USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 83
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4 I HEREBY CERTIFY,
That I attended deceased from
19
I last saw h.
......
alive on
1-
19 ........ , death is said to
have occurred on the date stated above. at.
1.55 M
.m.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) Prematurity - 5 mons
TWEEN DNISET
AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE
.. Years.
Months
Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City)
winthrop
(State or country)
Mass
17 NAME OF
FATHER
Eylvio vodoin
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Burlington
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER Alice NorLand
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Gunada
$
N.H
6
Place of Burial or Cremation
Dec. 7,
55
DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS
9 Chelsea St.,E.Boston, MasS.
DEC 5 1955
Received and filed 19
(Registrar)
21
Sylvio Jodoin
Informant
(Address)
Burlington, Vt.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Matter I. Traberg.
(Signature of Agent of Board of Health or other)"
12/5/55-
(Official Designation)
(Date of Issue of Permity
X
1
CTIONS R RTIFICATE ring DEATH enter an one r each and (c)
es not mean dying, such re. asthenia. the disease, ions which
conditions. grise to the (a) stating ing cause
ns contrib- cath but not disease or sing death.
10OM-10-53-910621
T "Suffolk (County)
Boston
20 1-9:56
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) tam
(Address) 1993
M. D.
F-G STB
Date :/
1955
St . Michael Cemetery
Boston
(City or Town)
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations
19
to
single
25
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).
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 he buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
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 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
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city of 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-5-55-915025
PLACE OF DEATH
Essex (County) Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS TIMT COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
Registered No.
251
Danvers State Hospital, llathorne, Mas(f .death occurred in a hospital or institution. No.
St. [ give its NAME instead of street and number)
2 FULL NAME.
Fred E. Brown
(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. 1020 Shirley St., Winthrop, Mass ..
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death
.years.
10
months 0 days. In place of residence. ........... years. .. months .. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
December
2,
1955
(Year)
(Month)
(Day)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
4 I HEREBY CERTIFY.
That I attended deceased from
Feb. 2,
55
Dec. 2,
19.
to
.alive on
Dec. 2,
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.
12
AGE
Years
Months
24
.Days
If under 24 hours
Hours.
Minutes
Occupation :.
13 Usual
Leather Worker - retired
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ...
Unknown
16 BIRTHPLACE (City)
(State or country)
Has3.
17 NAME OF
FATHER
Norman Brown
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Canada
19 MAIDEN NAME
OF MOTHER
Amelia Scott
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Canada
21
Informant
(Address)
Hathorne, lass.
7 NAME OF
FUNERAL DIRECTOR
J. E. Henderson Co.
ADDRESS
Everett Mass.
Received and filed.
STAN 12 lovu
19
(Registrar of City or Town where deceased resided)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? If so, specify Andrew Nichols III
(Address).
(Signed) ..
Hathorne, Mass. Date 12/2/
M. D.
19 55
Farmington, Farmington, N. II. 6
Place of Burial or Cremation (City or Town)
DATE OF BURIAL.
Dec. 6,
,55
Mary E. Sheehan
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
December 5,
.......
.......
19
55
have occurred on the date stated above, at.
INTERVAL BE-
DISEASE OR CONDITION
DIRECTLY LEADING Generalized
TO DEATH (a).
Arteriosclerosis
Yrs.
ANTE
Due To
CEDENT (b)
CAUSES
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Was autopsy performed ?.
No
Date of operation
Clinical &
Lab.
What test confirmed diagnosis?
55
I last saw
him
8:25a.
m.
TWEEN ONSET AND DEATH
82
0
[ R-302 1
1.S.
AF TO"
6
7HRCP
JAN12
E
1
+ PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town) 24 Atlantic St
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burlal pormit with Board of Health or 1ts Agent.
Registered No.
255
J(If death occurred in a hospital or institution, St. \ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME Frank M. Mayer
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
(Usual place of abode)
24 Atlantic St.
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
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
December 3, 1955.
DEATH
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
White
10 SINGLE
MARRIED
(write the word)
Married
4 J HEREBY CERTIFY.
That I attended deceased from
SEPT.
13
1951
to.
DEC. 3
19
55
I last saw h ..... M .... alive on.
DEC. 2
19.5J, death is said to
have occurred on the date stated above, at.
4:00 P. m.
INTERVAL BE-
(or) WIFE of
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) ACUTE CORONARY
THROMBOSIS
TWEEN ONSET AND DEATH 1/2 hr.
11 IF STILLBORN, enter that fact here.
5
12
AGE &.B.
.. Years
11
Months
-
.. Days
If under 24 hours
Hours ....
.Minutes
13 Usual
Occupation :
Retired a
(Kind of work done during most of working life)
14 Industry
or Business :.
Railroad
15 Social Security No ..
Boston
16 BIRTHPLACE (City)
(State or country)
Mass
17 NAME OF
FATHER
(Cannot be learned ) Meyer
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
OF MOTHER
Minnie Burke
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Mary S. Mayer
Informant
(Address)
24 Atlantic St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial ør transit permit was issued: Walter S. Makers.
(Signature of Agent of Board of Health or other)
12/5/55
(Official Designation)
(Date of Issue of Permit)/
1.1 V
CTIONS R RTIFICATE
ving : DEATH enter an one r each and (c)
es not mean dying, such re, asthenia, the disease. ions which
conditions. rise to the (a) stating ing cause
ns contrib- cath but not disease or sing death.
100M-10-53-910621
6 inthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 6 1955
19
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS
Received and filed.
DEC 5 1955
19
(Registrar)
4 YRS.
Due
GENERALIZED
(c)
ARTERIOSCLEROSIS
10YRS.
OTHER
NONE
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
NONE
Was autopsy performed?
No
Date of operation
What test confirmed diagnosis: CLINICAL + LABORATORY
5 Was disease or injury in any way related to occupation of deceased ?...... O.
If so, specify.
(Signed) Maurice
(Address) 562 SHIRLEY ST. WiHTIRDate
M. D.
DEC 3, 1985
Winthrop
PARENTS
50
(Was deceased a
U. S. War Veteran,
if so specify WAR)
or DIVORCED-
Sears
10a If married, widowed, or divorced,
HUSBAND of.
(Give maiden name of wife in full)
ANTE
Due To
ARTERIOSCLEROSIS
CEDENT (b)
CAUSES
HEART DISEASE
R-301A 1
No.
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 deccased. 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, per 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 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
ing rules of practice:
deemed to have taken place between February fourteenth, eighteen hundred and. .. The fulfillment of the purpose of these laws calls for the observance of the follow-
(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 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
100M-10-53-910621
PLACE OF DEATH
. cont X-9-56 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.
256
[(If death occurred in a hospital or institution, Winthrop Community Hospital No.
St. [ give its NAME instead of street and number)
2 FULL NAME. Sarah E. Binney
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 162 Central
Somerville, Mass
(If nonresident, give city or town and State)
25 ve
.months.
In place of residence
... years
months
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR OR RACE
W
10 SINGLE
-MARRIED
WIDOWED
*Vidowed
4 I HEREBY CERTIFY,
That I attended deceased from
Nov. 22, 1955
to ..
Dec 9
19
55
I last saw h.e.X ...... alive on
Dec 9
19 55, death is said to
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