USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1957 > Part 80
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SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT SERVICE NUMBER
Y 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.
233
Registered No.
S(If death occurred in a hospital or institution,,
St. { give its NAME instead of street and numher)
FRED S PITMAN 2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
14 PLEASANT PARK RD.
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
Novi
24
1957
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
1
55-
to ...
nn. 24
1957
I last saw h.L/Malive on
19057
death is said to
have occurred on the date stated ahove, at
9 A.m m.
INTERVAL BETWEEN ONSET AND DEATH
400
Due To
To an terio to sclerosis
(h)
generalized
Due To
Sevility
(c)
OTHER
Chronic Calculer
SIGNIFICANT
CONDITIONS
Heart Disease
Was autopsy performed? What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? 120 If so, specify.
(Signed). M. D.
.. Date ..
11-25- 1957
Tous 2 Way hayst 6 Place of Burial or Cremation (Cily or Town)
DATE OF BURIAL nov . 26 -
7 NAME OF
Maurice W Kirke
FUNERAL DIRECTOR
ADDRESS 210 Winthrop ST
NOV 27 1957
19
Received and filed
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
widowid
10a If married, widowed, or divorced
HUSBAND of.
LabiE
HESS
(Give maiden name of wife in full)
(or) WIFE of.
LOWIE SHEES
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
AGES
12
86
.Years.
Months.
Days
If under 24 hours
Hours ......
Minutes
13 Usual
Occupation :
Painter
14 Industry
or Business :
Automobila
15 Social Security No ..
unknown
16 BIRTHPLACE (City)
(State or country)
n. H.
17 NAME OF
FATHER
John a Pitman
18 BIRTHPLACE OF
FATHER (City)
Dover
(State or country)
n. H.
19 MAIDEN NAME
OF MOTHER
unknown
20 BIRTHPLACE OF
unknown
MOTHER (City)
(State or country)
Mr., Marion L Cartón
21 Informant
mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial por itansit permis was issued; 196 Upland the Newton High (Signature of Agent of Board of Health or other) Talare . - 4 erianne 11/2657 DI. V
(Official Designation)
He alle officer
Date of king of Permit)
-301A 1
TIONS
RTIFICATE
ing DEATH enter n one r each and (c)
not mean of dying, rt failure, It means > or compli- ch caused
if any, : rise to se (a), under- se last.
s contrib. th but not e terminal ition given
>
apter 137, 4, requires to print or cause or death on icates.
1
100M-11-55-916:45
PLACE OF DEATH
14 PLEASANT PARK RD. No.
(a) Residence. No.
(Usual place of abode)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(write the word)
PARENTS
WayLand
Never
(Kind of work done during most of working life)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
maccardial Heart
(a)
Direcsa
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased. furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased. his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- te n, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eighteen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law. or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
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. NOV 2 21557 11:1
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
01A
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.
231
No. 66 Summit Ave.
f(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME Abbott russell coffin
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 66 Summit Ave.
St
(If nonresident, give city or town and State)
Length of stay: In place of death 8 years months days. In place of residence3 .... years. months ......... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
26
1957
(Month) (Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
11/25/
,
19.
$7
11/26/
, 1957
to
I last saw hacalive on
11/26/, 1957, death is said to
have occurred on the date stated above, at
6:00 p.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Gente Coronary Occlusion
INTERVAL BETWEEN ONSET AND DEATH 1 Day.
8 yrs.
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None.
Was autopsy performed?
What test confirmed diagnosis? Clinical.
5 Was disease or injury in any way related to occupation of deceased ?Va-
If so, specify.
(Signed).
., M. D. Winthrop Mass Date 11/281 1957
6
Winthrop cemetery
Winthrop, mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
November
29,
1957
achu BB. March
7 NAME OF
FUNERAL DIRECTOR
ADDRESS 174 Winthrop St., Winthrop
Received and filcd
NOV ZU NYT
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWEDDivorced
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
Dorothy Witherall
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE6.4 Years.
