USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 11
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[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor wilo 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 tury in a city or town or remove therefrom a human body 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 threc of this chapter, or in lien thercof 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 fortli- with 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 deatlı, as the elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
Rec
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
James Wilbur Patchen
Sex,
Color,
Date of Death,
May 11
1899; Age, 74 Years,
2
Months,
.Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divoreed,
Married Occupation,
Farmer
* Residence,
§ If out of town, }
also state fully.
Place of Birth,
Rochester
Monroe County formaylvania
*Place of Death,
Name of Father,
Birthplace of Father,
Maiden name of Mother,. ...
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Ehelmedia Center
Dated at.
Chelmsford
Signature and
Haller Perlang
May 11
189
place of business
of Undertaker.
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, ;
Disease or Cause of Death, §
James Wilbur Palchi Age, 74 Y. 2M. .D.
died at
Chelmsford, Wann, May 11th
189 2
Duration of siekness, about the days
I certify that the above is true to the best of my knowledge and belief.
B. It, Chambulun M. D.
Signature and Residence S of Certifying Physician. Chilinspel
Date of Certificate, Thay 11- 1899.
Give also street and number, if any.
+ Or sex of infant not named. If still-born, so state. { If child died immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
No.
RETURN OF THE DEATH
OF
-
¥
at
Date,
189
Filed,
189
The provisions of chapter 444 of the Acts of 1897 require that every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. (See section 6.)
The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. (Sec section 7.) Penalty for neglect to comply with the requirements of seetions 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required faets. (See section 10.)
Penalty for refusal or negleet, ten dollars. (See section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
1
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
In un 16 kg 1899
2. Name,
Clifford Diewelt
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
male
4. Color, t
5. Age,
Years, 4 Months,. ~ Days. acuti jningilis
6. Duration of Siekness, . By whom certified,
& of Harlow In C.
West- Chelmsford
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, .
A G. Park hurst
DATED at. West Chelmsford on Thay 17th 1899
* 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.
Lowell
13,7 )will
man B Jung
Balık
Barcostego Nr 71
Commonwealth of Massachusetts.
80
Disease or Cause of Death, (Primary and Secondary), # -
10 days
[ 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.
81
Rec
PLEASE FILL OUT WITH INK. UNDERTAKER'S RETURN Tour of Chelmsford
To the Board of Health and the Clerk of the City of Lowell. 1
Undertakers Kust make this return before the burial or removal of the deceased Date of Death, 1891
Maiden Name,
Sex, .......... male, Color, .....
Single, Married or Widowed, Age34 years. ~ months-days.
Name of attending Physician,
Du fauer y philis ford
Residence of Deceased-No Highlandan
Street, (or Corporation), Ward
Occupation,
labores
Husband's Name,
Place of Death-No. Highland any V. Thetwo for
Birthplace of Deceased,
Ireland
Father's Birthplace,
Queland
Mother's Name,
Catherine
Mother's Maiden Name, ..
Purdawo
Place of Interment,.
Catholic
Cemetery, Range~ LIbt.
Grave,
Signature of Undertaker or Informer, 239
day of.
mann
189.2
Dated at Lowell, this.
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Mar 23
1899
Name and Sex of Deceased, Juincathy Input
male.
Place of Death-No.
north Chers feil
Street, (or Corporation.)
Disease or Cause of Death,
Paren menta
duration of*
ten days
Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, FE Tamney
Residence, No.
Street,
Dated at Lowell, this
232
day of
May
1899
*Reckoned to the time of death.
[Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married or widowed, and insert "fe" before male when the deceased is a female and when the deceased is colored please insert.]
.Street, [or Corporation], Ward
Father's Name, .. Natives Hour
Mother's Birthplace,
Jamies Til howell
When the Child is still-born so specify.
RETURN OF DEATH
OF
189
4
82
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 May 25th
Name. L'thomas Depric
Maiden Name,
Sex, male, Color,
Single, Married or Widowed,
Age 33 years months. days.
Name of attending Physician, Dr Hlegrand
Residence of Deceased-No. Whichwefind Street, (or Corporation), Ward
Occupation, Husband's Name
Place of Death-No.
Street, [or Corporation], Ward
Birthplace of Deceased, temada
Father's Name Peter Pekin
Father's Birthplace, Ugernada
Mother's Name Arany Chris
Mother's Birthplace,
Mother's Maiden Name, Burles
Place of Interment,
rechen
Cemetery, Range.
Lot .............. , Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
25 th
day of.
1899
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW. )
Date of Death,
Siwy 25. 14
189
Name and Sex of Deceased, DIlimiar
Depein
male.
Place of Death-No.
Street, (or Corporation.)
When the Child is still-born so specify .
Disease or Cause of Death,
2Valvular disease of Heart duration of* Several months.
Complications,
Hepatitis
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, ., ...
Umava Haward M.D.
Residence, No.
Chelmsford
Street,
Dated at Lowell, this
250
day of.
Mas
189.9.
*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,
BOARD OF HEALTH.
-
RETURN OF DEATH
OF
-
Unomas
May- 251809
83
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, 189 9 Name .. Didla Smith Daca 30
Maiden Name,
Sex,
male, Color,
Single, Married or Widowed,
Single
Age2 8 years ...... months. days.
Name of attending Physician,
Residence of Deceased-Volo Helisford Street, (or Corporation), Ward
Occupation Mill Operative, Husband's Name
Place of Death-No. No Chelmsford Street, [or Corporation], Ward.
Birthplace of Deceased, wieland
Father's Name Hamar Smith
Father's Birthplace,
Ireland
Mother's Name,
Mother's Birthplace, 1 1
Mother's Maiden Name,
Sharrad
Place of Interment Lowvell Um Cemetery, Range.
