USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 44
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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 mace 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 inake 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 offrom 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).
TOW 1112
LRULES OF PRACTICE
The fulfillmentof the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who though disabled by recognized disease unrelated to any form of injury, have died lidthulit recent medical attendance or whose physician is absent from home when therertihonte of death is needed.
(3) Medical inen 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 suddedi deaths på persons not disabled by recognized disease, and those of
t:
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
1 1 -
-
-
1
.
X
PLACE OF DEATH
Suffolk (County) Winthrop
(City or Town)
125 Cliff Ave
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.
129
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME ..
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
15
15
(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,
1
1955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 1
1955
to ..
June 13
19
55
I last saw h .C ... Y .... alive on
June 13, 1955 death is said to
have occurred on the date stated above, at
7:30- p.m.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
80 2
4
Months
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 (City) ..
(State or country)
England
OTHER
SIGNIFICANT
None.
CONDITIONS
Major findings:
Of operations.
None
Date of operation
What test confirmed diagnosis ?.
Clinical.
5 Was disease or injury in any way related to occupation of deceased? ho
[f so, s
(Signed)
(Address) Windleap Man Date 6/16/
M. D. 1955
6 Cedar Grove
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
June
16
55
7 NAME OF
FUNERAL DIRECTOR
ADDRESS-
JUN 16 1955
19
(Registrar)
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) England
19 MAIDEN NAME OF MOTHER Alice Conder
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 Louise , Paul
Informant. (Address) Woodland Rd. Northampton N.H
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burial or transit permit was issued: Walter A. Jaker (Signature of Agent of Board of Health or other) Health Aplicar 6/16/55
(Official Designation)
(Date of Issue of Permit) /
×
M R-301A 1
STRUCTIONS FOR AL CERTIFICATE n giving E OF DEATH not enter re than one se for each ), (b) and (c)
is does not mean le of dying, such failure, asthenia, > means the disease, plications which lealh.
rbid conditions, giving rise to the use (a) staling derlying cause
ditions contrib- the death but not o the disease or n causing death.
e :- Chapter 137. of 1954, requires cians to print or he cause or causes eath on death cates.
50M-3-54-911887
No.
Sarah E (Brook) Sidebottom
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, (if so specify WAR)
125 Cliff Ave.
St.
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widow
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Walter Sidebottom
(Husband's name in full)
DISEASE OR CONDITION,
DIRECTLY LEADING
TO DEATH
PERÉRAL HEMORRHAGE
2 wks
ANTE CEDENT (b) .. CAUSES
Due TARTERIOSCLEROSIS
10yrs
Due To (c)
Rochdale
17 NAME OF
FATHER
Thomas Brook
.Was autopsy performed? No
Boston
Received and filed
in C.
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, eightcen 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 derk 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 niven bedside care during a last illness from disease unrelated to any form ofinjury. (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 infind These includernot only deaths caused directly or indirectly by traumatism (thefuding 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-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. Registered No. 130 No.WinthropComm.Hospital Mande (Slovy) Wilcom 2 FULL NAME ... J(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number) PHYSICIAN - IMPORTANT (If deceased is a married, widowed or divorced woman, give also maiden name.) 38 Enfield Road (If nonresident, give city or town and State) Length of stay: In place of death years .. months. days. In place of residence 30 years. .months. .days. MEDICAL CERTIFICATE OF DEATH PERSONAL AND STATISTICAL PARTICULARS 3 DATE OF DEATH June .... 16, 1955 (Day) 8 SEX 9 COLOR OR RACE 10 SINGLE MARRIED WIDOWED Marreet (write the word) or DIVORCED 4 I HEREBY CERTIFY, That I attended deceased from 10a 191955 HUSBAND of om (Give maiden name of wife in full) INTERVAL BE- I last saw h ..... er .. alive on June 14, 19 5. Death is said to have occurred on the date stated above, a 9:05 P.M. (or) WIFE of (Husband's name in full) DISEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Coronary occlusion TWEEN ONSET AND DEATH 11 IF STILLBORN, enter that fact here. 3 hrs &2 AGE. 12 Years 6 .Months 6 Days If under 24 hours Hours ... .. Minutes ANTE Due To Generalized CEDENT (b) CAUSES. arteriosclerosis 4 yrs 14 Industry or Business: at forma 15 Social Security No. 012-07-7839 East wakefield 16 BIRTHPLACE (City) (State or country) 17 NAME OF FATHER Fred Florey Major findings: Of operations. none Date of operation Was autopsy performed ?. What test confirmed diagnosis ?. Clinical observation 5 Was disease or injury in any way related to occupation of deceased ?.. If so, specify (Signed) Civilreach The Date/17/5 (Address) M. D. 19 no. Place of Burial or Cremation (City or Town) DATE OF BURIAL June 20 195 7 NAME OF FUNERAL DIRECTOR OR Victoria . Perrolla ADDRESS. JUNE 20, 1955 19 Received and filed (Registrar) PARENTS 18 BIRTHPLACE OF East wakefield FATHER (City) (State or country) 19 MAIDEN NAME OF MOTHER Leargianna Roberts 20 BIRTHPLACE OF MOTHER (City) (State or country) 21 Informant (Address) 38 E field RUW Try I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: (Signature of Agent of Board of Health of other) Healthe Ofrecer 6/17/55 (Official Designation) (Date of Issue of Permit) 1 TRUCTIONS FOR L CERTIFICATE n giving OF DEATH not enter e than one e for each , (b) and (c) s does not mean e of dying, such Failure, asthenia, cans the disease, lications which eath. bid conditions. iving rise to the use (a) stating lerlying cause ditions contrib- he death but not the disease or causing death. :- Chapter 137. 1954, requires ans to print or e cause or causes ath on death Rtes. M.S. 50M-3-34-911887 150 Winthat theux Waller 7. 4 Jakerx durch. villar 13 Usual Occupation :. Nouveinte (Kind of work done during most of working life) Due To (c) OTHER SIGNIFICANT CONDITIONS (Month) (Year) 1945 to June .... 16 ... Į (Was deceased a U. S. War Veteran, if so specify WAR) (a) Residence. No. (Usual place of abode) 35 minutes 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 ninetcen 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 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 he obtained as to the deceased, or as to the manner of cause of the death, which the elerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition). Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.