USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 17
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To be filed for burial permit with Board of Health or its Agent.
52
Registered No.
(If death occurred in a hospital or institution, St. [ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME. Arthur. W ..... Jones
(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. 105 .Grovers ... Ave ...... Winthrop, Massst. (Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death ........ . years. months
58 days. In place of residence 021 years. .months days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Apr.
8
19.5.9
(Month)
(Day)
(Year)
8 SEX
Male
9 COLOR OR RACE
unite
10 SINGLE (write the word) married
MARRIED WIDOWED or DIVORCED
4 I HEREBY CERTIFY,
That I attended deceased from
Feb. 9
159
to ...
Apr.
8
59
... death is said to
(or) WIFE of
have occurred on the date stated above. at m.
INTERVAL BE-
(Husband's name in full)
DISEASE OR CONDITION
DIRECTLY LEAD
Acute myocardial
TO DEATH (a)
infarction
TWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12
16
1
Months
13 Days
If under 24 hours
.Hours
Minutes
ANTE
Due ToArteriosclerotic &
CEDENT (b)
SAYSES Typertensive heart disease
Due To (c) Generalized.arterio- sclerosis
OTHER SIGNIFICANT CONDITIONS
Bronchopneumonia
R wks
Major findings:
Of operations.
What test confirmed diagnosis? Clinical & Laboratory
5 Was disease or injury in any way related to occupation of deceased?
If so, specify .. )
(Signed)
Mi, Traunstein
M. D.
(Address).
Date 4-8-59
. Winthrop Cemetery Te Atro Place of Burial or Cremation
(City or Town)
DATE OF BURIAL.
Hpri
10,1959
19
7 NAME OF Howard S. Deyrolds FUNERAL DIRECTOR./ 180 winthrop St. Winthrop ADDRESS
Received and filed. APK 13 1953 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
unable to obtain
19 MAIDEN NAME
OF MOTHER
Mary Iles
20 BIRTHPLACE OF MOTHER (City) (State or country) England
Unable to obtain
2 Informant
Mes Marjorie Jones (Address) LOS Gruier: TUE
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) dialthe Gricole 4/10/59
(Official Designation) V
(Date of Issue of Permit)
M R-301A 1
RUCTIONS FOR L CERTIFICATE
giving OF DEATH
not enter than one , for each (b) and (c)
does not mean of dying, such ilure, asthenia. ans the disease, ications which 3th.
id conditions, ring rise to the se (a) stating rlying cause
itions contrib- e death but not the disease or causing death.
100M-10-53-910621
13 Usual
Occupation:
(Kind of work done during most of working life)
2 yrs14 Industry
Shoe Store Supplies
or Business:
15 Social Security No. 024-03-9933
3 yrs
16 BIRTHPLACE (City) norm Hdarris (State or country)
17 NAME OF
FATHER
Joseph Jones
Date of operation
0
Was autopsy performed?
0
FATHER (City)
(State or country)
England
Salesman
2. monsAG
Years
10a If married, widowed .. or divorced
Marjorie D). wilson
HUSBAND of ..
(Give maiden name of wife in full)
I last saw him
.alive on
12.40".p
Apr. 8
19
59
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 ninetcen hundred and seventeen. G. L. Chấp. 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 deathsonly 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 And Die mon dily 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
× PLACE OF DEATH
Suffolk (County) Winthrop (City or Town)
20010-20
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
[ (If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT -
(Was deceased a
Ù. S. War Veteran,
if so specify WAR)
1059 SARATOGA
St ...
EAST Boston
(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 male
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
Single
4 I HEREBY CERTIFY,
April 3, 1959
to
April
£
That I attended deceased from
10
1959
I last saw hebalive on
April
10, 1959, death is said to
have occurred on the date stated above, at
6:30 P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Coronary Occlusion
Due
·Coronary Artery Heart
Disease
Due To (c)
OTHER
Rheumatoid Arthritis
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased ? Ne If so, specify
(Signed)
Charles Liberman.
(A
Winthrop, Mass Date April 10:59
Holy Cross 6
Malden
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April
13
19
7 NAME OF
FUNERAL DIRECTOR
Frederick J. MAGRATA EAST Boston
ADDRESS
Received and filed APR 13 1953 19
(Registrar)
PARENTS
18 BIRTHPLACE OF
St. John's
FATHER (City)
(State or country)
New Brunswick
19 MAIDEN NAME
OF MOTHER
Minnie Ford
20 BIRTHPLACE OF
Buston
MOTHER (City)
(State or country)
MASS.
