USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1963 > Part 14
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MAR 5
....
Besin
.....
M. D.
PARENTS
1
19 63.
16 Days
NMASSACHUSETTS GENERAL HOSPITAL
-
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
RECEIVED
OF
TOW;
17.12 7
OFFICE
10.
i).
CLERK
5
6
DR. MARS
APR 1 1 1963 AM
,
FORM R-301
led for burial permit Board of Health or its Agent. INSTRUCTIONS FOR CAL CERTIFICATE
NT OR TYPE E OR CAUSES OF DEATH do not enter ore than one use for each a), (b) and (c)
is does not mean mode af dying, as heart failure. nia, etc. It means disease, or compli- " which caused
"ditions, if any, ich gave rise to ove ramse (a), ling the under- ng cause last.
Conditions contrib- to death but mat ed to the terminal se condition given ).
21/ -
Jurisdiction
waived by Medical Examiner
PR 1101963 8
2-62-932382
PLACE OF DEATH
TOWN
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
65
(City or Town making this return)
02430
Registered No.
((If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
2 FULL NAME
Louis Biggi
(If deceased is a married, widowed or divorced woman, give also maiden name.)
PHYSICIAN - IMPORTANT - ( Was deceased a U. S. War Veteran, if so specify WARY No.
(a) Residence. No
(Usual place of abode)
18 Hours
Length of stay : In place of death ...... years .. ..
.months ..
days. In place of residence.
7.
years ...
.. months ....... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 D.VTE OF
DEATH
March
2
1963
(Year)
(Month)
(Day)
4IHERENY CERTIFY , That I attended deceased from
March ..........
19 63 ..... 1 March .. 2
1.63
I last saw himlive on March 2.
... 1,63
,death is said to
have occurred on the date stated above, at3 :00 A ... m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Pneumonia
Due To
Chronic congestive
(b)
Due To
(c)
heart failure
OTHER
SIGNIFICANT
CONDITIONS
Coronary heart disease
Was autopsy performed?
What test confirmed diagnosis?
5 W'as disease or injury in any way related to occupation of deceased ? If so, specify
(Signature)
M. D. Raymon S. Riley
(Address)
6 Old Calvary
Boston
Place ol Burial or Cremation
(City or Town)
DATE OF BURIAL March .. 5,1963
19
7 NAME OF FUNERAL DIRECTOR Arthur S. Poroella
ADDRESS 876 Winthrop Ave., Revere
Recormed Ad filed MAR _6 1963 19 Charles A. Mairie
( Registrar )
8 SEX
9 COLOR
(write the word)
Male
White
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
Single
11 1f married, widowed, or divorced HUSHAND of (Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12-24-1888
12
AGE 74 Year, 2
Months
8
1)3y5
Il under 24 hours
Hours ........ Minutes
13 Usual
Occupation
Retired- Shipper
( Kind of work done during most working life)
14 Industry or Business '
15 Social Security No
16 BIRTHPLACE (City).
( State or country 1
Vas8
17 NAME OF John B. Biggi
18 BIRTHPLACE OF
FA111ER (City). ..
(State of country )
Italy
19 MAIDEN NAME
OF MOTHER Theresa Fennochetti
20 BIRTHPLACE OF
MOTHER (City)
(State or country )
Italy
21 InformantMrs . Nellie Christoforo ( Address)
27 Bowdoin St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death filed with me BEFORE the burial or transit permit was issued: R.R. Josman Jo (Signature ol Agent of Board of Health or other)
15400 13/4/63.
(Official Designation) (Date of Issue of Permit)
-
Boston
(City or Town)
No
--
IT Suffolk
(County)
STANDARD CERTIFICATE OF DEATH
New England Center Hospital
27 Bowdoin St., Winthrop, Mass.
St
WINTHROP
( If nonresident, give city or town and State)
A TRUE COPY ATTEST:
N.E. Center Ho's pitas March 2 63
19
PARENTS
Boston
Rayman 5. Riley
INTERVAL BETWEEN ONSET AND DEATH
120
A TRUE COPY ATTEST: Charles it. mackie City Registrai
RECEIVED
TOW;
OF
OFFI:
RK
00
HROB
APR 11 1963 AM
FORM R-302
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12, G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
PLACE OF DEATH
Suffolk (County)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
Chelsea
(City or Town making this return)
Registered No.
66
§(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
2 FULL NAME ........
Trying Henry Streeter Jr.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(Was deceased a WWII
U. S. War Veteran,
if so specify WAR, ..
Kor.
(a)
Residence. No ...
