USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1886-1892 > Part 1
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No.
30
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),
3. Sex, and whether single, Married, or Widowed,
1. Color, t .
5. Age,
Disease or Cause of Death,
6. Duration of Sickness,
By whom certified,
7. Residence, . .
8. Place of Death,
9. Occupation,
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father,
Sulle
14. Birthplace of Mother, .
15. Place of Interment, .
Signature of Undertaker or other person making the Return, . .
DATED at
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.]
Cadoit
Inan ..
1.2L.
14. 7 Years, 13 . Months, / 5. Days.
[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.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Discase or Cause of Deathi, - of ithe via
Date and Place of Death, - died at
.1.1 188
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician,
2
Date of Certificate, -7 188.
*Or Sex of Infant (not named).
[Extracts from Chapter 32 of the Public Statutes. ]
" SECT. 3. A physician who has attended a person during his last illness shall, when requested within fifteen days after the decease of such person, forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same. If a physician refuses or neglects to make such certificate, he shall forfeit ten dollars to the use of the town in which he resides."
" 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 ‹Jeath 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death.
20
2. Name,
(Maiden Name) .*
1
3. Sex. and whether single, Married, or Widowed,
1. Color. t .
5. Ago. Years, Months, Days.
Disease or Cause of Death, 6 Duration of Sickness,
By whom certified,
7. Residence, .
8. Place of Death. .
9. Occupation.
10. Płace of Birth. QuiLL
11. Name of Father.
12. Name of Mother,
13. Birthplace of Father.
14. Birthplace of Mother,
15. Place of Interment, .
1. .
Signature of Undertaker or other person making the Return, .
DATED at
., on
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.]
..
7
..
$
h
n
[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.
- 5
PHYSICIAN'S CERTIFICATE.
Hannah R coles Tame of Deceased,* -( ate and Place of Death, - died at A throne banho,
1886
Disease or Cause of Death, - \ of Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
tame and Residence of Certifying Physician, It. I. t ele Minwhich
Date of Certificate, U
1
1 1884.
*Or Sex of Infant (not named).
[ Extracts from Chapter 32 of the Public Statutes.]
" SECT. 3. A physician who has attended a person during his last illness shall, when requested within fifteen days after the decease of such person, forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same. If a physician refuses or neglects to make such certificate, he shall forfeit ten dollars to the use of the town in which he resides."
" 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."
-
V
RETURN (
S.
he
or
D
d
RETURN OF A DEATH. To the Clerk of the Town imwhich the Death occurred.
1. Date of Death,
1
2. Name, (Maiden Name),
3. Sex. and whether single, Married, or Widowed,
1. Color, t .
5. Age, Years. 5 Months, .. ... .... Days.
Disease or Cause of Death,
6. Duration of Sickness, · By whom certified.
7. Residence, .
8. Place of Death, 0
9. Occupation, ·
10. Place of Birth,
11. Name of Father, .
1
12. Name of Mother,
13. Birthplace of Father,
14. Birthplace of Mother,
15. Place of Interment, .
Rec
Signature of Undertaker or other person making the Return, .
DATED at
... ou
SA ......
1 1886.
* 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. 1
L
Cottage Creil
[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 to the best of his knowledge and belief, if ts
Tøyed by any city or town for such purpose, shall sign the certificate of the cause of death has been no physician in attendance. lle 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.
I
D
N'en
Be
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH. To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deccased,
Christina A. Bacon (female)
Date and Place of Death, . .
Winthrop Rask Jan. 4.
1886
Disease, or Cause
First or Primary,
Bronchitis
Duration of,*
6 tous
of Death,
Secondary, .
Membranous Group
Duration of, ...
a few hours
I certify that the above is a true Return, to the best of my recollection and belief.
Name, Professional Title, and Residence,
Euergi E. In Carthy MQ
Dated at Written Swiss Feb. 9, 11
1886.
"Be very particular to fill all Blanks.]
+ Reckoned to the time of death.
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. ]
The attending Physician is requested to make out his Certifieate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTHI.
NO. ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2 -164886 7
2. Name,
un .2
(Maiden Name),
5
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age, 00 Years, ... .Months, .. 3 Days.
Disease or Cause of Death,
6. Duration of Sickness,
By whom certified,
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 other person making the Return, .
DATED at 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.]
7
1
iC
4
r
1
[ 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 faets 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 eause 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. lle 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.
07-06
PHYSICIAN'S CERTIFICATE.
Name of Deceased,* - - Date and Place of Death,
died at Mirathrop fuze 180 Pracuminia
1886
Disease or Cause of Death, of
Duration of Sickness Alet al. ext
I certify that the above is true, to the best of my knowledge and belief.
Vame and Residence of Certifying Physician,
Date of Certificate, 1886.
*Or Sex of Infant (not named).
[Extracts from Chapter 32 of the Public Statutes. }
" SECT. 3. A physician who has attended a person during his last illness shall, when requested within fifteen days after the decease of such person, forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same. If a physician refuses or neglects to make such certificate, he shall forfeit ten dollars to the use of the town in which he resides."
" 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 carly 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. 1
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Daniel "1886
2. Name. (Maiden Name),
3. Sex, and whether single. Married, or Widowed,
4. Color, t .
5. Age.
6 Years,
F
Months.
Days.
Disease or Cause of Death, 6. Duration of Sickness, .
By whom certified, .
7. Residence. .
8. Place of Death.
9. Occupation. Transfer
10. Place of Birth, Varoffield Sa 2
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, .
DATED at
., on
1886
-
6
* 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. ]
1
..
[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, an l 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. Ile 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.
) Cannes
05.2/ 121/ 12327/
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed,
C /
L
1 Years,
.
Months .. "w. Days. 5. Age,
Disease or Cause of Death,
6 .. Duration of Sickness,
By whom certified,
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 In other person making the Return, .
DATED at
18
1
* 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.j
LILLI
.
1. Color, t .
27
[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 performning the burial or removing the body. Such certificate shall state that the facts required by this chapter have been returned and recorded; and no elerk 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 ceath 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 eannot 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.
Metr 188 ℃ RETURN OF A DEATH. Com Ceert To the Clerk of the Town in which the Death occurred. Invihar
1. Date of Death.
2. Name.
atelier1 8" 18X6 Granturiel voletto
(Maiden Name) .*
3. Sex, and whether single, Married, or Widowed,
Cindriver
Imile
4. Color. t .
5. Age,
88 Years, 11
Months.
Days.
Disease or Cause of Death,
6 .. Duration of Sickness, By whom certified,
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, .
. ... ( summer + 1orjol
Signature of Undertaker or other pruson making the Return,
DATED at
Ministrofo
on
Felmay 9€ 1886
* 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.]
1
(Southbay : nanie 10, illett
(Sur Chbay marie
1
1
S
1
Mechaniker
Avivre
5-6-15
En Tima
[Public Statutes, Chap. 32, Sect. 5.]
No human body shall be buried or removed from any city or town until a proper certificate hu been given by the clerk or registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certihcate shall state that the facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such citi te or burial permit until the certificate of the cause of death has been obtained from the physician, if any, in attendance at to i 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 cler. Lon application, the chairman of the board of health, or any physician employed by any city or town for such purpose, shall sigi the rtificate of the cause of death to the best of his knowledge and belief, if there has been no physician in attendance. He shall also sig uch 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. 2
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, .
(Maiden Name),
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