USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 47
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li under 24 hours
19
13
AGE
Years ..
Months.
Days
Hours . . ... Mfmies
14 Usual
Occupation :
Unemployed
(Kind of work done during most of working life)
15 Industry
or Business :
**
16 Social Security No.
unknown
17 BIRTHPLACE (City)
(State or country)
Boston
Mass2
18 NAME OF
FATHER
Charles Laskey
(Print or Type Signature)
(City or Town)
1.1
11 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
single
9 SEX
10 COLOR
male
white
Charles Laskey (father)
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 poison) 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
Medical Examiners in certifying to a death will state the cause and manner thereof, and will specify: (1) Under cause the nature of an injury and of its consequences; and (2) under manner the mode of its production together with the circumstances when these are known. For example: "Compound fracture of the femur with ensuing septicemia (gas bacillus) caused by a collision of railroad train and automobile." "Pistol shot wound of the chest with associated hemorrhage, homicidal." "Asphyxiation by suspension, suicidal." "Syncope while under the influence of ether administered as a surgical anaesthetic for (enter name of operation and disease or condition requiring surgery)." "Fracture of the skull with associated internal injury sustained under circumstances unknown."
If disease or injury was related to occupation, specify. If investigation shows the death to have been due to disease, specify: (1) Under cause its known or presumable nature; and (2) under manner, indicate the circumstances leading to medico-legal inquiry. For example: "Hemorrhage spontaneous of the brain (basal ganglia) (found dead in bed)." "Heart disease, presumably coronary sclerosis. (Sudden death.)"
PLACE OF DEATH
Suffolk (County)
Winthrop
(City or Town)
Ohr Commonwealth of massachusetts JOSEPH D WARD 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.
216
S(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
2 FULL NAME
Mary (Vincent) Milan
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 17 Winthrop Street
St.
(If nonresident, give city or town and State)
Length of stay: In place of death.
...... .
.. years. .
. months .
.. days. In place of residence
years.
months ..
days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October 3
(Month)
(Day)
Thar I attended deceased from
I last saw h. Y .. alive on
October 2, 1960
h is said to
have occurred on the date stated above, at
5:45 A.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
3 month
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Matthew Milan
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
55
AGE
Years
6
Months.
18
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.
012-28-3844
16 BIRTHPLACE (chewton
(State or country)
Mass
17 NAME OF
FATHER
Charles Vincent
18 BIRTHPLACE OF
FATHER (City)
(State or country
Canada
19 MAIDEN NAME
OF MOTHER
Lillian
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
England
21 Matthew Milan
Informant
(Address)17 Winthrop St. Winthrop, Mass
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: 2
(Signature of Agent of Board of Health or/other) /
(Official Designation)
(Date of Issue of Permit)
TRUCTIONS FOR IL CERTIFICATE
n giving E OF DEATH not enter re than one se for each , (b) and (c)
does not mean ode of dying, heart failure, , etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not to the terminal condition given M.S.
- Chapter 137, 1954, requires ans to print or he cause or of death on ertificates, and 48, Acts of equires Physi- o print or type nder signature.
6 Woodlawn Crematory Everett
Place of Burial or Cremation
DATE OF BURIAL
Oct City or Town)
60
19
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
Winthrop
Mass
Received and filed
OCT 4 1960
19
(Registrar)
PARENTS
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCEDMarried
4I HEREBY CERTIFY
August
, 1960
to.
October 3
1960
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Cancer
of Pancreas
Due To (b)
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
None
Was autopsy performed?
No
What test confirmed diagnosis Operative and pathological
5 Was disease or injury in any way related to occupation of deceased ? ha If so, specify
(Signed) Charles Liberman M. D. CHARLES LIBERMAN (PRINT OR TYPE SIGNATURE) (Address) WINTHROP, MASS Date! Oct. 3 19.60
M R-301A 1
17 Winthrop Street No.
Registered No.
PHYSICIAN - IMPORTANT [(Was deceased a { U. S. War Veteran, (if so specify WAR)
(Usual place of abode) 20
25
(write the word)
1960
(Year)
1-6-59-925686
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
Ohfed of the 1900 PM
The fulfillment of the purpose of these laws calls for the observer following 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 un- related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
PLACE OF DEATH
SUFFOLK (County )
Winthrop (City or Town)
No.
Convalescent Mount's Et Home
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.
212
[ (If death occurred in a hospital or institution, St. (give its NAME instead of street and number)
2 FULL NAME Oscar Jensen
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No ..
104 Highland Ave.
St.
Winthrop, Mass
(If nonresident, give city or town and State)
4 days. In place of residence
1
years
5
months.
4 days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
October 4, 1760
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
May
50
19
to ..
Oct
That I attended deceased from
19
60
I last saw h.
1lalive on
Oct. 3, 1960
death is said to
have occurred on the date stated above, at
8. A. m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Broncho pneumonia terminal
INTERVAL BETWEEN ONSET AND DEATH 2 da
7 wk
Due To
Arteriosclerosis Gen.
