The volume, 1952

Town Clerk, Winthrop · from the Internet Archive · 570 pages · 39.5 MB
open the file ↗ · original at the source ↗

J. L. FAIRBANKS D1V.
Thomas Groom & Co.

Stationers

105 Slate St., Boston

To duplicate this book order

NojJjO-A.

Digitized by the Internet Archive
in 2016 with funding from
Boston Public Library

https://archive.org/details/townofwinthropre1952wint

A R-301A

RUCTIONS

FOR

L CERTIFICATE

giving

OF DEATH

not enter
• than one
e for each

(b) and (c)

; does not mean
• of dying, such
ailure. asthenia, .
eans the disease,
licalions which
'ath.

bid conditions,
iving rise to the
use (a) staling
lerlying cause

dilions conlrib- •
’he death but not
3 the disease or
i causing death.

Suffolk

(County)

o Win throp

Id (City or Town)

©Ijp (Eommnnmpaltf) of iflaBBarljUBPtta
EDWARD J. CRONIN
Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

To b« filed for burial permit
with Board of Health
or its Agent.

No.

2 FULL NAME

2.6. Pleasant. St

Registered No

I (If death occurred in a hospital or institution.
. \ give its NAME instead of street and number)

Fdward F. Conley

(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 WAR)

(a) Residence. No. 2.6 El.S&T-.an.t St

(Usual place of abode)

St.

Length of stay: In place of death

years months days.

In place of residence

(If nonresident, give city or town and State)
years months . days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

(Day)

/f^L

(Year)

4 X H E SO? BY CERTIFY/ That I attended deceased from

/(f Mzcs . vsy . to • ... i*r/

I last saw h alive on ^ ^ . , 19 death is said to

DISEASE OR CONDITION
DIRECTLY LEADING
T0DEATH

ANTE Due To

CEDENT (b) /

CAUSES /

Due To 6
(c)

, / A

OTHER j0/a

SIGNIFICANT^*
CONDITIONS /

ZJz-^lXefjT\s\ /

INTERVAL BE-
TWEEN ONSET
AND DEATH

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Mai e..

9 COLOR OR RACE

lYhl t£L-

10 SINGLE
MARRIED
WIDOWED

(write the word)

Major findings:
Of operations

Date of operation

What test confirmed diagnosis?

Was autopsy performed?

/TOO

5 Was disease or injury in any way relatedto occupation of deceased? OXO
If so, spe.

(Signed)^ |_ • M^_D

10a If married, widowed, or jtced -

Hu;M&rgaret Knee land

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

ag58

Years

Months

Days

If under 24 hours

Hours Minutes

13 Usual

Occupation:

tfelder

(Kind of work done during most of working life)

14 ordEess:den 11 9 C t T 3 C . C.Q

15 Social Security No.

[removed]

16 BIRTHPLACE (City) V9 I\ 9 t, t

(State or country)

Mass

17 NAME OF
FATHER

Edward

18 BIRTHPLACE OF
FATHER (City)
(State or country)

'/forces ter

Mas s

19 MAIDEN NAME

OF MOTHER Harriet Oould

20 BIRTHPLACE OF QannOt
MOTHER (City)

(State or country)

Conley
pi -qt

learned

-St-

I HEREBY CERTIFY that a satisfactory standard certificate of death was
d with me BEFOREAhe buriH'OT tran/'t permit was issued:

gent of Board of Frealth or other) .

//M.CX,

if Permit) ' —

^Date of Issue of

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, nav)’ 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.

Xo 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. 1 14. 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 unbl 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 th ? 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 no.ie.

SPACE FOR ADDITIONAL INFORMATION.^-

DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT

SERVICE NUMBER

tM R-301A

ITRUCTIONS

FOR

Kl CERTIFICATE

n giving
E OF DEATH

not enter
re than one
se for each

I, (b) and (c)

is does not mean
\e of dying, such
failure, asthenia. .
neans the disease,
plications which
lealh.

rbid conditions,
living rise to the
t use (a) stating
derlying cause

t dilions conlrib- •
the death but not

0 the disease or

1 causing death.

Ullfp (Eommomnpaltlj of fHaHoarljuarttH

EDWARD J. CRONIN
Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

To b« filed for burial permit
with Board of Health
or ite Agent.

Registered No.

No.

2 FULL NAME

(If deceased is a married, widowed or divorced woman.

(a) Residence. No.

(Usual place of abode)

f I (If death occurred in a hospital or institution.
.,v. St. \ give its NAME instead of street and number)

give also maiden name.)

if so specify WAR)

PHYSICIAN — IMPORTANT

(Was deceased a •

U. S. War Veteran,

Length of stay: In place of death years months days. In place of residence

(If nonresident, give city or town and State)
rs . months days.

EDICAL CERTIFICATE OF DEATH

(Month)

(Day)'

J? *

(Year)

rB Y CERTIFY,

19 ft, pto

ist saw h C»alive on
have occurred on the date statefi^bove. at

I attended deceased from

3 , 19 yZK.

* 3 , 19 J dUkUT is said to

DISEASE OR CONDHTON
DIRECTLY LEADER „

TO DEATH (a)(

ANTE Due.
CEDENT (b
CAUSES

Due To
(c)

OTHER
SIGNIFICANT
CONDITIONS

INTERVAL BE
TWEEN ONSET
ANO DEATH

Major finding:
Of operatio:

o*m .!*

Date of operation!! Was autopsy c^rformed?

What test confirmed diagnosi jfr

5 Was disease or injury in any way related to <
If so, sp^

(Signed)|

(Address#.^ UU (U*Jt

Received and filed

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

9 COLOR OR RACE

10 B I >i C L E . (write the word)
MARRIED U. „ . _ M ' /

-w.imwE.ft" G-AXASj/

or DIVORCED

10a If married, widowed, or divorced

HUSBAND of

v (Give maidflO nam

(or) WIFE of

tijive maHlpfl name^f wife in full)

/?/ £jLc4/24sC-S t ^

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

e 3*7 Years

Months

Days

If under 24 hours
Hours Minutes

13 Usual

Occupation

(Kind of work^fone d

during most of working life)

14 Industry
or Business:

15 Social Security No.

16 ^ »>

17 NAME OF,
FATHER

18 BIRTHPLACE OF
FATHER (City)
(State or country)

19 MAIDEN NAME
OF MOTHER

J/UU*<*c<r

ncate

I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed/^vith ipe^BEFORE the/b49ial op<9ansit yjvfrmit issued:

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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 tne 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 bv Chap. 632, Sec. 4. Acts of 1945.

No undertaker or other persons shall bury a human body or the ashes thereof
which have been brought into the commonwealth until he has received a permit
so to do from the board of health or its agent appointed to issue such permits, or
if there is no such board, from the clerk of the town where the body is to be buried
or the funeral is to be held, or from a person appointed to have the care of the
cemetery or burial ground in which the interment is made.

. . . Chap. 114, Sec. 46. G. L.. (Tercentenary Edition).

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the follow-
ing rules of practice:

(1) Attending physician* 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.

(3) Medical Examiners will investigate and certify to all deaths supposably
due to injury. These include not only deaths causea 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.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT
SERVICE NUMBER

M R-301 A

TRUCTIONS

FOR

iL CERTIFICATE

n giving

: OF DEATH

not enter
e than one
te for each
. (b) and (c)

s does not mean
t of dying, such
'ailure. asthenia, .
.cans the disease,
dications which
rath.

bid conditions,
iving rise to the '
use (a) stating
lerlying cause

dilions contrib - •
'he death but not

0 the disease or

1 causing death.

Suff oik

(County)

Winthrop

(City or Town)

CCommonmpaltlf of JRaBBarljUBPttB

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No,

To ba filed for burial permit
with Board of Health
or its Agent.

...1 .3

No.

21 Adams S g death occurred in a hospital or institution.

give its NAME instead of street and number)

2 FULL NAME

William Frank Lehman

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a) Residence. No. .2.1... Ada .HIS St. St.

PHYSICIAN — IMPORTANT

(Was deceased a

U. S. War Veteran.

if so specify WAR)

(Usual place of abode) (If nonresident, give city or town and State)

Length of stay: In place of death 34 years months days. In place of residence .^r.Fiyears months days.

EDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

4 I H E

/?sTJL

(Year)

lat I attended deceased from

I last saw h Uj/TK] alive on .... 197JU death is said tc)

have occurred on the date statq^^bove, at 3 & ^

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Male

9 COLOR OR RACE

White

10 SINGLE (write the word)
MARRIED

WIDOWED jrorir,4Qj
or DIVORCED rla.rrl.QQ.

DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a)

DING D

OTHER

SIGNIFICANT

CONDITIONS

INTERVAL BE
TWEEN ONSET
HO DEATH

73>

Major finding
Of operatic?

Date of operation /?SD,

What test confirmed diagnosis?..

Was autopsy petformed?

/MCl

iation of deceased?. /no

5 Was disease or injury iij^ny way related to cm
If so, spepi
(Signed_ _

(Address) Date ^ _ .

V/inthrpp .......L. Vi.nth&Qp

Place of Burial or Cremation
DATE OF BURIAL

(City or Town)

sL§n * S' i. :-• *

IS 52

(Registrar)

10a If married, widojged. or divorced-, . , ,

I husband of kUyh u St odc.ard

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

12 71 5 4

AGE Years Months Days

If under 24 hours

Hours Minutes

13 Usual

Occupation:

Accountant

(Kind of work done during most of working life)

U ol4 Business: . MOWSpaper

15 Social Security No. 0*3 - / 6 - QS < &

16 BIRTHPLACE (City) B.OS.t Oil^

(State or country) lJl£L S S

17 NAME OF
FATHER

William K Lehman

18 BIRTHPLACE OF

FATHER (City) 3 O S t 011

(State or country) Ma S S

19 MAIDEN NAME

of mother Martha R Chambers

20 BIRTHPLACE OF
MOTHER (City) ....
(State or country)

Boston

Mass

Informant ^..RUt.n .... C. ... . LSh-T.ap. ,

(Address) 21 Adams St . mthr

I /HEREBY CERTIFY that a satisfactory standard certificate of death was
filed w^th, me BEFORE the burial or transit permit was issued:

V. / / (Signature of Agent of Board of Health or other)

k. •_.Ln ....L..w /..w...4^.;..^.....'^vy

icial Designation)

(Date of Issue of Permit)

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 chanter 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
cau’se 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 apppinted 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.

Statement of Cause of Death. — Physicians: see explanatory instructions
on face side of standard certificate of death.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT

SERVICE NUMBER..

A R-301 A

RUCTIONS

FOR

. CERTIFICATE

giving

OF DEATH

lot enter
than one
s for each
(b) and (c)

does not mean
of dying, such
lilure, asthenia, .
ans the disease,
ications which
ath.

>id conditions,
ving rise to the "
se (a) stating
rr lying cause

ilions conlrib - «
ie death but not
the disease or
causing death.

Qlfjp (ttommomupaltl) of HlasHacljuafttB

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.

Registered No.

>5 F f 0 Lit

(County)

Winthrop

(City or Town)

nFo* poo f TTnmP / (If death occurred in a hospital or institution,

No. ^ UUli uo Hco U - St. ^ give jts NAME instead of street and number)

PHYSICIAN — IMPORTANT

(Was deceased a
U. S. War Veteran,
if so specify WAR)

Winthrop

(If nonresident, give city or town and State)

2 full name M^r W '• he oar thy

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a) Residence. No. OT e S t AV Q .

(Usual place of abode)

St.

Length of stay: In place of death years 2. .9. months

days. In place of residence years months

days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

(Month)

(Day)

(Year)

4 I H E R \l B Y C_E R T I F Y ,

. ..AS..., 19 J /. to

I last saw l^^'t^ralive (
have occurred on the date stated ^fbove. at

That

attended deceased from

<^^"7 19>i ^J^eath is said to

DISEASE OR CONDITION
DIRECTLY LEADI
TO DEATH (a)

ANTE Due To
CEDENT (b)
CAUSES

Due To
(c)

OTHER
SIGNIFICANT
CONDITIONS

INTERVAL BE-
TWEEN ONSET
AND DEATH

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Femal e

9 COLOR OR RACE

White

10 SINGLE (write the word)
MARRIED

widowed Mam ea

or DIVORCED

Major findings:
Of operations.

Date of operation.

What test confirmed diagnosis?.

Was autopsy performed?.

5 Was disease or injury in any way related to occupation of deceased?

If so, specify...

(Signed) In „

(Address) fir) atyr^Ci,v>' ^

~6 F c w GnTvagy hem. Bo s ton

Plj(c£ oC&urial or Cremation (City or Town)

^al~ January 7

>< r

DATE O

,52

John F. 0" Brien

7 NAME OF

FUNERAL DIRECTOR V

address Soutn Boston, Lass.

Sor

Received and filed 19..

JAN 7 1S52

(Registrar)

10a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) wife of ..Ri.Qh.arh. .A. to Bar t. ay

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

AGE

Y ears

Months

Days ,

If under 24 hours

Hours Minutes

13 Occupation: jiQUSeVV*

(Kind of work done during most of working life)

14 Industry
or Business:

Home

IS Social Security No. l\OnS

16 BIRTHPLACE (City)
(State or country)

..Cl.e.v.el^ng

17 NAME OF

FATHER

18 BIRTHPLACE OF

FATHER (City) AO. t.
(State or country)

Edward 1 anan

A?- - t '-i, • .A.Vv

MAIDEN NAME

™ -#e-t hnown-

OF MOTHER

20 BIRTHPLACE OF

MOTHER (City) l>0..t. iL'IOV.TT

(State or country)

21 Informant CeUrVQlS ,

(Address, /ar d ht . So . Boston.

ass,

I HEREBY CERTIFY that a satisfactorjmsfandard certificate of death was
fi]$4 witlyjn# BEFORE Ahe, burial <fj transit permit was issued:

Board o M$a

(Official Designation)

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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.

Xo 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 «»r
cause of the death, which the clerk or registrar may require. — Chap. 1 14. 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 unril he has received a permit
so to do from the board of health or its agent appointed to issue such permits, or
if there is no such board, from the clerk of the town where the body is to be buried
or the funeral is to be held, or from a person appointed to have the care of the
cemetery or burial ground in which the interment is made.

. Chap. 114, Sec. 46. G. L.. (Tercentenary Edition).

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the follow-
ing rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons
to whom they have given bedside care during a last illness from disease unrelated
to any form of injury.

(2) Board of Health physicians will certify to such 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.

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
spine 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

M R-301A

ntUCTIONS

FOR

L CERTIFICATE

i giving

; OF DEATH

not enter
e than one
e for each

, (b) and (c)

s does not mean
• of dying, such
dilute, asthenia, .
eans the disease ,
lications which
rath.

bid conditions,
iving rise to the *
use (a) staling
ferlying cause

dilions conlrib- •
he death but not
) the disease or
causing death.

(Hammonuiraltl) of fHaBBarhuBPttB

EDWARD J. CRONIN
Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

To b« filed for burial permit
with Board of Health
or its Agent.

CERTIFICATE OF DEATH

Registered No.

No. 142 Pleasant St

j (If death occurred in a hospital or institution.
,St. I give its^NAME instead of street and number)

2 FULL NAME

^st. i give its^iNi

V Me Ayoy J

I PHYSICIAN

I ( Was deceased a

IMPORTANT

j U. S. War Veteran.

. if so specify WAR)

Elizabeth J. Callahan

(If deceased is a married, widowed or divorced woman, give also maiden name.)

50 Pleasant 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.

(a) Residence. No.

(Usual place of abode)

St.

EDICAL CERTIFICATE OF DEATH

3 DATE
DEATH

(Month)

IT]

(Day)

(Year)

BY CERTIFY.

19 + ...f to

I last saw Yr&Sr... alive on

I HEREBY C

C ,

[jat I attended deceased from

*/- ,nSZt

have occurred on the date stated above, at

y 77 19

19 ~=> .death is said to

DISEASE OR CONDITIO
DIRECTLY LEADING,
TO DEATH

ANTE Due
CEDENT (b)
CAUSES

'ION

ue To vr.:

Bue-Trr

(c)

1 1+1

1*7 + 1

Major findings:
Of operations

Date of operation ~~ Was autopsy performed?

What test confirmed diagnosis?

5 Was disease or injury in any way <91pted t£ occupation of deceased?

If so. spec .... y..

