USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1954 > Part 80
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129 Main Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death 35 rears months. days. In place of residence
35, ears
months .days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November 16
(Day)
(Month)
1954
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED S
of DIVORCEDIngle
4 I HEREBY CERTIFY.
That I
attended deceased from
19.
to.
19
I last saw h .............. alive on
19 ......... death is said to
have occurred on the date stated above, at.
11:15 I.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
5.2 Years
9
Months
6
Days
If under 24 hours
Hours .
Minutes
-
13 Usual
Occupation:
Plumber
(Kind of work done during most of working life)
14 Industry
or Business:
Contractor
15 Social Security No.
028-05-6135
16 BIRTHPLACE (City)
(State or country)
Mass .
East Boston
17 NAME OF
FATHER
James Smith
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Scotland
19 MAIDEN NAME OF MOTHER Florence Beaumont
20 BIRTHPLACE OF MOTHER (City) (State or country) England
21 Florence Smith
Informant
(Address)
129 Main St. Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit perant was issued: Walter of Hakes (Signature of Agent of Board of Health brother) Thealite Office 11/17/54 (Official Designation)
(Date of Issue of Permit)
·
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
.
Natural Causes
ANTE
CEDENT (b)
CAUSES
Due To Presumably
Due To
Coronary.
(c)
Occlusion
OTHER
SIGNIFICANT
CONDITIONS
None
-
Major findings:
Of operations ...
None
Date of operation.
Was autopsy performed ?.
No
What test confirmed diagnosis?
5 Was disease grinjury in any way related to getupation of deceased ?.
No
If so,
(Signed).
Winthrop Board of Health
Date ..
17 NOV 1954
(Address)
Winthrop
Winthrop
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Nov .19
19.54
7 NAME OF
ADDRESS
Received and filed
19
(Registrar)
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. ( if so specify WAR)
(a) Residence. No. (Usual place of abode)
UCTIONS FOR CERTIFICATE
riving OF DEATH t enter than one for each b) and (c)
does not mean f dying. such ure, asthenia, ns the disease, ations which h.
conditions. ng rise to the : (a) stating ying cause
ions contrib- death but not e disease or using death.
Chapter 137. 954, requires is to print or ause or causes on death es.
PRINTER'
MIS.
50M-3-54-911687
R-301A 1
No.
129 Main Street
Registered No.
PERSONAL AND STATISTICAL PARTICULARS
(write the word)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
30 min
M. D.
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 fouts 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-setem 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 ant ninety-eight and July fourth, nineteen hundred and two, and the Mexican bonfer" service of nineteen hundred and sixteen and nineteen hundred and seventeen G. L. Chap. 46, Sec. 10. p
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, untilhe 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 received a permit from the board of health or its agent aforesaid or from the clell 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, See. 4, Acts of 1945.
undertaker or other persons shall bury a human body or the ashes thereof Giftch 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 na funeral is to he held, or from a person appointed to have the care of the Cery or burial ground in which the interment is made.
cet Chap. 1.14. Sec. 46, G. L., (Tercentenary Edition).
12
11
.2
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 whom they have given bedside care during a last illness from disease unrelated Butt Form ofinjury.
Board of Health physicians will certify to such deaths only as those of though disabled by recognized disease unrelated to any form of Dave died without recent medical attendance or whose physician is absent hh Home when the certificate of death is needed.
other than the receiving tomb to another in the same cemetery, until he ha virus or poisonet thermal, or electrical agents, and deaths following abortion, but
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by umatism (including resulting septicemia), and by the action of chemical 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
WN
PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
292 Pleasant Street No.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal permit with Board of Health or its Agent.
240
Registered No.
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,
if so specify WAR).
(a) Residence. No.
292 Pleasant Street
(Usual place of abode)
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years ..
7
months
1 days.
In place of residence. 3.5.years.
months
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
nov.
17
1954
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
Sefor 27
19 204
to
now 17
1954
I last saw
her alive on
nov. 17
195 / death is said to
have occurred on the date stated above, at.
3:30 P.m.
INTERVAL BE-
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING_
TO DEATH (a)
Terminal
INBronchopneumonia
ANTE
Due To
arterioscientes
CEDENT (b) CAUSES heart disease
Due To
(c)
arteriosclerosis
generalized
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),
19 Huasteca VY Date 1-17-
(Address)
M. D. 195
6
Winthrop Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL
November 20
19 54
7 NAME OF
FUNERAL DIRECTOR.
