USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 18
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Commontocalty of massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, .
·
10
(Maiden Name ),* ·
(Name of Husband),*
3. Sex, and whether single,
Married, or Widowed,
1. Color. ¡
5. Age, .
3 Years,
Months,
Days.
Disease or Cause of Death, (Primary and Secondary ), ;
5. 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
tekel zno ford,
9-
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.
. .
·
Chelmsford
Chelmsford
S. r. Howard
. . ..... .. .
[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. 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 furnishi 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 tlie 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 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. Improved Ma 79.99
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN.
To the Board of Health and the Clerk of the City of thelong ford
Undertakers must make this return before the burial or removal of the deceased.
Date of Death,
, May 28
1893 Name ..
George Henry Gould
Maiden Name,
Sex, ........ male ; Color, Les
Single, Married or Widowed,
Age, / years, 2
months,
17
.. days.
Name of Attending Physician, . Ir Hall
Residence of Deceased-No.
north Chelmsford
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
Charth Chelmsford
Street (or Corporation), Ward.
Chath Chelmsford
Birthplace of Deceased,
Father's Name,.
Charles H Gould
Father's Birthplace,
Hopkinton h.H
Mother's Name, Sarah , KB.
Mother's Birthplace, ..
Lowell
Mother's Maiden Name,
Place of Interment,
Edson
Cemetery Rewel ot Inadate
..
Signature of Undertaker or Informer,
Bouvier
1
Dated at Lowell, this
day of.
189 .........
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
may 28.
1893
Name and Sex of Deceased George H6 gould
Place of Death-No.
north Chelmsford
Disease or Cause of Death,
Heart Failure
duration of*
Complications,
Dolary-
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,. 26 7 Hall MEC
Residence, No. 121 Branch
Street
Dated at Lowell, this Lenty winthe day of May -
189 2
*Reckoned to the time of death.
or corporation single married or widowed,
... ....... male,
Street (or Corporation).
Commontocatth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
.
Nora
(Maiden Name),* · (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .
6
Years,
Months,
.Days.
4
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, .
DATED at Mais to Let, on .............. ...... . ...... 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. (1.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. May, 1891 .~ 5,000.
11
11 17
1
Vicentral
ihay 21; ~ 143
.......
[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 licu 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 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.
6
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
(Maiden Name),* ·
4 ...
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
married lite
81
Years .........
Months,
Days.
5. Age, .
Disease or Cause of Death, (Primary and Secondary), ;
6. (Duration of Sickness, . By whom certified, .
War Lehrernberlin
Var, Chelombard
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, .
14. Birthplace of Mother, .
15. Place of Interment, .
DP Bram
DATED at
So Chelmsford
, on
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. Nov. 1890-5,000.
Mary E Mansfield Reed
Jemalo
4. Color, t ·
2 weeks
Bedford
D. C /led fite
1
Signature of Undertaker or other person making the Return, .
Commontocalth of Massachusetts.
[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 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, 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. 189
Ed. Zept., 1889. 5 M.
[ACTS OF 1889, CHAP. 208.] AN ACT
Plate.
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of cach city and town shall on the first day of each month make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certified copies to the clerk or registrar of the city or town in which suel deccased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained ; and the clerk or registrar so receiving sueh certified eopies shall record the same in the books kept for recording deaths or births. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the City of Lowell
(City or Town. )
during the month of. June 1893.
1. Date of Death, . June 6. 1893
2. Name,
(Maiden Name), . (Name of Husband),
Thomas Carroll
3. Sex, and whether single, Married, or Widowed,
Male
Single
4. Color, .
42 Years, Oedema ofthe Glottis
Months, Days.
Disease or Cause of Death,
Que darf
G. Duration of Sickness, By whom certified,. Hist Chelmsford
10. Place of Birth,
909 Middle Street Ireland
11. Name of Father,
Michael Carroll
12. Name of Mother, Bridget Carroll (Ryan)
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Catholic Cemetery Lowell
I certify that the foregoing is a true copy.
Attest : June12 1893
Clerk.
(City or Town.)
John H. nichole m. D
7. Residence,
8. Occupation, .
Labora
9. Place of Death, .
Freband
5. Age, .
Commonbocalth 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
5. Age, . . Disease or Cause of Death,
57 Years,
9 Months,
81 Days.
Dieafter
several Den.
De. Chamberlin
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,.
Daniel Bryan
DATED at To Thomford, on June 9 18 23
* If a Married Woman or Widow.
· If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Feb. 1890-5,000.
Grand Ist
Emeline query
Chelmsford 011 agy
da Chelmsford
1893
malc
Arhite
6. Duration of Sickness, . By whom certified,
Lowell
carmen two
[ACTS OF 18SS, 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 lias 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 negleets 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 lias been delivered to sueli board, or agent or clerk, 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 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 requested, make the same. When sneh 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 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.
No ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name, . . (Maiden Name),*
nathan
12. 1899 B Eachwards.
3. Sex, and whether single, Married, or-Widowed,
4. Color. t . .
5. Ago,
73% . Years, ... ........ Months, Days. Praemia ... .. ... .. ..... ...
Disease or Cause of Death,
6
Duration of Sickness,
Es Ga Harbour La 7
By whom certified, .
7. Residence, . .
8. Place of Death, .
9. Occupation, .
10. Place of Birth, 4
·
Watford Mark Peter
.... ... Inatha
13. Birthplace of Father, .
14. Birthplace of Mother,
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
& & Rawell.
DATED at
Lawell
on
1.2 June
189 3
* 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.]
North lehelmsford ..
Physician
11. Name of Father, ·
12. Name of Mother,
Wenham. Marc
Grafton Mars
North lehehusband.
White
[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.
1
No.
Commontocalth 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, .
Disease or Cause of Death, (Primary and Secondary), ;
6. {Duration of Sickness, . By whom certified,
Dr. Karlow
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, .
Freut Chelmotorel
Signature of Undertaker or other person making the Return, . ·
Stomater & Board of Health.
DATED at
20- Chelmotory, on.
tue, 17, 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. Nov. 1890-5,000.
Anne 17,1893 Jonas 6, Butterfield
manuel
White
75 Years,. 4 .Months, 18 Days. Cerebral meningitis Six weeks
For Chelmsford
Painter
Press Chelmsford
Benjamin Butterfield Eliza Butterfieles Lyngodors, Mais
[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. Sectiou three of chapter thirty-two of the Public Statutes, requiring attending physicians to furuish for registration certain facts relating to deceased persons, is ameuded so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furuish 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 uutil 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 caunot 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- livcred to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
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