USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 23
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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, Oel. 28#
1893 Name
matthew
R Johnson
Maiden Name,
Sex, .male; Color, au
Single, Married or Widowed, Manuel
Age, 13 years3 3
months,
days.
Name of Attending Physician,
Dr Arash
medical Of
Residence of Deceased -- No.
Chelmsford Centre
Street (or Corporation), Ward
Occupation,
Operative
Husband's Name,
Place of Death -No. Chelmitau Centre
Street (or Corporation), Ward
Birthplace of Deceased, Zona Deatia
Father's Name,
Johnathan Johnson Father's Birthplace, Nova Scotia.
Mother's Name,
many of ".
Mother's Birthplace,
Mother's Maiden Name, . many of love
Place of Interment,
Edsort
Cemetery Range
.......... , Lot
Grave
Signature of Undertaker or Informer, DasWBwork
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
61.28#
Name and Sex of Deceased Mother matthew
IS9 3
Johnson
male,
Place of Death - No.
Chelmsford Centre
Street (or Corporation).
Disease or Cause of Death Sucede by Apague duration of * ...
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, .
ft. With Medical Exam
Street
Residence, No.
...
Dated at Lowell, this
28
day of
CO cl-
189 3€
...
....
DEATH
-OF -
189
Commonwealth of Massachusetts.
~10.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Non, 8th 1893 Thomas I. linkham
2. Name, ·
(Maiden Name),* (Name of Husband),*
Male
3. Sex, and whether single, Married, or Widowed,
Widower Vrhitt
4. Color. t · .
81
Years,
10
.Months,
27 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 Deatlı, .
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, .
Arthur H, Sheldon
DATED ate
A. Chelmsford
OUI Aos 92.
1873
* 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. May, 1891. - 5,000.
Hepatitis 3 weeks
C. S Havious West Chelmsford Mass
West Chelmsford Mass Durham N.A. Bollard Pinkhom Mary( Folsom) Pinkham Newburyport Mass, Newburg Most Mass. North Chelmsford Mass,
[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 sickness, and the date of his deecase. If a physician negleets or refuses to make a certificate, as aforesaid, he shall be pun- islied by a fine not exceeding fifty dollars.
SECTION 2. Seetion five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No sueh permit shall be issued until there has been delivered to suchi 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 seetion three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is uo attending physician, or if the certificate of the attending physician eannot 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 ease of death by violence, the medical examiner shall, if requested, make the same. When sueh 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 deatlı, 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. [Approved May 4, 1888.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
( 6 6 . 2m )
1. Date of Death, .
2. Name,
(Maiden Name),*
8 11tier
rechuretten.
(Name of Husband),*
/30221 12.222
att , neste
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, ·
Signature of Undertaker or other person making the Return, .
DATED at
.50
..... .
.. , O11
10 ×6
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.
inhile
46 Years,
Months.
14 Days.
.............
So Chemateel
So Chicl naford
Jourzenet Mais
Leurline, Richauelzen
,hatt
4
(
Daniel By am
87this
[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 deeeased 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 deceasc. 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 rceeived 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 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 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 certificate as is required of the attending physician; and in case of death by violenee, the medical examiner shall, if requested, makc the same. When such satisfactory statement and certifieate arc dc- 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,
Dev 12
1893 Name evening Harrington
Maiden Name,
Single, Married or Widowed,
Age, 7.years,
months, ...
.days.
Name of Attending Physician,
Each Chelmsford mars
Street (or Corporation), Ward
. .......
Occupation, ..
Husband's Name,
Place of Death - No.
Middle Town Chelmsford
Street (or Corporation), Ward ...
Birthplace of Deceased,
byland
Father's Name,
John Harrington
Father's Birthplace,
Ireland
....
man,
Mother's Birthplace,
Mother's Name,
Many Sullivan
Mother's Maiden Name,
Place of Interment,
Cacería
Cemetery Range ..