16Fremont
(Usual place of abode)
silinthrop, Mass
(If nonresident, give city or town and State)
Length of stay: In place of death. ..... years ...... months ....... Jays. In place of residence .... Sears ...... months .......
.Mays.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Mar.17,1963
(Day)
(Year)
(Month)
4 I HEREBY CERTIFY, That I attended deceased from
....
DOA
19
to ..
I last saw himmalive on
Mar.18
19 .. 65death is said to
have occurred on the date stated above, at
11:45p
INTERVAL BETWEEN ONSET AND DEATH
(a)
Arteriosclerotic heart
Due To
(b)
disease
Due To (c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
What test confirmed diagnosis ?
5 Was disease or injury in any way related to occupation of deceased ?
If so, specify
(Signed)
Harold .... A.Engelke
M. D.
(Address
USNH Chelsea, Hasby 3/18/03
6
......
Winthrop Cem., Winthrop, Mass.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
Mar.21,1963
19
(Address)
7 NAME OF
FUNERAL DIRECTOR
Maurice Kirby
ADDRESS
210 Winthrop St . Winthrop, MaasVE COPY
Received and filed
APR 16 1963
19
(Registrar of City or Town where deceased resided)
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE (write the word) MARRIED WIDOWED DIVORCED UNKNOWN Married
11 If married, widowed, or divorced
HUSBAND of
Elinore ..... M.Perry
(or) WIFE of.
(Husband's name in full)
12
AGE.52. Years ...... .. Months ......
.. Day3
If under 24 hours
Hours ....
Minutes
13 Usual
Occupation :
Retired U.S.Army
(Kind of work done during most working life)
14 Industry
or Business :
U.S.Army.
15 Social Security No ... 0.12-28-4086
16 BIRTHPLACE (City).
(State or country)
Fort Warren Boston Har.
Mass.
17 NAME OF
FATHER
Hugh Streeter
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nashua, N.H.
19 MAIDEN NAME
OF MOTHERFlla Barraly
20 BIRTHPLACE OF
MOTHER (City).
(State or country)
Canada
2I Informant
Mrs.Irving Streeter
16 Fremont St. ,Winthrop, Mass.
ATTEST:
Greple aTyrrell
DATE FILED
(Registrar 61 City or Town where death occurred) Mar.20,1963
19
50M - 10-61.931673
E
Chelsea (City or Town)
No ... U.S.Naval .. Hospital
-
19
Male
White
(Give maiden name of wife in full)
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE --
4
DATE OF DISCHARGE
RECEIVED
RANK, RATING
MSGT
TO !!
ORGANIZATION AND OUTFIT
U. S. Army
SERVICE NUMBER
RA6113435
.....
...
OFF
6 3
INTHROR
APR 1 61963 AM
1
PLACE OF DEATH
Suffolk
1
(County) Winthrop
(City or Town)
The Commonwealth of Massachusetts KEVIN H. WHITE SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
(City or Town making this return)
CONSTANTINOS
on) Charles Spanos
PHYSICIAN - IMPORTANT
2 FULL NAME.
(If deceased is a married, widowed or divorced woman, give also maiden name.)
4 Brookfield Road
Sı
Winthrop, Mass
(a)
Residence. No.
(Usual place of abode)
2
.days. In place of residence 32
months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
MALE
9 COLOR
WHITE
10 SINGLE
MARRIED
WIDOWED
DIVORCED
UNKNOWN
(write the word)
MARRIED
11 If married, widowed, or divorced
HUSBAND of
LIMBEROPOULOS
(Give maiden name of wife in full)
(or) WIFE of.
(Husband's name in full)
12
AGE 70 Years.
11 Months.
.Days
If under 24 hours
Hours ........ Minutes
13 Usual
Occupation :
GROCERY
CLERK
(Kind of work done during most working life)
14 Industry
or Business :
RETIRED
15 Social Security No.
027-28-4816
16 BIRTHPLACE (City)
(State or country )
GREECE
17 NAME OF
FATHER
JOHN
SPANOS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
GREECE
19 MAIDEN NAME
OF MOTHER
MARY MOUTOUGLI
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
GREECE
WINTHROP CENTERY - WINTHROP
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL APRIL 13, 19) 63
7 NAME OF
FUNERAL DIRECTOR
Paul @ Dilyable
ADDRESS
336 BROADWAY- CAMBRIDGE
Received and filed APR 11 1963 19
PARENTS
CHRISOULA
SPAHOS
21 Informant
( Address)
4 . BROOKFIELD R.D. WINTHROP
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : j'aiphe &
(Signature pf Agent of Board of Health or other)
Health officin
Capul 11,1963
(Registrar)| (Official Designation)
(Date of Issue of Permit)
A TRUE COPY ATTEST:
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased, from
....