(Signed} ... 7 ..J. f"V £. , M.

(Address) /CUt^UL Date)j0<rU . Jj, 19^

's£

6 mitezp

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Female

9 COLOR OR RACE

'.Yhi te

10 SINGLE (write the word)
MARRIED

WIDOWED Tt. j _ j
or DIVORCED VlaOWea

10a If married, widowed, or divorced
HUSBAND of

(Give maiden name of wife in full)

(or) wife ofDaniel T. Callahan

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

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:

Own Home

15 Social Security No.

16 BIRTHPLACE (City)
(State or country)

Boston

-Massachusetts

17 NAME OF
FATHER

Michael J. McAvoy

18 BIRTHPLACE OF

FATHER (City) Fall Ri.V.S.r.

(State or country) ;,fla S Ba Ch.U S e 1 1 S

19 MAIDEN NAME
OF MOTHER

211 zaoeth Yagee

20 BIRTHPLACE OF

MOTHER (City) Phi lad Q lp>' “ ^
-(State or country) Pennsylvania

of Board of Health hr other)

///...XZ...

(Date of Issue of Permit)

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.

N'o 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. 1 14, 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 unril 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 th ? 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.

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
spme 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 no.ie.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT
SERVICE NUMBER

>1 R-301 A

RUCTIONS

FOR

. CERTIFICATE

giving

OF DEATH

lot enter
than one
i for each
(b) and (c)

does not mean
of dying, such
ilure, asthenia. •
ans the disease,
ications which
Uh.

id conditions. .
mg rise to the'
se (a) stating
rlying cause

itions conlrib - •
e death but not
the disease or
causing death.

<31)? (Sommamn?altt) of lHaBoad)UB?ttB

a EDWARD J. CRONIN

CL. Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No.

To ba filed for burial -permit
with Board of Health
or Its Agent.

2 FULL NAME

(a) Residence. No

(Usual place of abode)

, widowed or 'divorced woman, give^also maiden name.)

) (If death occurred in a hospital or institution.

St. I give its NAME instead of street and number)

PHYSICIAN — IMPORTANT

(Was deceased a
U. S. War Veteran,
if so spectfy WAR) •

St.

Length of stay: In place of death years months days. In place of residence

(If nonresident, give city or town and State)
years months days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH ..

(Month)

(Day)

(Year)

41 HEREBY CERTIFY.

... , 19 to

I last saw h -tTLi alive on

That I attended deceased from

> . 19^%

!r ... Y 19 . death is said to

vj # «£

have occurred on the date stated above, at / O \ m.

DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATj

C**-'*-' —

ANTE Clue To ft
CEDENT (b)

CAUSES ^

Due To
(c)

OTHER

SIGNIFICANT

CONDITIONS

IKTER VAL BE
TWEEN ONSET
UNO OEATH

Major findings:

Of operations

Date of operation — - Was autopsy performed? ..TT..

What test confirmed diagnosis? ."

5 Was disease or injury in any way related to occupation of deceased? ^Vv>

(Signed)YfrC?sS^ — M. D.

(Addi/ss) 0. ^ '**'y

Place of/Burial or Crema
DATE OF BURIAL

7 NAME OF
FUNERAL DIRE

ADDRESS

(City or Town)

Received and filed .

■IAN 7 >352

(Registrar)

.19

8 SEX

PERSONAL AND STATISTICAL PARTICULARS

10 SINGLE C (write the word)
MARRIED]

WIDOWEJ,
or DIVOJ

9 COLOR OR RACE

10a If married, widowed, or divorced
HUSBAND of

Elv^maiden -«a«rte of w

(or) WTFE o.

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

AGE

Days

Years Moi^h: ,

If under 24 hours

Hours Minutes

13 Usual

Occupation

(Kind of work done during most of working life)

14 Industry
or Business:

jdr fUOW...

15 Social Security No.

16 BIRTHPLACE (City) .
(State or country)

17 NAME f

FATHEI/^^^ /?2

18 BIRTHPLACE OF

FATHER (City)

(State or country)

19 MAIDEN NAlJft
OF MOTHER

'Z//

20 BIRTHPLACE OF

MOTHER (City)

/J . * . jt

(State or country)

Informajj
(Address)

I HER.EBY CERTIFY that a satisfactory standard certificate of death ^as
filed with me BEFORE the ^urial 05 transit permit was issued:

Board of Hearth or other) / \ — -

(Official Designation) (Date of Issue of Permit)

J J N

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 authonzed 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 ihe 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 *aken 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

thi cause of death shall thereafter furnish for*registration any other necessary
information w'hich 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. 1 14, Sec. 45,
G. L., (Tercentenary Edition).

Medical examiners shall make examination upon the view of the dead bodies
of pepons 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 w'hen not
disabled by recognizable disease, or w'hen any person is found dead. . — General
Laws, Chap. 38, Sec. 6., as amended by Chap. 632, Sec. 4. Acts of 1945.

. . . 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.

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 w'as 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

VI R-301 A

RUCTIONS

FOR

. CERTIFICATE

giving

OF DEATH

lot enter
than one
i for each

(b) and (c)

does not mean
of dying, such
\ilure, asthenia . .
ans the disease,
ications which
Uh.

'id conditions,
ring rise to the
se ( a ) staling
•r lying cause

ilions conlrib - •
\e death but not
the disease or
causing death.

Suf folic

(County)

.Vint hr op

(City or town)

(Comtmmmraltlj of 4HaB0arl?asrttB

EDWARD J. CRONIN, SECRETARY

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No.

To be filed for burial permit
with Board of Health
or its Agent.

_ .7,

No.

y 'J y D1 a o a o n + I (If death occurred in a hospital or institution.

^ i lCao .*.11 o g^t » WAUP ; * i ~r ... . i \

give its NAME instead of street and number)

A „ 4- V, ~ U TT^VT ~ r PHYSICIAN — lMPORTANT

2 FULL NAME A?. 1. H.» I» C.bl e I (Was deceased a

(If deceased is a married, widowed or divorced woman, give also maiden name.) | U. S. War Veteran, £l 0

l if so specify WAR)

(a) Residence. No 2 2 Pie .& .SEIlt St .Vint hr OC

(Usual place of abode) _ (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.

IEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

(Month) »

(Day)

/ 9 S-JL

(Year)

(If HEREBY CERTIFY,

J $ 19 SC

last saw h *<****.. alive on
have occurred on the date stated above, at

I attended deceased from

f.f... , 19 S.. ,%eath is said to

&OS-A

DISEASE OR CON
DIRECTLY LEA
TO DEATH (a)

fflE“ a/. +

......

ANTE Due To
CEDENT (b)
CAUSES

Due To

(c)

INTERVAL BE
TWEEN ONSET
AND DEATH

ifV-i-

Major findings:
Of operations.

Date of operation
What test confirmed diagnosis?

5 Was disease
If so, specif;
(Signed)
(Addr<

/y M. D

Pate^sT . J .. . 19^7>J

/ c c diawn j e me t e ry. Everett

Place of Burial or Cremation (City or Town)

DATE OF BURIAL J‘inUcir^ 7 19 ^ ^

Alice L. Kelly

7 NAME OF

FUNERAL DIRECTOR ....... v

innBr55n Lenaian .it East Boston

ADDRESS

Received and filed

7 1352

.19 .

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Mai e

9 COLOR OR RACE

.Yhite

(write the word)

10 SINGLE
MARRIED

widowed Carried

or DIVORCETtr1 1 J-cu

husbandI?.' wldow!,<btii,^ed A Grady

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

AGE . -*!?.? Years T... Months^ ^ Days

If under 24 hours

Hours Minutes

Kation:20.rapensation d; uster

(Kind of work done during most of working life)

Industry
or Business:

Insurance

15 Social Security No. 01 H — 03 — 4:799

BIRTHPLACE (City) EaS-t ACStOH

(State or country) i ■* .^54 « < * nil Q

.<i'a s s a o nu s e 1 1 s

17 NAME OF
FATHER

Isaac B. Noble

18 BIRTHPLACE OF

FATHER (City)

(State or country)

English d

19 MAIDEN NAME
OF MOTHER

Levica Harris

20 BIRTHPLACE OF
MOTHER (City) ...
(State or country)

East Boston
Ma o sac hus et t s

1 Informant ^

Louise Noble

I HEREBY CERTIFY that a satisfactory standard certificate of death
filed, with me BEFORE thehurial or transit permit was issued:

ficial Designation)

alth or other)/

«. J.U.A.Z

(Date of Issue of Permit)

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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 theretrom 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 mace 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.

