USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 1
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87
[PLEASE FILL OUT WITH INK.]
UNDERTAKER'S
RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased.
th Date of Death, Jan. 9 189
Name, . Ernesten Maison Sex, .... male; Color
Maiden Name,
Single, Married, or Widowed,
Age, Hf years, ~ months,- days.
Name of Attending Physician, Dr. Dutton
Residence of Deceased-No. North Chelmsford Street (or Corporation,) Ward
Occupation,
Husband's Name,
Place of Death-No. North Chelmsford Street (or Corporation,) Ward
Birthplace of Deceased,
France
Father's Name,
Father's Birthplace,
France
Mother's Name,
verjanea Debour other's Birthplace,
France
Mother's Maiden Name,
Place of Interment,
Catholic of Lowell
Cemetery Range, Lot Grave
S.D. ODonnell
Signature of Undertaker or Informer,
Dated at Lowell, this.
9 th
day of ..
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
[See extracts from Acts of Legislature below.]
Date of Death,.
9'
189 ..!.
Name and Sex of Deceased,
male.
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death, Phili
duration of* 3 21. ces.
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
Dated at Lowell, this x gelesen .....
day of Queensy?
189 /
#Reckoncd to the time of death.
[Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married, or widowcd, and insert " fe " before male when the deceased is a female, und when the deceased is colored, please insert. ]
Approved.
BOARD OF HEALTH.
A physician who has attended a person during his last illness shall when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. It a physician neglects or refuses to make a certificate, as atoresaid, he shall be punished by a fine not exceeding fifty dollars. [Extract from Acts of 1888, Chapter 300.
No Board of Health shall give a permit to bury or remove the body of a deceased person, until there has been delivered to such board, n satisfactory written statement containing the taets required by Chapter 32, of the I'nblic Statutes, together with the certificate of the attending physician. CHAPTER 402 .- An Act in relation to the return and record of deaths. Be it enacted. pte as followra
...
Street.
RETURN OF DEATH -OF-
................ 189 .. ..
-
Jo!
Ed. June, 1890. 5,000. nee
[ACTS OF 1889, CHAP, 208. ] AN ACT
88
l'late.
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each city and town shall on the first day of cach month make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certificd copies to the clerk or registrar of the city or town in which such deceased person or parents were resident at the time of said death or birth, stating in addition the name of the strect and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained ; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copics shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the Town of abington mass
(City or Town. )
during the month of. Jan mary 1891.
1. Date of Death,
January 14"
2. Name,
(Maiden Name), . (Name of Husband),
3. Sex, and whether single, Married, or Widowed, Mamie
4. Color,
72 Years, 5 Months, 19 Days. Peritonitis and Heart Quan
One week
H. J. Copland M. D.
north lebelford
7. Residence,
at home
8. Occupation,
9. Place of Death, .
abington
New Hampshire
Samuel HAVE
12. Name of Mother, (Maiden Name.)
13. Birthplace of Father, .
new Hampshire
"
4€ Vores Mark
15. Place of Interment, . I certify that the foregoing is a true copy.
Attest : John Manual
Jan 15 1891.
Low Clerki.
(City or Town.)
5. Age,
Disease or Cause of Death, 6. Duration of Sickness, By whom certified,.
10. Place of Birth,
11. Name of Father,
Phila Hows
14. Birthplace of Mother, .
Mary 8. Johnson
Res
[PLEASE FILL OUT WITH INK.]
UNDERTAKER'S
RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased.
Date of Death,
.189 / ...
Name, Lanus
James Mc Quaid
Maiden Name, ..
Sex, ......... male; Color
Single, Married, or Widowed,
Age, 65 years, ~months,-days.
Name of Attending Physician, Ir Howard
Residence of Deceased-No. Mouth Chelengforel
.Street (or Corporation,) Ward
Occupation,
Blacksmith
Husband's Name,
Place of Death-No. /With thebusface
Street (or Corporation,) Ward
Birthplace of Deceased, ....
Prelude
Father's Name,
Owen Mã Quece Father's Birthplace,.
.....
Mother's Name, Catu
Mother's Birthplace,
.... .....
. ... ......