Culture
0 malen
ADDRESS
Winthrop/ M355
Received and filed Nov. 19,1954 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Femalel
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED Lowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
James F Lyng
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months
Days
80
If under 24 hours
Hours ...
Minutes
13 Usual
Occupation:
Housewife
(Kind of work done during most of working life)
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Masc
17 NAME OF
FATHER
Owen Flynn
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Katherine O'Hara
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informant.
(Address)
202 Pleasant St Ainthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter. G. Raken
HO
(Signature of Agent of Board of Health or other)
cette
11/18/54
(Official Designation)
(Date of Issue of Permit)
..
-
14 Industry
or Business:
Own Home
Worcester
..
PARENTS
100M-10-53-910621
R-301A 1
ICTIONS OR ERTIFICATE
iving F DEATH t enter han one or each ) and (c)
Does not mean dying, such ure, asthenia. s the disease. tions which
conditions. g rise to the (a) stating ying cause
ons contrib- leath but not e disease or using death.
mis
2 FULL NAME ..
Ann T. Lyng
(If deceased is a married, widowed or divorced woman, give also maiden name.)
That I attended deceased from
9 COLOR OR RACE
(write the word)
-
Mne Richard Dorovan
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 hy 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).
RECEIVED
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 fir infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap 38 See & as amended by Chap. 632, Sec. 4, Acts of 1945.
/ 'No undestaker 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 heheld, or from a person appointed to have the care of the cemetery or burial groddd in which the interment is made.
ChantalAuSe: 46. G. L., (Tercentenary Edition).
6 5
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 whenfifty hav 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.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
× Suffolk (County) WinTHROP (City or Town) Winthrop ROSE ANNIE PLACE OF DEATH
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or town making return)
241
Registered No.
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
2 FULL
(If deceased is a married, widowed of divorced woman, give also maiden name.)
26 Bates.
Que
St.
WINTHROP
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
days. In place of residence.
.years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
DEATH
3 DATE OF NOVEMBER 21,
(Day)
(Month)
1954
(Year)
&SEX
Female
9 COLOR OR RACE
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
MARRIED
4 I HEREBY CERTIFY,
That I attended deceased from
19
to .....
Nov. 21,
1954
I last saw h.ER
.alive on.
NOV
24. 1956
, death is said to
have occurred on the date stated above, at.
INTERVAL BE-
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
15 do 12
HOURS
AGE
.76
Years
Months.
Days
If under 24 hours
Hours. . Minutes
13 Usual
Occupation:
Housework
(Kind of work done during most of working life)
YEARS
14 Industry
or Business:
GT Home
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Russia
OTHER
SIGNIFICANT
CONDITIONS
CHRONIC MYOCARDITIS 34 CORONARY HEART DISEASE YEARS
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, specifye edit a.n. Caplan MW (Signed) .. M. D. (Address) 186PRancelin et GB Daten 11-21 195K woBurn 6 Ottel IGies Place of Burial or Cremation (City or Town)
DATE OF BURIAL
nov 22
1954
7 NAME OF
FUNERAL DIRECTOR : avon
Dolor
..
ADDRESS.
1668 Beacon ST-Brookline
Received and filed. 11-2.2-54 19
(Registrar)
PARENTS
17 NAME OF
FATHER
MOR Decal
KaPulskie
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER Haine
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21
Informant
(Address)
max Yorks 290 River Rd Winthrop mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter Gi Baker
(Signature of Agent of/Board of Health on other)
HO
11/22/54
(Official Designation)
(Date of Issue of Permit)
-
ANTE
CEDENT (b)
CAUSES
CEREBRAL
Due To
(c)
HYPERTENSION
BY
YEARS
10a If married, widowed, or divorced HUSBAND of ABraltar
(or) WIFE of
(Give maiden name of wife in full)
YORKS
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a) CEREBRAL
HEMORRHAGE
· ARTERIOSCLEROSIS
SOM (A-1-51 903586
M R-301 1
RUCTIONS 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. cations which th.
id conditions, ing rise to the e (a) stating lying cause
lions contrib- death but not the disease or ausing death.
1
Medical
EXAMINER
2 M.S.
A TRUE COPY ATTEST:
Community YORKS
Hospital
(Was deceased a
U. S. War Veteran,
if so specify WAR)
no
(a) Residence. No. (Usual place of abode)
months. İ
8
-
-
CanBe Learned
Russia
11.256.m.
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 deccased, 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.
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