USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 4
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Self-20
189 KL
Name and Sex of Deceased,
Walter C nic bay
male.
Place of Death-No.
North Chelo ford!
Street (or Corporation).
Disease or Cause of Death,
Complications,
Meningitis
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
A 8 Carly
Residence chilisfond Ho. Chelas Ford
Street,
2
1891
| 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 ]
* Reckoned to the time of death.
Dated at Lowell, this
day of
Sefe-
duration of*
two days
Dated at Lowell, this
Mother's Name, latte Ja
Husband's Name
Residence of Deceased-No.
De Vival
Single, Married or Widowed,
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.
Maiden Name,
Sex, ... male ; Color,
Single, Married or Widowed,
Age, 40years,
months,
days.
Name of Attending Physician,
Residence of Deceased-No
Occupation,
Husband's Namex
Street (or Corporation){ Ward
Souther leefek
Place of Death-No.
Chelmsford
Street (or Corporation), Ward
Birthplace of Deceased,
Father's Birthplace,
Gotbrunn
Father's Name,
arthur
Mother's Birthplace,
Mother's Name,
Mother's Maiden Name,
Place of Interment,
Perweek
Cemetery Range
, Lot
, Grave
Signature of Undertaker or Informer,
day of
Sehr
IS9 4
Physician's Certificate of the Cause of Death. (See extracts from Acts of Legislature below.)
Date of Death,
Sent with
Name and Sex of Deceased enl
Le doyfete
male.
Place of Death-No.
Street (or Corporation) .
Disease or Cause of Death,
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Street, Siilk
Residence, No.
15
day of
IS9 X
* 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 ]
Avur oved.
duration of* ...
Dated at Lowell, this
15
In Atteinbeck
Dated at Lowell, this
15th
Porter
Date of Death, Sefit 15th 189 4
RETURN OF DEATH -OF-
189
-45
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, Dehl 19 189 4 Name,
Maiden Name,
annie Devitt Sex, Female : Color, What Age, 13 years, // months, 6 days.
Single, Married or Widowed,
Name of Attending Physician,
Dr Porter
Residence of Deceased-No. Chelmsford Center Street (or Corporation), Werd-
Occupation,
Husband's Name,~
Place of Death No. Chelmsford Center
Birthplace of Deceased, Lowill
Father's Name,
James Devitt.
Father's Birthplace,
Mother's Name,
Katie Devitt
Mother's Birthplace,
England England
Mother's Maiden Name, atie Holland
Place of Interment, Catholic (amil)
Cemetery Range , Lot , Grave 1
Signature of Undertaker or Informer, Peter Darry
Dated at Lowell, this
19
day of
IS9 «
Physician's Certificate of the Cause of Death. €
(Sce extracts from Acts of Legislature below.)
Date of Death, 19
Name and Sex of Deceased, annie Devilt
małe.
Place of Death-No. Chelmsford Center
Street (or Corporation).
Disease or Cause of Death, Paralysis
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.
15
Dated at Lowell, this
20
day of
X
* 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.
Street (or Corporation), Ward
RETURN OF DEATH
-- OF-
189
Rice No.
Commontocalth of Massachusetts.
49
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,
Married
4. . Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary),
6. {Duration of Siekness, . By whom certified,
Amasa Howard M. D. Chelmsford
7. Residence,
8. Occupation,
9. Place of Death, .
10. Plaec 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, .
Farmer
Chelmsford
IVcotton
Roses Hildreth
Elisat Murdock
Chelmsford
Chelmsford
S. K Horward
DATED at Chelmsford, on
* 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, speelfy what. [Be very particular to fill all Blanks.] Plate. Ed. September, 1892 .- 5,000.
Oct 6th 1892 Benjamin M. Hildrento
68 Years, 4 Months, 12 Days. Pruemonia
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305 ; Acts of ISS9, 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, sexton 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 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 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.
No.
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),*
Made
3. Sex, and whether single, Married, or Widowed,
Married
White
4. Color, t
67 Years, 11 .. Months,. 17 Days.
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
North Chelmsford Mars
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 to Sheldon
DATED at
N. Chelmsford, on
Seht 14th
1894
* 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.
Malarial Maisining-Primary secondary- im blows of Heart Oedema of lungs and contavous diseaseof inguinal region about fix monthy. 7.8. Varmes M. D.
