USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 14
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Lec
Commontocaith of Massachusetts.
No
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
181
1. Date of Death, .
11
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, ) Years, $ Months, / Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, ·
1 MB. Edwards Meg
7. Residence, . Licit
8. Occupation, . .
9. Place of Death, . .
10. Place of Birth, . r
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
r
DvrEn at
fc+24, on C CT- 14.15/1992
.
* 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.
2
... ...
V
Suicide
. ......... ... ..
Lavisites
[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. 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, 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 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 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 May 4, 1888.
RCC
182
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
12
189 .- X
Name,
Maiden Name,
Sex, Female; Color, 16 . 11.6.2.
Single, Married or Widowed.
Age, ..
.... years, ..
..... months,
.days.
Name of Attending Physician, On Edwood
Residence of Deceased-No. . Youth Chutneyford Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No. CYouth Chetrestout
Street or Corporation), Ward
Birthplace of Deceased, Fruta Thatis Kald
Father's Name,
Johnny Well( Father's Birthplace,
Mother's Name, Mitate u Mother's Birthplace,
Mother's Maiden Name, ce /lernt.tuy
Place of Interment,
Laweil Aba Cemetery Range
., Lot ............ , Grave ..
Signature of Undertaker or Informer,
Dated at Lowell, this
12 th
day of.
189
Physician's Certificate of the Cause of Death
(See extracts from Acts of Legislature below.)
Date of Death,
189.
Name and Sex of Deceased, Activia Badosa .. male,
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death, Choleraini andturn
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 chirias,il day of 1892
*Reckoned to the time of deatlı.
burada
RETURN OF DEATH -OF --
No.
Commonbocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
Och 13 - 1892 Manyet, Jay C
(Maiden Name),* · (Name of Husband),*
William A
3. Scx, and whether single, Married, or Widowed,
1L
4. Color, t ·
3. Age, .
80
Years,
Months,
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, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . ·
. DATED at helasford
Daniel m. George , 01 Oct,14 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. Nov. 1890-5,000.
Storewife
So, Shelves for
Joanaan
Jovane
[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 lias attended a person during his last illness shall, when requested, forthwithi furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the discase 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 healthi 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 sliall 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 pliysician; 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 fortliwithi 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 Muy 4, 1888.
Rec
Commonlocalth of Massachusetts.
184
No.
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,
temale
Married It hite
4. Color,t
J. 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), Freland. ....
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Ireland Lowell Plass ....
Signature of Undertaker or other person making the Return, . .
1x 2 mar to thelec on
DATED at?
18
7.
* 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.
50 Years, Months, Accidental talets prime 2 Weeks
omcushion
John H. Nichols I.D North Chelmsford Las Housekeeper North Enelmsford Mas Freland
It. 20
Honora
Gor Deremich Erowales
[ACTS OF 1888, CHAP. 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 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 therefrom the body of a deceased person until he has received a permit so to do from the board of health or its cluly 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 cnough 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.
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,
4. Color, ¡
5. Age,
Disease or Cause of Death, (Primary and Secondary), # 1
6. ‹Duration of Sickness, . By whom certified,
A Howard us) To. Chacunford
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,
Signature of Undertaker or other person making the Return, .
Patrick. Plcummings
DATED at
Chelaufen
, O11. Der22 189.2
* 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.] l'late. Ed. Nov. 1990-5,000.
Det 21-1892 Daniel Communs
22 Years Months, Days.
Prochaines Pulmonalis
Several months
cro. 6 herford Ireland
Arreman
Johanna (che learthy ... Ireland
4
Lowell
[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 thirec 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, fortliwith 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 liis 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. 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 suchi 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.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
28 -2 1892
Justin ... Howard
2. Name, ·
(Maiden Name),* ..
3. Sex, and whether single, Married, or Widowed,
1. Color. t .
Age,
Disease or Cause of Death,
Duration of Sickness,
By whom certified, ·
7. Residence, . .
8. Place of Death, . =
9. Occupation,
10. Place of Birth, ·
11. Name of Father,
12. Name of Motlier, .
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
DATED at
Kü helmustard
Out. 29th,
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.]
Savec te,
White
22 Years, ... 2 Months, .. 17 Days. Phthisis Tubercolosis
The year
John H. Nichols M.D. North Chelmsford Muss. North Chelmsford Mass. Diachimust" Boston Mass
Saimon Howard Jucy (Arlin) toward Class.
Janson
Amherst . r. N. Pembroke Na
.. .... -Male - C
[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.
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 Mar 12 the
1802
Name,
Derjaren
marshell
Maiden Name,
Sex,. ....... male; Color,
Single, Married or Widowed,.
Single
Age, 81
.years, 11
months
24 days.
Name of Attending Physician,
Residence of Deceased-No.
Chelsea ford Center
Street (or Corporation), Ward
Occupation,
Varmer
Husband's Name,
Birthplace of Deceased,
Chelmsford
Father's Name
Peter Marshell Father's Birthplace,
Mother's Name, Mary
Mother's Birthplace,
Mother's Maiden Name,
Marshell
Place of Interment,
ChilinLand Cemetery Range
Lot .. ...
. , Grave ..
.. ,
Signature of Undertaker or Informer,
2.1
Dated at Lowell, this
7
day of
180 2
Physician's Certificate of the Cause of Death
(Sce extracts from Acts of Legislature below.)
Date of Death, Har 12 The 18920
Name and Sex of Deceased,
Benjamin
O marshell
....... .male,
Place of Death-No.
Chilinfare
Street (or Corporation) .
Disease or Cause of Death,
duration of *
Complications,
Dearund of the heart
I certify that the above is a true return to the best of way recollection and belief.
Name and Professional Title,
lorus le, posto m
Residence, No.
33 Raty
Street
Dated at Lowell, this
13
...
day of
100
Antena to this time of month
189 2
1
C
-
Place of Death-No.
Street or Corporation), Ward
. ...
.. . ...
.......
-- 10-
RETURN OF DEATH
188
Commonlocalthy of Massachusetts.
NO.
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,
Married
White
4. Color,t
5. Age, .
Disease or Cause of Death, (Primary and Secondary),
6. Duration of Sickness, . By whom certified, ·
7. Residence, .
.
9. Place of Death, . .
10. Place of Birth, . .
11. Name of Father,
.
Wrest Chelmsford ness.
Ireland
not Knowon
11 11
13. Birthplace of Father, .
14. Birthplace of Mother, . Y Cord
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur & Sheldon
-
DATED atc
+ Chelmsford, on
Nov. 10th.
1892
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
1 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.
N.B. Edwards A. D. West Chelmsford 1 lass. Laborer
8. Occupation, .
68 Years,
Months, ...
Days.
Cancer
11 months
12. Name of Mother, ( Maiden Name). Ireland
Lowe
Hars.
1
Nou 9th ITy- Patrick Kiernan
Male
[ACTS OF 1888, CHAF. 306.]
AN ACT
RELATING TO THIE 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 Publie Statutes, requiring attending physicians to furnish for registration certain faets 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 deeease. 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 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 eity 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 elerk. 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 state- ment 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 certifieate 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 elerk, make such certificate as is required of the attending physician ; and in ease of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livand to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the elerk
--- whall theronfter furnish for registration any other
Commonbocalthy of Massachusetts.
No.
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, ·
69 Years, 11 Months, 1 .. Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
7. Residence, .
.
-
8. Oeeupation, . . ·
9. Place of Death, . ·
10. Plaee of Birth, . ·
11. Name of Father, ·
12. Name of Mother, araich. enalberta 1 (Maiden Name),
13. Birthplace of Father, .
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