USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 1
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Rec No.
Commontocalth of Massachusetts.
236
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Jan. 14th 1898 Cecil Ros, Shepherd
(Maiden Name),*
(Name of Husband),*
Male- Single
3. Sex, and whether single, Married, or Widowed,
While
4. Color, t
5. Age,
Years,
4
Months,
11
Days.
Disease or Cause of Death, (Primary and Secondary), #
Bronchitis
-
6. Duration of Siekness, . By whom certified, F. E. Varner M.D. North Chelmsford Mars,
7. Residence,
8. Occupation, .
9. Place of Death, .
North Chelmsford
North Chelmsford
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Temple, Maine. North Chelmsford Mars
Arthur A Sheldon
Signature of Undertaker or other person making the Return, . North Chelunsford
DATED at Han
14th
, on.
1898
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895. - 5,000.
George E. Sheinhard
Gertrude E (Moore) Shephard Ireland
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of teu dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body 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 therc has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement 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 hereinafter 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 sueh 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 certifieate arc delivered to the board of healthi or to its agent, the board or agent shall forth- with 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 exceed- ing fifty dollars.
234
Ree
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must must make this return before the burial or removal of the deceased.
Date of Death, Jan 15
189 8 . Name,
Malden Name,
Fourth, Nisivie Gagnon Sex, - male; Color, white
Single, Married or Widowed,
Age, -..... years. months, 16 days.
Name of Attending Physician, . Dr Schiller
Residence of Deceased - No.
Chelmsford Center Street, (or Corporation), Ward
Occupation, Husband's Name,
Place of Death - No. . Cheluns ford center Street, (or Corporation), Ward.
Birthplace of Deceased,
Chehungford center
Father's Name,
Cuisine Gagnon!
Father's Birthplace, Canada
Mother's Name, Clara
Mother's Birthplace, Dowell
Mother's Maiden Name, ." Raconte
Place of Interment,
Chelmsford
Cemetery, Range Lot , Grave, ...
Signature of Undertaker or Informer,
7
Joseph allach
Dated at Lowell, this
16 ch
C
day of
January
189 8
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Joseph Jan- 15
189 8
Name and Sex of Deceased,
Joseph Desire
Giugno
male.
Place of Death - No.
Chelmsford center
Street, (or Corporation).
Disease or Cause of Death,
Premative birth
duration of *
Complications,
general debility
I certify that the above is g true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
570 men
Street,
Dated at Lowell, this
16
day of
dan_
189 8
(When the child is still-born, so specify.)
1
RETURN OF DEATH
OF
...
... 189
238
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
Jan 18
189 8
Name,
Jerome B. Gilbert.
Maiden Name
Sex,
male; Color,
muté.
Single, Married or Widowed, married
Age, 71 years,
6
months,
17 days.
Name of Attending Physician,
Residence of Deceased-No.
Chelmsford Center
Street (or Corporation), Ward
Occupation,
Roused
Husband's Name,
Place of Death -- No.
1 helpno frio.
Street (or Corporation), Ward
Birthplace of Deceased,
Leeds mane
Father's Birthplace,
mane
Mother's Name,
Mother's Birthplace,
//
Mother's Maiden Name, F.F.
Place of Interment,
Edwww.
Cemetery, Range ... , Lot , Grave,
Signature of Undertaker or Informer,
day of
law
1898
Dated at Lowell, this
18 00
11
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* Jerome B. Gilbert.
Age,
74
ch
Date and Place of Death, + - died at. Cheks fond Dass. Jan. 18.189 8.
Disease or Cause of Death, -
of ....
Duration of Sickness,
(Primary and Secondary.)} Three days.
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, .. Charles @ Ordway his
Chelmsford Date & Certificate,
Jan
19% 180 8.
# Wa soldier or sailor who served in the War of the Rebellion.
* Or Sex of Infant (not named). If stillborn so state. T/Hf childl died immediately after birth so state. Plate. Ed. December, 1896. - 5,000.
Father's Name,
RETURN OF D
stating w tc www .
if a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides. SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body 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 suchi 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 elcrk, as the case may be, a satisfactory written statement 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 lich 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, 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 are delivered to the board of health or to its agent, the board or agent shall fortli- with 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 exceed- ing fifty dollars.
239
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
"Undertakers must must make this return before the burial or removal of the deceased.
Date of Death.
189 8
Name Victoring
menu
Maiden Name,
Sex,
male ;
Color,
Single, Married or Widowed,
Age, 44 years,. months, days.
Name of Attending Physician,
Du Varney
Residence of Deceased - No.
North Chelmsford
Street, (or Corporation), Ward
Occupation,
at Home
Husband's Name, .
Place of Death -
- No.
North Cheluns ford
Street, (or Corporation), Ward
Birthplace of Deceased,
Canada I. P
Father's Birthplace,
Canada
Mother's Name,
Ellent " Bergen
Mother's Maiden Name, ....
Place of Interment,
East Chelmsford
Cemetery, Range
, Lot
Signature of Undertaker or Informer, ..
Grave, Jaume + ODonnell
day of
1898
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
San 25th
1898
Name and Sex of Deceased,
Victorine Mines
male.
Place of Death -
NoMarth Chebuford
Street, (or Corporation).
