Town of Winthrop : Record of Deaths 1957, Part 57

Author: Winthrop (Mass.)
Publication date: 1957
Publisher:
Number of Pages: 566


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 57


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


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2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


89 Summit Ave.


St


Winthrop Mass.


(a) Residence. No ..


(Usual place of abode)


Length of stay: In place of death


6years ...... 11


months.


22


days. In place of residence ........... years. months .days.


MEDICAL CERTIFICATE OF DEATH


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


M


9 COLOR


W


10 SINGLE


(write the word)


Married


MARRIED WIDOWED or DIVORCED


10a If married, widowed, or divdleden J Smiddy HUSBAND of (Give maiden name of wife in full)


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


AGE


Yrg'sual


Occupation :


Longshoreman


(Kind of work done during most of working life)


14 Industry


or Business:


Retired


15 Social Security No.


029-05-5302


16 BIRTHPLACE (City)


(State or country)


Lagrange Wisconsin


17 NAME OF FATHER John E Pfeifer


18 BIRTHPLACE OF


Germany


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Caroline Wagner


20 BIRTHPLACE OF


MOTIIER (City)


(State or country)


Wisconsin


Helen J Pfeifer


21 Informant. (Address)


A TRUE COPY


ATTE


Charles 2. Macke


(Registrar of City or Town where death occurred)


DATE FILED


August 16/57


19


(Registrar of City or Town where deceased resided)


10-15


Due To


(b)


Hypertension


Due To


(c)


Obesity


OTHER SIGNIFICANT CONDITIONS


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)


Nezih Sevunduk Boston State Hospt


M. D.


(Address) ..


Winthrop Cem-Winthrop Mass.


6


Place of Burial or Cremation


August 14/57 19


DATE OF BURIAL.


7 NAME OF FUNERAL DIRECTOR


F J Magrath East BostonMas's.


ADDRESS


Received and filed. SEP 18 1957 19


¿tj or Town)


5031.11.55-916145


at the time of death should be transmitted on Form R.302 to the clerk of the city or town in which the deceased resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. 1 .. )


No.


John E Pfeifer


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(If nonresident, give city or town and State)


3 DATE OF


DEATH


August 12/57


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


July, 119


57


August


12


That I attended deceased from


57


19


I last saw heralive on


August 12 19 57


death is said to


have occurred on the date stated above, at


6;45AM


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Myocardial infarction


INTERVAL BETWEEN ONSET AND DEATH


2-3 Days


49


ears ..


Months.


Days


If under 24 hours


Hours ........ Minutes


PARENTS


Date


Aughat 12/57


X


302


1


Boston State Hospt. Bosta


RECEIVE.


TOWA


F


0


71.12. 4


10.


ERK


6


SEP 1 81957 AM


302


1


PLACE OF DEATH


Suffolk


(County)


Bos ton


(City or Town)


LIDER


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)


7528


Registered No.


$ (If death occurred in a hospital or institution,


St. { give its NAME instead of street and number)


(Was deceased a


U. S. War Veteran,


Winthrop Maggf! WAR)


S


(If nonresident, give city or town and State)


Length of stay: In place of death ............ years.


.. months.


15


.days. In place of residence.


.. years.


months


.days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


White


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


Charles Schmidt


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


2 Weeks


AGE.


56Years


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.


Brooklyn New York


16 BIRTHPLACE (City).


(State or country)


17 NAME OF FATHER Charles F Egan


18 BIRTHPLACE OF


FATHER (City)


(State or country)


New York


19 MAIDEN NAME


OF MOTHER


Mary Murphy


20 BIRTHPLACE OF


New York


MOTHER (City).


(State or country)


Charles Schmidt


A TREE COPY Les A. Track


ATTEST: (Registrar of City or Town where death occurred)


DATE FILED


August ... 19/57


19.


Mae F Schmidt


2 FULL NAME.


(a) Residence. No.


27 Enfield Road


(Usual place of abode)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


August 14/57


July31


19 ..


