USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 16
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156
I'late.
[ACTS OF 1889, CHAP. 208.] AN ACT 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 cach 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 birtli; and shall transmit said certified copics 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 deccascd 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- wealtlı.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
DEATH
recorded in the books of the of
(City or Town. ) during the month of
1896
1. Date of Death,
Sept 10th.
2. Name,
(Maiden Name), . (Name of Husband),
1
Je Single
3. Sex, and whether single, Married, or Widowed,
white
4. Color, .
5. Age, 3 Years, 1 Months, 8 Days.
Meneranno Croup.
Disease or Cause of Death, 6. Duration of Siekness, By whom certified,. .
I. E. Babcock m. S.
Tyngsboro mass,
7. Residenee,
8. Oceupation, .
North Starmouth .
9. Place of Death, .
Synsboro mars
10. Place of Birth, .
11. Name of Father,
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 : Hr. Hl Hamis
Joven Clerk.
(City or Town.)
18
.
Barbara N. (Viadell)
England
do Arth Chelmsford mars
Ed. Jan. 23, 1894. 5,000.
Copy of the Record of a
Margarite Daisy Anagford
Ru No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2
6
2. Name,
2
(Maiden Name),* .
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age, Years, / Months, 11 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, . Cinchnsione
10. Place of Birthi,
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
10
18ºC /
DATED at 5
Benjamin Hearing Melinda acerz Berwick Et york
+ 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.
[ 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 he died, the duration of his last sickness, and the date of his deeease; 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.
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 elerk. 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 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 sliall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as tlic 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. .
158.
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,
Maiden Name,
Parafinal
Kenesson
Sex .... Female; Color,
Single, Married or Widowed, Married
Age, 33 years, - months,days.
Name of Attending Physician, De Ordway
Residence of Deceased-No. Chelmsford
Street (or Corporation), Ward
Occupation Youse Muile
Husband's Name,
Peter Peterson
Place of Death-No.
Chelmsford Center
Birthplace of Deceased,
Father's Name,
tramite Engenheiro Father's Birthplace
Mother's Name,
Rangide ~ ~ Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,.
Edson
Cemetery, Range
, Lot
Grave,
A. M. Glowing. Hu
Signature of Undertaker or Informer,
Dated at Lowell, this
28- day of elift
.day of
- ISO 6
Physician's Certificate of the Cause of Death.
See extracts, from Acts of Legislature below.)
Date of Death,
Name and Sex of Deceased,
. Caroline.
Peterson
female.
Place of Death-No. Chelmsford Center
Street (or Corporation).
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Date and Place of Death, t -
Disease or Cause of Death, - (Primary and Secondary.)}
Duration of Sickness, -
Caroline Peterson
Age, ..
33
died at.
Chelmsford Inass Sefit 271806.
of
Tubeculosis Pulmonalis
I certify that the above is true, to thebest of my knowledge and belief.
Signature and Residence of Certifying Physician, ..
Date of Certificate, Sept. 27 th / 189 4.
7
Line Peterson
IS9 6.
.. Name,
Caroline
white
. Street (or Corporation), Ward
Namvang
1896
(
ΥΥΤΤΥΠΙΑΤ ΤΑ ΑΥΤΟΤΕΝΙ
OF
189
....
/5 59
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN Found thelong ford To the Board of Health and the Clerk of the City of Lowell.
Undertakers mustmake this return before the burial or removal of the deceased.
Date of Death,
1896
Name,
Jarah Harriman
Maiden Name,.
Sex Female; Color, 112
Single, Married or Widowed, LLC
Age, 69 years, 11 months,
.. days.
Name of Attending Physician,
De Linge
Residence of Deceased-No ...
cro #475 Hale
Street (or Corporation), Ward
Husband's Name,
I VCcian Hourzeman
Occupation,
Hest thelong ford gruss
Street (or Corporation), Ward
Place of Death-No.
Birthplace of Deceased,
England
Father's Name,
Samuel Lognes
Father's Birthplace, ( England
Mother's Name,
Chany
Mother's Birthplace .......
Mother's Maiden Name, Unknown
Place of Interment, ..
Edson
Cemetery, Range.
., Lot.
. Grave,
Signature of Undertaker or Informer,
day of
Sift
1896
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, Dell 4H
IS9 20 ..
