USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1955 > Part 9
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(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
X
PLACE OF DEATH
Essex (County)
Danvers
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Danvers
(City or town making return)
21
.1-54
Denvers State Mosnital No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
Sophie Lindahl (Loch)
(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.
34 Underhill
St.
throp
(Usual place of abode)+
(If nonresident, give city or town and State)
Length of stay: In place of death ._....... years.3 ........ months&
days. In place of residence.
years
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January
4.
1955
(Month)
(Day)
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
ried
4 I HEREBY CERTIFY,
That
I
attended deceased from
1955
I last saw her
alive ofan. 4.
19.
death is said to
55
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of.
Robert Lindahl
(Husband's name in full)
TWEEN ONSET
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
(a)
Hypertensive
AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE69.
.Years.
1.0. Month3.8
Days
If under 24 hours
Hours.
Minutes
Heart isease
Yrs
ANTE
Due To
CEDENT (b)
CAUSES
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Broncho neumonia
days
Major findings:
Of operations.
Date of operation.
Was autopsy performed ?..... NO.
What test confirmed diagnosis?@Linical.
· Laborat ny
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed) Andrew ichols 3rd
(Address) iathorne, lass Date 1/6/
193.5 ...
M. D.
6. int.no:
Gem
Vinshron
Place of Burial or Cremation (City or Town)
DATE OF BURIAL ......
January
7
55
7 NAME OF
FUNERAL DIRECTOR
Alfred B. Harsh
ADDRESS
wass.
Received and filed DPH 147955
19
(Registrar of City or Town where deceased resided)
PARENTS
19 MAIDEN NAME
OF MOTHER
Margaret Theresa (Unkno
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Poland
21
Informant.
(Address?
othorne, Lasst
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
January 10
19
55
X
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, 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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-3-53-909098
-
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
023-10-6803
16 BIRTHPLACE (City)
(State or country)
Pola
17 NAME OF
FATHER
Jacob Lech
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Poland
Mary F. Sheehan
Sept. 26, 153
to Jan.
4.
have occurred on the date stated above, atd ... LO A
.m.
INTERVAL BE-
RM R-302 1
Registered No.
2 FULL NAME
RECEIVED
OF
TOWN
11 1,2
1
GLE
3
6
THROP
FEB15 ÁM
X
Suffolk
(County)
Boston
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Bos ton
(City or town making return)
Registered No.
22244
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.)
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No.
(Usual place of abode)
(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
Jan. 7/55
(Day)
(Year)
4 I HEREBY CERTIFY,
That I
attended deceased from
Dec.30. 19 54.
to
Jan. 7
19
55
10a If married, widowed, or divorced
HUSBAND of
Anna .. Scucimara
(or) WIFE of.
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Arterio sclero tic
heart disease with old"
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE .. 79 .... Years.
Months.
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :.
Retired
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No.
16 BIRTHPLACE (City).
(State or country)
Italy
17 NAME OF
FATHER
Antonio Cuida
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
Date of operation.
.Was autopsy performed ?.
What test confirmed diagnosis ?... autopsy ..
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
M W O'Connell
M. D.
1955
(Address) Boston City Horst Date 2-7
St. Michael 's'Bos ton Mass.
6 Place of Burial or Cremation (City or Town)
DATE OF BURIAL
Jan.10/55
19
21
Informant
(Address)
Gennaro Guida
A TRUE COPY Les A. Inactie
ATTEST:
(Registrar of City or Town where death occurred)
Jan.11/55
DATE FILED
19
(Registrar of City or Town where deceased resided)
8 SEX
9 COLOR OR RACE
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Widowed
I last saw h .............. alive on
19.
death is said to
have occurred on the date stated above, at
6:08Am.
INTERVAL BE-
Weeks
ANTE
Due To
CEDENT (b)
...
CAUSES
Myocardial infarct
Due To
Generalized arterio
(c)
sclerosis
Yrs
OTHER
SIGNIFICANT
CONDITIONS
Major findings:
Of operations.
PARENTS
19 MAIDEN NAME
OF MOTHER
Anna --
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy ..
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
Fast Boston Mass.
ADDRESS.
Received and filed
FEB 24 1955
19
25M-3-53-909098
PLACE OF DEATH
RM 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,
No.
Boston City Haft.
Leo Guida
L1 Washington Ave.
St.
Winthrop Mass.
(Give maiden name of wife in full)
apical
X
(Month)
RECEIVED
TOW
OF
11 12.1
1.7.
-
5
6
FEB22 AM
X
PLACE OF DEATH
SUFFOLK ROSTON COUA
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
BOSTON
(City or town making return) 643
Registered No.
23
[(If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
2 FULL NAME
Arthur Banda
(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. (Usual place of abode)
83 Sunnyside Ave
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
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
11a If married, widowed, or dirge den Mclaughlin
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN. enter that fact here.
56
13
AGE
Years.
