USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 22
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Mother's Name, Chaly
Mother's Birthplace,
Mother's Maiden Name!
marcran
Place of Interment,
, Lot
Grave
Signature of Undertaker or Informer,
Daled at Lowell, this
day of
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.
Date of Death
Sept Eighteenth 189.3
Name and Sex of Deceased
girl name as
above
Fe male
male,
Place of Death - No.
..... Street (or Corporation).
Disease or Cause of Death
duration of *
Complications,
wio general attuply
....... ... I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
14
Central
Street
Dated at Lowell, this
Sept 10g
day of
189 3
U
* 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. ]
RN OF DEATH - OF -
.... 189 . ..
Ree No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
3.
2. Name, .
(Maiden Name) ,* .
(Name of Husband),*
.. ..
7
3. Sex, and whether single, Married, or Widowed,
4. Color.t
5. Age,
2 Years, 7
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, . ·
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
, on
18 5.
* 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.
2.1
.
1
[ACTS OF 1888, CHIAF. 30G.]
AN ACT
RELATING TO THIE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enucted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pull- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person nntil 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 suchi 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 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 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.
1
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
.
J
2. Name,
(Maiden Name),* · (Name of Husband) ,*
3. Sex, and whether single, Married, or Widowed,
LE-ETC.1
4. Color, t
5. Age, Years, 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, . Č ...
11. Name of Father,
12. Name of Mother, . (Maiden Name),
13. Birthplace of Father, . C. .. Lic ...
11. Birthplace of Mother, .
15. Place of Interment,
......
Signature of Undertaker or other person making the Return, .
1 .
1 (
DATED at
1
C
-
18 2.
* 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.
[ACTS OF 1888, CHAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Seetion three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration eertain faets relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his 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 chuly 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 10 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 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 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 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 execeding fifty dollars. [Approved May 4, 1888.
PLEASE FILL OUT WITH INK.
2
UNDERTAKER'S
RETURN
To the Board of Health and the Clerk of the City of Lowell.
Date .of Death, Lift 29"
Undertakers must make this return before the burial or removal of the deceased.
Name
Thomas Regan
Maiden Name,
...
11
1
Sex, ........ male ; Color
Single, Married or Widowed,
Name of Attending Physician,
Gast Befunden 8 Com 1
Street (or Corporation), Ward
Occupation quellabe Maperatura
Husband's Name,
Place of Death - No. Opet Chamoford Street (or Corporation), Ward
Birthplace of Defense
Ogland
Reagan
Porland
Mother's Name,
Mother's Birthplace,
.....
.. ...
Mother's Maiden Name,.
Place of Interment,
batholen
Signature of Undertaker or Informer,
Daled at Lowell, this
day of
189 .......................... .
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.
Date of Death 189 . ......
Name and Sex of Deceased
. ..........
. ......
Street (or Corporation) .
Place of Death - No.
. ... . .......
Disease or Cause of Death
Consum
duration of *
Complications, I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, E.l. Je
Residence, No. 161 laura Street
Dated at Lowell, this
Jefftimber2 day of
/
18933
......
welke married or widowed, and insert "fe" before male
. . ... .
male,
Father's Name, Thomas
Teaga Father's Birthplace,
1
Age 45 years, months, .. .days.
Residence of Deceased --- No.
RETURN OF DEATH - OF --
: ....
189
Commonlocalth of Massachusetts.
No.
. RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1893
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, (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, .
DATED at L 23 ,192-1, 011
* 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 fili all Blanks.] l'late. Ed. May, 1891. - 5,000.
********* ****** . .
L .
·
...
& Addie ((Betteridge) Chelasford
C
Years, 6 .. Months, 6. 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 thrce 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 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 cnoughi 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.
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,
Oct. 1.1"
Name Johanna Sullivan
Maiden Name, ..
.
Sex Le male ; Color,
Age 65 years,.
months,
.. days.
Single, Married er Widowed,
Name of Attending Physician,
Dr. Plunkett
Residence of Deceased --- No.
Chelunsford Centre
Street (or Corporation), Ward
Occupation,
at Harque
Husband's Name,
C
Place of Death -No. ..
Chilunsford Centre
Street (or Corporation), Ward
Birthplace of Deceased,
Ireland
Father's Name,.
Father's Birthplace,
Mother's Name, .
L
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Catholic
Cemetery Range
, Lot
·
Grave
.. . .
Signature of Undertaker or Informer,
Javers V. O Donnell
Daled at Lowell, this
11"
day of
October
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.
Date of Death
/1
189
Johanna
Sullivan
male,
Place of Death - No.
Chelmsford Centre
Street (or Corporation).
Disease or Cause of Death
Pertanto
duration of *
Complications,
I certify that the above is a truc return to the best of my recollection and belief.
Name and Professional Title, ....
Flo Plunkett, il 2
Street
Residence, No.
day of . .
October
189 3
Dated at ed at Lowell, this.
9 3
Name and Sex of Deceased
HET IS OF DEATH - OF -
189
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) ,*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, . ·
10. Place of Birth, . .
11. Name of Father, .
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
October 20(B) 1893
John C. Dane
male.
White
12 Years,
7
Months,
16 Days.
Typhoid Fever
Three weeks.
Dr. John Barthel
Wer Chelmsford
Student
West Chelmsford
Innasbon
Chas Dane
Westfire, mass).
methnem, mads.
West Chelmotorer.
Signature of Undertaker or other person making the Return,.
Vanhidden
Jo Chalmaford
DATED at
agony
, on.
Costata 20
1843.
* 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.
[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, fortliwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died. the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pull- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written 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 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.
.
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) .* . .
oct-21 Clair Roark Chung LE Duke
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. Place of Death,
.
Michalmotore David La Duke
(Manquerelle)
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,
Asshidden
DATED at
Hert Chili 2/10 on Oct 23
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.]
Hurt Chulmaths
10. Place of Birth, ·
. Name of Father,
·
St Um Delagrade Pr
marke
Hert chelmsford)
25 Years. 4 Months, .. Days.
Child Birth
9. Occupation,
[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 dangcrous 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.
>
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
Oct 2231 1895
1. Date of Death,
2. Name,
(Maiden Name),* · (Name of Husband),*
di le
chiusied
4. Color, t
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
7. Residence,
8. Oceupation, . .
9. Place of Death, . .
.
Greenfield 's 6
10. Place of Birth, . .
11. Name of Father, ·
Les reation
12. Name of Mother, . (Mai:len Name), . Best & ir taj.
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . ·
KOP Bya
DATED at
, 011
@af 73
18
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.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] l'late. Ed. September, 1892 .- 5,000.
to sell
3. Sex, and whether single, Married, or Widowed,
67 Years,
1
Months,
.Days.
7 days
.
Jean- teiner s 26 Greenfield 21. 26
[Public Statutes, Chapter 32, as amended by .Acts of 1888, 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 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 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 fine not exceeding fifty dollars.
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