USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 21
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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),*
·
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
.Years,
Months,
5
Days.
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, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
2
DATED at ., on
18
.
1
ice 1
é iennon (
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.] l'late. Ed. September, 1892 .- 5,000.
[ Public Statutes, Chapter 32, as amended by Acts of 1838, Chapter 305 ; Acts of 1839, Chapter 224.]
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 negleets or refuses to make a certificate, as aforcsaid, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate eausc of death as nearly as he ean state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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 statement 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 siid 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 delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the elerk 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.
236
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, Aug 26ª
1893.
Name
Unal
Sex, fremale ; Color, White
Age, .... years, ..
1
months,
19 days.
Single, Married or Widowed,
Name of Attending Physician,
Pike
Residence of Deceased -- No.
Chelmsford
.Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death -No. .
Chelmsford
Street for Corporation), Ward
Birthplace of Deceased,
Father's Name,
Charles & Vinal
Father's Birthplace,
Lawell Michh
Mother's Name,
Lizzie.
.
Mother's Birthplace,
Northbara More
Mother's Maiden Name ..
Lizzie
Davis
Place of Interment,
Edsonet
Cemetery Range
, Lot
, Grave
Signature of Undertaker or Informer,
Daled at. Lowell, this
26€
day of
IS9 3
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.
Date of Death
1893
Name and Sex of Deceased
vinal
. ...
finale,
Place of Death - No.
Street (or Corporation) .
Disease or Cause of Death
Mariannes
duration of *
3 weeks
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
7gr .Deke Ma
Residence, No. .
thelunsford.
Street
26%
Dated at Lowelly this To thelenford Any day of
1893
* Reckoned to the time of death.
[Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married or widowed, and insert "fe" before male when the deceased is a female, and when the deceased is colored, please insert. ]
Maiden Name,
RD
----
189
Commontucatth 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,
Single White
4. Color, t
5. Age, . . Years,. 5 Months, 9 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,
North Chelmsford Hars. North Chelmsford Mars. David A. Eller Clara (Hurd) Pollen
12. Name of Mother, (Maiden Name), 13. Birthplace of Father, . traversice 11ass. 14. Birthplace of Mother, . Haverhill Class. North Chelmsford Class,
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur to Sheldon
DAATED at.
-
ineford, on
Sept. 15th
1.893
+ If a Married Woman or Widow. f 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.
Geht. 14th 1893 Amy Rose Poller 1
Female
Marasmus
4 weeks
4. VV. Like 1.2
North Chelmsford Plass.
[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 physiciau 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 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.
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),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Widower ..............
4. Color, t
85 Years,
8
Months,
14 Days.
5. Age, ·
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . 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,
Daniel P Bran
DATED at.
South Chelmsford, 011 Sehr 10th
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.] I'late. Ed. September, 1892 .- 5,000.
One year
South Chelmsford Mass.
Charmer
South Chelmsford Mease. Hudson. 01.26
Games Me, elvino
Bugammal Barnett Chelmsford Mease Londonderry N. H. Lowell Mars
Signature of Undertaker or other person making the Return, .
Sept 10th 1893 John B. Melvin
[Public Statutes, Chapter 32, as amended by Acts of 1838, Chapter 305; Acts of 1889, Chapter 224.]
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 punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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 statement 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 delivered 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 deccased 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 (lollars.
Commontocalth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
+ 11 Elisabeth Mille
2. Name,
( Maiden Name ) ,* .
Elisabell,
(Name of Husband),*
Azdren Feller
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, . ·
: Years, 1 Months, .. Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, . .
10. Place of Birth, . Jame of Father,
12. Name of Mother, (Maiden Name).
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Edson Cemeter Larache
Signature of Undertaker or other person making the Return,.
DATED at - Ful. L.
Site tienda/1899
* 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.
1
Halbert
Maister Seattarzal 1
1
1
1
3. cal ((x2 )
1/2/12222/0201
Jaister collina
[ACTS OF 1888, CHAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain 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 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 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 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 sueh eity or town, from the city or town clerk. No such permit shall be issued until therc has been delivered to sueli board, or agent or elerk, 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 certifieate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or 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 arc de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the elerk or registrar for registration. Thic 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 seetion shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
I
Commonlocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Sept. 11th 1893 William Henry Lugter
(Maiden Name),* ·
(Name of Husband),*
Hale
Frale
3. Sex, and whether single, Married, or Widowed,
4. Color, t
J. Age,
5 minutes Years, Months, Days. Ashlixia 1
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
5 minutes 7. W Pike M. D.
North Chelmsford Class.
7. Residence, .
8. Occupation, .
'9. Place of Death, . .
10. Place of Birth, .
·
11. Namc of Father, ·
12. Name of Mother, (Malden Name),
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
1. Chelmsford
Sept: 11th
1.93
* 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.) Indlan. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. May, 1891. - 5,000.
North Chelmsford Mass. North Birimsford Mas. Villramon. Quigley Margaret Me Babe) Quigley North Chelmsford Mass. North Chelmsford Mass, Powell Mars.
No.
[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 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, thic 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 finc 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 deccased person until hc 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 casc 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, carly 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 samc. When such satisfactory statement and certificate arc 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 decease to . he manner and cause of the de the clerk or registrar may require. Any person violating any of the provisions this eş
odling fifty dollars. [Approved May 4, 1888.
1
Commontocatthy 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),*
Dicale - finale
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
7 Years,
Months,
Days.
Disease or Cause of Death, (Primary and Secondary),
6. {Duration of Siekness, . By whom certified, .
7. Residence, ·
8. Occupation, .
9. Place of Death, .
10. Place of Birth, . ·
11
11. Name of Father, . ·
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
. 15. Place of Interment, /1
Signature of Undertaker or other person making the Return, .
5
1. 2
2.0 1
11
DATED ats
ind, on afecta
1823.
/
* 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. September, 1892 .- 5,000.
1.21
.
Setite 18 1893.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224.]
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 punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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 statement containing the facts required by this chapter to be returned and recorded, together with the certificatc 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 delivered 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 finc not exceeding fifty dollars.
20
PLEASE FILL OUT WITH INK.
UNDERTAKER'S
ETURN
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,
189 U .. Name
Maiden Name,
.... ..... ...
Sex, .... .
.male ; Color,
Single, Married or Widowed,
Age,
. years,
months, days.
Name of Attending Physician,
Residence of Deceased -- No. forth Chehope Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death 1 No North Chelmsford
:
Birthplace of Deceased, .. Jak: Quence Father's Birthplace, Father's Name, ...
Street (or Corporation), Ward Druhand
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