Months.
Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
M T A Guard
(Kind of work done during most of working life)
15 Industry
or Business:
015-24-4808
16 Social Security No.
Boston Mass
17 BIRTHPLACE (City).
(State or country)
18 NAME OF
FATHER
John Banda
PARENTS
19 BIRTHPLACE OF
Italy
FATHER (City)
(State or country)
20 MAIDEN NAME
OF MOTHER
Caroline
21 BIRTHPLACE OF
-
MOTHER (City)
(State or country)
Wife
22 Informant. (Address)
A TRUE COPY
ATTEST:
Charles 21 Zacke
gistrar of City of Town where death occurred)
DATE FILED ....... Jan 24 19 55
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-305 to the clerk of the city or town in which the deceased resided as soon as possible
25m-(c)-11-49-900.475
-
Received and filed 19
M. D.
(Address)
Boston Mass
Date.
1/19 19 55
7
New Calvary .Com
Boston
Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL.
Jan .. 22
195.5.
8 NAME OF
FUNERAL DIRECTOR
Pennacchio & Son Inc
ADDRESS
Boston Mass
MAR 11 199
6 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
W J Brickley
(Specify type of place)
Manner of
Injury
Collapsed ... suddenly ... and
(How did injury occur?)
Nature of
Injury
died quickly
While at work?
?
Was autopsy performed? . N.O.
5 Accident, suicide, or homicide (specify) :.
Date and hour of injury.
19
Where did
Injury occur?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place?
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury was involved, state fully.) Hypertensive heart disease Acute cardiac failure
3 DATE OF
DEATH
Jan .... 19,1955
No. €
enroute to E Boston Relief Station
M R-305 1
(Registrar of City or Town where deceased resided)
Winthrop Mass
RECEIVED
OF TOW
11 12
1
ivis
6 5
HROP
MAR11 AM
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-305 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-5-52-907046
-Suffolk
PLACE OF DEATH
BostorfCounty)
(City or Town)
"Bo Somerset Ave.
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Bos ton
(City or town making return)
Registered No ...
21
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.) 31 Villa Ave.
(Was deceased a U. S. War Veteran,
Win thr opif Meansfy
WAR
(a) Residence. No.
(Usual place of abode)
30
(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
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY that I have investigated the death of the person above-named and that the CAUSE AND MANNER thereof are as follows: (If an injury wasinvolved state fuldease Arterio sc
11a If married, widowed, or divorced
HUSBAND of
(Give cosiden pare os tifsts ball
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13 71
AGE
.Years ..
.Months.
Days
If under 24 hours
Hours ....
Minutes
14 Usual
Occupation :.
Storekeeper
(Kind of work done during most of working life)
15 Industry or Business:
16 Social Security No.
Wor cester Lass
17 BIRTHPLACE (City).
(State or country)
C Louis Miville
18 NAME OF FATHER
19 BIRTHPLACE OF
FATHER (City) ..
(State or country)
Canada
20 MAIDEN NAME
OF MOTHER
Amanda Bolduc
Canada
·
7 Place of Burial, or Cremationdan. 24/55 (City or Town) DATE OF BURIAL 19
8 NAME OF
FUNERAL DIRECTOR
A M Roy
Worcester Mass.
ADDRESS
Received and filed.
MAR 11 1955
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR OR RACE
11 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Wido wed
probably coronary screrosig
5 Accident, suicide, or homicide (specify).
Date and hour of injury. 19
Where did Injury occur? (City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in public place? Collapses sudden luce and died.
Manner of
Injury
gut ckyHow did injury occur?)
Nature of
Injury 2 ..... No
While at work?
.Was autopsy performed?
6 Was disease or injury in any way related to occupation of deceased?
If so, specify. w .... J .... "pick-løy.
(Signed)
Boston Mass.
.Date. en To center 95
(Address) Notre Dame Gem
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
H E Miville
22 Informant (Address)
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred) Jan. 25/55
DATE FILED
19
No.
Alma Stetson
M R-305 1
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
PARENTS
St.
Jaur. 20/55
RECEIVED
OF TOWN
11 12
5
6
IROP
MAR11 AM
RM R-302 1
Ti
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 WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
25M-3-53-909098 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, CONDITIONS
PLACE OF DEATH
Essex (County)
Danvers.
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Danvers
(City or town making return)
25
J(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
Ina Blackburn (Bourne)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
witors DR. (a) Residence. No. 125 Cliff Ave. .
Winthrop
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.. years 2 months 2
days. In place of residence.
......
... years.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
January 2, 1955
(Year)
8 SEX
Female
9 COLOR OR RACE
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEDdowed
4 I HEREBY CERTIFY.
That I attended deceased from
Nov. 2
...
to. J.en.
19.5.5
I last saw er ..
.alive on
Jan.
