USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 10
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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,
March 14th 1892 Jane E. Draper Jane E. Nousbourne William L. Draper Female Married White
55 Years,
7
Months,
25 Days.
5. Age,
Disease or Cause of Death,
6. {Duration of Sickness, . By whom certified,
7. Residence, £
North Chelmsford Mass. Housekeeper
8. Occupation, .
9. Place of Deatlı, . .
North Chelmsford Mas. England
10. Place of Birth, ·
Jannes tourbourn
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 H. Sheldon
DATED at A. Chelmsford, on
March 16th
1892
* 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.]
Elizabeth (Foster) Your bourn England
England
Lowell Mass.
4. Color,t
[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 application, in case of death by danger- ous 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.
[Acts of 1887, Chap. 202, Sect. 5.]
Section one of chapter thirty-two of the Public Statutes is hereby amended by inserting after the word "burial" in the twentieth line of said section the words : - if the deceased was a married woman the name of her husband.
-
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
march 23ª 1892 Joseph A Hadley
2. Name,
(Maiden Name),
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age,
71 Years, 3 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, .
.
Sarah ........
Hudson MIX
New Bedford
14. Birthplace of Mother, .
15. Place of Interment, . ·
Signature of Undertaker or other person making the Return, .
DATED at
Minh 25
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.}
.... ..
.
1.1. millwright
Waterford (+1.
Stephen Headles
12. Name of Mother,
13. Birthplace of Father,
·
Midtower . . ... .. ..
Dr. Howard Choms ford Chelmsford mail
11 ,
Commonwealth of Massachusetts.
⑈
[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.
Y
.
SECTION 2. This act shall take effect upon its passage.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the. City of
Lowell
(Cityor Town. )
during the month of ...
March
1892.
1. Date of Death,
March 19, 1892
2. Name,
John Mibay
(Maiden Name), . (Name of Husband),
3. Sex, and whether single, Married, or Widowed,
male
Married
4. Color, .
68
Years, Old age
Months, Days.
(Disease or Cause of Death,
6. Duration of Sickness, By whom certified,.
J. J. Mulcahy m. D.
North Chilinsford Mars
7. Residence, .
8. Occupation, .
Fron Moulder
Johnis Hospital Lowill Mars, Ireland
10. Place of Birth,
11. Name of Father,
James le boy
12. Name of Mother, . 13. Birthplace of Father, .
Ireland
14. Birthplace of Mother, .
15. Place of Interment, .
Oactualice Ginster Lourde.
I certify that the foregoing is a true copy.
Attest : Michael J Dowd
March 26-1892
Clerk.
(City ar Town.)
9. Place of Death, .
Sarah Mahow
Ounitary
5. Age,
1
Commonwealth of Massachusetts.
14
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. Age, . · .Years, 5 Months, Days. 2 Group .. .. .... .. . .
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Deatlı, .
10. Place of Birth, .
11. Name of Fatlier,
12. Name of Mother,
13. Birthplace of Father, .
1.1. Birthplace of Mother, .
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
March 25 1892 Celina Caniveau
... .. Female 1
Single
...
. . ..
A few hours 2. A. Harlow M. D. North Chelmsford Maso
North Chelmsford Muss North Chelmsford Mass. Cyprien Caniveau LuminalChampigny Vaniveau Canada
Canada
Lowell
Mar
- Arthur A. Sheldon
DATED at A Chelmsford
, On
March 25th
1892
* 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.
L
.
[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. Seetion 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, forthwitli furnish for registration, a certificate stating, to thc best of his knowledge and belief, the name of the deceased, his age, the disease of which he dicd, 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 certificatc 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 thercfrom the body of a deceased person until he has received a permit-so to do front 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 tovn 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- 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, 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 certificatc as is required of the attending physician ; and in case of death by violenec, 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 dceeascd 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.
1
150
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, .. March 2/ 189 2
John A. Foley
Maiden Name,
Sex ... male; Color, Age, H5 years, - months, day's.
Name of Attending Physician,
Dr. Smith
Residence of Deceased-No.
Occupation, Farming
Husband's Name,
Place of Death-No.
Weet Pelosford Street (or Corporation) Ward
Birthplace of Deceased,
Father's Name, Kermis Folios .. Father's Birthplace, Ireland.