Machinist
North Chelmsford Mass. Fitchburg Mass.
Lewis Rihier
Sophia (Gardner) Rifles
Valhole N.t.
Temple N. A.
North. Chelmsford
September 13th 1894 Stearnes & Ripley
[Public Statutes, Chapter 32, as amended by Acts of 1838, Chapter 305 ; Acts of 1839, 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 forfcit 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 thercfrom 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 stid 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.
Rec No.
Commontocatth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Cit 14th 1894 Isabelle Smith
2. Name,
(Maiden Name),* (Name of Husband),*
Female
3. Sex, and whether single, Married, or Widowed,
Single White
4. Color, t
5. Age,
46 Years, 7 Months, ..
(Disease or Cause of Death, (Primary and Secondary), + 6. {Duration of Sickness, . By whom certificd, .
four months
HE Varner, M.D. North Chelmsford Class
7. Residence,
8. Occupation,
9. Place of Death, .
J 10. Place of Birth, .
11. Name of Father,
William Smith
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
All1. (Reed) Smith Scotland
14. Birthplace of Mother, .
Protland
15. Place of Interment, .
Potton, PQ Canada.
Signature of Undertaker or other person making the Return, . ·
Arthur tt Sheldon
DATED ats
A. Chelmsford, on.
Oct- 14 th
1894
* 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.] l'late. Ed. September, 1892 .- 5,000.
ـر
North Chelmsford Has.
Scotland
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, 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 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 he 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 finc not exceeding fifty dollars.
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, CEct-18
1894 Name YBakatall
Maiden Name,
Sex, .....
.. male ; Color,
Single, Married or Widowed, Age, 48 years, -months, 24 days.
Name of Attending Physician,
Dr. Hamer
1
Residence of Deceased
No Marth, Chehans ford Street (or Corporation), Ward
Occupation,
Husband's Name, ..
Place of Death-No. Garth Thermoford Street (or Corporation), Ward Birthplace of Deceased, La Canada
Father's Name
Mother's Name
Saphir
Mother's Birthplace,
Canada
Mother's Maiden Name,
Karenelle
Signature of Undertaker or Informer,
Chelmsford Ch Afresh
, Grave,
Dated at Lowell, this
18 0
day of
189
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
October 18th
189 4
Name and Sex of Deceased.
& Baptiste
Peuclean
male.
Place of Death-No.
Ino. Chelmsford
Street (or Corporation).
death andden
Disease or Cause of Death,
I heart disease (probably) duration of * fefer
ancora
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, ..
DEN arney
Residence, No.
no Chelmsford
Street,
Dated at Lowell, this
no. Chefunfund 1800
day of
October
1894
* 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. ]
RETURN
OF DEATH OF
18g
No.
Commonlocalth of Massachusetts.
53
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,
4. Color, t
5. Age,
6.8 Years,
9
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, .
West Chelmsford
Signature of Undertaker or other person making the Return, .
Der 18.1894. William H. Brown
male
9 months Dr. Tremblay Waar Chelmsford Railer Wear Chelmsford Yorkshire, England. low Brown Emily Brown yorkshire England
DATED at
Chelmsford, on
October 18.19921
* 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.] l'fate. Ed. May, 1891. - 5,000.
[ACTS OF 1888, CHAP. 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 thirce of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deccased 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, he shall be pull- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body nntil 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 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 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 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 deathi, 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 May 4, 1888.
54
Commonwealth of Massachusetts.
NO.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Nov, 2-94 Vienam Toye
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .Years, Months, Days. Disease or Cause of Death, (Primary and Secondary), # Cardiac /xyphenTrophy 2 years
6. {Duration of Siekness, . By whom certified,
7. Residenee,
8. Oeeupation, .
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 9 A, Joye
DATED at Thelemefood, on.
* 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. September, 1892 .- 5,000.
M. W
frances W. Chacunford Ireland
vector
[ Public Statutes, Chapter 32, as amended by Acts of 1833, Chapter 305; Acts of 1889, 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 aforesaid, he shall be punished by a fine not exceeding fifty dollars. In casc 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.
71
35
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,
Nav. 6 Ph
1894 Name,
Sun & Marshall
Maiden Name, Perice
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