USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 15
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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 nntil 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, carly 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 same. When snch 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.
Rev
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, hou
IS9 6
Name, Florence D. Jucke
Maiden Name,.
Sex .....
Female ; Color,
White
Single, Married or Widowed,
Age, / years, ..
1
months, -days.
Name of Attending Physician,
Dr. Porter
made
Residence of Deceased-No.
north Chelmsford Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No. north Thelusford mask
Birthplace of Deceased, ... "1
north Fayette the
Mother's Name,.
Kate
11
Mother's Birthplace,
Lowalle mase
Mother's Maiden Name, //
Cannon
Cemetery, Range
... , Lot
, Grave,
Place of Interment, ..
Edson
Signature of Undertaker or Informer,
M. young Theo
Far
Dated at Lowell, this
day of
November
189 6
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,.
Name and Sex of Deceased,
Florence D. Juck
.male.
Place of Death-No. Worth Thehusford Mask
Street (or Corporation).
Disease or Cause of Death.
Phenmonia
duration of *
4 days
Complications,
I certify that the above is a true return to The best of my recollection and belief.
Name and Professional Title,
Residence, No.
253
Street,
Canal
. .
Dated at Lowell, this
day of
(When the child is still-born, so specify.)
Street (or Corporation), Ward
Father's Name,
Edwin & Jucke Father's Birthplace!
RETURN OF DEATH
OF
:
189
......
-
1
Rec 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,
(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 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 Fatlier,
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
DATED at!
te /.et
, Olì
Nov. 4th
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. 1895 .- 5,000.
1
Ovou 3rd
1896
Yaselin
Female
White
Stillborn
....
G. A. Harlow M. D. Worth Chelmsford
North Chelmsford 1.
61
Phillip Vaselin
lessie (Dans (ord) baseline England England
Not Chelmsford Mass.
Arthur At. Sheldon
148
[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 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, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that sneh 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 same. 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 iu 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 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 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 sliall, upon request of said board, agent or elerk, make such certificate as is required of the attending physician ; and in ease 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 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 deatlı, 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- ing fifty dollars.
RO
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,
Det 3/20
189.6
Name
mary & Prince
Maiden Name,
Sex,
måle; Color,
Single, Married or Widowed,
49
years,
months,
.days.
Name of Attending Physician,
La du Chiste
Residence of Deceased-No.
Chehusford
Occupation,
Husband's Name,
Street (or Corporation, ) Ward.
Charles A Rinice
Place of Death-No.
Street (or Corporation), Ward
Birthplace of Deceased,
Bradford mag
Father's Name Samson Senhun Rather's Birthplace, Salem
Mother's Name
fermé
anarch
Mother's Maiden Name,
Place of Interment,
and Cemetery Range
, Lot
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
day of ..
31 at
IS9 6
Physician's Certificate of the Cause of Death.
(Bee extracts from Acts of Legislature below.)
Date of Death,
Geef 3128
Name and Sex of Deceased, 6
of Prince
male.
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death,
Peritonitis
duration of *
Complications.
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, aouly
Residence, No. v.
treet.
Dated at Lowell this day of
149
AlVernbeck
Mother's Birthplace,
Salem
OF
189
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,
eller. 29
IS9.
6
.Name,
Ntarrest effray
Maiden Name, ...
1
Sex ..
.......... nale ; Color,
Muté
Single, Married or Widowed,
married
Age, /2 years,
3
months,
22 days.
Name of Attending Physician,
Dr 2 terry Mc Clusky
Residence of Deceased-No.
N. Cheeines ford.
Street (or Corporation), Ward
Occupation.
MO chelmsford
Street (or Corporation), Ward
Birthplace of Deceased,
England
Father's Name,
Un kurum.
Father's Birthplace,.
England
Mother's Name,.
11
Mother's Birthplace, ..
Mother's Maiden Name, 11
Place of Interment,.
W. Chelmsford
Cemetery, Range
Lot
Grave,
--
Signature of Undertaker or Informer,
b. M. going To,
---
Dated at Lowell, this
day of
Physician's Certificate of the Cause of Death.
Date of Death, Cœur. 29"
extracts from Acts of Legislature below.)
Name and Sex of Deceased, Harriet Jeffrey
Emale.
Place of Death-No.
Weat Bhelmeheraf
Street (or Corporation).
Disease or Cause of Death,
Cancer of suver tuation of*
(Win the child is still-born, so specify.)
3 weeks.
........
Complications, ..
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, Henry L mibluebay, No. D.
Residence, No.
No.
Chelmsford
Street, ..
Dated at Lowell, this
day of
Husband's Name,
John feffroy
Place of Death-No.
RETURN OF DEATH
OF
189
150
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 .. 4
Name,
Antonio
Sarneau
Maiden Name
Sex, OFFemale ; Color,
While
Single, Married or Widowed,
Age, - years,
8
months,
15 days.
