USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 64
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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 eountersign it and transmit it to the elerk 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.
A physician or officer furnishing a certificate of death as required by the No undertaker or other persons shall bury a human body or the ashes thereof preceding section or by section forty-five of chapter one hundred and fount E ChiH 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 derk of the town where the body is to be buried of 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).
11 12
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of pråetiçe:
(1)' Atfending 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 dannyosm of injury.
8 Board of Health physicians will certify to such deaths only as those of Amp. though disabled by recognized disease unrelated to any form of pypry rhave died without recent medical attendance or whose physician is absent fromhome 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
other than the receiving tomb to another in the same cemetery, until he has Pres or poisonsythermal, 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
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN, SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
192
Registered No.
occurred in a hospital or institution, 'St. [ give its NAME instead of street and number)
Anthony Ciampa 2 FULL NAME
(If deceased is a married, widowed or divorced voman, give also maiden name.) 56 Seaview Av. Winthrop Mass
, (If nonresident, give city or town and State)
Length of stay: In place of death.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX M
9 COLOR OR RACE
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
4 I HEREBY CERTIFY,
That I attended deceased
from
9 -1-5419.
to
9-14-54
19
.
I last saw h. t.VAalive on
9.14-5009
death is said to
have occurred on the date stated above. at
111% p.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGED3
Years
Months
Days
If under 24 hours
Hours
.Minutes'
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry or Business: Retired Café Quener
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Berlin Driss
17 NAME OF
FATHER
Joseph Ciampa
Major findings: Of operations.
Date of operation
Wove
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? Wo. If so, specify .. C (Signed) ... (Address) 6
M. D.
felles 9-14054
6.
Place of Burial or Cremation
DATE OF BURIAL
Sept 18 .95420
7 NAME OF FUNERAL DIRECTOR Hoe A. Hangene TO
ADDRESS 58 messumac City
Received and filed SEP 18 1954 19
(Registrar)
PARENTS
18 BIRTHPLACE OF FATHER (City) . (State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria Lo Conte
20 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
21 Informant
lucille to 56 New View and MenThaad
I HEREBY CERTIFY that a satisfactory standard certificate of death Was filed with me BEFORE the burial or transit permit was issued:
Walter 6 Baker
Signature of Agent of Board of Health or other)
H.O
4
Sept, 16/54.
(Official Designation)
(Date of Issue of Permit)
(write the word)
3 DATE OF
DEATH
Sept. 14 1954 (Year)
(Month)
(Day)
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) Cerebral hemorrhage
ANTE CEDENT (b) CAUSES
Due Cardiac failure Ihr.
Due To (c) ...
Hypertension
12yrs.
OTHER SIGNIFICANT CONDITIONS
50M-2-49-25666
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, cations which th.
id conditions. ing rise to the se (a) stating Flying cause
tions contrih- e death but not the disease or causing death.
M R-301A 1
Winthrop Mass. (City or Ton) - Winthrop Community HospTo reach No.
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran, (if so specify WAR)
(a) Residence. No. (Usual place of abode) 150 Minutes ................ months. .days. In place of residence. .years months .days.
30.
Cen Minikick (City or Town)
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 heen delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused 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 he 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 hodies 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
recognizable disease, or when any person is found dead. . - General AS.CEIM 18. 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 para been brought into the commonwealth until he has received a permit b do tomithe board of health or its agent appointed to issue such permits, or such board, from the clerk of the town where the body is to be buried is to be held, or from a person appointed to have the care of the emaury tri ground in which the interment is made.
Chap. Se€:46, G. L .. (Tercentenary Edition).
MIN 3 RULES OF PRACTICE
WHY
The fulfillment ofthe purpose of these laws calls for the observance of the follow- Buonpractice: AStending physicians will certify to such deaths only as those of persons have given bedside care during a last illness from disease unrelated at fou ef lufy. udl of Health physicians will certify to such deathsonly as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent engwhen the pestificate of death is needed.
SEB Local Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
R-301A 1
PLACE OF DEATH
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.
193
2 FULL NAME .. Thomas Worrall Billcliff
(If deceased is a married, widowed or divorced woman, give also maiden name.)
154 Cottage tark Rd
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years.
months.
days. In place of residence
7
.years
.months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR OR RACE
white
10 SINGLE
(write the word)
MARRIED
WIDOWEDarried
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
1945
to.
Jan
1954
I last saw h Lym ... alive on
fund
19 , death is said to
have occurred on the date stated above, at
m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
Coronary cochini
TO DEATH (a)
TWEEN ONSET
AND DEATH
?
coronary occlusion
ANTE
Due To
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)
Hlemireille
M. D.
(Address) 109 Mood 55 Reverte
Date 9/17
6 Holy Cross:
malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL Sept. 18, 1954 19
7 NAME OF
FUNERAL DIRECTOR
J.Vincent ..... Murray
Revere Lass ..
ADDRESS
Received and filed.
19
(Registrar)
10a If married, widowed, or divorced
HUSBAND of .. .. mary ..
Daly
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGEZZ
Years
Months
Days
If under 24 hours
.Hours
.. Minutes
13 Usual
Occupation :
foreman
(Kind of work done during most of working life)
14 Industry
or Business:
maufacturing corp.
15 Social Security No.
010-05-1278A
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
Thomas Billcliff
PARENTS
18 BIRTHPLACE OF
FATHER (City)
England
(State or country)
19 MAIDEN NAME
OF MOTHER
Elizabethh Worrall
20 BIRTHPLACE OF MOTHER (City) (State or country)
Die England
21
Informant
mabel Balisdell
(Address) 16 Gottare Th, Rd. Winthr I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter 6, Baker
(Signature of Agent of Board ( Health or other)
H.O
(Official Designation)
(Date of Issue of Permit)
9/17/54 X
Registered No.
No. 164 Cottage Park Rd.
j(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, NO if so specify WAR)
(a) Residence. No. (Usual place of abode)
9
(Month)
(Day)
16 54 (Year)
3 DATE OF
DEATH
ICTIONS OR ERTIFICATE iving F DEATH tenter han one or each ) and (c)
Des not mean dying, such re, asthenia. s the disease, tions which
conditions, g rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
WORRETT
50M-10-52-908091
M.S.
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 dicd. defined as required by section one, where same was contracted, the duration of his last illness, when last scen 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 ninctcon hundred and seventeen G. L. Chap. 46, Sec. 10. 5
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 casc 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 thes & O tugh board, from the clerk of the town where the body is to he 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.
N4. Sec. 46, G. L., (Tercentenary Edition).
OF TOWN
CE
11 1.2
RULES OF PRACTICE
e fulfillmest of the purpose of these laws calls for the observance of the follow- ing rules of practice: Attendin's physicians will certify to such deaths only as those of persons tosvhow they sten bedside care during a last illness from disease unrelated
form of fury -
WHICH
to ny Board .of Health physicians will certify to such deaths only as those of ergens what though disabled by recognized disease unrelated to any form of sithout recent medical attendance or whose physician is absent the certificate of death is needed. Examiners will investigate and certify to all deaths supposably 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 I'D deaths from disease resulting from injury or infection related to occupation,
C s durch den deaths of persons not disabled by recognized disease, and those of persons found dead!
due
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.
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