USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 11
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Attest : epicmand Wright -
May 2. 1892
Novan Clerk. (City or Town.)
Male
94 Years, Months, Days.
thorell
Julia (M. (Pierce)
Dunstable
RIC NO.
Commonwealth of Massachusetts.
155
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
t
1. Date of Death,
41
li. T ... .......
2. Name,
(Maiden Name),* . (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age, > < Year's,
Months, 11 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,
12. Name of Mother, ( Maiden Name).
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
1
, Oll 7 1 18 6 .- 1
* 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.
.... ... ...
.
-
DATED At
Hier
[ACTS OF 1888, CHAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows .
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness sliall, 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, lie shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. Scction 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 10 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 violenee, 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 forthiwith 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 Ma 4 1588
Rec No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
June 17, 1842 Sarah & H. Fich
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
hidlow
4. Color, ¡ White
5. Age, . . Years,. 4 Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . 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,
So Chelinaford
WPBravi
Signature of Undertaker or other person making the Return,
DATED at
, on
Drive18
18
* 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. ] PIate. Ed. Nov. 1890-5,000.
r
Fairfield Trix
Thomas Parker
Leahuna Parker
....
None
Yo, Chelmsford, mark.
1.56
Yarak E : ir Parker
Hich.
[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 person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, thic 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 certificatc, 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, carly enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and 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. [Appro, J £, 1888.
15%
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
abril 19 1892,
2. Name,
(Maiden Name),* (Name of Husband),*
Ziale,
Married
3. Sex, and whether single, Married, or Widowed,
White
4. Color, t
5. Age, . 74 Years, 10
Months,
19 Days.
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
7. Residence,
Soull Give face ...
1 €
.
8. Occupation, . . ·
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
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, .
DATED at
80
Farmer.
annavorTh. N.M. V 1
C
Jan, on april 20
189.2
* 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. 1800-5,000.
[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 person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to thie 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 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 lias 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, orif the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in 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 n , exceeding fifty dollars. [Approved May 4, 1888.
158
Commonwealth of Massachusetts.
No
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
April William an
27 Sweat
. . . . . .....
(Maiden Name) ,* . ·
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age,
Disease or Cause of Death,
S
6 ..
Duration of Sickness,
By whom certified,
7. Residence, .
8. Place of Death, 0
11 .
Will Wright.
9. Occupation,
Bedford n. A Cara
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, 0
15. Place of Interment, .
Signature of Undertaker or other person making the Return, . ·
16 7 Chamberlin
DATED at
Lowell
on
April 29
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.]
....
Widower .. . . ....... . ..---
While
......
84, 3
......
Years,
.
Months,.
2
Days.
Senile degeneration
. .......
amara Howard MD. North Chelmsford. . .
Lebeneras Sweat-
11
Newhun hart Mas. Tostarted The North le helmsford
1 2
2. Name, . .
[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.
159
[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,
april 24 the 1802
Name,
albert & Partner
Maiden Name,
Sex
male; Color, ar
Single, Married, or Widowed, Singh
Age, 26 years, 9 months, 22 days.
Name of Attending Physician,
Residence of Deceased-No. Chelmsford Street (or Corporation) Ward
Occupation,
, Garmin
Husband's Name, -
Place of Death-No. Chelmsford
Street (or Corporation,) Ward
Birthplace of Deceased,
Father's Name, Wather & Ouetmez Father's Birthplace,. Holder MH
Mother's Name, Julia
Mother's Birthplace,
Mother's Maiden Name, ....
Place of Interment, Edm Lowell Cemetery Range,. Lot , Grave
Signature of Undertaker or Informer, James W. Brooks
Dated at Lowell, this
25 the
day of
april
189 2
Physician's Certificate of the Cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death,.
april 24 th
189.Ź
Name and Sex of Deceased, Albert & Outricy male,
Place of Death-No. Chelqueford
Street (or Corporation?
Disease or Cause of Death, Dorthin of Brain duration of* Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title,. G. F. Thomas M.2
Residence, No. 214 Westford Street
Dated at Lowell, this
day of
April
1892
RETURN OF DEATH
189
Or Chomuto
160
[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
April 25 .1892
Name, baralhar
Jialdina
Maiden Name,
Sex
male; Color, 11/2.
