USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 79
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death certificate contains a recital, as required by. section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registra- tion. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require .- Chap. 114, Sec. 45, G. L., (Tercentenary Edition).
Medical examiners shall make examination upon the view of the dead bodies of persons as are supposed to have died by violence, or by the action of chemical, thermal or electrical agents or following abortion, or from diseases resulting from injury or infection relating to occupation, or suddenly when not disabled by recognizable disease, or when any person is found dead. .. - General Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4, Acts of 1945.
No undertaker or other persons shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the cemetery or burial ground in which the interment is made.
Chap. 114, Sec. 46, G. L., (Tercentenary Edition).
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions 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
-301A 1
TIONS
ITIFICATE
ing DEATH enter n one each and (c)
not mean of dying, t failure, It means or compli- h caused
if any, rise to re
(a), under- last.
(c)
Due IGeneralized Arteriosclerosis
years
OTHER
SIGNIFICANT
CONDITIONS
-
Was autopsy performed?
no
What test confirmed diagnosis ?.
clinical
5 Was disease or injury in any way related to occupation of deceased ? mo If so, specify
(Ad
6 Joodlam Cemetery Everett, Mass. Place of MirlaKor Cremation City of Towny
7 NAME OF
FUNERAL DIRECTOR
Ceped B. March
ADDRESS
174 Winthrop St. Winthrop,
Received and filed NOV 18 1958 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
9 COLOR
10 SINGLE
(write the word)
MARRIED
widowed
WIDOWED
or DIVORCED
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
8:20 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Natural Causes
INTERVAL
BETWEEN
ONSET AND
DEATH
11 IF STILLBORN, enter that fact here.
12
AGE ... 8.8Years .. O
Months .15Days
If under 24 hours
_Hours .....
Minutes
13 Usual
Occupation :
writer
(Kind of work done during most of working life)
14 Industry
or Business:
self employed
15 Social Security No ....
none
London
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
William Hall
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Kay
20 BIRTHPLACE OF MOTHER (City) (State or country) England
21
Informant
Vivian E. Smith
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the bursal or kansit permit was issued:
Mass.
Italkle Jere anni
(Signature of Auchy of Board of Health or other)
Health Of
11/17/08
(Official Designation) (Date of Issue of l'ermit)
X
.
SOM-11-56-918978
PLACE OF DEATH
Suffolk (County)
FI Winthrop (City or Town) Boston 12-5-58
No. 78 Chester Avenue
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.
225
Registered No.
[(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,
NO.
if so specify WAR)
(a) Residence. Hotel Hemenway 91 Westland Ave (Usual place of abode)
Basit, OftownIaFS .. )
Length of stay: In place of death .........
.years ...
.1
months .... 7
days. In place of residence ... 28.years.
.months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
November
15
958
(Month)
(Day)
Year)
8 SEX
male
white
10a If married, widowed, qr divorced
Kathleen Pownley
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
Due
·Arteriosclerotic Heart Disease
(b)
years
(Signed)
Arthur CO. Murray
,
M. D.
Winthrop Board of Health
Date 16 NOV
1958.
DATE OF BURIAL -November/17. 1958
....
19
(Address)
78 Chester Ave. Winthrop
contrib- h but not terminal ion given
pter 137, requires o print or cause or death on cates.
2 FULL NAME -.
Arnold Hamer Hall
(If deceased is a married, widowed of divorced woman, give also maiden name.)
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 decmed 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 reeital, as required by. seetion 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, sueh 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 elerk of the town for registra- tion. The person to whom the permit is so given and the physician eertifying 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, See, 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, See. 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 sueh 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 aetion 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. NOVIC
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 oeeupa- 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 oceupation 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 oeeupation 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
Middlesex (County)
Cambridge
(City or Town)
CERTIFICATE OF DEATH
Cambrils (City of Town making this
Registered No.
1650
(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME Florence asson ······ {Hadler)
(If deceased is a married, widowed or divorced woman, give atso malden name.)
(a) Residence. No ....
22 .... Buchanan
(Usual place of abode)
St.inthrop.,
Massachusetts
(If nonresident, give city or town and State)
Length of stay: In place of death ........... years ...... ..... months ....
8days. In place of residence.
16 ars
months.
