USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 7
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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 siekness, and the date of his deeease. If a physician negleets or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he ean state the same. If a physician refuses or negleets 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 eity 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 elerk. No such permit shall be issued until there has been delivered to sueh board, or agent or clerk, as the ease 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 seetion three of this chapter, or in lieu thereof a certi.leate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician eannot 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 eity or town for the purpose shall, upon request of said board, agent or clerk, make such certifieate as is required of the attending physician ; and in ease of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the elerk 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 eause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exceeding fifty dollars.
(
Real 1 ...
Commontocatth of Massachusetts.
73
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 Deatlı, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Retegn,A. .
(
Vect Chelmsford
Royal & Reed
DATED at
Inch 5 th 195 Dawson Collard
Widower
85 Years, Months, W/5 Days.
aprofilety
5 weeks Dr. G. a. Harlow Weet Chelmsford
Carpenter
Week Chahneford
Kinda W.A. D able
Sucan Wetherbec
Harvard Quase
Barbaros
Dr. holmsford, on Much, 6 th
1895
. If a Married Woman or Widow. Af a Soldier who served in the War of the Rebellion. { If other than White. (M.) Mulatto. (f.) Indian: If of other Races, specify what. [Be very particular to fill all Blanks. ] Plate. Ed. May, 1891 .- 5,000.
[ACTS OF 1888, CHAP. 806. ] 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 lias 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 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 sliall 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 lien 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 healthi 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 May 4, ISSS.
74
Ree
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,
Mac
9 de
1895
Name,
abigail is Very
Maiden Name,
Sex, Lemale ; Color,
Single, Married or Widowed,
Widow
Age,
& years,
months,
days.
Name of Attending Physician,
Du Variet
Residence of Deceased-No.
north chetruffede
Street (or-Corporation), Ward
Occupation,
vooreenile
Husband's Name,
Caron M. Very
Place of Death-No.
North Chelmsford
Street (or Corporation), Ward
Birthplace of Deceased,
Mane
Father's Name,.
Samuel Trancher's Birthplace,
England
Mother's Name,
Patience
Mother's Birthplace,
Mother's Maiden Name,
Unbull
Place of Interment,
Burlington VL
Cemetery Range
, Lot.
, Grave,
Signature of Undertaker or Informer,
AV. 1200hr
Dated at Lowell, this
day of
Mar
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
abigail By terry
Name and Sex of Deceased.
*C/male.
Place of Death-No.
North Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Brouchilis
duration of *
one week
Complications,
asthma and organic diseases of heart
I certify that the above is a true return to the best of my recollection and belief. .
Name and Professional Title,
Street,
Dated at Lowell, this
muth
day of
March
5
Residence, No.
* 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
1
PLEASE FILL OUT WITH INK.
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, Mar 13th
IS95 ' Name, Robert & Leahy
Maiden Name,
Sex,
male ; Color,
Single, Married or Widowed,
months, days.
Residence of Deceased -No .. Chelmsford Street (or Corporation), Ward
Occupation,
Husband's Name,.
Place of Death-No. Chelmsford mar
Street (or Corporation), Ward
Birthplace of Deceased, tylland
Father's Name,C
Robert Legally
Father's Birthplace,
Leland
1
Mother's Birthplace,
Mother's Maiden Name, ,
Place of Internet billerica
Cemetery Range
, Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
19th
day of
Mar
18951
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, Mar 13th
Name and Sex of Deceased
Robert"& Leahy
male.
Place of Death-No 6 Lehnsford man
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,
AG. Mich Muchand Examiner
Residence, No. 267 Milwith
Street,
Dated at Lowell, this 14-
day of
munch
* Reckoned to the time of death.
[ Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married or widowed, and insert "fe" before male when the deceased is a female, and when the deceased is colored please insert. ]
-
Rec UNDERTAKER'S
married Age, 37 years, ...
Name of Attending Physician,
Mother's Name, tung Leaty
RETURN OF DEATH OF
189
-.
-
Ree
Commonwealth of Massachusetts.
