USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1894-1897 > Part 9
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Place of Interment,
.4
Signature of Undertaker or Informer ,
Dated at Lowell, this
29 day of
Physician's Certificate of the Cause of Death.
Date of Death July 29 -
(See extracts from Acts of Legislature below.)
Name and Sex of Deceased, John Gallanger
Place of Death-No.
noch chelder
male.
Street (or Corporation) .
ten days
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 Chelunsford
Street,
Dated at Lowell, this
29=
day of
July
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, marrled or widowed, and insert "fe" before
Realhole Con el Cemetery Range
Lot
.. , Grave,
Disease or Cause of Death, Cerebral demontage duration of*
Rel
RETURN OF DEATH
OF
189 ..
91
Commontocatth of massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
3125 1595
2. Name,
Jared & Miller
(Maiden Name),*
(Name of Ilusband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), ; 1
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, .
11. Birthplace of Mother, . 15. Place of Interment, .
Fest Chelmsford
Signature of Undertaker or other person making the Return, .
-
DATED at TY Chelmsford, on Int, 312 1895,-
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. 1 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.
single
2 Years, 6 Months, 15 Days. Pourmonia Vare week
Je Varner 72. 5" West- Chelris Lord
11
Peter Thiller
Selma Anderson.
[ACTS OF 1888, CHIAF. 306.]
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, fortliwith 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 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. Seetion 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 duly appointed agent, or, if there is no board of health in such city or town, from the eity or town elerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, carly enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of deatlı by violence, the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are de- livered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
-12
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 removalof the deceased.
Date of Death,
189
5. Name,
ana meunier
Maiden Name,
Sex, Le male : Color,
Single, Married or Widowed,
years, ... months 2 days.
Name of Attending Physician, ...
.
Really 5 Ranney
Residence of Deceased-No.
Chelmsford STREET (Corporation), Ward
Occupation,
Place of Death-No. Thehvisfand Tens (or Corporation) Ward
Husband's Name,
Birthplace of Deceased,
Father's Name
Alexandrihreur
Mother's Name,
Have
,
Mother's Birthplace,
Canada
Mother's Maiden Name, Tarde
Place of Interment
Chelmsford the Range
Lot
Grave,
Signature of Undertaker or Informer ,
-
day of
189
~
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below. )
Date of Death.
aug 9
189 5
Name and Sex of Deceased,
Eva Miller. (female)
male.
Place of Death-No. Chelmsford mais
Street (or Corporation) .
Disease or Cause of Death,
Inanition
duration of*
2 weeks
Complications, ...
-
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
archie.S
Residence, No.
lehelmeford mach
Street,
Chelmsford
Dated at Lowell, this
day of
aluguer
189.3
* 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. ]
Approved,
the. BOARD OF HEALTH.
for registration a certificate, stating to the best of his
Dated at Lowell, this.
RETURN OF DEATH
OF
189
Per
Ed. Jan. 23, 1894. 5,000.
[ACTS OF 1889, CHAP. 208. ] AN ACT
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The elerk or registrar of each city and town shall on the first day of each month make a certified copy of the record of all deaths and births recorded in the books of said eity or town during the previous month, whenever the deceased person or the parents of the child born, were resident in any other eity or town in this Commonwealth at the time of said death or birth; and shall transmit said certified eopies to the elerk or registrar of the eity or town in which such deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where sneh deceased person or parents so resided, whenever the same ean be aseertained ; and the elerk or registrar so receiving sneh certified copies shall record the same in the books kept for recording deaths or births. Sueh certified copies shall be made upon blanks to be furnished for that purpose by the seeretary of the Common- wealth.
SECTION 2. This aet shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the Town of Danvers
(City or Town. )
during the month of
August
18 9 5.
1. Date of Death,
Aug 17, 1895
2. Name,
Catherine Mc Mahon
(Maiden Name), .
unknown
(Name of Husband),
unknown
Female
3. Sex, and whether single, Married, or Widowed,
Married
4. Color, .
53 ..... Years, Months, Days.
Acute Entero Colitis
Disease or Cause of Death,
10 days
6. Duration of Sickness, By whom certified,. .
S. P. Syraque M.2
7. Residence,
House wife
8. Occupation,
Danvers Hospital
9. Place of Death, .
Ireland
10. Place of Birth, .
Dont know
11. Name of Father,
12. Name of Mother, (Maiden Name.)
13. Birthplace of Father, .
Ireland
14. Birthplace of Mother, . 15. Place of Interment,. I certify that the foregoing is a true copy.
Attest : Julius Deale
Aug 24, 1895
Town Clerk.
(City or Town.)
5. Age,
Chelmsford
11
93 Plate.
1.
94.
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,
Clu9279
180 G
Name, Frank Ready
Maiden Name,
Sex,. male; Color,
Single, Married or Widowed, ..
Age, 10 years,
months, ..... days.
Name of Attending Physician, North Chelmsford Street (or Corporation), Ward Residence of Deceased-No.
Occupation, School boy
Husband's Name,
Place of Death-No. South Chelmsford
Street (or Corporation) Ward
Birthplace of Deceased, .
