USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 22
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South Chelmsford
Street (or Corporation), Ward
Occupation,
Graces
Husband's Name,
Place of Death-No.
Street (or Corporation), Ward
Birthplace of Deceased,
Lesbank Mass
Father's Name
Ferdinand Rodlift
Father's Birthplace,
Deshonk mus
Mother's Name,
Roby Pocer
Mother's Birthplace,
... ... ..
Mother's Maiden Name Unknown
Place of Interment,
Claremont-NH.
Cemetery, Range .. , Lot
Grave,
Signature of Undertaker or Informer,
Dated at bewell, this South Chelinsford
day of
189 y
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
Que 20
189.7
Name and Sex of Deceased,
Daratio & Rodbiff
male.
Place of Death-No.
Savethe Chelmsford Mass
Street (or Corporation).
Disease or Cause of Death,
Cystitis
duration of*
Complications,
I certify that the above is a true return to the best of my, recollection and belief.
Name and Professional Title, Freek
A. Warnerm. D.
Residence, No.
56
Street,
day of
August
.....
Dated at Lowell, this
30M
(When the child is still-born, so specify.)
Rio
RETURN OF DEATH
OF
. ..
.....
9 ... 189
Ru No.
Commonwealth of Massachusetts.
211
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Aug. 25,1897. Florence G Ward.
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
17 Years, 11 Months, Days.
Vente tuve cuves 1
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
6 mg2.
20 0kg Afford.
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
DATED at -51 , on Cua. 2
1817
* If a Married Woman or Widow. {If a Soldier who served in the War of the Rebellion.
{ If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. Jan. 1895 .- 5,000.
-
1
Ich War
Susan G. Hanshill.
11
11
Formule vinagre
Trhite.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 203.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last 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 botlı 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 sneh eity or town, from the city or town elerk. No such permit shall be issued until there has been delivered to sneh board, or agent or clerk, as the ease 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 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 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 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 eause 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.
No .. . ...
Commontocalth of Massachusetts.
212
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,
Single
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
F & Varner M.D
North Chelinsford 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,
North Chelmsford
Signature of Undertaker or other person making the Return, .
Arthur H Sheldon
DATED atu N.Chelmsford
, on August 2320 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. Jan. 1895 .- 5,000.
August 22nd 1897 Sarah Warley
Female
37 Years, Months, 9 Days. Exhaustion from Insanity 10 months
North Chelmsford Muss. England
John L. Warley Sarah (Stanton) Warley England
indland
-
[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 deccase; 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 towu, 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 registratiou. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the deatlı, as 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.
Res No.
Commonwealth of Massachusetts. -213
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Sept 5Th 1897
2. Name, (Maiden Naine),* (Name of Husband),*
---
-
Female
3. Sex, and whether single, Married, or Widowed, 4. Color, t
5. Age, Years,~ Months, ~ Days. Stillborn
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, . ·
Arthur A Sheldon
DATED at
N. Chelmsford
, on Sept. 5th 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. Jan. 1895 .- 5,000.
4. E. Varney M.D.
.......
North Chelmsford Mass.
North Chelmsford Mass. North Chelmsford Mars. John N. M& Enancy Alice (MC Grath) MiGnaney Chelmsford Mass. .....
Chelmsford Mass. Lowell Mass
[ 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 & 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 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 fact that snch a ehild died after birth or was born dead. If a physician neg- lects or refnses to make a certificate as aforesaid, or makes a false statement therein, 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 eause of death as nearly as he can state the same. If a physician refuses or neglects to make sueh eertifieate 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 sueli eity 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 elerk, as the case may be, a satisfactory written statement containing the faets required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician 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 suel 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 snch 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 tlie clerk 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.
214.
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
UndertakersOnust make this return before the burial or removal of the deceased.
Date of Death
Sehr 128
189
7
Name,
le Cristiana 2 /tamara
Maiden Name
Secretary
Sex,
male ; Color,
Single, Married or Widowed,
Age,
69 years,.
V
months,
days.
Name of Attending Physician, De Candway
Residence of Deceased-No.
Street (or Corporation), Ward
Occupation,
Husband's Name,
Samuel A/ Saward
Place of Death-No.
Street (or Corporation), Ward
Birthplace of Deceased,
Father's Name, Father's Birthplace,
Mother's Name,.
Mother's Birthplace,
Mother's Maiden Name,
Cemetery, Range
,Lot
., Grave,
Place of Interment,
Signature of Undertaker or Informer, Setmet Webech
Dated at Lowell, this.
day of
feno
189 .
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
Sehr 128
189.
Name and Sex of Deceased, Christiana Howard & male.
Place of Death-No. Humeford
Street (or Corporation).
Disease or Cause of Death,
(When the child is still-borng so specify.)
Seven tunities.
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, Charles & Ordway bis
Residence, No
Chelmsford.
Street,
Dated at Lowell, this
Second
day of
ج189
*Reckoned to the time of death.
RETURN OF DEATH
OF
189
215
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
Sept 15
.. 189
Name,
Michael Little
Maiden Name
Sex,
male; Color,
Single, Married or Widowed,
Age, 52 years, - months, - days.
