USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 54
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(State or country)
lolland
21 James T Really
Informant
(Address)
197 Pleasant Park & Road. Deres
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial/or transit permit was issued: Table C. pereaun g
(Signature of Agent of Board of Health or other) /
11/22/60
(Official Designation)
(Date of Issue of Permit)
247
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
U. S. War Veteran,
if so specify WAR)
no
RUCTIONS FOR CERTIFICATE giving OF DEATH
not enter than one for each (b) and (c)
does not mean le of dying. heart failure, etc. It means se, or compli- which caused
ons, if any, gave rise to cause (a). the under- cause last.
tions contrib- death but not the terminal ondition given
Chapter 137, 1954, requires ns to print or le cause or of death on rtificates.
SOM-5-56-917573
MR-301A 1
As.
6
The Commomuralth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
To be filled for burial permit with Board of Health or its Agent.
(Usual place of abode)
INTERVAL
BETWEEN
ONSET AND
DEATH
5
PARENTS
East Boeton
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. 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 sooncr 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 ril
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 deathsonly as those of persons to whom they have given bedside care fritia fast illness from disease unrelated to any form of injury.
(2) Board of Health physicians wit 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 injur . These include traumatism (including resulting nhlvodythe action of chemical ed, directly or indirectly by (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 LOVETEMY CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Ida Peckham (Baker) 2 FULL NAME
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 94 Somerset Ave
St.
(If nonresident, give city or town and State)
Length of stay: In place of death
years
21
months. days. In place of residence. 1 years ... ... months .. days.
MEDICAL CERTIFICATE OF DEATH
20 1960
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
Oct. 31
19
60 .
Nov. 20
to.
19
, death is said to
have occurred on the date stated above, at
10:25A
m.
INTERVAL BETWEEN ONSET AND DEATH
DEATH WAS CAUSED BY: IMMEDIATE CAUSE Acute Pulmonary Infarction (a)
Due TAcute Cerebral Infarction (b)
with Right Hemiplegia
Due To
Arteriosclerosis
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
No
What test confirmed diagnosis ?_.
5 Was disease or injury in any way related to occupation of deceased ? N.O.
If so, specifyDorothy Cheney Appleton
(Signed)
Dorothy Cheney appleton
M. D.
(Address) 197 Woodside Cite
Date 11/20
19
60
PARENTS
18 BIRTHPLACE OF
FATHER (City).
Shoreham
(State or country)
Vermont
19 MAIDEN NAME
OF MOTHER
Inez Van Wormer
20 BIRTHPLACE OF
MOTHER (City)
Woodville
(State or country)
New York
BENJAMIN
Cremation, Woodlawn Cemetery Everett Place of Burial or Cremation (City or Town) 21 Informant Mrs. Whorf (Address) 94 Somerset Ave Winthrop
DATE OF BURIAL November 22. 19 60
Cefut B. March
7 NAME OF
FUNERAL DIRECTOR
ADDRESS174 Winthrop St. Winthrop, Mass.
Received and filed NOV-22-1960 19
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10-SINGLE
(write the word)
MARRIED
WIDOWED
Widowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
David Paul Peckham
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
2 Days AGE 81 Years .. 1.0Months.
5 Days
If under 24 hours
Hours ...... Minutes
13 Usual
Occupation :
housework-
(Kind of work done during most of working life)
14 Industry
or Business:
own home
15 Social Security No ...
none
10 Yr
Milwaukee
16 BIRTHPLACE (City)
(State or country)
Wisconsin
17 NAME OF
FATHER
Charles Frank Baker
SOM-5-56-917573
MR-301A 1
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.
litions contrib -- > death but not to the terminal condition given
- Chapter 137, 1954, requires ans to print or he cause or of death certificates.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with) me BEFORE the burial or transit permit was issued:
Talike à percanne 8 (Signature of Agent of Board of Health or other) }
Healle Vic 11/22/60
(Official Designation)
(Date of Issue of Permit)
Registered No.
[ (If death occurred in a hospital or institution,
St. [give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
(Usual place of abode)
No.
Winthrop Community Hospital
3 DATE OF
DEATH
NOV.
I last saw hetalive on
Nov. 20
60
60
3 Wks
-
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, 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
i;L
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 certity to suchillerthe only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance onthese physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and cerfif CAROL aths 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, also deaths from disease resulting from injury NO.Veckor algan abortion, but
lidloccupation, 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
1
ORM R-304
PLACE OF DELIVERY
SUFFOLK (County )
Winthrop (City or Town) Win. Com . Hospital No.
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF FETAL DEATH ( STILLBIRTH)
To be filed for burial permit with Board of Health or its Agent.
Registered No.
24!
(If death occurred in a hospital or institution, give its NAME instead of street and number)
3 DATE OF
DELIVERY
Nov ( Month )
22, 1440
( Day )
(Year )
4 SEX
Male .. .. Female ...... Undetermined ..
