USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 5
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No
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, . .
2. Name,
(Maiden Name),* . (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Single
White
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, .
144. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
DATED at AChelmsford, On Aug 6Th
1891
* 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. Nov. 1890-5,000.
August 5th 1891 Stella M. Wright
Female
15 Years, 4 Months, 5 .Days.
Consumption Six Months
N.B. Edwards M.L. North Cheimstore Lars.
North Chelmsford Plus. North Chelunsford Mass. Otis D. Wright basic (Fletcher) V.Fright Westford Alass. Roxbury Mass North Chelmsford Mass. Arthur H. Sheldon
[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. 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 ha attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to th best of his knowledge and belicf, 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- 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 licu thereof a certificate as hercinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early cnough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agcut 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 certificatc 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 finc not exceeding fifty dollars. [Approved May 4, 1888.
No. LCL
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,
6. Duration of Sickness, .
By whom certified,
7. Residence,
8. Occupation, . ·
9. Place of Death, . ·
10. Place of Birth, . Plymouth
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, .
Jepi 9th 189 Enmer t' Meler
Rufus .
87 Years,
3
Months,
Days.
...
......
10 days
Chambertin
South Exclusif and
Tengan
/12
L
DATED at
So Cl Ino
, on Sis Jiné
18%;
* If a Married Woman or Widow. - If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. "Be very particular to fill all Blanks.} Plate. Ed. Feb. 1890-3,000.
[ACTS OF 1888, CHAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVA 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 furui, registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician w atteudcd a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of h sickness, and the date of his decease. If a physician neglects or refuses to make a certificatc, as aforesaid, he shall b 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 nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city of or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such ; shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the att physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If t no attending physician, orif the certificate of the attending physician cannot be obtained, for good and sufficient reasons enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate ai livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any ( information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any per violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 18
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Aug 3rd
1891
» 2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Female
White
4. Color,t
5. Age,
Years ......-
Months, -
Days.
Still born
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
A. B. Edwards M.D. N. Chelmsford Mars
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
A & helmsford, On Aug 3rd
1891.
* 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. Nov. 1890-5,000.
N. Chelmsford Mass. N. Chelmsford Mars Stephen Vrard.
Ellen(Donnely) Ward Ireland 4. reland
Lowell Mass.
Arthur N. Sheldon
Ward
[ACTS OF 1888, CHIAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OY 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 ha attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to th best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his las 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 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 fu nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or towi 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 perni shall be issued nntil 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 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 snch 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 samc 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. [Approved May 4, 1888.
10%
[PLEASE FILL OUT WITH INK.]
UNDERTAKER'S RETURN. K
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./
. .
Name
Maiden Name,
Sex, male; Color
Single, Married, or-Widowed,
Age, .. years, months, days.
Name of Attending Physician,
Residence of Deceased-No. Tall
Street (or Corporation,) Ward
Occupation,
Husband's Name,
Place of Death-No Mail Chetive for Street (or Corporation) Ward
Birthplace of Deceased,
Father's Name,
Charter Invia Father's Birthplace,
Mother's Name,
Dizia
Mother's Maiden Name &
Dans
Place of Interment, Celles Lucull Cemetery Range,
, Lot Grave
Signature of Undertaker or Informer,
Dated at Lowell, this
day of ...... con.
189 ..
Physician's Certificate of the cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death Sett 84
1891
Name and Sex of Deceased, 727.7221
male.
Place of Death-No ..
Street (or Corporation).
Disease or Cause of Death,
duration of*
Complications,
I certify that the above is a trug return to the best of my recollection and belief
Nanfe and Professionnal Title, .
Residence, No. 126 M
Street Gemmule
Dated at Lowell, this
day of
*Reckoned to the time of deatlı. [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. }
Approved.
.... .......
Mother's Birthplace,
RETURN OF DATH - OF-
...
189
·
[PLEASE FILL OUT WITH INK.]
UNDERTAKER'S
RETURN. K
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,
Seit 13
189/. ..
Name
frank young
Maiden Name,
Sex,
male; Color
Single, Married, or Widowed,
Age, 6.3 .... years,
months,
days.
Name of Attending Physician, trucworthy
Residence of Deceased-No. Eastclicen Stord
Street for Corporation,) Ward
Occupation,
fairer
Husband's Name,
Place of Death-No.
Eastchelmsford
Street (or Corporation,)-Ward
Birthplace of Deceased,.
Veland
Father's Name, Johne young
Father's Birthplace,
Vieleud
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name, 1122Krakeuze
daniele
Cemetery Range,
.. , Lot
Grave
Place of Interment,
lattulic
Signature of Undertaker or Informer,
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,
Scht 12-
1891
Name and Sex of Deceased,
male.
Place of Death-No.
East Chelapul
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 Professionnal Title,
Residence, No.
52
Street
Dated at Lowell, this
day of
189.7 .....
*Reckoned to the time of deatlı. [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. ]
Approved.
BOARD OF HEALTH.
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 bellef, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his dosanos.If .
