USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 32
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(a) Residence.
No.
160 quincy Avenue
(Usual place of abode)
30 minutes
St. (If nonresident, give city or town and State)
Length of stay: In place of death
.years .....
months ....... days. In place of residence 10 years.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
MAY
11
1957
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
Dec
57
19
54
to
May 11
I last saw himalive on
may
1, 19.5 7, death is said to
have occurred on the date stated above, at
4:40 A.m.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a) Coronary Occlusion, acute
Due To
Coronary Artery
-
(b)
Heart Disease.
Due To Myocardial Infarction (c) Anterior, healed
2 1/2 yrs
OTHER
SIGNIFICANT
CONDITIONS
None.
Was autopsy performed?
no
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased no
If so, specify .
(Signed)
(Address)
Wirelles
Date
5/11/1957
6
Rushtown Cemetery Ruaht own, Ohio Place of Burial or Cremation (City or Town)
DATE OF BURIAL May 16.1957 12
7 NAME OF
FUNERAL DIRECTOR
alfred B. Manske
ADDRESS
174 Winthron-St. - Winthrop.
Received and filed
MAY -13 1957
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
male
white
10a If married, widowed, or divorced
HUSBAND
ofDelbertta Nazimove-Hole
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
.54 Years
7 Months
9
Days
If under 24 hours
Hours ..... Minutes
13 Usual
Occupation :
C.A. A. Inspector
(Kind of work done during most of working life)
14 Industry
or Business :
U.S. AirIForcetor
15 Social Security No ..
275-01-1486
Rarden
16 BIRTHPLACE (City)
(State or country)
Ohio
17 NAME OF
FATHER Randolph Jackson Newman
PARENTS
18 BIRTHPLACE OF
FATHER (City)
Sabina
(State or country)
Ohio
19 MAIDEN NAME
OF MOTHER
Nora Freeman
20 BIRTHPLACE OF
Sabina
MOTHER (City)
(State or country)
Ohi
21
Informant
Mrs. Everett O. Newman
(Address)
160 Quincy Ave Winthron
I HEREBY CERTIFY that, a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued.
MA88 -12424 (Signature of )getit of Board of Health or other)/
Official Designation)
(Date of Issue of l'ermit )
5/13/57
X
R-301A 1
CTIONS OR ERTIFICATE
Iving F DEATH tenter an one or each ) and (c)
es not mean of dying, art failure, . It means or compli- ich caused
, if any, ve rise to iuse
(a), he under- use
last .
ns contrib- - ath but not the terminal dition given
Chapter 137, 54, requires s to print or cause death on ifcates.
No. Rinthron Community Hospital
Registered No.
f(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)
W. W. 2
MARRIED
WIDOWED married
or DIVORCED
INTERVAL BETWEEN ONSET AND DEATH 6 hrs
21/2 yra.
M. D.
SOM-5-56-917573
I.V.G
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven 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 he 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
March 14,1942.
DATE OF DISCHARGE
June 26.1945
RANK, RATING
Lt.Col.
ORGANIZATION AND OUTFIT
U.S. Air Forcew:
SERVICE NUMBER
0-900-627
MAY 1 31957 MĄ F
10
OFFICE O
Co
6
NIN
TOWN
RECEIVED
....
MASS
18370
-
X
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
To be filed for burial permit with Board of Health or its Agent.
98
Registered No.
$(If death occurred in a hospital or institution,,
St. { give its NAME instead of street and number)
2 FULL NAME
Beatrice C. Phillips
(If deceased is a married, widowed or divorced woman, give also maiden name.)
239 Pleasant 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
May
12.
1957.
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
JAN 2V
1954
MAY
12
1957
I last saw
h&Ralive on
5/3
1957.
death is said to
have occurred on the date stated ahove, at
11 A
„.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
ROUTE CORONAY OCCLUSION
(a)
Due To ARTERIO -SCLEROTIC HEART (b)
DISEASE WITH CONGESTIVE FAILURE
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
NONE
Was autopsy performed?
