USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 15
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14. Birthplace of Mother, .
15 Marca
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
5
1
DATED at
1
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.
189
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. 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 (luly 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, 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 fortliwith countersign and transmit the samc 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, 18S.
190
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN.
To the Board of Health and the Clerk of the City of Lowell.
PUndertakers must make this return before the burial or removal of the deceased.
Date of Death
189.2 Name, at.
Higgins
Maiden Name,
Sex, ......... male; Color,
Single, Married or Widowed,
Age, 7 years months,.
.days.
Name of Attending Physician, ...
Derochet's
Residence of Deceased-No. Giccheremed
Street (or Corporation), Ward
Occupation, - Husband's Name,
Place of Death-No. cluelessand
Street or Corporation), Ward
Birthplace of Deceased,
Father's Name,
1205/6/22-2022-
Father's Birthplace,
Mother's Name,
Ellen
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment
Controlic Melk Sfuso Cemetery Range
.....
.. , Lot .. .
, Grave ..
A
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
189.2
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Nov 6h
1892
Name and Sex of Deceased,
John Higgins
male .male,
Place of Death-No.
Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Jungle Fever
duration o
3 days
Complications,
Gleminy
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
John HOVichols MM.2
Residence, No ..
chelmsford Mass, Lowellstr
Street
Dated at Lowell, this
Comeinfood south
day of . L.
November
1892
-
RETURN OF DEATH
-OF-
. . . .
1 80 ..... ..
19/
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deathı, .
2. Name,
(Maiden Name),* . (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Male
IMharried
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 Birthı, . ·
·
11. Name of Father, .
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, . 1
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
5 Years 2 Months, 15 Days. Inanition 14 days
N. B. Edwards At.2. North Chelmsford hass. Stone Cutter
North Chelmsford bass.
Thomas Vraglen Mary(Lake) Varier England Eine Land
North Chelunsford Meso.
DATED at
V. Chelmsford, on
19th You. 18%
* If a Married Woman or Widow. { If a Soldier who served iu 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.
Nov. 18th 1892 John D. v harley
[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 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 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- i ment containing the facts required by this chapter to be returned and recorded, together with the certificate of thic attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hercinafter 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 violenee, the medical cxaminer 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, ISSS.
Rec No.
Commonwealth of Massachusetts.
192)
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
(Maiden Name),* . 1. Sheridan · Michael 119 Phillips
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t .
5. Age,
(Disease or Cause of Death, (Primary and Secondary), # 6. Duration of 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, .
S
DATED at Forth Chelmsford ) Nov. 21st
1892
* 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.
ternale
Harned White
30 Years, Months, Days. Puerperal Sever 4 freeks
et varcon Il. L. Forth Chelmsford these Housekeeper
North Chelmsford- Mars Ireland
Dames Sheridan C Mary (Finnegan) Theredan Ireland
Ireland
Lowell plass.
Arthur to Sheldon
You. 20th ,872 Ann 11: Phillips
[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 furnishi 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 negleets or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding 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 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 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 sueh 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 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.
-
Celto.
Commonwealth of massachusetts.
193
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 IInsband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), t
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Oecupation, . .
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, . .
.
Grafton N. M.
Ponainon steeper
tvary[reare) Sice per Grafton r.N.
Mdr Known
Forth Chelmsford Mass
Arthur & Shexion
DATED at
Michelinword
, on
Dez. 2"
1872
t If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. tlf 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.
Lez. 24th /-2 Sotonin, exper
rate
Married
61 Years, 4 Months, 1 Days. Heart disease
mce years
Y. 12. Exwards 11. 2. North to bekons and Was. Farmer
Forth thekanstord Class.
[ACTS OF 1888, CHIAP. 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 faets relating to deeeased 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 deeease. If a physician negleets or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding 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 sneh 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 elerk, make such certificate as is required of the attending physician ; and in case of death by violence, the medical examiner shall, if regnested, 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 elerk 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.
Nô.
Commonwealth of Massachusetts.
19-1
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, Y + Years,
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom eertified,
7. Residenee,
€ 1. 1 2.1
8. Occupation, .
.
9. Place of Death, . ·
L - L. ( ....
10. Place of Birth, . ·
.... LE
11. Name of Father,
.
12. Name of Mother, · (Maiden Name),
13. Birthplaec of Father, . trestiv. 1
14. Birthplaec of Mother, .
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
DATED at L { on 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.] Plate. Ed. May, 1891. - 5,000.
.....
....
... . . 1,
.
....... ....... ........
....
.. . . . . .
V
.......................
.....
.. ... .....
Months, Days.
... ............................
......
- 209
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. 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 deceasc. 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 reecived 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 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.
S
Ree
No.
Commonlocalth of Massachusetts.
195
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),*
Asa Preston
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .
Years, ........
Months, 1 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,
Lowell - Edson Cemetery
Signature of Undertaker or other person making the Return, .
Q.K. Howard
DATED at
, on
Jan 2ml
1893
* 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.
.. . . ...
. .
Housekeeper
Calais
Calais NS-
Noah Power Ruth Gerry
1
1
Limara Ul-verlor
[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 sueli 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, 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 not exceeding fifty dollars. [Approved May 4, 188.
C
-
Rel 10.
Commonwealth of Massachusetts.
176
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name) ,* ·
Leroy
3. Sex, and whether single,
Married, or Widowed, ..
4. Color, t · .
.
5. Age, . ·
. .
Disease or Cause of Death, (Primary and Secondary), t
6. Duration of Sickness, . By whom certified,
7. Residence, .
.
......
8. Occupation, . .
9. Place of Deathı, . . ·
10. Place of Birth, . ·
11. Name of Father, ·
аве ОдеТя
EMGodina
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, .
, 1.
DATED at
on 18
* If a Married Woman or Widow. tlf a Soldier who served in the War of the Rebellion.
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