57


to ...


August 14


have occurred on the date stated above, at


3 AM


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Small bowel infarction


Due To


Peritoneal adhesions


(b)


(c)


OTIIER


Cystic left cerebral


SIGNIFICANT


Was autopsy performed ?.... Yes


What test confirmed diagnosis ?


autopsy


(Signed)


C L Clay


(Address).


Magg. General Hospt


6


Place of Burial or Cremation


DATE OF BURIAL.


7 NAME OF


FUNERAL DIRECTOR J O'Maley


Copies of returns ot deaths which occurred in your city or town in case the deceased resided in another city or town


Due To


Multiple abdominal operation


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, See. 12, G. L.)


CONDITIONS


infarct,old


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


(Month) (Day) (Year)


4 I HEREBY CERTIFY,


That I attended deceased from


19 57


I last saw


er .. alive on


August 14, 19 57 death is said to


INTERVAL BETWEEN ONSET ANO DEATH


Yrs


Yrs


2 Yrs


5 Was disease or injury in any way related to occupation of deceased ?. If so, specify


M. D.


19


Winthrop Cem-Winthrop Mass.


(City, or Town)


Angust 17/57 19


ADDRESS Winthrop Mass.


Received and filed.


SEP 19 1957


19


(Registrar of City or Town where deceased resided)


PARENTS


5011.11.55.916145


.


×


Masg. General Hospt.


No.


(If deceased is a married, widowed or divorced woman, give also maiden name.)


40


21 Informant. (Address)


RECEIVE.


TOWN


OF


11 12. 3 CLERK


SEP 1 91357 A:


302


XI 1


PLACE OF DEATH


‘Suffolk


(County)


Boston


(City or Town)


No.


Boston City Hospt.


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Bo stm


(City or Town making this return)


766971


$(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


Mary Moynahan or Moynihan


(If deceased is a married, widowed or divorced woman, give also maiden name.)


S


(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.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


White


10 SINGLE


MARRIED


(write the word)


Married


10a If married, widowed, or divorced HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


John J Moynihan


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


7 Days 12


AGE 39Years.


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 :


At Home


15 Social Security No ...


022-01-8721


16 BIRTHPLACE (City)


(State or country)


Boston ...... Mas.g.


17 NAME OF FATHER


Henry Johnson


18 BIRTHPLACE OF


Providence R.I.


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Gertrude O'Rourke


P.E.I.


MOTIIER (City) (State or country)


21 Informant. (Address)


John J Moynihan


7 Centre St. Winthrop


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occurred) August 22/57


DATE FILED


19


X


-


5031. 11.55 916145


2 FULL NAME


7 Center St.


(a)


Residence. No.


(Usual place of abode)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


(Month)


(Day)


have occurred on the date stated above, at


5;20PM


m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Due To


(b)


OTHER


SIGNIFICANT


CONDITIONS


Was autopsy performed?


No


What test confirmed diagnosis ?.


clinical


(Signed)


M W O'Connell


6


Place of Burial or Cremation


DATE OF BURIAL


F J Magrath


7 NAME OF


FUNERAL DIRECTOR


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, (. 1 .. )


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


(c)


Hodgkin's Disease


Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town


Due To


Staphylococcal pneumonia


August 18/57


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


August 11.7/57


to


August 1819 ....... 57


I last saw h ... . @live on


19


death is said to


INTERVAL BETWEEN ONSET AND DEATH


Mediastinal compression due to


lymphadenapthy prob.


7 Yrs


Days


5 Was disease or injury in any way related to occupation of deceased? If so, specify ...


M. D.|.


(Address)


Boston City Hospt


8-19


19


57


Woodlawn Cem-Everett Mass .


Gity or Town)


August 21/57


19


East Boston Mass.


ADDRESS


Received and filed.


19


(Registrar of City or Town where deceased residled)


Registered No.


(Was deceased a


U. S. War Veteran,


if


specify WAR)


Win throp


Mass .