.days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
(ullayember &5, 1950)
4 I HEREBY CERTIFY,
That I attended deceased from
October 719 58 to November 15, 1958 I last saw h. alive on November 1519 68death is said to
have occurred on the date stated above, at 6:15pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Malignant Meningioma Left
Frontal Lobe with Direct Due To (b)
OTHER
SIGNIFICANT
Diabetes Mellitus
CONDITIONS
Was autopsy performed ?.
Ho
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed) Philip J. banary, Jr.
M. D.
(Address) Holy Ghost Hosp. Date 77/16 19 58
6 Plate b7 Butiat & Cremation' Gemotory (City of Town)
DATE OF BURIAL Hovember -19, ......... 19 ...... 58
7 NAME OF
DIRECTOR. Richard C. hfrby ADDRESS 017 Bennington St. East BostonTTEST:
Received and filed JEC. J, 1958 19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
arriod
10a If married, widowed, or divorced
HUSBAND of.
(Give maiden name of wife in full)
(or) WIFE of
Byron 2, Nasson
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
Extensi AGE.58 Years.Q.
Months 15 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. 072-11-5405
Rast Boston
16 BIRTHPLACE (City)
(State or country)
Massachusetts
17 NAME OF
FATHER
Charles Hadley
18 BIRTHPLACE OF
FATHER (City).
Boston, Massachusetts ....
(State or country)
19 MAIDEN NAME
OF MOTHER
Anna Brill
20 BIRTHPLACE OF
MOTHER (City)
Boston, Massachusett
21 Informant. (Address) 22- Buchanan .St.
M ...... Byron A. -Hush
tas99 throp,
A TRUE COPY Frederick H. Burke
(Registrar of City or Town where death occurred)
DATE FILED
November 18
58
> 19 ....
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 Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town Due To (c)
No. Holy Ghost hospital
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF
R-302 1
PARENTS
throp (State or country)
25M-8-58-918227
INTERVAL BETWEEN ~ ONSET AND. DEATH
Female
white
(Was deceased a
U. S. War Veteran,
if so specify WAR)
r
TOM
OF
9
13
GLERK
10
*
6
DEC -51958 AM
X
PLACE OF DEATH
Suffolk (County) Winthrop
(City or Town) 41 Banks
Street
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.
227
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
2 FULL NAME
Elizabeth Pamela (Tobiasen) Ruud
(If deceased is a married, widowed or divorced woman, give also maiden name.)
41 Banks Street
St
36
(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
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Hjalmar N Ruud
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
76
1
12
12
AGE
Years.
Months
Days
If under 24 hours
.Hours ...... Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business:
Own home
15 Social Security No.
016-26-9599
16 BIRTHPLACE (City)
(State or country)
Norway
17 NAME OF
FATHER
Edward Tobiasen
PARENT'S
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Norway
19 MAIDEN NAME
OF MOTHER
Emily Tonnesen
20 BIRTIIPLACE OF
MOTHER (City)
(State or country)
Norway
21 Hjalmar Ruud
Informant
(Address)
41 Banks Street Winthrop
7 NAME OF FUNERAL DIRECTOR Allinthe x marks.
ADDRESS
Received and filed
NOV 18 1958
19
(Registrar)
, M. D.
(Address) / Revere 51, Mass. Date
Nov, 15 19 58
6 Winthrop
Winthrop
Place of Burial or Cremation
DATE OF BURIAL
Nov.
(City or Town) 18
19.58
50M-11-56-918978
301A 1
IONS
TIFICATE
ng DEATH nter a one each and (c)
not mean f dying, t failure, It means r compli- caused
if any, rise to (a). under- e last.
Due To (b)
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Was autopsy performed?
What test confirmed diagnosis?
Pathological Examinatio
of Tissue
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
1. www. +
1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
November 14
1958
January 25,
19.58
to
I last saw
HLalive on
November 149 58
death is said to
have occurred on the date stated above, at
1:15 am.
INTERVAL
BETWEEN
ONSET AND
DEATH
18 yr
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Metastatic Carcinoma
(a)
3 DATE OF
DEATH
November
15
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
36
No.
-Howard SAMnitas
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with the/BEFORE the burial or transit permit was issued: Talkb. C. fire amies (Signature of Agent of Board of Health or other) Healthe Officer 11/17/58 VAV
(Official Designation) (1)ate of Issue of l'ermit)
contrib- but not terminal ion given
pter 137, requires print or ause or leath on ates.
(Signed)
-27-Bennington St.,
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 seventecn. 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
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