USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 14
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{When the child is still-born, so specify.)
Disease or Cause of Death,
Cholera infantino duration of*
Complications,
Dentition
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No ..
It babal-
Street
Dated at Lowell, this
حى
day of
August
...
*Reckoned to the time of death. [ Be very particular to fill the blank's, 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. |
Street (or Corporation), Ward
Father's Name,
There Tremblay
RETURN OF DEATH
OF
189
Rec
Ed. Jan. 23, 1894. 5,000.
[ACTS OF 1889, CHAP. 208.] AN ACT
138
I'late.
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each 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 deceased 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 birth; and shall transmit said certified copics to the clerk or registrar of the city or town in which such deccased 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 certificd copics 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 or Town. )
during the month of. July 1896.
1. Date of Death, .
July 22, 1896
2. Name,
(Maiden Name), . (Name of Husband),
male Amale
3. Scx, and whether single, Married, or Widowed,
4. Color,
5. Age,
26 . Years, Months, Days. Railroad Accident
Disease or Cause of Death, - 6. Duration of Sickness, By whom certified,.
J. C. Frish Medical Examiner
Chelmsford Centro
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. Placc of Interment, .
Odson aimistery Lawill Mars
I certify that the foregoing is a true copy.
Attest : Oprava & O coman
(City or Town.) Clerk.
18 .
St John's Hospital
Lowill
Lowell
Patrick J. Edgleston
02
Ed. June, 1890. 5,000.
[ACTS OF 1889, CHAP. 208.] AN ACT
Plate.
IN RELATION TO THE RETURNS OF BIRTHS 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 deceased 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 birth; and shall transmit said certified copies to the clerk or registrar of the city or town in which such dleceased 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 copics 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 formof (City or Town. ) during the month of. Only 1896.
Westford
1. Date of Death,
July 281896
2. Name,
Martha' Morton
(Maiden Name), . (Name of Husband),
George
Female
3. Sex, and whether single, Married, or Widowed,
Married
4. Color,
5. Age,
Disease or Cause of Death,
Duration of Sickness, By whom certified,.
at & NameyeDe North Thehansford
Chelmsford
Housewife
9. Place of Death, .
10. Place of Birth,
Queeds England
11. Name of Father,
George
12. Name of Mother, (Malden Name.)
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, ·
I certify that the foregoing is a true copy.
Attest :
Bilmang Might
Angel 1896.
Johan Clerk.
(City or Town.)
20 Years, 6 Months, Days. Bright's Disease
7. Residence,
8. Occupation, .
Medford
Catherine
Leeds England
Next Chelunsford
39
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Ang- 1-1896 Charlotte A. Black Parker
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, ¡
5. Age,
Disease or Cause of Death, (I', imary and Secondary), ;
١
6. Duration of Siekness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Jeremiah M barrier Susan (Parker)
12. Name of Mother, (Maiden Name),
Kingston Ox.
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
G. A. Howard
DATED at
, 0 Ctus 2 1886
* 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.] I'late. Ed. September, 1892 .- 5.000.
Chances & black
6 Years ..... Months, .... Days.
Paralysis
Dit. Howard Chelmsford
Hourentity
Ghansford
Barcisle
Cheausford
140
[ Public Statutes, Chapter 32, as amended by Acts of 1938, Chapter 305 ; 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 siid 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.
o.
Commonlocalth of Massachusetts.
141
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
1 V ctl 2
(Maiden Name),* ·
(Name of Husband),*
. 3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
- Years, Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
7. Residenee,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, . 11
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, .
1
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
7
/
1
11
...........
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305 ; Acts of 1589, 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 aforcsaid, 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 hy 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. .
142
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, ..
August 19h
IS9 6
Name, Fanny E. Flanders
Maiden Name, ... Janny
& Bake
Sex. SEmale; Color,.
Ywhite
Single, Married or Widowed,
married
Age, 38 years, 5 months, 12 days.
Name of Attending Physician,
Dr
merge
Residence of Deceased-No.
460 Princeton
Street (or Corporation), Ward
Husband's Name,
man 2. Alandere
Place of Death-No. 460 Princeton
Street (or Corporation), Ward
Birthplace of Deceased,
Both mur
Father's Name,
Joseph take Father's Birthplace,
Bath ME
Mother's Name, pulsa
Johnson
Mother's Maiden Name,
north Ehelyes for Cemetery Range.
