USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 5
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Sex, Lemale ; Color,
white
Single, Married or Widowed,
Married
Age, 61 years, 11
months, ..
17 days.
Name of Attending Physician,.
Dr Chamberlin
Residence of Deceased --- No.
Channaford Man Street (or Corporation), Ward
Occupation.
Housewife
Husband's Name,
Samuel & Marshall
Place of Death-No ..
Chelmsford mars
Street (or Corporation), Ward
Birthplace _of Deceased,
Grelhasfarce mais
Father's Name,
Stephen Jeaver
Father's Birthplace,
Chelmsford mano
Mother's Name,
Mary
Mother's Birthplace,
Concard
٦
Cagrall
Mother's Maiden Name,
Place of Interment,
Chihmsfail
, Cemetery Range.
, Lot
-, Grave,
Signature of Undertaker or. Informer,
Chil m young&C.
.
Dated at Lowell, this
day of
189 4
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Nov. 6 th
189 21
Name and Sex of Deceased.
Ann & marshall ....
female.
Place of Death-No.
Chilifare
Street (or Corporation)>
Disease or Cause of Death,
duration of
18 moisite
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, .
Residence, No:
Street,
Dated at Lowel, this
cav of
I 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 is a female, and when the deceased is colored please Insert
Del
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,
1894 Name, Ellen In Black hole
Maiden Name, Ilone
Sex,
male ; Color, a
Single, Married or Widowed, Maned
Age, 50 years,
months,
days.
Name of Attending Physician, Dr bleland
Residence of Deceased-No.
Gast Chelmsford
Occupation, Hausewide
Street (or Corporation), Ward
Husband's Name, Dames Sta Mefale
Place of Death
No.
East Chelmsford
Street (or Corporation), Ward
Birthplace of Deceased,
Saco maine
Father's Name, , aunknown
Father's Birthplace,
Unknown
Mother's Name: "
Mother's Birthplace,
11
/1
11
Mother's Maiden Name,
Place of Interment,
Edson
?
Signature of Undertaker or Informer,
Dated at Lowell, this
9th
day of CHO
Physician's Certificate of the Cause of Death. . (See extracts from Acts of Legislature below.)
Date of Death,
Name and Sex of Deceased, Ellen a Stackpole
Place of Death-No. Gast Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Phthisis
duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, C. H. Leland My S.
Residence, No. 202
Street,
Lawell
Dated at Lowell, this
clay of
You.
-
150 4
* 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, marnie for widowed, and insert " fe " before male when the deceased is a female, and when the deceased is colored please insert. ]
male.
Cemetery Range , Lot , Grave
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, Nov 9 The
180ff
Name,
George W. Streeter
Maiden Name,
Sex, ..
.male ; Color,
Write
Single, Married or Widowed,
Age, 31 years,
8
months,
3 days.
Name of Attending Physician De Harney
chilifavel
Residence of Deceased-No.
North chelmsfordstreet (or Corporation), Want.
Occupation,
Labrar
Husband's Name,
Place of Death-No.
North chelmsford
.Street (or Corporation), Ware.
Birthplace of Deceased,
Clinton kay
Father's Name,
Um MM Streeter
Father's Birthplace,
Marshall M.fl.
Mother's Name,
Eliza
Mother's Birthplace,
Kirkland My
Mother's Maiden Name, McDonal
Place of Interment,
Chelmsford Mackentery Range
Lot. .. , Grave,
Signature of Undertaker or Informer,
Arthur de Sheldon
Dated at Lowell, this
Achelmsfrance.
day of Non, 10 the
189 4
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Nav. 9 th
1894
Name and Sex of Deceased. Bearg. If
Struter
male.
Place of Death-No. North chelmsford
Street (or Corporation ).
Disease or Cause of Death, 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.
Street,.
Dated at Lowell, this
day of
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 or corporation, single, married or widowed, and insert "fe" before
RETURN OF DEATI OF
18g
Ru No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Nov., you 1894
2. Name,
(Maiden Name),* (Name of IIusband),
Male
3. Sex, and whether single, Married, or Widowed,
White
4. Color, t
a Devolvermentes
5. Age,
Years, Months, Days. Infantile Cause
6. {Duration of Sickness, . By whom certified, .
fer minantes 7,8, Carney M.D. North Chelmsford Mars
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, .
"text Chelmsford Mars,
Signature of Undertaker or other person making the Return,
Arthur to thelion
DATED at
V. Chelmsford, O
Vous, 14th
18%
* 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.
[Re very particular to fill all Blanks.] Plate. Ed. September, 1892 .- 5.000.