. . . 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.

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 dunng 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

4 R-301 A

RUCTIONS

FOR

. CERTIFICATE

giving

OF DEATH

lot enter
than one
i for each
(b) and (c)

does nol mean
of dying, such
ilure, asthenia, .
ans the disease,
icalions which
ith.

id conditions, .
ring rise to the "
se (a) slating
•rlying cause

itions conlrib- ■
e death but not
the disease or
causing death.

Stye Cdommontnealty of HHanfiaityuaettB

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No

To be filed for burial permit
with Board of Health
or its Agent.

2 FULL NAME.

(a) Residence. No.

(Usual place of abodi

VV&ty&M (horn SVloLu

deceased is a rrLmed, widowed or divorced woman, give alsolm:
bod£)

aiden name.)

I (If death occurred in a hospital or institution,
t. i give its NAME instead of street and number)

PHYSICIAN — IMPORTANT

(Was deceased a
U. S. War Veteran,
if so specify WAR)

Length of stay: In place of death Z'O years months days. In place of residence

(If nonresident, give city or town and State)
years months days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

/ fcTA.

(Year)

4 I H E

(Day)

That I attended deceased from

......rr. 19

I last saw h — : alive on :

have occurred on the date stated above, at //•'

19 death is said to

DISEASE OR CONDITION
DIRECTLY LEAD
TO DEATH (a)

Ul 1 1U.N

OTHER
SIGNIFICANT
CONDITIONS

INTERVAL BE
TWEEN ONSET
UNO DEATH

Major findings: _

Of operations

Date of operation ' Was autopsy performed? /no

What test confirmed diagnosis? TT “*

5 Was disease or injury jp any way related tp^ccupation of deceased? /no
If so. S]

(Signed M. D

(Addre: 11

Place of Burial dr Cri
DATE OF BURIAL

■pmatinn

£Z-

Received and filed

JAN? 1952

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

9 COLOR OR RACE

10 SINGLE
MARRIED
WIDOWED
or DIVORCED

k>»X. \Ar~~AA^L->rs-*--3 or DIVORCE!

If married, widowed, or divorced F"l /X _ . -

I AND of O' *

Q (Give maiden name of wife in

(write the wool)

10a

HUSBAND

(or) WIFE of

maiden name of wife in full)
(Husband's name in full)

1 1 IF STILLBORN, enter that fact here.

AGE

lc\

Years V Months

13 Usual

Occupation :

Days

If under 24 hours
Hours Minutes

(Kind of work done during most of working life)

14 Industry
or Business:

15 Social Security No.

xlaoA

Jf / 9(1

0.ia,.r.mr....348S!

16 BIRTHPLACE (City) .
(State or country)

17 NAME OF
FATHER

18 BIRTHPLACE OF
FATHER (City)
(State or country)

19 MAIDEN NAME
OF MOTHER

20 BIRTHPLACE OF
MOTHER (City) ...
(State or country)

I HEREBY CERTIFY that a satisfactory standard certificate of death was
f filed with me BEFORE the burial or transit permit was issued:

/9f

(Official

(Signature/^ A^/fot^SJBoardaif Health or otter)

/hfk/2,. ... .Jdzikzr..'.... 77$ iL

icial Designation) (Date of Issue of Permit)

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, bee. 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 anil 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 buned, 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 at 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 bv 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.

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 ot persons

to whom they have given bedside care during a last illness from disease unrelated
to any form of injury. ...

(1) 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.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT

SERVICE NUMBER

SUFFOLK

(City or Town)

t (Commomnpaltlj of fRaaflarhuHFttB

^ EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

COPY OF

CERTIFICATE OF DEATH

70 /

No.

(City or town making return)
Registered No. ...rmtl,

Mass* Osteopatmrc Hospital xadi11* de?th m a hospital or institution.

give its NAME instead of street and number)

2 FULL NAME * ALPINB/^MC LEAN f (Was deceased a

(If deceaseo . a married, widowed or divorced woman, give also maiden name.) | U. S. War Veteran, M/-v

89 Circuit Hoad, „„ w. '"“r'1'7 MO

(a) Residence. No XXX W*ll.ktliPO.P:j —

(Usual place of abode) (If nonresident, give city or town and State)

Length of stay: In place of death years months. ... *7. .. days. In place of residence llj-years months days.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

g&?H0r January 8 1952

(Month) (Day) (Year)

41 HEREBY CERTIFY.

39*. X9...5.L., to

I last saw h. in alive on. Jan.

That I attended deceased from

8 SEX

Hale

9 COLOR OR RACE

White

10 SINGLE (write the word)
MARRIED

WIDOWED „ . ,

or DIVORCED ME I* 1*1 C Q

have occurred on the date stated

DISEASE OR CONDITION
DIRECTLY LEADINj
TO DEATH (a)

Jan.

above, at 1

y.i 19

19 52, death is said tc

10a If married, wid
HUSBAND of ...

iwed, or di^jtsgd

est

(Give maiden name of wife in full)

Passive pulmonsr y
embolus

ANTE Due To

CEDENT (b)

CAUSES

Due To
(c)

OTHER

SIGNIFICANT

CONDITIONS

Broncho pneumonia

INTERVAL BE
TWEEN ONSET
AND DEATH

(or) WIFE of..

(Husband's name in full)

1 1 IF STILLBORN, enter that fact here.

AGE 70 Years 10 Months 10 Days

If under 24 hours
Hours Minutes

13 Usual

Occupation:

Cre dit Man ager

(Kind of work done during most of working life)

14 Industry
or Business:

Window & Door Manufacturer

15 Social Security No. 011*07 -22 63.

16 BIRTHPLACE (City) AlmS , N.S ♦

(State or country)

Of operations Duodenal ulcer 0 Pag|||luo

tic/pri8 BIRTHPLACE 0F

Date of operatiotl.— If — . 52
What test confirmed diagnosis?

...Was autopsy performed?..

Clin.-Lab.

5 Was disease or injury in any way related to occupation of deceased?

(Address) ^Uj, BeaCOn St. Date 1-C

6 Glenwood Everett

Place of Burial or Cremation (City or Town)

date of burial January 12 * 19

17 NAME OF

father Alexander McLean

father (city) New GlascoWyN.S.

(State or country)

19 MAIDEN NAME

of mother Catherine S. Hatch

20 BIRTHPLACE OF
MOTHER (City) ....
(State or country)

Alma,N. S •

7 NAME OF
FUNERAL DIRECTOR.

ADDRESS.

Howard Reynolds
Wlnthrop , Mass ...

Informant .
(Addressj

Laura McLean

A TRUE COPY
ATTEST:

(Registrar of City or Town where death occurred)

Received and filed.

lUmYTBSI

(Registrar of City or Town where deceased resided)

.19 .

January 11, S2

DATE FILED Z. .7. 19

•

~ — —

: ■

. t ■

- -

. . .

— - *•-

. . .

- — — - - . - r~ _ ~^hS, »■ - -

- - -

• " .! t s.t: ' t

- • :

ooo wri *- r-.

: »iO. r#„ ■

' ■

0 Danvers..

j«j (City or Town)

3 K „

“• 0 Dimvers Static

®1|* (CommornDpaW) of jRaBBadiUBrttB

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

COPY OF

CERTIFICATE OF DEATH

Deuivers

(City or town making return)

Registered No. .

I (If death occurred in a hospital or institution.
\ &iye its NAME instead of street and number)

full name. ida Liberman ■{ A pnaky )

(If deceased is a married, widowed or divorced woman, give

also maiden name.)

(Was deceased a
U. S. War Veteran,
if so specify WAR)

“ISAibj*1 Washington Ave„

St.

