Town of Winthrop : Record of Deaths 1956, Part 52

Author: Winthrop (Mass.)
Publication date: 1956
Publisher:
Number of Pages: 534


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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