Mother's Maiden Name Cate
Place of Interment, Cathol Amelhor Cemetery Range,
., Lot Grave
Signature of Undertaker or Informer, ROD
Dated at Lowell, this
17
day of fame
189 ....
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
[See extracts from Acts of Legislature below.]
Date of Death,
January
17th
189/
Name and Sex of Deceased, James MC Quade male.
Place of Death-No. no. Chilenaford
Disease or Cause of Death,
Endo carditis
Street (or Corporation).
duration of* Several months
Complications,
old age
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, amara Howard, M, L.
Residence, No.
Chelmsford
Street.
Dated at Lowell, this
18 00
day of
Janmany
*Reckoned to the time of death.
[ Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married, or widowed, and insert " fe " before male when the decensed is a female, and when the decensed is colored, please insert.]
Approved.
BOARD OF HEALTH.
A physicinn who hns attended a person during his last illness shall when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his nge, the disense of which he died. the duration of his last slekness, and the date of his decease. If it physician neglects or refuses to make a certificate, as nforesaid, he shall be punished by n fine not exceeding fifty dollars. [Extract from Acts of 1888, Chapter 30G.
No Board of Health shall give a permit to bury or remove the body of a deceased person, until there has been delivered to such board, a satisfactory written statement containing the facts required by Chapter 32, of the Public Statutes, together with the certificate of the attending physician. CHAPTER 402 .- An Act in relation to the return und record of deaths. Be lt enncted, etc., as follows :-
Wat suition one of charter thirty-ben at the Font Strand
89
RETURN OF DEATH
189 . .....
Commonboratthy of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Jan 15 90 Quefinial. Digicom
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Finale ...
4. Color, t
5. Age, 17 Years, > Months, 17, Days.
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
7. Residenec,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Returng.
L'anul Bran
DATED at& texto Chelmsford, Ou LE de Jan 1891
* If a Married Woman or Widow.
{ If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate, Ed. Feb. 1890-5,000.
90
South Grimstad 1
Jauch 6 helowfod
E muito (las
Épp . da 6h
1
No
[ACTS OF 18SS, CHAF. 30G.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnislı for registration, a certificate stating, to tlie best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last siekness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of licalth in such city or town, from the city or town clerk. No such permit shall be issued until therc has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- inent containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending. physician, if any, as required by seetion three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, carly enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transinit the same to the elerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
-
Rec
[PLEASE FILL OUT WITH INK.]
UNDERTAKER'S
RETURN
To the Board of Health and the Clerk of the City of Lowell.
-Undertakers must make this return before the burial or removal of the deceased.
Date of Death,
fick 3'
189 |
Name,
Charles Dahil
d'alice
-
Maiden Name,
Sex, .... male; Color
Single, Married, or Widowed,
Age,
years, ..
5 months,
days.
Name of Attending Physician,
Residence of Deceased-No. Cancel
Street (or Corporation,) Ward
Occupation, Husband's Name,
Place of Death-No.
Elfut store
Street (or Corporation,) Ward.
Birthplace of Deceased & Chelmsford
Father's Name, Hasehhh
Father's Birthplace,
Mother's Name Analy KahnMother's Birthplace,
Mother's Maiden Name, Juan Hurley
Place of Interment Cathathe Cancometery Range,
Lot
, Grave
Signature of Undertaker or Informer,
Dated at Lowell, this
day of.
189
. .....
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
[See extracts from Acts of Legislature below.]
Date of Death,. 189
Name and Sex of Deceased, male.
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death,
Mario
duration of*
Complications,
Poncho
Pneumonia
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, NevyCa.y
Residence, No.
Street
Dated at Lowell, this
3
day of
189 /. ..
RETURN OF DEATH -OF-
1 8 9 . ... . ..
-
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, . ..... ..............
Married, or Widowed,
4. Color,t
.....
5 Years, 11 Months, ..... Days.
5. Age,
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
7. Residence,
1 ......
8. Occupation, . · .
9. Place of Death, . .
1. 1 1.
10. Place of Birth, ·
11. Name of Father, 1
12. Name of Mother, 1 10 1
13. Birthplace of Father, . 1.
11. Birthplace of Mother, .
15. Place of Interment, ( 121 2 .. 1
Signature of Undertaker or other person making the Return, .