Length of stay: In place of death years months.. 29 days. In place of residence

(If ndriresMenr, givrcity or town and State)
years months days.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

3 DATE OF

dea™ tejppy 8m 195&

ear)

8 SEX

Female

9 COLOR OR RACE

white

41 HEREBY CERTIFY, That I attended deceased from

Dee , 11, . I9 51 to Jan. 9 , 19 52

I last saw h. er .alive on... Jan. 9 f 19 S2ath is said td

have occurred on the date stated above, at Q P

10 SINGLE
MARRIED

rEPvoRCBearrie

(write the word)

MID OEATH

DISEASE OR CONDITION

?iRDElra L(Ea?DI.NG Cerebral Hemorrhage

cedent (b) Arterxoscle rotic he: rt

CAUSES j .

disease

Due To
(c)

OTHER

SIGNIFICANT

CONDITIONS

INTERVAL BE
TWEEN ONSET

10a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

Liberman

{Husband's name in full)

(or) WIFE of..

11 IF STILLBORN, enter that fact here.

4 day;i> age 15k i

ears ...Months Days

If under 24 hours
Hours Minutes

13 Usual

Occupation: Unable to work

(Kind of work done during most of working life)

years

14 Industry
or Business:

IS Social Security No.

X ne

16 BIRTHPLACE (City)..
(State or country)

Russia

Major findings:
Of operations..

Date of operation .’. Was autopsy performed?.. •No

What test confirmed diagnosis? C l i n i c al - L-a b ,

S Was disease or injury in any way related to occupation of deceased?

If so, specify w

(Signed) Andrew.. Nxchols. 3rd* m. d

<Address> Danver > ■■■■£■'&■&& Date 1/11/ >952

P&fBu^^m Bethel ,

17 fatheerf Morr is Ar on sk y

18 BIRTHPLACE OF

FATHER (City)

(State or country)

Russia

19 MAIDEN NAME

OF MOTHER

Beatrice ?

20 BIRTHPLACE OF

MOTHER (City)

(State or country)

Russia

DATE OF BURIAL

January 10 19 52

~ : : : fAddreS5J a-iash.

Ben lamin Burnbacn a true copy ^

7 funeral director B.i .nj^

ADDRESS.

Dor Chester, I .ass.

Received and filed

RE8 8 1852

(Registrar of City or Town where deceased resided)

.19 .

ATTEST:

/t, — ^-ffar of City or Town where death occurred)

J.aaua.ry 14,1

DATE FILED

R-301 A

UCTIONS

:OR

CERTIFICATE

riving
)F DEATH

>t enter
than one
for each
b) and (c)

toes not mean
•f dying, such
ure, asthenia. .
ns the disease,
ations which
h.

1 conditions,
ng rise to the
: ( a ) stating
tying cause

ions conlrib-
death but not
le disease or
lusing death.

CCommomnpaltlj of fflaBflarljuBPtla

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

^O'V'V /<? 19 V'Kc

I last saw h J>X alive orv. Jy*
have occurred on the date stated above, at ^

STANDARD

CERTIFICATE OF DEATH

To be filed for burial permit
with Board of Health
or Its Aftnt.

Registered No.

I (If death occurred in a hospital or institution.
St. \ give its NAME instead of street and number)

2 FULL NAME

(If deceased i s/p. married, widowed or divorced i

(a) Residence. No. U- Q

(Usual place of4bode)

Oman, give also maiden name.)

PHYSICIAN — IMPORTANT

(Was deceased a

U. S. War Veteran. ___

if so specify WAR)

. St.

Length of stay: In place of death years / months ... days. In place of residence-^^ years .... “1 months — days.

(If nonresident, give city or town and State)

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH ..

<y (Month) (/

(Day)

/ ?S 2

(Year)

41 HEREBY CERTIFY

attended deceased from

.oh-

/[ n

DISEASE OR CONDITION
DIRECTLY LEAnrt>G

TO DEATH /(a)

ANTE Due To
CEDENT (b)
CAUSES

sl*

35*

Major findings: . __ , n

Of operations. .

Date of opera

What test confirmed diagnosis?

Was autopsy performed?. #

5 Was disease or injury in any way related to occupation of deceased?
If so. spefjfy..

(Signed)!

(Addre&O 2*.

Place of Burial m CmluiSTiul

DATE OF BURIAL

7 NAME OF C/~ ''f

FUNERAL DIRECTOR /JrOk ..... 4

Received and filed

JAN 14 1952

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

3<sYvixdbl

9 COLOR OR RACE

10 SINGLE
MARRIED
WIDOWED
or DIVORC

(write the word)

10a If married, widowed, or divorced

HUSBAND of

) (Give maidyyname of wife in full) ,,

(or) WIFE of

(Husband’s name in full

1 1 IF STILLBORN, enter that fact here.

'AGE

Years

Months ....,

Days

If under 24 hours

Hours Minutes

13 Usual

Occupation:

14 Industry

or Business: V

^ (Kind of worlfr’aone during most of working life)

15 Social Security No.

16 BIRTHPLACE (City).
(State or country)

17 NAME OF
FATHER

18 BIRTHP&ACE OF
FATHER (City) ...
(State or country)

' / S

19 MAIDEN NAME

/£~~4

R(fo^n^r5^.

(Address) f

7'^tha

I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed wi thyme. BEFORE the burLJ or transit permit was issued:

(Signature of Agent of Board of Health or other)

tt,9, 73**,,

(Official Designation) (Date of Issue of Permit)

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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 t Ye 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, w'hich 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 ljuried
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.

Statement of Cause of Death. — Physicians: see explanatory instructions
on face side of standard certificate of death.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT
SERVICE NUMBER 4

\ R-301A

tUCTIONS

FOR

CERTIFICATE

giving

OF DEATH

ot enter
than one
for each
(b) and (c)

does not mean
of dying, such
‘lure , asthenia, .
ins the disease,
cations which
th.

d conditions, .
ing rise to the
e (a) staling
’lying cause

lions conlrib- •
' death but not
he disease or
ausing death.

..Suffolk

(County)

Win t hr op

(City or Town)

QJljr CEmnmnmnpaltfj of iHaflflacljUHPttH

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No

To b« hied for burial permit
with Board of Health
or its Agent.

: 12

33 Bellevue Avenue

2 full name Armi.fi Amelia Webster

(If deceased is a married, widowed or divorced woman, give also maiden name.)

I (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)

33 Bellevue Avenue

abode)

Length of stay: In place of death years months

(a) Residence. No. _

(Usual place of abocfe)

St.

days.

(If nonresident, give city or town and State)
In place of residence 27 years months days.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

14 <d„,1962<y,„,

4LHEREBY CERTIFY,

/o iQ yo, to

Vo-*-

fc'last saw hJpA*’ alive on
have occurred on the date sta*

(/d t

That I attended deceased from

CL4.4SUA.au / Y

toy / 3\ 9

above, at

DISEASE OR CONDITION

eath is said to

ANTE Due To
CEDENT (b)
CAUSES

Due To
(c)

OTHER

SIGNIFICANT

CONDITIONS

INTERVAL BE-
TWEEN ONSET
MO DEATH

16 BIRTHPLACE (City)
fiSI (State or country)

Major findings:

Of operations

Date of operatioru^tr^<^/*^‘^^! Was autopsy perfumed?

WThat test confirmed diagnosis ^ V

5 Was disease or injury in any way related to occupation of dece

If so, spec/l/C &

(Signed) >

(Addres^jZ?/.

M.-*.

Jaj

Place of
DATE OF BURIAL

7 NAME OF
FUNERAL DIRECTOR

ADDRESS

174 ffin-throp a fr . Win t hr op , Mq

Received and filed 19 ...

JAN 17 1952

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

female

9 COLOR OR RACE

white

10 SINGLE (write the word)
MARRIED . n

widowed married

or DIVORCED

10a If married, widowed, or divorced &U

husband of George Bjmrgean Webster

{Give maiden name of wife in full)

(or) WIFE of ./?*..

(Husband's name in full)

11 IF STILLBORN, enter that fact here.

> AGE

?6*

^ P7

Months Daysg

13 Usual

Occupation: .

Mon^h

me- V

If under 24 hours

Hours Minutes

14 Industry
or Business:

art— he me-

(Kind of work done during most of working life)

^ QUu>-r~rU'

15 Social Security No.

none

’ugwashjjQ^.^ Soot

17 NAME OF
FATHER

John Lowden

18 BIRTHPLACE OF
FATHER (City)
(State or country)

Pugwash

Nova Scotia

19 MAIDEN NAME
OF MOTHER

20 BIRTHPLACE OF
MOTHER (City) ....
(State or country)

Mary Ann Dewar

Pugwas h

nova Scotia

Informant

(Address)

Miss Myrtle Webster
33 Bellevue Ave.Jinth

rop

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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 bv Chap. 632, Sec. 4. Acts of 1945.