Drafthand Max
Mother's Name, Mary
Mother's Birthplace,
South Chel ford
Mother's Maiden Name
athotel
Place of Interment,
Grave,
Signature of Undertaker or Informer y
Dated at Lowell, this.
day of.
Cluqush
189 5-
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death ..
189
Name and Sex of Deceased,
male.
Place of Death-No.
no Chelmot
and
IMars
.Street (or Corporation) .
Disease or Cause of Death,
Jetanns !
duration of*
5 days
Complications,
none
I certify that the above is a true return to the best of my recollection and belief. .
Name and Professional Title, ..
archie & Kawney MA
Residence, No. Chelmsford
. Street,
Dated at Lowell, this
masa
In day of
august
. 189 ......
* Reckoned to the time of death.
[Be very particular to fill the blanks
11
Father's Name, John Ready
Father's Birthplace, ....
5
Frank
RETURN OF DEATH OF
18g
No.
Commontocalth of Massachusetts.
95
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, ¡
. Age, 29 Years, 10 Months, 27 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified,
Chelmsford
7. Residence,
Harschlechter
8. Occupation, .
9. Place of Death, .
Chelmsford
Chelmsford
10. Place of Birth, .
11. Name of Father,
Emana Mansfield
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. H. Howard
DATED at
le helmsford, on Cinq. 25-
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.
Lehelindstore
Chelmsford
ana 23.1895. 1 alice E. Ward Georges O Spaulding
[Public Statutes, Chapter 32, as amended by Acts of 1888, 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, 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.
Ria
Commonlocalth of Massachusetts.
96
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
1 Auca 30 th. 15 :- til itro . Vickles
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Male Mairie de aflite
4. Color, t .
5. Age, 63 .Years, 3 Months, 11 Days. Carcinoma of Stomach Two months 0 afRame MO 1 Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified, 1
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, .
Mornas of Green
Oracleile
DATED at , O11 tua 30 th
* 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.
Meier, Fichier.
[ Public Statutes, Chapter 32, as amended by Acts of 1838, 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 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 ncarly as he can state the same. If a physician refuses or neglects to make such certificate hc 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 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 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.
Commontocalth of Massachusetts.
97
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
Sept. 4th 1895
1. Date of Death,
2. Name,
(Maiden Name),* (Name of Husband),*
Male
3. Sex, and whether single, Married, or Widowed,
White
4. Color,t
8 hours
5. Age,
Years,
Months, ..
Days.
premature birth
4.8 Varney M.D. A. Chelmsford Mais
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 & Sheldon
DATED at N. Chelmsford, on.
Left: 4th 1895
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. f If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] I'late. Ed. September, 1892 .- 5,000.
A. Chelmsford Mass.
A Chelmsford Mars. Phillip Gasselin
Julia( Don store) Wasselin England
England
Disease or Cause of Death, (Primary and Seeondary), # 6. {Duration of Sickness, . By whom certified,
[ Public Statutes, Chapter 32, as amended by Acts of 1989, 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 dcccased, 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 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 arc 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.
98
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, Sept stc
18937
Name,
Agnetti Otzen
Maiden Name,
Sex, e male ; Color,
white
Single, Married or Widowed,
Jungle
Age, 2 years, -months, ~ days.
Name of Attending Physician, Or Heller
Residence of Deceased-No. Chalmoford Constreet (or Corporation), Ward
Occupation, Howwork
Husband's Name,
Place of Death-No .... Chelmo fare Conlestreet (or Corporation) Ward
Birthplace of Deceased,
Father's Name Harman Olsen Father's Birthplace, Marwan
Mother's Name,
Agnete
Mother's Birthplace,
Mother's Maiden Name,
Larson
Place of Interment,.
Edson
Cemetery Range
.. .... , Lot
, Grave,
Signature of Undertaker or Informer,
day of
189-7
Dated at Lowell, this
8
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death ..
189 .'
Name and Sex of Deceased, Leneste Olsen
w./male.
Place of Death-No.
Street (or Corporation) .
Disease or Cause of Death,
Ohthisis
duration of*
about 2 quando
Complications, ..
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,. Tel. Wallin mr.
Residence, No. 599 Central
Street, .
day of
Sept -
1890 -
Dated at Lowell, this
Rec
RETURN OF DEATH OF
... 18g
99
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Sept. 11th 1895 Betsey B. Blodgett
2. Name,
(Maiden Name),* 11 Johnson
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Married White
J. Age, 78 Years 84 Months, 19 Days. Disease or Cause of Death, (Primary and Secondary), # Cirrhosis of Liver & Kidneys 6. {Duration of Sickness, . By whom certified, Three months F & Varney 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 at Sept. 12th r. Chelmsford
1895
* 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.
North Chelmsford Mass,
John W. Johnson
Mary (Blodgett) Johnson Westford Mass:
Groton Mass. North Chelmsford
Frederic W. Blodgett . Female
4. Color, j
[Public Statutes, Chapter 32, as amended by z1cts of 1888, Chapter 305 ; Acts of 1339, 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 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 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 thrce 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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