Name of Attending Physician,
In Varney
Residence of Deceased-No.
te Chembeford
Street (or Corporation), Ward.
Occupation,
Husband's Name,.
Place of Death-No
Tto 6 homesford
Street (or Corporation), Ward
Birthplace of Deceased,
"
Father's Name.
Joseph Garneau Father's Birthplace,
Canada
Mother's Name,
Exceda
Mother's Birthplace,
Mother's Maiden Name,.
Boissoneau
Place of Interment,
Themesford
Cemetery, Range
Lot
, Grave,
Signature of Undertaker or Informer,.
Dated at Lowell, this
28
day of
IS9 6
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)
Date of Death
Oct. 27
SQ 6
Name and Sex of Deceased,
Antônio Garneau
.male.
Place of Death-No.
No. Chehaford
Street (or Corporation).
Disease or Cause of Death,
onolira Infantino duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, warner M.W.
Residence, No ..
NVV. Eltono vá.
Street,
(When the child is still-born, so specify.)
Dated at Lowell, this
clay of
IS9
RETURN OF DEATH
OF
189
.....
N
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Oct 25 1896. Isaiah @ Spaulding
(Maiden Name),*
(Name of Husband),*
Male.
3. Scx, and whether single, Married, or Widowed,
Married.
4. Color, t
5. Agc, 78 Years, 6 Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
8 months
6. Duration of Sickness, . By whom certified,
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,
Dank & Biam
DATED at S Skelmeford, on Oct- 26
* If a Married Woman or Widowk { 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. 1935 .- 5,000.
Such Chelnund.
South Chelmsford
Isaiah Spaulding. Paths Sam
Chelpackard.
Southhelmand
Signature of Undertaker or other person making the Return, .
Commonwealth of Massachusetts.
159
[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, forthwitli 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 siekness, 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 child, shall, when requested, forthwith fornisli for registration a certificate, stating to the best of his knowledge and belief. the fact that such a ehild died after birth or was born dead. If a physician neg- leets or refnses to make a certifieate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exeeeding 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 canse of death as nearly as he ean state the same. If a physician refnses or negleets to make such certifieate 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 bnry in a city or town or remove therefrom a human body until he has received a permit so to do from the board of healthi or its dnly appointed agent, or, if there is no board of health in suchi city or town, from the eity or town elerk. No sneli permit shall be issued until there has been delivered to sueli 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 seetion three of this chapter, or in lieu thereof a certifieate as liereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient rcasons, 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, npon request of said board, agent or clerk, 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 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 deatlı, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exeeed- ing fifty dollars.
153
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
24. 10 6
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowcd,
4. Color, t
5. Agc,
68 Years, .Months, Days.
1 Paralysis
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certificd,
7. Residence,
8. Occupation, .
Cut-Jour Charm
Chelmsford
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, .
. M. However
DATED at
thelostora, on
Cez 24
18 9.6
+ 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.
Ru No.
[ 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- 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 refnses or neglects to make sueli certifieate 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 eity or town or remove therefrom a human body until he has received a permit so to do from the board of healthi 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 clerk, 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 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 samc. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with eountersign 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 fine not exeecd- ing fifty dollars.
154
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 retury before the burial or removal of the deceased.
Date of Death,
October 18cl
IS9. 6
.Name,
Herge & Davis
Maiden Name, ..
Sex.
male ; Color,
while
~
Single, Married or Widowed,
Single
Age,.
64 years,
months,
.. days.
Name of Attending Physician,
De Varney
Residence of Deceased-NQ.
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death- North Intensaand Corporation), Ward
Birthplace of Deceased,
Father's Birthplace,
Lowell
Mother's Name,.
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment, ..
Lowell
Cemetery, Range
.3 Lot.
.... . Grave,
Signature of Undertaker or Informer,
2. 13 Сигал
day of
1896
cect
Dated at Lowell, this
20
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Oct. 18th
IS9 6
Date of Death,.
male.
Name and Sex of Deceased,
George & Davis
Place of Death-No.
Though Chelmsford
Street (or Corporation).
Disease or Cause of Death,
applexy
duration of*
two weeks
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, North Chelmsford
Street,
Dated at Lowell, this
19che
day of
Ochation
(When the child is still-born, so specify.)
Lowell
Father's Name,
Elisha Davis
ACIUAN OF DEATH
OF
.
189
1
Rec No.
155-
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
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 Birthi,
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 of Sheldon
DATED at & K.Chelmsford, on Out- 6th 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.
Oct. 6th 1896 William W. Spaulding
Male
Married White
27 Years, 11 Months, 16 Days.
Hephritis
one year
F.E Name M. D. North Chelmsford Machinist
North Chelmsford
Westford Mars.
Calvin W. Spaulding Mary 1. (Harris) Shouldme Groton Mass.
England
Westford Class
[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 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 dcad. 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 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 thercfrom 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 therc 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 threc of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, 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 samc. 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 finc not excecd- ing fifty dollars.
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