. . . 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.

Statement of Cause of Death. — Physicians: see explanatory instructions
on face side of standard certificate of death.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK. RATING

ORGANIZATION AND OUTFIT

SERVICE NUMBER

I R-301 A

tUCTIONS

FOR

CERTIFICATE

giving
DF DEATH

Dt enter
than one
for each
b) and (c)

does not mean
>/ dying, such
lure, asthenia, .
ns the disease ,
ations which

\h.

d conditions, .
ng rise to the
e ( a ) stating
lying cause

ions contrib - «
death but not
he disease or
ausing death.

(City or Tbwn)

Gllfr (UommomDPaltlj of fHaaaarliUBPttH

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

, STANDARD

OF DEATH

Registered No

To be filed for burial permit
with Board of Health
or its Agent.

I (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. 1+0 ...Mast Eagle .. ..S.t st East Best on. , ... Mass .

(Usual place of abode) (If nonresident, give city or town and State)

2 full name Louis Barbarossa

(If deceased is a married, widowed or divorced woman, give also maiden name.)

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

/ r

(Month)

(Day)

/?&*-

(Year)

41 HEREBY CERTIFY, That I

// 194*. ^rr, to

llast saw h./Jfat. alive on zb* "

attended deceased from

SS~~

... 19 death is said to)

8 SEX

have occurred on the date stated above, at

DISEASE OR CONDITIO
DIRECTLY LEADING
TO DEATH (a)

ANTE Due To
CEDENT (b)
CAUSES

Due To
(c)

OTHER

SIGNIFICANT

CONDITIONS

INTERVAL BE
TWEEN ONSET
AND DEATH

Major findings:

Of operations

Date of operation Was autopsy performed?

What test confirmed diagnosis?

5 Was disease or injury in any way related to occupation of deceased?
If so, specify

(Signed)

(Address) / )/

H-

6 _ ._

Place of Burial or Crematio

DATE OF BURIAL

7 NAME OF
FUNERAL DIRECTOR-

ADDRESS ....

, M. D

Date // / r. 19^2-11

(City or Town)

JIT

Received and filed

JAN law

.19

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

9 COLOR OR RACE I 10 SJNGLE (write the word)
MARRIED i-

_ I WIDOWE-

S&'A-S. , i or DIVO

1 D jm ^ /*ll<

10a If marrii
HUSBAND of

(or) WIFE of

gd, £T divorced, ' ^

(Give maiden name of wife in full)

(Husband's name in full)

1 1 IF STILLBORN, enter that fact here.

16 BIRTHPLACE (City)
(State or country)

fathEerF

18 BIRTHPLACE OF
FATHER (City)
(State or country)

-f

19 MAIDEN NAM '
OF MOTH

20 BIRTHPLACE OF
MOTHER (City) ....
(State or country)

Informant

(Address)

* >r- ■ •«*

i v's-,

I HEREBY CERTIFY that a satisfactory standard certificate of death was
fij,ecywith rp^ BEFORE the^uyal or transit perrriit was issued:

of Health^ef^otne^]

IJLL 7.££,.

(Date of Issue of permit) '

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 thereirom 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 tne 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 bv 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 l>c 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.

(3) Medical Examiners will investigate and certifv 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.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT

SERVICE NUMBER

[ R-301A

ACTIONS

FOR

CERTIFICATE

giving

OF DEATH

at enter
than one
for each
b) and (c)

does not mean
>/ dying, such
lure, asthenia, .
ns the disease,
ations which
’,h.

d conditions. .
ng rise to the "
e (a) stating
lying cause

ions contrib - «
death but not
he disease or
ausing death.

Jinthr op

(City or Town)

OJfP (Eummanttiealtlj of fHaaBarljUBfttB

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.

Registered No.

.14

no. 10 Surf side Avenue

2 FULL NAME

(If deceased

Mary Ann Hill

ceased is a married, widowed oi

or divorced woman, give also maiden name.)

I (If death occurred in a hospital or institution,
St. \ give its NAME instead of street and number)

PHYSICIAN — IMPORTANT

(Was deceased a TTD

U. S. War Veteran.
if so specify WAR)

(a) Residence. No. 10 Surf side Avenue

(Usual place of abode)

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 _ --.ro

death January 15,1952

r (Day)

at I attended deceased from

/>s' , 1<P'-Z-

(Month) (Day) (Year)

41 HEREBY CERTIFY,

. i vT./. , to

I last saw hj2rThrrrt. alive on

have occurred on the date Itz/te d above, at & l OH) f!
DISEASE OR CONDITION
DIRECTLY LEADIN'

TO DEATH (a)

/ y/ 19 Qg? death is said

(or) wife of Charles JAurphy

(Husbancrs name in full)

1 1 IF STILLBORN, enter that fact here.

If under 24 hours

AGE 55 Years ^3 Months 2.4^ays

Hours Minutes

Major findings:

Of operations

Date of operation Was autopsy performed?

What test confirmed diagnosis?

DATE OF BURIAL JanUS/P

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

female

9 COLOR OR RACE

white

10 SINGLE (write the word)
MARRIED ( vl)1*PlS(1

widowed uivuroeu.

or DIVORCED.

10a If married, widowed, or divorced
HUSBAND of '

(Give maiden name of wife rri full)

13 Usual

Occupation: .

^ e t iredThous ekeep er

N (Kind of w<5rk done during mostTJf worl

working life)

14 Industry
or Business:

15 Social Security No.

private home

none

16 BIRTHPLACE (City)
(State or country)

Hewtonville

Mass.

17 NAME OF
FATHER

18 BIRTHPLACE OF
FATHER (City)
(State or country)

John Thompson Hill

London

19 MAIDEN NAME
OF MOTHER

England

20 BIRTHPLACE OF
MOTHER (City) ...
(State or country)

■Ann Deary

Ireland

Informant . Mrs Charles Fredenberg

.865 K . S quan turn 8 t T 8 qiffi t u m

I HEREBY CERTIFY that a satisfactory standard certificate of death was
filed me BEFORE the byfriaA or traiSit permit was issued:

zff Board of HealTTi^or othe^)

J/J.Q '££.

(Date of Issue of Permit)

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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 tne 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. 1 14, Sec. 45,
G. L.. (Tercentenary Edition).

disabled by recognizable disease, or when any person is found dead. — General

Laws, Chap. 38. Sec. 6., as amended bv Chap. 632, Sec. 4. Acts of 1945.

. . . 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.

Statement of Cause of Death. — Physicians: see explanatory instructions
on face side of standard certificate of death.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE

DATE OF DISCHARGE

RANK, RATING

ORGANIZATION AND OUTFIT

SERVICE NUMBER

25M <e)-6-50. 902253

SUFFOLK

(City or Town)

(Emmmimnraltl) of HlaBBarljaBrttB

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

COPY OF

CERTIFICATE OF DEATH

BOSTON

(City or town making return)

Z&tT'

Registered No. .

I (If death occurred in a hospital or institution.

No U S Public Health Service Hospital St. \ give its NAME instead of street and number)

2 FULL NAME.

John H

Hoey

livorcea w

(Was deceased a

U. S. War Veteran, TWfflf T T

if so specify WAR) ...t*.

(If deceased is a married, widowed or divorcea woman, give also maiden name.)

(a) Residence. No 7 7... Tr it on A.v . a d. Winthrop Mass

(Usual place of abode) ' (If nonresident, givff city or town and State)

Length of stay: In place of death years months... . 4. days. In place of residence . 35 ..years months days.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

3 BeIthOF January 15, ...195.2

(Month) (Day) (Year)

8 SEX

Male

41 HEREBY CERTIFY, That I attended deceased from

Jan. .!.!..., 19 52 , to Jan 15 19.5.2

I last saw h . . im alive on Jan 15 19 52 death is said tq

have occurred on the date stated above, at 4 .*.1.0 m.