WIDOWED


or DIVORCED


PARENTS


20 BIRTIIPLACE OF


SEP 2 2357 '


302


1


Doston


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


Boston


(City or Town making this return) 172


7711


S(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 widow wed or divorced woman, give also maiden name.)


Home of Little Sisters of the Poor


St.


(If nonresident, give city or town and State)


Length of stay: In place of death ........... years ...


months.


9


days. In place of residence445.


.years.


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


August 19/57


(Month)


(Day)


(Year)


4 [ HEREBY CERTIFY,


August 15 57 to.


That I attended deceased from


August


19, 57


I last saw h ... emlive on


August 1919 57, death is said to


have occurred on the date stated above, at


2:45PM


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a) Coronary thrombosis


Due To


Arterio sclerotic heart disease


(b)


Yrs


Due To (c)


OTHER SIGNIFICANT CONDITIONS


Was autopsy performedNo What test confirmed diagnosis?


5 Was disease or injury in any way related to occupation of deceased? If so, specify .


(Signed) S Yuen


(Address)


Boston State Hospt 8-19 19 57


Tufts School of Med.


General Laws


Place of Burial or Cremation August 21/57 19


DATE OF BURIAL


7 NAME OF


J S Waterman & Sons


FUNERAL DIRECTOR


ADDRESS Boston ... Mas s.


Received and filed. SENT. 24. 1957 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


W


10 SINGLE


(write the word)


MARRIED


WIDOWED Single


or DIVORCED


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


87


AGE.


Years.


Months.


Days


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Retired


(Kind of work done during most of working life)


14 Industry or Business:


15 Social Security No.


16 BIRTHPLACE (City)


(State or country)


17 NAME OF


FATHER


Charles Meahan


18 BIRTHPLACE OF


Ireland


FATHER (City)


(State or country)


19 MAIDEN NAME


OF MOTHER


Catherine Green


20 BIRTIIPLACE OF


MOTHER (City)


(State or country)


England


21 Informant (Address)


Bostan State Hospt


A TRUE COPY


Garles it. Macke


ATTEST:


(Registrar of City or Town where death occurred)


DATE FILED


August ... 26/57


19


VB V


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 of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


resided as soon as possible, after the close of the month in which the death occurred. (Sec Chap. 46, Scc. 12, G. L.) .


50MI 11.55.916145


PLACE OF DEATH


Suffolk


(County)


CERTIFICATE OF DEATH


Registered No.


Boston State Hospt


No.


Martina Meahan


(Was deceased a


U. S. War Veteran,


if


ify WAR.


Winthrop Mass.


(a) Residence. No .. (Usual place of abode)


INTERVAL


BETWEEN


ONSET AND


DEATH


1 Day


New Brunswick


PARENTS


M. D.


FORM 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.) 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)


Bost a


(City or Town)


The Commonwealth of Massarinisetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF


Besten


(City or Town making this


771


CERTIFICATE OF DEATH


Registered No.


S(If death occurred in a hospital or in St. { give its NAME instead of street and


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


Home of Little Sisters of the Poor, 19 Summ t Av


(a) Residence. No .. (Usual place of abode)


Length of stay: In place of death ............ years ....


.months.


9


days. In place of residence.


.. years.


months.


.days.


MEDICAL CERTIFICATE OF DEATH


3 DATE OF DEATH


August 19/57


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


August, 15/ 5%


August ...... 1.9,


19.


I last saw h .... e.afive on


August 19/5,7 death is said to


have occurred on the date stated ahove, at


2:45P, Mm.


INTERVAL BETWEEN ONSET AND DEATH


1 Day


Due To


Arterio sclerotic heart


(1))


disease


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) S Yuen M. D.


Boston State Hospt 8-19


19


(Address)


Tufts School of Medicine


6


Place of Burial or Cremation August 21/57 19


(City or Town)


DATE OF BURIAL


7 NAME OF UNERAL DIRECTO


J S Waterman & Sons Boston Mass.