KerTURII OF DEATH - OF -
... ....
189.
/
[PLEASE FILL OUT WITH INK.]
UNDERTAKER'S RETURN. K
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, evet 13
189
1
Name
manyde
Maiden Name,
Sex,.
male; Color
Single, Married, or Widowed,
Age 2 5 years, -
..... months,
days.
Name of Attending Physician,
Residence of Deceased-No.
Street (or Corporation,) Ward
Occupation,
crautine
Husband's Name,.
Place of Death- No. worth Unchanged Street (or Corporation,) Ward
Birthplace of Deceased, .......
Father's Name,
Patrick
Father's Birthplace,
Ireland
Mother's Name,
mary
Mother's Birthplace,
.
Mother's Maiden Name ..
Place of Interment,
battclic forcenter
Cemetery Range,
....
Lot
, Grave
Signature of Undertaker or Informer,
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, ... . Oct. 13th
189 J.
Name and Sex of Decease 1, more que mammon .
Le male .
Place of Death-No ..
Street (or Corporation).
Disease or Cause of Death, Ahthisis
duration of *. .........
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professionnal Title,
Residence, No. ..... .104 High
Street
day of
Det
189.1.
Dated at Lowell, this
*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. ]
Approved.
BOARD OF HEALTH.
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
.......
RETURN OF DEATH
- OF -
..
... .
189
1 1 2 To.
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
3. Age, .
89 Years,
/
Months
1
Days.
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 Birth, .
11. Name of Father, 1
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, . .4 ..
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
1 8.
11
1
(
DATED at
11.1
1
18
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] l'late. Ed. Nov. 1800-5,000.
1
1 1 . . .. . 1
1
(
1
1
18/1
h Cl ...
....
[ACTS OF 1888, CHAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVE BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section thirce of chapter thirty-two of the Public Statutes, requiring attending physicians to furni registration certain facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician v attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of li sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforcsaid, he shall be 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 1 nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or t or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such par. t shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written -1 inent containing the facts required by this chapter to be returned and recorded, together with the certificate of the atten! physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If th no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons. enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose s upon request of said board, ageut or clerk, make such certificate as is required of the attending physician ; and in ease of { by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate al livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the cler . 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 Muy 4, 1855
-
[PLEASE FILL OUT WITH INK. ]
UNDERTAKER'S « RETURN. K
To the Board of Health and the Clerk of the City of Lowell.
DOP Undertakers must make this return before the burial or removal of the deceased.
Date of Death,
Maiden Name,
L
189./ .. Name Terely C
Sex, male; Color
Single, Married, or Widowed, Age, 2 years,. / months, 2 5 days.
Name of Attending Physician, L Mann , 321
Residence of Deceased-No.
Street (or Corporation,) Ward
Occupation,
Husband's Name,.
Place of Death-No ....... +4/6/4
Street (or Corporation,) Ward.
Birthplace of Deceased,
Father's Name, Velavoro (Che)
Father's Birthplace, Letiva, Billeder
Mother's Birthplace,.
Mother's Name, Agreat
.. Mother's Maiden Name, ..... ..
Place of Interment, Culturi
Cemetery Range, . ...... , Lot Grave
Signature of Undertaker or Informer, C
· day of
. 189
..
Dated at Lowell, this ..
.... .
Physician's Certificate of the cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death, ....
Name and Sex of Deceased,
male.
Place of Death-No.
.. 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 beliej.
Name and Professionnal Title,
Street
Dated at Lowell, this clay of 189
*Reckoned to the time of death. [Be very particular to fill the blanks, and strike ont 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. ]
Approved.
BOARD OF HEALTH.
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 miled ragad boljet the name of the deceased bis are the disease of which he died, the duration of his last sickness, and the date of his decease. If a
Residence, No.
RETURN OF DEATH
.. .
......
189 ...
1
1 No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Gel 25# 1891 Susan
2. Name, . .
(Maiden Name),* .
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age,
5%
.Years,
Months,
Days.
Inflammation of zowel
Disease or Cause of Death,
6 Duration of Sickness,
By whom certified,
In Howard
7. Residence, . .
8. Place of Death, . 0
9. Occupation,
0
New york City
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, .
Hudson or M
Signature of Undertaker or other person making the Return, .
DATED at on 18
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
4 Hegeman Gillespie
manuel . . .. .
Chelmsford Mall
11. 1
Housewife
1
Commonwealth of Massachusetts.
[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 cl registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that the required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit un certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the decease placed in the hands of said clerk or registrar; and in cities and towns where there are boards of health, the certificate of the car - death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chair 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 d . to the best of his knowledge and belief, if there has been no physician in attendance. He shall also sign such certificate, upon app tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot 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.
,
[PLEASE FILL OUT WITH INK. ]
UNDERTAKER'S
RETURN.
To the Board of Health and the Clerk of the City of Lowell.
Date of Death,
October 30th
189 / ...
Name
Jane Hon Pearson
Maiden Name,
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