. ... 1
DATED at 4,on 1. 18 /
* If a Married Woman or Widow. t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Feb. 1890-5,000.
72
1
1.
1
.....
2/
1 1
No. e
[ACTS OF 1888, CHAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a finc not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is ful. nished, is amended so as to read as follows :- Section 5. No undertaker, sexton or other person shall bury in a city or town or remove thercfrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by scction three of this chapter, or in lieu thereof a certificate as hercinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate arc de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
No.
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deathı,
Feb 18th 1891
2. Name,
(Maiden Name) ,* .
3. Sex, and whether single, Married, or Widowed,
.....
....
.. ... ...
Rhoda J. Sampson
Rhoda Taisey
Female - Married
White
4. Color, t .
5. Age, 69
.Years, 5 Months, 18 Days. Discared heart . ......
Disease or Cause of Death,
6. Duration of Sickness, ·
By whom certified,
Charles Dutton M. D.
North Chelmsford Mass.
'7. Residence, .
8. Place of Death,
9. Occupation, .
.
10. Place of Birth, Groton Mass.
11. Name of Father, .
James Taisey
Ruth Darling Jaisey
12. Name of Mother, Groton Mass.
13 .. Birthplace of Father,
14. Birthplace of Mother, . Groton Mass.
15. Place of Interment, . North Chelmsford Mass
Signature of Undertaker or other person making the Return, .
Arthur Art, Sheldon
DATED at
Chelmsford, on
Feb. 19th
1891.
* If a Married Woman or Widow.
* If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ]
North Chelmsford Mass.
[Public Statutes, Chap. 32, Sect. 5.]
No human body shall be buried or removed from any city or town until a proper certificate has been given by the clerk or registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that the facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit until the certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the deceased, and placed in the hands of said clerk or registrar; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the board of health, or any physician employed by any city or town for such purpose, shall sign the certificate of the cause of death to the best of his knowledge and belief, if there has been no physician in attendance. He shall also sign such certificate, upon applica- tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deatlı.
2. Namo,
(Maiden Name),* . .
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age, .
61 Years, 11 Months, .. Days.
Disease or Cause of Death, Apoplexy ... .
6. Duration of Sickness,
By whom certified,
of days N.B. Edwards M.D. North Chelmsford Mas
7. Residence, . · .
8. Place of Death, .
9. Occupation, ·
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, .
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
Arthur A Sheldon
DATED :t.
A Chelmsford. on March 2nd
1891
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
C 93
..
Owen ME Encany Mary Deary Me Encany Ireland Ireland
Lowell Mass
March 1St- 1891 Rosanna Me Eneaney MC Emcaney Female - Widow White
North Chelmsford Mas
Ireland
[Public Statutes, Chap. 32, Sect. 5.]
No human body shall be buried or removed from any city or town until a proper certificate lias been given by the clerk or registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that the facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit until the certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the deceased, and placed in the hands of said clerk or registrar; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the board of health, or any physician employed by any city or town for such purpose, shall sign the certificate of the cause of death to the best of his knowledge and belief, if there has been no physician in attendance. He shall also sign such certificate, upon applica- tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name, ·
(Maiden Name),* · (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Hiclou
4. Color,t
/
.. Years,
Months,
1
0 Days.
6. Duration of Siekness, . By whom certified,
.............................................. ....... ..
7. Residenee, .
8. Occupation, . .
.
turzilei
9. Place of Death, . .
10. Place of Birth,
11. Name of Father, .
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
. ...
.1/ 18
DATED at
L
* If a Married Woman or Widow.
+ If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Feb. 1890-5,000.
M
1-
Dolly Javier .......
/
.............
6.2.
.....
March
5. Age, . Disease or Cause of Death,
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Seetion three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain faets relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who lias attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his deeease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceediug fifty dollars.
SECTION 2. Seetion five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or towu clerk. No such permit shall be issued until there has been delivered to sueh board, or agent or clerk, as the ease may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, orif the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in ease of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manuer aud cause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
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