USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 45
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT SERVICE NUMBER
.
M R-302 1
PLACE OF DEATH
SUFFOLK
(County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
BOSTON
(City or town making return)
Registered No.
5050
132
J(If death occurred in a hospital or institution,
........ XSEX give its NAME instead of street and number)
JOHN SKEHAN
(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.
66 Plummer Ave.
.........
Winthrop Hass
(If nonresident, give city of town and State)
(Usual place of abode)
Length of stay: In place of death
.. years.
months ..
.8 ..... days. In place of residence ..
years.
.months ..
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATHJ.une.
7
1954
(Month)
(Day)
(Year)
WU HEREBY CERTIFY,
That el
attended deceased from
5/30
19.
to
6/7
.,
19 ... 54
We last saw h .... 1 m .. alive on
6./7
1954, death is said to
have occurred on the date stated above, at
7.87.5m
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of.
Als.ce .... Hoar
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a).
myocardial in-
farction
7days
ANTE
Due To
CEDENT (b)
CAUSES
coronary ..... artery ..
disease
yrs
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
Date of operation
Was autopsy performed ?.
What test confirmed diagnosis ?.
clinical
5 Was disease or injury in any way related to occupation of deceased ?..........
If so, specify.
(Signed) V
.. Cass
M. D.
(Address).
PR.BH
Date ...
6/7
84
6HolyCross
Place of Burial or Cremation
(City or Town)
Malden
DATE OF BURIAL
Jun .... 9.
15.4
7 NAME OF
FUNERAL DIRECTOR
G ..... Treanor
ADDRESS
F-Boston
Received and filed
WIN21-1954
19
(Registrar of City or Town where deceased resided)
PARENTS
17 NAME OF
FATHER
John Skehan
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
-unknown-
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Informant
M .... Casey ..
(Address)
A TRUE COPY
ATTEST: Parles 4 Mackie
(Registrar of City of Town where death occurred)
Jun 10
54
DATE FILED 19
V.B.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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 of town in which the deceased resided as soon as possible,
25M-10-53-910621
ms.
11 IF STILLBORN, enter that fact here.
12
AGE.6.5 Years.
Months.
Days
If under 24 hours
Hours .......
.. Minutes
13 Usual
Occupation:
Fireman - ret
(Kind of work done during most of working life)
14 Industry
or Business:
Boston Fire Dept
15 Social Security No.
021-20-5126
16 BIRTHPLACE (City).
(State or country)
Bast Boston, Mass
(Give maiden name of wife in full)
TWEEN ONSET
AND DEATH
8 SEX
9 COLOR OR RACE
N
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
2 FULL NAME
No. Peter .... BentBrigham ... Hospital.
CERTIFICATE OF DEATH
JUNE .: ...
PLACE OF DEATH/
Suffolk (County)
Revere
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
REVERE
(City or town making return)
133
Hospital J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
2 FULL NAME
Tura Lane (Chandler)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 46 Sturgis Street (Usual place of abode)
Length of stay: In place of death. ...... years. 1 months 26 days.
30 years
In place of residence.
.. months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
9.
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
April 13
1954
to ...
June .... 9
1954
I last saw
alive on.
June 9
54
death is said to
have occurred on the date stated above, at L.Q : 10A ..
m.
INTERVAL BE-
11 IF STILLBORN, enter that fact here.
12
AGELI
Years 9
.Months.
17
.Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation:
.Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
At .... Home
15 Social Security No.
None
16 BIRTHPLACE (CityRutland
(State or country)
Vermont
17 NAME OF
FATHER
Herbert E. Chandler
18 BIRTHPLACE OF
FATHER (City).
Alstead
(State or country)
New Hampshire
19 MAIDEN NAME
OF MOTHER
Elizabeth M. Mottoson
20 BIRTHPLACE OF MOTHER (City) .. Nashua (State or country) New Hampshire
21 Informant Cl11eChandler.Halliday (Address) 46 Starcia St.
A TRUE COPY
ATTEST:% ..
(Registrar of City or Town where death occurred)
DATE FILED
June 11.
54
19.
(Registrar of City or Town where deceased resided)
8 SEX
Female
9 COLOR OR RACE
Whi
10 SINGLE
(write the word)
MARRIED
WIDOWED Itidowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Arthur W. Lane
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Myocarditis
TWEEN ONSET AND DEATH 3
kear
ANTE
CEDENT (b)
CAUSES
Due To
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
.Was autopsy performed ?.
No
What test confirmed diagnosis?
