USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 23
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Place of Death-No.
So Chelinsford
Birthplace of Deceased,
Lowell Mass
Father's Name,.
antoine ayotte,
Father's Birthplace,
Canada
Mother's Name
Kizilda
Mother's Birthplace,
Mother's Maiden Name, ...
Lambert
Place of Interment,
Chelmsford
Cemetery, Range
... , Lot
, Grave,
Signature of Undertaker or Informer,
Joseph albert
Dated at Lowell, this
20 th
day of
October
189. 9 ..
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
25"
Name and Sex of Deceased,
antoine Cyatt
1897
male.
Place of Death-No.
South Chelmsford
Street-(or-Corporation).
Disease or Cause of Death,
Deplethina
duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief,
Name and Professional Title Onward H. Chanhulice W,
Residence, No.
Chilmustard
Dated at Lowch, this 20000
day of
Street,».
Ocholio
189 .
Street (or Corporation), Ward
(When the child is still-born, so specify.)
Rex
OF
189
Ree No.
Commonbocalth of Massachusetts.
22/
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),*
male
3. Sex, and whether single, · Married, or Widowed,
White
4. Color, 1 .
5. Age, / Years, 5- Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
2 Irce ks
6. Duration of Sickness, . By whom eertified,
E.A. A
DEA Chamberlain
to Chefmotor (
7. Residence,
8. Oecupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
(Charies F. M Tien
EnChan &
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
Lexington Maak
15. Place of Interment, W.P. Byam
Signature of Undertaker or other person making the Return, .
DATED at
So Chelmsford, on Oct- 25
189.7
* 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.
Oct- 25 1897. Charles EM Jich
So Chefword
[ 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 dicd, 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 dicd 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 healthi 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 lien 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 anyr 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- withi countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the deathi, as thic clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
Rec
222
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
· (Maiden Name),* (Name of Ilusband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, Years, .. Months, 14 Days. Inanition
Disease or Cause of Death, (Primary and Secondary), # G. {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, .
October 29th 1897 Beatrice Bridgford
Female - Single
2 weeks George A. Harlow North Chelmsford
North Chelmsford North Chelmsford William Bridgford Mary 9. (Liddell) Bhideford England
England
North Chelmsford
Arthur A. Sheldon
DATED at A. Chelmsford, on Oct. 31st 1897
* 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.] I'late. Ed. Jau. 1895 .- 5,000.
o.
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 300 ; 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 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 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 bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town elerk. No such permit shall be issued until there has been delivered to such board, or agent or elerk, 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 seetion three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a eity or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same. Wlien sueh 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 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.
223
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must must make this return before the burial or removal of the deceased.
Date of Death,
nov , at
1897
. Name,
Thomas Kyolle
Maiden Name,
Sex,
male :
Color,
White
Single, Married or Widowetl,
Age,
years, ¿ 6 .... months,
days.
Name of Attending Physician. E. H. Chamberlin
Residence of Deceased - No. So Chelmsford
Street, (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death - No. Lo Chelmsford
. Street, (or Corporation), Ward
Birthplace of Deceased,
antoine ayotte
Father's Name,
Father's Birthplace,
Mother's Name,
azulda
Mother's Birthplace,
Mother's Maiden Name, azulda Lambert
Place of Interment,
theliaford
Cemetery, Range
Lot
. Grave, .
Signature of Undertaker or Informer,
Jos albert.
Dated at Lowell, this
/ st
day of
november
189
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Name and Sex of Deceased, Thomas 189 7 ayotte
male.
Place of Death - No.
Soul Chelinkford, Mars
Street, (or-Corporation).
(When the child is still-born, so specify.)
Disease or Cause of Death,
Dipulizia"
duration of
8 dage
Complications, I certify that the above is a true return to the best of my recollection and belief.
Name and Professional 'Title, 6,78, Chambulin
Residence, No.
Chiliusted
.Street,
Dated at LoweH, this
120
day of
november
189 7
RETURN
OF
189
224
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must must make this return before the burial or removal of the deceased.
Date of Death,. 2.200-2
. Name,
alexandre Dyotte
Maiden Name,
Sex,
male ; Color,
Single, Married or Widowed,
Age,
3 .. .. years, .
6
months,
days.
Name of Attending Physician,
E. H. Chamberlin
Residence of Deceased - No.
. Street, (or Corporation), Ward
Occupation,
Husband's Name.
Place of Death - No.
So Chelmsford
Street, (or Corporation), Ward ..
Birthplace of Deceased,
So Chelmsford
Father's Name,
automne ayotte
Father's Birthplace,
Canada
Mother's Name,
salda
Mother's Birthplace,
Mother's Maiden Name azildaLambert
Place of Interment,
Chelmsford Cemetery, Range
, Lot
Grave,
'Signature of Undertaker or Informer, albert
Dated at Lowell, this
Second
clay of
189 7
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
189 .7
Name and Sex of Deceased,
alexander
ayette
male.
Place of Death -No. So chelifedmass.
Street, (or Corporation).
Disease or Cause of Death,
Acplittune
duration of *
3 1/2 days
Complications, I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title. 6 75 Chamberi
Residence, No.
. Street, Waar
Dated at Lowell, this chilifux
clay of
189.9
(When the child is still-born, so specify.)
ULIVIIN
DEATH OF
189
-
1 Primit Warten.
Rec
225
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
100
3rd 1897
Orgin D. Batchelder
(Maiden Name),*
(Name of Husband),*
Male
3. Sex, and whether single, Married, or Widowed,
Married White
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Oceupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Malden Name),
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, .