ADDRESS


Received and filed. SEP 25 195 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULAR


8 SEX


F


9 COLOR


10 SINGLE


(write


S


W


MARRIED


WIDOWED


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


(or) WIFE of


(Hushand's name in full)


11 IF STILLBORN, enter that fact here.


12


AGE 87 Years.


Months .....


Days


If under 24


Hours ........


13 Usual


Occupation :


Retired


(Kind of work done during most of worki


14 Industry


or Business:


15 Social Security No ....


New Brunswick


16 BIRTHPLACE (City)


(State or country)


17 NAME OF FATHER


Charles Meeha


18 BIRTHPLACE OF


Ireland


19 MAIDEN NAME OF MOTHER Catherine Gree


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Boston State


21 Informant (Address) Boston Mas


A TRUE COPY


ATTEST:


(Registrar of City or Town where death occ


DATE FILED


August 26 /57


MARGIN RESERVED FOR BINDING


WRITE PLAINLY, WITH UNFADING BLACK INK - THIS IS A PERMANENT RECORD


50M -: 1-55-916145


Suffolk


Boston State Hospt.


No.


Martina Meahan


(Was deceased a


U. S. War Veteran,


if so specify WAR)


Winthro


(If nonresident, give city of town


45


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


(a)


Coronary thrombosis


Yrs


PARENTS


FATHER (City) ..


(State or country)


England


302


1


Bostan


(City or Town)


The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH


Bostan


(City or Town making this return)


Registered No. 1 73 7806


((If death occurred in a hospital or institution, St. { give its NAME instead of street and number)


Ruth Scott


2 FULL NAME


(If deceased is a married, widowed or divorced woman, give also maiden name.)


(Was deceased a


U. S. War Veteran,


if so specify WAR)


(a) Residence. No ..


(Usual place of abode)


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 24/57


(Month)


(Day)


(Year)


4 | HEREBY CERTIFY,


That I attended


August 24


deceased from


57


Aug.4,


19


57,


to


August, 24/57


said to


have occurred on the date stated above, at


12;18PM


DEATH WAS CAUSED BY: IMMEDIATE CAUSE Malignant lymphoma stemm cell


(a)


type


Due To


with massive involvement


(b)


of lungs and liver


2 Mos


Due To (c)


OTHER


SIGNIFICANT


CONDITIONS


Yes


Was autopsy performed?


What test confirmed diagnosis?


autopsy


5 Was disease or injury in any way related to occupation of deceased?


If so, specify


M. D.


(Address)


Mass, General Hospt 19


20 BIRTHPLACE OF


Latvia


Jewish Nat. Workers Cem-Danvers


Mas GQTHER (City). (State or country)


6 Place of Burial or Cremation (City or Town)


DATE OF BURIAL.


August 26/57 19


....


7 NAME OF


FUNERAL DIRECTOR


B Schlossberg & Sons


Mattapan Mas's.


ADDRESS


Received and filed SEP 2% 1957 19


(Registrar of City or Town where deceased resided)


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


F


9 COLOR


W


10 SINGLE


MARRIED


WIDOWED


or DIVORCED


(write the word)


Married


10a If married, widowed, or divorced HUSBAND of.


(or) WIFE of.


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


Years


Months.


Days


If under 24 hours


Hours ....


Minutes


13 Usual


Occupation :


(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)


17 NAME OF FATHER Joseph Latt


18 BIRTIIPLACE OF


FATHER (City)


(State or country)


Latvia


19 MAIDEN NAME OF MOTHER


Ida Herzkovitz


(Signed)


D A Clark


PARENTS


21 Informant. (Address)


Israel Scott 40 Trident Ave Winthrop


A TRUE


ATTEST:


Orles H. macks.


(Registrar of City or Town where death occurred)


DATE FILED


August 28/57


19


Copies of returns ot deaths which occurred in your city or town in case the deceased resided in another city of town


at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased


resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) .


