USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 6
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64
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,
Kaw 28
1890
Name,
nem Nancy M: Cabe.
Maiden Name
Sex, 0 male ; Color,
Single, Married or Widowed,
Age, 02 years,
months,
days.
Name of Attending Physician, De Varyen
Residence of Deceased-No.
North Chelmsford
Street (or Corporation), Ward
Occupation,
at Home
Husband's Name,
Place of Death-No. North Chelmsford
Street (or Corporation), Ward
Birthplace of Deceased, frebanda
Father's Name,
Patrick A: Caly
Father's Birthplace,
Ireland
Mother's Name,
Ataly
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Catholic
Lot , Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
28
O hermel low
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
h Jan
28"
1895
Name and Sex of Deceased.
Nancy
me= Cabe
Le male.
Place of Death-No.
north Chelmsford
Street (or Corporation).
Disease or Cause of Death,
nefritis
duration of *
about two years.
Complications,
Organic disease of heart.
I certify that the above is"a true return to the best of my recollection and belief.
Name and Professional Title, PENummer
Street, North Cheliusford
Residence, No
no. Chileford
Dated at LoweN, this
29th
day of
January
1895
* 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
1890
Ree
Under laten marlet com
Amil
RETURN OF DEATH OF
18g
65
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; January 31 1895 Name, Joseph A Jacan Play
Maiden Name,
Sex, ... male ; Color,
Single, Married or Widowed,
Age, years, 10 months, days.
Name of Attending Physician, Di- Benoit
Residence of Deceased -No.
Street (or Corporation), Ward
Occupation, Husband's Name,
Place of Death-No. Theho Parl
Street (or-Corporation), Ward
Birthplace of Deceased,
Father's Name,
Juk ramblay
Mother's Name, Henriette
Father's Birthplace, Canada Mother's Birthplace,
Mother's Maiden Name, Perrault
Place of Interment,
Chelmsford Cemetery Range
, Lot
, Grave,
Signature of Undertaker or Informer,
Joseph Albert,
Dated at Lowell, this day of
January
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, Jamy 31 st 1895
Name and Sex of Deceased. Joseph H. Jrombley male.
Place of Death-No. Chelmsford
Street (or Corporation).
Disease or Cause of Death, Pneumonia
duration of *
one week
Complications,
I certify that the above is a truc return to the best of my recollection and belief.
Name and Professional Title, B. Benoit(M.D.)
Residence, No. 58 Thirteenth.
Street,
Dated at Lowell, this Thirty- first
day of
Jammen
189.5-
* 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
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 make this return before the burial or removal of the deceased.
Date of Death,
Help 3- the
189 3.
Name,
Grace A Jolley
Maiden Name,
Sex, Le male ; Color,
Single, Married or Widowed, madrid
Age, 28 years,
8 months,
16 days.
Name of Attending Physician,
Der Varney)
Residence of Deceased -No. .
Marth Chelmsford Street (or Corporation), Ward
Occupation, Housewife
Husband's Name
Robert W, Dolly
Place of Death-No. North Chelmsford Street (or Corporation), Ward
Birthplace of Deceased, Chelmsford.
Father's Name,,
Samuel Bilder Father's Birthplace,
AHampshire
Mother's Name Lucy
Mother's Birthplace, Holdenero ALL.
Mother's Maiden Name,
Place of Interment,
A Chelons for Cemetery Range
, Lot.
............... , Grave,
Signature of Undertaker or Informer,
day of
189.5.7
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
Name and Sex of Deceased.
Grace of Jolley)
Lemale.
Place of Death-No. Marth Chelmsford Street (or Corporation).
Disease or Cause of Death,
Puerperal Septicemia duration of *
about 3 1/2 weeks
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No. north Chelwe find
Street,
no. Chalanford
Dated at Lowell, this
day of
Feby
* 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.
18957
Dated at Lowell, this
6 th
66
RETURN OF DEATH
OF
189 ..
Rec No.
Commontocatth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Feb 9 893. Mary D.(Dicken)
2. Namc,
(Maiden Name),* . (Name of Husband),*
Daniel H Lane Married,
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Agc,
75 Years,
9.
Months,
26 Days.
Disease or Cause of Death, (Primary and Secondary),
6. {Duration of Sickness, . By whom certified,
7. Residence,
Chelmsford
8. Occupation,
House Pecker
9. Place of Death, .
Ripley Me
10. Place of Birth, .
11. Name of Father,
Davier Dicker
Polly Decker
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, .