0
Yrs.
OTHER
SIGNIFICANT
CONDITIONS
Atter. Heart Disease
Yrs.
Was autopsy performed?
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
M. D. 5.19 4 Washington to Date 10-4 19.60
FAIRVIEW CEMETERY HYDE PARK 6
Place of Burial or Cremation
DATE OF BURIAL NOV 2,, 1960
7 NAME OF
FUNERAL DIRECTOR
ALFRED D. THOMAS
ADDRESS 4 FREMONT ST. MATTAPAN
Received and filed November 2, 1960
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
M
9 COLOR
TIT
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Widowed
EDITH
10a If married, widowed, or divorces
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
AGE78
Years.
Months
Days
If under 24 hours
-
.Hours ...... 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)
NORWAY
17 NAME OF
FATHER
JENS OLSEN
18 BIRTHPLACE OF
FATHER (City)
(State or country)
NORWAY
19 MAIDEN NAME
OF MOTHER
KAREN
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
NORWAY
Informant
WELFARE DEPARTMENT
(Address)
43 HAWKINS ST. BOSTON
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : 11
(Signature of Agent of Board of Health or other)
(Official Designation)
(Date of Issue of Permit)
TRUCTIONS FOR IL CERTIFICATE
n giving , OF DEATH not enter e than one se 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. nis.
litions contrib -- death but not to the terminal condition given
Chapter 137, 1954, requires ins to print or le cause or death on :rtificates.
50M-11-56-918978
MR-301A 1
Registered No.
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
NO
(Usual place of abode)
Length of stay: In place of death .......... years_5 months ..
if so specify WAR)
(write the word)
Due To
Cerebral Vascular Acciu
(b)
(c)
(Address)
PARENTS
(City or Town)
21
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 ncarly 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 he 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 ERIK
The fulfillment of the purpose of these laws calls for the observance of the follow- ing rules of practice:
(1) Attending physicians will certify ta 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 from home when the certificate of death NOV -21960.71
(3) Medical Examiners will investigate and ceftify to all deaths supposahly 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 discase 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)
No.
Winthrop Community Hosp.
.........
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Ellen C Bowes
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
887 Shirley St.
St.
Winthrop Mass
(Usual place of abode)
Length of stay: In place of death .............. years.
months
21
50
days. In place of residence.
.years ......
.nonths.
............. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
October
17
1960
(Month)
(Day)
(Year)
8 SEX
F
9 COLOR
White
Single
10 SINGLE
(write the word)
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Hushand's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
Years ..
88
0
Months.
Days
If under 24 hours
Hours ............ Minutes
13 Usual
Occupation :
None
(Kind of work done during most of working life)
14 Industry
or Business :
At home
15 Social Security No. None
Halifax
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
George Bowes
18 BIRTHPLACE OF
Halifax
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Ellen Turner
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
Halifax
21 Arthur Bowes
Informant
(Address) 100 Terrace Ave Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
7 NAME OF
FUNERAL DIRECTOR
Howard S Reynolds
ADDRESS
.... Winthrop ........ Mass.
Received and filed OCT-10-1960
.19.
(Registrar)
PARENTS
il, M. D.
(Signed)
Charles
Liberman
(Addre
(PRINT OR TYPE SIGNATURE) Winthrop Mass Date 10/7/1960
6
Forrest Hills
Boston
Place of Burial or Cremation
DATE OF BURIAL
Oct.10
The Commonwealth of Massachusetts JOSEPH D. WARD 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.
218
Registered No.
TRUCTIONS FOR L CERTIFICATE
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 ise, or compli- which caused
ions, if any, gave rise to cause (a), the under- cause last.
ditions contrib- death but not o the terminal condition given
Chapter 137, 1954. requires ans to print or le cause or of death on rtificates, and 48, Acts of quires Physi- print or type der signature.
ยท6-59-92 5686
M R-301A 1
-
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Anemia, Hypochrom camos
Was autopsy performed?
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
Due To (b) ....
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Arterio selexotic Heart
Disease
INTERVAL
BETWEEN
ONSET AND
DEATH
5yrs
PERSONAL AND STATISTICAL PARTICULARS
4 I HEREBY
-
1955, to
CERTIFY,
That I attended deceased from
1960
I last saw ha kalive on
...
@ex.7
1960
death is said to
have occurred on the date stated above, at ....
1:40 pm.
(If nonresident, give city or town and State)
(Signature of Agent of Board of Health or other) 1
15/4/66
(Official Designation)
:
(Date of Issue of Permit)
1
[(Was deceased a U. S. War Veteran, [if so specify WAR)
(City or Town)
19.60
RECEIVED
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE.
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER.
OFFICE.OF
TOWN
11.72
109:28
3
...
8
4
9 ..
ASS.
OCT 101960 AM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following 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 un- related 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 occu- pation, 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 impor- tant, 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. Chil- dren 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.
KLERK:
A R-305 1
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town at THIS IS A PERMANENT RECORD
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