USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 2
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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),*
Galerie Hvala
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, . .
.
Glacesche,'
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
1.1.1.120
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 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.
94
Lasehr sch
69 .Years, Months, ............. Days.
. .
[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 threc 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, 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 such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, orif the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and 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.
Ree
95
[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,
April 6th
189 ...
Name,
Lilla SA Rice
Sex,
male; Color
Maiden Name,
e . . .... .. .. .
Single, Married, or Widowed, Age, UM years, 3 months, days.
Name of Attending Physician,
Residence of Deceased-No.
Chalwexlerd Street (or Corporation,) Ward
Occupation, Life 2011/8/ „Husband's Name,
Place of Death-No.
Street (or Corporation,) Ward
Birthplace of Deceased, Highgate Ut
Father's Name, Franklin Rice Father's Birthplace,. Sheldon 201
Mother's Name, Mother's Birthplace, Highgate .... .....
Mother's Maiden Name,. ... ..
Place of Interment, Chelmustard Cemetery Range, ., Lot . ... , Grave
Signature of Undertaker or Informer,
day of A/21:(
189 .....
Dated at Lowell, this
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
[See extracts from Acts of Legislature below.]
Date of Death,
Name and Sex of Deceased, Silvia of Rece 189/.
4 Cmale.
Place of Death-No. Chelmsford Road
Street (or Corporation).
Disease or Cause of Death, consumption of love ( duration of* 4 heal Complications, ...... . b.
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, 1. ....
Residence, No ...
Street
Dated at Lowell, this
day of
189/
Rice
RETURN OF DEATH -OF-
..
. ........ 189 .. ....
Commonwealth of Massachusetts.
NO.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Date of Death,
March 31st- 1891 Joseph Cummings
2. Name, .
(Maiden Name),* . .
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
Male - Single White me hour
Tears, ....... Months; -Days.
Difficult birth ......
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,
13. Birthplace of Father, .
14. Birthplace of Mother,
15. Place of Interment, . ·
Signature of Undertaker or other person making the Return,
Arthur H, Sheldon
DATED at
A. Chelmsford, on March 31st
1891.
* 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.]
4
5. Age,
Ermasa Howard M.D. North Chelmsford Mass North Chelmsford Mass.
North Chelmsford Mass. Patrick P Cummings Julia Harrington Cummings Ireland North Chelmsford Mass. Lowell Mass.
[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.
4
?
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, .
Maren Ellen Svinn
(Maiden Name),* (Name of Husband) ,*
.......
Single -
4. Color, j ... . .... . .... .. Months, Days.
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, 62
12. Name of Mother, .
March Iv. " com - (drather.) incds-
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
DATED at
.. . .......... , Oll 18
* 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.
96
Paralysis
.. ...... ...
.
Dnes Howard
Salem-
68 Years,
3. Sex, and whether single, Married, or Widowed, .. . ....
[ACTS OF ISSS, 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 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 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 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- 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.
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Apr. 27th 1891 George W. Whidden Jr.
2. Name, . .
(Maiden Name) ,* . ·
3. Sex, and whether single, Married, or Widowed,
.. ... ..
Male - Married
White
4. Color, t . .
5. Age,
27 10 Months, . .Years, 10 Days. Congestion of lungs. From collapse of lungs 5 years
Disease or Cause of Death, S
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,
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, . ·
Signature of Undertaker or other person making the Return, . .
Arthur H. Sheldon
DATED at
N Chelmsford, on hr. 27th
1891.
* 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.]
N. B. Edwards M.D. North Chelmsford Mass. North Chelmsford Machmust Manchester N.A. George W. WWhidden
Catherine M(Cowan) Whichden Westford Mass. Nashua N.H. North Chelmsford Mas.
[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.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
(Abril
28 Susan & Ward
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 6 Years, 11 Months, Days.
Disease or Cause of Death, 6
8
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
Hause Kiewier
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, .
DO Mandfield
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
to thelion
C 1
Signature of Undertaker or other person making the Return .
... 1 LP By am
DATED at
So Chelmsford.
, On
april 28
18
* 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.] l'late. Ed. Feb. 1890-5,000.
1
So Chelons hard
[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 uudertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased persou until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; aud in case of death by violence, the medical examiner shall, if requested, make the samc. 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.
20 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),*
1 cm
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, 22. tt. 1 1
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
L
X .......... ...
DATED at . ......... ........ of , On. .... ......
18
* 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.
98
......
.
·
. ....
1
2
Years, 1 Months, 1 Days.
[ACTS OF 1888, CHAF. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. 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 neglects or refuses to make a certifieate, as aforesaid, he shall be pun- ished by a fine not exeeeding 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 sueh eity or town, from the eity or town clerk. No sueh 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 thercof a certifieate 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 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 sueh 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.
Ree
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
11. 1.
///
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,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, V
12. Name of Motlicr, (Maiden Name), , -
13. Birthplace of Father, .
14. Birthplace of Mother, .
ILL
...... 11
........
15. Place of Interment, L
1 .....
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.
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.
98
11 Years,
.... Months, L.Days.
r. L.
No.
E
)F
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOV 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 bnry in a city or town or remove therefrom the body of a deceased person nntil he lias 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 snch city or town, from the city or town clerk. No such permit shall be issned 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 enongh 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 requested, make the same. When such satisfactory statement and certificate are de- livered to the board of healthi 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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