USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1959 > Part 20
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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
4.15%
UCTIONS :OR CERTIFICATE giving OF DEATH ot enter chan one for each b) and (c)
Does not mean of dying, heart failure. tc. It means of compli- hich caused
is, if any, ve rise to ause (a). the under- ause
bons contrib- - > eath but not the terminal edition given
Chapter 137, 54, requires s to print or cause Or death on
ifcates. f
SSATI
50M-1-58-921876
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 filled for burial permit with Board of Health or its Agent.
Registered No. 59
WINTHROP COMMUNITY HOSP. St. (give its NAME it No .. MINNIE LOURIE
(If deceased is a married, widowed or divorced woman, give also maiden name.)
85 SAGAMORE QUE
St. WINTHROP
(If nonresident, give city or town and State)
Length of stay: In place of d
years
days. In place of residence:
... years
months.
. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
April (Month)
20 (Day)
1959 (Year)
4 I HEREBY CERTIFY
August
1957
to
April
20
59
I last saw h CXalive on
20, 19 34, death is said to
have occurred on the date stated above, at 4:15 A.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Coronary Occlusion
Hypertensive - Cardio-
Vascular Disease,
Due To (c)
OTHER
SIGNIFICANT
None,
CONDITIONS
NO
Was autopsy performed ?
What test confirmed diagnosis? Clinica
5 Was disease or injury in any way related to occupation of deceased NO If so, specify
(Signed)
Charles Liberyes.
M. D.
(Address Winthrop, Mass Date 4/20/1959
6
TEFEBETH ISRAEL FELRENT Place of Burial or Cremation (City or Town)
DATE OF BURIAL apr 21 1959
7 NAME OF
FUNERAL DIRECTOR
arnold Halong
ADDRESS 1668 Beacon It Brakline
Received and filed
APR 2 1959
19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX F
9 COLOR
W
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
(write the word)
SINGLE
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE6 4 Years
0
Months.
3 Days
If under 24 hours
.Hours ...... Minutes
13 Usual
Occupation :
BOOKKEEPING
(Kind of work done during most of working life)
14 Industry
SUPPLY CLOTHING CO. BOSTON.
15 Social Security No.
16 BIRTHPLACE (City)
BESTEN , MASS
(State or country)
17 NAME OF
FATHER
MOSES. M. LOURIE
18 BIRTHPLACE OF
FATHER (City)
(State or country)
RUSSIA
19 MAIDEN NAME
OF MOTHER
CHESNA BAUD
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
RUSSIN
21 SARAH LAURIE
(Address)
to SAGAMORE AUE WINTHROP
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 or other)
Jealete Officer 4/20/59
(Official Designation) (Date of Issue of Permit)
nstead
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
April
That I attended deceased from
INTERVAL BETWEEN ONSET ANO DEATH 7 Days
(b)
2yrs,
PARENTS
35
f(If death occurred in a hospital or institution,
2 FULL NAME
in
last.
hı
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 une 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 If death is application make the certificate required of the attending physician. 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 boardof 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
× PLACE OF DEATH
Suffith (County) Wenthun (City or TownĄ 007580
65- 6 58
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To he filled for burial permit with Board of Health or its Agent.
60
No. in in Community Hospital
Premature mule Roundy 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
15 marion ST
St.
Cost 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.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
abril
(Month)
20 .
(Day)
1959 (Year)
4 I HEREBY CERTIFY,
april do .
59, to
abril 20
I fast saw himalive on
april 20., 1959.
death is said to
have occurred on the date stated above, at 6:1SP
.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Prematurity
born 4:18 AM Birth weight 2 lbs 8g.
Due To
(b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
Yes
What test confirmed diagnosis ?.
5 Was disease or injury in any way related to occupation of deceased? W. If so, specify
(Signed)
G. Paul Da Hagopian
M. D.
(Address) 9 CARY AV. CHELSEA Date Ubv dk
1959
6
It michel temerty> Borten
(City or Town) Place of Burial or Cremation DATE OF BURIAL april 14, 1953
7 NAME OF
FUNERAL DIRECTOR
Cuña Cincilte
ADDRESS 3 no Ky. Boston Horas
Received and filed APR 23-1953 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX M
9 COLOR
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Single
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years
Months
Days
If under 24 hours
14
_Hours D. Minutes
13 Usual
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business:
15 Social Security No ...
16 BIRTHPLACE (City)
(State or country)
(Vendría
17 NAME OF
FATHER
Bey Roundy
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Waterville Maine
PARENTS
19 MAIDEN NAME
OF MOTHER
Mira Apenacola
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Barton Man
21
Informant
(Address)
1 105 martin et Ci + 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 Serranul
(Signature of Agent of Board of Health, or other).
nto
april 23/1959
(Official Designation)
(Date of Issue of Permit)
X
R-301A 1
UCTIONS FOR CERTIFICATE
giving OF DEATH t enter than one for each h) and (c)
Des not mean of dying, heart failure, 'c. It means 6, or compli- hich caused
is, if any, ve rise to ause (a). the under- suse
last.
bons contrib -- zath but not the terminal dition given
Chapter 137, 54, requires s to print or cause or death on lficates.
50M-1-58-921876
[(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,
if so specify WAR)
(a) Residence.
No.
(Usual place of abode)
Registered No.
Roundy
(write the word)
That I attended deceased from
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 of 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 intetment 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 dertify 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 uhrelated to any form of injury, have died without recent medical attendance of whose physician is absent from home when the certificate of death"is needed."
(3) Medical Examiners will investigate andcertify 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, land 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.
APR 2-31959 AM
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
UCTIONS FOR CERTIFICATE
igiving OF DEATH it enter ethan one for each , b) and (c)
ves not mean of dying, leart failure, c. It means . or compli- hich caused
is, if any, ive rise to ause (a), the under- lause
lions contrib -- ·ath but not the terminal dition given
Chapter 137, 54, requires s to print or cause or death on
eificates.
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
To be filed for burial permit with Board of Health or its Agent.
61
[(If death occurred in a hospital or institution, St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
25 Perkins
Street
St.
44
. (If nonresident, give city or town and State)
months
. days.
MEDICAL_CERTIFICATE, OF DEATH
3 DATE OF
April 22,1959
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Fel 3
19
51
to
APR. 22
19.5%
I last saw hi Malive on
APRIL LL
1959
, death is said to,
have occurred on the date stated above, at
11 SSP
.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
CORONARY OCCLUSION
(b)
Due To
GENERAL ARTERIOSCLEROSIS
+ HYPERTENSIVE HEART DISEASE
4 YRS
Due To (c)
OTHER
SIGNIFICANT
RHEUMATOID ARTHRITIS
CONDITIONS
CHRONIC CHOLECYSTITIS
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)
Jayson 3 Kug
M. D.
(Address) 222 PLEASANT ST WINTHROP APRIL 23
1959
Forest Hills Crematory , Boston 6
or Town) DATE OF BURIAL
7 NAME OF
FUNERAL DIRECTOR
J.S. Waterman
ADDRESS
Boston, Mass.
Received and filed 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
Married
10a If married, widowed, or divoSarah Fish
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
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