26
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
1. Color, t
5. Age,
20 Years, L.(Months, Days.
Disease or Cause of Death, (Primary and Secondary), # 6. Duration of Sickness, . By whom certified,
7. Residence,
Ja Chelmsford
8. Occupation,
9. Place of Death, .
So 6 hal molard Dorchester
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father,
11. Birthplace of Mother, .
Storia hotonen
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
do Chelmsford Daniel & Byum
DATED at To Chel mefera on March 16 18 9.5
* If a Married Woman or Widow. 1 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. May, 1891 .- 5,000.
march 15 William LI Battels
male :
garner
Benjamin Battles
Charlotte Smith Stoughton
[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 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 pin- 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 liealth 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- unent 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 elerk 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, ISSS.
NO.
RETURN OF. A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
March 3/
2. Name,
(Maiden Name),* (Name of Husband),*
5
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
Years, - „Months, 1 Days. Infantile
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . -
Dr Staward
7. Residence,
Chcemford
8. Occupation, .
9. Place of Death, .
15
10. Place of Birth, .
James T Bray
12. Name of Mother, (Maiden Name),
Margaret (Nociana) Narcenter
13. Birthplace of Father,
England
15. Place of Interment,
Jawell
Signature of Undertaker or other person making the Return, .
, 01 the 1 189.5
* 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.
DATED at
Commonwealth of Massachusetts.
77
By whom certified,
11. Name of Father,
14. Birthplace of Mother, .
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 355; 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 aforcsaid, he shall be punished by a fine not exceeding fifty dollars. In case the deccased 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 issucd 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 thercafter 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 (lollars.
78
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 returnbefore the burial or removal of the deceased.
.
Date of Death,
Name, ..
Maiden Name,
Sex,
male ; Colør,
Single, Married or Widowed, ..
Age, 69 years,
months,
days.
Name of Attending Physician,
Der Varney
Residence of I)eceased-No.
Chelmsford
Street (or Corporation), Ward
Occupation,
Gron Moulder
Husband's Name,
AV. Chelmsford Street (or Corporation), Ward
Place of Death-No.
Birthplace of Deceased Aufand
Father's Name, not kurin
Father's Birthplace,
Ireland
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Catholic
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
37 36
TI
day of
Mar
1890-
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
March 31
Name and Sex of Deceased.
William Quigley
male.
Place of Death-No.
North Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Organic Disease of the fraction of *
one year
Complications,
Bronchitis
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
G & Varney
Residence, No.
No. Chelmsford
Street,
no. Chelundan.
Dated at Lowell, this
31 cl
day of
mark
* 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 place joseph
RETURN OF DEATH OF
189
No.
Commonwealth of Massachusetts.
79
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
april 201 895. Robert- Dunston
2. Name, (Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Married
4. Color, t
5. Age,
5'2 Years, .. Months, 20 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
7. Residence,
Chelins ford
8. Oeeupation,
Farher.
9. Place of Death, .
Chelmsford
10. Place of Birth,
11. Name of Father,
Ganache Robert Durston Martha Courrier
12. Name of Mother, (Maiden Name),
Ireland.
13. Birthplace of Father, .
Scotland
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
? L. K. Howard
DATED at
Chelmsford, on april 9
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. ] l'late, Ed. September, 1892 .- 5,000.
[ 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.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, abril 25 - 1895. Thomas M. Cidans
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Single
4. Color,t
5. Age,
84 Years,
Months,
13 Days.
Disease or Cause of Death, (Primary and Secondary), +
6. Duration of Siekness, . By whom certified,
7. Residence, Chelmsford
8. Occupation, .
Retirdel
9. Place of Death, .
Chelmsford
10. Place of Birth,
11. Name of Father,
Isaac adams
Hannah Adams
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, . ·
S. R. Howard
DATED at Chelansford, on april 25. 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.] Plate. Ed. September, 1892 .- 5,000.
Chelmsford
Westford
Chelmsford
Commontocatth of Massachusetts.
80
-
[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 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 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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