USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 52
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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
SERVICE NUMBER
R-302 1
PLACE OF DEATH
Suffolk (County)
Bostan
(City or Town)
Faulkner Hospt.
The Commomuralth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or Town making this return)
186
Registered No. 467€136
$ (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.) 205 Somerset Ave.
(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
3 DATE OF
DEATH
May 15/56
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
May 14, 19
56
to ....
19
I last saw h. Lave on May 15 , 19 50 death is said to
have occurred on the date stated above, at 12;30A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Atelectasis
Due To
rematurity
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed ?. Yes
What test confirmed diagnosis? autopsy
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
C P Sheldon
M. D.
(Address)
Winthrop Cer-Winthrop Mass
Place of Burial or Cremation
City or Town)
DATE OF BURIAL.
May 16/56 19
7 NAME OF FUNERAL DIRECTOR Winthrop Mass.
ADDRESS
Received and filed. AUG 2: NES 19
....
(Registrar of City or Town where deceased resided)
PERSONAL AND, STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
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 ...........
.Days
If under 24 hours
18ours ........ Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston Mass.
17 NAME OF FATHER
Arthur Johannesen
18 BIRTHPLACE OF
Winthrop Mass.
FATHER (City). (State or country)
19 MAIDEN NAME
OF MOTHER
Beverly Baker
Boston Mass.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
21 Informant.
Father
A TRUE COPY
AsPartes H. Mackie
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
May 17/56
19
(a) (1)) 6 resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
50M.11-55-9:6145
(Signed).
Boston Moss.
Date 5-15 .19 56
Howard S Reynolds
PARENTS
(Was deceased a U. S. War Veteran, if so specify WAR)
Win throp Mass.
St
That I attended deceased from May 15 56
INTERVAL BETWEEN ONSET AND DEATH 12 Hrs
No.
Baby Boy Johannesen
TO:
..
6
HR
AUG20 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 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
X PLACE OF DEATH
Norfolk
(County)
Quincy
(City or Town)
Dredge "Toledo" on Town River
J(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
Alexander DeCosta
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 34 Pebble Avenue
Winthrop 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
DEATH
July
15,
1956
(Month) (Day)
(Year)
9 SEX
Male
10 COLOR OR RACE
White
11 SINGLE
MARRIED
WIDOWED
Single
or DIVORCED
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.) Probable acute cardiac failure.
F.o.und .... dead ... in ... bunk.
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?
Manner of
Injury
(How did injury occur?)
Nature of
Injury
While at work?
. Was autopsy performed?
no
6 Was disease or injury in any way related to occupation of deceased? If so, specify George D. Dalton
(Signed).
754 Hancock Street
M. D,
(Address) Quincy
Winthrop Cemetery, Winthrop Place of Burial, or Cremation. (City or Town)
DATE OF BURIAL July 19, 19
8 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass.
.....
Received and filed.
AUG 1.3.1956
19
(Registrar of City or Town where deceased resided)
1
PARENTS
19 BIRTHPLACE OF
FATHER (City). (State or country)
20 MAIDEN NAME
OF MOTHER
21 BIRTHPLACE OF MOTHER (City) (State or country)
22 Ralph Payne
Informant winthrop Shore Drive,
(Address) +
winthrop
A TRUE COPY.
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
July 18,
.19 ..
56
X 1
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
54
- -
If under 24 hours
Hours.
Minutes
AGE
Years
Months.
.Days
14 Usual
Occupation:
Engineer
(Kind of work done during most of working life)
15 Industry or Business:
Steamship
16 Social Security No. Norwood
17 BIRTHPLACE (City)
(State or country)
Mass ...
18 NAME OF FATHER
25m-(h)-10-48-24658
RM R-305 1
No.
The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS COPY OF MEDICAL EXAMINER'S CERTIFICATE OF DEATH
Quincy
(City or town making return)
Registered No.
137
2 FULL NAME.
(Was deceased a U. S. War Veteran, if so specify WAR)
(write the word)
(Usual place of abode)
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
(Specify type of place)
.Date
7/16
19 ...
516
AUG13
X PLACE OF DEATH
Suffolk
(County) Chelsea
(City or Town) U.S.Naval
Hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea ......
(City or Town making this return '
332
Registered No. 138
§ (If death occurred in a hospital or institution, St. ¿ give its NAME instead of street and number)
WWII
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.) 164 Nahant Ave.