LR Howard
DATED at Chelmsford, on Feb.11. 18 9.5
* 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.
Chelmsford
[ 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 refuscs 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 therc 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 certificatc 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.
Rue
No.
Commonwealth of Massachusetts.
68
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Feb. 11th 18932 Adaline J. han
2. Name,
(Maiden Name),* (Name of Husband),*
Ziba Gay Female Married
Write
4. Color, t
5. Age, Disease or Cause of Death, (Primary and Secondary), #
72 Years, 4 Months, 9 .Days. Pneumonia
i've days
6. Duration of Sickness, . - By whom certified,
Fr &, Varner, M.D. North Chelmsford Mass
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, .
Arthur H. Sheldon
DATED atc A. Chelmsford, on Feb, 11Th 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.
North Chelmsford Muss
Hancock N.4. Josiah Taylor
Phele (Butterfield) Taylor Beverly Muss. Francestoron NA North Chelmsford Muss.
Taylor
3. Sex, and whether single, Married, or Widowed,
[ Public Statutes, Chapter 32, as amended by Acts of 1838, 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 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 collars.
No.
Commontocatth of Massachusetts.
69
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Can 3/ 1895.
2. Name,
49 ervise Davis
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
Years,
Months,
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified, ·
7. Residence, Chelensford
8. Occupation, . V
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, Luciana Davis
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, .
L. I Howard
DATED at Chelmsford, on Feb 22 189.5
* 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.
Chelmsford
Mini Kareenald Radi1, Falls
festina inats Preferred.
[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 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 deccased 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
Commontocalth of Massachusetts.
70
NO.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Feb. 17th , 895
2. Name,
Mand &. Wright
(Maiden Name),* (Name of Husband),*
Female
3. Sex, and whether single, Married, or Widowed,
Single White
4. Color, t
13 Years, Months, 9 Days.
Pleuro pneumonia
Disease or Cause of Death, (Primary and Secondary), # 6. {Duration of Siekness, . By whom certified,
7. E Varney 1.D.
7. Residence,
8. Occupation,
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
Potsdam N.M.
13. Birthplace of Father, .
14. Birthplace of Mother, . 15. Place of Interment,
Vest Buxton Me. North Chelmsford Mass.
Signature of Undertaker or other person making the Return, .
Arthur H, Sheldon
DATED ate
A. Chelmsford,on ...
Feb. 18th
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.] Plate. Ed. September, 1892 .- 5,000.
5. Age,
one week
North Chelmsford Mass. Student
North Chelmsford Mars. North Chelmsford Mass. William L. Wright- Etta B. (Hanson) Wright
[Public Statutes, Chapter 32, as amended by Acts of 1838, 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 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.
Rec No.
Commonlocalth of Massachusetts.
7/
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Feb 20th, 1895
2. Name, (Maiden Name),* (Name of Husband),*
Frederick Nr Robinsona
3. Sex, and whether single, Married, or Widowed,
Midowes
4. Color, t
5. Age,
85 Years 5 Months, 11 Days.
Disease or Cause of Death, (Primary and Secondary), } 6. {Duration of Sickness, . By whom certified,
7. Residence, Chelmsford
8. Occupation, .
Starner Chelmsford
9. Place of Death, .
Harvard Mass
Eseoral Robinson
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
Killingly Com
14. Birthplace of Mother, .
Harvard mass
15. Place of Interment,
Lowell Cemetery
Signature of Undertaker or other person making the Return, .
S. T. Howard
DATED at
Chelmsford, on Jebe 20
18 95-
* 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.
10. Place of Birth,
11. Name of Father,
Annis Hillard
[ 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 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.
Res
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),*
Job 21, 1895) David Yerhan
3. Sex, and whether single, Married, or Widowed, 4. Color, t
Married
5. Age,
81
Years,
L.Months,
..... Days.
Disease or Cause of Death, (I'rimary and Secondary), # 6. {Duration of Siekness, . By whom certified,
7. Residence,
Chelmsford Retired
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, .
2. K. Howard
DATED at
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.
[Be very particular to fill all Blanks.] Plate. Ed. September, 1892 .- 5,000.
72
David Serhan Rebecca Spalding
[ Public Statutes, Chapter 32, as amended by Acts of 1838, Chapter 305 ; Acts of 1839, Chapter 224.]
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