USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 21
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Mark Oltermined
Street (or Corporation), Ward
Birthplace of Deceased,
Conway
Father's Name,
Thomas Merite Father's Birthplace,
Mother's Name,
Budico Menta
Mother's Birthplace, Commen Mx
Mother's Maiden Name,
Place of Interment,
Scharn
Cemetery, Range
Lot
Grave,
...........
Signature of Undertaker or Informer,
Dated at Lowell, this
270
day of trees
189 >
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
25
1899
Name and Sex of Deceased, Harriet !
Colmands
...
.....
...
male.
Place of Death-No.
Lust Ihlensbuch Man
Street (or Corporation).
Disease or Cause of Death,
, Quan 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,
Residence, No. 267 Metrithe Street,
(When the child is still-born, so specify.)
Dated at Lowell, this
26
day of
189 7
*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, marriedor widowed, and insert " fe " before male when the deceased is a female and when the deceased is colored please insert.]
DENER
Harmel Samandy OF
1895
1
201
Commonlocalth of Massachusetts.
No.
....
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
July 27th 1894
2. Name,
Joseph T. Remmes
(Maiden Name),* (Name of Husband),*
Male
3. Sex, and whether single, Married, or Widowed,
Married
White
4. Color,t
5. Age,
72 Years,
.Months,
.Days.
utewhatis
Six years
F.E. Barnes
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 &. Sheldon
DATED at AChelmsford.
, on
July, 27th
1897
* If a Married Woman or Widow. { If a Soldier who servedl 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. 1995 .- 5,000.
North Chelmsford Mais
Laborer
North Chelmsford
Waldeck Germany. . ...
not Known
Mothers name not Known
Germany
Germany
Lowell Mass
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, .
[ Public Statutes, Chapter 32, as amended by Acts of 18SS, 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 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 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 cansc 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, scxton 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 threc of this chapter, or in lieu thereof a certificate as hercinafter 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; and in case of death by violence the medical examiner shall, if requested, make the samc. 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 thercafter 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.
C
202
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 28
189 / ..
Name,
John. & Pravdou
Maiden Name.
Sex,
male; Color,
Single, Married or Widowed,
Age, ................ years, 2 .months, 21 days.
Name of Attending Physician,
Fr Howard
Residence of Deceased-No.
E. Chelmsford
Husband's Name,
Street (or Corporation), Ward
Occupation,
Place of Death-No.
O Chelunsford
Street (or Corporation), Ward
Birthplace of Deceased,
6 Chelmsford
Father's Name,
Jan.
Father's Birthplace,
E. Chelustund
Mother's Name,
Mary ..
Mother's Birthplace,
Ireland
Mother's Maiden Name,
Marvin
Place of Interment,
Catholic
Cemetery, Range
, Lot
, Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
July 28
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,
Cholera Infantici duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
A. Howard
Residence, No. Street,
Dated at Lowell, this day of
189
...
*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,
(Whenthe child is still-born, so specify.)
A. H. O Donnell
Rec
RETURN OF DEATH
OF
.. ..
189
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.
C
Date of Death
July
31
189
7
Name,
Maiden Name
Sex,
male; Color,
Single, Married or Widowed,
Age,
46
.years, ..
. months,
. days.
Name of Attending Physician,
Residence of Deceased-No.
Smith ave
Ve
Street (or Corporation), Ward
Occupation,
Pantes
Husband's Name,
Place of Death-No.
Amilli ave Chelmotor Corporation), Ward
Birthplace of Deceased,
Pensilvania
Father's Name,
un Know
Father's Birthplace,
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
dron
Cemetery, Range
., Lot
, Grave,
Signature of Undertaker or Informer,
5
m
young To
Dated at Lowell, this
31
day of
189 7
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death July 31
Name and Sex of Deceased,
Stillin
189
male.
Place of Death-No.
Smith. a
elne fan (or Corporation).
(When the child is still-born, so specify.)
Disease or Cause of Death,
Oscare 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,
16- Inch Medical Exam
Residence, No.
267 hesmith
Street,
Lowwell
Dated at Lowell, this
2
day of
ang.
189 Z
*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, nffried or widowed, and insert " fe " before male when the da sed is: female Lachan ha disco şel is colora place insert
arhite
married
OF
Nm T. Lee 7 weg (1 189>
204
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
August 10th
189
7
Name,
Margaret MI Jesaid
Maiden Name
Sex,
.male ;
Color,
days. Single, Married or Widowed, Du Yaward8.
Residence of Deceased-No.
Street (or Corporation), Ward
Occupation,.
at Home
Husband's Name, worth , Theles ford st Street (or Corporation), Ward
Place of Death-No.
Birthplace of Deceased) Ireland
Father's Name,
Bernard Dulden
Father's Birthplace,
Diehand
Mother's Name,
Tate
bolden
Mother's Birthplace,
Dirman
Mother's Maiden Name, ."
