USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 55
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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
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
Registered No. 161
[(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.)
(a) Residence. No ..
555 Shirley St.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
..... years ........
.. months
days. In place of residence 0 years.
months.
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
August
28
1957
(Year)
(Month)
(Day)
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
6. A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
INTERVAL BETWEEN ONSET AND DEATH
Presumably clue to
Due To natural causes,
- (b)
probably coronary
Due ·occlusion. 1
(c)
Board of Health
OTHER
SIGNIFICANT
CONDITIONS
Case.
Was autopsy performed?
No
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify .....
(Signed)
Cheartes Liberman
M. D.
OF MOTHER
Elizabeth Mattison
(Address)
Winthrop Mass Date 8/29/1957
6 Woodlawn d Cemetery Nashua, N.H. Place of' Burial or Cremation (City or Town)
DATE OF BURIAL August 30, 1957 19
7 NAME OF
FUNERAL DIRECTOR.
Alfred BB. March
ADDRESS
174 Winthrop St. Winthrop, Mass.
Received and filed JAUG 30 1957 19
(Registrar)
8 SEX
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
Archie Halliday
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE84 Years
9 Months 23 Days
If under 24 hours
Hours _...
Minutes
13 Usual
Occupation :
Real Estate Broker
(Kind of work done during most of working life)
14 Industry
or Business :
Self Employed
15 Social Security No.
none
16 BIRTHPLACE (City) West Rutzane
(State or country)
17 NAME OF
FATHER
Herbert Elmer Chandler
18 BIRTHPLACE OF
FATHER (City).
Alstead
(State or country)
N. H.
19 MAIDEN NAME
20 BIRTHPLACE OF
MOTHER (City) ..
Nashua
(State or country)
N.H.
21
Informant
Charles Elmer Chandler
(Address)
Quincy Massachusetts
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Halph Sirianne (Signature of Agent of Board of Health or other) afC 8/30/57
(Official Designation) (Date of Issue of Itermit)
V.B.V
ore 1
ONS
1FICATE
g DEATH ter one each nd (c)
ot mean dying, failure, It means compli- caused
f any, rise to (a), under- last.
contrib- but not terminal on given
ter 137, requires print or use or eath on
tes.
SOM-5-56-917579
PARENTS
PERSONAL AND STATISTICAL PARTICULARS
Female
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR).
NO.
(Usual place of abode)
No. 555Shirley St. Nellie Belle Chandler Halliday
To be filed for burial permit with Board of Health or its Agent.
01A 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 seetion 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 certifieate 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 sueh 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 aceompanied, 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 eertificate. 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 eause 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, See. 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 of 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 wul 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 aetion of chemical (drugs or poisons) thermal of electrical agents, and deaths following abortion, but also deaths from disease Westalting 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 .- Preeise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this seetion for every person aged 10 years or over. If the oceupa- 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 sehool 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 oeeupation by the appropriate terms, as housekeeper-private family, cook-hotel, ete. 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
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.
Registered No. 162
[ (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.
29 MOORE
St.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death 8 .... years.
.... months
days. In place of residence .. 8.years. months. days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
FEMALE
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.
JACOB LEITER
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 77 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 ....
NONE
16 BIRTHPLACE (City)
(State or country)
RUSSIA
17 NAME OF
FATHER
JACOB BRIZELLI
18 BIRTHPLACE OF
FATHER (City)
RUSSIA
(State or country)
19 MAIDEN NAME
OF MOTHER
C.B.L.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIA
6
ha masters
M. D.
Chelsey man Date 8/28
19.5-
LINAS HADZEDICK-GOLDMAN, EVERETT
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
AUGUST 28
19 5.7
7 NAME OF
FUNERAL DIRECTORTORF FUNERAL SERVICE INCLHEREBY CERTIFY that a satisfactory standard certificate of death
ADDRESS
151 WASHINGTON AVE. , CHELSEA
AUG 2 8 1997 19
(Registrar)
PARENTS
21
Informant
(Address)
. 29 MOORE STREET, WINTHROP
was filed with me BEFORE the burial or transit permit was issued: alph Sirianni (Signature of Agent of Board of Ilealth or other)
H.O. J
aff
8/28/57
(Official Designation)
(Date of Issue of Permit)
X
ONS
IFICATE
g
DEATH ter one each nd (c)
ot mean dying, failure, t means compli- caused
any, ise to (a), under- last.
Due To WITH. - CONGESTIVE
(b)=
HEART FAILURE
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
SOM-5-54- 917573
Received and filed
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(Month)
(Day)
28
1957
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
19. 4000 to. aug 28 52
last sawn -Zalive on
(27, 19 57, death is said to
have occurred on the date stated above, at
1:50Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) ARTERIOSCLEROTIC
HEART DISEASE
INTERVAL BETWEEN ONSET AND DEATH
EMOS
No. 29 MOORE
2 FULL NAME MOLLIE LEITER
(If deceased is a married, widowed or divorced woman, give also maiden name.)
01A 1
contrib -- but not terminal n given
ter 137, requires print or use or ath on tes.
MORRIS KAPLAN
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 cleath 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 derk 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.
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.
163
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a)
Residence. No ..
38 Banks Street
St
(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.35 .... years ............ months.
.......
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
August
29
1957
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Sept.22
53
to
August.
29
19.5.7.
I last saw h.e.Talive on
August
_28
1957, death is said to
have occurred on the date stated above, at
8:52
am.
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
AGE.7.8Years.
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 ..
Genoa
16 BIRTHPLACE (City).
(State or country)
Italy
17 NAME OF
FATHER
John Baptista
18 BIRTHPLACE OF
Genoa
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME OF MOTHER Teresa Antonelli
20 BIRTHPLACE OF
MOTHER (City).
Genoa
(State or country)
Italy
21 Alice Hennessey
Informant
(Address)
370 Main St Winthrop
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS.
Received and filed
AUG 30 1957
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDdowed
(write the word)
Female
White
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Anthony Buffa
(Husband's name in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Arteriosclerotic ... Heart Disease
5 yrs.
Due To
(b)
Generalized ... Arteriosclerosis
Due To
(c) Diabetes Mellitus.
Hypertension
NO
Was autopsy performed?
What test confirmed diagnosis ?. P.hy ........ Ex ..
Urinalysis &
Blood Sugar
5 Was disease or injury in any way related to occupation of deceased? If so, specify.
(Signed)
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