USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 8
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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 certificatc 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.
Ril
[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,
January 230℃
189.2.
Name
Tham / Tranch
Maiden Name
Sex,
male ; Color
20
Single, Married, or Widowed,
married
ge, 7 .yea
years, ~ months,.
- days.
Name of Attending Physician, Dr Hunter
Residence of Deceased-No. . East Chelmsford Street (or Corporation,) Ward
Occupation, farmer Husband's Name, ..
Place of Death-No. East Chahnofare Street (or Corporation,) Ward
Birthplace of Deceased, Callerica Mano
Father's Name Authe Branch Father's Birthplace, Fitchburg ...
Mother's Name,
Sarah,
-
Mother's Birthplace,.
Mother's Maiden Name, Sarah Odawert
Place of Interment, ..
Cemetery Range,
, Lot.
.. ..
, Grave
.....
Signature of Undertaker or Informer, James M. Baroko
Dated at Lowell, this
23 cm
Way of Janna
189 Z
Physician's Certificate of the cause of Death.
[See extracts from Acts of Legislature below. ]
Date of Death, January 23 ch
Name and Sex of Deceased, Thomas I Branch 189.7
male. Street (or Corporation).
Place of Death-No. East Chalmaford
Disease or Cause of Death, E febled by agro exposure duration of * 3 wake the latter
Complications,
Jup pulmonary assess The absolute cause of death
I certify that the above is a true return to the best of my recollection and belief.
Name and Professionnal Title,
Horatio Milamiten In for
Residence, No.
13
Birk.
Street
Dated at Lowell, this.
2339
day of January
1892
*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. ]
.
RETURN OF DEATH
- OF_ -
189
13 Pontos st
1 L
o
Commontocattly 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,
Female Married 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, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
- Arthur Sheldon
DATED atC
A. Chelmsford
, Oll
Jan. 27th
1892
* 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.
68 Years, 10 Months, 4 Days. Incumonia
6 days
N. B. Edwards M. D. North Chelmsford Mars. Housekeeper
North Chelmsford Mass
Dracut Mass.
Theodore H. Hamblett Edna (Varnum) Hamblet Dracut Mass.
Dracut Mass
West Andover Mass
Jan 27th 1892
Abigal B.H. Juck
Atamblett
William Juck
[ACTS OF 1888, CHAP. 306. ] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Seetion three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration 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 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 eity 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 faets 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 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 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 infor ation as to the deceased or to the manner and cause of the dort as the clerk or registrar may require. Any person
liz any of th > provisions of this section shall be punished by a xeeeding 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, . .
2. Name,
Jan. 30th 1892 William Juck
(Maiden Name),* · (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Male
Widower 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, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . ·
Arthur H. Sheldon
DATED at North Chelmsfordto ...
Jan. 30th
1892
* 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.
79 Years, 10 „Months, .... Days. Pneumonie × Hepatitis 10 days
N. B. Edwards MD. North Chelmsford Mass Laborer
North Chelmsford Mass.
Andover Mars. John Juck
Elizabeth (Bailey) Juck Andover Mass.
Andover Mass.
West Andover Was,
[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 certaiu 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 tlie best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickuess, aud the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fiue 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 iu 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 \ 'nting any of the provisions of this section shall be punished by a + exceeding fifty dollars. [App rd May 4, 1888.
1
L
Commonbocalth of Massachusetts.
No
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Man. 30th 1892
2. Name,
(Maiden Name),* ·
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age, . .
Disease or Cause of Death, (Primary and Secondary.), #
6. ‹ Duration of Sickness, . By whom certified, ·
7. Residence, .
8. Occupation, . .
9. Place of Death, . .
.
10. Place of Birth, . ·
.
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
North Chelmsford 0
Jan 30th
1892
* 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.
Rebecca Cummings Rebecca MC Glenna William Cummings Female Widow White
66 .Years, 3 Months, 22 Days. Pneumonia following La Grippe 7 days
N.B. Edwards M.D. North Chelmsford Has House Keeper
11. Name of Father,
North Chelmsford Mas Westford Plass, William MECloning Deborah Woods ME Glenna Demstable Mass.
Dunstable Mass.
Tyngsboro Mass,
[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 aforcsaid, 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 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 cnough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purposc 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 certificatc are de- livcred to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
No.
Commonbocalth 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, ·
Years, 5 Months, 7 Days.
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,
Lamell No. 2
DATED at. , on 18
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
f 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.
Berwick A
Signature of Undertaker or other person making the Return, .
) am
31 1892 Abigail S, Kimball gars 3 Kimball
[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 rcad 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 nndertaker, 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 snch 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 threc 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, carly enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livcred to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person v' lating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
12
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Jan. 31-1892 Johanna reardon
2. Namc,
(Maiden Name),* .
(Name of Husband),*
Michael Greenday
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
.Years,
Months,
Days.
Grifo
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, .
Strandon
DATED at.
Chelmsford
tisfr1892
* 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.
2 Testes ....
grelacal
Tralacual
[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 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.
[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, Feb. 3rd IS9 2 Name,
John Jay
Maiden Name,
Sex, male; Color
Single, Married, or Widowed,
Age,
60 years,- months, - days.
Name of Attending Physician, Dr. Howard
Residence of Deceased-No. Chelmsford Cantstreet (or Corporation,) Ward
Occupation,
Farming Husband's Name,
Place of Death-No. Chelmsford Street (or Corporation), Ward
Birthplace of Deceased, Ireland
Father's Name,
John Jay Father's Birthplace,
Ireland
Mother's Birthplace,
Ireland,
Place of Interment,
Cemetery Range,
Lot
.. , Grave
Signature of Undertaker or Informer,
e
Donnell
Dated at Lowell, this
Third
day of
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
[See extract from Acts of Legislature on other side.]
Date of Death, Tab. 3d
Name and Sex of Deceased, John Fay 189 2
male.
Place of Death-Nor Chilmaford Mass
Street (or Corporation).
Disease or Cause of Death, Pulmonary Consumption duration of several years. Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title. Umana Howard M. D.
Residence, No. China ford ... Marv.
Street
Dated at Lowell, this
L day of February to
*Reckoned with time of death.
...
Mother's Name, Catholic at Low
RETURN OF DEATH
189
137
Commonboratth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
you silvice
(Maiden Name),* . (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .
Years,
.5
Months,
Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, .
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