Place of Interment,
Catholic ()
O Donnell
, Grave,
Signature of Undertaker or Informer,
10
day of.
1897
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death ang. 10th
Name and Sex of Deceased,
margaret
1897
Quade
female.
Place of Death-No.
north Chelmsford.
Street (or Corporation).
Disease or Cause of Death,
Paralysis
duration of*
several days.
Complications,
Inflammation
I certify that the above is artrue return to the best of my recollection and belief.
Name and Professional Title, maradtoward M. R.
Residence, No ...
Chelmsford
Street,
Dated at Lowell, this
day of
189
*Reckoned to the time of death.
LR: 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
Name of Attending Physician,
Forth helens ford
Age, 6 y 2. years, months,
Dated at Lowell, this.
RUC !
(When the child is still-born, so specify.)
RETURN OF DEATH
OF
189 .....
1 rel No.
Commontucatth of glassachusetts.
205
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, Clara, 11-1800
2. Name,
(Maiden Name),* lavi Queluzno
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
1
4. Color, t
5. Age, 7.3 Years,
Months,
Days.
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),
13. Birthplace of Father, .
- thelionsford
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . .
( text/ 1226,224 Sf. h. Howard
DATED at
18
* 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., 1896 .- 5,000.
tolvcertes fruitier
Rec
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, fortliwith 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 dcccase; 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 healthi 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.
Rue
206
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
Auf 16
189.7
Name,
marie . Tremblay
Maiden Name
Sex, Female; Color,
Single, Married or Widowed,
Age, . -years, 0 months, 5 days.
Name of Attending Physician,
An Rochette
Residence of Deceased-No.
to headfood Centre
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
Thanksford teente
Street (or Corporation), Ward
Birthplace of Deceased,
1
Father's Name,.
Jules Tremblay
Father's Birthplace,
Canada
Mother's Name,
Henriette
Mother's Birthplace,
Mother's Maiden Name, .
-
Tenn
Place of Interment,
themesford
Cemetery, Range
, Lot
,
,
Grave,
Signature of Undertaker or Informer,
Joseph
Albert
Dated at Lowell, this.
16
day of
189
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
c aug 16
189.
Name and Sex of Deceased,
Place of Death-No.
Cheul paret Center)
Street (or Corporation).
Disease or Cause of Death,
Clara infantino
(When the child is still-born, so specify.)
duration of*
13 dias
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Dr Pruebaette
Street,
Residence, No.
Dated at Lowell, this
16 00
day of
189 .22.
*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.]
male.
RETURN OF DEATH
OF
189 ..
...
207
OFFICE OF THE
Rec
Board of Selootmen. Report of death Chelmsford, Mas., 189
Name Mars Isabella Callahan
Date of death Sept/ 5th 1897 Youe 5 months
Color -. White Disease Marasmus
Certifiey by Way. Sleeper M. D.
Where born- Westford Mass Where died- North Chelmsford Mas. Father's nome-John t Callahan Were born - Lowell Mass. Mothers name-Annie (Bradley) Callahan Where born ~ Lowell Mais Place of interment - Lowell Mass.
Reported by Arthur H. Sheldon
Daten N. Chelmsford Jeht. 6th 1895
Rec
Commonlocalth of Massachusetts.
208
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
Sept-5-1897 Kuredge
1. Date of Death, .
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
4 hours
Years,
Months,
Days.
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),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Action Thetedge A(2 Jours) Nova Scotia Lowell
Signature of Undertaker or other person making the Return, .
Albion Kittredge
DATED at
Safe, 6 1897
* 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., 1896. - 5,000.
5. Age,
Statbord infantile
Cheausford "
No.
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1993, 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 duratiou 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 ncg- 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 iu 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 teu dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sextou or other person shall bury in a city or towu 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 exceed- ing fifty dollars.
20g
Commontocalthy of Massachusetts.
No. RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred,
1. Date of Death, SCk 1, 3 1x//
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
YLE1 / 2CL
4. Color, ¡
5. Age,
17 Years -Í
Months, A ... Days. Heart disease
(Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . 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. Place of Interment,
Signature of Undertaker or other person making the Return, .
1
tourazil
DATED at
18/
* 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., 1896. - 5,000.
126-22
1
-
[ 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 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 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 ; ury 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 certifieate as is required of the attending physician; aud 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 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 aud cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exeecd- ing fifty dollars.
210
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell. South Chelas for
Undertakers must make this return before the burial or removal of the deceased.
Date of Death
Aug 30
1897 .
Name, .
Horatio N Radlith
......
Maiden Name
Sex,
male ; Color,
Single, Married or Widowed,
Married
Age, 78 years,
.months,
days.
Name of Attending Physician,
In Warmer
Residence of Deceased-No.
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