, Lot
. Grave,
Place of Interment,
Signature of Undertaker or Informer, Dani youngtheo
Dated at Lowell, this ..
194
day of
august
IS9 6
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
19 8967
Name and Sex of Deceased, Harry E. Alanders
Female.
Place of Death-No.
460 Princeton
Street (or Corporation).
(When the child is still-born, so specify.)
Disease or Cause of Death Pulmonary Techrculosis Auration of *
. ...
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, lu meigo, Ms.
Street, ...
Merrimack
Residence, No.
160
Dated at Lowell, this
nineteenth
day of
Rec
Occupation,
House wife
Mother's Birthplace,
11
RETURN OF DEATH
OF
189
.....
1
Rec
No.
Commonbocalth of Massachusetts.
143
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
12.0 15,6
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
1 1
4. Color, t
5. Age, 22 Years, 11 Months, 26 Days.
Disease or Cause of Death, (Primary and Secondary), }
6. Duration of Siekness, . By whom certified,
7. Residence,
8. Oeenpation, .
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,
-Child:29
Signature of Undertaker or other person making the Return, .
DATED at ........ (ral, on
r
* 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.
Elevii.
Cholinato
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305 ; Acts of ISS9, 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 aforcsaid, 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 casc 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, 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 requestcd, 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.
Reo No.
Commontocalth of Massachusetts.
144
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,
Fernale- Imgle
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, .
Nov. 24th Régina Magant
1896
23 Years, 3 Months, 14 Days. Phthisis
B. Benoit M. D.
A. Chelmsford
Student
N. Chelmsford
Nashua N.A.
Arthur B. Magent
Philomane (Magent) Magant Canada
Canada
New Bedford Mais.
Arthur H Sheldon
DATED at
Chelmsford, on Nov. 24
1896
* 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. 1905 .- 5,000.
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1993, 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 ehild dying immediately thereafter, or at the birth of a stillborn ehild, 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- leets or refuses to make a certifieate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In ease 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 samc. If a physician refuses or negleets 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 sueh board, or agent or clerk, as the case may be, a satisfactory written statement containing the faets required by this ehapter to be returned and recorded, together with the eertifieate of the attending physician, if any, as required by seetion three of this ehapter, or in lien thereof a certifieate as liereinafter provided. If there is no attending physician, or if the eertificate 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 eity or town for the purpose shall, upon request of said board, agent or elerk, make sueh 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 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 thic elerk 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.
1451
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 Deat
h nov
1800
1896
Name,
Mary M
11
Carthy
Maiden Name
Many Harpes
Sex .. (
male; Color,
Single Married or Widowed ,
Age,
50
years,
.months,
days.
Name of Attending Physician, Dr & M" Cartas
Residence of Deceased-No. ..
Richmond)
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
East Chelmsford Mass Street (or Corporation), Ward
Birthplace of Deceased,
Ireland
Father's Name,
Thomas Hauses
Father's Birthplace,
Mother's Name,
Bridget
Mother's Birthplace,
Mother's Maiden Name", .:
Delaney
Place of Interment
Lowell Mass
Cemetery, Range
... , Lot
.... , Grave,
Signature of Undertaker or Informer,,
John
F Rogers
Dated at Lowell, this
2/20/
day of ..
17200
896
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death
nov
Name and Sex of Deceased, Mary Mi Carthy
male.
Place of Death-No
Cast SChelmsford Yorkam Street (or Corporation).
Disease or Cause of Death,
Filtros 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.
6/4 Central
Street,
Leawell Mass
Dated at Lowell, this
2/8/
clay of
Rex
ATATOTAXI
VI
..
OF
... . .
189
.
1
:
:
nec No.
Commonwealth of Massachusetts.
146
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,
Widowed
4. Color, t
5. Age, 75 Years, 6 Months, Days. 1
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, .
1.1. Birthplace of Mother, .
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
& K. Howard
DAATED at
Nov 10th
181.6,
* 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.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed Jan. 1895 - 5,000.
Chelmsford
Olivier Lane
Lanix Share
Gloucester Gloucester
South Chelmsford
Nor 9th 1896
DI. ELane
Raad Hruester
[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 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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