............. ,
Lot
, Grave
Signature of Undertaker or Informer,
Peter Darry
Daled at Lowell, this
12
day of.
IS9 3
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.
Date of Death Re 12
189 3
Name and Sex of Deceased Jeremiah Harrington male,
Place of Death - No.
Middletown Chalneford
Street (or Corporation) .
Disease or Cause of Death
duration of *
Complications, I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, .
77
Street
Residence, No ..
Dated at Lowell, this
12"
day of
189 3
; time of death.
Trorrat, such as street or corporation, single, married or widowed, and insert "fe" before male
Residence of Deceased --- No.
Laborer
Sex, .... male ; Color, white
RETURN OF DEATH - OF-
189
Commonfocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Lee. 1. 1993.
2. Name, Elisabeth A Hvor
(Maiden Name) ,* ·
Harrer
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
90 Years,
3
Months,
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, . · ·
Sf. R. Htc
DATED at
theto form
, on
Sex. 20
18 9.3.
* 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.
...
....
Chelindforel
...
22213 Torres
22 202222262
2228 /2+22
[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 deccased 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 tlic 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 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 dc- 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 No.
Commontocaith of Classachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Dec 26th 1893
2. Name,
Martha S. Dadman
(Maiden Name),* (Name of Husband),*
Charlie " James Nathan PDadmin
3. Sex, and whether single, Married, or Widowed,
Mindona
4. Color, t
5. Age,
74
.Years,
21
Months,
6 Days.
Disease or Cause of Death, (Primary and Secondary), }
6. {Duration of Sickness, . By whom certified, .
7. Residence,
8. Occupation, .
Housekeeping
9. Place of Death, . .
10. Place of Birth, .
11. Name of Father,
Sears b. Sans
Clean B. Shedd
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
(
Signature of Undertaker or other person making the Return, .
1
-
V
DATED at
Dee 27th
189.3.
* 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.
,
Chelmsford
Chelmsford
12. Name of Mother, . (Maiden Name),
Chelmsford
[ 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 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 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.
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,
Dec 27th 1893 Chester Fisher
Male-
Single
4. Color, t White
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, Hames Fisher 12. Name of Mother, (Maiden Name). Grace (Gorrie) Fisher 13. Birthplace of Father, . Nova Scotia Nova Scotia North Chelmsford Mass.
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur to Sheldon
DATED at
N. Chelmsford
., on
Dec. 24th
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, IS91. - 5,000.
2 Years, 6 Months, . .
Days. Convulsions 5 hours 1
7. W. Pike i. D.
North Chelmsford Muss.
. North Chelmsford Muss. North Chelmsford Mass.
--
[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 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 therc has been delivered to such 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, thie chairman of the board of health or any physician employed by a eity 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 deatlı 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 elerk 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.
F
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Dec 31st 1893
2. Name,
Martha Justini
Ma Grath
(Maiden Name), *
(Name of Husband),*
Laviel t. Questi. Finale
3. Sex, and whether single, Married, or Widowed,
Widow White
4. Color, t
83
.. Years,
3
Months,
23
.. Days.
5. Age, .
Disease or Cause of Death, (l', imary and Secondary), ;
6. {Duration of Sickness, . By whom certified, ·
F. V. Plice M. D.
North Chetingford Class
7. Residence,
8. Occupation, .
9. Place o Deatlı, . ·
10. Place of Birth,
11. Namc 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 a
A. Ctuliusford
, O11
Die, 31st
1893
* If a Married Woman or Widow. { 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. September, 1892 .- 5,000.
North Chutinsford Muss
Groter UN.N.
John Vis Gratti
Margaret (Taylor) MY. Grat .....
Deril, U.K.A.
North Chelousford Class
- Arthur H. Shielden
Cancer
2 months
[Public Statutes, Chapter 32, as amended by /1cts of 1388, Chapter 355 ; 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 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 elerk. 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 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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