USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 68
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Boston, Mass.
19 MAIDEN NAMElara B.Ewer OF MOTHER
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Boston, Mass.
21 Wildred H.Noyes-Daughter Informant3 ........ xerrace, Winchester, Mass . (Address)
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the buriahor transit permit was issued: Walter A: 12 aker (Signature of Agent of Board of Health or other)
Thealth Officer
10/4/50
(Official Designation)
(Date of Issue of Permit)
CTIONS R ERTIFICATE
ving F DEATH enter an one r each and (c)
es not mean dying, such re, asthenia. the disease, ions which
conditions. g rise to the (a) stating ing cause
ns contrib- eath but not disease or sing death.
Chapter 137. 54, requires to print or use or causes on death I.
50M-5-55-915025
-
R-301A 1
4 I HEREBY CERTIFY,
June
1935
That I
Oct 6
to.
I last saw h ..
er alive on.
Gcx 6
1955
. death is said to
have occurred on the date stated above, at
740Pm.
.m.
INTERVAL BE-
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War VeteranNO
if so specify WAR)
108 Waldemar Ave. Winthrop, Masg ..
(If nonresident, give city or town and State)
Widowed
Housewife
PARENTS
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 belicf 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-( .: te n, 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' ta 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.
/Chấp. 1114, Sec. 46, G. L., (Tercentenary Edition).
THROP
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
001 Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness front 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
R-301A 1
JCTIONS OR CERTIFICATE iving F DEATH t enter han one or each ) and (c)
oes not mean dying, such ure, asthenia, s the disease. tions which
conditions, ag rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
TOOM-10-53-910621
X PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 104 Highland Aver
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial pormit with Board of Health or its Agent.
208
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)
98 Bellevue Ave.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death. ...... years. months. 77 .days. In place of residence. 27
.years.
months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
(Month)
(Day)
That I attended deceased from
Ect )
1955
I last saw h
un alive on
Get. 6
19 5'S death is said to
have occurred on the date stated above, at
230/km.
INTERVAL BE- TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months.
Days
If under 24 hours
.Hours ........ Minutes
13 Usual
Occupation:
Office Manager
(Kind of work done during most of working life)
14 Industry
or Business:
Dry Goods
15 Social Security No
(11-14 -8039
16 BIRTHPLACE (City).
(State or country)
Mass.
17 NAME OF
FATHER
Harrison Whittemore
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Peabody
19 MAIDEN NAME
OF MOTHER
Unice McCoob
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Maine
Lincolnville
6 Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Oct. 10
55
19
7 NAME OF
FUNERAL DIRECTOR VALI
Minthref mass.
ADDRESS
Received and filed
OCT IV 1955
19
(Registrar)
8 SEX
Male
9 COLOR OR RACE |
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Widowd
4 I HEREBY CERTIFY,
7
1950
to
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ...
CORONARY THROMBOSIS
ANTE CEDENT (b) CAUSES
Due To ARTERIO SCLEROSIS
5 yrs
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? A/C
If so, specify L 7 Saleves
(Signed)
(Address) 17: Pleasant St
M. D.
Date Get 8
1955
Winthrop
Helen Whittemore
21
Informant
(Address)
98 Bellevue Ave.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Waller f. Baker
(Signature of Agent of Board of Health or other)
Heath trice
10/10/55
(Official Designation)
VV
(Date of Issue of Permit)
2 FULL NAME.
No.
Charles H Whittemore
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. (Usual place of abode)
Ect
7
19.55
(Year)
10a If married, widowed, or divorced
Lottie Turnbull
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
87-
3
0
2 days
Boston
2
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.
Na 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 to any form of injury.
(2). Board 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 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
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,
PLACE OF DEATH
Essex.
(County)
Newburyport (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Newburyport (City or town making return) 209
Registered No.
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
2 FULL NAME. Fred Earnest .... Si ... ert
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. .. 22 Adams
St. Winthrop ,Mass.
(If nonresident, give city or town and State)
Length of stay: In place of death
15 years.
.. months.
.days. In place of residence.
.years.
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October 11,
.1955
8 SEX
9 COLOR OR RACE
10 SINGLE
MARRIED
WIDOWED
DIVORCE
(write the word)
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
Oct.
19 ... 55.,
to.
Oct. 11, ...
... 19 ... 55
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
I last saw h .........
.alive on
19
death is said to
have occurred on the date stated above. af ... 0.54 .m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Acute ..... coronary.
thrombosis
TWEEN ONSET
AND DEATH
1 hr.
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
Date of operation
.Was autopsy performed ?. No
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(SignedEdward J.Dervan M. D.
Wburyport Date. 10/11 19 .....
6 Place af buthartemation Winthrop
DATE OF BURIAL. Oct.1.3.
19 .. 645
7 NAME OF
FUNERAL DIRECTOR Howard 3. Reynolds
ADDRESS
inthran Meggy
Received and filed. 19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE63 Years 11
Month? 8
Days
If under 24 hours
Hours.
.Minutes
13 Usual
Occupation :
Maint Q.i ...
banco
(Kind of work done during most of working life)
14 Industry
or Business:
Brewany
15 Social Security No. 022-10-1209
16 BIRTHPLACE (City).Chelsea , Mass. (State or country)
17 NAME OF
FATHER
Charles F.Siefert
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Cambridge, Mass:
19 MAIDEN NAME
OF MOTHER
Elizabeth Hopkins
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Maine
21 Irene Siefert 22 Adams St .
Informant
(Address)
Winthrop
A TRUE COPY Tenorio
ATTEST:
(Registrar of City or Town where death occurred) October 17,
55
DATE FILED
.19
PARENTS
25M-3-53-909098
No.
76 ... Street .... Plum ... Island
(Was deceased a
None
U. S. War Veteran.
if so specify WAR)
(Usual place of abode)
Mal white
Marriel
(or) WIFE of ..... Tren
Loeffler
RECEIVED
TO
OCT18
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased resided as soon as possible,
after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.)
25M.(B)-11-51-905807
PLACE OF DEATH
Suffolk (County)
M R-302 1 Rovero
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or town making return)
1
[(If death occurred in a hospital or institution. St. [ give its NAME instead of street and number)
rank L. Whitman
2 FULL NAME
(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. 22 Elliot Street, Winthrop
(If nonresident, give city or town and State)
.months
4
.days. In place of residence.
3 years
.. months.
.days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
arried
4 I HEREBY CERTIFY.
That I attended deceased from
I last saw him alive on Cet, 11, 1955 death is said to
10a If married, widowed, or divorced
HUSBAND of ... Lena.PAK
e maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ....... Years ...
Months 26 Days
If under 24 hours
Hours
Minutes
13 Usual
Occupation:
Colosman
14 Industry
or Business:
Lumber
15 Social Security No ....... 0.30
16 BIRTHPLACE (City).
(State or country)
Lova Partia
17 NAME OF
FATHER
Ocorre Whitman
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Deborah Freeman
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Iva Scotia
6 Woodlaim Crema ory Place of Burial or Cremation (City or Town)
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