Name of Attending Physician,
O'Conna
Residence of Deceased-No.
Past Chelev forud
Street (or Corporation), Ward
Occupation,
Vatoren
Husband's Name,
. ..
Place of Death-No.
Street (or Corporation), Ward
Birthplace of Deceased,
Jazus
Father's Name,
Father's Birthplace,
Preland
Mother's Name,
felice
Mother's Birthplace,
Mother's Maiden Name,
not know
Place of Interment, donces. cuchilig
Cemetery, Range
., Lot
, Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
festival day of.
189
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
Pept
13
1892
Name and Sex of Deceased, Michal Little
male.
Place of Death-No.
Easy Chelmsford
Street (or Corporation).
Disease or Cause of Death,
(When the child is still-born, so specify.) duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Street,
Residence, No.
Dated at Lowell, this
Sixtunch
day of
189
RETURN OF DEATH
OF
189
216
Rec
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
Sept 18
189.1
Name,
William In chartere
Maiden Name
Sex,
male; Color, ...
Single, Married or Widowed,
Age,
48 years,
months, . ... ... days.
Name of Attending Physician,
Lar Verney -
Residence of Deceased-No.
north Chemford
Street (or Corporation), Ward
Occupation,
Coachman
Husband's Name,
Place of Death-No.
north Chemetover
Street (or Corporation), Ward
Birthplace of Deceased,
north chematonce
Father's Name,
James
Father's Birthplace,
Englemer
Mother's Name,
margaret
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Ywith Chemefue Cemetery, Range
.,
Lot
,
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
Sept- 19th
1897
Name and Sex of Deceased,
William
Charters
.. male.
Place of Death-No.
1. chelmsford
Street (or Corporation).
Disease or Cause of Death
Unaémia
(When the child is still-born, so specify.)
duration of*
six days.
Complications,
nephritis.
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
JEVarney.
Residence, No.
I. Chehonderd
Street,
Dated at Lowell, this
20th Loft
day of
Lille
.. .
1897
RETURN OF DEATH
OF
.
189
2M
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.
Name,
Stephen B Leavitt
Date of Death
189
Maiden Name
Marcado
.years,
2
months,
days.
Name of Attending Physician,
north, Conclus fatto chestation), Ward
Residence of Deceased-No.
Occupation,
MachiningHusband's Name,
Place of Death-No.
North Chelmsfordsk det (or Corporation), Ward
Birthplace of Deceased,
Mane
Father's Name,
Father's Birthplace,
Unknown
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
North Chelseade
Lot
, 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
Clef- 3-Ch
Name and Sex of Deceased,
B. Leavitt
male.
Place of Death-No.
north Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Acute nephritis
duration of*
weeks .
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Summen. South mot
Residence, No.
500 School
Street,
Dated at Lowell, this
Seventh
day of
Oct
... . ...
3-
Single, Married or Widowed,
Sex,
male ;
Color,
w
9. WOBrooks
(When the child is stin born, so specify.)
RETURN OF DEATH
OF
Stalden Leavell Oct5- 1802
Rec
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
Ca1-18 1897
Name,
antonia Gelinean
Maiden Name.
Sex, Luce, Color,
Single, Married or Widowed,
Age,
............... years,
months 5 days.
Name of Attending Physician, Dr. Harney
Residence of Deceased-No.
North Gluhno fun te (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
North Chelmsford Street (or Corporation), Ward
Notte Chilin fun a
Birthplace of Deceased,
Father's Nag Largh Gehencan Father's Birthplace,
Mother's Na
Man Janine
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
., Lot
,
Grave,
Signature of Undertaker or Informer,
RArchambault
Dated at Lowell, this
18
day of
189 4
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
Oct- 18th
1897
Name and Sex of Deceased,
antonia Gelineau
male.
Place of Death-No.
H. Chelunsford.
Street (or Corporation).
Disease or Cause of Death,
Marasmus.
duration of*
Ber 4 meetes.
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
JE. Varney
Residence, No.
2. Chelmsford.
Street,
Dated at Lowell, this
1840
day of
Ocl-
IS9 2.
(When the child is still-born, so specify.)
218
OF
٠ ٠٠٠
١٠١
٠٠
189
مرة
Rec No.
Vonumnonlocalth of Massachusetts.
219
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
00121.18
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, ¡
5. Age, 40 .Years, 4 .Monthis, 22 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, .
Signature of Undertaker or other person making the Return, .
........
of have
Chelque/ 03
1.4 Reflect 4-200 Olice a Hold
Millon
DATED at.
1 1 Get 21 18%.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. Dec., 1896 .- 5,000.
أحمر ..
[ 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, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last siekness, and the date of his deeease; 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, forthiwith 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 ean 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 tury 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 eity 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 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 threc 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 enongh 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; 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 deceased or to the manner and eause 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.
220.
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
Oct 25
189 7
Name,
antoine ayotte
Sex,
male; Color,
White.
Maiden Name
Single, Married or Widowed,
Age,
6
.years,
10 months, 25 days.
Name of Attending Physician,
Dr. Chamberlain
Residence of Deceased-No.
So Chelmsford
Street (or Corporation), Ward
Occupation, Husband's Name,
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