Single, Married, or Widowed,
Midoulad Age, $5 years,
months, S
days.
Name of Attending Physician,
Harald
Residence of Deceased-No.
Street (or Corporation,) Ward
Occupation,
Husband's Name,
Place of Death-No.
Chetiefer Street (or Corporation,) Ward
Birthplace of Deceased, Chelinesfeld
Father's Name, Chhraim ShallenFather's Birthplace,
Mother's Name,.
.1 Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Chehnuferd Cemetery Range, Lot
.... , Grave
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
Physician's Certificate of the Cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death, 1891
Name and Sex of Deceased anathan ) holding male,
Place of Death-No.
Cheffeneyeul
Street (or Corporation.
Disease or Cause of Death, Paralysis
duration of * few hours.
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Umara Haward, M. D.
Residence, Ne- Chileford Thass .Street
Dated at Lowell, this mais 10x
189.7
RETURN OF DEATH
/6/
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN.
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased.
Date of Death
189% Name, 1/2/11
Maiden Name,
Sex, .male; Color,
Single, Married or Widowed,
Age, 14 years, 10 months, .days.
Name of Attending Physician,
Residence of Deceased-No. East Fedhar c22 Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No. Chevrexx and Cc1/61 Street or Corporation), Ward
Birthplace of Deceased, . ...................
Father's Name, Anech Kallersback Father's Birthplace,
Mother's Name, .1 I. I.p . Mother's Birthplace. ............................
Mother's Maiden Name, ...... Erst Derthan Cemetery Range
, Lot .. , Grave.
Place of Interment,
Signature of Undertaker or Informer, Chad
Dated at Lowell, this
13 -
day of
....... 189 1
Physician's Certificate of the Cause of Death,
(See extracts from Acts of Legislature below.)
Date of Death,
189 2
Name and Sex of Deceased, Hemen D . Kallenback male,
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death, duration of *
Complications, ......
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
Street
Dated at Lowell, this day of 189
*Reckoned to the time of death. [Be very partienlar 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.
ar hie last illness shall when requested, forthwith furnish for registration, a certificate ion of which he died, the duration of his last
7
. ..
.......
RETURN OF DEATH
No.
Commonfocalth of Massachusetts.
162
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
J. Age, 6% Years, Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
7. Residence, .
8. Oecupation, . · ·
9. Place of Death, . ·
10. Plaee of Birth, .
11. Name of Father, ·
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
1.4. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker
. or other person making the Return, . .
Arthur H, Sheldon
DATED at M. Chelmsford, on
June 23rd
1892
* If a Married Woman or Widow. { If n 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.
June 23rd 1892 Mary Mc Mahon Mary Mc Bride Michael MC Mahon Female
Married
-
-
€
Paralysis Linnea Howard mg North Chelmsford Mass. Housekeeper
North Chelmsford Mars. Ireland
Patrick MC Bride Mary (Brady) MC Bride Avelani
Freland
L'oracle Mass. ,
[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 thrce of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a finc not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is 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 statc- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, orif the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate arc de- livcred 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 perinit is so given shall thercafter 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.
Ree NO.
Commonbocalth of Massachusetts.
163
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,
Single White
4. Color, t
5. Age, . · Years, 2 Monthis, 2 Days.
Disease or Cause of Death, 1 (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
North Chelmsford Mais.
7. Residence, .
8. Occupation, . ·
9. Place of Death, . ·
10. Place of Birth, . ·
11. Name of Father,
North Chelmsford Mass.
Westford Mass.
Silas Read
Hannah (Chamberlain) Read
12. Name of Mother, (Maiden Name), Westford Mass.
13. Birthplace of Father, . Westford Mass.
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . ·
Arthur H. Sheldon
.....
DATED at
Chelmsford
, o1
July 2nd
1892
* 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.
July 2nd 1892 Harriet B, Read
Female
91
Cla ace
rels 11.2
......
North Chelmsford Mass.
[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, liis 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 pull- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body nntil 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 stato- 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 110 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.
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