USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 12
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1
L
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,
Mar 11
189.6
Name,
Mizabeth Davis
Maiden Name, Sex, Le male ; Color, ..
Single, Married or Widowed, Age, 73 years, - months,. ~ days-
Name of Attending Physician, De Turk Med Examin
.
Residence of Deceased-No.
Medfriend May Street (or Corporation,) Ward
Occupation,
at Home
Husband's Name, Denjanni Damit
Place of Death-No_
Chleurshard Man Street (or Corporation), Ward
Birthplace of Deceased,
Father's Name,.
Peter
Jones
Father's Birthplace, continuum
Mother's Name, Maria James
Mother's Birthplace,
france
Mother's Maiden Name, ..
Que Me toques
Place of Interment,
Ednon-
Cemetery, Range
.. , Lot
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
13
day of
Man
189,6
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Mar
IS9 6
Name and Sex of Deceased, Elizabeth Davis male.
Place of Death-No ... Clarinsfard Mass
Street (or Corporation).
Disease or Cause of Death,
Denser Jeant duration of
Complications.
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title,
Residence, No. 264 Lesmente Feet Revell
Dated at Lowell, this.
13
day of
IS9.6.
OF
189
121
2cl
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 yeturn before the burial or removal of the deceased.
Date of Death, Mar 180
189 6
Name,
Margaret M. Guessy
Maiden Name,
Sex,
male ; Color,
Single, Married or Widowed,
Age, 5+4 years, ........ months, days.
Name of Attending Physician, .. Dr . Haulow
Residence of Deceased-No.
Heat Chelmsford Street (or Corporation,) Ward
Occupation,
at Home
Husband's Name,
Place of Death-No. Heat Chehuxford
Street (or Corporation), Ward
Birthplace of Deceased! freland
Father's Name,
John Mª andif Father's Birthplace,
ruland
Mother's Name Namal
ク
Mother's Birthplace,
Mother's Maiden Name,
Donnelly
Place of Interment,
. Cemetery, Range
Grave,
Signature of Undertaker or Informer,
James
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,
har.
1596.
Name and Sex of Deceased,
Place of Death-No. West Chelmsford
Disease or Cause of Death, Cancer
Street (or Corporation). duration of One year
Complications,
bolitis
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Granville a Harlow Il
Residence, No.
Tyngsboro
treet. .
Impland
margaret, he Quesoy
female .
Dated at Łowe, this.
1 9th
day of
march
OF
189
Ret
Ed. Jan. 23, 1894. 5,000.
[ACTS OF 1889, CHIAP. 208.] AN ACT
l'late.
IN RELATION TO THE RETURNS OF BIRTHIS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of cach city and town shall on the first day of each month make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever the (leceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birthi; and shall transmit said certified copies to the clerk or registrar of the city or town in which such deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained ; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the. City of (City ofTown.)
Lowell
during the month of. March 1896.
1. Date of Death,
March 19 1896
2. Name,
Elgan A. Wotton
(Maiden Name), . (Name of Husband),
Male
3. Sex, and whether single, Married, or Widowed,
4. Color,
5. Age,
1 Years,
Months, 16 Days.
Erysipelas, Meningitis
6. {Duration of Siekness, By whom certified,.
J. E. Varney M. D.
7. Residence,
North Chelmsford
8. Oeeupation,
39, School Street Lowell Mars
10. Place of Birth,
do Chihansford
11. Name of Father,
Hud
12. Name of Mother, (Maiden Name.)
Oatman
13. Birthplace of Father, .
Nova Scotia
Canada
15. Place of Interment, . I certify that the foregoing is a true copy.
Attest :
18
Clerk.
(City or Town.)
(Disease or Cause of Death,
9. Place of Death, .
Annie
14. Birthplace of Mother, .
121
Commonlocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
1.16 -
2. Name,
Landia 1.
(Maiden Name),* S. Con etc.,
(Name of IIusband),*
41€22€
0
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 68 Years, 6 Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
G. Duration of Siekness, . 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,
1
Signature of Undertaker or other person making the Return, .
DATED at. 1 (, on 18
* 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. September, 1892 .- 5,000.
tot2. (1.2 ... 1
Time.L. (
1
V
1 1
1 1
No.
€ ......
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1839, Chapter 224.]
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 punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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 statement 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 delivered 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.
Rel) No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
May 2nd 1896 George H. Osgood
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, (Primary and Secondary), #
6. {Duration of Siekness, . 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, .
48 .Years, .Months, Days.
Fracture Skull R.R.Cecident Ab. Irish Med. Exe North Chelmsford
Painter North Chelmsford
North Chelmsford Arthur At. Sheldon
Mary 2na 1896 at North Chelmsford
* 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. Jan. 1893 -5,000.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or iminediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body 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 statement 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 healthi 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 samc. When such satisfactory statement and certificate are delivered to the board of healthor to its agent, the board or agent shall forth- with 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 deccased 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 exceed- ing fifty dollars.
Commontocalth 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, i
six hours
5. Age,
-Years.
.. Months,
Days.
