USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 13
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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 nntil 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.
No.
Commontornithy 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,
4. Color,t
5. Age,
.Years,
6
Months,
27 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, .
Ci
DATED at
, on
16/1993 ·
+ Ifa 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, epay what.
[Be very particular to fill all Blanks Plate. Ed. May, 1891 .- 5,000.
/2020
......
·
.
[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, 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 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, 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 transinit 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 finc not exceeding fifty dollars. [Approved May 4, 1888.
1
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),*
C 12 27
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, · 5 Years, 10 Months, 0 Days. Disease or Cause of Death, (Primary and Secondary), # Gamer of Bladder Two years
6. Duration of Sickness, . By whom certified,
7. Residence, .
٠٠٠٨٠٠١٠٠
-
8. Occupation, . ·
.
1. 1. 11 .22, ETC.1
10. Place of Birth,
11. Name of Father, .
Ler02 2. die f
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, . . .
.11.17
DATED at
Cohet2.
Circon
18 /. 1
* Ha 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. ] l'late. Ed. May, 1891 .- 5,000.
2
(, x, 1x 2.
1
.j ores. 122 c
Fiai iced Ihre
1
9. Place of Death, . . ·
[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, 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 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 deatlı 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 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.
T
Commonwealth of Massachusetts.
176
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
September 13 1892
2. Name,
Mabelle & Fletcher
(Maiden Name),*
Mabelle E. Ward.
(Name of Husband),*
Fi.b L. Fletcher
3. Sex, and whether single, Married, or Widowed,
Married. White
24 Years Months, 12 Days.
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,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Chelmsford ........
Signature of Undertaker or other person making the Return,.
-
DATED at ..
, on S
189.2
* If a Married Woman or Widow. . If other thau White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Feb. 1890-5,000.
John Holyoke Nichols M!) Chelmsford
Dressmaker
Chelmsford
Chelmsford
John W. Ward
Juran Emma Ward
Chelmsford
Charisfond
Female
4. Color, t
5. Age, Disease or Cause of Death,
Chronic Rheumatism Six months
------
[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, 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 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 towu 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 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 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 deecased 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.
Rcc
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name, ..
Pil lée teller
(Maiden Name),* ·
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
62 . Le
4. C'olor, t
5. Age,
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, .
If. Birthplace of Mother, .
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, . ·
1 1
DATED at
1
26. 189.2.
* If a Married Woman or Widow. If a Soldier who served in the War of the Rebellion.
If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1891 .- 5,000.
1
S
‹
.....
.Years, Monthis, Days.
........
Ch. 1, . , .LC
V
[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, 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 exeeeding 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- i 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 dc- livered to the board of licalth 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 thercafter furnish for registration any other information as to the deeeascd 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.
178
Commonwealth of Massachusetts.
10.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Lowcy r. avidson
(Maiden Name),* ·
(Name of Husband),*
Giddings
Robert 2. Lavieson
Female
3. Sex, and whether single, Married, or Widowed,
Widow
White
4. Color,t
5. Age, .
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, . . Jaun de bono / tv. John Giddings 11. Name of Father, · Mary (Hadley) Giddings
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
V Prelmsford hass.
Signature of Undertaker or other person making the Return, .
DATED at A. Chelmsford, 011
×
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. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1891. - 5,000.
22
84 Years, 3 Months, .2.2 .... Days. Bronchitis
11 days
A. B. Edwards 1. D. Forth Chelmsford Class
North Chelonsford 1
Rec
[ACTS OF 1888, CHAF, 30G.]
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 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 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 sueh 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 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 perinit 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 ut tion shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
-
179
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
189.2 Name,
+?
instituto
Maiden Name, Sex, male; Color, 417
Single, Married or Widowed,. ...........
Age,
....
.. years,
months, 4 days.
Name of Attending Physician,.
Residence of Deceased-No ... theterristured cias Street (or Corporation), Ward
Occupation, .
Husband's Name,
Place of Death-No.
1 Street -or Corporation), Ward
Birthplace of Deceased,
Father's Name,
leccian Rett Ce la Father's Birthplace,
Mother's Name,
Mother's Birthplace,
Engianee
Mother's Maiden Name,
Place of Interment,
Energ Conzettany Cemetery Range /0, Lot. 7.47, Grave.
. .. ,
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
189
Physician's Certificate of the Cause of Death.
(See extracts from Aets of Legislature below.)
Date of Death,
189 2.
Name and Sex of Deceased, Leiteit
male,
Place of Death-No
Street (or Corporation).
Disease or Cause of Death,
Dvaniture
duration of * aral/18du).
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, 6- 78 5 lambert ....
Residence, No. Chelustra_
Street
Dated at Lowell, this
day of
189 2
* Bootsmed to the ti
RETURN OF DEATH -OF --
.........
....
180
Ree
...
Commonwealth of Massachusetts.
150
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,
male.
married.
4. Color, t . ·
5. Age, .
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
7. Residence, .
8. Occupation, . .
9. Place of Death, . 1
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, ( Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
Signature of Undertaker or other person making the Return, .
S
DATED at
Chelmsford
, Oll
Oct 911.
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.
....
Chelmsford Farmer.
ord-
Chelmsford.
Anos Baram
Lucy Adams.
Chelmsford
15. Place of Interment, 11 S. R. Howard
Oct. 9 ch. 1892. Amos A. Hyam.
84
Years,
1
Months,
Days.
[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 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 siekness, and the date of his deecase. If a physician negleets or refuses to make a certificate, as aforesaid, he shall be pull- ished by a fine not execeding fifty dollars.
SECTION 2. Seetion 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 eity or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or elerk, as the ease 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 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, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certifieate as is required of the attending physician; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clorl- or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration information as to the deceased or to the manner and eause of the death, as the clerk or registrar may require. A violating any of the provisions of this seetion shall be punished by a finc not exceeding fifty dollars. [1p >>
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