.24
155.
death is said to
INTERVAL BE-
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Albert blackburn
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)
Arteriosclerotic
Heart Disease
yrs
ANTE
Due To
CEDENT (b) Generalized Arterio ......
CAUSES
selerosis
Due To
(c)
OTHER
SIGNIFICANT
Virus ..... Infection
Days
Major findings:
Of operations.
Date of operation
Was autopsy performed ?. No
What test confirmed diagnosis linical ? Laboratory
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed) .... A.
W Nichola 3rd.
My D.
(Address).athorne ....... Mas
Datel/28/
195
6 Riverside Com. Place of Burial or Cremation (City or Town)
DATE OF BURIAL ..
January
29
155
7 NAME OF
FUNERAL DIRECTOR.
floward S. Reynolds
ADDRESS
Winthrop, Mass.
Received and filed.
FEB 1& 1000
19
(Registrar of City or Town where deceased resided)
11 IF STILLBORN, enter that fact here.
12
AGE 76 Year
Months 6.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Unable to work
Occupation:
(Kind of work done during most of working life)
14 Industry or Business:
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Nebraska
17 NAME OF
FATHER
Thomas Bourne
18 BIRTHPLACE OF
FATHER (City)
(State or country)
En ;land
19 MAIDEN NAME
OF MOTHER
Polly Thacker
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
En Land
21
Informant
Mary N. Sheehan
(Address}
ilthorne, Masa
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred) 0
DATE PILED
January
31
19
55
Registered No.
CERTIFICATE OF DEATH
NDanvers State Hospital, Hathorne
2 FULL NAME.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(Usual place of abode)
(Month)
have occurred on the date stated above. at.
12:45 A
TWEEN ONSET
AND DEATH
PARENTS
... Rochester .. ........ Y ...
RECEIVED
TOWA
U
11 12
13
CUM
6
THEO?
FEB14 AM
X Suffolk (County)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
1
To be filed for burial ·permit with Board of Heaith or its Agent.
26
J(If death occurred in a hospital or institution. .. 8 | give its NAME instead of street and number) No.
2 FULL NAME ..
(a) Residence. No. 6 Loring Road (Usual place of abode) 45
.....
St.
(If nonresident, give city or town and State)
Length of stay: In place of death years. months days. In place of residence
45 .. years .months .days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
FEBRUARY 1
6955
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY.
That
February 1
1955
attended deceased from
JANUARY 10 19 1940
I last saw
.. alive on.
February /195'S death is said to
6:10 PM
have occurred on the date stated above, at
INTERVAL BE-
TWEEN ONSET
AND DEATH
11 IF STILLBORN. enter that fact here.
12
AGE
90
Years
4
Months
1
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) Unable to obtain (State or country) Swetdan
17 NAME OF FATHER Fagerstedt
Major findings:
Of operations
none
Date of operation.
NONE
.. Was autopsy performed ?.
NO
What test confirmed diagn Clinical & labratori
5 Was disease or injury in any way related to occupation of deceased? (×6 If so, specify. J. abrams M.V (Signed).Jacar. t (Addres )562 Stanley St. What go
M. D.
2/3/5
6 Winthrop
Cemetery Winthrop (City or Town)
Place of Burial or Cremation
DATE OF BURIAL February 4 19:53
7 NAME OF
Victoria G. Runtolds
FUNERAL DIRECTOR 180 Whichnop St. Winthrop
ADDRESS
Received and filed.
FEB ........ 3.1955
..... 19
(Registrar)
PARENTS
19 MAIDEN NAME
OF MOTHER
Unable to obtain
20 BIRTHPLACE OF MOTHER (City) Unable to obtain
(State or country) Sweddin
21 Mrs Violet Hagman Bucknam (Address) G Koring Road Winthrop,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter I. Baker & (Signature of Agent of Board of Health or other) Healtle Muce 2/3/55
(Official Designation)
(Date of Issue of Permit)
X
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, such lure, asthenia. ns the disease. cations which th.
d conditions. ing rise to the e (a) stating lying cause
lions contrib- death but not he disease or ausing death.
· Chapter 137. 1954, requires ns to print or cause or causes th on death tes.
SOM-3-54-911687
PLACE OF DEATH
I R-301A 1
Winthrop (City or Town) 6 Loring
Road Emily Albertina (Fagerstedt) Hagman (If deceased is a married, widowed or divorced woman, give also maiden name.)
9 COLOR OR RACE
(write the word)
8 SEX
Female White
10 SINGLE
MARRIED.
WIDOWED Widowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Eric G. Hagman
(Husband's name In full)
4 days
ANTE CEDENT (b)
Cerebral ARTERIOSCLEROSIS
2 yrs
Due To (c) UREMIA
48 hrs
OTHER SIGNIFICANT CONDITIONS
18 BIRTHPLACE OF FATHER (City) (State or country) Sweddan
Unable to obtain
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran.
( if so specify WAR)
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH
Levebral HEMORRHAGE
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 1 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
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