USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 18
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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 agc, 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 regnested, forthwith furnish for registration a certificate, stating to the best of his knowledge and bclicf 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, 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 such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth withi 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 canse 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, .
2. Name,
Feb. 26. 1897. Sarah J. Hansen Sarah). Elliott
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Married
4. Color, t
5. Age,
12 Years, 0 Months, Z ..... Days.
Disease or Cause of Death, - (I'rimary and Secondary), # 6. {Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
Housekeeping
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Epheran Eltion Dover Elkins
12. Name of Mother, (Maiden Name), Thornton N. H.
13. Birthplace of Father, .
KThornton f.H
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
S St. R. Harvard
DATED at
Chebresford, on
Feb. 2%.
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. Jan. 1593 - 5,000.
174
14. Birthplace of Mother, .
Canada
[ 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 thereiu, 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 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 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 health or its duly appointed agent, or, if there is no board of health in such eity or town, from the eity 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 faets 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 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 clerk, make such certificate as is required of the attending physician; and in ease of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the elerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the 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.
175
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
March 11. 189%
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),
G. (Duration of Sickness, . By whom certifiecl,
7. Residenee,
Ce hetenslord
8. Oeeupation, .
Hareschaef, 2224
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, .
DATED at
6oct221/024, on
Tharch 11 189%.
* 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. Jan. 1895 .- 5,000.
Sprech A. Sezzelh Sarah A Patheros Elbridge s. Smith
6 Years,
Months, 11 Days.
Thornaston the
Charles H. Mathews
Frenesse b. bounds Rockland /118
banden the
Chelinstance
[ 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.
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 ageut, 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 licu 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.
Rel Vo.
Commonbocalth 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,
72 Years, 9 Months, 2.2 Days.
Organic disease of Heart
6. Duration of Sickness, . By whom certified,
F & Varney M.D W 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,
Signature of Undertaker or other person making the Return, .
A. G. Par Khara1
DATED at Chefinofory , on march 1/ 187% 189.
4 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 - 3,000.
March 16th 1897 Jonathan. Hoyt
Male Married
Disease or Cause of Death, (Primary and Secondary), #
2 years
W. Chelmsford Mass Gilford N.H.
Henry How
Rolls Colírio
Grilling N.H.
W. Chelmsford Mass.
176
[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 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 licu 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 eity or town for the purpose shall, upon request of said board, agent or clerk, inake sueli 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.
Rec ١ Vo.
*
Commontucalth of Massachusetts.
177
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
(march, 14th 18 7 ).
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 1, 3 Years 8 Months, 13 .. Days.
Disease or Cause of Death, (Primary and Secondary), 6. {Duration of Sickness, . By whom certified,
7. Residence,
8. Oeeupation, .
9. Place of Death, .
10. Place of Birth, .
Hathole, 1.71
11. Name of Father,
Masz ( Bund,
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, .
if. R. Harvard
DATED at
* 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.
Which,-store
Meret He22 1,1020 11.91
Hathate , 1.7.
[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.
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 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 excecd- ing fifty dollars.
Rec No.
Commonwealth of Massachusetts.
178
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 IIusband),*
3. Sex, and whether single, Married, or Widowed,
//02ried
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
Plana Whacker
9. Place of Death, .
Chelastard
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. .
1 CL. T. Harward
DATED at tofiet2020ford, on March 23, 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. Jan. 1895 .- 5,000.
March, 22. 1547 John S Sted
y9 Years,
Months, 23 ... Days.
Chelonsforel
1122
to fremfor21
ChetrustArd
[ 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 dceease; 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 thercin, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate lic shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No nndertaker, 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 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 tlie 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 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 deecased or to the manner and cause of the death, as the 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.
179
may 2
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
1991
Name, .....
Matthew
Maiden Name
Sex.
male ; Color,
*Single, Married or Widowed,
Age,
80 years.
months,
.. days.
Name of Attending Physician,
Residence of Deceased-No. Cettetime for$
Street (or Corporation), Ward
1
Gecupation, Husband's Name,
Place of Death-No.
Street (or Corporation), Ward 1
Birthplace of Deceased, Ireland
Fathers Name .. /.
vist known
Father's Birthplace,
tilland
Mother's Name,
-
Mother's Birthplace,
4
1
Mother's Maiden Name,
Place of Interment,
Catholic
Cemetery, Range .. , Lot , Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
189 7
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)
Date of Death 189.
Name and Sex of Deceased,
.. male.
Place of Death-No.
Street (or Corporation) .
Disease or Cause of Death,
duration of*
Complications, .....
.......
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No. ...........
Street,
Dated at Lowell, this
clay of. ....
IS9
(When the child Is still born, so specify.)
RETURN OF DEATH
OF Matthew Hay cs
March, 21, 1897
180
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
March 23
Name,
Di Jennie (parter
Maiden Name
M. Jennie Coburn
Sex. female; Color,
Single, Married or Widowed,
Married
Age, 43 years.
1
months, 27 days.
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