Clinical Signs
5 Was disease or injury in any way related to occupation of deceased? If so, specifyfores. .............. Burns (Signed). Broadway
M_D.
(Address).
Woodlawn Cemetery 6 Place of Burial or Cremation
Nashua.N.H ..
(City or Town)
DATE OF BURIAL
June 12,
50%
7 NAME OF
FUNERAL DIRECTOR.
Howard S.Reynolds
ADDRESS.
180 Winthion St., Winthrop
Received and filed 19
....
PARENTS
25M.(B)-11-51-905807
M.S.
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
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,
M R-302 1
No. Grover Manor ...
Registered No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
St.
Winthrop
.Mass
(If nonresident, give city or town and State)
Days
Date 6/9/
19.5.11.
JUL -- 0
X
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
Registered No.
134
2 FULL NAME. Agnes Edna Ryan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
32 Putnam Street
.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. years months. 5 ... days. In place of residence 60 .. years
.months . .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June
(Month)
12 (Day)
1954 (Year)
8 SEX
remale
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED married
or DIVORCED
4 I HEREBY CERTIFY.
That I attended deceased from
June 10
19 54.
to.
JUNE 12
19.
54
I last saw her
alive on
June 12
19.11, death is said to
6:29Pm.
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE7.5 Years
7 .. . . Months . 2 . .. Days
If under 24 hours
Hours
. Minutes
13 Usual
Occupation :
writer
(Kind of work done during most of working life)
14 Industry
or Business:
Free-lance
15 Social Security No. .
N.O.
Stuart
16 BIRTHPLACE (City).
(State or country)
TOWa
17 NAME OF
FATHER
Edward Louis Ryan
18 BIRTHPLACE OF
FATHER (City)
Quebed
(State or country)
canada
19 MAIDEN NAME
OF MOTHER
Mary LaVoie
20 BIRTHPLACE OF
MOTHER (City)
Brandon
(State or country)
vermont
21 Informant Mr. Henry B. Stevens (Address) 32 Putnam It Wontleros
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial on transit permit was issued: Walter Baker
Signature of Agent of Board of Health or other)
Healthe Office
6/14/54
(Official Designation)
(Date of Issue of Pérmit)
50M-5-52-907046
7 NAME OF
FUNERAL DIRECTOR
BUbred B. March
ADDRESS 174 Winthrop St. Winthrop Mass.
Received and filed WIN 14 1954 19
(Registrar)
Di
OTHER
SIGNIFICANT
CONDITIONS
Electrolyte imbalance
?
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, spécify
(Signed)
M. D.
(Address) .. 194 WashingtonQue
Date June 14 1954
Private Cemetary Steven's Farm Place of Burial or Cremation MILI Rd. (City or Town)
DATE OF BURIAL.J.Une, ... 151 ! 54 Durham, N . H.
PARENTS
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of Henry Bailey Stevens->
(Husband's name in full)
DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) 15ron chopnexusone terminal
ANTE
Due To muncordial heart
CEDENT (b) ...
CAUSES
d, Fense
-
(c)
Diabetes Mellitus
Due To
RUCTIONS FOR . CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease. ications which ath.
id conditions, ring rise to the se (a) stating rlying cause
itions contrib -- e death but not the disease or causing death.
M R-301A 1
No.
winthrop Community Hospital
f(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
To be filed for burial permit with Board of Health or Its Agent.
PHYSICIAN - IMPORTANT -
(Was deceased a U. S. War Veteran, if so specify WAR)
(write the word)
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.
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, 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 toany 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
M R-302 1
PLACE OF DEATH
SUFFOLK OSTON (County)
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.
5203
135
N E Deaconess Hospital No.
[(If death occurred in a hospital or institution, XXXX give its NAME instead of street and number)
HAROLD W LOVELL
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
1025 Shirley
St.
Winthrop Mass
(a) Residence.
No.
(Usual place of abode)
(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
3 DATE OF
DEATH
June
13
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
5/27
That I
6/13
deceased from 54
19
I last saw
h
alive on
19
death is said to
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADINGronchopneumonia
TO DEATH (a).
TWEEN ONSET AND DEATH days
11 IF STILLBORN, enter that fact here.
12
AGE
Years
4
,60
Months.
6
.Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation:
Clerk - ret.
(Kind of work done during most of working life)
14 Industry
or Business:
Retail Stores
15 Social Security No .....
029-01-3588
16 BIRTHPLACE (City).
(State or country)
Providence ..
