USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 6
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Sex,
male; Color
Single, Married, or Widowed,
Dr.
Name of Attending Physician,
West Chelmsford Street (or Corporation) Ward
Residence of Deceased-No.
Occupation,
at Home .-
Husband's Name,
Place of Death-No.
Birthplace of Deceased,
Ireland.
Father's Name,
Thomas beatrick Father's Birthplace,
Ireland.
Mother's Name,
Bridget-
Mother's Birthplace,
Ireland.
Mother's Maiden Name,
wod, Known
woche of Lowell
Place of Interment,
Cemetery Ranges
Lot
, Grave
OConnell
Signature of Undertaker or Informer,the
Detaler
189 ...
Dated at Lowell, this
30
day of
Physician's Certificate of the cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death,. 189 ...........
male. Name and Sex of Deceased,
Place of Death-No
Street (or Corporation).
Disease or Cause of Death,
Suicidelay Downing
duration of*
...
........
Complications, ..
I certify that the above is u true return to the best of my recollection and belief.
Name and Professionnal Title,
Street Levele
Residence, No. 126
day of
Let
1891-
Dated at Lowell, this. 3.0
*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.
Undertakers must make this return before the yurial or removal of the deceased.
)
Age,
6/
years,-
. months,
... days.
AVil helmagora Street (or Corporation,) Ward
-
ETURN
-OF -
......... . ...............
........
1 Nos
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,
Micho il.
4. Color, j
81
Years,
Months.
14 Days.
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified, ·
7. Residence, .
8. Occupation, . .
.
+ 18 2 1 22 : 2
10. Place of Birth, . ·
.
Cavour Cite le
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 COLEC.
, On
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. ] Plate. Ed. Nov. 1890-5,000.
....... ..
........
9. Place of Death, . ·
.
t
C
[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 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 lie 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 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 fortliwith 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, ISSS.
-
Commonlocalth 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,
... .. . . . .
.. ....
Years, . Months, -3 Days.
5. Age, .
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
7. Residence, .
8. Oceupation, . .
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,
Signature of Undertaker or other person making the Return, .
: ... 20€.
DATED at
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. ] Plur. Ed. Feb. 1890-5,000.
1
1
.....
4. Color,t .
[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 ueglects 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 no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and 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.
.
Commonincalth of Massachusetts.
To.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deatlı,
LEC €. William Bauchtanz
189
2. Name,
(Maiden Name), *. .
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,
5-4 Years, Months, ~Days. Typhoid, Pneumonia , Three weeks 3. 1evoit nr. 20 1
7. Residence, .
8. Place of Deatlı, ...
9. Occupation, 0
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, .
11 Ecran
La Lawell
...
Signature of Undertaker or other person making the Return,
.... / ...
DATED at
Lawell, on
2
Llée
189 189/.
--
* 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.]
Lord
fliers
Warme 2 heat William
mary Watwieshere here ...
.... . .....
..
Married
vale
4
[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 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.
.
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),*
21 December 1991 Charlotte Parker as above
3. Scx, and whether single, Married, or Widowed,
4. Color, ¡
5. Age, .
· abvali
Disease or Cause of Death,
6. {Duration of Sickness, . By whom certified,
7. Residence, . .
.
8. Occupation, . .
9. Place of Death, . ·
10. Place of Birth, . darne
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, .
Kamil PByany
DATED at
So Cheil word, 01.
in Decenives 1891.
* 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.] l'late. Ed. Feb. 1890-5,000.
00 neunionel. one week Dr lecker
8 4 Years, Months, ....... .Days.
Chelmsford
Efencall
Parker
Rebecca
Parker
Dunstable,, Mass Thetimeford Centre
[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 furuisl 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 scction three of this chapter, or in lien thereof a certificate as hereinafter provided. If there is no attending physiciau, 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.
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),*
-
Female
3. Sex, and whether single, Married, or Widowed,
Simple
4. Color, t
72 Years,
3
Months,
3
Days.
3. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
7. Residence, .
8. Occupation, .
9. Place of Deathı, .
North Chelmsford Mass West Boylston Mass
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name),
Ephraim Kennan Thankful (Ball) Kennan Holden Mass.
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
North Chelmsford Mas,
Signature of Undertaker or other person making the Return, .
Arthur A. Sheldon
DATED at :
Abbelmsford, on Dec. 23rd
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
Dec. 22nd 1891
Emeline A. Kennan
Ahoplexy
one hour
A. B. Edwards, H.D. North Chelmsford Mass. Tailoress
Holden 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 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 cxeeeding 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 eity or town, from the city or town clerk. No such permit shall be issued until there has been delivered to sueh 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 ease 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. 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, Dec. 20th .1894. Name Sarah I. Offin
Maiden Name,
Sarah &MCNally
Sex,
male; Color
Age, 33 years,
months,
days.
Single, Married, or Widowed,
Name of Attending Physician, ... Dr. Howard
Residence of Deceased-No. Chelmsford Hast Street (or Corporation,) Ward
Occupation, Housewife Husband's Name, Charles W Goffin
Place of Death-No. ... Chelmsford Centre Street (or Corporation,) Ward.
Birthplace of Deceased, .. Chelilsford
Father's Birthplace,
Ireland
Father's Name,
.....
Mother's Birthplace, Ireland
..... Mother's Name,
Mother's Maiden Name,.
Place of Interment, Catholic Country of Loweco
mass.
Let , Grave ...
Signature of Undertaker or Informer,
20th
day of ..
(December 189).
Physician's Certificate of the cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death, Doc. 20M
Name and Sex of Deceased,
Sarah 1, Colfru
male.
Place of Death -- No ...
Chelmsford 11
Disease or Cause of Death,
Athibis
Street (or Corporation).
duration of* over
a clear;
/
Complications, . .
I certify that the above is a true return to the best of my recollection and belief.
Name and Professionnal Title, Amava Howard
Residence, No ...
Chelmsford
Street
Dated at Lowch, this !. ... .. .
chilmagord, Decl 21 st
day of ......
......
189 } .. .
*Reckoned to the time of death. [Be very particular + 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. ]
E. F. O" Donnell
Dated at Lowell, this . .. .. .. ..
189 ...
RETURN OF DEATH - OF --
180
....
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),*
Male
3. Sex, and whether single, Married, or Widowed,
Married
White
4. Color, ¡
3. Age, .
61 Years, 9 Months, Days.
Bronchitis
Disease or Cause of Death, (Primary and Secondary), ;
6. {Duration of Sickness, . By whom certified,
A. B. Edwards M.D.
7. Residence,
8. Occupation, . . .
9. Place of Death, . ·
10. Place of Birth, .
11. Name of Father,
michael takes
Bridget Ma Dermot) Fahrer . .. . ........... .....
.... .... . ........
....... . .
13. Birthplace of Father, . Ireland
1.1. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur A, Sheldon
DATED at
N. Chelmsfordie, 011
Jan 6th
1892
* 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.] l'late. Ed. Nov. 1830-5,000.
23 days
North Chelmsford Mass Laborer
South Chelmsford Mars Ireland
12. Name of Mother, (Maiden Name),
Freland
Lowell Mass
..
2 5
Jan. 5th 1892 Edward taker
[ACTS OF 1888, CHAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHIS, 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 yfrom 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 caunot 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 certifieate arc 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 mauner 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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