9 COLOR OR RACE

■White

10 SINGLE (write the word)
MARRIED

WIDOWED ~ , -

or DIVORCED Single

DISEASE OR CONDITION
DIRECTLY LEADING

to death (a) H.omor rha.go from

esophageal varices

ANTE Due To

CEDENT (b)

CAUSES

Laenneo* s cirrhosis

Due To

(c)

OTHER •

siGNiFicANTArteriQ sclerotio . heart

CONDITIONS

dis. Cardiac insufficiency

INTERVAL BE
TWEEN ONSET
AND DEATH

6 days

10a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

1 1 IF STILLBORN, enter that fact here.

AGE 4:4 Years 7 Months 5 Days

If under 24 hours
Hours Minutes

unknow i

13 Usual

Occupation:..

Salesman

(Kind of work done during most of working life)

14 Industry
or Business:.

Automobile

15 Social Security No.

[removed]

unknow ^

16 BIRTHPLACE (City)..
(State or country)

Pittsburgh Pa

Major findings:

Of operations

Date of operation Was autopsy performed?... ysa

What test confirmed diagnosis?

5 Was disease or injury in any way related to occupation of deceased?

If so, specify

(Signed) J ...JB ...Yarden m. d.

(Address) URFFR Wft »p Date Jan 21 19.52

6 Winthrop, Cem Winthron Mass.

Place of ButTal or Cremation (City or T<

17 NAME OF
FATHER

Lloyd F Hoey

18 BIRTHPLACE OF

FATHER (City)

(State or country)

Boston Mass

19 MAIDEN NAME
OF MOTHER

Arnia Lefstron

20 BIRTHPLACE OF
MOTHER (City) ....
(State or country)

DATE OF BURIAL ? 19

own)

Jan 18 lo52

Pittsburgh Pa

Informant..

(Addressj

USPHS . Hosp . rec.ard.s

7 NAME OF
FUNERAL DIRECTOR.

H S Reynolds
address Winthrop. Ma ss

A TRUE
ATTEST

W. • -...'-o /V77

rf.. —

(Registrar of City or Town where death occurred)

Received and filed ./....tt.i;),. ........

tl. L I

.19

(Registrar of City or Town where deceased resided)

DATE FILED .'. Jail... 24..

.19..

..42-

Entered Service

Date of discharge
Rank, rating
Organization and outfit

Service number

May 28, 1942
Oct 22, 1945
Cpl.

Base Serv. Sqdn 515 Air Serv Group

31132215

R-301A

JCTIONS

lERTIFICATE

Suffolk

(County)

Winthrop

No.

‘W££m

Qtye Qloinmomnpalth of IffinHaadjUB^tta

A EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No.

To be filed for burial permit
with Board of Health
or its Agent.

nil... Ayg-r- Sl. {

(If death occurred in a hospital or institution,
give its NAME instead of street and number)

» full name . 9?*** A, ? .) Small I5E2SSS7 ,MPO"T*~T

(If deceased is a married, widowed or divorced woman, give also maiden name.) ] U. S. War Veteran,

o T-, „ . I it so specify WAR)

ttw. no 63 Faun Bar Ava. st

(Usual place of abode) (If nonresident, give city or town and State)

Length of stay: In place of death yea rse?^. months. 9?"/.. days. In place of residence 6i.5years months days.

iving

IF DEATH

t enter
hen one
or each
>) and (c)

oes not mean
' dying, such
ure, asthenia, .
is the disease,
itions which

conditions,
ig rise to the '
(a) staling
ying cause

ons contrib - ■
ieath but not
e disease or
using death.

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH ...

Alonth)

(Day)

(Yea

•W

41 HERE

HEREBY CERTIFY.

19 'f Ty , to

I last saw h.av alive on
have occurred on the date stated above, at
DISEASE OR CONDITION
DIRECTLY LEADING
TO DEATH (a) v V

That I attended deceased from

$ 19 W

ANTE Due To

CEDENT (b)

CAUSES

Due To
(c)

OTHER

SIGNIFICANT

CONDITIONS

Major findings:

Of operations

Date of operation .777 Was autopsy performed?..

What test confirmed diagnosis? rr™

5 Was disease or jn.iurv in anv wav relatecLtrwiciSlaoation of deceased? Vo
If so, specif, , ^

(Signed) H V* T|.

(Address) op ka-k, ^

6 int.hr.Qp > 1 ltl.P:t&rpp

Place of Burial or Cremation (City or Town)

DATE OF BURIAL c * -.7. 19.5.2

Received and filed

■IAN IT «52

(Registrar)

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

Female

9 COLOR OR RACE

White

10 SINGLE (write the word)
MARRIED

WIDOWED , i

or DIVORCED t7ldOWed

10a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

J oshua C Small

(Husband’s name in full)

(or) WIFE of

1 1 IF STILLBORN, enter that fact here.

12 101 6

AGE "Years Months Days

If under 24 hours

Hours Minutes

13 Usual Noil opt-II "Pp

Occupation: r'Ya‘u ” ^

(Kind of work done during most of working life)

tSUXTrU

"ttsu MJtem

15 Social Security No .t!:..™?!®..

16 BIRTHPLACE (City). , ®t> J OilH

(State or country) l . 0 \ 7 . J 3T*U. II S V7 1 C It

17 NAME OF _

father Thomas Tracy

18 BIRTHPLACE OF

FATHER (City)

(State or country)

Ireland

19 MAIDEN NAME

OF mother Elizabeth Sharpe

20 BIRTHPLACE OF
MOTHER (City)

(State or country) -feo/Q It) t,Q T^tTl

Informant t 0 fl ilOmp.S.Qp,

(Address) d U £i OV/fl 0 1 U St . 4

..'intl'ir-qp-

I HEREBY CERTIFY that a satisfactory standard^tertificate of death was
fil£<) w$l>-nae BEFORE the burial trao^ijl permit was issued:

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

a ohvsician 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 % as
contracted, the duration of his last illness, when lastsecnalnu- bythe physician
or officer and the date of his death. . .Gen. Laws. Chap. 46. Sec. 9.

a ohvsician or officer furnishing a certificate of death as required by the
preceding slct, on 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 inthe
armv navv 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
shalUlso 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
of said chap'er 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
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 it0 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 fr<>m cler
of the town where the body is buried. Xo 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 «o 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
o? health, or employed by it or by the selectmen for the purpose. shaU upon
application make the certificate required of the attending physician. If death is
caused bv 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 ^

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. It 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. bee. 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 funergl 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-

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

t0(2)y 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 tp all deaths supposably
due to injury. These include not only deaths caused directly or '"directly 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 unport-
ant so that the relative healthfulness of various pursuits can be known. Make
some enlrTin this section for every person aged 10 yearn or over If the occupa-
tion had been given up or changed, or if the deceased had retired from business,
report the kuufof work done during most of working life even if retired. Children
nol 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
bylhe 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

25M ( E >-6-50-9022 53

■ ' '

iunty)

(City or Town)

Cammamoraltt; of fHaBBadjUBPttB

<2^ EDWARD J. CRONIN

Secretary of the Commonwealth
DIVISION OF VITAL STATISTICS

COPY OF

CERTIFICATE OF DEATH

(City or town making return)

a ’*i

Registered No. . ^40^-

JLr

No.

2 FULL NAME.

I (If death occurred in a hospital or institution.

St* John.*8 ...Hasp.* St. { give its NAME instead of street and number)

Sajrat Louise Nickeraon ( Nee Healey.)

(If deceased is a married, widowed or divorced woman, give also maiden name.)

(a) Residence. No ®.l

(Usual place of abode)

. St. .

(Was deceased a
U. S. War Veteran,

_ if so specify WAR)

winthrop, Mass,

(If nonresident, give city or town and State)

Length of stay: In place of death years months l^ays. In place of residence, lid. years months days.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS

3 death°F J&.n.*....16 1.95*2

(Month) (Day) (Year)

8 SEX

Female

41 HEREBY CERTIFY, That I attended deceased from

Jan, 5, . 19 Hid to Jan* 16 *.

I last saw h .0.j* . alive on JcA-Ii » 1 5 * 19 5j^ath is said tc

9 COLOR OR RACE

White

10 SINGLE
MARRIED

(write the word)

WIDOWED , ..e- •T'T*1 pd
or DIVORCETF* j x

have occurred on the date stated above, at jd A * m.

DISEASE OR CONDITION
DIRECTLY LEADING

to death (a) Cerebral thronbosis

ANTE Due To TT , . _

cedent (b) Hypertension.