Name and Sex of Deceased, Sarah, Hansinvan
male.
Place of Death-No.
Test Chelunsford 21-
Street (or Corporation).
Disease or Cause of Death,
aphoplay
duration of *
" twoof us
Complications, I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No. 408
Street,
day of
Fapt
Dated at Lowell, this 5th
(When the child is still-born, so specify.)
Dated at Lowell, this
/ 2
ACIUAN OF DEAIII
OF
..... ....
. . ..
.- ...
189 .......
160
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,
Selvt 9-1895 John Noci and
(Maiden Name),*
(Name of Husband),*
S
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, ~ Years, 4 Months, ~ „Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
Chas A Ordenar
7. Residence,
8. Occupation, .
9. Place of Deathı, . 11 11
10. Place of Birth, . 11 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, .
Sitter w melde
DATED at
Chelmsford, on
Sajit-9 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. Nov. 1890-5,000.
5
Stephen YV.
Alice ( gaskin.
No, Cherusford England
el
Cholera Infanti
[ACTS OF 1888, CHIAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to (cceased persons, is amended so as to read as follows :- Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his dcccase. If a physician neglects or refuscs to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate &s 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 deatlı by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livercd 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 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 exceeding fifty dollars. [Approved May 4, 1888.
161
Commonbocalthy of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
2
1
6
1. Date of Death, .
2. Name,
(Maiden Name),* (Name of Husband),*
3. Scx, and whether single, Married, or Widowed,
4. Color,t
3. Age,
2% Ter Montlıs, 26 Days.
Disease or Cause of Death, (Primary and Secondary), # -
6. Duration of Sickness, . By whom certificd,
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,
7
DATED at UNELE
18 43
* 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. September, 1892 .- 5,000.
Cari, Jervoir 2
Signature of Undertaker or other person making the Return, .
[ Public Statutes, Chapter 32, as amended by Acts of 1838, 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 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 bc, 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.
162
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Geht 8 1896
2. Name,
Sjaal A Chamberlain
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
male wed.
4. Color, ¡
5. Age,
GY Years, Months, Days.
Disease or Cause of Death, (Primary and Secondary), ; 6. {Duration of Sickness, . By whom certified,
medical Examiner
Hartford Conn.
7. Residenee,
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,
Thathe Chelnspace
Signature of Undertaker or other person making the Return, .
DATED at Ntheunsford, on
Siht-9
* If a Married Woman or Widow //t 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.
Det
Commonlocalth of Massachusetts.
No.
North Chelmsford
[ 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 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.
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.
/Ed. Jan. 23, 1894. 5,000.
[ACTS OF 1880, CHAP. 208.] AN ACT
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each eity 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 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 elerk or registrar so receiving such certified eopics shall record the same in the books kept for recording deaths or births. Such certified eopics 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 passagc. [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. Your of Westborough, Mass.
(City or Town.) during the month of august 1896
1. Date of Death,
2. Name,
(Maiden Name), . (Name of Husband),
Females
3. Sex, and whether single, Married, or Widowed, 4. Color,
Widowed
White
6.5 Years, Months, Days.
Organic Dementia Y exhaustion
2 yrs at Hospital
Disease or Cause of Death, 6. Duration of Sickness, By whom certified,.
Elle & Keith This.
Chelmsford. The
7. Residence,
More
8. Oceupation,
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, 1
Lowell Mars
I certify that the foregoing is a true copy.
Attest :
Clerk.
(City or Town.)
18
Westborough . Mas
Vermont
163
Plate.
aug 12. 1896.
Mrs Paura a themados
5. Age,
No.
Commonlocalth of Massachusetts.
164
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,
2 2, Years, Months,. Days.
Phthisis
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 Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
Alice (Carlin) Shields Exeland
Ireland
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur A Sheldon
DATED atc
North Chehusfordon.
Dec 8 th
$76
* If a Married Woman or Widow. tlf a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, speelfy what. [Be very particular to fill all Blanks.] P'late Ed. Jan. 1895 .- 5,000.
Dec. 7th 1896 Mary J. Shicias
Fernale
Single White
Six months
F & Varmer M. L. North Chelmsford
North Chelmsford
North Chelmsford
Athin Shields
Lowell Mais.
[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 physieiau 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 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 fiue notexceeding 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 eause 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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