5 COLOR (if
determined)"
6 THIS BIRTH (Check one)
Single"
Twin Triplet.
2nd
.3rd ..
FATHER
8
FULL
NAME
John Cincotti
14 MAIDEN NAME
MOTHER
Brenda Kelfer
Brenda Cincotti
PRESENT NAME
9 RESIDENCE, NO. 35 Carlson Ave.
CITY OR TOWN Revere,
STATE
STREET
Mass.
15
RESIDENCE, NO.
CITY OR TOWN
35 Carlson Ave. Revere,
STATE
Mas
10 COLOR
RACE.
Shite
11 AGE AT TIME OF ~
THIS DELIVERY 20
(Years)
16 COLOR OR RACE. White
17 AGE AT TIME OF THIS DELIVERY
20 (Years)
12 PLACE OF
BIRTH
Boston, Mass.
City or Town
(State or country)
18 PLACE OF
BIRTH
Revere, Mass.
(City or Town)
State or country
13 OCCUPATION
Clerk
19 INFORMANT Housewife
20 PREVIOUS DELIVERIES TO MOTHER (Do not include this fetus)
(a) How many children are
now living?
€
(b) How many children were born alive but are now dead ?
(c) How many previous fetal deaths of ANY gestation age ?
21 LENGTH OF
PREGNANCY
211/2 completed
weeks
22 WEIGHT OF FETUS 7 Lb.
Y .Oz. Grams
23 WHEN DID FETUS DIE? Before Labor
During Labor or Delivery .
Unknown.
25 FETAL DEATH WAS CAUSED BY : IMMEDIATE CAUSE (a) Intrauterine Anoxia
Due To (b) Premature Seperation of Placed Sie Due To (c)
OTHER SIGNIFICANT CONDITIONS
26 HOLY CROSS Cemetery, MALDEN Place of Burial or Cremation
DATE OF BURIAL Nov. 23,
(City or Town) 1960
27 NAME OF FUNERAL DIRECTOR John CONcetti+SONS
ADDRESS 7 Cooper St. Boston
Received and filed
NOV 23 1960
19
(Registrar )
I HEREBY CERTIFY that this delivery occurred on the date stated above at 5 m., and product of conception was not a live birth. it Signature of Attending Physician or Medical Examiner ; f Louis Bule M.D.
Louis Burke (PRINT OR TYPE SIGNATURE) 1093 Beach ft
Address
Date 11/22060
I HEREBY CERTIFY that a satisfactory certificate of fetal death was filed with me BEFORE the burial or transit permit was issued :
,
Talle C. yereanny.8 Signature of Agent of Board of Health or other
1/23 60 (Official Designation y
( Date of Issue of Permit?
In giving CAUSE OF ETAL DEATH do not enter more than one cause for each of (a), (b) and (c)
etal or maternal ondition causing etal death (do ot use such erms as stillbirth r prematurity.) 'etal and/or ma- ernal conditions, any, which gave ise to above ause (a), stating he underlying ause last.
Conditions of fetus r mother which may have contrib- ted to fetal eath, but, in so ar as is known, ere not related o cause given 1 (a).
15M-6-60-928241
1
2 NAME OF FETUS (if given
Baby
Cincotti
St.
A TRUE COPY ATTEST :
(or
...
24 AUTOPSY
Yes
No.
STREET
7 IF MULTIPLE BIRTH, BORN :
1 st.
FETAL DEATH
OF TOWN il i? ? 340
EXTRACTS OF CERTAIN SECTIONS OF CHAPTER 46 AS AMENDED OR ADDED BY CHAPTER 48, ACTS OF 1960.
Section 2A. "Examination of records and returns of illegitimate births, or abnormal sex births, or fetal deaths, . .. shall not be permitted except . .NOV 2 31960 AM
Section 9A. When a child is born dead, after a period of gestation of not less than twenty weeks, and in the fetus there is no attempt at respiration, no action of heart and no movement of voluntary muscle, the physician or officer attending at the birth of such child shall forthwith furnish for registration, at the request of an undertaker or other authorized person or of any member of the family of the deceased, a certificate of fetal death on a form which shall be prepared by the secretary of state as required by section sixteen. Town clerks shall record certificates of fetal death in the town register of deaths in the same manner as a death certificate, but they shall not be required to record such certificates in the town register of births.
Section 12. ". .. No birth record of a child born out of wedlock or of a child of abnormal sex, and no record of fetal death shall so be transmitted to any other city or town."
Section 24. In any statement of births, deaths and fetal deaths printed by a town the name of an illegitimate child or of its parents or of the parents of a child born dead shall not be printed, but the word "illegitimate" or "fetal death" shall be used in place thereof. A town violating this section shall forfeit to the mother of such child not more than one hundred dollars.
X
PLACE OF DEATH
Suffolk
(County)
"inthror (City or Town)
TENERE 12-9-600
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
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