USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1956 > Part 80
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(write the word)
SAN 3 1957
R-302 1
-
Revere
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
Revere
(City or Town making this return)
Registered No.
228
Grover Manor Hospital No.
$ (If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
2 FULL NAME
Alice McNaught (Collins)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ...
92 Plummer Avenue
(Usual place of abode)
Winthrop
St
(If nonresident, give city or town and State)
Length of stay: In place of death.
.years.
months.
LOdays. In place of residence
50 years.
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Nove ber
13,
1956
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
Nov. 3.
56
Nov.
13
19. to ...
I last saw R.k.alive on
TTOv
13
19.56, death is said to
have occurred on the date stated above, at
9:15 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Uremia
INTERVAL BETWEEN ONSET AND DEATH 48
Hours
years
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
Patholo, y
5 Was disease or injury in any way related to occupation of deceased ?...... Q. If so, specify
(Signed).
James M. Burns
M. D.
537 Bronuway
Date.
11/13/156
6
Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL November 16.
19.56
7 NAME OF
FUNERAL DIRECTOR
Howard S. Reynolds
ADDRESS Winthrop, Lass
Received and filed DEC 11956 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
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
John A. Mic Taught
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ... 7.Q.Years.
7
Months.
15 Days
If under 24 hours
.Hours.
Minutes
13 Usual
Occupation :
Ho sewife
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No ..
None
16 BIRTHPLACE (City).
(State or country)
England
17 NAME OF
FATHER
Henry Collins
18 BIRTHPLACE OF
FATHER (City).
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Jessie Penlin-ton
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Enrland
21 John A. "c"aucht
Informant ...
(Address)
92 Plummer AvC.,
Linthrop
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
November .
16,
19
56
X
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.)
50M -11-55-916145
PLACE OF DEATH
Suffolk (County)
(City or Town)
CERTIFICATE OF DEATH
at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
--
PARENTS
(Address)
Everett
3
Due To Carcinoma of ovaries
(b)
That I attended deceased from
19
56
(Was deceased a
U. S. War Veteran,
(if so specify WAR)
0
X
PLACE OF DEATH
T
(County)
(City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
HOSTON
(City or Town making this return) 229
Registered No.
$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Mary Bornstein
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ... 493 Shirley
St
Winthrop,
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years.
months.
-12 days. In place of residence. I.t. Oyears.
.months ..
.days.
MEDICAL CERTIFICATE OF DEATH
HOYS Yamber 36 1956
4 I HEREBY CERTIFY,
That I attended deceased from
Nov
16, 1956
I last saw h ........ alive on Nov16 19.56 death is said to
have occurred on the date stated above, at 7:50A m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Pulmonary Embolus
Due To (b) Thrombophlebitis
OTHER
SIGNIFICANT Cholecystitis,
CONDITIONS
Cholelithiasis
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed).
J G Lonergan
M. D.
(Address) ..
faulkner Hospt
Date 11-16 156
Tverett
DATE OF BURIAL Nov 18 1956
7 NAME OF
FUNERAL DIRECTOR
A Golov
ADDRESS
Brookline Mass
Received and filed.
DEC 2. NEV
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
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
Morris Fornstein
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
10 minsAGE.62Years
Months.
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housework
(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) Lithuania
17 NAME OF
FATHER
Hilton Kabatchnick
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Lithuania
19 MAIDEN NAME
OF MOTHER
Fella
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Lithuania
21 Informant. Manuel Hiller
(Address)
€
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Nov 23
19
56
1
R-302 1
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.)
(Usual place of abode) 3 DATE OF DEATH Nov 4 56 to 19 Due To (c) 6 Winthrop Cem Place of Buriaf or Cremation at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased Was autopsy performed? What test confirmed diagnosis? Yes
INTERVAL BETWEEN ONSET AND DEATH
50M .: 1.55.916145
(City or Town)
PARENTS
No .. Faulkner .Hospt
(Was deceased a
U. S. War Veteran,
if so specify WAR)
DECAS
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. (Sec 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
(County)
(City or Town)
The Commamwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
(City or Town making this return) 230
Registered No.
10324
§ (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.)
83 Shore Drive
S
(If nonresident, give city or town and State)
Length of stay: In place of death ............ years.
.. months.
13.
.days. In place of residence.
15years
months
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
F
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divorced HUSBAND of Michael Staller
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
69
AGE
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 :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Russia
OTHER SIGNIFICANT CONDITIONS
No
Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased ?. If so, specify
(Signed) M B Rosenthal
M. D.
(Address)
941 vorton
St
Date
11-17
19
56
6
Jewish Alliance Place of Burial or Cremation
Danvers
DATE OF BURIAL
(City or Town) Mov ...... 18 .... 19 .. 56
Informant
(Address)
7 NAME OF FUNERAL DIRECTOR A Golov
Brookline, Mass
ADDRESS
Received and filed
DEC. 20,1956
19
(Registrar of City or Town where deceased resided)
A TRUE COPY
ATTEST:
(Registrar of City or Town where death occurred)
DATE FILED
Nov 21
56
19
-
11
-
(Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No (Usual place of abode)
November 17
(Month)
(Day)
1956 (Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Nov
5
Nov
16
19 56
I last saw h ........ alive on
19
56
to
Nov.
16, 19 56 death is said to
have occurred on the date stated above, at 3:00A. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Generalized Arterio-
sclerosis with heart disease
INTERVAL BETWEEN ONSET AND DEATH
yrs
Due To (b) Cerebral hemorrhage
6 wks
Due To (c)
17 NAME OF FATHER Noah Baskin
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Russia
19 MAIDEN NAME
OF MOTHER
Esther
20 BIRTHPLACE OF
MOTHER (City) ......... Russia
(State or country)
21 Husband
50M -::- 55.916145
R-302 1
No.
