USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 17
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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 eity 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 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 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.
. . ..
165
Plate.
1 Ed. Jan. 23, 1994. 5,000.
[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 elerk 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 (leceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time. of said death or 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 clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the. Lily of (City or Town. )
Lowell
during the month of December
1896.
1. Date of Death, .
December 12. 1896,
2. Name,
Surge Provincha
(Maiden Name), . (Name of Husband),
3. Sex, and whether single, Married, or Widowed,
Married
4. Color,
White 78 Years, Months, Days.
Prostatic Hypertrophy
Disease or Cause of Death, 6. Duration of Sickness, By whom certified,.
I. V. mange ML
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name.)
Canada
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
West Chelmsford
I certify that the foregoing is a true copy.
Attest : Chrard
(City or Town.) Clerk.
18
IN touch Chelmsford
Hool Sorter
General Hospital
Canada
Canada
Red
Male
5. Age,
Ree
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
PUndertakers must make this return before the burial or removal of the deceased.
Date of Death
filer 17
1 So 6
Name,
Still Bar
Maiden Name
Sex, ____ male; Color,
Single, Married or Widowed,
Age, - years, ~months,-days.
Name of Attending Physician,
Residence of Deceased-No.
Street (or Corporation), Ward.
Occupation,
Husband's Name,
Place of Death-No.
Street (or Corporation), Ward
Birthplace of Deceased,
11
Father's Name.
Gerne Contre Father's Birthplace,
Mother's Name,
11
Mother's Birthplace,
Mother's Maiden Name, .,
Beaupré
Place of Interment,
Chemesfind
Cemetery, Range
., Lot
.... , Grave,
.....
Signature of Undertaker or Informer,
Dated at Lowell, this.
day of
alec
1896
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death
December 17h
I So 6
Name and Sex of Deceased,
male.
Place of Death-No.
the Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Still born
(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.
the Chelmsford
Street,
Dated at Lowell, this.
En21
day of.
December
1896
166
RETURN OF DEATH
189
OF
..
...
1
.. ......
-
Ree No.
Commonwealth of Massachusetts.
167
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
LC
2. Name,
(Maiden Name),* .
-111 MirGaine
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
1
4. Color, t
5. Age,
Years;
7
Months,
20 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
7. Residence, ·
8. Occupation, .
9. Place of Deatlı, .
10. Place of Birth,
11. Name of Father,
David Mc Cain. Many Bickind agradou derré 22, 7 .
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, .
toward
DATED at
187.6
4 If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion,
{ If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] l'late. Ed. Jan. 1595 - 5,000.
Cherry 2.2 4 5 L.
[ 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 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 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 execeding 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 sun 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 suchi permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of healthi or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the 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 deatlı, as tlie elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not execed- ing fifty dollars.
A Ovo.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death,
Sce 31, 5yt Ellen 7 inflor
2. Name,
(Maiden Name),* . (Name of Husband),*
Nathaniel ACaller
Denziale
Aider
4. Color, t
5. Age,
52 Years, - Months,
28
Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
Chelmsford Mass
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,
Fairview Lean Prestra Plass
Signature of Undertaker or other person making the Return, .
11
11
Infil Davis
Caroline it Sooft
Royalton Vi-
- Richardom
DATED at
, on
189%
* 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. Dec., 1895 .- 5,000.
Commontocalth of Massachusetts.
168
11 Davio
3. Scx, and whether single, Married, or Widowed,
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.1
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 healthi 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 couutersign 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.
169
Ree)
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
Yan
4
189.%
Name, Aun M Hubbard
Maiden Name
Sex ...
Le male; Color,
months,
16 days.
Single, Married or Widowed,.
Name of Attending Physician,
Residence of Deceased-No.
Chlunsford May Street (or Corporation), Ward.
Occupation,
at Home
1
Street (or Corporation), Ward
Place of Death-No
Birthplace of Deceased, Greatgetarian Man
Father's Name.
Robert gemert
Father's Birthplace, ..
Georgetown Nun
Mother's Name Matuchatice Junety Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Georgetown Chantery, Range
Lot
................... , Grave,
Signature of Undertaker or Informer,
& B Curving
Dated at Lowell, this
7the
day of.
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death
Jan 4
1897
Name and Sex of Deceased,
Ann M Hubbard
male.
Place of Death-
Disease or Cause of Death,
Zumalguna of Heart
duration of*
Complications,
......
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Charles Bulky Ordway InD
Residence, No
Chelmsford.
Street,V
Dated at Lowell, this
Bipthe
.day of.
January
1897
*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 " below ingle when the deceased is a female and when the deceased is colored please insert.]
Street (or Corporation).
still-born
Age,.
74 years,
Husband's Name,.
Charles Hubbard
RETURN OF DEATH
OF
189
$
170
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, Jan 11th IS9 7
Name Martin Hall Cantine
Maiden Name, ..
Sex. male ; Color,
Single, Married or Widowed,
Name of Attending Physician, Dr Like Varney Age,
5.9
.years,
months,. .. days.
Residence of Deceased-No. North Cheland Street (or Corporation), Ward
Occupation, Husband's Name,
Place of Death-No North Chelmsford
Street (or Corporation), Ward
Birthplace of Decensed,
Stoddard NA
Mother's Name, Harriett
Mother's Birthplace,
Reaching mass
Mother's Maiden Name,
Place of Intermelo Chelmsford Cemetery, Range , Lot , Grave,
Signature of Undertaker or Informer,
John A Meinbeck
Dated at Lowell, this
130
day of fange 13
..
189
7
Father's Name.
Darren di Intishe's
Father's Birthplace,
Cher
RETURN
Ree
Commonbocalth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Jan 28 1897
2. Namc,
(Maiden Name),* .
(Name of Husband),*
3. Scx, and whether single, Married, or Widowed,
Merci Marcali Hale Marcel Mariah Shoulding Isaac Ihale- Female Widow White
4. Color,t
70 Years, 6 Months, 14 Days.
5. Age,
Disease or Cause of Death, (Primary and Secondary), }
Heart Failure "´ Hoy Zeralmin Five Days.
Living
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. Placc of Interment,
Carlisle Mass
Signature of Undertaker or other person making the Return, .
Thomas A. Green
WHY Harman Richardson
DATED at
Carlisle
on
Jan. 30 th
189.7.
* 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.
Charles Quetheory (Ordway In.D) Chelmsford Mais Housearife
Chelmsford Mass
Billerica- Mass. Benoni Spaulding
Rebeccale Brown. Bilínica Mass
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; 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 thercfrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars.
Commonwealth of Massachusetts.
172
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Pan 30th 1897
2. Name, .
Edith A Winning
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
5 Years, 4 .Months, 27 Days.
membranous
Crown
about one week.
Amasad toward Th. D. No leheimsward
7. Residenec,
8. Oeeupation, .
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,
do Enemford 1
.7 Walter R Winning Julia & Johnson Andone Mass Buther Me So Chelmsford Daniel P. Bram
Signature of Undertaker or other person making the Return, . ·
DATED at. Jo hoheliminare, on Pam 31ch 189.7
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
{ If other than White. (M.) Mulatto. (1.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895 .- 5,000.
Edith
Menale
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
[ 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 furuish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birthi 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 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 physiciau, 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; aud 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 healthi or to its agent, the board or agent shall fortli- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to 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.
Rec No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
51-22 1897 -10451711
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Viale learned
4. Color, t
5. Age,
77 Years, 10 Months, / Days. babetes and Gun Vorisering
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, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return
Daniel P. Byon
DATED at
So Chelmsford, on Feb 23
18 9.7
* 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. 1995 -3,000.
173
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
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