USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 4
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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. Scx, 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, .
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
So Chelinford UPByam
Signature of Undertaker or other person making the Return, .
DATED at So Chalnidad on Ami 30
18
91
* 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.] Plute. Ed. Feb. 1890-5,000.
30.05 il harling ...
Male
28 Y'cars, .. ...
.... . Months, Days.
Bartos Mars
Laran ulare
[ACTS OF 1888, CHAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statc- inent 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 threc of this chapter, or iu lieu thereof a certificate as licrcinafter provided. If there is no attendiug 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 ageut, 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
6 No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
6 th 15 91
2. Name,
(Maiden Name),*
(Name of Husband),* ...
. ..................
3. Sex, and whether single, Married, or Widowed,
Male IN Married
Ichile
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
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,
1
DATED at -Chelmsford ., on
34 Years, 8 Months, Days. Consumption- 8 6mouth
to Chefinofazer
Farrier
So Chetmafores
Baston
So Chelondres
* 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.
[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. Scction 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 certificatc, 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 snch permit shall be issued until therc has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, orif the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence, the medical examiner shall, if requested, make the same. When snch satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith conntersign 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 canse 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,
July 16
Th
James A. Ward
1891
2. Name, .
(Maiden Name),* . ·
3. Sex, and whether single, Married, or Widowed,
Male - Married
White
4. Color, t .
5. Age,
28 Years, 4 Months, 21 Days. Tubercular phthisis 5 Months
Disease or Cause of Death,
Duration of Sickness,
By whom certified,
7. Residence, . ·
·
8. Place of Death, ·
2. 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 att Chechensford, on
Julie 18th
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.]
N. B. Edwards M.D. North Chelmsford Mass. North Chelmsford Mass Iron Moulder
North Chelmsford. Anthony Ward
Ann (Doyle) Ward Ireland Ireland
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 th certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the deceased, an 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.
Ed. Sept., 1SS9. 5 M.
Plate.
[ACTS OF 1889, CHIAP. 208.] AN ACT IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each city and town shall on the first day of cach month make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever thc deceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certified copies to the clerk or registrar of the city or town in which such deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained ; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or birthis. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the City of Lavell
(City or yown. ) during the month of July 1891.
1. Date of Death,
July 4, 18910
2. Name,
Elizabeth Growly
(Maiden Name), .
Elizabeth M. barrow
(Name of Husband), Luimich Crawley
Finale
3. Sex, and whether single, Married, or Widowed, Manned
4. Color, .
5.2 Years, ...
Months, Days.
Gangrene
6. {Duration of Sickness, By whom certified,.
Dr Plunkett
7. Residence,
8. Occupation, at Home
9. Place of Death, .
St. John's Hospital Lowell
10. Place of Birthı,
John M Canon
12. Name of Mother,
Ireland
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
Catholic Century Lorall Claro
I certify that the foregoing is a true copy.,
Attest : "Michael Woud
July 1% 189).
City Clerk.
(City or Town.)
5. Age,
Disease or Cause of Death,
No Chelmsford
Ireland .. ...
11. Name of Father,
Irland
[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,
July 13
189 / ..
Name,
Ernest Roberge
Maiden Name,. .. ..
....
.Sex, ........ male; Color
It hite.
Single, Married, or Widowed, Age, ~ years,. 2 months, .. // ... days.
Name of Attending Physician,
DU Brusselle
,
Residence of Deceased-No. Chelmsford Street (or Corporation,) Ward
Occupation, Husband's Name,.
Place of Death-No.
Street (or Corporation,) Ward
Birthplace of Deceased, Chelmsford
Father's Name,
J. B. Rober ge Father's Birthplace,
Mother's Name,
Caroline
Mother's Birthplace, Canada
Mother's Maiden Name, Lussier
Place of Interment,
Catholic
Cemetery Range,. ... , Lot ., Grave
Signature of Undertaker or Informer, Helix & Albert
Dated at Lowell, this
13 th
day of.
189 /
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
[See extracts from Acts of Legislature below. ]
Date of Death, July
189 / ....
Name and Sex of Deceased, . .........
male.
Place of Death-No. Country
Street (or Corporation).
Disease or Cause of Death, Chalana
duration of* 4 tags
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
Street
Dated at Lowell, this 13 day of ..
*Reckoned to the time of deathı. [ 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. ]
RETURN OF DEATH -OF-
. . . . . ....
. . . .
.. . .
189
......
No.
Commonbocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
July 24th 1891 Delia Autres
2. Name, .
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Female
Single
white
4. Color,t
5. Age, .
Years, -
Months,
28 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
M Edwards, ng,
South Chelmsford Mass.
7. Residence, · .
8. Occupation, .
North Chelmsford Mars
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, .
Arthur H. Sheldon
DATED at
Alchelmsford
July 25th
189/.
* 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.] Platc. Ed. Nov. 1890-5,000.
100
.................
Diarrhoe, .......
24 hours
Month Chelmsford Mars Abram Autres
Esther (Sauson) futures
Canada
Canada
Lowell Mass.
[ACTS OF 1888, CHAP. 306. ] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL 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 f registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who h: attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to t. best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his 1: sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pu 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 certificatc is f nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or tow! 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.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
811
1
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 1 Years,
Months,
Days.
Colore
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
7. Residence, 1 .......
8. Occupation, .
9. Place of Death, . ·
10. Place of Birtlı, .
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, .
1
Y
DATED at
on
18 1.1. 4
·
€
1
.........
1 11
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. ak If whor thay White always Indian If afather landy
[ACTS OF ISSS, CHAP. 306. ] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL. 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 fox registration certain faets relating to deeeascd 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 deeease. 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 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 sneh 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 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, npon request of said board, agent or clerk, make such certifieate as is required of the attending physician; and in case of death by violenee, 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 eountersign 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.
Commontocaith of Classachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred. £
1. Date of Death, . . .
Levi
171
2. Name, .
.
(Maiden Name),* · (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
16.00
.....
4. Color, j .
5. Age, .
Disease or Cause of Death, (Primary and Secondary), # 1
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, .
i
12/
DATED at
€ 1, 1
7,011
18
/
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
t If other than White. (MI.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks. ] l'late. Ed __ Nov. 1890-5,000.
> 2 Years,
Months, C. Days.
Parat 35
CIL
1
, Lebo
4
C.,L.,
.V
LaILL ............
[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 furuish fo registration certain facts relating to deceased persons, is amended so as to read as follows :- Section 3. A physician who Is. attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to 11 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 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 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 city or town, from the eity or towu clerk. No such permit shall be issued until therc has been delivered to sueh 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, orif 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 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 perinit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
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