USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 20
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Street (or Corporation), Ward
Sinamingham Mass
Father's Name.
Father's Birthplace,
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Edson
Cemetery, Range
Lot
,
Grave,
Signature of Undertaker or Informer, Sklo unier
Dated at Lowell, this.
day of
IS9
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death.
June 28th
Name and Sex of Deceased,
Philip DEdemands
male.
Place of Death-No.
East Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Laryngeal pavesio
duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Jinak A Warner M.D.
Residence, No ..
56
Street,
Kirk.
Dated at Lowell, this.
2 8th
day of
Same
IS9
*Reckoned to the time of death.
!. . . .. ..
(When the child is still-born, so specify.)
Rel
RETURN OF DEATH
OF
189
Rel
Commonwealth of Massachusetts.
193
Vo.
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,
6 Years, 1 Months, 4 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,
61. Low 24/
11. Name of Father, 1.
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
L1. lin 4 -2l
6
Signature of Undertaker or other person making the Return, .
1.
DATED at
111
zel , 011
1
18
·
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
tlf other than White. (M.) Mulatto. (f.) Indian. If of other Races, specify what. [Bo very particular to fill all Blanks.] Plate. Ed. Jan. 1505 -5,000.
1
2) die 5
-
V
/
[ 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 furuish 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.
1945
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
July
4
189 >
Name,
Eva m. Findeau
Maiden Name
Sex, Female; Color,
white
Age, 1
... years, ..
7
months,
1
days.
Single, Married or Widowed,
Name of Attending Physician, Tout Chemilford
Residence of Deceased-No.
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
Worth themes ford
Street (or Corporation), Ward
Birthplace of Deceased,
Father's Name,
William Trudeau
Father's Birthplace,
Canada
Mother's Name,
maria
Mother's Birthplace,
Gauthier
Mother's Maiden Name, .......
Place of Interment,
Catholic
Cemetery, Range
Lot
, Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
40
day of.
July
..
1897
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
1897
Name and Sex of Deceased,
Era Me Puedean
Place of Death-No. March Chelaufend
male.
Street (or Corporation).
Disease or Cause of Death,!
Malignant growth of abadaration of*
(When the child is still-born, so specify.)
six months
Complications,
1
'I' certify that the above is a true return to the best of my recollection and beliefs
Name and Professional Title,
I Elaney m2.
Residence, No. 2th Chilunsford
Street,
Dated at Lowell, this
French
day of
189)
*Reckoned to the time of death.
the ation sing marcel or widowed, and ingert "he " before male
RETURN OF DEATH
OF
189
-
Rue No
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the City or 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, ¡
Og Years, Months, 26 Days.
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
Amara Itoward M
1
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
Valera oil
1
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, .
>
L
DATED at ..
W
18
* If a Married Woman or Widow. { Ifa 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., 1896. - 5,000.
1
Bella Salve 1
Plows
Quábun
195
Caly 4, 1897 AutointelVet
A megle
Squill degeneration
[ 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 i ury in a city or town or remove therefrom a human body until lic 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 coutaining 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 physiciau; 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.
196
Bei
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. 1
Name, Mary Teren
Maiden Name Sex, miale ; Color, Age, 12 years, months, days. Single, Married or Widowed,
Name of Attending Physician,
DU O'connor
Residence of Deceased-No.
st helms ford Street (or Corporation), Ward
Occupation,
at Home
...
Husband's Name,
Place of Death-No.
Street (or Corporation), Ward
Birthplace of Deceased, Ireland
Father's Name, laquo Yjitty
Father's Birthplace,
Duland
Mother's Name, Julia "
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment, Catholic Towel
Cemetery, Range
Signature of Undertaker or Informer,
Dated at Lowell, this
12
day of
July
189
7
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death 12 1897
Name and Sex of Deceased,
Many
Reven
male.
Place of Death-No.
(When the child is still-born, so specify.)
Disease or Cause of Death,
duration of*
Complications,
I certify that they above is a true return to the best of my recollection and belief.
Name and Professional Title,
...
Residence, No.
25 Mamuir 18
Street,
Dated at Lowell, this
Thuleenel
day of
189
7
... ..
Street (or Corporation).
Date of Death
July 12th
1897
RETURN OF DEATH
OF
..
189
Rec
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
/ 197 7
1. Date of Death, .
11 inti1
2. Name, (Maiden Name),* Mary Col diwood (Name of Ilusband),* Léviont à' Lambirene C
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age, 57 Years, Months, .Days.