21
Informant
(Address)
Jasper Jeffers 69 Falcon Sh East Boston
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Ralph E Sinanni
(Signature of Agent of Board of Health or other) April 12, 1459
(Official Designation) (Date of Issue of Permit)
50M-11-56-918978
R-301A 1
UCTIONS OR CERTIFICATE iving OF DEATH t enter han one for each b) and (c)
es not mean of dying, cart failure. c. It means or compli- hich caused
s, if any, ve rise to zuse (a), he under- Iuse last.
ons contrib- ath but not the terminal dition given
Chapter 137, 54, requires to print or cause or death on
ificates.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
10
1959
(Year)
(Month)
(Day)
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.
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
Time Keeper (RET.)
(Kind of work done during most of working life)
14 Industry
or Business :
Stii
Refined SHIPFITTER
15 Social Security No .. cn6%.
16 BIRTHPLACE (City) EAST Boston (State or country) MASSI
17 NAME OF
FATHER
Robert Jeffers
20 yrs
To be filed for burial permit with Board of Health or its Agent.
53
MAY Flower NURSING Home Robert T. Jeffers
2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence.
No.
(Usual place of abode)
4
INTERVAL BETWEEN ONSET AND DEATH 2 days 12 52 Years Months. Days
6 mos.
- (b)
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 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 år 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 fulfill nent of the purpose ofthese 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 tare during a last illness from disease unrelated to any form of injury. 0
(2) Board of Health physician's 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 Potrora distis caused directly or indirectly by traumatism (including resulting septicemia) and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very import- ant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation whatever write none.
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
X PLACE OF DEATH
Suffolk (County)
Winthrop (City or Town)
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
51
No. . 28 James Avenue Fred Striebeck
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
28 James Avenue
(Usual place of abode)
3
St
(If nonresident, give city or town and State)
Length of stay: In place of death 8years.
months
days. In place of residence 5 8years ...
months.
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April
11
1959
(Year)
(Month)
(Day)
4 I HEREBY CERTIFY,
That I attended deceased from
19 ...
to.
19
I last saw h ...... alive on
19
-
, death is said to
have occurred on the date stated above, at
11:30 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
(a)
INTERVAL
BETWEEN
ONSET ANO
DEATH
sudden
Due To
Arteriosclerotic Heart
Disease
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 ? ho If so, specify
M. D. Id: Winthrop Board of Health Abril 105 9
6
Winthrop Cemetery
Winthrop, Mass.
Place of Burial of Cremation
(City or Town)
DATE OF BURIAL
April 14,1959
19
7 NAME OF
FUNERAL DIRECTOR
ADDRESS
174 Winthrop St. Winthrop,
Received and filed 19
APR 14 1950
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
widowed
male
white
10a If married, widowed, or divorced
HUSBAND of
Mary Campbell
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE81Years 6 Months 30 Days
If under 24 hours
Hours
Minutes
13 Usual
Occupationretired Office Manager
Kind of work done during most of working life)
14 Industry
or Business : ...
Armour & CO.
15 Social Security No ..
none
16 BIRTHPLACE (City)
(State or country)
New York
New York City
17 NAME OF
FATHER
Gustave Striebeck
PARENTS
18 BIRTHPLACE UF
FATHER (City)
(State or country)
Germany
19 MAIDEN NAME
Natalia
OF MOTHER
Withxxix Schnoore
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21
Informant Mrs. Ralph E. Poor
(Address)
14 Wadsworth Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
was filed with me BEFORE the burial or transit permit was issued :
Talkle Chereaung).
(Signature of Agent of Board of Health or other)-7
Lass.
Chealth Optick
4/7/4/59
(Official Designation)
(Date of Issue of Permit)
RUCTIONS FOR CERTIFICATE
giving
OF DEATH ot enter than one for each (b) and (c)
oes not mean of dying, heart failure, tc. It means . or compli- which caused
ns, if any, ave rise to cause (a), the under- last.
ause
ions contrib -- leath but not the terminal ndition given
Chapter 137, 54, requires s to print or cause or death on
ificates.
( )
.
50M-11-56-918978
(b)
Due To
Coronary Occlusion
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