USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1958 > Part 9
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Length of stay: In place of death ....... years months
days. In place of residence .. 38years .months ......... days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
ma10
white
10a If married, widowed, or divorced
HUSBAND of
ROS8 Bray
maiden nameof wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE85 Years .... 7 Months.
]]Days
If under 24 hours
Hours ...... Minutes
13 Usual Occupation: retired linotype operator Kind of work done during most of working life)
14 Industry
or Business :commercial printing 00.
15 Social Security No ...
010-05-9197
London
16 BIRTHPLACE (City)
(State or country)
England
17 NAME OF
FATHER
John Owen Pearce
18 BIRTHPLACE OF
FATHER (City)
(State or country)
England
19 MAIDEN NAME
OF MOTHER
Rachel George
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
(Address)
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 Healthor, other)
1/3/1 48
(Official Designation) (Date of Issue of Permit)
X
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January
29
1958
(Year)
(Month)"
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
Dee
, 1957, to Jan. 29
1958
I last saw himalive on
Jan. 29, 19 S & death is said to
have occurred on the date stated above, at
11:50Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a) Cancer of Stomach.
INTERVAL
BETWEEN
ONSET AND
DEATH
Gmos.
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None.
Was autopsy performed?
What test confirmed diagnosis?
Clinical + X-ray
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
(Signed)
Charles Liber man
M. D.
(Address).
Winthrop, Mas Date
1 30 1958
7 NAME OF
FUNERAL DIRECTOR ...
aefeut B March
ADDRESS174 Winthpop St. Winthrop ,Mass.
Received and filed JAN 31-1958 19
(Registrar)
PARENTS
6 Winthrop Cemetery Winthrop Mas.s.
DATE OF BURIAL -- February 1-1958 19
Place of Burial or Cremation (City or Town) 21 Informant Roland Pearce 41 mileston Road
50M-5-57-920345
MR-301A 1
TRUCTIONS FOR L CERTIFICATE
n giving OF DEATH
not enter e than one e for each (b) and (c)
does not mean de of dying, heart failure, etc. It means ase. or compli- which caused
-
ions, if any, gave rise to cause (a). the under- cause last.
litions contrib- death but not to the terminal condition given
- Chapter 137, 1954, requires ans to print or the cause of of death on certificates.
C
Registered No.
(Was deceased a U. S. War Veteran, if so specify WAR) NO.
St.
(If nonresident, give city or town and State)
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 helief, 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 he 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, 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 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 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 eertify 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
MR-301A 1
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.
22
[(If death occurred in a hospital or institution, St. (give its NAME instead of street and number)
2 FULL NAME
William Smith
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
405 Revere Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
......
.years.
. months
days. In place of residence5].years.
months ...
... days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
January 29 1958
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
VAN
10a If married, widowed, or divorced
28, 1958
to.
JAN 29
58
HUSBAND of
Mary Bromilow
I last saw himalive on
JAN 29, 1950
, death is said to
have occurred on the date stated above, at
8 15 Am.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CORONARY OCCLUSION
INTERVAL
BETWEEN
ONSET AND
DEATH
1/2HR
Due To
BRONCHOPNEUMONIA
(b)
INK
Du
ARTERIO-SCLEROTIC HEART DIS.
3 YRS.
OTHER
SIGNIFICANT
CONDITIONS
SENILE PSYCHOSIS MILD
6MO
Was autopsy performed?
No
What test confirmed diagnosis?
CLINICAL
5 Was disease or injury in any way related to occupation of deceased? NO If so, specify
(Signed)
Myron n. Kung
M. D.
(Address) 222 PLEASANT ST
1/30
1957
Wilma Pate
6
Winthrop Cemetery Winthrop, Mass Place of Burial or Cremation (City or town)
DATE OF BURIAL __..
February 1.1958
7 NAME OF
FUNERAL DIRECTOR
alfred 13. Marsli
ADDRESS
174 Winthrop St. Winthrop,
Received and filed JAN 31 1958 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
Harold Smith
FATHER (City).
(State or country)
Alabama
19 MAIDEN NAME
OF MOTHER
Rebeoot Rogers
20 BIRTHPLACE OF
MOTHER (City)
Montgomery
(State or country)
Alabama
Frederick B. Smith
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Mass. Kalku ... (Signature of Agent of Board of Health or other) Y
1/3//20
(Official Designation) (Date of Issue of Permit)
TRUCTIONS FOR L CERTIFICATE giving OF DEATH not enter than one e for each (b) and (c)
does not mean de of dying. heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
itions contrib -- death but not o the terminal condition given
Chapter 137, 1954, requires ans to print or be cause or of death on ertificates.
50M-5-57-920345
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED married
or DIVORCED
male white
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 85 Years.
7_Months 16 Days
If under 24 hours
Hours _.___ Minutes
13 Usual
Occupation :
retired machinest
(Kind of work done during most of working life)
14 Industry
or Business:
Charleston Navy Yard
15 Social Security No.
none
Bermingham_
16 BIRTHPLACE (City)
(State or country)
Alabama
17 NAME OF FATHER
Montgomery
21
Informant
(Address)
92 Johnson Avenue Winthrop
Registered No.
No. 405 Revere Street
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO.
(Usual place of abode)
(c)
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, eightcen 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 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 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) thetmall or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING.
ORGANIZATION AND OUTFIT.
SERVICE NUMBER
[ R-301A 1
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 burlal permit with Board of Health or its Agent.
23
2 FULL NAME
Mary A Verry
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 Waldemar Ave.
St
(If nonresident, give city or town and State)
Length of stay: In place of death ..
.......... years ............ months ...
.days. In place of residence/1/ ... years ........ .. months. .days.
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCEMarried
10a If married, widowed, or divorced
HUSBAND of ... ,
(Give maiden name of wife in full)
(or) WIFE of
William B. Verry
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
80Years
Months ...
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
Own Home
or Business:
15 Social Security No ...
16 BIRTHPLACE (City).
(State or country)
Masg
17 NAME OF
FATHER
Charles Coakley
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Ireland
19 MAIDEN NAME
OF MOTHER
Hanora Kane
20 BIRTHPLACE OF MOTHER (City). (State or country) Ireland
Catherine Verry
21 Informant. (Address) 4 Waldemar Ave Winthrop I HEREBY CERTIFY that a satisfactory standard certificate of death way filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health (or other)
1/31/58
(Official Designation )
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving OF DEATH not enter than one for each (b) and (c)
does not mean e of dying, heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a), the under- cause last.
ition contrib. death but not the terminal andition given
Chapter 137, 954, requires js to print or cause or of death on
Hincates.
G Winthrop
Winthrop
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
February 3 19.58
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
Winthrop Mass
ADDRESS.
Received and filed.
JAN 3.1-1958
19
(Registrar)
INTERVAL BETWEEN ONSET AND DEATH
2 YRS.
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
GENERAL ARTERIO-
CONDITIONS
SLERESiS.
Was autopsy performed?
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased?
1f so, specify ...
(Signed)
Thyron n. 1ung
M. D.
1/31
1958
(Address) 122 PLEASANT ST WINTHROP Date
PARENTS
100M.11.55.916145
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
January 30, 1958
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY
That I attended deceased from
JAN 25
19
58
58
JAN 30
to ..
I last saw hEllalive on
30 1958
death is said to
have occurred on the date stated above, at
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
LEUKEMIA
No.
4 Waldemar Ave.
ยก(If death occurred in a hospital or institution,,
St. { give its NAME instead of street and number)
Coakley )
1
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence. No ...
(Usual place of abode)
Registered No.
Boston
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.
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