USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 11
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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
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
FEB-+8
WINTHROP
a
173
SERVICE NUMBER
.....
RM R-305 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.)
PLACE OF DEATH
Suffolk
(County)
Revere
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
REVERE
(City or town making return)
26
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
34 Arcadia St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
......... years.
months.
.days. In place of residence
30
.years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
February
9,
1956
DEATH
(Month) (Day)
(Year)
4I 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.) Coronary Heart Disease
11a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE
58
Years
Months.
.Days
If under 24 hours
Hours ...
Minutes
14 Usual
Occupation 1.
Retired Policeman
(Kind of work done during most of working life)
15 Industry
or Business:
Police Dept
16 Social Security No.
17 BIRTHPLACE (City).
Somerville
(State or country)
lass.
18 NAME OF
FATHER
Nicholas E. Kenney
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Boston
Mass.
20 MAIDEN NAME
OF MOTHER
Eva J. Wallace
21 BIRTHPLACE OF
Boston
MOTHER (City)
(State or country)
Mass.
22 Eva J. Kenney
Informant
(Address)
34 Arcadia St., Revere
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
Received and filed.
MAR & 1956
19 58
(Registrar of City or Town where deceased resided)
PARENTS
6 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
Wm. J. Brickley, M.D.
M. D.
(Address)
Boston
Feb. 9 10 50
winthrop
Winthrop
7 Place of Burial, or Cremation.
(City or Town)
DATE OF BURIAL February 13,
19
5€ .....
8 NAME OF
FUNERAL DIRECTOR
Winthrop, Mass.
Arthur J. O'Maley
ADDRESS.
Date.
25m-(h)-10-48-24658
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
(Specify type of place)
Manner of
Collapsed suddenly
Injury
(How did injury occur?)
Nature of
Died
quickly
Injury
While at work?
Was autopsy performed?
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Single
Acute cardiac Dilatation
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?
(Was deceased a
U. S. War Veteran,
if so specify WAR)
WW 2
Revere
(a) Residence.
No.
(Usual place of abode)
34 Arcadia St.
No.
Walter J. Kenney
2 FULL NAME.
(City or Town)
Registered No.
DATE FILED
February
14.
56
DATE OF ENTERING MILITARY SERVICE DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT S RVICE NUMBER
-September 11, 1942 -May 16, 1945 -Sepc. lcl Port Security -U.S.C.G. 595-647
in
...
6
X
Suffolk (County)
: R-301A 1 Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filled for burial permit with Board of Health or its Agent.
27
2 FULL NAME Florence Irene Countaway (If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 51 Somerset Avenue
...... St
(If nonresident, give city or town and State)
Length of stay: In place of death. .......... years ..... 2 months 7 days. In place of residence 40 years. months. .. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
February
1.8
1-9.56
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
July
19.S.S., to ...
Feb
17
1956
I last saw hey ... alive on
2-17
19.56, death is said to
have occurred on the date stated ahove, at 6:400m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Coronary thrombosis
Due To (b)
7 mos.
Due To (c)
OTHER
SIGNIFICANT
Thyroid adenoma
CONDITIONS
Was autopsy performed? yes What test confirmed diagnosis? auto pay
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
M. D.
442 Chumley Sto
(Address) Winthrop Mass Date. 2-20 1956
6 Winthrop Come Place of Burial or crefifth tery, wint ar al.w.Mass
DATE OF BURIALFebruary 21/ 1996/7/ 19
7 NAME OF
Alfred V3. Marsle
FUNERAL DIRECTOR
ADDRESS .. 174 Winthrop St. Winthrop, Dass
Received and filed ..
FEB 21 1956
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
female
white
10a If married, widowed, or divorced HUSBAND of .. (Give maiden name of wife in full)
(or) WIFE of
ObediahP. Countaway
11 IF STILLBORN, enter that fact here.
12
AGE56 Years 5
.Months .. 2.4.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
housewife
(Kind of work done during most of working life)
14 Industry
or Business :
own home
15 Social Security No. 011-20-9904
16 BIRTHPLACE (City) ...... a.9-t-Boston
(State or country)
Lass.
