USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 2
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Lowell maro
Father's Name,
that I Holt
Father's Birthplace, Merrimack Kde.
Mother's Birthplace,
awall mart
Mother's Name, mary
Mother's Maiden Name,
North Chelch Bange
Place of Interment,
......
, Grave
, Lot.
.
Signature of Undertaker or Informer,
Daled at Lowell, this
5° the
day of.
maso
IS9
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.
:
Date of Death
March 4 Th
189.24
Name and Sex of Deceased
George B. S. Holt
male,
Place of Death - No. North Chelmsford
Disease or Cause of Death
Empresa
Street-(or Corporation).
. duration of *
12 Weeks
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
For Pike MD
Residence, No.
North Chelmsford
Street
Dated-at-Lowell, this
North Chelmsford day of
march 5 Th
189%
or widowed, and insert "fe" before male
RETURN OF DEATH -OF -
...
189
1
No.
Commonwealth of Massachusetts.
30
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),*
Female
Single White
4. Color, t
5. Agc, Years, 10 .Months, Days. Disease or Cause of Death, (Primary and Secondary), # Cerebro Spinal Meningitis 10 days
6. Duration of Sickness, . By whom certified,
F. W. Like M.D
North Chelmsford Less
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, .
North Chelmsford Class
North Chelmsford Nors. John Shields
fürel Garoline) Shields Freland
Ireland
Lowell Mass,
Arthur & Sheldon
DATED at& M. Chelmsford, on March 11th 1894
* If a Married Woman or Widow. { If a Soldier who served In the War of the Rebellion. t If other than White. (M.) Mulatto. (f.) Indlan. If of other Races, specify what. [Be very particular to fill all Blanks. ] l'late. Ed. September, 1892 .- 5,000.
Marzia 11 2 . 54, la ninine E Shields
3. Sex, and whether single, Married, or Widowed,
[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 aforcsaid, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required 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.
Commonfocalth of Massachusetts.
No.
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 ·
3. Age,
77
Years, ..
Months,
.Days.
7. Residence,
Chelmsford
8. Occupation, . 9. Place of Death, .
Boarding
Chelmsford
Jacksontown N. B.
Benjamin
Chasehill
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, .
S. R. Howard
DATED at
Chelmsford, on
March 16 %. 1894
* 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.
March 16th 1894 John R.Churchill
Wedoner
.
Disease or Cause of Death, (Primary and Secondary), # 6. Duration of Sickness, . By whom certified,
10. Place of Birth,
Elisabeth
Lowell
31
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305 ; Acts of ISS9, Chapter 224.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of 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.
No.
Commonbocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
March 17th 1894
2. Name,
Elisa I. Dean
(Maiden Name),* (Name of Husband),*
Horace & Dean
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age,
82 Years, 2 Months, 17, Days. .......
Disease or Cause of Death, (Primary and Secondary), ;
6. (Duration of Siekness, . -
By whom certified,
7. Residenee,
8. Oecupation,
Honschacher
9. Place of Death, .
Chetinocoml
10. Place of Birth,
Millord. N. H
11. Name of Father,
Lowmi A. Luxen
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
Barlow Dass
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
S. R. Howard
DATED at
Chelius/ou harch 199894
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion. t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
{Be very particular to fill all Blanks.] l'late. Ed. September, 1892 .- 5.000.
Belier Sould
Milford NS
Elija I. F. hiim
[Public Statutes, Chapter 32, as amended by Acts of 1838, Chapter 305 ; 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 therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of stid 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.
13
Commontocalth of Massachusetts.
No.
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),*
Female
3. Sex, and whether single, Married, or Widowed,
Single
4. Color, t
5. Age,
17 Years, 1 Months, 5 Days. Bronchitis
1 Disease or Cause of Death, (I':imary and Secondary), ;
6. Duration of Siekness, . By whom certified,
Fib Plunkett M.D.
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, .
Arthur A Sheldon
DATED at N.Chelmsford, on Abril 29th 1894
* 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.
North Chelmsford Mas Mill Operative
North Chelmsford Muss, North Chelmsford Mass John Shields
Alice ( Carolin) Shields
Ireland
Ireland
Lowell Mass
April 29th 18944 Hannah A Shields
[ Public Statutes, Chapter 32, as amended by Acts of 1883, Chapter 305 ; Acts of 1839, Chapter 22.4.]
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 immechiate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of 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.
.
