USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 77
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Length of stay: In place of death ........ years ... .. months ... 2 8lays. In place of residence 3Gears months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November 17 .1955
8 SEX
female white
9 COLOR OR RACE
10 SINGLE
(write the word)
MARRIED
WIDOWED Widowed
or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
lan.
19 .. 46. to .. nr.17 أبكور
I last saw halive on
nor /2, 1955, death is said to
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Charles H. Holroyd
(Husband's name in full)
DISEASE OR CONDITION
MULTIPLE
DIRECTLY LEADING
TO DEATH (a)
CEREBRAL Thromb
OSis.
1 Month
12
AGE .... 8.0.Years
6. Months .2.7 ... Days
If under 24 hours
Hours .
.. Minutes
13 Usual
Occupation :
housewife
(Kind of work done during most of working life)
14 Industry
or Business:
ownhome
15 Social Security No.
none
16 BIRTHPLACE (City)
(State or country)
canada
17 NAME OF FATHER Mason
18 BIRTHPLACE OF FATHER (City) (State or country) Canada
19 MAIDEN NAME
OF MOTHER
unable to obtain
20 BIRTHPLACE OF MOTHER (City) (State or country) Canada
21 Informant Mrs. Ethel L. Coakley (Address) 181 Mystic St. Arlington
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Watter & Kaker
lass
Seattle Officer (Signature of Agent of Board of Health or other)
11/18/55
(Official Designation)
(Date of Issue of Permit) /
X
50M-3-54-911887
6 Bellevue Cemetery Lawrence Mass. Place of Buria
DATE OF BURIAL ...... November 19 1955
7 NAME OF
FUNERAL DIRECTOR
alfred BB. March
ADDRESS 174 Winthrop St. Winthrop,
Received and filed.
NOV IT!
(Registrar)
8 yrs
Due To (c)
OTHER SIGNIFICANT CONDITIONS
CARdide FAILURE
1 day
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 ...... 22/2010
andrew Cupin (Signed). M. D. (Address) 603 Bodamay Bena Date Nov 2 195
PARENTS
11 IF STILLBORN, enter that fact here.
ANTE CEDENT (b) CAUSES
Due To Arteriosclerosis.
INTERVAL BE- TWEEN ONSET AND DEATH
have occurred on the date stated above, at . 12:30Am.
(Month)
(Day)
(Year)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO ..
(Usual place of abode)
RUCTIONS FOR CERTIFICATE giving OF DEATH
ot enter than one for each (b) and (c)
does not mean of dying, such ilure, asthenia, - ins the disease, cations which th.
id conditions. ing rise to the ie (a) stating rlying cause
tions contrib- e death but not the disease or causing death.
Chapter 137. 1954, requires ns to print or cause or causes :h on death tes.
.. Winthrop (City of Town)
To be filed for burial -permit with Board of Health or its Agent.
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 deccased, 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, hy a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose. the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .--- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap, 114, Sec. 46, G. L., (Tercentenary Edition).
NECEIVED
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 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 traumatismo (including resulting septicemia), and by the action of chemical (drugs of pohons) thermal, or electrical agents, and deaths following abortion, but also deathsfrom 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."
Staterbent 6? 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
X SUFFOLK (County)
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.
235
WINT: 800 COMMUNITY HOSPITAL
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
BABY GIRL SULLIVAN 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) NOVE
(a) Residence.
221 WIDTH ?? (Usual place of abode)
St.
(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
3 DATE OF
DEATH
Nov
(Month)
18 (Day)
1955
(Year)
That I attended deceased from
4 I HEREBY CERTIFY,
Nov 18.
19.
55
to.
19
I last saw h en alive on
Nov. 18, 1955
, death is said to
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
DISEASE OR CONDITION
DIRECTLY LEADING
V.
TO DEATH (a)
PREMATURITY
ANTE
Due To
CEDENT
CAUSES
(b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations NONE
Date of operation.
NONE
Was autopsy performed? No.
What test confirmed diagnosis ?.
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? 40.
If so, specify Gyan Kary Mo.
(Signed)
(Address) 222 PLEASANT ST. WINThe Date 11/18
195 ...
M. D.
6 HOLY CROSS
Place of Burial or Cremation
DATE OF BURIAL
NOVEMBER 14
1955
7 NAME OF
FUNERAL DIRECTOR
Daniel a. Milio
ADDRESS 3 DEXTER ROW CHARLESTOWN
Received and filed.
