USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 13
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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 transinit 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.
129
Rel
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,
189.6
Name.
Daniel
mathison
Maiden Name,
Sex,
male; Color,
Single, Married or Widowed,
Age, 61 years, -months,
~days.
Name of Attending Physician, Wood
Residence of Deceased-No.
Intel Corporation, ) Ward
Occupation,
Machining
Husband's Name,
Place of Death-No.
May Street (or Corporation), Ward
Birthplace of Deceased,
England
Father's Name, .
Father's Birthplace,
England
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
REdrar
Cemetery, Range
... , Lot
, Grave,
Signature of Undertaker or Informer,
day of
189 6
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
So 6
Name and Sex of Deceased,
David Smithrow
... male.
Place of Death-No
Chlemsford Mars
Street (or Corporation).
Disease or Cause of Death,
Denile Emphysema
duration of
Complications,
I certify that the abovegis a true return to the best of my recollection and belief. Name and Professional Title, Cohas LWords MED.
Residence, No.
10
Street,
4ohm
Dated at Lowell, this
8
clay of
July
1896
Dated at Lowell, this
RETURN OF DEATH
OF
189
130
ice
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,
vily
IS9
6
.Name,
Della le tenlaycon
Maiden Name,.
Celle & Day
Sex. Le male; Color,
Single, Married or Widowed,
manuel
Age,
3 -4 years, -months,
9
days.
Name of Attending Physician,
Der Howard
Residence of Deceased-No.
lehematora
Street (or Corporation), Ward
Occupation, House wife
Husband's Name,
Harris Il tenlayRow
Place of Death-No.
Chemeforce
Street (or Corporation), Ward
Birthplace of Deceased,
(") Wesley. Mase
Father's Name,
atich Hay-
Father's Birthplace,
Neeley Mar
Mother's Name, Margaret
Mother's Birthplace,
1
1 .
Mother's Maiden Name,
Hay wood
Place of Interment,
Edson
Cemetery, Range ......... , Lot : Grave,
Signature of Undertaker or Informer,
Crmyoung two
Dated at Lowell, this
day of
1896
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, July
IS9 6
Name and Sex of Deceased, Cella Le tenlayeon
male.
Place of Death-No.
lehereford
.Street (or Corporation).
Disease or Cause of Death,
(When the child is still-born, so specify.) 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.
Street,
Dated at Lowell, this clay of
*Reckoned to the time of death. [ Be very particular to fill the blanks, and strike out words that fire 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
. ..
L
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
July 11th 1896 Bridget Dalen Marken
(Maiden Name),*
(Name of Husband),*
Daniel Daher
3. Sex, and whether single, Married, or Widowed,
Married
4. Color,t
5. Age, Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
7. Residenee,
8. Oecupation, .
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,
Arthur A. Sheldon
DATED at N. Chelmsford
, on
July 12th
896
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. { If other thau White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895. - 5,000.
F. E. Varner 1.2. North Chelword Mass Krusekeiner North Chelmsford Ireland Edward Marken Kate- Markes Ireland
Ireland
Lowell Class
Signature of Undertaker or other person making the Return, .
54 Years,. ~ Months, - Days.
Brights Disease Unknown
Female
131
Commonlocalth of Massachusetts.
2ce
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 203.]
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 deccase; 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 furuish 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 immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate lic 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 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 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 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 exceed- ing fifty dollars.
1320
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,
July
11 th
...
IS9 6
ham James
Surran
Maiden Name, ...
male ; Color,
Single, Married or Widowed,
Age, 29 years, -months,- days.
Name of Attending Physician,
Residence of Deceased-No.
40 Lewis
Street (or Corporation), Ward
Occupation,
Cugineer,
Husband's Name,
Place of Death-No ...
B.r. M. Raulwad F. Chelmsford Street (or Corporation), Ward
Birthplace of Deceased,
Dieband
Father's Name,
Edward Curriand
Father's Birthplace,
freland
Mother's Name,
Gathering
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment, Catholi
Cemetery, Range ..
1
, Lot
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
day of
July
IS9 6.
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, ..
IS9
Name and Sex of Deceased, male.
Place of Death-No.
Street (or Corporation).
(When the child is still-born, so specify.)
Disease or Cause of Death,
RK Cecciclul duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, Mb nach practical Examen
Residence, No.