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
11-18/01
2. Name, (Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
1.
1
4. Color, t
5 7 Years, .. Months, Days.
5. Age,
Disease or Cause of Death, (Primary and Secondary), ;
6. (Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name),
1
13. Birthplace of Father, .
14. Birthplace of Mother, .
Pccenter 11 1
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
S. K. Howard
DATED at , on
1895
7
Bice rica
Spaceting)
* 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. September, 1892 .- 5,000.
Rec No.
[Public Statutes, Chapter 32, as amended by /Acts of 1888, Chapter 305 ; 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 therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of 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.
Ed. Sept., 1889. 5 M.
[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 certificd 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 clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certificd 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. City of Lowell
(City or Town. ) during the month of Jime 189%.
1. Date of Death, . June 8. 1894
2. Name,
Henry M. Labe
(Maiden Name), . (Name of Husband),
3. Sex, and whether single, Married, or Widowed,
male
Married
4. Color, .
5. Age,
62 Years, Months, Days. Accidental dicroving
6. Duration of Sickness, By whom certified,.
& C. Frisk Medical Examiner
north Chelmsford
7. Residence,
8. Occupation,
Laborw
9. Place of Death, . Merrimack Awww
10. Place of Birth,
Ireland
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
Catholic Cemetery Lowile Mars.
I certify that the foregoing is a true copy.
Attest :
June 16
1894.
asst. betty Clerk.
(Cits or Town. )
3 Plate.
Freland
Disease or Cause of Death,
30
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,
10
189V
Name,
Jamas Holland Sex, ..... male ; Color,
white
Single, Married or Widowed, Dr. Award
Name of Attending Physician,
Residence of Deceased No.
Street (or Corporation), Ward
Occupation,
Operation
Husband's Name,
-
Place of Death-No.
Chelmsford Centra
Street (or Corporation), Ward
Birthplace of Deceased,
England
Father's Name,
James Holland
Father's Birthplace,
Ireland
Mother's Name,
Bridget
Mother's Birthplace,
fredand
Mother's Maiden Name,
Bridget Rowley
Place of Interment,
Catholic
.. Cemetery Range
, Lot
, Grave
Signature of Undertaker or Informer;
Peter Darry.
Dated at Lowell, this
10
day of
189
4
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)
Date of Death,
I89
4
Name and Sex of/Deceased,
Janão Hall mod
male.
Place of Death-No.
Chelmsford Center
Street (or Corporation).
Disease or Cause of Death,
Ohthisis
duration of*
about one year
Complications,
I certify that the above is true return to the Best of my recollection and belief.
Name and Professional Title.
Amasa toward, M. D.
Residence
Cheburford
Street,
Chilmok
day of
June
18944
Dated at Lowell, this
* 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 " before male when the deceased is'a female, and when the deceased is colored please insert. ]
Maiden Name,
Age, 36 years,
.. .. monthis,
days.
)
RETURN OF DEATH
-OF-
189 ...
1
1
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN,
To the Board of Health and the Clerk of the City of Lowell.
Date of Death,
189 4Name,
Maiden Name,
Ollen
Hew Seenany Sex, male; Color: Obhete Age, years, .... months, .. days.
Single, Married or Widowed,
Name of Attending Physician A Sleepy Residence of Deceased~No. Blesk The husford Store
Occupation, at Nonce
Husband's Name,
Place of Death-No. West Chelmsford
Street (or Corporation), Ward
Birthplace of Deceased, Father's Name, Late The band Formule Father's Birthplace,
Ireland
Mother's Name, Not exoten
Mother's Maiden Name,
Place of Interment, fortheore
Grave
Signature of Undertaker or Informer,
Dated at Lowell, this
day of 189
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)
Date of Death, June 13-
IS9 4
Name and Sex of Deceased,
What Chelmsford
Street for Corporation).
Disease or Cause of Death,
Carcinoma ofthrash
duration of *...
1 year
Complications,
I certify that the above is a true return to the best of my regollection and belief
Name and Professional Title, Walter Sleeper. mx
Watford
Residence, Nez
Watford
Dated at Lowell, this
1 × ch
day of
Jane-
IS9 4
* 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 " before
Street (or Corporation), Ward
Mother's Birthplace,
Ellen
Keenan
female.
Place of Death-No.
RETURN OF DEATH -OF-
189 ..
1
1
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN,
To the Board of Health and the Clerk of the City of Lowell.
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