SOM1.11.55.916145


5


PLACE OF DEATH


Suffolk (County)


Mass. General Hospt.


No.


40 Trident Ave.


Winthrop Mass.


19


I last saw h ....... @Ive on


(Give maiden name of wife in full)


Igrael Scott


INTERVAL BETWEEN ONSET AND DEATH 4 Mos 12 AGE 66


Housewife


Latvia


RECEIVE )


TOW


IF


;LERK


0


SEP 871957 EM


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.


S(If death occurred in a hospital or institution,,


St. { give its NAME instead of street and numher)


2 FULL NAME.


Annie F. (Moore) Enright


(If deceased is a married, widowed or divorced woman, give also maiden name.)


20 Eliot


St


Winthrop.


(If nonresident, give eity or town and State)


Length of stay: In place of death ............ years ....


....... months.


10


.days. In place of residence ............ years ....


.. months.


.days.


PERSONAL AND STATISTICAL PARTICULARS


8 SEX


Female


9 COLOR


White


10 SINGLE


MARRIED


Married


or DIVORCED


10a If married, widowed, or divorced


HUSBAND of


(Give maiden name of wife in full)


James A. Enright


(or) WIFE of


(Husband's name in full)


11 IF STILLBORN, enter that fact here.


12


85


AGE.


Years


Months.


.Days®


If under 24 hours


Hours ........ Minutes


13 Usual


Occupation :


Salesl dy


(RETIREd) J. J.S.


(Kind of work done during most of working life)


14 Industry


Clothing store


or Business :


15 Social Security No ..


023-01-2479


16 BIRTHPLACE (City)


(State or country)


Ireland


17 NAME OF


FATHER


James Moore


PARENTS


18 BIRTHPLACE OF


FATHER (City)


(State or country)


Ireland


19 MAIDEN NAME


OF MOTHER


Mary


20 BIRTHPLACE OF


MOTHER (City)


(State or country)


Ireland


21


Informant


(Address)


20 Eliot st. Winthrop


I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the bugfal or transit permit was issued: Kalch Serianme


A: O.


(Signature of Agent of Board of Health or other) arte Sept. 6/37


(Official Designation )


(Date of Issue of Permit)


100M. 11.55-916145


7 NAME OF


FUNERAL DIRECTORJohn J. Spencer


ADDRESS


527 Broadway,So. Boston


Received and filed


SEP C - 1957


19


(Registrar)


INTERVAL BETWEEN ONSET AND DEATH 2 DAYS


Due


ABTEIG-SCLARCTIC


(h)


HEART DISEASE


5 yes


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 deceasedle If so, specify.


(Signed


Fred D Regan


113 Places ong de Withich


Date 4/5


157


Holy Cross


Malden


6 Place of Burial or Cremation


(City or Town)


DATE OF BURIAL


Sept. 6


19.57


M. D.


(Addre


(Month)


(Day)


(Year)


4 I HEREBY CERTIFY,


That I attended deceased from


19:57


June 1


1957


to ......


{ last saw


hetalive on


Left 4'


. 1957


ICH


have occurred on the date stated ahove, at .. m.


DEATH WAS CAUSED BY: IMMEDIATE CAUSE


BRONCHO-PNEUMONIA


(a)


MEDICAL CERTIFICATE OF DEATH


3 DATE OF


DEATH


4


1457


No.


Mount's Conv. Home 104 Highland ave


To be filed for burial permit with Board of Health or its Agent.


301A 1


ONS


TIFICATE


ng DEATH nter one each nd (c)


not mean dying, failure, It means · compli- caused


if any, rise to (a), under- last.


contrib. but not terminal on given


pter 137, requires print or ause or eath on


ates.


James A. Enricht


124


(a) Residence. No ..


(Usual place of abode)


No


PHYSICIAN - IMPORTANT


(Was deceased a


. U. S. War Veteran,


if so specify WAR)


Mass


(write the word)


·


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 whichit 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).




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