=
North Chelmsford Class. North Chelmsford Mass. Charles Ce. MC innis Clara (Hodgson) Mi Ennis Chelmsford Muss .... Bradford England
Disease or Cause of Death, (Primary and Secondary), #
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305; Acts of 1889, Chapter 22 ;. ]
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, liis 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 immechiate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate lic 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 gool 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 siid 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.
NNo.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Nov 3 - 1895
2. Name,
timed Stodgran
(Maiden Name),*
(Name of Husband),*
S
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Placc 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 Thecentral
Signature of Undertaker or other person making the Return, .
James Had don 1
DATED at. Cheaufort
, on
189X
* 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.) Indlan. If of other Races, specify what. [Be very particular to fill all Blanks.] l'late. Ed. September, 1892 .- 5,000.
7 Years, - Months, .. Days. Spinal Dincare 2000 Gears
10. 6heems por
.... 4
To Chelampor Forpasture England Samuel
Martha (Hallam)
England 11
Commonlocalth of Massachusetts.
59
[Public Statutes, Chapter 32, as amended by Acts of 1338, 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 belicf, 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 samc. 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.
Commonboratth of Massachusetts.
60
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Jazz 6th 895
2. Name,
Mattina A 1221 cia
(Maiden Name),* (Name of Husband),*
SLattina Harland
Abbott Russa
3. Scx, and whether single, Married, or Widowed,
I Vidon
4. Color, t
5. Agc,
71 Years, 11 Months, .Days.
(Disease or Cause of Death, (Primary and Secondary), # , {Duration of Sickness, .
a By whom certified,
7. Residence,
Chelmsford
8. Occupation, .
Chelmsford
10. Place of Birth, .
Jobshan 12
Almos Garland
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Chelmsford.
(
Signature of Undertaker or other person making the Return,
1 S. R. Howard
DATED at Chelmsford, on Jan yth 189.j
* 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.
9. Place of Death, .
11. Name of Father,
Betses Parker
[ Public Statutes, Chapter 32, as amended by Acts of ISS8, 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 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 ur 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.
1
61
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),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age,
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, . . .
Lara 1-1895 Richard Fürmich
Male Single
32 Years, .Months,. .Days. Cancon of Stomach
about one year
O númasa Howard East Chelmsford
Lavoron
East cheloxxi1 East Chelmsford Thomas Finnick
Catherine ne Tamente Ireland
Ireland
Lowell
DATED at Chelmsford, on Jan 16 189.
* 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.) Indlan. If of other Races, specify what. {Be very particular to fill all Blanks.] Plate. Ed. September, 1892 .- 5,000.
Gel No.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305 ; Acts of 1889, Chapter 224.]
X 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 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 suid 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.
X
A
62
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, Jan 25th 189 5 Name, Gargant T Jully
Maiden Name,
male ; Color,
Single, Married or Widowed,
Name of Attending Physician,
Residence of Deceased-No.
Chelmsford entry
Street (or Corporation), Ward
Occupation, Chelmsford Centry
Birthplace of Deceased,
Father's Name, Timothy If sully Father's Birthplace, Jagland Ireland Mother's Birthplace,
Mother's Name,
Figgis
11
Jelly
Place of Interment,
Catholic Lopes@brinell
..... , Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
.26
day of
faut
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Name and Sex of Deceased.
Place of Death-No.
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, Residence, No.
Street,
Dated at Lowell, this
day of
189
* Reckoned to the time of death. [ Be very particular to fill the blanks, and strike ont 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. ]
male. Street (or Corporation).
duration of *
Age,.
years,
months,
7
days.
Husband's Name,
Street (or Corporation), Ward
Mother's Maiden Name,
RETURN OF DEATH OF
P
1
Jan 25 Margaret 2. Twee, 189,"
NO. HER
Commonlocalth of Massachusetts. 63
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Jan, 13th 1895 Sarah , Cook
2. Name,
(Maiden Name),* (Name of Husband),*
Nelson O. Book female
3. Sex, and whether single, Married, or Widowed,
Widow
4. Color, t
72 Years, 8 Months, 9 Days.
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
7. Residenee,
8. Oceupation, .
9. Place of Deatlı, .
10. Place of Birthı, .
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. H. Sheluon
North Chelmsford Chelmsford Mass Agrariah Proctor Luci (Holy man) Proctor Chelmsford Mass. Chelongford Mass. Chelmsford Mass,
DATED at
A. Chelmsford, on Jan. 28th
1895"
* 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.] l'late. Ed. September, 1892 .- 5,000.
Sarah Proctor
Choplex 4 Diel Suddenly
to E barney M. A. North Chelmsford
[Public Statutes, Chapter 32, as amended by Acts of ISSS, 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 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, scxton 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.
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