/
Winthropif Masseify WAR)
St
(If jonresident, giye 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
8 SEX Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Married
10a If married, widored thivorden. Cruzen 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 48 10 19
If under 24 hours
AGE.
Years.
Months Days
.S. Army
Hours ........ Minutes
2 das 13 Usual Occupation :
(Kind of work done during most of working life)
14 Industry or Business :
15 Social Security No ...
16 BIRTHPLACE (City Johnstown, Pa. (State or country)
Charled Edward Schmitz
17 NAME OF
FATIIER
18 BIRTHPLACE OF
Johnstown, Pa.
FATHER (City). (State or country)
19 MAIDEN NAWanna Clyd Wales OF MOTHER
20 BIRTHPLACE OF MOTHER (City) Johnstown, Pa
(State or country)
Records-U. S. Naval Hosp.
Chelsea, Mass ..
Willwerth Funeral Home
7 NAME OF FUNERAL DIRETARPVille, Mass. ADDRESS
Received and filed
AUG 13 1956
19
(Registrar of City or Town where deceased resided)
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Wound dehiscence after
Due To cholecystectomy
Cholecystitis choletithiasis.
OTHER
Obesity
SIGNIFICANT
yes
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?
J. D. Constable
(Signed) USNH, Chelsea, Mass. 7/24/56 M. D.
Date 19
Arlington National Cem. , Ft. Myer 6 Place of Burial or Cremafjuly 27 . 195 gity or Towny DATE OF BURIAL 19
21 Informant (Address)
A TRUE COPY Josephe a. Tyrrell
ATTEST:
"Registrar of City or Town where death occurred)
DATE FILED
July 2 5,1956
19
3 DATE OF DEATH (b) Due To (c) (Address) Copies of returns of deaths which occurred in your city or town in case the deccased resided in another city or town resided as soon as possible, after the closc of the month in which the death occurred. (Scc Chap. 46, Sec. 12, (i. I .. ) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased CONDITIONS
50M.11.55.916145
(Month)
(Day)
(Year)
HEREBY CER IFY, T
56
July
That I
attended deceased
24
56
1-m. 19 July
24,
-56
19
I last saw h ........ alive on
19
death is said to
7:15A.
have occurred on the date stated above, at
m.
R-302 1
No.
Edward Louis Fox
(Was deceased a U. S. War Veteran,
(a) Residence. No. (Usual place of abode) 1 11
July 24,1956
PARENTS
S. Army
5 yrs
L
R TON
...
HROP
AUG13 AM
Enlisted Feb.8,1952 Discharged July 24, 1956 CWO W2 Army W2152765
[ R-302 1
Revere
(City or Town)
The Commomuralth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Revere
(City or Town making this return)
Registered No.
139
S(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Margaret Monaghan (Bolwell)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .... 307 Bowdoin Street Winthrop St
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
months.
14 days. In place of residence.
.......... years ....
months.
......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
July
30,
1956
(Month)
(Day)
(Year)
4 1 HEREBY CERTIFY,
That I attended deceased from
July 16,
56
to ...
July 30
19 56
I last saw
QLalive on
July
30, 1956
death is said to
have occurred on the date stated above, at
10:55 P
DEATH WAS CAUSED BY: IMMEDIATE CAUSE.
(a)
Uremia
Due To
Basilar artery thrombos
(c) Diabetes mellitus
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
TTO
What test confirmed diagnosis ?.
Clinical si ns
5 Was disease or injury in any way related to occupation of deceased ?. no. If so, specify
(Signed)
James :. Turns
M. D.
(Address)
537 roa way
Date July 31956
Everett
6
.Winthrop
Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL. ALLust 3
1956
7 NAME OF
FUNERAL DIRECTOR
Maurice W. Kirby
ADDRESS 210 Winthrop St ..
Winthrop
Received and filed.
SEP 11 1956
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
hite
10 SINGLE
(write the word)
Female
MARRIED
WIDOWEDMarried
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Philip w. . ona-han
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 59 Years.
Months.
......
.. Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
ourowie
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Lacs.
17 NAME OF
FATHER
John Bolwell
PARENTS
18 BIRTHPLACE OF
FATHER (City).
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Cary Grant
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Scotland
21
Informant.
h 11 1. ona han
(Address) 307 Bovioin St., Winthrop
A TRUE COPY
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
August 3,
.19 ...
VI
56
WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD
(1)) resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To
50M - 11-55-916145
X PLACE OF DEATH
Suffolk (County)
INTERVAL BETWEEN ONSET AND DEATH 48
hours
Es
7
weeks
6
years
Boston
1
Grover fanor Hospital No.