Copley Hos pt
Rose Staller
Winthrop,
3 DATE OF
DEATH
X
Suffolk
(County)
Winthrop
(City of Town)
Winthrop
Community
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent
231
No. 40 Lincoln St
[(If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
2 FULL NAME Mrs. Alice Babb.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15 Pearl Ave ... Winthrop Mass
(a) Residence.
No.
(Usual place of abode)
Length of stay: In place of death years months 7 days. In place of residence.
.20
years
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Vidowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Edgar 0. Babb
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
Nov. 13, 156 87
AGE
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)
~Maine
17 NAME OF
FATHER
Pease
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Maine
19 MAIDEN NAME
OF MOTHER
Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Cannot be learned
21 Frank McAuliffe
Informant
(Address)
15 Pearl Ave Winthrop
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS
Winthrop Mass
19 56
Received and filed
. Registi al )
7 YEARS
(b) DISEASE
Due To (c)
OTHER
INTERTROCHANTERIC FRACTURE
SIGNIFICANT LEFT HIM WITH PLATE REPAIR AUG
CONDITIONS
1955
Was autopsy performed?
No
What test confirmed diagnosis? EKG-X-RAY
5 Was disease or injury in any way related to occupation of deceased? No.
If so, specify
(Signed).
Dorothy Cheney appleton, M. D.
(Address) 197 Woodside are Date 12/1
19.56
Wenthurt, masa
6
Seaview
Rockland Me.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
December 5
1956
PARENTS
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Ralph E. Siveanni
(Signature of Agent of Board of Health or other)
Sec.2.1956
(Official Designation) (Date of Issue of Permit)
X
UCTIONS OR CERTIFICATE
iving OF DEATH t enter han one for each b) and (c)
es not mean of dying, heart failure, tc. It means or compli- hich caused
s, if any, ve rise to ause (a), the under- last. ause
ons contrib- cath but not the terminal dition given
Chapter 137, 954, requires s to print or cause or death on tificates.
SOM-5-56-917573
3 DATE OF
DEATH
DeceMBER
1
1956
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
11-23
250
12 - 1
to
19.12
I last saw hEalive on
DECEMBER 1, 1956, death is said to
have occurred on the date stated above, at
11:20Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ACUTE MYOCARDIAL INSUFFICIENCY
(a)
INTERVAL
BETWEEN
ONSET AND
DEATH
1
CERTIFICATE OF DEATH Ho sp.
Registered No.
PHYSICIAN - IMPORTANT
( Pease)
(Was deceased a
U. S. War Veteran,
if so specify WAR).
(If nonresident, give city or town and State)
PLACE OF DEATH
R-301A 1
Due To
ARTERIOSCLEROSIS HEART
Rockland
Rockland
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 dicd, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall. if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, 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 sclectmen 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 sooncr 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 pn 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
Suffolk (County)
Winthrop (City of Townhay flower
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filed for burial permit with Board of Health or its Agent.
232
( (If death occurred in a hospital or institution,, St. { give its NAME instead of street and number) No .. 39 Grovers Avenue, Winthrop
2 FULL NAME Mary L. White
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 15 Sunset Road, Winthrop St
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .. ] ..... years .. 6 months:days. In place of residence 16 years. .months. ... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
December
£
DEATH
(Month)
(Day)
/
1956
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19 ....
to
19.
-
I last saw h ........ alive on
., 19 .......... , death is said to
have occurred on the date stated above, at
4:30 A. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL BETWEEN ONSET AND DEATH
Due To
To Presumably Coronary
(b)
Occlusion
(c)
Arteriosclerotic Heart
Disease
years
OTHER
SIGNIFICANT
CONDITIONS
Hypertension
years
Was autopsy performed ?.
no
What test confirmed diagnosis? - -
5 Was disease or injury in any way related to occupation of deceased? no If so, speerty
(Address)
Winthrop Board of Health
1956
Winthrop Cemetery, Winthrop 6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL December ..... 4th 19.5.6
7 NAME OF
FUNERAL DIRECTOR.
Richard C. Kirby
ADDRESS917 Bennington St., E. Boston
Received and filed.
DEC 1 - 1956
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
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
Hugh White
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE71
Years
3 Months 16 Days
If under 24 hours
.Hours ........ Minutes
Occupation :
13 Usual
At home-Housewife
(Kind of work done during most of working life)
14 Industry
or Business :.
Housewife ++/ Hci12 C-
15 Social Security No ....
None
16 BIRTHPLACE (City)
Worcester
(State or country) Mass.
PARENTS
17 NAME OF
FATHER
Richard Phelan
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
M. D. OF MOTHER Mary Donnell
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21 Mr. Hugh White-husband
Informant
(Address) 75 Sunset Rd., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was Aled with me BEFORE the burial or transit permit was issued: Malkle C. Pereaque
(Signature of Agent of Board of Health or other)
Health"
Officer
12/3/56
(Official Designation)
(Date of Issue of Permit>
UCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means > e, or compli- which caused
ns, if any, ave rise to cause (a), the under- cause last.
ions contrib- cath but not the terminal ndition given
Chapter 137, 1954, requires ns to print or e cause or of death on rtificates.
100M- 11-55-916145
R-301A 1
CERTIFICATE OF DEATH
Registered No.
(Phelan)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
No
if so specify WAR)
1
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.
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