Lo ....... , Grave,
Signature of Undertaker or Informer, Sex
Dated at Lowell, this.
30 th
day of
1899
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW. )
Date of Death,
Clay 30 th
189
Name and Sex of Deceased,
Citala smith
male.
Place of Death-No. C/d
Street, (or Corporation.)
Disease or Cause of Death,
Consumption
When the Child is still-born so specify .
duration of * Eight months
Complications,
tuber cular defacil in Juelvis
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,.
F.E. Varney now
Residence, No.
north Chekus ferd.
Street,
Dated at Lowell, this
3/11
day of May
189.9.
*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,
BOARD OF HEALTH.
RETURN OF DEATH
OF
189
Ru
Commonlocalth of Massachusetts.
84
RETURN OF A DEATH. To the Clerk of the City or 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, .
A& Richardson
DATED at Prest Chelousforshe May 31. 189.9
* 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. Dec., 1590. - 5,000.
1
May 30. 1699 Fold Downs
Male Widower White 27 Years, Months, Days.
Aneconomia with effusion and gangren of Kung three weeks." F.E. Varney ms. West Chelmsford
England lenge Downs martha E ass
Luderech Lou
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, 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; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belicf the fact that such a child dicd after birth or was born dcad. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, 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 a human body until hc 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 hercinafter 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 forth- with 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 exceed- ing fifty dollars.
Reo
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH, INK. ALL NAMES TO BE IN FULL.)
Name,
Haline I Might
Sex, male Color, white
Date of Death,
June 9
1899 ; Age,
80 Years,
1 Months, 23 Days.
Maiden Name,
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, anderic
1
Occupation, растеч.
*Residence, aiso state fully. )
{ If out of town, {
Place of Birth,
la helmstedt
*Place of Death,
Name of Father,
Duchene Miruich
Birthplace of Father,
Maiden name of Mother,
Sully Putnam
Birthplace of Mother,
Place of Interment, (Give name of Cemetery) Enfichurefund
Dated at
Signature and
X Walter Perhan
on
1899
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Place and Date of Death,#
Disease or Cause of Death, §
Palvin V. Hright
Age,
80% { M. 23 D.
died at
Chelmsford
189.9
Cystitis and Senile degeneration.
Duration of sickness,
Several months
I certify that the above is true to the best of my knowledge and belief.
Mieux Howal ward. M. D.
Signature and Residence of Certifying Physician. Chelmsford Mars.
Date of Certificate, June q. 1899
Give also street and number, if any ..
t Or sex of infaut not named. If stillborn, so state. * If child died immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
No.
RETURN OF THE DEATH
OF
Palvin J. Wright
at
Date, 189.9 ...
Filed, Anne 10 189 9.
The provisions of chapter 444 of the Aets of 1897 require that every householder in whose house a death oecurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death oceurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death oeeurred. (See section 6.)
The commanding offieer of a vessel shall give notice of the death of any person under his elarge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after sueh death. (See section 7.) Penalty for neglect to comply with the requirements of seetions 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, npon request, furnish for registration a certificate setting forth the required facts. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death oeeurred.
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
Lucky 2
189 9
Name
James
Ashworth
Maiden Name
1
Sex
male, Color, White
Single, Married or Widowed Married
Age 60 years 2 months 8 days.
Name of attending Physician,
Dr . Arthur G. Seobra.
Residence of Deceased, No.
Chelmsford Street, (or Corporation), Ward
Occupation,
Overseer
Husband's Name
Place of Death, No.
Chelmsford
Street, (or Corporation), Ward
Birthplace of Deceased,
England
Father's Name, James
ashworth Father's Birthplace,
England
Mother's Name ) Margaret !!
Mother's Birthplace,
England
Mother's Maiden Name,
Sulcusjor Cemetery, Range
, Lot.
... , Grave
Place of Interment,
Signature of Undertaker or Informer, Manny La
Dated at Lowell, this
day of ..
3 July
1899
Physician's Certificate of the cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
& 2nd.
James
Achurch
inale.
Place of Death, No. Chelmsford
Street, (or Corporation.) Sick abed
Disease or cause of Death,
Leukaemia
duration of*
Indefmile about 600 / week,
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title Arthur D. Scolonia (Mit).
Residence, No. Chebusfond, Mrs. Street,
Dated at Lowell, this. July 3,
day of
189.04
"Reckoned to the time of Death. [Be very partienlar 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,
BOARD OF HEALTH.
189 9
Ashworth
Name and Sex of/ Deceased,
When the Child, is Still-born, so specify.
RETURN OF DEATH
OF
189
57
Re
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,
1899
Name ..
Marie Perry
Maiden Name,
Sex,
male, Color,
Single, Married or Widowed,
Ag .......... years. < months-days.
Name of attending Physician,
Sweetser
Residence of Deceased-No.
Lowell
Street, (or Corporation), Ward
Occupation,
Husband's Name
Place of Death-No. Highland Park theins forstreet, [or Corporation], Ward.
Birthplace of Deceased,
Lowell
Father's Name,
Josefle Perry
Father's Birthplace, custerne Island
Mother's Name, ..
Roze Pary
Mother's Birthplace,
................
Mother's Maiden Name, ..
Rose Isabell
Place of Interment,
batholie Lowert
Cemetery, Range
Lot ..
, Grave,
Signature of Undertaker or Informer,
I Hilly Descott
Dated at Lowell, this.
day of
189.9 ...
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, July 1899
Name and Sex & Deceased, mariePerry male.
Place of Death-No .... Street, (or Corporation.) helmsford When the Child is still-born so specify . Disease or Cause of Death, Aachencularmonagas , 'duration of* 2 months Complications, Diarrhea
I certify that the above is a true return to the best of my recollection and belief.
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