Deaths 1894-1897, Part 3

Author: Chelmsford (Mass.)
Publication date: 1894-1897
Publisher:
Number of Pages: 436

USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 3

Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).

Undertakers mest make this return before the burial or removal of the deceased.

Date of Death, June 20. 1894 Name,

Maiden Name,

Eugene ME. Emis Sek, male; Color, Age, ..... . years, 2/. months, 2/ days.

Single, Married or Widowed,

Name of Attending Physician,

Hourand

Residence of Deceased-No.

Street (or Corporation), Ward

Occupation,

Husband's Name,

Place of Death-No.

Street (or Corporation), Ward

Birthplace of Deceased,

Father's Name,

Father's Birthplace,

Mother's Name, Mary From MY. Ero Mother's Birthplace,

Mother's Maiden Name,

Mic Envio

Place of Interment,

Controlo

Cemetery Range ... . , Lot

, Grave

Signature of Undertaker or Informer,

Dated at Lowell, this

day of

189

4.1

Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)

Date of Death,

June 20 th

Name and Sex of Deceased, Guyane M: Ensis 189 4

male.

Place of Death -= No.

no. Theluce ford

Street (or Corporation).

Disease or Cause of Death,

Whooping

Cough

duration of*

...

Complications,

I certify that the above is a true return to the best of my recollection gnd belief.

Name and Professional Title

musa toward m. D.

Residence, No.

Chelmsford

Street,

Dated at Lowell, this

21af

day of

June

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 op corporation, single, married or widowed, and insert " fe " before male when the deceased is'a female, and when the deceased is colored please insert ]

[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305; Acts of 1839, Chapter 22.4.]

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 age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, 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 the body of a deceased person 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 forthwith 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 exceeding fifty dollars.

PLEASE FILL OUT WITH INK.

UNDERTAKER'S RETURN,

To the Board of Health and the Clerk of the city of Lowerelmsford

Undertakers must make this return before the burial or removal of the deceased.

Date of Death, Aug 8th 189 4. Name, John H Whidden Maiden Name, Sex, .male ; Color, 20 Age, 0 years, // months, days.

Single, Married or Widowed,

Name of Attending Physician,

(medical Examiner

Residence of Deceased-No.

West Chelmsford

Street (or Corporation), Ward

Occupation,

R.R. Station Agent Husband's Name,

Place of Death-No. West Chelunsford

Birthplace of Deceased,

Street (or Corporation), Ward hulstford mass

Father's Name,

Mother's Name,

martha

Mother's Birthplace,

Fletcher

Mother's Maiden Name,

Place of Interment,

Jaest & helmsford Cemetery Range

, Lot

, Grave

Signature of Undertaker or Informer,

Dated at Lowell, this

day of

Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)

Date of Death,

August

1894

Name and Sex of Deceased,

John H& Whielden

male.

Place of Death-No.

Street (or Corporation).

Disease or Cause of Death, KR. accident duration of*

Complications,

I certify that the gboye is a true return to the best of/my recollection and belief./ medical Exam

Name and Professional Title,

Street, Revuele

Residence, No. 267

day of

Dated at Lowell, this

* 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 ]

189 4-

Father's Birthplace, . marinac.

h.H.

mash

RETURN OF DEATH -OF-

189.

Commonwealth 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 Husband),*

Female

3. Sex, and whether single, Married, or Widowed,

Single

White

4. Color.t

5. Age,

3 Years, 4 .Months, Days.

Disease or Cause of Death, (Primary and Secondary), ;

6. Duration of Sickness, . --

By whom certified,

TH Shelia of Board of Health Lowell Mass

7. Residence,

8. Occupation,

9. Place of Death, .

North Chelmsford Class

Lowell fluss

10. Place of Birth, .

11. Name of Father,

12. Name of Mother, ( Maiden Name).

Elmere Dupuis) Le Blanc Canada

13. Birthplace of Father,

14. Birthplace of Mother, .

Canada

awell Class

15. Place of Interment, .

Signature of Undertaker or other person making the Return, .

Arthur A, Sheldon

DATED at J. Chelmsford, Oul Aug Stri 18961 17

* If a Married Woman or Widow. { If a Soldier who served in the Warof 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. May, 1591. - 5,000.

NO.

Anci 5

1894 ELima Le Blanc

Accidental drowning

Augustin de Blanc

Ebelt

[ACTS OF 1888, CHIAF. 30G.]

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 Public Statutes, requiring attending physicians to furnish for registration certain facts 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 age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, lie 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 (luly 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, carly 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 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 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 exceeding fifty dollars. [Approved Muy 4, 18SS.

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,

(Maiden Name),* (Name of Husband),*

3. Sex, and whether single, Married, or Widowed,

Single

4. Color,t

j. Age,

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, .

Arthur to Sievon

DATED ate t. A. Chelmsford , on Thule 16th 894

* 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. September, 1892 .- 5,000.

Amasa Howard M. D. North Chelmsford Mais. Student

North Chelmsford Kas, Philadelphia Pa. Richard Checkles

Adelaide Sweet Checkler Pittsburg la North thelunsford Mais North Chelmsford Mas,

Signature of Undertaker or other person making the Return, . .

Aula, 15th 1874 billie May Sweat

Female

17 Years, 6 Months, .. 20 Days. Consumption One year

[ Public Statutes, Chapter 52, as amended by Acts of 1888, Chapter 305 ; Acts of 1539, Chapter 224.]

