USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 9
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TIJDStecher
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 (Recursion, 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.
There Fore (
Cricette
....
.
2-13
[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 certifieatc, 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 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 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 violenee, the medical examiner shall, if requested, make the same. When sueh satisfactory statement and certifieate 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 seetion shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
Commonwealth of Massachusetts.
138
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Feb. 14th 1892 Clara 7. Holt
2. Namc,
(Maiden Name),* 16 Mansur
(Name of Husband),*
Joseph B. Holt
Female
3. Sex, and whether single, Married, or Widowed,
Widow White
4. Color, t
5. Age, .
Disease or Cause of Death,
6. Duration of Sickness, . By whom certified,
Amasa Howard M. D.
North Chelmsford Mass.
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, .
Signature of Undertaker or other person making the Return, :
Arthur H. Sheldon
DATED at N. Chelmsford; on
Feb. 16th
1892
* If n 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.]
North Chelmsford Mars. Wilton N.H. William Mansur Sarah (Bridge) Mansur Temple N.H.
Leominster Mass.
North Chelmsford Mass.
No.
91
.Years,
1
.Months.
12 Days.
Paralysis of heart
[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 application, in case of death by danger- ous 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.
[Acts of 1887, Chap. 202, Sect. 5.]
Section one of chapter thirty-two of the Public Statutes is hereby amended by inserting after the word "burial" in the twentieth line of said section the words: - if the deceased was a married woman the name of her husband.
No
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
2 ...
1. Date of Death, .
2. Name,
1
(Maiden Name),* (Name of Husband),*
3. Scx, and whether single, Marricd, or Widowed,
4. Color,t
5. Age, .
.
46 Years, Months, Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified, .
7. Residence,
8. Occupation, .
9. Place of Deathı, .
10. Place of Birth, .
11. Namc of Father, .
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
-
DATED at
~4, on 618 18 9.2
* 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.
>
Thomas resim
[ACTS OF 1888, CIAP. 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 threc 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 arc 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 fine not exceeding fifty dollars. [Approved May 4, 1888.
Commonbocalth 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,
Male
Single White
4. Color, t
5. Age,
Disease or Cause of Death,
Pneumonia
2 days
N. B. Edwards M.D.
North Chelmsford Mais.
7. Residence, ·
8. Occupation, . .
9. Place of Death, . .
10. Place of Birth, . ·
11. Name of Father, ·
12. Name of Mother, .
Victorine (Dion) Menard Canada
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur A. Sheldon
DATED at KChelmsford
....... .... . , on .
Feb. 23rd
1892
* 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.]
Feb 22nd 1892 Wilfred Menard
......
Years, ....... .
Months,
28 Days.
6. {Duration of Siekness, . By whom certified, .
·
North Chelmsford Mass. North Chelmsford Mass. Henrie Menard.
Canada
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 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 application, in case of death by danger- ous 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.
[Acts of 1887, Chap. 202, Sect. 5.]
Section one of chapter thirty-two of the Public Statutes is hereby amended by inserting after the word "burial" in the twentieth line of said section the words: - if the deceased was a married woman the name of her husband.
- No.
Commontucatth 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, ¡
5. Age, .
80 Years, 5, 7
Months, 17 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Oeeupation, . . .
9. Place of Deathı, . .
·
Hartford FC
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
Chiarita, ou 29/12 yet-192
* 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. 1590-5,000.
12.22-1992 Sauford Masen
Partherria (Minister) Montfort (Tt
11
[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 faets relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certifieatc, 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 certifieate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such 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 ease 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, 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 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 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 seetion shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
Commonbocalty of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
March AL-1897 Miranda E. Hooper
(Maiden Name),* ·
Roberto
(Name of Husband),*
010
3. Scx, and whether single, Married, or Widowed,
4. Color, t .
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, . .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . ·
DATED at
Chelefort
Mark J
18 92
* 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.
37
Ycars,
Months,
Days.
Emeline yale
[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 eertain facts relating to deeeased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last 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 fine not exeeeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certifieate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No 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 section three of this chapter, or in lieu thereof a certifieate as hereinafter provided. If there is no attending physieian, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early cnongh 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 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,
illa-en 4.
189 2.
Name.
Hildeela
Maiden Name, Ouija & Willundack
82
1
Sex, female; Color urile
Single, Married, or Widowed, Age, . years, ..... months, 18 days.
Name of Attending Physician, -1 Truewarthey
Residence of Deceased-No. Chelmsford
Street (or Corporation,) Ward
- 1 ...
Occupation,
Husband's Name,
Maser U Hindreth
Place of Death-No. Onelinefard Center Street (or Corporation,) Ward
Birthplace of Deceased,
Father's Name Laund Meet dack Father's Birthplace,
beatland
Mother's Name,
Mother's Birthplace, artiste
Mother's Maiden Name, Havevan
Place of Interment, and Gon Cemetery Range, ....
, Lot
, , Grave
Signature of Undertaker or Informer, Chas
.. ... day of ... March .....
Dated at Lowell, this
189.211
.
RETURN OF DEAT
Eliza A. tied - OF
1893
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,
March 8 th 1892 Grank & Fazer
(Maiden Name),* .
3. Sex, and whether single, Married, or Widowed,
Married
4. Color, t .
5. Age,
50 Years,
11 Months ...
2 Days.
Disease or Cause of Death, 6. Duration of Sickness,
By whom certified,
Dr Howarde Chelmsford
.. ........ ..... ..
9. Occupation, .
.
machinist
Newhampton Ntb Cutting aver Hangh
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
ladu Barry
DATED at
on
1847
* 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.]
. ..
7. Residence, . ·
8. Place of Death,
10. Place of Birth,
11. Name of Father, .
12. Name of Mother,
Hill Kol.
Newhampton 1.2. Edson Cemetery.
[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, sball 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.
1
Commonwealth of Massachusetts.
Y
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, .
(Maiden Name),* . .
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
5. Age, 79 Years, Months, .~ Days. Heart failure Disease or Cause of Death, . . ....... Seven days
6. Duration of Sickness, £ .
By whom certified, ·
Dr. Harlow
.. Near Chelmsford .
7. Residence, . .
8. Place of Death, .
·
0
9. Occupation,
10. Place of Birth, · ·
not known
11. Name of Father, ·
12. Name of Mother,
13. Birthplace of Father,
14. Birthplace of Mother,
15. Place of Interment, .
Wear Chelmsford
...
Signature of Undertaker or other person making the Return, .
DATED at
W. Chelmoton on.
.. ....... . ... for Board of Health march 18 1892.
* 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.]
march 13. 1892 margaret miles Margarer Heathwood Female. Marney; white
-
Ireland . .
...... not known
-
,
[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 givenby 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.
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