RI
17 NAME OF
FATHER
George Lovell
18 BIRTHPLACE OF
FATHER (City)
Providence,
(State or country)
19 MAIDEN NAME
OF MOTHER
Lucy Marean
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Hubberston,Mass
winthrop
Place of Burial or Cremation
Winthrop, Mass
(City or Town)
DATE OF BURIAL.
Jun 16
1954
7 NAME OF
FUNERAL DIRECTOR
A Porcella
Boston
ADDRESS
Received and filed
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
B& COPY Parles & Mackie
(Registrar of City or Town where death occurred)
DATE FILED
Jun 16
..............
.. 19 ..
54
WRITE PLAINLY, WITH ONFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-10-53-910621
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,
Due To chronic bronchitis
ANTE CEDENT (b) CAUSES and bullous emphysema, sovere
9yrs
Due To
Congestive heart
(c)
failure & portar
Artists of liver
OTHER
SIGNIFICANT
CONDITIONS
Diabetes mellitus
22yrs
Major findings:
Of operations
Date of operation
Was autopsy performed?
yes
What test confirmed diagnosis ?.. & ..... U.
& & autopsy
5 Was disease or injury in any way related to occupation of deceased?
If so, specify.
A Marble
M_D.
(Signed)
(Address)
81 Bay State Robate
6/13/54
.wks
Vrs
Irs
10a If married, widowed, or divorced
HUSBAND of
Marie Hendericks
(Give maiden name of wife in full)
have occurred on the date stated above,
10:05a.
.m.
INTERVAL BE-
8 SEX
M
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
19
6/13
,54
1m
PARENTS
21
Informant.
(Address}
Mrs M Lovell
.
(City or Town)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
X - Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
136
Winthrop Community Hospital
j(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Arthur L O'Brien
(If deceased is a married, widowed or divorced woman, give also maiden name.)
235 Court Rd.
(a) Residence. No. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
... years ..
months. 1
days. In place of residence. 48
.years.
.. months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
June 14. 1954
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDarried
4 I HEREBY CERTIFY,
June 13,1954
19
to
June 14,
That I attended deceased from
154
I last saw h.
im
alive on
June 13
death is said to
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
72 Years
8
Months
26ay5
If under 24 hours
Hours .....
Minutes
13 Usual
Occupation:
Purchasing Agent
(Kind of work done during most of working life)
14 Industry
or Business:
Steamship Co
15 Social Security No.
012-07-0067
16 BIRTHPLACE (City)
Yarmouth
(State or country) Nova Scotia
17 NAME OF
FATHER
Calvin F O'Brien
PARENTS
18 BIRTHPLACE OF FATHER (City). (State or country) Nova Scotia
19 MAIDEN NAME
OF MOTHER Elmira Burns
20 BIRTHPLACE OF MOTHER (City) (State or country)Nova Scotia
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR.
Howard Schynolds
ADDRESS Winthis mais
JUK I
Received and filed. 19
(Registrar)
A TRUE COPY ATTEST:
50M-(A).11-51-905807
PLACE OF DEATH
M R-301 1
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each b) and (c)
does not mean f dying, such lure, asthenia, > ns the disease, ations which h.
id conditions, ng rise to the (a) stating lying caus
itions contrib. death but not he disease or ausing death.
5 Was disease or injury in any way related to occupation of deceased ?.
If so, specify, ButIT
(Signed) ..
M. P.
(Address) Revere 51, Mass Date . June 1410 54
6 Winthrop
Was autopsy performed? No
What test confirmed diagnosis ?.
TWEEN OHSET AND DEATN 36 hr
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
None
Date of operation.
None
Winthrop
June 16 19.5. (Addres 235 Court Rd. Winthrop
21 Informant Viola I O'Brien
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter & Baberg (Signature of Agent of Board of Health or other)
Theallthe Office (Official Designation) (Date of Issue of Permit) 6/16/97
(City or town making return)
Winthrop
(City or Town)
No. .
2 FULL NAME.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
10a If married, widowed pedigsad I Dewar
HUSBAND of.
(Give maiden name of wife in full)
have occurred on the date stated above, at ..... 50
A.
.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Coronary Thrombosis
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 hest of his knowledge and helief the name of the deceased, his supposed age, the disease of which he died, defined as required hy section one, where same was contracted, the duration ot his last illness, when last seen alive hy 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 hy section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and helief, served in the army, navy or marine corps of the United States in any war in which it has heen engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate hoth 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 hetween February fourteenth, eighteen hundred and ninety-eight and July fourth, ninetcen hundred and two, and the Mexican horder service of nineteen hundred and sixteen and nineteen hundred and seven- teen. G. L. Chap. 46, Sec. 10.
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