Arthur H. Sheldon
DATED at
Chelmsford
, 011
Nov. 6th
1897
* If a Married Woman or Widow. { If n Soldier who served in the War of the Rebellion. tlf other than White. (MI.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895 .- 5,000.
Dr. Chamberlain Chelonsfora Mass. Machinist
Chelmsford Mais.
Francestoron N.A. Israel Batchelder Lydia (Dole) Batchelder Wenham Mass
New London N.A.
North Chelmsford Mass.
68 Years,
10
Months,
22 Days.
Heart Disease with Bright Difiant
[ 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 canse 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 snch 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 cnough 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 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- withi countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not excecd- ing fifty dollars.
226
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deatlı,
Nov 13th 1897
2. Name,
I dia Westling
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Female
4. Color, t
Years, 1
Months, ...
3
Days.
Acule Meningitis
Disease or Cause of Death, (Primary and Secondary), #
Two ways
& A Harlow 7D.
Trust 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, .
11. Birthplace of Mother, .
15. Place of Intermeut,
Signature of Undertaker or other person making the Return,. .
West Chelmsford
West Chelmsford-
Carl of Westheure Anna Mailsont
Truden
Pueden
Trest Chelmsford
A L, D'ink horst
DATED at
West Chelmayorabou Nov
13th
189%
* 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. May, 1891 .- 5,000.
5. Age,
6. Duration of Sickness, . By whom certified, .
Lec No
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Publie Statutes, requiring attending physicians to furnish for registration certain faets relating to deceased persons, is amended so as to read as follows : - 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 agc, the disease of which he died, the duration of his last. sickness, and the date of his decease. If a physician negleets or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. . Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - 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 (Inly 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 state- ment 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 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 such satisfactory statement and certificate arc de- livered 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 perinit 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 elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4, ISSS.
227
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowett.
CHOy
Undertakers must make this return before the burial or removal of the deceased.
Date of Death
Nov 16
Name, 1
Elizabeth & Severance
Sex, Le male; Color,.
Maiden Name
Single, Married or Widowed,
Age, 85 years,
7
months, 16 days.
Name of Attending Physician, Dr Chamberlain.
Residence of Deceased-No.
Ellenes fuld Mens Street (or Corporation), Ward
Occupation,
at themme
Husband's Name, Marston Securance
Place of DeathNo.
Phlunsford ~
Street (or Corporation), Ward
Birthplace of Deceased,
Father's Name,.
Salomon Honey
Father's Birthplace,
Mother's Name,
41.
Mother's Birthplace,
22
Mother's Maiden Name,
Place of Interment,
Edson
Cemetery, Range
...
, Lot
Grave,
Signature of Undertaker or Informer,
IB Caricias
Dated at Lowell, this.
18th
day of.
100
189>
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
Nave 16
189.5
Name and Sex of Deceased,
Place of Death-No. ehlersbord. Mars
Street (or Corporation).
{When the child ig spol-born, so specify.)
Disease or Cause of Death,
Valvular DianeHead duration of*
several years
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
-
Residence, No.
Chelmsford
Street, ..
muss
17 Vate
Dated at Lowell, this day of
189 .9.
*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.]
Elisabeth B Severance
male.
Huntoon
Rec
Lainn de Chilemasterer
RETURN OF DEATH
OF
189
Rec
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must must make this return before the burial or removal of the deceased.
Date of Death, Can 24
189 7 Na
Medard Robert male ; Color,
Single, Married or Widowed,
Age, 85 years, months, days.
Name of Attending Physician.
Di Drick
9
Residence of Deceased --- No. 33 Fish areNow
Street, (or Corporation), Ward
Occupation, atHome Husband's Name,
Place of Death ---- No. Cheemfor
Street, (or Corporation), Ward.
Birthplace of Deceased, Canada)
Father's N
Sodav
Robert-
Father's Birthplace,
Canada
Mother's, Name Catherine
1
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Canada
Martin
Cemetery, Range
,
Lot
,
Grave, ....
A Michambault-
Signature of Undertaker or Informer,
Dated at Lowell, this
24.7
day of
Har 189
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).
(When the child is still-born, so specify.)
Disease or Cause of Death,
useany Hand-duration of *
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title. AU Inthe Medical Ethics
Residence, No.
Street,
gerneel
Dated at Lowell, this . 24
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, married or widowed, and insert "fe" before male when the deceased is a female, and when the deceased is colored please insert. ]
224
Maiden Name,
-
"¿TURN OF DEATH
OF
189
---
Rec No.
Commonwealth of glassachusetts.
229
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
how 28 1897 Frederick George Reed
2. Name, (Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
male
4. Color, t
5. Age,
Years,
Months,
6
Days.
Disease or Cause of Death, (I'rimary and Secondary), #
6. Duration of Sickness, . By whom certified,
Charles P Ordway In. 2.
Chelmsford.
7. Residence,
8. Oecupation, .
9. Place of Death, . .
€ 1
10. Place of Birth, .
Fredrik A Reed
11. Name of Father,
Better a miller
12. Name of Mother, (Maiden Name),
Woburn mass
13. Birthplace of Father, .
Halifax h. J.
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return _. -
alberi y Dufau
DATED at
, 011
nav 29
18
97
* 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.
Chileshard
White
Constitutional weakness
[ Public Stat
SECTION
tration, a ce
clied, the de immediatel stating to ' leets or re fifty dollar
the prima
to make s SECT has recei
or town, clerk, as recorded
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