USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 16
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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.
6
. ....
(Name of Husband),*
41
Plazziert
· 4
.. Years, 8 Months, Days.
tohle + istry
C
1
[ACTS OF 1888, CHIAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enucted, 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 siekness, and the date of his decease. 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 duly appointed agent, or, if there is no board of health in such eity 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 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 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 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 clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other 'r;formation as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person latinz any of the provisions of this ›u shall be punished by a fine not exceeding fifty dollars, 7. May 4, 1888.
Rec No ..
Commontocalthy of Massachusetts.
197
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. Scx, and whether single,
Married, or Widowcd,
4. Color, t
5. Agc, . ·
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, .
(
7
J. K. Herard
18 .3
* If a Married Woman or Widow. { If a Soklier 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. ] Plate. Ed. May, 1891 .- 5,000.
59 Years, 1 Months, 23 Days. Partici Hemorrhask 2 days
Princeton Mas Hasselton Wilson Alzijn Wheels Projector Mars
DATED at
Ja, 23, 15,0
hasen & 15its. ......
[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 of 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 hercinafter provided. If there is no attending physician, or if the certificate of thc 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 dceeased 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.
Commonwealth of Massachusetts.
198
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
›. Age,
Disease or Cause of Death,
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,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
DATED at.
Chelmsford
, On
Help 2
1893
* 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.] Plate. Ed. Feb. 1890-5,000.
George
Joye
Daniel Il Grange ...
11
. ........
53 .Years, Months, Days. bangestion of Nerves
So Cheenword Housewife So. Cheers /porel
Millian 1 0ml Maria
11
Lan, 31 -1893
Anna
[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 aud belief, the uame of the deccased, 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 uutil hc has received a permit so to do from the board of health or its chily appointed ageut, 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 coutaining the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by sectiou three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no atteuding 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 trausmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish " information as to the deceased or to the manner and cause of the death, as the clerk or registra- tration any other Any rerer . ting any of the provisions of this section shall be an ished by a fine not exceeding fifty doll. ..
1
Rel
Commonlocalth 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),*
Marc ........
3. Sex, and whether single,
Married, or Widowed,
Single
I'Mrite
4. Color, t
5. Age, .
Years,
Months,
4
Days.
Disease or Cause of Death,
1
(Primary and Secondary), #
Meningitis
if clar, 8
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, . Ireland
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . . ·
Arthur H, Sheldon
DATED at A Chelmsford
Feb. 25th
1893
* If a Married Woman or Widow. f 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.
N.13 Edwards 11.1. North Chelmsford LLess
North Glukosjord Hass North Chelansford Alos5
Bridget(Sheridan) / relish Ireland
Lowell Mass
tel. 24th 1843 Martin John Welsh
[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 siekness, and the date of his deeease. If a physician negleets or refuses to make a certificate, as aforcsaid, he shall be pun- ished by a fine not cxeceding 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 deecased 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 sueh permit shall be issued until there has been delivered to sueh board, or agent or elerk, as the case may be, a satisfactory written state- t 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 section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is 110 attending physician, orif the eertificate 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 certifieate are de- livered to the board of health or to its agent, the board or agent shall forthwith eountersign 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 1 violating enT
Rec
Commontocalth 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
while
. .. . ..... . ..
72 Years,
Months,
20 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,
Signature of Undertaker or other person making the Return, .
W. P. Bram
March 1 189.9
DATED at.
Saulty ( nelpreford
athal,
Samanth Dani's
Gardner
New Bedford h.t.
*****
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (1.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Feb. 1890-5,000.
200
March /2) Fredrick & havs
5. Age, Disease or Cause 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 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 licalth 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 sncli 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 thercof a certificate as hereinafter provided. If therc 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 snch 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 snch 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 registrati information as to the deceased or to the manner and canse of the deat1 ·anvist
un' hed by a
·revisione: +
No.
Commonlocalth of Massachusetts.
201
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, . Disease or Cause of Death,
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, . Ireland
14. Birthplace of Mother, .
15. Place of Interment,
Lowell Mass.
Signature of Undertaker or other person making the Return, .
Arthur +, Sheldon
DITED at AV. Chelmsford, on March 16th
1893
* If a Married Woman or Widow. t If other than White. (M.) Mulatto. (1.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. Feb. 1890-5,000.
March. 1 . + Vergani Itine
Jueur /.2.4
Female Widow White .......... ..
25 Years, Months, Days. Consumption - 6 months ............. ........... N. B. Edwards U.D. North Chelmsford Haus.
North Chelmsford Stars.
Ireland
Incloud
[ACTS OF 1888, CHIAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Scction three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a persou during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. 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 thercfrom 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 towu, from the city or town clerk. No such permit shall be issued until therc has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such 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- livercd 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 furuish 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.
Rer
Commonwealth of Massachusetts.
202
No ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
11-2/2011 2x- 553
2. Name, .
Francais
(Maiden Name),* . .
3. Sex, and whether single, Married, or Widowed,
J.
4. Color, t .
5. Age, Years, 7 Months,./3 Days.
Disease or Cause of Death,
6 Duration of Sickness, .
By whom certified,
7. Residence, . .
8. Place of Death, . .
9. Occupation, . .
10. Place of Birth, ·
11. Name of Father,
12. Name of Mother, . 0
13. Birthplace of Father, ·
14. Birthplace of Mother, .
15. Place of Interment, .
tai fax ...
Signature of Undertaker or other person making the Return, .
DATED at !
., on .
1
18 2
* 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.]
.. . .
.....
-12
.
Hacían
.
1
.. .. . .........
.
[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.
203
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, March 29
189 ....
Name
Mary alleure
Maiden Name,
Sex, ... .male; Color,
Smgle, Married or Widowed,
Age,
..... ..
8 2 years,
.months,
days.
Name of Attending Physician,
a comer
Residence of Deceased-No.
East chelmsford
Occupation,
at Horn
Husband's Name,
Place of Death-No.
Cast chelmsford ruats
Street (or Corporation), Ward
Birthplace of Deceased,
Mark Buckle
Father's Birthplace,
Dukunne
Mother's Name,.
Margaux ..
Mother's Birthplace, ..
. .. ...
Mother's Maiden Name, Margaret barbar
Place of Interment,
Cothatve
Signature of Undertaker or Informer,.
Dated at Lowell, this
2C/ ML
day of
11/11.1
18923
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
March
29
189 2.
Name and Sex of Deceased ..
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