USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 24
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thereof cannot physici require When with c shall t clerk
ing fi
Hautes
amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
who has attended a person during his last illness shall, when requested, forthwith furnish for regis- ) the best of his knowledge and belief, the name of the deceased, his age, the disease of which he sickness, and the date of his decease; and a physician who has attended at a birth of a child dying . ¿ the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, owledge and belief the fact that such a child died after birth or was born dead. If a physician neg- ertificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding leceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both Alary or immediate eause of death as nearly as he can state the same. If a physician refuses or neglects e shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
irtaker, sexton or other person shall bury in a city or town or remove therefrom a human body until lie o do from the board of health or its duly appointed agent, or, if there is no board of health in such city town clerk. No such permit shall be issued until there has been delivered to sueh board, or agent or e, a satisfactory written statement containing the facts required by this chapter to be returned and the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu preinafter provided. If there is no attending physiciau, or if the certificate of the attending physician good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any Leity or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is g physician ; and in ease of death by violence the medical examiner shall, if requested, make the same. statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- ransmit the same to the clerk or registrar for registration. The person to whom the permit is so given I for registration any other information as to the deceased or to the manner and cause of the death, as the require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
230
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,
dec 3
189 7
. Name,
Henry BiMagoun
Sex,
male ;
Color,
Maiden Name,
Age,
7Z .years,
months, 8 days.
Name of Attending Physician,
Residence of Deceased - No.
Checonstar
Street, (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death - No.
Chelmsford
Street, (or Corporation), Ward
Birthplace of Deceased,
Father's Name,
nathaniel
Father's Birthplace,
Mother's Name,
Abigail
Mother's Birthplace,
Boston cinase
Mother's Maiden Name,
Santath
Geaauch, Grave, 12)
Place of Interment,
..
Quevier
Signature of Undertaker or Informer, .
Dated at Lowell, this
clay of
Physician's Certificate of the Cause of Death.
(SEE, EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, De, 3%.
Name and Sex of Deceased,
Henry B. Ma coun
189 .. ]
male.
Place of Death
-NO.
Chelmsford
Street, (or Corporation).
Disease or Cause of Death,
Cendo - carditis
(Whey the child is still-born, so specify.)
duration of *
Two years
Complications.
agr and anaemia
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
masa toward M. S.
Residence, No
Chilmedford
3-4
-Street,
Dated at Lowell, this
.. day of
Dicembre
1897
* 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.]
Rec
oracle Cemetery, Range
Single, Married or Widowed, .
ATH
OF
189
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
NEC, 13-1897 James A. Parker
(Maiden Name),* .
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
71 .Years, 4 1 Months, 26 Days.
Heart failure
Disease or Cause of Death, (Primary and Secondary), }
6. Duration of Sickness, . By whom certified,
Death instantaneous Arthur ly- Scoloria UD. Liderton Mans
7. Residence,
8. Occupation, . X
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, ×
12. Name of Mother, (Maiden Name),
y
13. Birthplace of Father, Y
14. Birthplace of Mother, X
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
EF Sucenord.
ADDwhour
DATED at
Chelmsford, Of DE0 13, 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.] Plate. Ed. Jan. 1895 .- 5,000.
Commonwealth of Massachusetts.
23/
Chiefcus ford
Pepperell Mark Augusta Parker Demifinal Blanchard" fecharell
Littletre
[ 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, fortliwith 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 finc 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 snch 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 hercinafter 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 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 thereafter furnish for registration any other information as to thic deceased or to the manner and cause of the dcatlı, as tlic 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.
sec No.
Commonwealth of Massachusetts.
232
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),*
Lice 26 Mary o facto, tenfile Mary a tu Hai's Samuel Tenhle
3. Sex, and whether single, Married, or Widowed,
1 dound
4. Color, t
5. Age,
91
Years,
L ..... Months,
27
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, .
a Q Prhow
DATED at
Dee, 28
* 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.
[ 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 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 lie 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 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 sueli city or town, from the eity 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 section three of this chapter, or iu 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 healthi 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 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 perinit 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 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.
233
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. 1
Date of Death,.
Dreimber 29,
1897
Name,
matter Stores
Maiden Name,
Sex,
male ; Color,
white
Single, Married or Widowed,
2. Sousa
...
Age,
Name of Attending Physician,
Residence of Deceased - No.
. Street, (őr'Corporation), Ward
Occupation,
Place of Death - No.
Chelucford
Street, (or Corporation), Ward
Birthplace of Deceased,
Father's Name
Night Ball
Father's Birthplace,
Mother's Birthplace,
Mother's Maiden Name,
Gregg
Place of Interment,
Signature of Undertaker or Informer,
latin of Members
Dated at Lowell, this
2 ª Ete
clay of.
189 %
Physician's Certificate of the Cause of Death. (SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW,)
Date of Death, Dre 29
Name and Sex of Deceased, 1 mattis & Sauce
0
male.
Place of Death - No. Un sustora masa
Street, (or Corporation).
Disease or Cause of Death,
Peritonitis
(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, 02
Residence, No.
. . 4.
Street,
Dated at Lowell, this
day of
189 ......
*Reckoned to the time of death.
36 years,
months,
days.
Husband's Name, Orval
Mother's Name,
Persia
Cemetery, Range Lot , Grave,
RETURN OF DEATH
OF
...... 189
234
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
Dec 9am
189 2
Name,
Man Garda Hard
Maiden Name. Mand Liddell
Sex, Lemale; Color,
white
Married
Age,
35 years,
months,
/7 days.
-Single, Married or Widowed,
Name of Attending Physician, .
A Chelmsford
Residence of Deceased-No.
Occupation
House Wife
Husband's Name,
Street -(or Corporation), Ward-
Birthplace of Deceased,
William Liddell
Englanden
Father's Name,
Annil
4
Mother's Birthplace, ..
Mother's Name,
Mother's Maiden Name,
Place of Interme
N. Chelmsford
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
Dee. 30.
1897.
Name and Sex of Deceased, Mary sabella Bridgeford
male.
Place of Death-No.
Chelmsford
Street (or Corporation).
(When the child is still-born, so specify.)
Disease or Cause of Death,
Career of atornado
duration of*
one year
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Is a Harcou wr3
Residence, No.
Street,
Chehus
Dated at Lowed, this
80 to
day of
December
1897
*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.]
Street (or Corporation), Ward
William Rudyard
Place of Death-No.
tengland
Father's Birthplace,
,
Rec
RETURN OF DEATH
OF Man Dridgford 1 DEc 80 1897
236
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,
Jan
12
18947
.. Name, ..
Obrero
Maiden Name,
Sex, ... . .male ; Color,
Single, Married or Widowed,
Age,
49 years,
~ months,
days.
Name of Attending Physician,
Residence of Deceased - No.
Street, (or Corporation), Ward
Occupation, .
Hamm
Husband's Name,
Place of Death - No.
Street, (or Corporation), Ward
Birthplace of Deceased,
Father's Name, Benjamin & Other
Father's Birthplace,
Mother's Name, Rebecca
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment, Edson
Cemetery, Range
Signature of Undertaker, or Informer, ...
Dated at Lowell, this
day of
January 1898
Physician's Certificate of the Cause of Death
RETURN O
OF
٠٠٠٠٠
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