Disease or Cause of Death, (Primary and Secondary), #
1
6. {Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
Brasifind
Gostava ATwooEL.
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 R. Houra
DATED at , 011
1891
.
* 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.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] l'late. Ed. Jan. 1893 .- 5,000.
.......
1
ARD
1397 MASS:
SW
14
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Acts of 1889, Chapter 221; 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 lie died, the duration of his last siekness, 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 ehild, 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- 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 eause of death as nearly as he can state the same. If a physician refuses or neglects to make such certifieate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom a human body until lie 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 sueh 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 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 certifieate 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 eity or town for the purpose shall, upon request of said board, agent or elerk, 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 sueh satisfactory statement and certifieate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the 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 tlie elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exceed- ing fifty dollars.
Rel No.
Commonwealth of Massachusetts.
198
RETURN OF A DEATH. To the Clerk of the City or 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,
Widower
4. Color,t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, -
V. A. Howard
Chelmsford
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,
Westend That
Signature of Undertaker or other person making the Return, . .
L. K. Howard
DATED at Phethestud Only 16 18%
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion. t If other than White. (31.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate, Ed. Dec., 1896 .- 5,000.
Paco 16, Hereviun Li Kriterien
88 Years, 3 Months, ... Days.
Chelmsford
Becial
[ 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 can state the same. If a physician refuses or negleets to make sneh 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 reecived a permit so to do from the board of health or its dnly appointed agent, or, if there is no board of health in sueli 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 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 elerk, make sueli certifieate 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 eonntersign 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 deathi, 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.
199
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
July
13
.. 189 7
Name,
Christopher Roby
Maiden Name
Sex,
male; Color, White
Single, Married or Widowed,
Age,
82 years,
9
. months,
5 days.
Name of Attending Physician,
Walter A, flechas
Residence of Deceased-No.
Street (or Corporation), Ward
Occupation,
Maturey salesman
Husband's Name,
Place of Death -No.
Wear Chelmsford
Street (or Corporation), Ward
Birthplace of Deceased,
Arnotable.
masa
Father's Name,
Father's Birthplace,
Dunstable mads
Mother's Name, Betsy Cummings Roty
Mother's Birthplace,
Mother's Maiden Name, "T
Place of Interment,
Trest Chelmsford
Cemetery, Range ., Lot , Grave,
Signature of Undertaker or Informer,
Alfred Is
Parkhaus
Dated at Delaogong July
13
day of.
189
Physician's Certificate of the Cause of Death. (SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Christopher Roby
Age,
83
Date and Place of Death,t - died at West Chelius ford Mars, July 13 1897.
Disease or Cause of Death, -
(Primary and Secondary.)}
Duration of Sickness,
-
Hypostolic Engestion of trug Implication of Bronchitis my Weak Herh
of
Leute allack- 2 weeks-decline in health 2003 grs. Acertify that the above is true, to the best of my knowledge and belief
Signature and Residence of Certifying Physician, IF W. W Early Westford Mass
Date of Certificate,
July 13
189 7
....
* Or Sex of Infant (not named). If stillborn so state. [ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
# I a soldier or sailor who served in the War of the Rebellion.
Rac
OF
RETURN OF DEA
WEST ACTS Of 1893, Chapter 263.]
SECTION 3. A physician who has attended a personearing This 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 . lie 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 certifieate 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 otli the primary and the secondary or immediate cause of death as nearly as he can state thic same. If a physician refuses or neg cts 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 unti he lias 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 sueh or town, from the city or town elerk. No such permit shall be issued until there has been delivered to sneh board, or agen clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned recorded, together with the certificate of the attending physician, if any, as required by seetion three of this chapter, or in thereof a certifieate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physi cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or physician employed by a city or town for the purpose shall, upon request of said board, agent or elerk, make such certifieatc a required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the sa: When sueh satisfactory statement and certifieate are delivered to the board of health or to its agent, the board or agent shall for with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so gi shall thereafter furnish for registration any other information as to the deceased or to the manner and ease of the death, as : elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exec ing fifty dollars.
200
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
July 25
Name, Harriet
Eduizend
Maiden Name
Sex, Le male; Color, 74 years, 6 months, - days.
Single, Married or Widowed, .... Age,
Name of Attending Physician,
Da Such ablech
Rfanien
Residence of Deceased-No.
East Che lems fond Street (or Corporation), Ward
Occupation,
at Haine
Husband's Name, Herman & Edmandy
Place of Death-No.
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