Mother's Name,
Ellen
Mother's Birthplace,
Mother's Maiden Name, Ellen Fleming
Place of Interment, Source Catholi Cemetery Range,
Lgt ..
Grave
Signature of Undertaker or Informer,
Dated at Lowell, this
2 4
day of.
March - 1802.
Physician's Certificate of the Cause of Death. [Sce extracts from Acts of Legislature below. ]
Date of Death, ..
189
Name and Sex of Deceased, male, Place of Death-No. Street (or Corporation. duration of * ...
Disease or Cause of Death,
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Street Residence, No. Dated at Lowell, this day of 189
* 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 deceased is a female, and when the deceased is colored, please Insert.]
Approved.
BOARD OF HEALTH.
[PLEASE FILL OUT WITH INK.]
Single, Married, or Widowed,
Dakota - Street (or Corporation,) Ward
RETURN OF DEATH
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
1
2. Name, .
(Maiden Name),* .
10
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
65
Years,
1
Months,
i
Days.
5. Age, . . .
Disease or Cause of Death, (Primary and Secondary), ;
6. < Duration of Sickness, . By whom certified,
7. Residence, .
.
L.L L. 1
8. Occupation, . ·
.
9. Place of Death, .
10. Place of Birth, .
11. Name of Fatlier,
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, .
DATED at
112 20 1 - 20 18
* If a Married Woman or Widow. ' { If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (1.) Indian. If of other Races, specify what,
[Be very particular to fill all Blanks.] Plate. Ed. Nov. 1890-5,000.
1) 1.01.
.......
·
01.0
-
.
[ACTS OF 1888, CHLAP. 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 agc, 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 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 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 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 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 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.
152
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Marcia 31st
2. Name,
(Maiden Name) ,*
....
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Male Married.
4. C'olor, t
23 .. Years, 10 Months, Days.
5. Age, . .
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
7. Residenee, .
8. Occupation, . .
9. Place of Death, . .
.
Princhester. .
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, .
DATED at
Calle
18/20.
* 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.] l'late. Ed. Feb. 1890-5,000.
...
South Chelmsford. Crates.
South Chelmsford)
Javali -16 Spetters!
Юрист. Ovest Cantidad.
О.О. В зам.
.... , on
1
[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. Scction 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 wlio has attended a person during his last illness shall, wlicn 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 refuscs 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 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 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 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 " to the manner and cause of the death, as the clerk or registrar may require. Any person section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888. ini " as to the dec .. . - of the nr .
Commonfocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
212
5/2
2. Name,
.......... ..
(Maiden Name),*
. .
(Name of Husband),*
3. Sex, and whether single,
Married, or Widowed,
4. Color, t
3. Age, . Years,
Months
13
Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified, ·
7. Residence, .
8. Occupation, .
Muere real Gravelle
9. Place of Death, .
10. Place of Birth, .
11. Namnc of Father,
12. Name of Mother, · (Maiden Name),
13. Birthplace of Father, . C Falderuns Astr.
14. Birthplace of Mother,c.
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, . .
Sf. 4 Hours
DATED at
1897
* 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. May, 1891. - 5,000.
..
. ..... .. . ...
No. ... X
[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. 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 persou 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 fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a hinman body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No uudertaker, 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 ageut, or, if there is no board of health in such city or towu, 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 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 caunot 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; aud 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 conntersign 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 MMay 4, 1888.
Keys found between record 153 and 154
pe
ud. June, 1890. 5,000.
[ACTS OF 1889, CHAP. 208.] AN ACT
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 each 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 certified 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 street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained; and the elerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copies 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 Mestford
(City or Town. ) during the month of. April 1842
1. Date of Death,
March 28 1842
2. Name,
Charles ) Hutchins
(Maiden Name), . (Name of Husband),
3. Sex, and whether single, Married, or Widowed,
Married
4. Color,
5. Age,
Disease or Cause of Death,
Consumption
6. Duration of Sickness, By whom certified,.
7. Residence, .
8. Occupation,
Real Estate Devin
9. Place of Death, .
Colorado Esquinas tror.
10. Place of Birth,
11. Name of Father, ·
cilseboumet.
12. Name of Mother, · (Maiden Name.)
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, .
I certify that the foregoing is a true copy. ..
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