(Was deceased a
U. S. War Veteran,
if so specify WAR)
19.
SEPII
[ R-302 1
(County) Bos ta
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Boston
(City or Town making this return)
140
7021
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME John G Winters
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No .. 452 Shore Drive
(Usual place of abode)
St.
Winthrop Mass
(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
Augus t 1,1956
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
August 1 19.
56
to ..
August
1
19
56
I last saw h. 1l@live on
August 1
19.
death is said to
6 PM
m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Pulmonary congestion edema
Due To (b)
Due To (c)
OTHER
Portal cirrhosis
SIGNIFICANT CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed)
C L Clay
M. D.
(Address)
Mass. General Hospt
Date.
19
Winthrop Cem-Winthrop Mass.
6
Place of Burial or Cremation
DATE OF BURIAL
August 3/56 gor Town) 19
7 NAME OF
FUNERAL DIRECTOR
E P Caggiano Winthrop Mass.
ADDRESS
Received and filed. SEP 6 1956 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX M
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 1F STILLBORN, enter that fact here.
12
AGE72
Years.
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Truck Driver
(Kind of work done during most of working life)
14 Industry
or Business :
Transportation
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Bostan Mass.
17 NAME OF FATHER James Winters
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Mary Larlsin
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Informant.
James .... Winters ... ·
Charles H. LAackde
ATTEST: (Registrar of City or Town where death occurred)
DATE FILED
August 6/56
19
50M .::- 55.9:6145
n
.
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L .. ) at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased
PLACE OF DEATH
Suffolk
No ..
Mass . General Hospt.
Registered No.
(Was deceased a U. S. War Veteran, if so specify WAR)
W W #1
have occurred on the date stated above, at
INTERVAL BETWEEN ONSET AND DEATH Hrs
Mos.
PARENTS
SEP .-
Entered Service March 25,1917 Discharged April 28,1919 Cook Co. 101st Infantry Service No. unknown
R-301A 1
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town) 435 "inthrop
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.
141
$(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.)
435 Winthrop 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
3 DATE OF
DEATH
August
(Month)
2 nd
(Day)
1956
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct. 13 -
1954,
to ..
July 26
1956
I last saw himalive on
July 26
19.56, death is said to
have occurred on the date stated above, at
6:30 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Arteriosclerotic Heart
Disease
Due To
Generalized Arteriosclerosis.
(b)
Due To
(c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
(Address). 624 Bennington St.
E. Boston, mass. Date Aug. 2 1956
6
Winthrop
Winthrop
Place of Burial or Cremation (City or Town)
DATE OF BURIAL Aug 4 19.56
7 NAME OF
Ernest P Caggiano
ADDRESS.
147 Winthrop St Winthrop Mass
Received and filed
AUG 3 1956
19
....
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE (write the word) MARRIED Married WIDOWED or DIVORCED
10a If married,
MAnelsor Mirgaine
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
72
2yrs
AGE
Years
7
Months.
Days®
If under 24 hours
Hours ........ Minutes
13 Usual
Retired Towerman
Occupation
(Kind of work done during most of working life)
14 Industry
None
15 Social Security No.
Lublin
16 BIRTHPLACE (City)
(State or country)
Ireland
17 NAME OF
FATHER
Joseph Ford
18 BIRTHPLACE OF
FATHER (City)
Dublin
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Unknown
20 BIRTHPLACE OF
Dublin
MOTHER (City)
(State or country)
Ireland
21 Mrs Agnes Ford
Informant ...
" winthrop St winthrop Hass
(Address)
435
I HEREBY CERTIFY that a satisfactory Standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Walter et detable .
(Signature of Ageut of Board of Health or other)
Milable Office 8/3/56
(Official Designation )
(Date of Issue of Permit)
1
UCTIONS OR CERTIFICATE
giving OF DEATH ot enter than one for each b) and (c)
oes not mean of dying, eart failure, tc. It means > e, or compli- which caused
ns, if any, ave rise to cause (a), the under- ause last.
ions contrib- death but not the terminal ndition given
Chapter 137, 1954, requires ns to print or e cause or f death on rtificates.
1)
X -
No.
2 FULL NAME John Joseph Ford
None
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No .. (Usual place of abode)
20
20
Registered No.
PARENTS
M. D.
100M-11-55-916145
INTERVAL BETWEEN ONSET AND DEATH
or Business:
Railroad
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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