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 age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforcsaid, 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, scxton or other person shall bury in a city or town or remove thcrefrom the body of a deceased person 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 thercof 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, carly 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 forthwith 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 exceeding fifty dollars.

Richard Pitsburg Pa 20 aura

Commonwealth of Massachusetts.

1 No.

RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.

1. Date of Death,

15-1894

2. Name,

Sarah & Stone

(Maiden Name),*

(Name of Husband),*

Secret & Miller Ich S. Stone

3. Sex, and whether single, Married, or Widowed, Marvel

4. Color, t

5. Age,

74 Years, 4 Months, 21 Days.

Disease or Cause of Death, (Primary and Secondary), ;

6. Duration of Siekness, . By whom certified,

7. Residence, Chelmsford

8. Occupation,

Boarding

9. Place of Death, .

Chelmsford

10. Place of Birth,

Lexington

Jonas & Miller

11. Name of Father,

Abigail miller

12. Name of Mother, (Maiden Name),

Billerica

13. Birthplace of Father, .

14. Birthplace of Mother, .

15. Place of Interment,

Signature of Undertaker or other person making the Return, .

Billerica.

Billerica

2 d. H Howerel

DATED at Chelmsfordon Jects - 16th 18 94

* 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. September, 1892 .- 5,000.

[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224.]

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, Antes 108 1894 Name Versity Brady

Maiden Name,

Sex,

mate; Color,

Single, Married or Widowed, manged

Age, 40 years, 11 months, 2 6 days.

Name of Attending Physician, a frisch Residence of Deceased -. No. 428 Hestrin

Street, for Corporation), Ward

Occupation, Husband's Name,

Place of Death - No. 7 428 attrice Teacher and

Street (or Corporation), Ward

Birthplace of Deceased, Lowell Mas

Father's Name,

David Brael Father's Birthplace, Albany dry

Mother's Name, Sarah 81.

Mother's Birthplace, Amerling Mider

Mother's Maiden Name, A.

Place of Interment,

Lowell

Cemetery Range

, Lot

++ +. . , Grave

Signature of Undertaker or Informer,

Daled at. Lowell, this

12%

day of

mil

IS9

Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.

Date of Death

Name and Sex of Deceased

male,

Place of Death - No.

428 Historio

Teacher Poner

Street (or Corporation) .

Disease or Cause of Death

accidental Drowning duration of *

Complications, I certify that the above is a true return to the best of my recollection and belief.

Name and Professional Title Ab Mich Medical Examen

Residence, No. 267 Hesmith Street tomule

Dated at Lowell, this

230

clay of

July

189 4-

[Be very particular to fill the blanks, and strike out words that are not correct, such as street of corporation, single, maried or widowed, and insert "fe" before male when the deceased is a female, and when the deceased is colored, please insert. |

* Reckoned to the time of death.

Les Mentech

Merrill

RETURN OF DEATH

- Powell J. Bradt -OF-

q mix 1, 1894

> No.

Commontocaith 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 Husband),*

3. Sex, and whether single, Married, or Widowed, 5

4. Color, t

Years,

.Months, ..

„Days.

5. Age,

Disease or Cause of Death, (Primary and Secondary), # -

6. Duration of Sickness, . By whom certified,

TTO Parter

7. Residence,

8. Occupation, .

9. Place of Deathı, .

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, ·

Zawell

Signature of Undertaker or other person making the Return, .

Lams Bury

DATED at

Mary Namn 1

Ireland

, 01 Jeux- 26 189.0

[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224.]

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 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 certificatc 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 forthwith 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 exceeding fifty dollars.

27.5

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,

189

4. Name: Francis

Maiden Name,

Sex, male: Color,

Single, Married or Widowed,

Age, .... years,

months,

days.

Name of Attending Physician,

Residence of Deceased-No.

Chelmsford Street (or Corporation), Ward

Husband'S Name!

Occupation,

Place of Death-No.

Street (or Corporation), Ward

Birthplace of Deceased, 1. Chelms ford

Father's Name,

Father's Birthplace,

Mother's Maiden Name,

Place of Interment, Catholic

Signature of Undertaker or Informer,

Dated at Lowell, this

day of

Aug

1894

Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)

Date of Death,

Aug. 25

189

Name and Sex of Deceased, Francis 2 Bumer

male.

Place of Death-No. n Chelmsford

Street (or Corporation).

Disease or Cause of Death,

Cholera Infantis

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

day of

august

1 89

* 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 ista female, and when the deceased is colored please insert !

Irland

Mother's Birthplace,

Mother's Napre, Mary Planu

RETURN OF DEATH

-- OF-

189 ..

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,

189 < Name Sand Haller CA Cy Sex, ... male ; Color,

Maiden Name,

Age, .

years,

2months,

7 de

days.

Name of Attending Physician,

A. Cheles fondswet (o Corpo

Occupation, Place of Death-No.

en ford Street (or Corporation), Ward

Birthplace of Deceased,

Father's Name,

Father's Birthplace, Mother's Birthplace,

Undland

Mother's Maiden Name,

Place of Interment, Catholic

Signature of Undertaker or Informer,

189

Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)

Date of Death,

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Deaths 1894-1897, Part 3

Author: Chelmsford (Mass.) Publication date: 1894-1897 Publisher: Number of Pages: 436

Author: Chelmsford (Mass.)
Publication date: 1894-1897
Publisher:
Number of Pages: 436