17 NAME OF FATHER
PARENTS
18 BIRTHPLACE OF
Andrew Millington
FATHER (City) .......
Liverpool
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Harriet Giller
20 BIRTHPLACE OF
MOTHER (City)
Liverpool
(State or country)
England
21 Informant. Obediah R. Countaway
(Address)
51
Somerset
I HEREBY CERTIFY that a satisfactory standard certificatede death was filed with me BEFORE the burial ør transit permit was issued : Naturit- -
(Signature of Agent of Board of Health /or other)
Health Officer 2/21/56
(Official Designation)
(Date of Issue of Permit)
1./v
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean of dying, heart failure, etc. It means > e, or compli- which caused
ns, if any, ave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ndition given
Chapter 137, 1954, requires ns to print or e cause or of death on rtifcates.
100M-11-55-916:45
PLACE OF DEATH
No. Winthrop Community Hospital
Registered No.
S(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) ....... O.
(Usual place of abode)
INTERVAL BETWEEN ONSET AND DEATH
MARRIED
WIDOWEDmarried
or DIVORCED
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- 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 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 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 myet of working life even if retired. Children not gainfully employed may be return ed as at school of at home. > Pof a woman? whose only occupation was that of nome house och\ write housework .. For an person engaged in domestic service Owages; however, designate the occupation by the appropriate terms, as housekeeper private family, cool-Hotel etc. Pot a person who had no occupation whatever write none
2
BOVA
SPACE FOR ADDITIONAL INFORMATION
AM
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)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
28
St. ¿ give its NAME instead of street and number) No.
2 FULL NAME
Eva M. Hallberg
(If deceased is a married, widowed or divorced woman, give also maiden name.) 160 Woodside Ave
St
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years. months. .days. In place of residence.
17.years.
.months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Feb.
20
1956
(Month)
(Day)
,
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Feb. 14,
19 56,
to ..
Feb. 20
1956
I last saw he.v.alive on
Feb
20, 19 56 death is said to
have occurred on the date stated above, at 4:20 pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
a Cerebral Hemorrhage
INTERVAL BETWEEN ONSET AND DEATH 18 hrs.
2 yrs.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
NO
Was autopsy performed ?.
What test confirmed diagnosi@ linical.
5 Was disease or injury in any way related to occupation of deceased? No. If so, specify
(Signed)
Charles Like man
M. D.
(Address).
Winthrop, Mass Date 2/20/1956
6 Vinthron
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 23 19 ...
56
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass.
ADDRESS.
Received and filed.
FEB 21 1956
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
White
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED Married
10a If married, widowed, or divorced
HUSBAND of ......
(Give maiden name of wife in full)
(or) WIFE of
Reinhold L. Hallberg
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE64
Years ............ Months.
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own Home
15 Social Security No ..
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
Burpee Brittain
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Mary Allen
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21
Informant.
Reinhold I Hallberg
(Address)
150 Woodside Ave Vinthron
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Walter f- Jakerg- (Signature of Agent øf Board of Health or other) Mattle Officer 2/21/06
(Official Designation)
(Date of Issue of Pernity
V.V
ICTIONS OR CERTIFICATE giving OF DEATH t enter han one for each b) and (c)
Does not mean of dying, eart failure, tc. It means , or compli- hich caused
s, if any, ve rise to ause (a), the under- ause last.
ions contrib- cath but not the terminal ndition given
Chapter 137, 1954, requires is to print or e
cause or death on rtificates.
ausT M.s.
100M-11.55-916145
To be filed for burial permit with Board of Health or its Agent.
Winthrop Community Hospital
$(If death occurred in a hospital or institution,,
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No. (Usual place of abode)
Due To
Hypertension
(b)
Forest Glen
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- 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
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