Premature birth
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified, F .E. Varney M.D. North Chelmsford
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 N Chelmsford, on May 9th 1896
* 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. Jan. 1895 .- 5,000.
North Chelmsford North Chelmsford Patrick Ready
Mary (O'Hare) Ready Ireland
Ireland
Lowell, Mass.
Arthur H. Sheldon
May 8th 1896 Patrick Ready
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn ehild, shall, when requested, forthwith furnish for registration a eertifieate, stating to the best of his knowledge and belief the faet that sueh a ehild died after birth or was born dead. If a physician neg- lects or refuses to make a certifieate as aforesaid, or makes a false statement therein, he shall be punished by a finc not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he ean state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body 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 elerk. No sueh permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement 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 elerk, make such certificate 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 arc delivered to the board of healthi or to its agent, the board or agent shall fortli- with 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 thic manner and cause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not execed- ing fifty dollars.
Rec
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,
May
13
189
6
Name. Timothy
Crowley
Maiden Name,
Sex,
małe; Color,
Single, Married or Widowed,
Age,
60 years,
months, days.
Name of Attending Physician, ..
Residence of Deceased-No.
Lowell
Street (or Corporation, ) Ward
Occupation,
Husband's Name,
Place of Death-No. North & helford Street (or Corporation), Ward
Birthplace of Degeased, Freeland
Father's Name, ...
John powelly
Father's Birthplace,
Irelande
Mother's Name,
Johannah
Mother's Birthplace,
..... ..
Mother's Maiden Name,
tohannah Sullivan
Place of Interment,
Lowell
Cemetery, Range
, Lot
, Grave,
Signature of Undertaker or Informer,
fat wa alermott
Dated at Lowell, this
15 mg
day of
May
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
May 14
ISO 6
Name and Sex of Deceased,
Janochy Crowley
male.
Place of Death-No.
no Chelun fort
Disease or Cause of Death, Phthisis
duration of *
Jeans
Complications,
I certify that the above iste true return to the best of my recollection and belief.
Name and Professional Title,
Street,
Residence, No
Dated at Lowell, this.
150
day of
way
125
Street (or Corporation).
IS9
6
RETURN OF DEATH
OF
189
1
ree No.
Commonwealth of Massachusetts.
126
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, (Primary and Secondary), #
6. {Duration of Siekness, .. By whom certified,
7. Residence,
8. Oeeupation, .
9. Place of Death, .
10. Place of Birthı, .
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, .
9. & Hall
DATED at
011
May 19
18
6
+ 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.) Indlan. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. Jan. 1895 - 5,000.
Mas 18-1896 Stenger Stall
SI0 S
6 .Years, Months, Days. Valvular deveau Theart
Artaria AN
Nunwell
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the faet that sueli a child died after birth or was born dead. If a physician neg- leets or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the samc. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
las 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 elerk. No such permit shall be issued until there has been delivered to such board, or agent or elerk, as the ease may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by seetion three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of liealth or any physician employed by a eity 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 delivered to the board of health or to its agent, the board or agent sliall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the perniit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the deathi, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
127
Rec
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 remov Sof the deceased.
Date of Death, Lance VI
IS9 6.
Name,
Mensal Steams
Maiden Name, ..... Sex male ; Color,
Single, Married or Widowed, Married,
Age,.
7 3years,
months,
.. days.
Name of Attending Physician,
Dr. Otoward.
Residence of Deceased-No.
Chelmsford maso.
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
Chelmsford mass.
Street (or Corporation), Ward
Birthplace of Deceased, ...
Father's Name,
Ins.
Stearns
Father's Birthplace,.
Mother's Birthplace,
Mother's Name,
11
Mother's Maiden Name un know.
Cemetery, Range
, Lot
, Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this#
21
{day of
of fame
1996.
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,. PS9 6
Name and Sex of Deceased,
Edvin . Stearn
Stearns.
male.
Place of Death-No.
Chelmo And maso
Street (or Corporation).
(When the child is still-born, so specify.)
Disease or Cause of Death,
Uraemia
duration of *
Complications,
I certify that the above is a true return to the best of my recollection and belief. ‹
Name and Professional Title, A. A. Rammer UN.
Residence, No. Street, (Separate Certificate)
Dated at Lowell, this day of
*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. |
Place of Interment, ..
RETURN OF DEATH
OF
..
189 ...
Ree No.
Commontoralth of Massachusetts.
128
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death
-ml 22
2. Namc,
(Maiden Name),*
(Name of Husband),*
Framall
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
..... Ycars,
-
Months,
- Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, .
DrHoware
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
Albion Riveredge
12. Name of Mother, (Maiden Name),
Nova Scotia
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, ·
4
Signature of Undertaker or other person making the Return, .
Albion Kittredge
DATED at
Chequesford, 011
Ruce 221896
* 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. September, 1892. - 5,000.
гилад
Steel bowl
11
[ Public Statutes, Chapter 32, as amended by Acts of 1883, Chapter 305 ; Acts of 1939, Chapter 224.]
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 punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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