CAU SES

Due To

(c)

OTHER

SIGNIFICANT

CONDITIONS

Art e r i.a sdle ratio
heart dim

.ease

INTERVAL BE-
TWEEN ONSET
MD DEATH

10a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

Calvin Hie kerson

(Husband's name in full)

(or) WIFE of

11 IF STILLBORN, enter that fact here.

J 1 (j ay i I AGE, bl. Years ^Months ^ Days

If under 24 hours
Hours Minutes

13 Usual

5- 6

r -r» q Occupation : . . ..Waitress

• i (Kind of wori

(Kind of work done during most of working life)

14 Industry

Busmess: Kestaum nt

15 Social Security No.

16 BIRTHPLACE (City).
(State or country)

Hnva Scotia

Major findings:
Of operations..

Date of operation Was autopsy performed?..

What test confirmed diagnosis?

5 Was disease or injury in any way related to occupation of deceased? ttO

If so, specify.

(signed) idanuel Cof^-an , j*. d

(Address) B Merrinnek St -Date 1716/9

vrMde^ft££ftr Wi«-*rhPO(^- -

DATE OF BURIAL 1.9.., 19

17 NAME OF
FATHER

Joaeph Hcalcy-

18 BIRTHPLACE OF

FATHER (City) Bfl&laM

(State or country)

19 MAIDEN NAME
OF MOTHER

Haria Nickerson

20 BIRTHPLACE OF

MOTHER (City) M.„.

(State or country)

Nova Scot!*

5iB

7 funeral director. ..Howard S*.Beyn.al&s

informantile.rb.e.rt...J.. Nl.ck.ex3.on.

f Address j.

A TRUE COPY

,r>3 -Wafit 1 ■ ■nil Av-e.

ADDRESS IBP wiirtAtrop

Received and filed..

ATTEST:

- C . j ,

(Registrar of City or Town where deceased resided)

DATE FILED

(Registrar of City or Town where death occurred)

1/17/52

.19 .

ftEO :: i v t- u

R-301 A

ICTIONS

ERT1FICATE

iving

F DEATH

l enter
ban one
or each

i) and (c)

yes not mean
dying, such
ire, asthenia, .
s the disease,
.lions which

conditions,
g rise to the'
(o) stating
ting cause

yns contrib- ■
leath but not
’ disease or
using death.

(CummomnraUfj of IfflaBBarluiBFtta

EDWARD J. CRONIN

Secretary of the Commonwealth

DIVISION OF VITAL STATISTICS

STANDARD

CERTIFICATE OF DEATH

Registered No.

To bo fiUd for burial permit
with Board of Haalth
or its Agent.

. 18

2 FULL NAME

(a) Residence. No

(Usual place of aboefe)

I (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)

(If nonresident, give city or town and State)

Length of stay: In place of death years ....^ months days. In place of residence l®Zxyears months days.

MEDICAL CERTIFICATE OF DEATH

3 DATE O
DEATH

(Month)

(Day)

(Y<4r)

4 I H E R Y CERTIFY, That -1 attended deceased from

... 19 Y') > to // 19

I last saw h jQ/F alive on //? death is said toj

have occurred on the date stated^rfjove, at

8 SEX 9 COLOR OR RACE

DISEASE OR CONDITION
DIRECTLY LEADIN,

TO DEATH (a)

ANTE Due T,
CEDENT (b)
CAUSES

OTHER

SIGNIFICANT

CONDITIONS

PERSONAL AND STATISTICAL PARTICULARS

10 SINGLE (write the worfl)
MARRIED,.) K "

WIDOWED
or DIVORCED

Major findings: ^

Of operations

Date of operation Was autopsy performed? ... /7vo

What test confirmed diagnosis?

7 NAME OF,
FUNERAL DIRECT!

ADDRESS/)

Received and filed , 19

JAN 18 19S2

(Registrar)

10a If married, widowed, or divorced
HUSBAND of..

(Give rj^iden na

(or) WIFE of.

* of wife in ful

(Husband’s name in full)

11 IF STILLBORN, entei^rf.at fact here.

AGE,

Days

If under 24 hours

Hour* Minutes

13 Usual

Occupation:....

14 Indust' r
or Business

/Jutf Vw*

(Kind^of work jayie during most q| f woi life)

si'ness : ^

IS Social Security No.

17 NAME OF
FATHER

18 BIRTHPLACE OF
FATHER (City)
(State or country)

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 tg 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 thfe 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 affceaf u^on 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 physcian 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
cau’se of the death, which the clerk or registrar may require. — Chap. 1 14. 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**b32, Sec. 4, Acts of 1945.

. . . 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 wtthout recent medical attendance or whose physician is absent
from home when the certificate of death is needed.

Statement of Cause of Death. — Physicians: see explanatory instructions
on face side of standard certificate of death.

SPACE FOR ADDITIONAL INFORMATION

DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE

RANK, RATING !

ORGANIZATION AND OUTFIT

SERVICE NUMBER

4 R-301A

RUCTIONS

FOR

CERTIFICATE

giving

OF DEATH

iot enter
than one
for each
(b) and (c)

does not mean
of dying, such
ilure, asthenia, •
ins the disease,
cations which
t th,

id conditions. .
-ing rise to the"
se ( a ) stating
rlying cause

lions conlrib- •
e death but not
the disease or
zausing death.

Suffolk

(County)

’.Yinthrop

(City or Town)

®l?r (ftummmtaipaltfj nf UJaaBad)UBPttB
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.

Registered No.

±a

No.

Oarage at 78 InglesicLe Ave.

I (If death occurred in a hospital or institution.
St. \ give its NAME instead of street and number)

2 full name James Moore Letson ,

(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 WAR)

(a) Residence. No. 59 Ingle side Avenue

(Usual place of abode)

St.

Length of stay: In place of death years months days. In place of residence 1 years months days.

(If nonresident, give city or town and State)

MEDICAL CERTIFICATE OF DEATH

3 DATE OF
DEATH

4 I H E

(Day) / (Year)

That I attended deceased from

I last saw h alive on “ " ,19 . death is said to

have occurred on the date stated above, at <o : JO ft m.

DISEASE OR CONDITION
DIRECTLY LEADIN'

TO DEATH (a)

INTERVAL BE-
TWEEN ONSET
AND DEATH

OTHER

SIGNIFICANT

CONDITIONS

Major findings: „

Of operations SttsVWX.

Date of operation — ~ Was autopsy performed?. syiso

What test confirmed diagnosis? : ”

S Was disease orjnjur
If so, spec
(Signed) L
(Addressy^^

ny way related to oajupation of deceased? /no

Place of Burial orH^remation

Place

DATE OF BURIAL

PERSONAL AND STATISTICAL PARTICULARS

8 SEX

male

9 COLOR OR RACE

white

10 SINGLE (write the word)
MARRIED ^,1

widowed married

or DIVORCED

10a If married, widowed, or divorced

husband of Hel en Si . „

(Give maiden name of wife in full)

(or) WIFE of

(Husband’s name in full)

11 IF STILLBORN, enter that fact here.

age54 Years 10 Months 28 Days

If under 24 hours

Hours Minutes

Occupation: ... accountant

(Kind of work done during most of working life)

14 Industry

or Busmess: United ?rUjt QO«

15 Social Security No. - Q1Q-Q3-Q6Q2

16 BIRTHPLACE (City) .
(State or country)

-N(

ew msMs*

17 NAME OF
FATHER

Henry ffarnham Letson

18 BIRTHPLACE OF

FATHER (City) HaUfaX

(State or country)

Nova Scotia

19 MAIDEN NAME / j' j

of mother El i 2 a Abrams Letson

20 BIRTHPLACE OF

MOTHER (City) Halifax

(State or country)

Nova Scotia

Informant Mrs. James M. Letson

nther) /

Permit) / V

EXTRACTS

FROM THE LAWS OF THE

COMMONWEALTH OF MASSACHUSETTS

GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

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.

NTo undertaker or other person shall bury or otherwise dispose of a human body
in a town, or remove there! rom 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 bv Chap. 632, Sec. 4. Acts of 1945.

. 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.

Statement of Cause of Death. — Physicians: see explanatory instructions
on face side of standard certificate of death.

The text goes on. The rest is in the file.