June
19 61
to ..
April9
1963
I last saw h.f ... Mive on
April
1963, death is said to
have occurred on the date stated above, at
6:10 Pm.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Cerebral Hemorrhage
INTERVAL BETWEEN ONSET AND DEATH 2 days.
Due
(b)
To Arteriosclerosis
2 yrs
(c)
Hypertension
2485
OTHER
SIGNIFICANT
CONDITIONS
None.
Was autopsy performed?
10
What test confirmed diagnosis ?
Clinical
5 Was disease or injury in any way related to occupation of deceased Na. If so, specify
(Signature)
Charles Fritte man
CHARLES
LIBERMAN
(Address)
(Print or Type Name) WINTHROP, MASS Date ..
4/9/ 1963
Registered No.
Winthrop Community Hospital N ʻ
[(If death occurred in a hospital or institution, ....... St. ¿ give its NAME instead of street and number)
w.w.
(Was deceased a
U. S. War Veteran,
if so specify WAR).
I
(If nonresident, give city or town and State)
Length of stay: In place of death .......... years .......... months ...
3 DATE OF
DEATH
April
9
1463
(a)
FORM R-301
ed for burial permit Board of Health r its Agent. INSTRUCTIONS FOR CAL CERTIFICATE
NT OR TYPE E OR CAUSES F DEATH o not enter ore than one use for each a), (b) and (c)
s does not meon mode of dying, as heart foilure, sia, etc. It meons iscase, or compli- s which coused
ditions, if ony, ich gove rise to ce cause (0), ing the under- ng couse lost.
Conditions contrib- to death but not d to the terminal e condition given
2-62-932382
(Month)
CHRISOULA
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
JUNE 27 1918
DATE OF DISCHARGE
NOV
28
1918
RANK, RATING
PVT
ORGANIZATION AND OUTFIT
ARMY
SERVICE NUMBER
366 4433
OF TOW:
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance 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 occA-PR 1 1 1963 PM
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.
17 92 of the O.
İLERK
6
Tr
PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
No.
47 Shirley Street
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.
68
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number) PHYSICIAN - IMPORTANT
2 FULL NAME
(First Name)
( Middle Name)
(Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
230 Everett
East Boston
(a) Residence. No.
(Usual place of abode)
Length of stay :
In place of death ....
.. years ..
months
days. In place of residence ........
... years ...
months .........
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
19
.. , to ..
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Thomas Gizzi
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
76
12
AGE
Years ..
.........
.. Months ...
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.
None
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Louis Licciardi
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria (unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country) Italy
Helen Piano (daughter)
21
Informant
(Address)
47 Shirley St., Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Caiphí. dereanice (3) (Signature of Agent of Board of Health or other) Health Officer april 16.6 ..
(Official Designation)
(Date of Issue of Permit)
1 X
TRUCTIONS FOR L CERTIFICATE
giving , OF DEATH not enter e than one e for each , (b) and (c)
daes not mean de of dying, heart failure, , etc. It means ase, or compli- which caused
lions, if any, gave rise to cause (a), & the under- cause last.
ditions contrib- death but not ta the terminal condition given
e :- Chapter 137, of 1954. requires cians to print or the cause or s of death on certificates, and er 48, Acts of requires Physi- to print or type under signature.
6
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
April 17,
63
19
7 NAME OF
FUNERAL
DIRECTOR
Vincent Rapino
ADDRESS
9 Chelsea St., East Boston, Mass.
Received and filed APR 17 1963 19
(Registrar)
PARENTS
LIBERMANOM. P
(PRINT OR TYPE SIGNATURE)
(Address) L'iutterap
45/18/1963
Holy Cross Cemetery
Malden
OTHER
SIGNIFICANT
CONDITIONS
history Winthrop Board of Health
Was autopsy performed?
What test confirmed diagnosis?
INTERVAL BETWEEN DNSET AND DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Death Presumably due to
(a)
Due Tonatural causes probably (h) acute cerebro vascular Due Toocclusion based on medical (c)
That I attended deceased from
I last saw h ........ alive on
19 ...
........ , death is said to
have occurred on the date stated above, at
6:30 am
St.
Registered No.
Angelina. Gizzi
[(Was deceased a U. S. War Veteran, (if so specify WAR)
no
(1f nonresident, give city or town and State)
MARRIED
WIDOWED Widowed
or DIVORCED
3 DATE OF
April
13.
1963
E9-4-9
M R-301A 1
50-928145
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
CHARLES
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE
RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
c. : " ERK
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice : (1) Attending physicians willcertify to such deaths only as those of persons to whom they have given bedside cafe 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.