10Months
13Days
If under 24 hours
Hours ...... Minutcs
13 Usual
Occupation :
Pipe coverer
(Kind of work done during most of working life)
14 Industry
or Business:
Beacon Oil Refinery
15 Social Security No. 012-09-1907-H
16 BIRTHPLACE (City)
Marblehead
(State or country)
Mass.
17 NAME OF
FATHER
Simeon Coffin
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Mass.
Marblehead
19 MAIDEN NAME
OF MOTHER
Stella B. Marr
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Mass.
21
Informant (som) A. Russell Jr. (Address) Rocky Hill Rd. Plymouth, Mass,
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health of other), realele Musiche 1/29/57
(Official Designation)
(Date of Issue of Permit)
V.EV
ONS
FICATE
&
EATH ter one ach ad (c)
ot mean dying, failure, t means compli- caused
any, ise to ( a ) . under- last.
contrib -- but not terminal n given
ter 137, equires print or use ath OD tes.
SOM-5-36-917573
PLACE OF DEATH
Suffolk (County)
(b)
·Hypertensive- Coronary
Artery Heart Disease
No
(Address).
Marblehead
COFFIN
PARENTS
Registered No.
PHYSICIAN - IMPORTANT
Lawas deceased a
U. S. War Veteran,
if so specify WAR).
V.M. #1
(Usual place of abode)
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 scction 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 relicf 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 ninetcen 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 issuc such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
December 9,1917
DATE OF DISCHARGE
March 2,1919
RANK, RATING.
Private
ORGANIZATION AND OUTFIT
612th Aero Sqadron
SERVICE NUMBER
1071025
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.
235
WINTHROP COM. HOSP.
No.
[(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
2 FULL NAME
EVA WELLS
(MC CARTHY
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
24 TEMPLE
AVE
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
.years
months 2 days. In place of residence ye
months.
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
FEMALE 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.
JOHN
L
WELLS
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
6 day SAGE 55 Years.
Months
Days
If under 24 hours
Hours .....
Minutes
13 Usual
HOUSE WIFE
Due To
(b)
Coronary sclerosis
3 yearsOccupation :
(Kind of work done during most of working life)
14 Industry
or Business:
At HOME
Due To Arteriosclerotic heart dis
(c)
Arteriosclerosis, general
CONDITIONS
10 years
NAME OF
FATHER
CALAHAN MCCARTHY
Was autopsy performed?
no
What test confirmed diagnosis?
clinical and lab ...
5 Was disease or injury in any way related to occupation of deceased? no If so, spesify .
(Signed).
M. Traunstein
M. D.
(Addres
73 Bartlett RoadDate 11/26/157
6 HOLYHOOD
Place of Burial or Cremation
(City or Town)
BRUKLINE
DATE OF BURIAL
NOV. 29
1257
7 NAME OF
FUNERAL DIRECTOR
Maurice H Ruby
ADDRESS 210 WINTHROP ST WINTHROP.
Received and filed 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
IRELAND
FATHER (City).
(State or country)
19 MAIDEN NAME
OF MOTHER
ELEZABETH (UNKNOWN)
L
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
IRELAND
21 MAS ROBERT MAHONEY
(Address)
24 TEMPLE ALE WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was hled with me BEFORE the burial or transit permit was issued: Malfall a Serianuo (Signature of Agent of) Board of Health or drher)
Healthe Office
11/27/77
(Official Designation)
(Date of Issue of Permit)
SOM-5-56-917573
.301A 1
IONS
TIFICATE
ng DEATH nter one each and (c)
not mean f dying, t failure, It means r compli- caused
if any, rise to e (a), under- last.
contrib- but not terminal ion given
pter 137, requires print or ause or leath on
;ates.
.
3 DATE OF
DEATH
November 26 1957.
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
January19.
to.1917
Nov ..
1957
I last saw helalive on
11/26/
19
5 7eath is said to
have occurred on the date stated above, at
7:55 am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Acute myocardial infarc-
tion
INTERVAL
BETWEEN
ONSET AND
DEATH
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