NOV-2-1-1955
.19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FE
MALE
9 COLOR OR RACE
WHITE
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
If inder 24 hours
Hours
Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City) WINTHROP
(State or country)
MASS
17 NAME OF JOHN D. SULLIVAN FATHER
PARENTS
18 BIRTHPLACE OF
BOSTON
FATHER (City)
(State or country)
MASS
19 MAIDEN NAME
OF MOTH
CAROL M. MACDONALD
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
MASS
SOMERVILLE
21 Informant JOHN
D. SULLIVAN (Address) 21 WINTHROS STI WINTORES
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: natter 6. Baker
(Signature of Agent of Board of Health or other)
HIS
.
72-14-1955
1
(Official Designation)
(Date of Issue of Permit)
UCTIONS OR CERTIFICATE
iving OF DEATH t enter han one for each ›) and (c)
oes not mean dying, such ure, asthenia. is the disease, itions which 1.
conditions, ig rise to the (a) stating ying cause
ons contrib- death but not e disease or using death.
100M-10-53-910621
WINTHROP (City or Town)
Registered No.
PHYSICIAN - IMPORTANT
SINGLE
have occurred on the date stated above, at 1219P m. INTERVAL BE- TWEEN ONSET AND DEATH 1/8 hrs AGE Years 12
Months
Days
MALDEN (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 been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
death certificate contains a recital, as required by section ten of chapter forty-six. that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate. shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45. G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons: as, are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. ... - General Laws, Chap .. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof · which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is; to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
6)
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 any form of injury.
NOV25" 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
PLACE OF DEATH
Suffolk County) Winthrop (City or Town)/ Winthrop Convalescent Home No. 14Z Pleasant St
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. 236
2 FULL NAME
James Di lasso (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 176 Bevere
St.
Bevere, mass
(If nonresident, give city or town and State)
55 years. .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
nov. 1 19-1955
(Day)
(Year)
(Month)
8 SEX
male
9 COLOR OR. RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word) fingle
10a If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 6 Years
10
Months Days
If under 24 hours
Hours ....... Minutes
13 Usual
Occupation :.
Bricklayer
(Kind of work done daring most of working life)
14 Industry
or Business:
Self-employed
15 Social Security No ... 622-16-2926
16 BIRTHPLACE (City) (State or country) Italy
17 NAME OF FATHER Joseph i Masso
18 BIRTHPLACE OF FATHER (City) (State or country)
Italy
19 MAIDEN NAME OF MOTHER Maria Grazia Gallon
20 BIRTHPLACE OF MOTHER (City) (State or country)
Italy
21 Ingela De maro
Informant (Address)
42 James It Beaux
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
Walter In Haler (Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
JCTIONS OR CERTIFICATE
Iving F DEATH t enter han one or each ) and (c)
oes not mean f dying, such ure, asthenia, as the disease, alions which h.
conditions. ng rise to the (a) stating ying
ons contrib- death but not e disease or using death.
Chapter 137, 954, requires s to print or ause or causes h on death es.
50M-5-55-915025
7 NAME OF
Paul Buonfiglio
FUNERAL DIRECTOR
ADDRESS ... 128 Ve ever st Valued
Received and filed NOV 211955 .19
(Registrar)
6 Mos
6 MM
Due To (c)
OTHER SIGNIFICANT CONDITIONS
CARDIAC FAILURE
1day
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 andrunlatino M. D. (Signed).
(Address) 03Kmcom
6 Holy Cross Cem Place of Burial or Cremation
malden -
(City or Town)
DATE OF BURIAL. 1955
22
TWEEN ONSET AND DEATH
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Brunchogerie
CARCINOMA METASTASIS Ribs
4 I HEREBY CERTIFY,
That I attended deceased from
1955
to ..
Nor 19
55
I last saw ham alive on nov 19
1955
., death is said to
have occurred on the date stated above, at. 5 1. m.
INTERVAL BE-
months. 7 days. In place of residence
j(If death occurred in a hospital or institution,
- Winthrop St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a U. S. War Veteran, if so specify WAR) WWI
(Usual place of abode)
Length of stay: In place of death years
HEIERZ. 12-5-55
Registered No.
11/21/55
PARENTS
Date2/ 1955
ANTE CEDENT (b) . Due To CARCINOMA of CAUSES NUpper Lobe
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.
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