, Mass
12. CITIZEN OF
WHAT COUNTRY?
13. FATHER'S NAME
Isaac Blair
15. WAS DECEASED EVER IN U. S. ARMED FORCES?
(Yes, no, or unknown) | (If yes, give war or dates of service)
16. SOCIAL SECURITY
NONone
17. INFORMANT
George Blair
18. CAUSE OF DEATH Enter only one cause per line for (a), (b), and (c)
MEDICAL CERTIFICATION
INTERVAL BETWEEN YINSET AND DEATH Ihrs plus
*This does not mean the mode of dying, such as heart failure, asthenia, etc. It means the disease, injury, or complication which caused death.
ANTECEDENT CAUSES
Morbid conditions, if any, giving DUE TO (b) Art. Sclerotic heart disease, old
rise to the above cause (a) stating
the underlying cause last.
myocard infarct congestive failure
DUE TO (c)
II. OTHER SIGNIFICANT CONDITIONS
Conditions contributing to the death but not
related to the disease or condition causing death.
19a. DATE OF OPERA-
TION
19b. MAJOR FINDINGS OF OPERATION
20. AUTOPSY?
K
Yes
No
21a. ACCIDENT
SUICIDE
HOMICIDE
(Specify)
21b. PLACE OF INJURY (e.g., in or about home, | 21c. (CITY, TOWN, OR TOWNSHIP)
farm, factory, street, office bldg., etc.)
(COUNTY)
(STATE)
21d. TIME
OF
INJURY
(Month) (Day) (Year) (Hour)
m.
21e. INJURY OCCURRED
While at
Work
Not While At Work
.....
19 ........ , that I last saw the deceased
.m., from the causes and on the date stated above.
23a. SIGNATURE
Frederick R Brown, Jr
(Degree or title)
M D
23b. ADDRESS
Portland, Maine
23c. DATE SIGNED
5/28/54
24a. BURIAL, CREMA- TIQU, REMOVAL(Specify)
24b. DATE
6/1/54
24c. NAME OF CEMETERY OR CREMATORY
Winthrop
Lot
Sec.
24d. LOCATION (City, town, or county)
Winthrop, Massachusetts
ADDRESS
DATE REC'D BY LOCAL 5/28/1954
REG.
REGISTRAR'S SIGNATURE ..
25. FUNERAL DIRECTOR
Hay and Peabody
Portland, Maine
(1) a community of less than 2,500 population or (2) outside corporate limits of an incorporated place. The Residence
of a deceased infant will be that of mother. In Item 17 the Informant will not be the funeral director unless he is of the
family of the deceased.
21f. HOW DID INJURY OCCUR?
22. I hereby certify that I attended the deceased from
alive on
19.
and that death occurred at
19.
... , to
(State)
FORM C
b. LEGAL
RESIDENCE
Portland, Cumberland, Maine
Days 17
14. MOTHER'S MAIDEN NAME
Jennie Carruthers
I. DISEASE OR CONDITION
DIRECTLY LEADING TO DEATH* (a)
Lobar pneumonia
R-301A 1
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.
124
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME.
Helen Josephine Keyes
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. (Usual place of abode)
59 Sunnyside Avenue St.
(If nonresident, give city or town and State)
Length of stay: In place of death .years. months days. In place of residence. 45.years .. months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
May
29.
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased
from
april
53
54
to
May
19
I last saw her .....
.alive on
25 April 1954.
s said to
have occurred on the date stated above, at
1:30 P.m.
INTERVAL BE-
TWEEN ONSET ANO DEATH 10 yrs.
11 IF STILLBORN, enter that fact here.
12
AGE
7.5Years
9 Months ..
11 Days
If under 24 hours
Hours ..
Minutes
13 Usual
Occupation :.
retired stationer
(Kind of work done during most of working life)
14 Industry
or Business:
Self employed
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
Orland
Maine
17 NAME OF FATHER John R. Keyes
18 BIRTHPLACE OF
FATHER (City)
(State or country)
B.o.s.t.on
Mass
19 MAIDEN NAME
OF MOTHER
Cybelle Wardwell
20 BIRTHPLACE OF
MOTHER (City)
North Blue Hill
(State or country) Maine
21 Informant Miss Maude J .. .... Keyes
(Address) 59 Sunnyside Avenue
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Mass ...
Walter S. Dakle
Signature of Agent of Board of Health or other) Thealeto Officer 61154
(Official Designation) (Date of Issue of Permit)
50M-5-52-907046
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
174 Winthrop St Winthrop, 19
Received and filed.
JUN 2-1954
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
white
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
single
10a If married, widowed, or divorced HUSBAND of. (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Parkinson's Disease
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
NONE
Date of operation
What test confirmed diagnosis ?.
Was autopsy performed ?.
Clinical
NO
5 Was disease or injury in any way related to occupation of deceased? NO
Decis arthur @: murray
(Signed).
(Address) Winthrop
Date 31 194 1954
M. _ D.
6 Woodlawn Cemetery. Everett Mass (City of Town)
Place of Burial or Cremation
DATE OF BURIAL June/2 1954; ..... 19
Alfred 13. March
1 5.
RUCTIONS FOR CERTIFICATE
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tions contrib- death but not the disease or causing death.
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No.
59 ... Sunnyside Avenue
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 seventeen. G. L. Chap. 46. Sec. 10.
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