267 Redwith
Street,. enel
Dated at Lowell, this 11
day of
189 6.
*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. 1
James I/O Donnell
Ree
RETURN OF DEATH
OF
189. ...
133
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
1
1
11
6
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
J - 5
4. Color, t
5. Age, Years,
Months, 1 Days.
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, 1
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, .
₡
7
DATED at 6 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.] l'late. Ed. September, 1892 .- 5,000.
......
1 261
1 1 1260 2 (Maiden Name),
1 1 1
Rec
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 305 ; Acts of 1889, 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 perinit 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 fine not exceeding fifty dollars.
Rec No.
Commonwealth of Massachusetts.
134
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, July 29
2. Name,
(Maiden Name),* (Name of Husband),*
Female
3. Sex, and whether single, Married, or Widowed,
Single
4. Color, t
5. Agc,
Years,- Months, ....... - .... Days. still born
Disease or Cause of Death, (Primary and Secondary), ;
6. {Duration of Sickness, . By whom certified,
F.E. borner M.D.
7. Residence,
8. Occupation, .
9. Placc 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,
A. that, ford A Chelmsford Edgar Dixon Lena Alemalt) Dixon England NoChelmsford Af Chelmsford
Signature of Undertaker or other person making the Return, .
Arthur At Sheldon
DATED at AChelmond, on. July 29 1895
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895. - 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 statiug, 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; 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, forthiwith 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- 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 ean state the same. If a physician refuses or neglects to make such certifieate lie shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sextou 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 towu, from the city or town elerk. No sueh permit shall be issued until there has been delivered to sueh board, or agent or elerk, 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 certifieate 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 such satisfactory statement and certificate are delivered to the board of health or 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 deceased or to the manner and eause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exceed- iug fifty dollars.
135
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,
IS9 6 Name,.
Katie Mc Millan
I
Maiden Name,
Sex.
male ; Color,
Single, Married or Widowed,
Age, J years, ...
months, ..
........ days.
Name of Attending Physician,
Mc Cauti
Residence of Deceased-No.
East thetus orch
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No. .
Bast thelaw ford
Street (or Corporation), Ward
Father's Name,
Michael
Father's Birthplace,
Tretard
Mother's Name,
Rose
Mother's Birthplace,
Mother's Maiden Name,
Conway
Place of Interment,
cutione
Cemetery, Range
, Lot
, Grave,
Signature of Undertaker or Informer, R.F. On time
Dated at Lowell, this
29 day of
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Only"
29
6
Name and Sex of Deceased,
Katie Michelvan
male.
Place of Death-No.
Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Phithisis
( When the child is still-born, so specify.)
duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Den Centy
Residence, No. ..... ...
Street, ..
Dated at Lowell, this
130
day of
IS9 6
*Reckoned to the time of death.
that are not correct, such as street or corporation, single, married or widowed, and fasert " fe " before
-
Birthplace of Deceased,
dowill
Maso
RETURN OF DEATH
OF
189.
136
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,
Aula 30th Lucy
1896
Seymour
3. Scx, and whether single, Married, or Widowed,
Female - Single
White
4. Color, t
5. Age,
2 Years, 1 Months. 20 Days. Meningitis
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.
A. Chelmsford, on.
July 31
1896
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. { If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895 .- 5,000.
F. E. Varney M. D.
North Chelmsford
North Chelmsford
North Chelmsford Edward Seymour Julia (Mason) Seymour Burlington UT. Canada
Lowell, Mass.
Rec
(Maiden Name),* (Name of Husband),*
[ 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 aud 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 certificatc, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dcad. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement thercin, 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 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 eity 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 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 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 delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the elerk 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 eause 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 exceed- ing fifty dollars.
137
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,
IS9
Name,
Pierre N. Tremblay
Maiden Name,
Sex. - male; Color,
.months,
1 7 days.
Single, Married or Widowed,
Age, ...........
-years, 10
Name of Attending Physician,
Residence of Deceased-No. 6 herilsford
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
Birthplace of Deceased, .....
1.
Father's Birthplace,
...
Canada
Mother's Name,
mary
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Therefore Cemetery, Range
, Lot
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
189
6
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, ...
Aug 19-
IS9 6,
Name and Sex of Deceased,
Pierre . Tremblay
male.
Place of Death-No. Chelmsford
Street (or Corporation).
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