X -
PLACE OF DEATH
(County)
Winthrop
The Commonwealth of Massachusetts EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
CERTIFICATE OF DEATH
Registered No.
f(If death occurred in a hospital or institution,
St. (give its NAME instead of street and number)
2 FULL NAME
Samuel
Nager
(If deceased is a married, widowed or divorced woman, give also maiden name.)
39 Grovers Ave.
St
Winthrop
(If nonresident, give city or town and State)
Length of stay: In place of death
4
ears.
months
days. In place of residence.
...__ years
months ..._. days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
APRIL 13, 1963
(Month)
(Day)
(Year)
8 SEX male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWED
divorced
or DIVORCED
4 I HEREBY CERTIFY
That I attended deceased from
MARCH IS, 1958
to
APRIL 13
19
63
.
I last saw h. Malive on
APRIL 11, 1963, death is said to
have occurred on the date stated above, at
8 00 p.m.
10a If married, widowed or dixogcedein
HUSBAND off. da
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE
If under 24 hours
.. Hours ...... Minutes
13 Usual
Occupation :
painter
(Kind of work done during most of working life)
14 Industry
or Business:
retired
15 Social Security No. none
16 BIRTHPLACE (City)Minsk, Russia (State or country)
OTHER
CHRONIC BRONCHITIS
SIGNIFICANT
CONDITIONS
5 YRS
Was autopsy performed ?
ovo
What test confirmed diagnosis? CLINICAL
NO
5 Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
PROCRESCENT AVE
Date
4/13
1963
Tifereth Isreel Cem. Everett 6
Place of Burial or Cremation
April 14
DATE OF BURIAL 19
7 NAME OF
Murray Goldman
ADDRESS174 Ferry St. Malden
Received and filed
19
(Registrar)
PARENTS
17 NAME OF
FATHER
Samuel
18 BIRTHPLACE OF Russia FATHER (City) (State or country)
19 MAIDEN NAME
OF MOTHER
Fannie(unknown )
20 BIRTHPLACE OF
MOTHER (City) ..
(State or country)
Russia
21
Irving Neger-brother
Informant 29 . Nichols St. Everett.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued : Lasph
(Signature of Agent of Board of Ilcalthi or other)
Health Officer
(Official Designation)
(Date of Issue of Permit)
Cifocal 1, 19 63
X
1
.
MR-301A 1
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 ase. or compli- which caused
ions, if any, gave rise to cause (a), the under- last.
ditions contrib- - death but not to the terminal condition given
· Chapter 137, 1954, requires ans to print or he cause OT of death on ertificates. C . 1
50M-1-68-921876
(City or Town)
No.
Mayflower Nursing Home
PHYSICIAN - IMPORTANT
(Was deceased a
U. S. War Veteran,
if so specify WAR)
NO
(a) Residence.
No.
(Usual place of abode)
4
PERSONAL AND STATISTICAL PARTICULARS
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
GENERALIZED ARTERIO -
(a)
SCLEROSIS
INTERVAL
BETWEEN
ONSET AND
DEATH
15Yes
74
Years
Months
Days
Due To (b)
Due To (c)
(Addressy
, M.D. M. D.
(City or Town) 63
(Address)
To be filled for burial permit with Board of Health or its Agent.
EXTRACTS FROM THE LAWS OF THE COMMONWEALTH OF MASSACHUSETTS GOVERNING THE
RETURN OF CERTIFICATES OF DEATH
A physician or registered hospital medical officer shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death. . . Gen. Laws, Chap. 46, Sec. 9.
A physician or officer furnishing a certificate of death as required by the preceding section or by section forty-five of chapter one hundred and four- teen, shall, if the deceased, to the best of his knowledge and belief, served in the army, navy or marine corps of the United States in any war in which it has been engaged, insert in the certificate a recital to that effect, specifying the war, and shall also certify in such certificate both the primary and the secondary or imme- diate cause of death as nearly as he can state the same. For neglect to comply with any provision of this section, such physician or officer, shall forfeit ten dollars. For the purposes of this section and of sections forty-five, forty-six and forty-seven of said chapter one hundred and fourteen, the word "war" shall include the China relief expedition and the Philippine insurrection, which shall, for said purposes, be deemed to have taken place between February fourteenth, eightcen hundred and ninety-eight and July fourth, nineteen hundred and two, and the Mexican border service of nineteen hundred and sixteen and nineteen hundred and seventeen. G. L. Chap. 46, Sec. 10.
No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original inter- ment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a
permit for the removal of a human body, not previously interred, from one town to another within the commonwealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such removal; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the
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