Disease or Cause of Death,
Pur Jusal Fever
duration of *
Jour days-
Complications.
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
V. E. Varney
Residence, No.
North Cheluisfine.
.Street,
Dated at Lowell, this
200
day of
January
1898
Father's Name,
Olur Gow
Mother's Birthplace,
Dated at Lowell, this
25
(When the child is still-born, so specify.)
Re
RETURN
FRE
OF
189
Rec No.
Commonwealth of Massachusetts.
240
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),*
Male
3. Sex, and whether single, Married, or Widowed,
Married White
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Siekness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, ·
Joanna (Stanberry) Truber England
England
North Chelmsford
Signature of Undertaker or other person making the Return, .
Arthur A. Sheldon
DATED at North Chelmsford, on. Jan, 25th 1898
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
{ If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895 .- 5,000.
Jan. 25th
1898
George E. Truber
66 Years .... 6 Months .... .. . Days. Pulmonary hemorrhage resulting from heart disease 3 or 4 years ti E. Varney M.D.
North Chelmsford Mass. Stone Cutter
North Chelmsford England John Truley
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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 siekness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belicf the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement thereiu, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sun of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body 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 elerk. 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 statement 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 thercof 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, 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 certifieate 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 delivered to the board of health or to its agent, the board or agent shall forth- with 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 thic clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
Rec
Commontocalth of glassachusetts.
24/
RETURN OF A DEATH. To the Clerk of the City or 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. Age, 84 Years, .3 Months, 21 Days. Disease or Cause of Death, (Primary and Secondary), + old og dage.
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, ,
11. Name of Father,
12. Name of Mother, (Maiden Name).
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
Bridgewater Mass at home. Chebusford Mass
"Hay. Theodore Mitchell Rikauch Surton Bridgewater Mask Brookfield. mass Bridgewater Mass albert @ Derhair
DATED at
, o1
fare 27
189.80
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [ Be very particular to fill all Blanks .! Plate. Ed. Dec., 1896. - 5,000.
Jan. 26/898, Louisa Witchell
noch married single (female)
white
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the faet that such a ehild died after birth or was born dead. If a physician neg- lects or refuses to make a certifieate as aforesaid, or makes a false statement therein, ne shall be punished by a fine not cxeeeding fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate eause of death as nearly as he ean state the same. If a physician refuses or neglects to make sueh eertifieate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom a human body 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 elerk. 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 statement containing the faets required by this chapter to be returned and recorded, together with the eertifieate of the attending physician, if any, as required by seetion three of this chapter, or in lieu thereof a certifieate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician eannot 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 eity or town for the purpose shall, upon request of said board, agent or elerk, make sueh eertifieate as is required of the attending physician; and in case of death by violenee the medical examiner shall, if requested, make the same. When sueh satisfactory statement and certifieate are delivered to the board of health or to its agent, the board or agent shall forth- with 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 exceed- ing fifty dollars.
Reu
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Carre 29, 1898
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Widowed
White
4. Color, t
5. Age,
86 Years, 9 Months, Days.
1
6. {Duration of Sickness, . By whom certified,
Dr. Scaboria
So Chelmsford
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birthı, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Chelmsford
Signature of Undertaker or other person making the Return, .
Daniel P. Byam
DATED at
So Chelmsford, Onl Jan. 29,
1898.
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895. - 5,000.
1
Disease or Cause of Death, (Primary and Secondary), #
Aproblem Twelve days
Carpenter
So. Chelmsford
So Chelmsford
Eli Parker
Elizabeth Bowers
242
Eli P. Parker
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263. ]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- leets or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In ease the deceased was a soldier or a sailor wlio served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body 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 suel city or town, from the city or town elerk. 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 statement 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 certifieate 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, 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 are delivered to the board of health or to its agent, the board or agent shall forth. with eountersign 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 deathi, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
243
Rec
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must must make this return before the burial or removal of the deceased.
Date of Death ..
189
. Name,
Herman Miner
Maiden Name,
Sex,
male; Color,
Single, Married or Widowed,
Age, years, months, 3 days.
Name of Attending Physician, Varney
Residence of Deceased - No. Worth thelinford
.. Street, (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death - No. Worth Cheliusford
Birthplace of Deceased,
Father's Name,
Henry Miner
Father's Birthplace,
Canada
Mother's Name,
Victoring
Mother's Birthplace,
Mother's Maiden Name
you
Place of Interment,
Cemetery, Range
Lot , Grave, ...
Signature of Undertaker or Informer, ..
Jament. O'Donnell
Dated at Lowell, this day of tel
189 2.
Street, (or Corporation), Ward
RETURN
Rec No.
Commontocalth of Massachusetts.
244
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Fel. 4th 1848 Caroline W. Robe,
2. Name, (Maiden Name),*
Wheeler
(Name of Husband),*
Christopher Roby
Female
3. Sex, and whether single, Married, or Widowed,
Widow
4. Color, t
5. Agc, 74 Years,. .Months, .. 24 Days. Heart Disease
Disease or Cause of Death, (Primary and Secondary), #
G. {Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Sally (Pelsue) Wheeler
13. Birthplace of Father, . Acton Mass
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
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