USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 1
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PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and age of deceased ;
Tobrilho Collins Ag. 819
an. , 5'
189 .... 7 .
Date and place of death: Jan. 5 '97
Almont Dr.
Disease or cause of death : Exhaustion, Pulmonary Celeron and Mitral Discern, Paralysis and CoJE,
Duration of disease : * Hear from ill for mord- petr hat green.
I certify that the above is true, to the best of my knowledge and belief.
Name and residence }
N
...... M. D.
of physician.
* It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A. M. tm 2 P. M .; Sundays, 10 A. M. till 12 M .; Holidays, from 10 A. M. till 12 M .; other days, from 9 A. M +;11 5 P. M.
. mos ..... .... dys.
UNDERTAKER'S RETURN-Boston, Mintup
Date of death,
lethi, Jan. 5
89 % Name, John M. Robbins
Sex,
110
Maiden name,*
Married, single, or widow of wife of
Color, Age& Jyears, cars, mos.,.
days. Residence,
Almont 570
Place of death (street and) Almont
ward
Place of birth Lancaster Mass. Occupation,
Real
Estaba
Name of father, Joshua
Maiden name of mother
the Party Manning
Birthplace of father, Uitrol Mais Birthplace of mother, Lancaster mane
Place of interment,f
forest delle
Damit.
* If a married woman or a widow.
* Give the name of the burial ground. Signature of Undertaker : Aby Broun.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
verett
Floyd
(Maiden Name),*
(Name of Husband), *-
3. Sex, and whether single, Married, or Widowed,
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,
-
Summer ifloyd
DATED at
on January9 189.7
* If a Married Woman or Widow. { If a Soldier who served itthe 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.] l'late. Ed. Dec., 1895 .- 5,000.
-
Minitrope Cemelly
Signature of Undertaker wother person making the Return, .
Years, 1 Months, Days.
1
[ 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 physlelan 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 dled, 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 bellef 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 flfty 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 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 statement containing the facts required by this chapter to be returned ande recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in licur thereof a certificate as herelnafter provided. If there Is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and suffjelent reasons, early enough for the purpose, the chairman of the board of health or any physlelan 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 orto 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 deatlı, as the clerk or registrar may require. Any p of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
D
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Everett Nelsonofloyd
Date and Place of Death,t. 1
Ase, 1-7-27 Tat Printhof (Semword Che) How Y" 189 7 I intuberia
Disease or Cause of Death, - of (Primary and Secondary.)} Duration of Sickness, - -
I certify that the above is true, to thebestof my knowledge and belief.
Signature and Residence of Certifying Physician,
Date of Certificate,
four of 189)
·
1 If a soldier or sailor who served in the War of the Rebellion.
Or Sex of Infant (not named). If stillborn so state. ¡ If child died immediately after birth so state. Plate. Ed. October, 1895 .- 5,000).
[ 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 (lied, 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 ilfty 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 lie 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 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 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 sufficlent 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 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.
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),*
Jan 18th 1897 an Susan M. Dimock Veran For MERill andrino Desnack Female m mande
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 60 Years,
.Monthis, Days. 5
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residenee,
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,
Winthrop
Holdermes
Harmat & Batchelder Protony Maso.
Northwood N26
Rua From Cometary
SummenFord
Signature of Undertaker wother person making
the Return, . .
.
S
C
DATED at Winthrop
, on
Jan 10 "
1897
* If a Married Woman or Widow. { Ifa 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. Dec., 1895. - 5,000.
White
Nr O.k. Holmen
1
[ 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 dend. 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 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 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 elerk, as the case may be, a satisfactory written statement containing the faets 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 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 canse of the death, as the elerk 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.
1 Pinè eme Lies, 10
2-11
-
.S
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Susan WW Dimock
Age, 60-3-20
Date and Place of Death,t - died at Winthrop (Quivery are) Jan 10" 180}, Heart Disease "(anasanca) of Two months
Disease or Cause of Death, (Primary and Secondary.)} Duration of Sickness,
I certify that the above is true, to the bestof my knowledge and belief. S. E. Johnson me
Signature and Residence of Certifying Physician,
Date of Certificate, fan !! 189
Or Sex of Infant (not named). It stillborn so state.
[ If child died immediately after birth so state. Plate. Ed. October, 1895 .- 5,000.
t If a soldier or sailor who served in the War of the Rebellion.
1
[ 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 deccase; 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 chill 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 lie 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 clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case inay be, a satisfactory written statcinent 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 Hien 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 forth- with countersign and transmit the sainc 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 canse 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.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
2am2 10 "1897 Todeler 13 Batte
(Maiden Name),* ·
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age, Days.
Disease or Cause of Death, (Primary and Secondary), +
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, . ·
9. Place of Death, .
10. Place of Birth, .................
11. Name of Father,
Fred Of 13 attis
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, .
- Sunis
...
DATED at
, on
Jan 11
18Q
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. t If other than White. (M.) Mulatto. (f.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Dec., 1895 .- 5,000.
1 Years, ~ Months,
[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 dcad. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, ne 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 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 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 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 snch 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 forthi- 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.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Helen B. Batti's
Age,
Date and Place of Death, t - died at. Winthrop JanTo"
Disease or Cause of Death, (Primary and Secondary.) }
- Duration of Sickness, -
of Pneumonitidy Three days
+ 1 years 189 7, /
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Albert B. Domman M.D.
Date of Certificate,
18917
* Or Sex of Infant (not named). If stillborn so state. ¡ If child died immediately after birth so state. Plate. Ed. October, 1895 .- 5,000.
{ If a soldier or sailor who served in the War of the Rebellion .
[ 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 furulsh for regis- tration, a certificate stating, to the best of his kuowledge 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 bellef 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 botlı 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 such city or town, from the city or town clerk. No such permit shall be issned 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 lien 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 snch satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with conntersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furulsh for registration any other information as to the deceased or to the manner and canse 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.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston Jan 21 189 ... ,2
Name and age of deceased : commetta alloro
Age 49 yrs mos. .. dys.
Date and place of death: Tom 19
Underhil St
Disease or cause of death : Cancer ard
Duration of disease : *
Cyfrowy one
and The fall ywant
I certify that the above is true, to the best of my knowledge and belief.
Name and residence )
of physician. Extral F. Ga.
M. D.
* It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A. M. till 2 P. M .: Sundays, 10 A. M. till 12 M .; Holidays, from 10 A. M. till 12 M .; other days, from 9 A. M. till 5 P. M.
UNDERTAKER'S RETURN .- Boston.
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