NO
What test confirmed diagnosis ?. CLINICAL
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify.
(Signed)
M. D.
(Address) 322 PLEASANT, STY
5/13
1957
Winthrop
Winthrop
G
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL May 15
7 NAME OF
FUNERAL DIRECTOR.
Arthur J. O'Maley
Winthrop Mass
ADDRESS
Received and filed.
MAY 14 1957
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED 1 do wed
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
Joseph Phillips
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE78
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)
Ire land
17 NAME OF
FATHER
Patrick Crofton
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Bridget Spellman
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Ireland
21
Informant
(Address)
Old Age Ass't Records
Winthrop Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death way filed with me BEFORE the burial or transit pernuit was issued:
(Signature of Agent of Board of Health or other)
Kcalthe Crucis
5/14/57
official Designation
(Date of Issue of Perinit)
VIV
UCTIONS FOR CERTIFICATE giving OF DEATH ot enter than one for each (b) and (c)
does not mean e of dying, heart failure, etc. It means > se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
tions contrib- death but not the terminal ondition given
· Chapter 137, 1954, requires ans to print or he
cause or of death on ertificates.
100M. 11.55.916145
. R-301A 1
No.
239 PleasantSt
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No ...
(Usual place of abode)
3
30
.. , to.
INTERVAL BETWEEN ONSET AND DEATH
1 HTR.
6mo
PARENTS
›
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 .eceived 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).
TO!
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 mjury 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. o. G.T. (Tercentenary Edition).
RULES OF PRACTICE
The fulfillmentof 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-301A 1 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 filed for burial permit with Board of Health or its Agent.
Registered No. 99
TOY HIGHLAND AVE ( (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)
(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. Winthropmuss
MEDICAL CERTIFICATE OF DEATH
7
3 DATE OF
DEATH
May
16
195€
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
June 1916 to .. mas 16
57
I last saw heralive on
19 J & death is said to
have occurred on the date stated above, at
11454 m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) cerchio vascular
Due To arteriosclerosis (b)
generälege de
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) people fregene M. D. 19 y Washingtonshot Date 5-16-570 Date.
6 NINTHRUP
WINTHROP
Place of Burial or Cremation (City or Town)
DATE OF BURIAL MHP 18 995% (Address) N.I.
7 NAME OF
ADDRES ZION INTHROP ST NIITARIA
Received and filed MAY 2.1 105 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
FEMALE WHITE
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
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 5.5 Years.
Months.
Days®
If under 24 hours
Hours ........ Minutes
Occupation :.
13 Usual
RESTAURANT WORKER
(Kind of work done during most of working life)
14 Industry
or Business :
RESTAURANT RESTAURANT)
15 Social Security No CHABLE TO OBTAIN
16 BIRTHPLACE (City) ~.. BPIPTETOWN (State or country) ISLE OF BARBAOS
BARBADOS
17 NAME OF
FATHER
FREDERICK,
PARENTS
19 MAIDEN NAME
OF MOTHER
ETHEL POLGREEN
20 BIRTHPLACE OF
MOTHER (City)
(State or country) ISLE OF BARBERS
21 Informant. PERCY.
I HEREBY CERTIFY that a satisfactory standard certificate of death wax filed with me BEFORE the burial or transit permit was issued : Jayzu (, Mi12 (Signature of Agent of Board of thealth or other) Thaise Cruces 1
YOfficial Designation) V
(Date of Issue of Permit)
X
RUCTIONS FOR CERTIFICATE
giving OF DEATH ot enter than one for each (b) and (c)
does not mean le of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
S
PLACE OF DEATH
SUFFOLK (County)
MOUNTS REST HOME No. Evelyn
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.) loft Higholanud hva St. itvulescent inone
INTERVAL BETWEEN ONSET AND DEATH jimmy
100M.11-55-916145
18 BIRTHPLACE OF FATHER (City) (State or country) TSEE-OF-34BBAOS
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